Patricia Arean, PhD: Effective Strategies for Community Engagement and Digital Innovations in Mental Health Research.

Episode Transcript
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(00:00):
Welcome to the Research Matterspodcast, where I interview leading
researchers in psychology and othersocial sciences in order to understand
what makes them so good at what they do.
My goal is to draw out the tips, tricks,habits, and routines of extraordinarily
productive researchers in a waythat leads to actionable methods

(00:21):
that can improve your own research.
A warning for psychology studentsand early career researchers.
If you enjoy the tribulations ofwriter's block and a haphazard
workflow, this podcast is not for you.

Jason Luoma (00:53):
This first interview of Season 3 was
conducted back in 2021 with Dr.
Patricia Arion when she was still aprofessor at the University of Washington.
Since the interview was conducted,she has moved to the National
Institutes of Mental Health and isnow the Director of the Division of
Services and Intervention Research.

(01:13):
Today's interview is with Dr.
Patricia Arion, a clinical researcherand professor at the University of
Washington, Seattle, in the Departmentof Psychiatry and Behavioral Sciences.
Her research currently focuses onincreasing access to mental health
services for underserved communities.
She also runs a research center, theUW Alacrity Center, funded by the NAMH,

(01:36):
where she works towards redesigningpsychosocial interventions so that
they're more accessible to clinicianswho work with underserved communities.
Additionally, Dr.
Aryan is head of the CreativeLab, which conducts research on
digital mental health offerings.
The lab utilizes mobile technologyto improve access to evidence based

(01:57):
psychosocial treatments in communitiesthat might not otherwise have access.
In this episode, we talk about how shebuilt her connections with underserved
communities and organizationsthat serve these communities.
We also talk about how to partner withpeople in community organizations and
how that can allow research with bothhigh internal and external validity.

(02:21):
I love this interview, learned so much,and am so glad to share it with you all.
So far I've remembered everytime to actually turn on the
recording and it looks like I'vedone that successfully today.
So great to have you on the podcast.
I thought we'd start offwith a brief intro to.

(02:44):
Know if you're what youdo and your work context.

Patricia Arean (02:47):
Sure.
So yeah, I'm happy to be here.
My name's Pat Arion and I am a professorin the department of psychiatry
and behavioral sciences at theuniversity of Washington and Seattle.
And uh, I am a clinicallicensed clinical psychologist.
So I have a PhD in clinical psychology.
I am at the university primarilyas a clinical researcher.

(03:09):
I conduct research on better waysto access mental health services
by underserved communities.
I run A-N-I-M-H or National Instituteof Mental Health funded Research Center.
It's called Alacrity Center.
And we are very interested in redesigningpsychosocial interventions so that
they're more accessible to clinicianswho work with underserved communities, as

(03:33):
well as the people that they work with.
And I also run a research lab called theCreative Lab where we conduct research
on digital mental health offerings.
This is uh, Something I've beendoing for the past 12 years.
I've been a scientist for, if youcount my graduate school, for 30 years.
And so the last part of my career has beenfocused on how to use mobile technology.

(04:00):
Not only to facilitate researchrecruitment but also is this a really
with the question of whether or notthis is a good way to improve access to
evidence based psychosocial treatmentsin communities who wouldn't normally
have access to a psychotherapist.

Yeah, that's such a fascinating interface between
technology and reach and working withand serving underserved communities.
And I'd be reallyinteresting to explore that.
I thought maybe we'd start with thepart of working with underserved
communities could you say a little bitabout how you got involved in that area

(04:43):
of research and were the struggles?
What was the process of getting up tospeed and getting a lab going and things
like that around that research topic?

Yeah.
So my training, I hadtrained in the Northeast.
I went to, I got my PhD at FairleighDickinson University, New Jersey, and
I did which meant, which is in Teaneck,New Jersey, very close to Manhattan.
And so I lived in Manhattan and did mostof my clinical work there in the city.
And I had always worked ineither public hospitals or

(05:18):
community mental health centers.
And just was really interested inworking with underserved communities.
Just out of a sense of social justicereally early on in my career, I was
interested in working with olderadults largely because selfishly when
I looked at, where are there gaps?
In the research that was one area itwas in geriatrics and in particular

(05:41):
in geriatric psychosocial treatments.
And at the time, this is like in the1980s the only person who was really
doing any research on mood disordersand older adults was Duluth Gallagher
Thompson and Larry Thompson at Stanford.
And so this was to me areally wonderful opportunity.
To address a population that's veryunderserved by research and mental

(06:04):
health services and figure out how tomake intervention, whether or not our
behavioral interventions were effective.
And if they were, how do weget them to, to older adults?
So I say very early on, I started workingquite a bit with primary care medicine
and and just by virtue of where I was,it was always in like a public sector,
primary care setting or federally.

(06:25):
qualified health center.
And just understanding the uniqueneeds of people who are living in
poverty, particularly older adultsin poverty really felt wow, this
is an underserved group of people.
And I really want to contribute to that.
To the work for them,not to their disparity.
Sorry.

