Brown School › 2020 › Page 18

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.

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.

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.

Public health departments that have been accredited by the U.S. Public Health Accreditation Board are more likely to have capacity and support for evidence-based decision making, according to a new paper from the Brown School at Washington University in St. Louis.

In a survey of 350 local health departments, staff were asked about six factors of their organization’s support for evidence-based decision making (EBDM). About one-third of the departments were accredited, another third were preparing for accreditation and the remainder were neither accredited nor preparing.

Accredited health departments were more likely to report higher capacity and resource availability for EBDM than health departments that reported not yet preparing for accreditation.

The U.S. national movement for voluntary public health department accreditation by the Public Health Accreditation Board has gained momentum since it began in 2011. Standards include evidence-based practice. As of March 2019, 79% of the U.S. population resided in areas served by accredited health departments.

“Survey findings support the premise that the national voluntary accreditation movement is linked with improved health department performance,” wrote the study’s lead author, Dr. Peg Allen, Research Assistant Professor at the Brown School. “Accreditation standards may help motivate organizational supports for evidence-based decision making.”

The study was published Dec. 17 in Frontiers in Public Health.

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On Wednesday, January 22, 2020, Missouri became the newest state to take up legislation for a statewide Child Development Account (CDA) policy.  

Filed by Rep. Jonathan Patterson, the bill creating the Missouri Children’s Savings Account Program would automatically open a Show-Me Child Savings Account with a $100 seed deposit for every resident born on or after January 1, 2021.

Patterson’s filing represents the culmination of considerable work, much of it done by State Treasurer Scott Fitzpatrick and Margaret Clancy, policy director with the Center for Social Development (CSD) in the Brown School at Washington University, along with the Missouri Child Development Account Coalition, which includes Brown School Associate Professor Jason Purnell.

The proposal draws upon research on the CDA policy modeled in SEED for Oklahoma Kids (SEED OK), a randomized, statewide CDA experiment conducted by the Brown School’s Center for Social Development (CSD) since 2007. The findings have shaped state policies elsewhere.

“Seven states have adopted automatic statewide CDA policies,” said Margaret Clancy, a member of the coalition’s leadership committee and CSD’s policy director. Clancy advised policymakers on the development of all statewide CDAs and this policy proposal in Missouri. Nebraska, Illinois and California enacted CDA legislation in 2019, and Pennsylvania did so in 2018.

“The level of commitment that we’ve seen across this region has really been quite remarkable,” said Jason Purnell, co-chair of the coalition’s leadership committee, as well as director of Health Equity Works and faculty director with CSD. “We all share a commitment to the brightest possible futures for our children,” Purnell added. “This is just an approach that makes sense for investing in the future of our children, in the future of our state, and our families and communities.”

“We want every baby born in Missouri to have this,” Purnell said.

“A big key to our success so far was turning interest from State Treasurer Fitzpatrick into a full-on commitment to support and to champion this,” said Kaycee Nail, director of client and legislative affairs with the Penman Group. “It was really helpful for him to see the fact that Nebraska passed this legislation unanimously.”

Child Development Accounts

A CDA is a long-term investment account opened with a seed deposit when a child is born. That seed grows with market appreciation and supplemental deposits until he or she is ready to use the assets for higher education. The policy is designed to be universal and automatic, and assets may be used only for postsecondary education. The effects of the accounts extend beyond the assets they hold.

“The concept is that, by providing assets very early, CDAs can lead to financial planning for college and greater financial capability, a college-bound identity, educational preparation and later, college success,” said Clancy.

The benefits of CDAs are widely documented in publications from SEED OK. Findings show that the accounts expand assets for children’s education but that they also shape family behavior, boosting children’s social-emotional development, parents’ educational expectations for their children, and positive parenting practices, while reducing depressive symptoms among mothers.

Clancy added, “These findings matter because other studies have shown that these positive outcomes, particularly the higher education expectations, affect later educational success.”

Some of the benefits are greater for disadvantaged families. “Financially vulnerable families face numerous challenges that can negatively affect children’s development,” Clancy said. “For maternal depressive symptoms and positive parenting practices, the CDA effects were greater for families who participated in TANF and Head Start than for families who did not.”

Ray Boshara, a member of the coalition’s leadership committee and director of the Center for Household Financial Stability with the Federal Reserve Bank of St. Louis, noted the potential effects of a CDA policy on the gap between the wealth of black and white households. Citing estimates from a 2016 study, he said that a universal CDA program established in 1979 could have eliminated 23% of the gap between black and white households for young adults.

Leadership committee member David Dwight added, “CDAs are a powerful starting point for chipping away at those disparities.” Dwight is the executive director and lead strategy catalyst of Forward Through Ferguson.

The Proposal for Missouri

When a child is born in Missouri, the state’s Department of Health and Senior Services collects vital records information. The bill directs the department to transmit some of that (names, address, and date of birth) to the state treasurer’s office, which would contact the child’s family about the program and automatically enroll the infant unless parents opt out. The treasurer’s office also would communicate how families can access account balances and details online.

Enrolled children would receive a Show-Me Child Savings Account with a $100 “scholarship.” With additional deposits and market appreciation, assets would grow in these long-term investment accounts until accessed for trade school, community college or university. Like all statewide policies, the Missouri program would manage its CDAs through the state 529 college savings plan. Boshara added that the state’s plan offers “the best platform for inclusive asset building and wealth building.”

Additional details:

As the legislature began its work on the bill, Clancy expressed optimism. “This bill has the support of legislators from both sides of the aisle.”

Forward Through Ferguson’s Dwight shared his hopes for the bill : This is where we can start: universal at-birth investment in Missouri’s children and families for their opportunity, their health, and their well-being for the future.” He added, “When Missouri babies grow up and take their first steps into the state, what future will they find? And what future will we leave them?”

To learn more about the Center for Social Development’s work with Child Development Accounts, please visit their website.