1. Beat the Blues Case Study: Everyone Wins Community-Academic Partners and African American Older Adults Supported by NIMH #RO1 MH 079814, R24 MH074779 and RC1MH090770. Clinical Trial #NCT005116801

2. The Partners  Thomas Jefferson University (2007-2011)  Center in the Park (2007 to Present)  Johns Hopkins University (2011 to Present)

3. Unique Features  Academic-community partnership  Target an underserved population  Involvement of community partner in every phase of project  Design  Intervention development  Implementation  Dissemination  Screening/Intervention - embedded in senior center operation to optimize translational potential

4. Time Line of Partners’ Collaborations 2003-2007 AOA - Harvest Health: CDSMP for AA Older Adults Using Stanford University Model EBP 2006-2011 NIMH - In Touch: Mind, Body & Spirit (IP-RISP) 3 pilot studies and service programming 2007-2008 PA Department of Aging– Healthy Steps Fall Prevention-SE PA Regional Pilot 2007-2013 NIMH –Beat the Blues

5. Mental Health Disparities  Primary care principle setting for depression detection and treatment  Depression in older African Americans under- detected and undertreated in that setting  Prevalence ranges from 10 to 35% depending upon sample, clinical comorbidities, life circumstances  Depression one of the primary sources of burden and disability  New depression care models a public health priority  Need to create multiple access points for depression care

6. Why Senior Centers? Linking Depression Treatment to Senior Centers Promotes Positive Aging and Reduces Isolation

7. BTB Study Design and Roles of Partners (N= 208) 4 Months Post randomization Follow-up Assessment TJU/CIPinterviewers TreatmentCIP/TJUWait-listControl Recruitment Screening Baseline Assessment Randomization Follow-up Assessment TJU/CIPinterviewers 8 Months Post randomization TreatmentCIP/TJU CIP care managers CIP research coordinator and TJU recruiter CIP care managers CIP research Coordinator Criteria African American > 55 years Community-dwelling English speaking Has telephone Cognitively intact (MMSE short form > 5) Depression symptom score > 5 twice within two weeks CIP and TJU Focus groups Brochure development TJU and CIP interviewers TJU

8. 4 Month Outcomes for PHQ-9 Severity Score (N=182) P=.001 Cohen’s d=.47

9. Secondary 4-Month Outcomes (N=182) DomainDifference of adjusted mean 95% Confidence Interval P- valueCohen’s d Depression knowledge 0.30.2,0.4.000.69 Well-being0.60.4,0.8.000.89 Quality of life2.91.7,4.2.000.54 Behavior activation 0.80.5,1.1.000.84 Anxiety-0.4-0.6,-0.2.000.59 Functional difficulty -0.2-0.3.0.0.019.25

10. 8 Month Outcomes for PHQ-9 P=.001 Cohen’s d=.47

11. ChallengesChallenges

12. Challenges the Partnership Faced  Identifying and training appropriate staff  Defining roles and supervision to reduce conflict – exp., 2 project managers  Differing pay scales – academic vs. community-based non profit  Time and priority conflicts  Management of different funding sources and shifting roles  Keeping the commitment alive and on-going  Assuring on-going mutual respect and trust

13. Unique Challenges for Community Partner Setting   Staff understanding of importance of research and evidence based programs   Juggling competing demands of the funded collaboration and other service contracts   Adjusting to time line of research which is more prolonged than service delivery   Assuring appropriate levels of staffing, juggling budgets and grant reporting demands   Managing uncertainty and expectations around sustainability

14. Unique Challenges for the Academic/Research Setting  Need for flexibility in research design  Time spent in training non-researchers in basic research tasks  E.g., importance of documentation, communicating alerts, keeping records up to date  Knowing when to take the lead and when to step back  Juggling competing demands/needs of the funded collaboration and other funded studies  Managing the unknowns (e.g., staff changes, new service demands on community partner that necessitate changes in research design)

15. BENEFITSBENEFITS How Everyone Wins

16. For Older African Americans   Integrated as a member of the team to help inform the research process   Able to give back to future generations (a key value of target population) in a significant way   Benefits derived from participation in evidence- based programs   Help shape and engage in the programming offered at the community site   Help shape systematically the program of research pursued by the academic site   Help shape training of future health professionals

