Community-Partnered Research Projects

Principal Investigators: Kristen Ochoa (DHS), Kenneth Wells (UCLA)

Our project assembles a partnership between UCLA and The Los Angeles County Department of Health Services in order to determine the outcomes of patients who utilize the psychiatric emergency service in Los Angeles County at Olive View-UCLA Medical Center, Harbor-UCLA Medical Center and LAC+USC Medical Center. The limited literature on patients using psychiatric emergency services suggests that they are a vulnerable, high risk population. This CTSI Pilot/Collaborative project employs a novel methodology for data linkage and integration across County and State datasets allowing us to follow a cohort of patients and track forensic, outpatient and inpatient outcomes as well as mortality. Results will enable the Department of Health Services to make efficient, data-driven and outcomes-based decisions regarding the disposition of patients from the Psychiatric Emergency Service, thereby improving both clinical care and productivity. This project also creates a new collaboration between the Department of Health Services and UCLA CTSI and a new area of investigation that, despite its importance and relevance within the changing healthcare environment, has not yet been explored by researchers nationally.

Additional Information

Presentations & Documents

• Presentation at 2014 American Public Health Association Annual Meeting
  Characteristics and Outcomes among Adult Psychiatric Emergency Services Patients in a Large Urban Safety Net Health System. Toktam Sadralodabai, PhD, Kristen Ochoa, MD, MPH, Vichuda Matthews, DrPH, Irene Dyer, MPH, MS, Anish Mahajan, MD, MPH.

• Findings from the LA County Psychiatric Emergency Services Outcomes Study – August 31, 2015
  Participant Recommendations from Community Forum
  Slides: Outcomes Among Psychiatric Emergency Services Patients in a Large Urban Safety-Net Health System

Principal Investigators: Katherine Butler (DPH), Raymond Perry (DHS), Tony Kuo (DPH), Lauren Gase (UCLA), and the Los Angeles County School Attendance Task Force Workgroup

School truancy is associated with a variety of negative behavioral and health consequences. In addition, health factors may contribute to why students miss school. This project aims to gain better understanding of the characteristics and needs of truant youth in order to identify opportunities for improving school attendance in Los Angeles County. The project focuses on three research questions: 1) What are the characteristics and needs (e.g., academic, social, health) of truant youth?; 2) How do youth who cut or skip class encounter different school- community- and law-enforcement based systems?; and 3) What programs and policies can help meet the needs of truant youth? To answer these questions, we conducted key informant interviews with representatives from schools, law-enforcement, and community based organizations; in-depth interviews with youth who have school attendance problems; and a review of evidence-based diversion programs and interventions.

Additional Information

Publications

• DeFosset A, Gase LN, Ijadi-Maghsoodi R, Kuo T.  Youth Descriptions of Mental Health Needs and Experiences with School- based Services: Identifying Ways to Meet the Needs of Underserved Adolescents. Journal of Health Care for Poor and Underserved, 28(3); 1191-1207.
• Lauren N. Gase, Katherine Butler, Tony Kuoa, The Los Angeles County School Attendance Task Force Workgroup.  The Current State of Truancy Reduction Programs and Opportunities for Enhancement in Los Angeles County.Children and Youth Services Review Volume 52, May 2015.
• Gase, L. N., DeFosset, A., Perry, R., & Kuo, T. (2016). Youths’ Perspectives on the Reasons Underlying School Truancy and Opportunities to Improve School Attendance. The Qualitative Report, 21(2), 299-320.

Principal Investigators: Kenny Kwong (DHS), Paul Fu (Lundquist/Harbor-UCLA)

Asthmatic children with frequent asthma exacerbations require preventative long term care to reduce morbidity, yet many of these patients belong to community health care organizations (HMOs) without a network/contracted pediatric emergency department (PED). This may result in no transition from costly acute to cost effective preventative care, poor disease control and leading patients to use the PED in “revolving door” fashion. It is unclear whether lack of transition from acute to chronic asthma care occurs between the PED at Harbor-UCLA Medical Center (HUMC) and out of network community HMOs and whether this leads to increased asthma morbidity. This current study compares pediatric asthma patients who receive regular asthma care at HUMC versus community HMOs with primary outcomes being asthma control, asthma PED visits, asthma hospitalizations, preventative provider visits and asthma controller prescriptions. Results will identify barriers to smooth transition of asthmatic care between 2 health care systems that can be targeted to improve care to asthmatic children.