Yeah.
Really important work.
And it's a huge honor to be talkingto you about that and you sharing
what what you've learned because it'sso important of work and just, yeah.
Um, there, there are a lot ofresearchers out there who would At

(07:04):
various levels want to have more ofthat social justice aspect of their
work of reaching the most marginalizedand underserved groups and but maybe
you don't know how to go about it or,um, don't have the right relationships.
And so I'm curious if you could startwith your journey, can you take us through

(07:27):
the story of how you actually got startedin the research and how you developed
the relationships and the access to beable to have groups, involved with your
research that oftentimes are pretty.
suspicious of research or uninterestedin being involved with science for good
reasons, for good historical reasons.
I'm wondering if you could walk usthrough your story of how that unfolded.

Sure.
So I would say that, when I wasin grad school, a big chunk of
my interest was in geriatrics.
And then just by virtue of whereI was working a lot of these were
people who are living in poverty.
And then I moved to San Franciscoto do my postdoctoral fellowship
in clinical services research.
And I was, my mentor was Dr.

(08:10):
Jeannie Miranda.
And it was really there that Istarted to dig into the social
justice Work aspect of this work.
So Jeannie, I've been doing aclinical trial on cognitive behavioral
therapy and clinical case managementfor low income minority adults who

(08:31):
were identified as needing care fordepression and primary care medicine.
In fact, she's really one of thefirst people to do a psychotherapy
integration study in, in that setting.
And and.
We worked at San Francisco GeneralHospital, which is now called Zuckerberg
General the team that Jeannie hadput together, was not just a bunch

(08:51):
of psychologists, but also quite afew social workers and social work
by virtue of their training is verysteeped in social justice theory.
And so when we were working with thesevery impoverished populations and I
was, under Jeannie's mentorship, I wasinvolved in her research projects really

(09:11):
started to learn about how there'sa very different way of looking at.
mental health in this community thatwe were never taught in grad school.
As an example, a lot of, the, these arepeople who have, there's a tremendous
amount of real mental illness.
However, there's this reallyinteresting driver for a lot of

(09:32):
people where it is just this kind of.
Like cognitive overload from livingin, in so much adversity, having
to struggle to find meals livingin areas where it's dangerous.
So it's really hard to get outof your house without having the
fear of being, attacked or havingthe experience of being attacked.
These were an urban center.
So there was a lot of the stressorsfrom noise pollution that can really

(09:55):
impact your, impacts your sleep.
It impacts your level of stress.
And so it wasn't when we were looking,doing genie study, it was interesting
because the cognitive behavioral therapieswere helpful to a point, but when we were
running the groups with these populations,it was pretty clear that it wasn't enough.

(10:16):
That if you think about Maslow'shierarchy of needs, if you're
struggling to find a place to sleep,the last thing you're thinking about
is, is this a cognitive distortionor am I really have a balanced
perspective of what my life is like?
Because that was what we would get alot in the groups was, but yeah, but
it, my this is really hard for me.

(10:36):
And this was something I was alsoseeing when in my work with older
adults that, some of the theoreticalprinciples that we use in evidence based
practices are great if you're, a middleclass or upper middle class person.
But when you're living in poverty,they don't make a whole lot of sense,
behavioral activations there, youhave to be very creative to be do
anything behaviorally activated.

(10:57):
And it's not to say that they won't work.
It's just that you needed a lot of outsidestructures to support the treatments.
And so doing things like clinical casemanagement, which is all about advocating
for patients to help them get services.
Not necessarily, a lot of ourpsychological interventions are
pretty focused on I'm going tohelp you do this for yourself.

(11:19):
Whereas with the social justice model,it's There are things you can do for
yourself, but there are things you Ican help you with and I will do that and
that can be very therapeutic for peopleto, find a safer place to live or get
services that would allow you to haveregular access to medication or food.
So those, that's, I started to getreally fascinated with this idea of how

(11:40):
we need to modify our interventions.
CBT is a very effective intervention,but when you start to put a lot
of environmental stress on theintervention, it only goes so far.
And so I felt like this would be a reallycool opportunity to see what other things
could we be doing for this population.
You'd ask me how did I startby working these relationships?

(12:01):
And I think the big challenge for alot of people entering this field, if
services research, particularly workingwith underserved populations, is that
there aren't that many of us that do thiswork because it's extremely hard to do.
And I've.
sought out working doing this postdocat San Francisco General because there
were investigators that were steepedand doing community based participatory

(12:25):
research and social justice research.
Cliff Atkinson, who was the personwho directed our postdoctoral
program, did a lot of stuff injuvenile justice and child welfare.
And so there were a ton of expertsthere who really understood, already
had a lot of these connections.
The thing that, so Jeannie had alot of connections in primary care,

(12:45):
the thing she didn't have wereconnections to geriatric services.
And so with her help and mentorship,I was able to, she would tell me
let's go talk to somebody aboutwhere like, all the old people are,
where do they get their services?
Who do you need to talk to?
And then she would coachme through give me advice.
And this is advice I give people is thatyou can't walk in saying I'm a scientist

(13:07):
and I'm here to solve your problems.
But, walking in and saying, I'm reallyinterested in helping this population.
I'm curious about, what kind of,research you're interested in doing.
So really taking the, oftentimes it's thethe clinic's perspective of what would be
most helpful and then going from there.
So just to illustrate therewas a it's now called the

(13:28):
Curry Center in San Francisco.
But at the time was calledNorth Beach Senior Center.
It's a federally qualified health centerthat served older adults living in one
of the poorest areas of San Francisco atthe time called the Tenderloin District.
And the medical director at thetime when I went to visit with him.
Was really like I'm happyto help you with your study.

