Scaling up Science-based Mental Health Interventions in Latin America

Funding Source: National Institute of Mental Health (NIMH) (U19 MH109988) 

Project Period: 06/01/2016 – 05/31/2021

Principal Investigator: Lisa A. Marsch, PhD (Geisel School of Medicine at Dartmouth College); Carlos Gómez- Restrepo, MD (Pontificia Universidad Javeriana, Bogotá, Colombia)

Other Project Staff:  Beverly Pringle, PhD (NIMH); Denise Pintello, PhD (NIMH); William Torrey, MD (Dartmouth); Leonardo Cubillos- Turriago, MD, MPh (Dartmouth); Emily Scherer, PhD (Dartmouth); MaryAnn Greene, MS (Dartmouth); John Naslund, PhD Candidate (Dartmouth); Miguel Uribe, MD (Consultant); Fernando Suarez, MD (Pontificia Universidad Javeriana, Bogotá, Colombia); Sergio Castro, MD (Pontificia Universidad Javeriana, Bogotá, Colombia); Paulo Rossi Menezes, PhD (Universidade de Sao Paulo, Brazil); David Mohr, PhD  (Northwestern University); Paulina Bravo, PhD (Pontificia Universidad Catolica de Chile); Aixa Contreras, MSc (Pontificia Universidad Catolica de Chile); Jaime Sapag, MD, MPh, (Pontificia Universidad Catolica de Chile); July Caballero, MD, (Peruvian National Institute of Mental Health); Vanessa Herrera, MD (Peruvian National Institute of Mental Health); Humberto Castillo-Martell, MD (Peruvian National Institute of Mental Health)

Other Partners/Advisors: The World Bank; Pan American Health Organization (PAHO/WHO); Ministry of Health (Colombia); Ministry of Health (Peru); Asmet Salud (Colombia); CooSalud EPS (Colombia); Javesalud (Colombia); Fundacion Internacional Unidos Contra la Depression (Colombia); Hospital Universitario San Ignacio (Colombia); Empresa Social del Estado Regional de Duitama (Colombia): Hospital Especializado Granja Integral Lerida-Tolima (Colombia)

Project Summary:

Mental health disorders are increasingly recognized as a major cause of the global burden of disease, accounting for an estimated 7.4% of the disease burden worldwide and significantly contributing to disability and death.  This challenge is particularly evident in low and middle-income countries (LMICs) where more than half of the world’s population live.  Latin America is one region of the world composed of LMICs where the burden of mental health problems is high and services for mental health are low (and account for <2% of the health budget in the region).   In the Latin American country of Colombia, 8 out of 20 individuals have a lifetime prevalence of one or more mental health disorders.  Depression and substance use, often coupled with other mental health problems resulting from endemic violence in Colombia, are particularly striking concerns in the region.  Only 11% of persons with a mental health disorder in Colombia receive mental health care.

This project brings together a broad array of stakeholders, including leading researchers in both the US and Latin America; governmental organizations (e.g., Ministry of Health in Columbia; National Institute of Mental Health in Peru); patient advocacy organizations; insurance company payers in Latin America; and non-governmental and/or multilateral organizations (PAHO/WHO; The World Bank; industry partners; and primary care systems in Latin America).    

This project is designed to create a new mental health service delivery model for Latin America that will enable a rapid scaling-up of access to evidence-based mental health care.  Specifically, in this new mental health service delivery model, we plan to: (1) harness mobile behavioral health technology for mental health (with a primary focus on depression and a secondary focus on problematic alcohol and other substance abuse), (2) launch new workforce training and service delivery models (including the integration of technology into service delivery), (3) launch and evolve an integrated data management system for systematic data tracking and outcomes assessment, and (4) launch and grow a learning collaborative of organizations integrating mental health into primary care.  We will launch this project at multiple primary care sites in various parts of Colombia, with a plan to inform subsequent adoption in several other Latin American countries, including Chile and Peru.

The project includes 3 primary Cores with the following Specific Aims, respectively.

Administrative Core Aims: Support a core organizational structure and management approach to maximally benefit from a broad array of stakeholders and ensure efficient and successful coordination and integration of the activities across project Cores

Aim1a: To provide scientific and programmatic leadership to ensure efficient and successful coordination and integration of the activities across the proposed activities

Aim 1b:  To provide a novel infrastructure to enhance synergy among an interdisciplinary expert team by facilitating productive communication, centralization of knowledge and resources, and integration of methods and results across research activities

Scale-Up Core Aim:

Aim 2: Conduct systematic, multi-site mental health implementation research in both rural and urban primary care settings with a broad group of stakeholders in the US and Latin America

Capacity Building Core Aims: Use science-based methods and information to build sustainable capacity for conducting mental health implementation research and informing mental health policies and programs in Latin America 

Aim 3a:  Establish resources and an infrastructure to aid Colombia and its regional partners of Chile and Peru to build capacity for mental health implementation research 

Aim 3b:   Build sustainable capacity to use science-based methods and information for developing mental health policies and programs

Public Health Relevance:

Overall, through the integration of Core activities, this project will create new knowledge to inform unprecedented, science-based approaches to scaling-up mental health implementation research and building sustainable research capacity and science-based policies and programs in Latin America. This project brings together an outstanding expert team to test and refine an entirely new model for delivering widespread, science-based, mental health care in Latin America. This project may also serve as an important demonstration project to LMICs globally as they tackle the significant burden of mental health disorders and scale-up access to evidence-based models of mental health service delivery.

