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​An intervention integrating child savings accounts with financial literacy and income-generating activities for families with children who have lost parents to HIV/AIDS in Uganda resulted in health and emotional benefits for the children, according to a new study from the Brown School at Washington University in St. Louis.

The study is a cost-effectiveness analysis of Bridges to the Future, a randomized control trial that incorporates child savings accounts with financial literacy training and microfinance/income-generating activities for 1,410 schoolchildren orphaned by AIDS. One arm of the intervention provided a 1-1 match incentive for savings accounts, while another arm provided a 2-1 match.

After four years, the study showed that the larger match significantly improved self-rated health, HIV knowledge, self-concept and self-efficacy and lowered hopelessness in children.  The smaller match accounts improved only self-rated health.

“Children who have lost a parent to HIV/AIDS face multiple stressors affecting their health and development,” wrote the study’s senior author, Fred Ssewamala, William E. Gordon Distinguished Professor at the Brown School. “Family economic empowerment interventions have the potential to improve these outcomes and mitigate the risks they face. These findings contribute to the evidence supporting the incorporation of economic empowerment interventions within national social protection frameworks.”

The study was published Dec. 31 in PLOS ONE. Read more here.

As the Kathryn M. Buder Center for American Indian Studies celebrates three decades at the Brown School, it has emerged as the preeminent center for the academic advancement and study of American Indian issues related to social work, public health and public policy.  

Offering a unique graduate degree focus for social work students, the center recruits American Indian scholars and provides student support in a rigorous course of study; develops curriculum; conducts research, and engages in policy development that has a positive influence on Native populations.

Kathryn M. Buder respected and admired American Indians since childhood and believed that education was a key factor in maintaining self-esteem and growth in tribal communities. In 1990, she established the G.A., Jr. and Kathryn M. Buder Charitable Foundation to provide scholarships for American Indian students through the center, as well as funding for staff and student development. The foundation funds two-year scholarships covering the tuition, living expenses, books and professional development of up to 10 first- and second-year MSW students on a continuing basis.

Center Director Kellie Thompson (Seneca) sees the center’s 30th anniversary as an opportunity to honor the founding vision of Kathryn Buder while also looking to a future that is evolving as the needs of students and communities change. The issues facing Native individuals and communities—continued vulnerability to mental health issues, suicide, generational trauma and substance abuse—require multi-faceted solutions rooted in the resiliency and strength of these communities. 

“We still have the same vision as when the center was founded in 1990: Preparing Native students to become leaders in Native communities,” Thompson said.  “But after 30 years, the Buder Center has more than 200 alumni representing 77 tribes in the U.S, and they are working in a variety of settings and fields. The reach and network we have is much greater, and deeper in its expertise.”

One of the members of that network is Joe Masters, MSW ’13 (Sault St. Marie Band of Chippewa), now a behavior health therapist at SSM Health in St. Louis. He said his experience at Brown after becoming a first-generation college graduate near his tribal home in northern Michigan gave him the confidence to undertake a life-changing challenge. 

“It’s not easy to come off the reservation and into a city like St. Louis,” said Masters. “The support of the Buder family of other Native students and the Buder Center was a key to my success.”

Masters wanted to pursue a career in mental health and management, but wanted training in a program that included a Native American perspective. “Being a Native, we always look at things through two different lenses,” he said.  “The Buder Center offers that second lens.”

That perspective will strengthen his work when he returns to his community, but it has also added a holistic approach to therapy that he believes has bolstered his current work in St. Louis. Telling stories, a key feature of Indian culture, is also an effective therapeutic element for his clients.  “They see themselves in the story,” he said.

Like many alumni, Masters stays in touch with the center and returns to visit for events such as the annual Washington University Pow Wow, where both Native and non-Native people come together for conversation, craft vendors and the centerpiece dance contests. Alumni also return to speak, mentor students and serve as practicum supervisors.

Sarah Kastelic (Alutiiq), MSW ’97, PhD ’08, who is the Executive Director of the National Indian Child Welfare Association and the recipient of a Distinguished Alumni Award from the Brown School, has welcomed the opportunity to partner in research activities and to host and supervise Buder scholars in their practica. She is pleased to give back to the center. 

“As a first-generation college student, the Buder scholarship made graduate education possible for me. The Native-specific content prepared me for a career in public policy and Native human services and changed the trajectory of my career.” 

