Digital Health Equity Partnership Evaluation
The goal of the Digital Equity Partnership program is to increase digital inclusion among low-income people with disabilities and people with unstable housing by supporting participating organization to develop Tech Navigator programs. For the purposes of this program, the target population of people with disabilities includes people with serious mental illness, people with SUD, people with ID/DD, people with brain injury, people with physical disabilities and any other condition that is considered a disability.
PI: Dharma Cortés
Point Person at the Lab: Katie Holmes, Peyton Williams
Improving Mental Health Treatment for Individuals in Crisis Interacting with the Criminal Justice System
As part of Michigan State University’s P50 for the National Center for Health and Justice Integration for Suicide Prevention (NCHATS), CHA’s Health Equity Research Lab will be working with the Cambridge Police Department (CPD) to assess the effectiveness of the Family and Social Justice Section (FSJS) intervention, a police-based multi-system intervention to train patrol officers in mental health first aid and trauma-informed policing, link community and healthcare services, and follow-up on mental health-related calls with police department-based case management by a team of specialty mental health resource officers and mental health clinicians. The FSJS intervention will be compared to usual treatment in neighboring towns and an enhanced FSJS intervention that includes a CHA-based family navigator who works closely to connect individuals to services when they are brought into the emergency department by CPD officers. These assessments will take place at both CHA and Mt. Auburn Hospital.
PI: Benjamin Lê Cook, James Barrett
Point Person at the Lab: Akhil Reddy, Taylor Witkowski
Team members: Christopher Fischer, Will Schleyer, Valeria Chambers, Dharma Cortes, Brian Mullin, Michael Flores, Gabriel Rios
ALACRITY CENTER FOR EARLY SCREENING AND TREATMENT OF AT-RISK YOUTH (ESTORY)
Cambridge Health Alliance’s Health Equity Research Lab has been awarded a NIMH P50 grant entitled the Center for Early Screening and Treatment of at-Risk Youth (the eSToRY Center) (PIs Benjamin Cook and Philip Wang). The eSToRY Center is dedicated to early detection of mental illness, preventing adverse outcomes, improving quality of care, and fostering equity in treatment for racial, ethnic, and language (REL)-minority youth (defined as children, adolescents, and young adults <25 years of age). Across multiple research projects, we hope to establish a learning health community in the diverse neighborhoods surrounding Cambridge Health Alliance (CHA) to address the well-recognized barriers to care for youth with mental health needs, deploying a sophisticated health data infrastructure to adapt, test, and implement evidence-based practices to accelerate health care improvements. We will hold regular training events and pilot research grant opportunities intended to build capacity to identify and reduce racial, ethnic, and gender disparities in mental health treatment. Click here to read more about the R34s.
PI: Benjamin Lê Cook
Point Person at the Lab: Taylor Witkowski
Team members: Margaret Weiss, Eleanor Richards, Nicholas Carson, Dharma Cortés, Ana Progovac, Valeria Chambers, Michael Flores, Linda Overhage, Gareth Parry, Brian Mullin, Gabriel Rios, Jahvon Johnson, Rujuta Takalkar, Akhil Reddy, Katie Holmes, Matthew Nock, Sharon-Lise Normans, Philip Wang, Katherine Grimes, Diya Kallivayalil, Kate Zona, Caryn Rodgers
COVID-19’s Impact on Economically Vulnerable Children and their Parents
Consistent evidence suggests that severe adversity in early life—stemming from stressors such as deep and persistent poverty, abuse or neglect, exposure to community violence, and/or the cumulative burdens of racial or ethnic discrimination—is a risk to healthy child development, and can lead to physiological disruptions that contribute to lifelong problems in learning, behavior, and both physical and mental health. Importantly, much of this research is being conducted in the absence of comprehensive information about the social and physical environments that create adverse circumstances for young children. The Center on the Developing Child at Harvard University (the Center) has convened a group of scientists who are actively developing a multidimensional but brief battery of the biological indicators of “toxic stress” in children (i.e., chronic or excessive activation of stress response systems). The ultimate goal of the research on both the biological indicators and the social and behavioral triggers of toxic stress is to generate novel interventions to reduce the development of toxic stress and to ameliorate its adverse consequences for health. In addition to the original surveys, our team has begun to readminister a second set of surveys to identify different social factors that contribute to toxic stress and to advance the measurement of social risks that affect young children and their parents in the context of the COVID-19 pandemic. We hope that this study will help us to come up with ways to reduce the development of toxic stress and lower its negative health outcomes and identify the needs of parents and their children in the context of the pandemic.
PI: David Williams
Point Person at the Lab: Taylor Witkowski
Team members: Benjamin Lê Cook, Dharma Cortés, Michael Flores, Xenia Johnson Bhembe
Impact of State Policies on Smoking among Individuals with Substance Use Disorder (NCI)
This project is funded by the National Cancer Institute (NCI) and it directly responds to concerns raised by clinical stakeholders about the difficulty of reducing smoking in the Substance Use Disorder (SUD) population. It also contributes to realizing the vision of NCI to eliminate smoking, and the cancers and other harms it causes, through research on tobacco prevention and cessation interventions, especially those aimed at vulnerable populations at increased risk of tobacco use. The project examines the impact of tobacco control policies, specifically looking at whether expanding coverage for tobacco dependence treatment (TDT) and raising cigarette excise taxes increase TDT use and decrease smoking among the SUD population. It also explores whether states with rising taxes will further reduce smoking if they also have generous Medicaid coverage of TDT, which allows for more actionable information to state policymakers. Results will be disseminated to clinicians and policymakers and directly inform coverage and taxation policies that address smoking behaviors in this high-risk population. This project is the first to examine the smoking behaviors and factors affecting TDT and cessation among individuals with SUD who are not in SUD treatment.
