This career development award seeks to prepare the candidate for a career as a mental health intervention and implementation researcher who adapts and packages evidence-based practices (EBPs) to be accessible, acceptable, and sustainable in rural communities. Rural Americans experience depression at rates similar to their urban peers; yet are significantly less likely to receive treatment. Substantial barriers, including a lack of mental health professionals, cost, travel burden, stigma and preference for informal care, contribute to this disparity. Research is necessary to adapt and implement EBPs for depression in ways that reduce known barriers, align with rural residents' help-seeking preferences, and build internal capacity to delivery EBPs within rural communities. The proposed training goals and mentored research activities will prepare the candidate to bridge the gap between research and practice by successfully adapting and implementing EPBs in usual care settings. The candidate seeks to (1) develop expertise in implementation science and research to enhance her ability to integrate EBPs into usual care settings; (2) enhance her knowledge of community-based participatory research (CPBR) methods as they relate to adapting and implementing interventions with the best chance for acceptability and sustainbility in non-mental health settings; (3) increase her knowledge and skills in intervention development, randomized controlled trial designs, and quantitative analytic techniques; and (4) build upon her clinical background to enhance her expertise with cognitive behavioral therapy (CBT) for depression and anxiety through focused training supporting her ability to adapt CBT while retaining core components, train and supervise non-mental health professionals delivering interventions, and assess fidelity of adapted interventions. All career development goals are infused with relevant rural-focused content. The goals will be achieved through a rigorous training plan that includes coursework at the University of Michigan's (UM) top-ranked Schools of Social Work, Public Health, and Medicine; targeted off-site training and attendance at national conferences; state-of-the-art clinical training through UM Department of Psychiatry and the Beck Institute; as well as outstanding mentorship from leaders in mental health intervention and implementation research; depression and anxiety; and cognitive behavioral therapy (CBT). Training goals are further supported by mentored research activities facilitated by UM's resource rich scientific environment. The proposed research, informed by the Replicating Effective Programs framework (REP) and CBPR, seeks to (1) adapt and package group CBT for depression for implementation in the rural church setting, and conduct an open pilot test of the adapted intervention; (2) conduct a pilot randomized controlled trial (pRCT) to assess the intervention's preliminary effect on depression and explore the relationship between potential mechanisms of change and expected outcomes; and (3) explore intervention acceptability and feasibility using mixed methods to assess multiple stakeholders perceptions of the intervention and its implementation.
Rural Americans have faced decades-long disparities in access to mental health treatment and are significantly less likely to receive evidence-based care compared to urban peers. The lack of infrastructure and mental health professionals in rural areas requires consideration of ways to deliver evidence-based treatment within non-mental health settings to increase accessibility, acceptability, and sustainability of needed care. Adapting and packaging evidence-based practices in a context-specific way by incorporating rural residents' perspectives and treatment preferences, reducing practical barriers such as transportation and cost, and collaborating with informal providers within the de facto mental health system, has the potential to make an large impact by increasing access to care and ultimately improving the lives of rural residents with depression.