Before joining NICWA, Kastelic led the National Congress of American Indians’ welfare reform program, where she saw the need for timely, credible data to inform policymaking at the tribal and national levels, a gap that her Buder training helped her fill.  Policy is still a focus for her at NICWA, a national child advocacy organization. 

The Buder Center had a similar impact on Caitlin Donald (Osage, Ponca), MSW ’14, the Program Manager for the Northwest Native American Center of Excellence at Oregon Health & Science University in Portland, Oregon. “The Buder Center transformed my graduate school experience, providing me with a robust and lifelong learning community of American Indian and Alaska Native capacity builders, change makers, and healers,” she said. “Years later, I still feel and am grateful for its impact on my life.” And the impact it has had on the people she serves is also profound. 

The center’s director of research is David Patterson Silver Wolf, associate professor, who also chairs the American Indian and Alaska Native concentration.  He said training students from native communities provides better social work and public health services to those communities.

“Buder Scholars are obtaining a graduate degree so they can better help their own people.  When social workers have personal connections to communities they plan to serve, practices and decisions are rooted in how they will impact on us, rather than on them,” he explained. 

He also points out that having Buder scholars in other classes brings context and awareness the Brown School would not have otherwise. 

The changing needs of Native communities have prompted a fine-tuning of the concentration, for example the addition of an Indigenous Mental Health Practice course, Patterson Silver Wolf said. “We’re also branching out from student services to increase our research capacity, partnering with nations and tribes to figure out what works for particular communities.”

Noting that 70% of Native Americans live in urban areas, he said the center is aiming to develop a science around the needs of urban Natives, as well as graduates who serve their Native communities off reservations.

Although Joe Masters has spent his years since graduation in St. Louis, he plans to return someday to his Michigan roots to practice his skills as a therapist. In the meantime, he said, he’ll stay connected with the Buder Center, which he looks forward to visiting regularly.

“It feels like going back home again,” he said.

“The Center’s founding goals have helped to inspire and fulfill the Brown School’s mission to achieve equity and social justice for vulnerable populations,” said Mary McKay, Neidorff Family and Centene Corporation Dean at the Brown School. “We are so proud to have this one-of-a kind Center and its alumni working for the benefit of Native communities across the United States.”

Learn more about the Buder Center.

Making sure community concerns and participation are top of mind was the aim of a course taught by Jessica Levy to the inaugural class of the Master in International Development program, a partnership between the UN System Staff College and IE University in Madrid.

Levy, associate professor of practice at the Brown School, developed the week-long course with Brian Burke, assistant professor at Appalachian State University. It was taught in November 2019, the inaugural year for the master’s program, which focuses on sustainable development to equip graduates to be at the vanguard of change at the UN or elsewhere.

“It was essential to include community empowerment during this first semester of the program. Students need to have community concerns and values front and center as they work through other courses on development economics, the political economy of climate change, and program management,” Levy said.

The 39 students in the program come from 18 countries. Many already have worked at the United Nations or other development organizations, and all plan to pursue development in the private or public sector after graduation.

“We developed this course using simulations and case studies so students could really feel the changing dynamics and challenges of community work,” Levy said. By the last two days, students were applying their new skills to actual development projects launched by the World Bank, the United Nations, and the Minga Foundation. Levy helped found the Minga Foundation, a U.S.-based nonprofit that works in long-term partnership with grassroots organizations pursuing health, gender equity, holistic well-being, and social change.

Levy said it was a challenge to fit all the material in to a one-week intensive graduate course, but the students responded well and many would not have been exposed to it otherwise. As one student said at the end of the week, “We need to be talking more about these issues. This class has given me a new lens to think about power and inequality as a central part of well-being.”

When Leopoldo J. Cabassa and Byron Powell were new investigators, each was drawn to the Center for Mental Health Services Research (CMHSR) at the Brown School.

Founded by Enola Proctor, Shanti K. Khinduka Distinguished Professor (2014-18), it was the first Advanced Center for Interventions and Services Research within a school of social work to be awarded a training program grant by the National Institute of Mental Health (NIMH). CMHSR had also become a proven leader in mental health services research and implementation science.

Both Cabassa and Powell participated in the training program and credit it with jump-starting their academic careers. The innovative institutional training offers financial support to pre-doctoral and post-doctoral students as they mature as scholars and undertake groundbreaking research in a broad variety of fields. It has been continually funded by NIMH and is now celebrating its 25th year at the Brown School.