Principal Investigators: Lauren Daskivich (DHS), Carol Mangione (UCLA)

Diabetic retinopathy (DR) is the leading cause of blindness among working-age Americans, and among Los Angeles Latinos—the ethnic majority of patients in the Los Angeles County (LAC) safety net—the prevalence of DR is ~50%. Despite evidence that early detection and treatment can prevent blindness from DR, a significant number of persons with diabetes in our system fail to receive annual screening examinations and/or sight-saving treatments due to lack of access to specialty care. To date, the effect of a system level intervention on improving access to eye care and definitive treatment for diabetic retinopathy in an urban medically underserved, or safety net, population has not been evaluated. The objective of this project is to evaluate the impact of teleretinal screening on access to specialty ophthalmic care for diabetic patients in LAC who need monitoring or treatment for diabetic retinopathy. We propose a pre-post analysis of the LAC teleretinal screening implementation, and we aim to evaluate the number of patients screened for diabetic retinopathy, the number presenting for timely ophthalmic follow-up care and treatment, and the cost of the program.

Additional Information

Publications

• Lauren P. Daskivich, Carolina Vasquez, Carlos Martinez Jr, Chi-Hong Tseng, PhD, Carol M. Mangione, MD, MSPH. Implementation and Evaluation of a Large-Scale Teleretinal Diabetic Retinopathy Screening Program in the Los Angeles County Department of Health Services. Journal of American Medicine Association, Internal Medicine. March 27, 2017.

Press

• A Simple Test is Helping Thousands of Diabetics in L.A. County Who Face an Increased Risk of Going Blind, LA Times, June 12, 2017.
• Large-scale Screenings for Diabetic Retinopathy Boost Exam Rates, Reduce Wait Times, UCLA Newsroom, April 17, 2017.

Presentations

• Teleretinal Screening for Diabetic Retinopathy
  LA County DHS Diabetes Day 2014
  Lauren Patty Daskivich, MD, MSHS: DHS Teleretinal Diabetic Retinopathy Screening Program: A Teachable Moment
  

Principal Investigators: Theodore Friedman (CDU), Jasmine Eugenio (DHS)

The overall objective of the study is to test the effect on body weight of attending a group weight loss program that serve an underserved population. The group setting is more likely to be successful than traditional physician patient encounters as it incorporates two crucial aspects of the patient’s health experience: the patient’s own effectiveness in managing medical problems together with his or her health care team, and the patient’s own community for support in integrating medical recommendations into his or her daily life. Our experience has found that the group setting is well received by patients and enhances access to care.

Additional Information

Presentations

• Endocrine Society's 97th Annual Meeting and Expo, March 5–8, 2015
  Obesity Group Visits: A New Approach for a Big Problem of Inner City Obesity
  Speakers: Adaku Ume, Petra Duran, Elizabeth Driscoll, Juan De La Cruz Mayhua, Cindy Nativi, Felicia Eugenio, Jasmine Eugenio and Theodore C Friedman
  

Press

• Group meetings turn doctor visits inside out, Los Angeles Times, September 17, 2013, p. 1
  
• Some doctors turning patient visits into group experience, Iowa Gazette, March 28, 2014 

Principal Investigators: Joshua Chodosh (UCLA) and Joseph Gaugler (University of Minnesota)