(13:49):
This was documenting the prevalence ofmental illness in low income, older adults
in primary care medicine and wanted todo an epidemiological study there so they
could, start to think about what werethe mental illnesses that were prevalent?
What were their needs?
And he said, I'd be happy tohelp you as long as I can use
some of that data to help withfundraising and going to the county.

(14:10):
to get more money to justify moremental health services in our clinic.
And so for him, it waslike a real opportunity.
I basically said, sure, I'dlove to do that with you.
Let me know if there are additionalquestions you want to ask.
And so we created the survey together.
And then he gave me, accessto get myself in some research

(14:31):
assistance access to his clinic.
And, just that relationshipbuilding helped him.
He introduced me to other peoplein the field of Jerry in geriatric
medicine in San Francisco.
I started working with other federallyqualified health centers in the Bay area,
and it was just the snowball effect.
I think what helped too, is that it wasone of the few people doing geriatrics.
At the time so picking an area wherethere's a lot of need and not a lot

(14:55):
of interest is usually pretty helpfulbecause if there isn't, if there aren't
scientists or, service models alreadyin place, then for a given problem, then
the people who see that problem on adaily basis are actually very welcoming.
My experience has been, they're verywelcoming of any help that you can
provide them in better understandingthe needs of their community

(15:19):
as well as providing resources.

Really?
Yeah.
Really good.
They, tons of questions have come up andI'm never going to get to ask them all.
The first thing that's coming to mindfor me is what you said about it taking
a lot of work and my experience has beenthat, they're particularly in the last few
years, I think there are a lot of whitepeople who are researchers out there who
have developed more of an awareness of.

(15:45):
At least issues around race, but itmay be around diversity in general and
have a sense that they'd like to dosomething but don't know where to go.
And.
I, I found myself in some of those.
I've been interested in those topicsmy whole career I've been a stigma
researcher and have put more timeinto that recently and part of what I

(16:08):
personally have been bumping into is,Realizing how much time it's going to
take that, that I really do have to,at least this is what I keep hearing
and seeing is that I really do have toput the time into just developing the
relationships, like really forming realrelationships that are not I'm this expert
scientist come in, I'm going to help youor you're going to help me in my research.

(16:32):
And I'm curious what you have to sayabout the process of, as a scientist
developing relationships and at some levelyou're Developing their relationships
because you have this interest in anoutcome that you want research access.
You, you bring your own scientificideas and your own particular topics

(16:54):
that you want to study, but at thesame time, You want to pay attention
to the interests and the needs of thepeople that you are interacting with.
And I'm curious if you couldtalk about that tension.
If it, if you see it as a tension betweenperhaps what you're most interested in and
what the people or the communities you'reinterfacing with are most interested in

(17:19):
or needing and how you've dealt with that.
If that indeed is a.
a useful way of framing it.

No, it's a great way of framing it.
And particularly when you're doingwhat I do, which is clinical services
research often what we think is goingto be helpful or what we'd like to study
is not at all what the community isthinking is the issue or the solution.
And I would say over the years,There's a couple of things here.

(17:45):
One is that it's usually not thatdifficult to make a connection with
the person who's like the chiefmedical officer or the chief executive
officer of a clinic or an organization.
Now I will say I do a lot of myresearch through health services.
And so it's a little different whenyou're trying to, work with an actual,

(18:07):
like just recruiting from the community.
And those are two different things.
And I'll talk about that in a second,but, it's, I find it's easy, hard.
It was one of those dynamics where whatyou're always looking for is who is the
champion in the community that you shouldtalk to who, has the perspective or has,

(18:29):
the leadership role in the communitythat can help you understand what their
needs are and what kind of challengesyou're going to face in trying to recruit.
And in my work, it's largely beenthe chief medical officer who
I have had to interact with.
And they're usually chief medical officer,CEO, they're usually pretty on board.

(18:51):
They don't say we absolutely shouldbe doing evidence based practices.
We have a really huge need patients here.
And they're usually the first people whowill tell me in my experience that, but
you're not going to just find, you'regoing to find a lot of depression,
but it's going to be depression withX, Y, and Z, substance abuse, PTSD.
So if you were looking for a clean sample,that's just not going to happen here.

(19:13):
And that was something I had to get on.
board with really quickly becauseand it's actually a good thing
because that is who's out there.
It isn't the typical randomized clinicaltrial person who will come in and do
five MRIs to participate in a study.
The people who are inneed are not those people.
Those people have needsto, in the community.
And so I had to get used to accepting thefact that it would have messier samples.