Cabassa and Powell have returned to CMHSR at the Brown School — and are leading it as co-directors. Proctor, who recently took part-time emerita status, remains on the steering committee of the center’s training program and continues to be a mentor for fellows and faculty.

“This NIMH training was critical for me,” said Cabassa, an associate professor. “It gave me the skills and knowledge to successfully navigate the grant process.” It resulted in getting an NIMH dissertation grant award to examining how Hispanic adults with depression make decisions about care and set the stage for other NIMH grants Cabassa has received since graduating from the Brown School.

For Powell, now an assistant professor, a major benefit of the fellowship was the opportunity to gain exposure to the NIMH funding landscape and the high-intensity network of students and faculty stars in his field of implementation science.

“You’re thrown in the mix with post-docs and PhD students who are years ahead of you,” he recalled. “You immediately get to learn from them and are treated as a colleague.” The fellowship also provided funds that enabled him to travel to national meetings that expanded his horizons and strengthened him professionally.

“Washington University was the place for implementation science, it was leading the way,” he said.

It still is.

“We’re creating leaders in the field, and developing innovation in mental health care,” Cabassa said.

Since 1995, the T-32 program has prepared 63 pre- and 18 post-doctoral fellows for academic and research careers. The program has also resulted in the publication of original research by fellows. In the last 15 years, pre-doc fellows have published 165 papers. Currently, the program has six active pre-doctoral trainees and three post-doctoral fellows.

The training programs at CMHSR accepts doctoral students in social work who are already doing research in the field of mental health or other areas of study in the NIMH umbrella, such as implementation science and HIV treatment.

The program focuses on researching ways to improve access and delivery of mental health care and outcomes for vulnerable populations. Fellows receive additional training each year at the Brown School as part of their larger studies and research. The training, overlaid with other classes, includes:

“The strength of this program is its breadth,” Cabassa said. “We train fellows to five knowledge domains: mental health services research, research with vulnerable populations, intervention research, implementation science, and advanced research methods, such as systems science.”

The program’s connection between mental health and social work makes sense, Cabassa said. “Social work is where the rubber meets the road for services. We work in different service sectors, like schools, prisons, and hospitals, where mental illness is an issue. We’re everywhere, and mental illness is everywhere.”

The program has evolved as the Brown School has grown. This is evident in an emphasis on equity and disparities, as well as new areas of research, like early interventions for schizophrenia. It is also reflected in an expanding roster of faculty, particularly as the Brown School moved into the field of public health.

One recent post-doctoral fellow, Virginia McKay, participated in the training in 2015-16 and is now a research assistant professor. Her research interests include implementation science and the use of evidence in practice, particularly for infectious diseases. Like Powell, she came to the Brown School because of its reputation.

“For me, the value of the NIMH T32 was being able to come and get exposure to established implementation scientists,” McKay said. “Getting your PhD is about learning science; it’s different when you go about actually doing science. The NIMH fellowship gave me access to active projects on the ground.”

One of the projects she worked on as a trainee was a pilot study in collaboration with the School of Medicine to reduce use of antibiotics by finding out why surgeons overprescribe and how to persuade them to stop. (Overuse of antibiotics can make them lose effectiveness and increase body resistance.)

Proctor was her mentor in the program. “She helped me to figure out how to articulate my expertise, and guide my research to start me down a successful trajectory for my career,” McKay said.

During her T32 training, McKay completed a grant application as a learning experience. She unexpectedly received the grant, which is now funding her study of the use of ineffective programs by HIV prevention organizations.

“Being a post-doc is sort of like being your own startup, it’s really hard,” she said. “The fellowship allows you two years to do all of that stuff. It gives you the opportunity to engage with other researchers and move forward. With NIMH, you have the freedom to work with whomever you choose. That’s not true of many other post-doc programs.”

Powell said the training program embodies the enthusiasm within the Center and the Brown School to collaborate across the school, the university, and beyond.

Powell said that along with the center’s leadership in implementation research, it will expand future efforts into community-engaged research, partnering with on-the-ground organizations to design and conduct research that will make the most critical impact.

“The T32 fellowship and associated CMHSR efforts such as the Implementation Research Institute have been influential in building and nurturing a broad network of scholars nationally,” Powell said. “We will continue to collaborate with that network in an effort to improve the quality of behavioral health services nationally and internationally.”