In the next decade Latinos will make up the largest racial/ethnic minority group among U.S. adults 65 years and older. However, Latino older adults face a number of challenges, including increased burden of chronic illness and limited access to health care. This extends to Alzheimer’s disease or related disorders; the prevalence of dementia among Latinos is potentially higher than in other racial/ethnic groups as symptom onset has been shown to occur six to seven years earlier in Latinos than in non-Latinos. The objective of this cross-institutional project is to ascertain the feasibility, acceptability, and utility of the Alzheimer’s Disease Coordinated Care for Hispanic and Latino seniors intervention (ADC-HL), a community-centered, dementia care management protocol designed to reduce caregiver burden as well as dementia-related symptoms (e.g., behavioral disturbances) in 15 persons with memory loss for Hispanic/Latino families in St. Paul, Minnesota. Innovative components of this project include a focus on dementia care in an underserved community, the use of mixed methods to collect and analyze a range of qualitative and quantitative process data, and reliance on an evidence-informed approach to build and refine a coordinated care management protocol for Hispanics/Latinos with dementia and their families.

Principal Investigators: Hector Rodriguez (UCLA) and William Riley (University of Minnesota)

Large-scale federal investments in health information technology (HIT) are intended to spur health care providers and organizations to share patient information to better coordinate and improve quality of care. However, the uptake of HIT has lagged in ambulatory care settings that care for high proportions of low-income patients. Our pilot study seeks to generate knowledge about facilitators and barriers to the spread of electronic health information exchange (HIE) for improving quality of care among underserved populations. We have established partnerships with two health care organizations: Citrus Valley Health Partners (CVHP), a provider network serving many underserved patients in the East San Gabriel Valley, Calf., and the Federally Qualified Health Center Urban Health Network (FUHN), a group of ten clinic organizations serving the Minneapolis-St. Paul area. We are conducting key informant interviews of physicians, front office staff, IT personnel, and executives. Through these interviews, we are learning about the barriers to electronic exchange of health information within the clinics and practices, between these sites, and at city-wide or regional levels. This multi-level framework elucidates the opportunities and challenges for ambulatory care practices serving underserved populations in adopting and sustaining HIT.

Additional Information

Publications

• McCullough JM1, Zimmerman FJ, Bell DS, Rodriguez HP. Electronic Health Information Exchange in Underserved Settings: Examining Initiatives in Small Physician Practices & Community Health Centers.

Principal Investigators: Francisco Ramos-Gomez (UCLA) and Robert Jones (University of Minnesota)

The overall goal of our study is to develop an integrated care plan that effectively addresses the shared risk factors of early childhood dental decay, early childhood cavities (ECC) and obesity. It encourages parents of disadvantaged and of minority backgrounds to adopt broad self-management goals and overall comprehensive health-promoting habits. There is a pressing need for community-based participatory early intervention approaches to prevent both early childhood dental decay and obesity at a younger age. Within the recent healthcare environment, oral health (dentistry) may play an important role within the whole community approach to obesity prevention as an entry point for discussing diet and nutrition early on. Some key reasons for the importance of oral health integration into obesity prevention is that children’s oral health diseases share key risk factors with early obesity. In our study, the Infant Oral health visit promotes dietary guidance early in childhood, and oral health promotion is done in a culturally manner, which we use to discuss other broad health-promoting habits. Our immediate goal utilizes a university and community-based team to improve the ability to predict future dental decay in children and integrate oral health risk assessment with broad health-promoting habits that may one day prevent obesity in the key early years of the child development.

Principal Investigators: Bowen Chung, Michael McCreary, Loretta Jones, Felicia Jones, James Gilmore, Elizabeth Dixon, Kenneth Wells, Susan Ettner and Michael Ong

  Click here to see the presentation.    Click here to see the supplement.

Community Partners: Healthy African American Families II, QueensCare Health and Faith Partnership 

This project will determine the cost of low- and high-intensity interventions for depression.  The project will also compare the costs of the interventions and determine whether they save money for the health system or society in general, since people who recover from chronic depression may require less public support because they will need to see a doctor less and will be able to work more.  The low-intensity approach is called Resources for Services. Under this approach, we give providers and agencies technical assistance on how to (1) screen for depression,  and (2) educate patients around depression and their treatment options, which include cognitive behavioral therapy and medication. We also train providers and agencies to deliver these treatments. The high-intensity approach is called Community Engagement and Planning, which calls for adapting depression-care materials to agency networks and providing intensive, in-person trainings, conferences and site visits.

