Jessica Wolf , UCLA
Based on a promising pilot program that screens for and treats depression in college students, researchers and faculty with UCLA’s Depression Grand Challenge have received a five-year, $12 million grant from the National Institute of Mental Health to increase the reach of their efforts.
The funding will enable the UCLA Depression Grand Challenge team to refine and expand the care program known as STAND, or Screening and Treatment for Anxiety and Depression.
The highly competitive federal funding supports the establishment of a campus research center under the National Institute of Mental Health’s program called Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness, or ALACRITY.
The ALACRITY center at UCLA will focus on optimizing STAND for community colleges and support related research topics such as pairing patients with treatment that takes into account a patient’s social and environmental factors alongside their symptoms while exploring innovative ways to use data when screening for and treating anxiety and depression. The grant will support other projects that are designed to tackle reducing barriers to seeking care in Latino communities, as well as a broad analysis of mental health services and needs at 10 community colleges in California.
“The recent marked rise in depression and mental health disorders is among the most vexing challenges facing society today,” UCLA Chancellor Gene Block said. “I am grateful that this federal funding will help UCLA continue to play a leadership role in addressing the mental health crisis through the expansion of STAND and other projects.”
Michelle Craske serves as co-director of both 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 optimize STAND through personalization tools and facilitate expansion of its reach across community colleges statewide, and ultimately nationwide,” Craske said. “And we are committed to better understanding and responding to the social determinants of mental health.”
How the program works
STAND launched in a pilot phase with UCLA students in 2017. Craske leveraged a variety of evidence-based practices to build an all-in-one, opt-in system that provides screening, prevention, digital online treatment support with coaches, or in-person care with clinicians for students based on survey answers about anxiety, depression and suicidality.
Based on data and experiences from that 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 spring 2021.
Using their responses to specific questions about mental health symptoms, participants are triaged to one of three different tiers 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 mental health care.
The three STAND treatment tiers are:
Wellness: Students with no symptoms are guided to the wellness tier, which, through a self-paced, online curriculum teaches participants skills for coping with common stressful experiences.
Online Cognitive Behavioral Strategies Paired with Coaching: Students exhibiting symptoms consistent with a range of anxiety and depression severity are guided to a UCLA-created program, which includes online interventions that provide evidence-based cognitive behavioral strategies responsive to the needs (symptoms) of each person. A student using this online tool is paired with a certified student coach who provides support through remote video chat.
Clinical Care: Students with severe depression or suicidal ideation are guided to the clinical care program, through which licensed providers provide evidence-based psychotherapies and medication.
Weekly assessments help inform when students need a bit of 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 strain, housing and food insecurity.
“The way I conceptualize it really is that there is there is a life continuum we are all on,” she said. “We all go up and down and our needs are going to be different at different times.”
Plans build on a 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 the DMH + UCLA Public Partnership for Wellbeing. The Los Angeles County Department of Mental Health is the largest county mental health agency in the country.
“Early intervention for young adults experiencing mental health issues is critical and meaningful, especially since the 18-25 age is usually when issues of anxiety and depression begin to 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. “Also, students at community college frequently experience high levels of stress such as financial and housing strain or food insecurity, all of which can impact mental well-being. We are looking forward to continued collaboration with UCLA as we create we a more holistic system for meeting the changing needs of young adults.”
UCLA selected 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 Latino community. Previous research shows that adoption of mental health services is historically low in these communities, Craske said, something that the new grant will also help address.
As part of the new ALACRITY center funding, UCLA professor of psychology Denise Chavira is undertaking a series of qualitative focus groups to better understand what prevents people, especially those from Latino communities, from reaching out for mental health care. She plans to develop community informed and culturally responsive strategies such as video testimonials and digital fotonovelas, to destigmatize the issue and generate interest in student participation.
Using data to inform care
The ALACRITY signature study will run in five cohorts of about 200 students each year, with the first cohort beginning this fall. Students participating in STAND at East Los Angeles College are invited to opt-in to the study. Researchers will check in weekly with participants over the course of the school year and include screenings for substance abuse and psychosis, as well as capturing broad demographic information on other factors in students’ lives, such as medical and family histories and also 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 what tiers of care students receive.
Co-director of the ALACRITY center is Kate Wolitzky-Taylor, associate professor in the department of psychiatry and biobehavioral sciences.
“This signature project is essentially comparing our typical model of care in which we triage people based on symptom severity to what we think will be 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,” Wolitzky-Taylor said.
With the bigger 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, evaluating existing mental health service options alongside data from the annual Healthy Minds Survey. Eisenberg leads the survey, which examines mental health, service utilization, 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 make the case for more mental health funding and provide a demonstrated treatment model that can be used with already promised funds, Craske said.