(19:38):
I was, this was really early on inthe field of effectiveness research.
And so there was a little bit of,it was something I had to put up
with from some of my colleaguesabout how it was messier science.
And it wasn't quite as clean and pristine.
I have to educate them that there'sactually an investigative pipeline.
And this is not unlike doing afield trial, just because it worked

(19:58):
in your lab doesn't mean it'sgoing to work in the real world.
And but they're usually the most welcomingit's the next stage, which is when they
introduce you to the people who youwill be working with, which is staff
and all of that and so figuring out howto do recruitment in a way that won't.
Interfere with their workflow.
That is acceptable to them as cliniciansthat they feel comfortable because

(20:22):
oftentimes the clinicians will feellike they need to be the gatekeeper
that, these are communities who havebeen abused by science historically,
African Americans, in particular inthis country have been very badly
abused by the scientific community.
Native Americans the same way have been.
Abuse, torture, and even when theyparticipate in research, sometimes

(20:46):
the results are cast in such a waythat it villainizes the population.
So it's really challenging.
You walk in just understanding,that there are these, there
have been these transgressions.
And I've always taken the positionof I want to meet with the clinical
staff first, because they're the oneswho are going to either facilitate
or not facilitate recruitment.

(21:07):
I'll even, work with them around theresearch protocol with clinicians
this is something I learned later.
I'll get into that in a second.
But, when it just comes tofrankly, just recruitment for
participation and a research trial.
It's going to take a little bit oftime to address everybody's concerns.
You have to accept that not allthe clinicians will be on board.

(21:27):
So you'll have a smallerpool to recruit from.
But my found that as other clinicians jumpon board and, you know, the clinicians
who aren't participating, see howseamless the study goes, you learn a lot.
They start to want to participateto, partly because the patients
start saying, how come I'm notin the study, so I've also always

(21:47):
formed community practice boards.
So these are usually representativesfrom the clinic or the community that
I'm recruiting from before I plan out theresearch, I have them look at the surveys.
I asked them there are outcomes thatwe have to collect, as part of science.
Take a look at these.
What do you think of them?
What else should we be asking that wouldmake you feel like this intervention that

(22:11):
we're testing would be effective for you?
What are we missing?
So I don't ever, completely pull away fromwhat would be a public health question.
But I add, based on what the communitytells me is important to them.
Just like I said, with my very firstexperience with the chief medical
officer at North beach seniorcenter he was like I need data for,

(22:35):
to get more money for my clinic.
And it's what data do you need?
And I just added it to the protocol.
So when you're trying to recruitfrom outside of a service system,
that even gets more challenging.
And I think that what happensis that again, you do need
that community like state, likegatekeeper or champion to help you.

(22:58):
And some of my colleagues who've hadto do that, say for Alzheimer's studies
and the Latino populations, they'llfind a variety of sources where they
will recruit, like from neighborhoodchurches, senior center organizations.
With my colleagues who workwith kids, it'll be from schools
or after school programs.
And so you basically, you justhave to find the right person to

(23:21):
partner with and make sure youwalk in that this is a partnership.
It's not you coming in.
Doing this, that you two are going to worktogether to try to solve this problem.
I would say another thing you have tobe, when I've mentored people in this
area is that you're going to get thedoor slammed in your face a couple of
times, where people, and people are nice.
They'll say, I think it's a reallygreat idea, but we just don't

(23:43):
have any bandwidth right now.
Sorry.
Keep your foot in the door a littlebit and just say, I understand
this is a really diff that, thishas happened a lot during COVID.
This is a really difficult time.
I'm hoping we can worktogether in the future.
Is it okay if I keep in touch withyou about what I'm doing, in this
area and then that way it's nota oh, you don't have to walk away
with your tail between your legs.

(24:05):
But you say that like I'm vestedin this area and I hope we can
work together in the future.
The other reason why you want to dothat too is that sometimes leadership
changes is actually very common forchief medical officers to rotate out
of clinics every three to five years.
And you may want to weigh a little bitand see that you know the next chief

(24:26):
medical officer might be more friendlyto research and the previous one.
I had mentioned the North BeachSenior Center, which is now Curry
Center in San Francisco, where thechief medical officer I first worked
with was very friendly to research.
He got promoted in the health systemand his replacement hated research.
And so I ended up not continuing to workthere because of her abject adversity

(24:50):
to anything scientific, and potentiallymental health oriented, but I had already
established a nice relationship withother FQHCs that he had introduced me to.
So I could move on, and I let her, Iwould try, I tried, and I let her know
that, try to remind her the value ofher patient population participating
in this research, because they'reso underrepresented in science.

(25:13):
Wouldn't it be nice tohave an evidence base?
Hands over ears.
That's fine.
I'm not going to push a rope.

When you're trying to identify those key people,
the champions or, influencers andideally you have a warm handoff.
Someone introduces you.
I I'm curious how you go about that.
You're associated withuniversity of Washington.
You've been associated withvery high profile universities.

(25:43):
I'm sure that helps a lot, buthow do you go about thinking
through, how can I meet the people?
How can I identify the people?
And I'd also wonder do you ever docold contacts, call somebody who
you have zero connection to and ifso, how would you go about that?

Yeah when I moved from San Francisco to Seattle about
six years ago, I actually did haveto do cold calls because a lot of
the work that the department wasdoing was with how can I say this?
So there was a lot of work withrural FQHCs, but they weren't
necessarily interested in geriatrics.
And so I could havegone in that direction.
I could have said, Hey, helpme out here with colleagues

(26:23):
that were doing work there.
But I came with very specificresearch projects and they weren't
quite oriented towards the federallyqualified health center, organization.
And I did, I make cold calls.
I call My staff and Iwouldn't say I did it all.
I want to make sure that thepeople who helped me make those

(26:45):
connections get the pat on the back.
But we contacted senior housing, seniorcenters it was a lot of phone calling.
And then for the most part, I thinkpeople were willing to listen to what we
had to say and like, how can I help you?
And very clear about what the ask was.