17. “I never realized I was depressed and learned a great deal about depression. I have a new outlook on life and think more positively about things.” Lenny, age 80 “You not only helped me to recognize that I had symptoms of depression and that having those feelings was a problem, but how to get myself out of it.” Jo, age 61 “I have a positive outlook for the future, have become more active, and my self- esteem has improved.” Ben, age 75

18. For the Academic and Senior Center   Access to new funding streams   Avenue for professional development of participants from each site   Important role of the collaborative is mentorship and personal/professional growth of key staff   Community partner gains access to intellectual resources it may not have had previously   Academic partner gains access to research participants, helping to close the gap between research and practice   Senior Center benefits from increased participation in programs and activities.

19. What Makes the Partnership Work?  Trust  Mutual Respect  Clear identification of roles  Understanding the expertise of each partner  On-going communication  Partners are passionate about project goals  Top leadership at the table talking  Having partners you really like being with!

20. Some of the Nuts and Bolts  Layers of meetings in which academic and community leaders attend  Executive committee phone meetings monthly if possible  Weekly interviewer meetings  Bi-weekly interventionist meetings  Problem solving with staff concerning oversight/turf issues that can emerge  Assuring that solutions work for all partners and meet the goals of the project

21. More of the Nuts and Bolts  As Kellogg defines the collaborative approach: Equity & Recognition  Being intentional about informing and involving each other  Giving each other “credit” and recognition for unique roles and strengths  Managing Expectations  Respecting each other’s mission

22. Next Steps for our Partnership   Working together to translate BTB in other settings and with other populations   Seeking grant funds to support continuation of BTB Intervention at CIP   Seeking grant funds to advance BTB as a replicable and sustainable service   Identifying value proposition of BTB and how to scale it up and have widespread dissemination   Developing manuals, training materials, on-line and face-to-face trainings  materials  Licensure agreements for equal use of materials

23. ConclusionConclusion  Addressing multi-faceted problems such as depressive symptoms in older African Americans requires an academic-community partnerships  Embedding research within the aging network and specifically senior centers is complex BUT DOABLE  Embedded designs using CBPR principles enhances senior center practice AND improves science  Attention to the collaborative process and partnership building is critical for success

24. Team Members Thomas Jefferson University and Johns Hopkins University   PI - Laura N. Gitlin, Ph.D.   Project manager - Nancy L. Chernett, MPH,   Intervention coordinator - Laraine Winter, Ph. D.,   Data analysts   Marie Dennis, Ph.D.   Edward Hess, MA   Statistician – Walter Hauck, Ph.D.   Interviewing staff:   Laura Holbert, MSW   Karen Morrison, MSW   Barbara Parker   Christa Caruso   Daneen Whinna   Abby Schwartz, MSW   Intervention staff:   Laura Holbert, MSW   Karen Morrison, MSW   IRB coordinator and research assistantship– Lauren Acquarole, MS   Data entry staff:   Mary Barnett   Barbara Parker   Administrative assistance – Helen Jones   Cost effectiveness Team   Laura Pizzi, PharmD, MPH   Eric Jutkowitz   Consultants   Nancy Wilson, MSW   Melinda Stanley, Ph.D.   Barry Rovner, MD   Nancy Whitelaw, Ph.D. NCOA  Alixe McNeill, MPA, NCOA   Data safety and monitoring board members   Neville E. Strumpf, Ph.D., R.N.   Kimberly Van Haitsma, Ph.D.   Mary D. Sammel, Sc.D.   Virginia Smith, Ph.D.   Frances Barg, Ph.D.   Robin S. Goldberg-Glen, Ph.D.

25. Team Members – Center in the Park  Co-investigator - Lynn Fields Harris, MPA  Co-investigator - Renee Cunningham-Ginchereau, MSS, Co- investigator  On-site project manager - Megan McCoy, MSS, MLSP  Recruiter, screener - Erika Barber  Interventionist supervisor - Barbara R. Davis, A.C.S.W., L.S.W.  Interventionist - Susan Burgos, MSW, LSW  Social Services Supervisor – Courtney White  Intake specialist – Dorcas Essilfie  17 care managers over 5 years (trained in screening procedures)  CIP administrative staff