Our partnership began with a series of conversations and pilot studies conducted several years before receipt of IP-RISP funding. In 2002, Northwestern Human Services (NHS) approached intervention and services researchers at the University of Pennsylvania (Penn) Center for Psychotherapy Research about developing a collaboration focused on the implementation of evidence based interventions and outcome assessment practices within one of its subsidiaries—Northwestern Human Services of Philadelphia (NHSP). A nonprofit, publicly funded community behavioral health care organization, NHSP provides a variety of programs (e.g., adult and child outpatient psychotherapy, day treatment programs, drug and alcohol programs) to more than 5,700 consumers at 3 locations throughout the city. The consumer population is diverse, with 69% ethnic minorities, 63% single, and 30% having fewer than 12 years of education. The majority of consumers receive some form of public assistance as well as Medicaid for medical and behavioral health services. Nearly 60% of of NHSP adult consumers have received a diagnosis of a mood disorder, and 21% have received a diagnosis of major depressive disorder. The researchers from Penn have extensive experience conducting studies on treatments for major depressive disorder and substance abuse as well as on psychotherapy process and training. In 2006, after 4 years of planning and collaboration on preliminary projects and feasibility research, Penn and NHSP applied for and received a 5-year IP-RISP grant to build collaborative capacity to conduct research on treatments for depression.
The NHSP and Penn have been equal partners in the development of the research agenda, budget, and proposals for funding. Core members of the IP-RISP partnership include NHS’s regional director of practice development, directors of outpatient services, intake directors, an NHSP director, a clinician, 4 Penn researchers, and 2 support staff. Additional individuals from a variety of positions and perspectives have participated in our planning meetings, on the advisory board, and on subcommittees. Decisions regarding research topics, study design, and implementation are made through consensus. For example, in identifying major depressive disorder as the central focus of the grant, we considered common consumer diagnoses, NHSP’s interest in new assessment and treatment procedures, and researchers’ backgrounds.
Because a partnership of this nature requires a bidirectional flow of information and ideas, we sought opportunities for direct contact between the core IP-RISP partners and a broad group of NHSP personnel and consumers. Although an NHSP clinician has served on the executive committee since the partnership began, additional clinician involvement and input has been essential given the large number of clinicians at NHSP. Because of the size of NHSP, busy clinical schedules, and clinician turnover, a variety of measures have been necessary to keep clinicians informed about ongoing projects, solicit their input, and facilitate referrals for ongoing research.5
Discussion and formal presentations about research projects and findings have been included in monthly clinical meetings. We also formed ad hoc committees to address specific aspects of upcoming studies, and had informal conversations (e.g., time in between appointments) about IP-RISP initiatives. When recruiting therapists for pilot psychotherapy studies, we place informational flyers in clinicians’ mailboxes, and the outpatient director follows up with discussion of the project at staff meetings. A research assistant (RA) orients new clinicians and staff to the IP-RISP to make them aware of research projects and procedures. Her availability allows clinicians and staff to provide input, share ideas, or ask questions at their convenience. To date, clinicians have contributed to and played a role in IP-RISP activities as standing members of the advisory board, through one-time participation in ad hoc advisory meetings, by making suggestions, responding to surveys, referring clients, serving as study therapists, and collaborating on research projects.
Recruitment of consumer members to the advisory board has been challenging. Calls for consumer participation have been made through the quarterly newsletter that is distributed throughout the agency, signs in the waiting rooms, and clinician outreach to their consumers. Despite offers to compensate consumers for their time and transportation, volunteers have not been forthcoming. Some potentially interested consumers were not able to commit to longer term involvement because of practical considerations such as childcare, work, or family obligations. Many depressed consumers who seek treatment for depression do not continue in longer term treatment,6
and others struggle with symptoms such as lack of motivation or levels of impairment that limit their ability to make a commitment to the IP-RISP. The IR-RISP studies have focused on consumers who typically attend therapy once a week, and the level of engagement and investment in the agency may be lower among this consumer population than among consumers who participate in more intensive outpatient programs. Some consumers who were identified as potential advisory committee members were clients of clinicians who served on the IP-RISP committees. Thus, their participation would have introduced additional challenges related to dual relationships. In sum, these obstacles made it difficult to receive input from a standing committee of representative consumers.
As we sought consumer collaborators, other more familiar and accessible approaches to solicit consumer input were needed. We have tried to find ways to solicit suggestions and feedback in ways that require less of a commitment on the part of the consumer and that have been outside the scope of formal research projects. For instance, consumers have been willing and able to meet with us for one-time discussions, even if they could not commit to longer term involvement. During the design phase of some studies associated with the IP-RISP, we discussed ideas and procedures with consumers to assess interest, satisfaction with the proposed study, or the “user friendliness” of the procedures. We have also sought their opinions and feedback within the context of research projects. Over time, as a result of this contact with consumers, we have noticed increased communication between IP-RISP personnel and consumers. Now that the IP-RISP activities and personnel are more familiar, consumers have started to recognize us, share ideas, and express interest in research activities.
The strategies employed to date have afforded increased communication and built trusting relationships between a large number of clinicians, consumers and other members of the IP-RISP partnership. We continue to grapple with the best way to promote consumer involvement within the partnership. We have been encouraged by an increase in informal contact between research personnel and consumers. Less formal contact may be more comfortable and feasible for many consumers, and IP-RISP personnel have become increasingly accessible for such conversations. However, we also believe that ongoing collaboration with consumers requires more of a stable and consistent consumer presence in the partnership. It is our hope that, as consumers have the opportunity to become familiar and comfortable with the IP-RISP initiatives and core personnel, recruitment of consumer advisors through direct contact and outreach will be more fruitful.