Yeah.
What would you say?

So it would be.

Yeah.
I'd love to hear a littlebit of exactly what you said.

Oh gosh, I'm so stuck at nature now I have to think about it.
So it'd be something along thelines of I'm Pat Arian from
the University of Washington.
I moved here, I've just moved hereand I've been doing research at UCSF
for 20 years in geriatric mentalhealth and I am just trying to get
a lay of the land about what seniorservices are like here in Seattle.

(27:33):
And I'd love to meet you and seeyour organization if you have time.
And so I didn't walk in saying Ihave a research project and I
need to recruit they probably knewthat in the back of their head.
That's probably a big driving principle.
But yeah, and so it most, I wouldsay, Seattle people were pretty open
to, to say, I'd meet, I'd like tomeet with you and see, and I'm happy

(27:56):
to show you around and tell you alittle bit about geriatric services
in the city and and in the county.
And so I started off first just doingsome investigation and it wasn't just me,
I had hired a project manager who alsowould help me with that, so it wasn't
just me all over the city, but alsostart to introduce that we are a group.
And so that was the first thing, it'slike how does it work here, because all

(28:18):
counties are different, all communitiesare different and I would ask questions
about what's the demographic like inlate life, you know how many what is the
underrepresented minority population here?
What happens to people?
Do they stay here in Seattle?
Do they move to other counties?
So I just have a list of questions toask and, it's that whole thing of getting
people to talk about what they do andwhat they love really helps people.

(28:42):
And then, then they would usuallyask me, so what are you doing?
What are your plans?
And I would take a broad picturefirst, that my interest is in
helping underserved communitiesaccess evidence based treatments.
I've been studying that.
My, my.
The advantage of being olderis that I could say I've
been doing this for 20 years.
And and then I would say, but, I'm reallyinterested in doing research where people

(29:03):
who work with older adults older adultsthemselves have a voice in the science.
And so part of what I'm doinghere is trying to figure out
how can I be helpful to you?
And is there a way, that wecould potentially work together
that would help you and also mighthelp us better understand what the
needs are for, underserved olderadults in the Pacific Northwest.

(29:24):
So that's basically, it's it doestake time to build a relationship
when you're junior you're firststarting your career it's hard.
So I will say that ideally, if youcan be in a setting where there are
other people who really have alreadyestablished those relationships,
your career will go a little faster.

(29:45):
But if you're new on the blockand you're coming in with a new,
which is my entire career has beenthis it it can take some time.
And so when you're sayingacademic, there's so much
pressure for us to publish.
It's how we're reviewed for promotion.
And what I would advise people to dois try to write as much as You can

(30:05):
off of data that's already there findexisting data sets right about some
of, even thought pieces or conceptualpieces, while you're trying to build
this relationship because it actuallycan take quite a number of years
before you've first I've Relationship.
Okay, that I took meabout a year to do that.
Now I've got to do a pilot study.

(30:26):
I've got to figure out how to do that.
And what I've done is the otherthing too, is when you do come up for
promotion is to make sure you seekout external letters of reference from
people like you who do community basedpractice research, because they are in
a better position to review your CV.
They can write a better letter thansomebody who's just the expert on
depression because then those reviewerswill put your work into context or

(30:53):
the promotions committee, basicallysaying, look, nobody has done X, before.
This person's breaking ground.
It's very hard to break into thesecommunities and collaborate with
them and they're showing verygreat potential for doing that.
We now at least have 20 years ofexperience that it takes a long time
for junior people to get into thewho do community based research.

(31:17):
To get their CVs and portfolios up,but we know what those of us who
do this work know what the markersof a successful career look like.
And so we can speak to that.

I think that's a great idea.
I'm thinking back to, I was ingrad school involved in research on
suicide and this was before therewas much of any funding going that
way 20 years ago, it started right.
As I left graduate school, that'sAnd it was very common that we

(31:49):
would get destroyed on reviews forour rigor of various things about
the study designs or the measures.
And it was because that areaof work had been so neglected.
And if you compared research onsuicide to research on depression.
It's just thousand times, 10, 000 timesmore research on depression and people

(32:13):
would be comparing apples and orangesand saying your work's not as good.
It's not as good because Idon't have thousands of other
people's work to build on.
And if people can't appreciate how nascentthe area is and how, Groundbreaking the
work is, and put it in that context,then yeah, you can very much become

(32:34):
look down on or seen as not doing asgood a work when in fact you're doing
fantastic work, but just in an areathat's not as strong which also often
goes along with, it's more difficultbecause the pathways aren't so clear.

Yeah.
And this will happen sometimesthroughout your career.
So a really good example of that iswhen I started to get into technology
as a means of improving treatment.
Lemme tell you thatlittle story 'cause it's

Sure.

