Key points to remember:
- The partnership with Los Angeles County connects UCLA’s expertise where it’s needed.
- East Los Angeles College’s program could be a model for continued growth throughout California.
- Related research will focus on how to reduce the stigma surrounding mental health care in Latin American communities.
Based on a promising pilot program that screens for and treats depression in college students, UCLA Depression Grand Challenge researchers and faculty have received a five-year, $12 million grant from the National Institute for mental health to increase the reach of their efforts.
The funding will allow the UCLA Depression Grand Challenge team to refine and expand the program of care known as STAND, or Screening and Treatment for Anxiety and Depression.
Highly competitive federal funding is supporting the establishment of an on-campus research center as part of the National Institute of Mental Health program called Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness, or ALACRITY.
UCLA’s ALACRITY Center will focus on optimizing STAND for community colleges and support related research topics such as matching patients with treatment that takes into account a patient’s social and environmental factors as well as their symptoms while exploring innovative ways to use data when screening for and treating anxiety. and depression. The grant will support other projects designed to reduce barriers to care-seeking in Latin American communities, as well as a broad analysis of mental health services and needs at 10 California community colleges.
“The recent marked increase in depression and mental health disorders is one of the thorniest challenges facing society today,” said UCLA Chancellor Gene Block. “I am grateful that this federal funding helps UCLA continue to play a leadership role in addressing the mental health crisis through the expansion of STAND and other projects.”
Michelle Craske is co-director of the ALACRITY center and the Depression Grand Challenge. She is a Distinguished Professor in the Departments of Psychology and Psychiatry and Biobehavioral Sciences at UCLA.
“Our long-term goal is to leverage STAND through customization tools and facilitate the expansion of its reach into community colleges statewide, and ultimately nationwide,” said Craske. “And we are committed to better understanding and responding to the social determinants of mental health. »
How the program works
STAND was launched in a pilot phase with UCLA students in 2017. Craske leveraged a variety of evidence-based practices to create an all-in-one, opt-in system that provides screening, prevention, digital treatment support online with coaches or personal care with clinicians for students based on survey responses on anxiety, depression and suicidal tendencies.
Based on the data and experiences from this first iteration, the Depression Grand Challenge team created a new platform and custom treatment materials. With funding and partnership from the Los Angeles County Department of Mental Health, the Depression Grand Challenge team was able to deploy STAND at East Los Angeles College in the spring of 2021.
Using their answers to specific questions about mental health symptoms, participants are triaged into one of three different levels of care. The STAND system includes a rigorous training and certification program for peer coaches created by the Depression Grand Challenge team. Once certified, student coaches at East Los Angeles College are offered paid hands-on experience in the field of mental health care.
The three levels of STAND processing are:
- The well-being: Students with no symptoms are guided to the level of well-being which, through a self-paced online program, teaches participants the skills to cope with common stressful experiences.
- Online cognitive-behavioral strategies paired with coaching: Students with symptoms consistent with a range of anxiety and depression severity are guided through a program created by UCLA, which includes online interventions that provide evidence-based cognitive-behavioral strategies that meet needs ( symptoms) of each person. A student using this online tool is matched with a certified student coach who provides remote video chat support.
- Clinical care: Students with severe depression or suicidal ideation are guided into the clinical care program, through which licensed providers provide evidence-based psychotherapies and medications.
Weekly assessments help indicate when students need a little extra help or a different level of care, Craske said. The team includes a social worker who can help students navigate available programs that help with financial hardship, housing, and food insecurity.
“The way I really conceptualize it is that there’s a continuum of life that we’re all on,” she said. “We all go up and down and our needs are going to be different at different times.”
Plans build on partnership with Los Angeles County
The STAND at East Los Angeles College demonstration project is part of a larger partnership between UCLA and the Los Angeles County Department of Mental Health launched in 2019 called DMH + UCLA Public Partnership for Wellbeing. The Los Angeles County Department of Mental Health is the nation’s largest county mental health agency.
“Early intervention for young adults struggling with mental health issues is essential and meaningful, especially since the age of 18 to 25 is usually when anxiety and depression issues begin to set in. emerge, and community colleges generally don’t have as many mental health resources as other institutions,” said Curley Bonds, chief medical officer for the Los Angeles County Department of Mental Health. Community college students frequently experience high levels of stress, such as financial and housing difficulties or food insecurity, all of which can impact mental well-being.We look forward to continuing our collaboration with UCLA as we are creating a more holistic system to meet the changing needs of young adults.
UCLA chose East Los Angeles College as a pilot site for these reasons, and the Depression Grand Challenge team has committed to screening approximately 1,500 students per year through STAND.
East Los Angeles College also serves a predominantly Latin American community. Previous research shows that uptake of mental health services is historically low in these communities, Craske said, which the new grant will also help address.
As part of new funding for the ALACRITY Center, Denise Chavira, professor of psychology at UCLA, is undertaking a series of qualitative focus groups to better understand what stops people, especially those in Latino communities, from seeking health care. Mental Health. She plans to develop community-informed and culturally appropriate strategies, such as video testimonials and digital fotonovelas, to de-stigmatize the issue and generate interest in student participation.
Using data to inform care
The ALACRITY Signature Study will run in five cohorts of approximately 200 students each year, with the first cohort beginning this fall. Students participating in STAND at East Los Angeles College are encouraged to enroll in the study. Researchers will check on participants weekly throughout the school year and include substance abuse and psychosis screenings, as well as collecting broad demographic information about other factors in students’ lives, such as backgrounds. medical and family, as well as other life stressors such as trauma or food and housing insecurity. All of this informs an algorithm that will be tested in the study and potentially used to select and modify the levels of care students receive.
The co-director of the ALACRITY center is Kate Wolitzky-Taylor, associate professor in the department of psychiatry and biobehavioral sciences.
“This flagship project essentially compares our typical model of care where we triage people based on symptom severity to what we believe is a more sophisticated, data-driven algorithm that takes into account other important variables such as early life adversity, experiences with discrimination, access to social support and other stressors,” said Wolitzky-Taylor.
With the big picture in mind, Daniel Eisenberg, professor of health policy and management at the UCLA Fielding School of Public Health, will lead a research effort for the ALACRITY center that spans 10 community colleges, assessing existing mental health service options alongside data from the Annual Mental Health Survey. Eisenberg leads the survey, which examines mental health, service use and related issues among undergraduate and graduate students.
The goal is to provide a broad needs analysis that will help community college and university leaders across the state to advocate for increased mental health funding and provide a demonstrated model of treatment that can be used with funds already pledged, Craske said.