Stephen Schueller co-designed a new study on how to better deliver mental health services via a digital platform to a Latino population with limited English proficiency. Photo by Han Parker
UCI, UCB and UCSF researchers aim to enhance use of digital interventions
The National Institutes of Health is awarding nearly $4.7 million over five years to support research teams from University of California campuses in Irvine, Berkeley and San Francisco who are collaborating on a new project that will combine peer support with the use of a digital platform to better serve the mental health needs of Latino patients with limited English proficiency.
Evidence-based digital health interventions, such as those that leverage internet and mobile technologies, can increase access in low-resource settings by removing barriers like costs, transportation and appointment scheduling. Improved accessibility can enhance equity in mental health services for traditionally underserved populations. The researchers hypothesize that complementing existing digital interventions with peer support will boost scalability and sustainability and help counterbalance mental health workforce shortages, a reality particularly prevalent in the Latino community.
“We do not have enough mental health providers to treat those in need, period. We are grossly underrepresented in terms of Spanish-speaking providers, especially in comparison with the population of Spanish-speaking people seeking mental health care in California. We need a better portfolio of options to provide care and increase equity in care,” said Stephen Schueller, associate professor of psychological science and one of the project’s co-designers. A recent report found that in California only 5 percent of psychiatrists, 9 percent of psychologists and 28 percent of social workers are Latino, which is highly disproportionate to the population.
The name of the new study is Support From Peers to Expand Access, and the acronym SUPERA is the Spanish word for “overcomes.” The researchers will evaluate the implementation of an evidence-based, Spanish-language, digital, cognitive-behavioral therapy intervention (SilverCloud) in primary care settings for Latino patients with depression and/or anxiety. Primary care is the de facto treatment setting for these common mental health problems, and as demonstrated previously, Latino patients tend to prefer this to referral to special mental health services.
SUPERA will simultaneously assess the most effective ways to integrate SilverCloud into primary care settings and how to best support patients using the digital tool so that they get the most out of it. The researchers will examine implementation strategies at the provider level by comparing the efficacy of traditional provider referrals with the use of a clinic patient registry to identify candidates who could benefit from a digital mental health intervention. At the patient level, the researchers will contrast the effectiveness of two modes of delivery of the platform: self-guided v. peer-supported by community health workers from the Latino community, known in this project as promotores.
Schueller noted that it’s usually best to have some form of human support available with digital interventions. Promotores will check in with patients and make sure they understand the digital lessons, but they will not provide supplemental therapy. The researchers are enthused to measure how promotores might help patients navigate multiple cultural variables. “Although the digital program is linguistically tailored and culturally tailored, we hear from Spanish speakers – and other non-English-speaking populations that use these tools – that there are a lot of places where the adaptations and the cultural pieces don’t really land right. We’re hoping that the promotores will be able to provide the wraparound cultural expertise to make this intervention more effective for this specific population,” Schueller said.
His team at UCI will evaluate and analyze data and manage relationships with the technology vendor. Clinical recruitment, cultural adaptation and patient analysis will happen in primary care clinics at the Zuckerberg San Francisco General Hospital under the direction of Adrian Aguilera, co-designer of SUPERA and associate professor in UC Berkeley’s School of Social Welfare and UC San Francisco’s Department of Psychiatry and Behavioral Sciences.
He said: “I’m excited to test a promising program and implementation strategies that will address the pressing need for linguistically appropriate services for Spanish speakers. We recognize the importance of testing this approach in clinic settings that have a long history of serving this population and have the trust of community members. While we desperately need more Spanish-speaking providers, digital tools in Spanish can also provide an essential resource.”
Schueller and Aguilera first crossed paths doing postdoctoral research at the Zuckerberg San Francisco General Hospital under the guidance of shared mentor Ricardo Muñoz, UCSF professor emeritus of psychology. Muñoz’s groundbreaking work in depression treatment and prevention started in the 1970s and continued for four decades. The SUPERA team members, Schueller said, feel like they’re continuing his legacy of innovation.