It's funny.
I I had been studying problemsolving treatment for a
form of late life depression.
That is characterized by thiscognitive control deficit.
So basically these are older adults wholook like they may have had ADHD when
they were, or ADD when they were younger.
And given how poorly diagnosed thatdisorder was in their age cohort, it's

(33:22):
likely that was probably the issue.
And it's a population that's not verywell responsive to psychiatric medication.
And a colleague of mine at Cornell hadbeen doing a lot of research on that.
So he asked me when he sawthat I was doing research on
this behavioral interventioncalled problem solving therapy.
He asked me to collaboratewith him on that.
And so it was one of those things where itwasn't necessarily focused on underserved

(33:45):
communities, unless you considerolder adults in general, part of that.
But it was a really interestingidea of like, how do you tailor
or select treatments basedon neuroscience principles?
So we've done this study and itwas really fascinating because the
outcomes from that project were thatthis very highly selected group of
older adults with this very specificcognitive deficit did ex, densely.

(34:09):
With problem solving therapy, thisis a big study, like 250 older adults
with this cognitive impairment.
And so much and they did likesubstantially better than what you
would expect with antidepressants.
So it was a big deal.
It was a big paper in the field.
And my colleague and I got intoa little disagreement about why
we thought that was, because Iwas thinking psychotherapies or
behavioral interventions are likeThey're like training, they're

(34:31):
like cognitive remediation.
You're basically teaching peopleskills, these skills that they do
over and over again, you use thisprocess for solving a problem.
And I wonder if there is some actualneuro mediation in that he was thinking
it's probably more of a structure orcrutch, for this disability that I decided
to do just something I'd never donebefore, which was Functional MRI study

(34:53):
to see whether or not problem solvingtherapy affected that area of the brain.
And it was that a mediatorfor treatment outcomes.
So extremely basic science, notat all what I've done in the past.
And what was interesting is that my callI, I was at UCSF and there was really,
there was a number of MRI labs there.
There are like, repletein imaging equipment.

(35:16):
But there was really only atthe time one guy who was doing
functional MRI Adam Ghazali.
And so I went to talk to him aboutso what would it take to do a study?
Because he would, rent out hismachine for people to do research on.
And he got really jazzed about my idea.
Cause he's I, he's I studyolder adults and I studied
that exact same neural network.

(35:36):
Only I'm interested in cognitive agingand maintaining cognitive reserve.
And I did lay out this therapeuticvideo game, with Lucas arts, he's
really good at getting money andit's going to be published in nature.
And I.
I was like, Oh, that would be, do youmind if I use that as a control condition?
Because it would be really interestingto see do we get the same level

(35:57):
of movement and psychotherapythat you do in this video game?
And I totally anticipated therapygame, the serious game wouldn't
really do anything with mood.
Cause it wasn't designed to do that.
So it was really interesting.
I got awarded the study at NIH andI got very excited about doing it.
And then at the same time cause wewere starting to find some really
promising outcomes from that.

(36:19):
The older adults loved the game and we'reprobably more adherent to that than they
were with problem solving treatment whichwas, which is such a gas but we but.
At the same time, NIMH had juststarted getting really interested
in the use of smartphone technologyfor mental health services.
And they had this RFA, this call forproposals to study novel technologies

(36:42):
for behavioral interventions.
And I applied with Adam and whatwe decided to do was this fully
remote randomized clinical trialof three different therapy apps.
One of those was histherapeutic video game.
I bootstrapped an app forproblem solving treatment.
And then we worked with this companythat at the time was really just a

(37:04):
tracking company, but it's now a bigmental health company called ginger IO.
And and they created like a healthtips app, like a control app for us.
And so we got the award from NIMHand we did this enormous study.
It wasn't meant to be that big.
It was only meant to be about 150 people,but we recruited like 2000 people really

(37:25):
quickly and a really small budget.
Not only that, but it was blownaway by the fact that we didn't
even do targeted recruitment.
And the demographics of our samplewere bang on to the U S census.
estimates of ethnic minorities at thetime, and so it was like, I didn't even
try that hard and I got all these subjectsand they were very ethnically diverse.

(37:47):
And so it was really fascinating.
So I thought for sure, this wasgoing to be a big deal paper.
I submitted to JAMA psychiatry andtheir first reaction is yeah, only
50 percent of the samples stayed.
And I'm like, Excuse me, thisis way better than the internet
based studies are, which onlyretain 1 percent of the sample.
And eventually it got published inBMJ, and it's gotten a lot of press.

(38:12):
It's been the thing that hasgotten my foot in the door with a
lot of other technology companiesto work with them in research.
But it was fascinating becauseit's exactly what you're saying.
Nobody had done this before.
I was the first person to doa randomized clinical trial
solely on people's smartphones.
And of course, there was goingto run into some issues because I

(38:32):
was the first person to do this.
But the level of understanding that someof the more serious journals or, About
this is that they've never done it.
They don't know how, what the issues are.
The purpose of the study was tobasically tease out, what do you
run into if you do a study this way?
So yeah, so you, you take it onthe chin a little bit dang it,
this was a, this is a big deal.

(38:53):
But fine.
And other journals thought itwas a great deal, a big deal too.
And so we did eventually.