Principal Investigators:Martin Shapiro

  Click here to see the presentation.

Community Partners: Healthy African American Families and St. John's Well Child and Family Centers

In this project, we will study a community-based intervention to improve blood pressure control among low-income adults. We will randomly divide participants into two groups: One group of volunteers will receive a home blood pressure monitor and payments for submitting to monthly blood pressure checks. Volunteers in the second group will receive a blood pressure monitor and a financial incentive for (1) using the monitor, (2) lowering their blood pressure, and (3) recording whether they have taken their medicine. The second group also receives an intervention that helps them identify things that are important in their lives and their reasons for staying healthy. 

Principal Investigators: Arleen Brown (UCLA), Loretta Jones (HAAF), Katherine Kahn (UCLA), D’Ann Morris (UCLA), Keith Norris (UCLA), and Roberto Vargas (UCLA)       

Click here to see the presentation.

Community Partners: Healthy African American Families (HAAF), Los Angeles Urban League

South Los Angeles, an area that is over 95% Latino and African American, has the highest rates of obesity (37%), hypertension (32%), and diabetes (11%) in Los Angeles County. In addition to preventable chronic disease, the community also has high rates of behavioral and social risk factors such as poor nutrition, smoking, low graduation rates, and high rates of unemployment.

In 2008, the HCNI partnership was formed to better understand and intervene upon health and social disparities in a low-income bi-ethnic community in South Los Angeles by designing and implementing a household survey including four components: consent form, adult interview, the health screening, and laboratory data collection. The partnership included the Los Angeles Urban League (LAUL), Healthy African American Families Phase II (HAAF II), Charles R. Drew University (CDU), and the University of California Los Angeles (UCLA).  Two more academic institutions—Cedars-Sinai Medical Center and Lundquist/Harbor-UCLA Medical Center—joined the partnership when the UCLA Clinical and Translational Science Institute (CTSI) was funded in 2011.

The HCNI uses Community Partnered Participatory Research (CPPR) to achieve the following three aims: 1) understand clinical and social factors that might be intervened upon to influence health outcomes in this South LA community; 2) examine patterns of chronic condition disease prevalence and the relationship between clinical and social outcomes; and 3) engage community residents, agency representatives, and other stakeholders in collaborative data analysis, interpretation, and dissemination in order to set priorities for future intervention development.

Additional Information

Study Documents

• HCNI Consent Form
  
• Consent Form FAQs/Fact Sheet
  

Publications

• Brown, AF, Morris, DM, Kahn, KL, Sankar?, IC, King, KM et al. (2016) The Healthy Community Neighborhood Initiative: Rationale and Design. Ethn Dis. 2016 Jan 21;26(1):123-32.
  
• Sankar?, IC, Bross, R, Brown, AF, del Pino, HE, Morris, DM et al. (2015) Strategies to Build Trust and Recruit African American and Latino Community Residents for Health Research: A Cohort Study. Clin Transl Sci. 2015 Oct;8(5):412-20.
• King, KM, Morris, D, Jones, L, Lucas-Wright, A, Jones, F et al. (2015) The Los Angeles Healthy Community Neighborhood Initiative: A Ten Year Experience in Building and Sustaining a Successful Community-Academic Partnership. J Community Med Public Health Care 2: 007.
  

Posters

• The Design of the HCNI: A Community Partnered Approach to CVD Risk Factor Reduction in South Los Angeles. NIMHD Summit, National Harbor, MD. December 17-19, 2012
• Willingness to Share Specimens and Data in a Sample of Participants Using Partnered Approaches. ACTS Meeting, Washington, DC. April 9-11, 2014

Good News Radio Magazine Programs Highlighting HCNI

• Family Well Being and The HCNI Study Project: Pastor Brian Johnson, Karina Madrigal, Ibrahima Sankare
  Wednesday, February 20, 2013. Visit the website to download the program.
• HCNI Study: Why Minority Participation in Research is Important.: Felica Jones, D'Ann Morris, Joyce Sales
  Wednesday, March 13, 2013. Visit the website to download the program.

