Nov. 1, 2019 – I can hardly believe today was one of my last Patrick’s Passport visit to the Plaza! I’ve met countless fantastic teams here, and today’s group — Child and Adolescent Services Research Center — was no exception. This 30-year-old collaborative of more than 100 researchers and employees unites experts from Rady Children’s, UC San Diego and San Diego State University — the main partners — as well as institutions such as University of San Diego and University of Southern California. Their focus is on optimizing high-quality and effective youth and family behavioral health programs, with an emphasis on developing, implementing and improving community-based services. They are also a major hub for training graduate students, postdocs and fellows.
My guide for the tour was Dr. Mary Baker, CASRC’s operations director. She met me at the head of a winding pathway of individual organization and institution logos, which she introduced as the “Pathway of Partners.” This route would take me all along my journey, and would give me an idea of the myriad organizations CASRC works with to innovate behavioral health models and services — here in San Diego County, throughout California, across the country and even around the world! The impressive list spanned everyone from our own Chadwick Center and Autism Discovery Institute, to the California Health and Human Services Agency and First Five California, to the National Institutes of Health and beyond. No research is conducted onsite at Rady Children’s; rather, it happens in the field with CASRC’s partners. “We don’t do anything without partners,” Dr. Baker said. “That’s how we start every study. We connect with the community.” As we made our way to our first stop, I also learned a bit about the CASRC structure. Because of its collaborative nature, even researchers and team members who have offices at the Plaza are not necessarily Rady Children’s employees. In fact, Dr. Baker is actually one of just two Rady Children’s research scientists (the other is Dr. Andrea Hazen).
I then met with Dr. Greg Aarons, CASRC’s scientific director, and Dr. Lauren Brookman-Frazee, CASRC’s associate director. We dove into the center’s history, dating back to 1989, when SDSU researchers identified a need for mental health care within the child welfare system, and a standardized service model for said care. Between 1994 and 2005, CASRC was in a major growth period, and was focusing on areas such as parent-mediated behavioral health interventions and multisector service models. From 2005 forward, the center has been leveraging its established strength in implementation science (essentially, studying innovative ways to integrate evidence-based practices into new or enhanced care models, and then supporting their acceptance and use within a health care or public health sector) to disseminate EBPs and related programs addressing important issues such as disparate access to behavioral health care for minority populations. Dr. Aarons and Dr. Brookman-Frazee both spoke to CASRC’s great sense of community, teamwork and synergy, which plays out particularly well in this office. Dr. Aarons referenced the frequency of “hallway collaboration” among colleagues — casual chats that turn into great new ideas. Love that!
Next, Dr. Baker and I moved on to see a research group session in action. These gatherings bring together project stakeholders such as researchers, care providers and service recipients to discuss important topics including status, milestones, next steps, outcomes and future recommendations. Today, the discussion centered on one key question: how do we keep young adults on the autism spectrum using “success moves;” or cognitive, behavioral and social tools that can be used in day-to-day life and in the workplace; after they initially learn them? I was designated as session leader, but I used my authority to ensure I listened and learned! I found out that young people hone these skills through CASRC-developed programs offered in high school, college and vocational rehabilitation settings, and a few research group experts were program graduates themselves! Donovan Mera, Gabe Hensley and James Benton (all of whom also happen to be Rady Children’s employees) provided great insights and suggestions that might help fellow grads practice and retain their success moves, such as keeping a detailed weekly planner or having CASRC develop a text- or email-based reminder program. The group also discussed how companies can prepare their management staff to support employees on the autism spectrum, and how a formal training program would be an excellent thing to offer. I very much enjoyed being a part of this thoughtful exchange, and seeing how CASRC’s programs have come full-circle for Donovan, Gabe and James.
After the session, we met up with team members including Dr. David Sommerfeld and Dr. Danielle Fettes to explore CASRC’s evaluation process. Many partners turn to CASRC to assess their behavioral health programs — for example, the center looks at all of San Diego County’s initiatives — and to help pinpoint strategies, stakeholders and community needs. Dr. Sommerfeld reiterated Dr. Baker’s prior statement regarding the importance of integrating with collaborators and communities served to ensure programs are effective and flexible. “We want to be co-learners with people on the ground,” he said, and also explained that a primary goal is supporting, developing or expanding programs that are action-oriented and NIH-quality. Dr. Fettes then walked us through building out a behavioral health program. I even got to pick the focus: integrating mental health evaluations and follow-up services into pediatric primary care. First, we identified the ideal outcomes, which included reducing the rate of youth suicide. Next, we identified advocates we could work with to determine service logistics, help build community awareness and support, and actually implement the program. This was a big list, and included kids and their parents, primary care providers, schools and teachers, insurance companies, partner organization leadership and funders, mental health experts, and the county. Finally, we addressed what data we may have and what data we may need to gather to inform a well-thought, evidence-based program; and what factors we needed to consider to roll out the program to different audiences. I was impressed at the level of care and detail that goes into this aspect of CASRC’s responsibilities, and it made me proud to know our organization is able to take a leading role in helping the best possible services reach our community.
I then reunited with Dr. Brookman-Frazee to talk about training the next generation of researchers and practitioners, a major focus for CASRC. For FY 2018 – 2019, 45 trainees hailing from prestigious universities and entities such as the NIH called CASRC home — that’s a huge mark on the future of behavioral health programs and implementation! I discovered that Dr. Brookman-Frazee trained here herself, and her experience actually led her to her field of expertise: autism spectrum disorders. Fast-forward to present day, and Dr. Brookman-Frazee now mentors many young researchers and practitioners and helps other experts “train the trainer.” I also had the opportunity to connect with current trainees, and with Dr. Allison Jobin, who has been here since graduate school and now trains leaders all over California in evidence-based best practices for supporting ASD services. “I have been able to shift as a clinician and researcher in a way that has really supported and developed me,” she expressed. There’s that full-circle factor again!
My final stop brought me back to Dr. Aarons and a panel of experts including Dr. Nicole Stadnick, who took me through a deeper look at implementation science and its proven efficacy in taking research projects from new initiative to informing widely accepted, evidence-based practices. They shared a study with me that determined with implementation science, EBPs can be standardized in about three years. Without? 17 years! No wonder this is a driving force behind everything CASRC does — it saves years, even decades, of precious time that could be used to help youth and families. We also explored the amazing reach of CASRC implementation projects in key areas such as pediatrics, behavioral health, child welfare and education. Check out what the center has done in San Diego County, and in countries including Africa and Norway.
At that point, my visit had come to an end, but I left thoroughly impressed with this multidisciplinary, ultra-collaborative team … and well-traveled along the Pathway of Partners. Thank you, CASRC!