That's it.
That's a good story.
I do want to ask you a little bitmore about the kind of working with
technology companies in a moment,but I had one more question about
partnering with Organizationsaround underserved communities.
And I was curious about the roleof representation on the research
team in terms of the researchteam, reflecting the communities

(39:24):
that you're trying to work with.
Could you say something about theimportance of that and how you work with
either having that representation ornot having that representation and how
I might address that and how it mightaffect your research and your strategies.

Yeah.
You'll get a lot of people sayingdifferent things about that.
My experience has been that ithasn't been absolutely necessary.
I did try very early on to make suremy team was fully representative of the
samples that we were trying to recruit.
But what I ended up learningis that it's not so much.

(40:00):
Do they look like me?
Do they look like the community?
As much as it is, arethey good social beings?
I have had good success with researchassistants who are white working
in an African American community.
Because they were just great to workwith, and they were okay, knew that they
were walking in, and, would be somewhatapologetic, but not even how apologetic

(40:25):
can you be, but, At the same time, we'reextremely compassionate individuals and
the, and that our participants in thecommunities actually really took to them.
I have always had a diverse team and it'sjust by, I think the nature of the work
that I do who is it that likes to do thiswork, but I've never found it to be like,

(40:47):
And that's just me because I think otherpeople have felt very differently that
it's important to have the same look inthe, on your team as is in the community.
And I think that's, I think that'sprobably true too but what we're missing
is that it's the ability to talk topeople and to work with people in a

(41:08):
way where you're not threatening.
Too, it's, the thing that I've alwaysobjected to about I've got the black
person on my team is going to recruit allthe black people is that there's a lot
of diversity, even within, these groups.
So for instance, I grew up in the Southand the African American community there
was conservative, religious very differentthan the African American communities I

(41:32):
worked with in, in San Francisco and NewYork City who are much more urban, have
a very different life experience and notsaying that they aren't religious they
tend not to be as conservative, but it'sa little bit tokenistic, I think, to say
I've got my my person of color and they'regoing to help me get into the community.

(41:52):
Now the people I work with in thecommunity who are like my gatekeepers,
the ones who I partner with, theyoften are part of the community.
So that helps a lot.
I think that's the transition of I hate tosay like transition of trust, but a little
bit of a halo effect that, they vetted me.
So I might be okay.
Yeah.

Yeah.
Yeah.
Sure.

Yeah.
So I guess the short story is that I thinkit's more about who the assistant or
your team is, and less about do you haveeverybody who needs to be represented?
On your team,

I really appreciate you sharing all these ideas
are very valuable and.
Even personally, as a white guy who'strying to be more responsible and,
making efforts towards having ourresearch and business be more just and
contribute to breaking down systemicracism and yeah, disadvantages of

(42:48):
various sorts, these conversations are.
Helpful and heartening because there'salso a big piece of this that has to
do with motivation and, continuing tokeep your feet moving over the marathon
of this, not just thinking it's aproject, but that it's, something that
I hope to be involved in for decadesand develop those relationships.

(43:10):
So this is just personally very helpful.
So onto the, just.
We don't have that much time left, butI would love to hear the extent that you
can I'm sure you could talk about thisfor a long time, but if you would talk
a little bit about your experiences withpartnerships with technology companies
or other profit making organizations andwhat that's, yeah, anything you feel like

(43:32):
might be interesting to talk about inrelation to your role as a researcher.
In those partnerships.

Yes.
So my experience.
That's interesting.
I, like I said, I got intothis in a really weird way.
And part of it.
So part of the way that I'vedeveloped these relationships with.
Industry, like for instance the companythat that actually now holds Dr.
Ghazali's video game is called AkiliInteractive and they're really big

(44:02):
industry, have a lot of donor fundingright now, but when they first started,
they were a really small startupand the same was true of Ginger.
io.
And and it was just really easy to workwith these guys because there were only
a couple of them and they were reallyeager to break into the healthcare system.
And, part of it was reallykind of transaction.

(44:22):
There was a back and forth like I,they were helpful to me in my research.
And then they would ask mequestions because of my expertise
in health services research.
They were asking me questions about,so how do I make this product,
interesting to buyers or to payers?
And I, for some of the companies, I wouldintroduce them to my colleagues who were.

(44:43):
in research and development in placeslike OptumHealth or Kaiser Permanente.
So there, there was a littlebit of like it's interesting.
It's similar to what I was sayingabout the community based practices
is that our partnerships builtout of, what's in it for both of
us we're both interested in this.
You're helping me.
How can I help you?
And so I think for the most part,my experience has been, really

(45:08):
positive because we've beenable to help each other out now.
It is very different working with.
Technology industry than it is with thehealth care industry, because the health
care industry moves exceedingly slowly.
Technology moves faster than we can.
And one of the big challenges ofworking with say a startup is that

(45:29):
their product will change or disappear.
And, that's usually, the case.
So I know that NIMH has been trying orNIH in general has been trying very hard
to keep a pace with, and I'm being veryunderstanding to researchers about the
fact that the person that they partnerwith now changed their model on you.

(45:50):
And it's the same, butnot exactly the same.
And so usually what they do isit's on you to find, cause we're not
interested in the actual company.
We're interested in theprinciple you're testing.
So it's up to you to find that otherperson who can do that for you.
So they're a little bit moreunderstanding of that kind of
thing than they used to be.
But that is one of the challenges.
So I talked about how ginger IO originallywas developing a mood tracker app.