Principal Investigators: Alex Ortega, Michael Prelip and Deborah Glik 

Community Partner: Volunteers of East Los Angeles (VELA) 

  Click here to see the presentation.

This project provides technical assistance and training on survey methods, human subjects and research ethics, survey data collection and quality control to community members so they can conduct professional-level interviews of corner store patrons. The Corner Store Grocery Project seeks to improve the availability of healthy foods in East LA and Boyle Heights, Latino communities with large populations of new immigrants and a dearth of supermarkets. 

Additional Information

Press Releases

• UCLA helping to change the way a community eats, one store at a time.

Principal Investigators: Nina Harawa (Charles R. Drew University, UCLA) and Charles Hilliard (Charles R. Drew University)

Community Partner: Spectrum Community Services and Research

  Click here to see the presentation.

The purpose of this project is to better understand the post-incarceration  needs and resources of HIV+ former prisoners. This population has a poor history of remaining in medical care, resulting in increased viral load, morbidity and disease transmission risk.  We have analyzed records of 363 Spectrum case management clients, developed a focus group discussion interview guide and recruitment tools, and received IRB approval to conduct focus groups. 

Additional Information

Publications

• Facilitators of HIV Medical Care Engagement Among Former Prisoners. Bracken N1, Hilliard C1, McCuller WJ1, Harawa NT.

Principal Investigators: Moira Inkelas, Lila Guirguis, Alex Morales and Patricia Bowie

Community Partner: Magnolia Place Initiative

  Click here to see the presentation.

The Magnolia Place Initiative is a collaboration of faith-based and community groups within a 500-block portion of Los Angeles that crosses Pico Union, West Adams and the North Figueroa Corridor, west of downtown. This project used smartphones to help a group of Magnolia Place residents record images and information from their neighborhoods  in ways that may contribute to meaningful change while building community capacity for  research. We developed a "Holiday Campaign" around Halloween, which involved taking snapshots and mapping the observations, and created a rating scale for measuring holiday spirit. We also wrote a Spanish-language guide for the project.

Additional Information

Websites

• Magnolia Place Website
• UCLA Project Highlights: Magnolia Place Project

Principal Investigators: David Zingmond, Jerry Kominski and Ami M. Shah

  Click here to see the presentation. 

Using a variety of public data sources, we calculated the disease burden of six major clinical areas—heart disease, diabetes, pulmonary disease, cancer, HIV/AIDS and mental health—for the eight service planning areas and 26 health districts within Los Angeles County. The purpose of the project is to quantify disease "hot spots" within Los Angeles County and share our results with community stakeholders, policy makers and researchers so the data may be used to shape the design and implementation of community-driven initiatives.

Additional Information

Publications

• Los Angeles County Health Profile: UCLA CTSI (June 2015). Authors: Ying-Ying Meng, David Zingmond, Melissa C. Pickett, Ami Shah, Tamanna Rahman.
• Los Angeles County Health Profile: UCLA CTSI (June 2013). Data Sub-Committee One-Year Report. Authors: David Zingmond, MD, PhD, Ami M. Shah, MPH, E. Richard Brown, PhD, Gerald Kominski, PhD.

Principal Investigators: Moira Inkelas, Terry Silberman, Mary Wang and Shannon Whaley 

Community Partner: Los Angeles County Women, Infants and Children supplemental nutrition programs 

  Click here to see the presentation.

Los Angeles County Women, Infants and Children (LAC WIC) programs provide supplemental nutrition, health care referrals and nutrition education for low-income pregnant women or women with children under age 5 who are at nutritional risk. Although LAC WIC programs are often approached with research requests,  they do not have a strategic plan to vet, manage or optimize in-house research. This project will create a strategic plan that will provide guidelines and tools to facilitate research of interest to LAC WIC leaders, participants, staff and academics.

