Catherine G. Greeno - US grants

DESCRIPTION (Applicant's abstract): This Mentored Research Scientist Development Award application is designed to provide training in 1) ethnographic research methods, 2) diffusion of innovations and 3) rehabilitation approaches to care for people with severe mental disorders. People with severe mental disorders have a high burden of physical disease, many of which are affected by lifestyle. Behavioral medicine has contributed a thirty-year history of efficacy studies conducted in university settings to increase healthy behaviors and improve physical health and well being. Although efficacious treatments are available, they have been tested primarily in academic research settings, and little work has addressed the health behavior environment or the needs of people with severe mental illnesses. Prior experience with diffusion of innovation from a variety of social science disciplines suggests that a thorough understanding of community provider settings is necessary to successfully transfer programs out of academic settings. Furthermore, the assumptions underlying health behavior change programming, such as easily accessible grocery stores and ample storage space for fresh produce, may not characterize people with severe mental disorders. I propose to work with two community clinics that provide services to people with severe mental disorders to conduct ethnographic studies to document 1) features of the provider setting that facilitate treatment transfer, and 2) the health behavior environment of people with severe mental disorders. Based on the information gathered in the ethnographic studies, I will revise standard health behavior change programming so that it can be provided for severely mentally ill consumers in community mental health settings. Finally, I propose a preliminary effectiveness test of the revised program materials. This work will provide the background needed to develop an R01 proposal to pursue full effectiveness testing of the revised program. Mentored career development and research activities are designed to provide me with the skills and experience that I need to achieve my long-term goal of developing, implementing and testing broadly based behavioral medicine health improvement programming that can improve the physical health and well-being of people with severe mental illnesses.

DESCRIPTION (Applicant's Abstract): This research enhancement project is submitted as a component of the Social Work Research Development Center (SWRDC). Consistent with scientific goals of the Center, we will study ecological factors in the lives of mothers that affect their own and their child's illness, and their decisions to obtain treatment. Parental psychopathology is a relatively neglected risk factor in child psychiatry. In our pilot study 18/33 (54%) mothers who brought their children for care met criteria for anxiety and depressive disorders, and only 3 of these were receiving treatment. We believe that maternal disorders are common child settings, and that treatment of ill mothers is important for the health of both child and mother. However, too often mothers do not obtain treatment for themselves. Our long term goal is to develop a program for mothers who bring their children for treatment which ensures that maternal needs are recognized and met, and, in particular, that ill mothers receive effective treatment. In this proposal we will determine the prevalence of maternal diagnosis, provide referral of diagnosed mothers, and conduct a six-month follow-up to document outcome, including whether referred mothers obtain treatment for themselves. We are concerned that even if excellent treatment is available, mothers may not receive it, because ecological factors may hinder them. We will utilize a quasi-experimental design to study relationships between maternal illness, child illness and treatment attendance. This proposal represents a rare collaboration between senior social work and psychiatric faculty with combined expertise in clinical treatment research, family studies and caregiver burden, a group uniquely suited to conduct the proposed studies.