(46:15):
And that's how I was working with them.
And then a couple of years into,thankfully, my project had ended,
but a couple of years into ourrelationship, they actually changed
to be a health service provider.
And it was just a big company decision.
So now my relationship with them is muchmore on a kind of a consulting basis.
I'm now on their advisory board.

(46:36):
However I also do research, actuallydo research with talk space.
They, are a big company, sothey're always under attack in
the news about their services.
90 percent of the tack is gee, I couldsay that about all mental health services,
not just talk space, but they're extremelyinterested in working with scientists.

(46:57):
to developed an evidence base.
And so I, just in talking to theirdirector of research, they were
interested in one thing that I haddone around using passive sensing from
smartphones as a way to, measure outcomes.
I just turned around andsaid, nobody's done this study
looking at message based care.

(47:19):
Are you guys willing to do that?
And they said, yes, I was shocked.
I thought for sure they would say no,but there's a certain, I think one of
the things that researchers bring to thetable for these companies is that it's
an independent review of their product.
The good, bad thing,the good news is that.
if the product works, thenthey're golden boys, right?
They actually have evidence.

(47:39):
Silver cloud is a really goodexample of a product like that.
But they take the risk of itnot working and The, or not being
as good as they think it is.
So fortunately Talkspace'sphilosophy is we want to know
that so we could fix our product.
I think they're pretty confidentthat it's an effective tool.
But we'll see we're in theprocess of doing that study now.

(48:00):
But a lot of the companiesdo the research internally.
And so there's always this levelof skepticism about yeah, but
what data were you looking at?
This kind of lack of willingness toshare the data I think actually makes
it difficult to partner with companies.
So if you're in this area,companies will reach out to you.
They'll want to put you on theirpaper, because it gives their

(48:21):
publication some academic gravitas.
They'll want you to be on as a consultant.
But when it boils down to it, majorityof the companies that I've worked with
don't share their data, it's not publiclyavailable and they will do the data
analysis for you, but they, but thetrouble is, if you try to publish that,
you have to have a data sharing agreement.

(48:41):
And and so you get dinged.
For not being able to do that.
Some companies like Akili andTalkspace so far my two examples
of where they're totally finewith, this being a buff board, my
understanding the data and so forth.
So those are, they're fewer and harder tofind and their business reasons for that.

(49:02):
But just keep looking because Ithink the more pressure there is
on digital technologies to showan evidence base, the more they're
going to be looking for scientiststo do independent investigation.
And I will hope, back to theunderrepresented population piece, I would
totally hold their feet to the fire aboutmaking sure that we see whether or not
their product is viable in underservedcommunities because they're so many

(49:25):
challenges with technology and underservedcommunities that we haven't addressed.

Yeah.
Can you say more about howthose two have come together?
Because it's not to me an obviouspairing to search for technology based
or mobile solutions to mental healthproblems in underserved communities.
How have you thought about that.

So a couple of my colleagues here at the
University of Washington haveand and I have done that sort of
indirectly through my remote files.
But what they've done much more onthe I'm partnering with a company.
In order to have thetool, the test, right?
And so it's not so muchin the company's mission.
It's actually very hard to convince acompany that this is an area of growth

(50:12):
for them because you're starting todeal with the public health system.
I was actually consulting to one, and Iwon't say which company it is, another
one that I had joined their board.
And I know majority of us on theboard were saying, the missed
opportunity here in the United States.
States are people who live in ruralareas who need access to mental health
services don't have it, but, also havethese issues with broadband and data plan

(50:37):
limitations and older generation phones.
And so if there's a way to thinkabout your product so that it could be
accessible to this population you wouldbe the only people doing this, right?
I don't think we convinced.
But I know from the research sidethere's a lot of excitement about

(50:58):
that from funders like PCORI and NIMHand DARPA and all that, where, we're
interested in developing ways tohelp rural populations access care.
You were mentioning your work in suicide.
Rural areas.
Places like Montana have someof the highest suicide rates,
largely because there's so muchPTSD exposure and there's so few

(51:19):
clinicians available in those areas.

Yeah.
Interesting.
We're about out of time.
I'm wondering if there's any last thingshave come up that you'd like to share?

No, I think I'm a little talked out, but yeah,
no I, hopefully this was helpful.
I know it was a little, it

was great,

big journey here, but been around for a long time.
So

yeah.
This is really really great interview.
And I know we're getting tothe end of the day as well.
We're probably both a little tired.
So why don't we, why don't we wrapit up and just want to thank you
so much for being on the podcastand we can cut it off here.
Okay, great.

(52:06):
Thanks for tuning in.
If you want to interact aboutthe show or have suggestions, you
can find me on Twitter at JasonLuoma or on my Facebook page.
Links to all the resourcesmentioned in the show can be found
in the show notes at jasonluoma.
com slash researchmatters.
If you want to help out the show andencourage me to do more episodes,
then share the show on social media orsend it to your colleagues or friends.

(52:31):
Also, if you know an amazing researcheryou'd love to see interviewed, so
that we can learn more about howthey do it, please let me know.
Till next time, thanks for listening.

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