Note:  CTBH Director, Dr. Marsch, is affiliated with the small business that developed a mobile platform tool to be used as part of this project.  This relationship is managed by her academic institution. 

 


Mobile Augmented Screening Tool to Increase Adolescent HIV Testing and Linkage to Care

Funding Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (1R41HD088325)

Principal Investigator: Ian David Aronson, PhD

Other Project Staff: Theodore C. Bania, MD; Lisa A. Marsch, PhD

Project Summary: Adolescents face combined problems of increased HIV risk, infrequent testing, inconsistent linkage to care, and a lack of prevention related knowledge. We propose to address this by developing a Mobile Augmented Screening (MAS) tool that will increase youth HIV testing through the use of a tablet-based intervention in clinical settings, and then use text messages to facilitate linkage to care for those who test positive, and deliver ongoing prevention education via text message to those who test negative.

Many adolescents and young adults at greatest risk for HIV are unlikely to have access to primary care, and therefore have limited access to HIV testing and prevention education. When young people are offered testing, many decline because they believe (perhaps incorrectly) they are not at risk or because they fear being stigmatized. Our proposed MAS will enable care providers to privately and discretely offer routine HIV testing and counseling, including prevention education, to high need, diverse adolescent populations at a low cost.

The MAS will consist of 3 components. A tablet-based intervention including a very brief video (<2 minutes) designed to increase adolescent HIV testing; automated text-messages to facilitate linkage to care for those who test positive; and text-based education for those who test negative or decline testing. All 3 components will be linked by an easy to use administrative interface.

Our team has created multiple NIH-funded interventions to increase HIV testing among patients in high volume, urban emergency departments (EDs). Patients, including those who initially declined testing, cited the privacy and clarity of our technology-based approach as reasons they ultimately agreed to test for HIV. In a recent pilot trial, we recruited 100 ED patients aged 18 – 24 who declined testing at triage. Participants completed a brief tablet-based video intervention, and after watching a short video, 30 accepted an HIV test offered by computer. Of those who accepted tests, 21 agreed to receive text messages about HIV testing and prevention for 12 weeks. Two thirds responded to texts at week 6, more than half responded at week 8.

In this Phase I STTR project we plan to develop a set of videos and text messages through an iterative development process that includes formative and mixed-methods summative evaluations.

Public Health Relevance: Adolescents and young adults face markedly increased HIV risk, yet frequently do not test. We are, therefore, developing a Mobile Augmented Screening (MAS) tool designed to increase HIV testing, and to facilitate linkage to care and ongoing prevention education via text message. This tool will help clinicians address undiagnosed youth HIV, and enable young patients to receive much needed treatment and avoid unknowingly transmitting infection. Our product is designed to help existing program staff reach an increased number of clients; and to improve public health by encouraging reluctant young patients to accept important HIV testing and care they may otherwise decline.

 


April 1, 2016

Making Sense of Big Health Data through Visual Analytics and Machine Learning

Amar K. Das, MD, PhD
Associate Professor of Biomedical Data Science, Psychiatry, & The Dartmouth Institute for Health Policy and Clinical Practice
Director, Division of Biomedical Informatics, Department of Biomedical Data Science
Director, Biomedical Informatics Core, SYNERGY Clinical and Translational Science Institute
Head, Informatics Collaboratory for Design, Development, and Dissemination
Geisel School of Medicine at Dartmouth


 

About the Presentation:

The speed by which we can generate and gather Big Health Data from health systems, social media, high throughput technologies and other sources has quickly outpaced our ability to use that complex data effectively and rapidly.  We are in need of new data science methods by which health data consumers, such as policy makers, healthcare providers and patients, can find meaningful, actionable information. In this presentation, Dr. Das will discuss research in the Social Computing & Health Informatics Lab (SCHI Lab) to develop new visual analytics and machine learning approaches for Big Health Data that is deep, longitudinal, and heterogeneous.  Dr. Das will demonstrate the application of our methods to breast cancer care and relate these efforts to mental health care and behavioral research as well.


Victor Bergelin

Visiting Graduate Research Assistant

Deep Learning; Machine Learning; Wearable Sensors


victor aktuellVictor is a visiting graduate student working with deep learning in wearable sensors. His background is in machine learning from a masters in engineering physics and mathematics at Linköpings Univeristet in Sweden. During his visit, V. Bergelin explores new methods to increase prediction rates in complex human activity recognition and practical approaches to current challenges as labeling noise, missing data labels and unsupervised learning in this field. 

Being in the New England region is similar to the nature and country side where Victor spends his weekends in Sweden; skiing down a route that he just climbed up, or doing hiking and rock climbing in the summers.


March 4, 2016

The Ethics of mHealth

Dr. Tiffany Cvrkel
Bioethicist, Philosopher, and Lecturer
Molecular, Cell, & Developmental Biology
UCLA


 

About the Presentation:  

As the capacities and wide-spread acceptance of mHealth devices grow, so too does their potential in research and clinical contexts. Collecting and working with this type of data raises unique ethical concerns. The purpose of this talk is two-fold. First, we will be outlining some of the most pressing ethical challenges presented by mHealth. Second, we will start thinking about solutions, exploring how these ethical concerns can and should inform our use of this technology.