Principal Investigators: Geraldo Moreno, Carol Mangione, Mignon Moore, Laura Trejo, Ivy Lee, Carmen Reyes and Catherine Sarkisian 

Community Partners: Los Angeles Community Academic Partnership for Research on Aging and Los Angeles City Department on Aging 

  Click here to see the presentation. 

This study will examine the barriers that prevent minority elders from participating in research, particularly those studies that involve collection of biomarkers. Minority elders face health disparities but are underrepresented in research. As a consequence, research results are potentially non-generalizable to older, minority adults. 

Principal Investigators: Marie Mayan-Cho, Miriam Hernandez and Laurie Shaker-Irwin

Community Partners: Providence Access to Care/Health Education Outreach and Providence Latino Health Promoter Program 

  Click here to see the presentation.

This study will develop a toolkit to assist investigators with employing and utilizing the skills of community health workers, or promotoras, to encourage participation of underserved ethnic and minority populations in research.

Principal Investigators: Lark Galloway-Gilliam, Annie Park, Jessica Jew, Ami M. Shah, Nina Vaccaro and Roberto Vargas

Community Partners: Community Health Councils and South Coalition of Community Health Centers

  Click here to see the presentation.

This study aims to improve access to quality care and reduce poor health outcomes associated with cardiovascular disease generally and congestive heart failure in particular. The study will review public health data and conduct statistical analyses to understand factors related to excess hospitalization and death from heart disease in South Los Angeles. The findings will be used to inform prevention, early detection and treatment interventions.

Principal Investigators: Beth Glenn, Hector Rodriguez and Roshan Bastani

Community Partners: Building Clinic Capacity for Quality, a program of Community Partners 

  Click here to see the presentation.

This project will develop an electronic prototype for collecting information from patients about health behaviors, including physical activity, stress, anxiety, depression and tobacco use. The study will involved four safety-net clinics to address the infrequent and inconsistent assessment of behavioral risk factors in primary care.

Principal Investigators: Barbara Vickery, Eric Cheng, William Cunningham, Susan Ettner, Honglu Liu, Brian Mittman, Amytis Towfighi, Lillie Hudson, Nerses Sanossian, Tom Anderson, Robert Bryg, Jeff Guterman and Sandra Gross-Schulman 

Community Partners:  Healthy African American Families II, Partners in Care Foundation and Watts Labor Community Action Committee

  Click here to see the presentation.

This study, which is also funded by the American Heart Association, will assess whether lifestyle group clinics, care managers and support from community health workers may reduce the risk of a second stroke in socioeconomically disadvantaged minority patients.

Principal Investigators: Bowen Chung, Jeanne Miranda

Community Partners:  Healthy African American Families II, Health Services and Society, First African Presbyterian Church, California Community Foundation

 Click here to see the presentation.

This project, Building Resiliency and Increasing Community Hope (B-RICH) proposes to pilot and then
conduct a randomized, single blind trial of a psychosocial intervention called a “Resiliency Class” (RC), to provide depression education and health promotion to individuals with depressive symptoms, by training non- professionals to offer this class to clients receiving services within diverse community settings (e.g. health care clinic, church, community advocacy organization, social services agency).  This class is not designed to be therapy, but rather is designed as a class that is informed on cognitive behavioral therapy (CBT) principles used to address depressive symptoms, on how to improve mood, and to enhance resiliency in the face of stress.

Principal Investigators: Eric S. Daar, Katya Calvo and Deborah Collins

Community Partner:  Long Beach Department of Health and Human Services

 Click here to see the presentation.

This study, which also involves collaborations with USC and UC San Diego, in addition to the Long Beach Department of Health and Human Services,  is focused on linking people with HIV infection, or a high risk of HIV infection, to clinical care.Participants will be randomly assigned to receive treatment (for infected individuals) or prophylaxis (for at-risk individuals) with or without an intervention designed to improve adherence. The study will also evaluate incentive-based social network recruitment for HIV testing of high-risk individuals. There will be a special emphasis on African Americans who as a group are disproportionately unaware of their HIV infection status.