PI: Benjamin Lê Cook
Point Person at the Lab: Katie Holmes
Team members: Doug Levy, John Hsu, Brendan Saloner, Ana Progovac, Benjamin Cook, Zev Schuman-Olivier, Geoff Ferris Wayne, Timothy Creedon
Medicaid Payment Policy and Access to Care for Dual Eligible Individuals (nimhd r01)
Dr. Cook and Dr. Vicki Fung at Massachusetts General Hospital (MGH) were granted a NIMHD R01 grant for 5 years with the aim to assess the impact of recent Medicare policy changes on racial/ethnic disparities in mental health care. The Lab will assess the effects of policy changes on racial/ethnic minorities in medical care use, quality process measures, clinical events and total and component medical spending. Racial/ethnic minorities are less likely to receive mental health care than Whites and these Medicare policies have the potential for reducing these disparities. Data to be used are a 20% sample of fee-for-service beneficiaries linked to provider and area-level data implementing difference-in-difference and within-person statistical analysis.
PI: Benjamin Lê Cook, Vicki Fung (MGH)
Point Person at the Lab: Benjamin Lê Cook
Team members: Michael Flores, Brian Mullin
CMS Disparities (ACOs) by Race/ Ethnicity, Gender, and Gender Identity Status (cms office of Minority Health)
The Health Equity Research Lab was awarded one of the 5 Office of Minority Health seats with the CMS Virtual Research Data Center. This project studies the differences in ACO participation by race/ ethnicity, gender (including gender minority status), and mental health status beneficiaries. This project will also study disparities within ACO’s by dual eligibility status, race/ ethnicity and gender/gender identity in access, utilization, and quality of mental health services, and also compare access, utilization, and quality of disparities for beneficiaries treated within ACOs to those not treated in ACO’s by race/ethnicity and gender.
Center for Mindfulness and Compassion EVALUATIONS
The Center for Mindfulness and Compassion (CMC) is an interdisciplinary center within Cambridge Health Alliance, CMC is an organization grounded in current scientific understanding of mindfulness and compassion, and the promotion of empirically supported theory and practice. CMC is committed to using mindfulness and compassion to foster an inclusive and caring community that ensures access on the basis of intersecting factors such as race, gender, sexuality, language, mental and physical ability, and economic status. The HER Lab is partnered with CMC on multiple projects that align both center’s focus on improving physical and mental health in diverse communities. These projects include:
“Effect of Mindfulness Training on Opioid Use and Anxiety During Primary Care Buprenorphine Treatment.” This study will pilot test the Mindful Recovery OBOT Care Continuum model and demonstrate capacity for a multi-sites Randomized Control Trial (RCT) comparing Group-Based Opioid Treatment versus M-ROCC in primary care office-based opioid treatment (OBOT).
“Effects of Remote Motivational Enhancement and MySafeRx via Video on Post-Detox Engagement and Retention in Buprenorphine Treatment.” This study will both investigate the effects of starting remote motivational enhancement during inpatient detoxification on rates of engagement in during inpatient detoxification on rates of engagement in buprenorphine treatment and evaluate the impacts of MySafeRx, a mobile device application which integrates remote motivational coaching with daily observed dosing from secure electronic pill dispensers at home via video-conference on treatment retention and overdose prevention.
“Mindfulness Influences on Self-Regulation: Mental and Physical Health Implications, and Effects of Remote Motivational Enhancement.” This study seeks to understand the impact of mindfulness training on the underlying neural mechanisms of self-regulation for patients who are participating in mindful primary care at CHA.
Point Person at the Lab: Benjamin Lê Cook
Center for Mindfulness and Compassion: https://www.chacmc.org/
Assessing suicidal behavior using digital phenotyping among adolescents and transitional age youth
An EMA (ecological momentary assessment) and qualitative interview study examining suicidal thoughts and behaviors among youth of color and their families, and the effects of how family conflict, discrimination, and childhood trauma during the COVID-19 pandemic. Our aims in this study are to:
Establish feasibility and acceptability (as measured by qualitative responses and app utilization data) of a smartphone application for passive and active data collection related to suicidal behavior. The app will be optimized for use by disadvantaged youth and young adults in outpatient mental health treatment for suicidal behavior, as well as their caregivers.
Users will report the app is feasible and acceptable, with suggestions to address privacy concerns and maintain initial engagement in the app over longer periods of time.
Explore the experiences of despair, discrimination, and COVID-19-related stress of disadvantaged youth as they relate to their communities and household and the interplay of these spaces with the COVID-19 pandemic. The interviews will focus on 1) where, when, and how youth move in their day-to-day life; and 2) the relation between those spaces and their experience of suicidality, discrimination, and access to resilience recourses.
Establish digital phenotypes of suicidal individuals based on passive smartphone data and behavioral data recorded by adolescents and their caregivers.
We will identify associations between suicidal behavior, psychiatric symptoms, discrimination, trauma, and family conflict that will help to isolate intervention points for improved detection of suicidality.
Investigators: Nicholas Carson, Dharma Cortes, and Todd Reid
Point Person at the lab: Peyton Williams
Team members and collaborators: Lily Xie, Lecsy Gonzalez, Varshini Odayar, Brian Mullin, and Eric Schlossberg
Check out our past projects here!