“Through CMHSR and its training programs (T-32 and IRI) we are building a tremendous legacy developing the next generation of leaders in mental health services research dedicated to improving the lives of people and families living with mental illness through science, policy and practice,” said Cabassa.

CMHSR will celebrate their accomplishments and look toward the future with a relaunch event on March 24, 3:00-5:00 p.m. in the Clark-Fox Forum, Danforth Campus. For more information, contact Stacey McCrary.

Mental health issues are a leading cause of disability around the world and are increasingly recognized as a significant public health problem. With a new Mental and Behavioral Health specialization  within its Master of Public Health Program, the Brown School is poised to offer training to students who can make a broad difference in the public-health arena to complement traditional clinical care.

“There’s a growing recognition that we can impact mental and behavioral health at the population level through traditional public health activities like surveillance, prevention programs and policy,” said Associate Professor Alexis Duncan, who is chairing the new specialization.

“As a public health program embedded in a school of social work, the Brown School’s MPH program is uniquely positioned to equip students to view and promote mental and behavioral health through a transdisciplinary lens,” she noted.

Two new courses will be among the requirements for the specialization, which will be open to all Brown School students beginning in the fall of 2020: 

The specialization also will offer elective courses in both Transdisciplinary Problem Solving and traditional formats, as well as practica focused on mental and behavioral health. Graduates will be well prepared for careers involving program and policy development and evaluation related to mental and behavioral health, as well as research.

“This specialization is an excellent opportunity to tap into the wealth of expertise across the Brown School faculty,” said Lora Iannotti, associate professor and associate dean for public health. “We anticipate great interest among applicants and incoming students who are now considerably more aware of mental health as a public health issue.”

Duncan agreed that she has seen increased interest in mental and behavioral health from public health students, but only a few other MPH programs in the U.S. offer a focus on mental health.

“Just like with physical illnesses, we can and should develop public health programs to decrease the likelihood of developing mental and behavioral health problems, screen individuals for unrecognized mental illness, increase access to care, and minimize negative outcomes related to mental illness for individuals, families and communities,” she said.

Duncan noted that the specialization will address the additional complexities involved when using public health methods to combat mental illness. These include lack of funding for research and treatment, stigma, and difficulties in clear measurement and diagnosis, as well as health disparities in the availability of and access to mental health services related to factors such as age, income, race and location.

A psychiatric epidemiologist with training in behavior genetics, Duncan’s research focuses on exploring the interplay between individual, family, and social risk factors in the development of psychopathology, particularly among women.

Additional faculty for the specialization include Associate Professors Patrick Fowler and Jean-Francois Trani. Fowler is trained in child clinical-community psychology and leads research that aims to prevent homelessness and its mental and behavioral health effects. Trani investigates the intersection of disability, including mental illness, and poverty with a focus on informing policy and services for people living in conflict-affected states around the world. The specialization leaders will coordinate activities with the Brown School’s Center for Mental Health Services Research (CMHSR).

Learn more about the specialization.

Researchers from the Brown School at Washington University in St. Louis used an agent-based computer model to project the potential effects of strategies to reduce the density of retailers that sell tobacco in various locations. They found that the impact may depend on setting and timing.

The team of scientists built the model, called Tobacco Town, to represent a hypothetical town populated by cigarette smokers who travel between home and other destinations making choices along the way about whether to buy cigarettes and what to buy. The model simulates changes driven by different retail policies and their impact on purchase decisions and costs.

The study varied retailer density across wide ranges, in different town-type settings. Researchers found that when retailers were relatively abundant, small or moderate density reduction had minimal impact on cost to consumers. But when retailers were scarce, those reductions had dramatic impacts. They also found less cost impact from density reduction in poor urban and suburban areas than in high-income areas.

“Retail-focused interventions are quickly becoming a priority for tobacco control programs across the US,” Ross Hammond, the study’s lead author and Betty Bofinger Brown Associate Professor at the Brown School.

“Tobacco Town is intended to serve as a policy laboratory for retail tobacco interventions. Future work will include expansion of the model to consider geographical data-driven settings, retailer dynamics, tobacco initiation and cessation, and underage tobacco use, and to further expand the exploration of behavioral decision rules begun here.”

The paper was published online Dec. 20 in Health & Place.