1 00:00:04,972 --> 00:00:06,740 GOOD MORNING. 2 00:00:06,740 --> 00:00:09,776 MY NAME IS CHRISTINA BORBA THE 3 00:00:09,776 --> 00:00:11,778 DIRECTOR OF THE NIMH OFFICE ON 4 00:00:11,778 --> 00:00:12,312 DISPARITIES RESEARCH AND 5 00:00:12,312 --> 00:00:16,483 WORKFORCE DIVERSITY. 6 00:00:16,483 --> 00:00:17,751 A LITTLE BIT ABOUT OUR OFFICE. 7 00:00:17,751 --> 00:00:20,020 WE COORDINATE TWO SIGNIFICANT 8 00:00:20,020 --> 00:00:22,923 PRIORITIES AT NIMH. 9 00:00:22,923 --> 00:00:24,625 FIRST, REDUCE MENTAL HEALTH 10 00:00:24,625 --> 00:00:25,926 DISPARITIES AND PROMOTE EQUITY 11 00:00:25,926 --> 00:00:28,495 IN THE UNITED STATES AND 12 00:00:28,495 --> 00:00:30,097 DIVERSIFY THE MENTAL HEALTH 13 00:00:30,097 --> 00:00:31,198 RESEARCH WORKFORCE. 14 00:00:31,198 --> 00:00:34,501 THE OFFICE COMBINE FOCUS ALLOWS 15 00:00:34,501 --> 00:00:35,469 NIMH TO SUPPORT ADVANCE 16 00:00:35,469 --> 00:00:37,771 PRACTICES WITH EQUITY AND MENTAL 17 00:00:37,771 --> 00:00:38,705 HEALTH RESEARCH. 18 00:00:38,705 --> 00:00:40,474 THE OFFICE WORKS CLOSELY WITH 19 00:00:40,474 --> 00:00:42,075 THE CENTER FOR GLOBAL MENTAL 20 00:00:42,075 --> 00:00:44,611 HEALTH RESEARCH TO ADDRESS 21 00:00:44,611 --> 00:00:46,446 DISPARITIES IN LOW AND MIDDLE 22 00:00:46,446 --> 00:00:48,248 INCOME COUNTRIES. 23 00:00:48,248 --> 00:00:51,251 IT GIVES ME GREAT PLEASURE TO 24 00:00:51,251 --> 00:00:53,387 INTRODUCE DR. PETER KILMARX OF 25 00:00:53,387 --> 00:00:56,223 THE FOGARTY CENTER AND ACTING 26 00:00:56,223 --> 00:00:57,958 DIRECTOR FOR THE NATIONAL 27 00:00:57,958 --> 00:00:59,693 RESEARCH AT THE NIH. 28 00:00:59,693 --> 00:01:03,196 HE JOINED FOGARTY IN JULY OF 29 00:01:03,196 --> 00:01:04,798 2015 AND ASSUMED HIS CURRENT 30 00:01:04,798 --> 00:01:06,967 ROLE IN JANUARY 2023. 31 00:01:06,967 --> 00:01:10,971 DR. KILMARX IS AN EXPERT ON 32 00:01:10,971 --> 00:01:21,315 INFECTIOUS DISEASE RESEARCH AND 33 00:01:21,315 --> 00:01:24,451 HIV/AIDS RESEARCH AND REPRESENT 34 00:01:24,451 --> 00:01:25,652 THE CENTER AT NIH AT NATIONAL 35 00:01:25,652 --> 00:01:27,854 AND INTERNATIONAL FORUMS. 36 00:01:27,854 --> 00:01:31,258 HE CO-LED AN INITIATIVE TO 37 00:01:31,258 --> 00:01:32,025 TRANSFORM AFRICAN HEALTH 38 00:01:32,025 --> 00:01:32,993 PROFESSIONAL EDUCATION IN 39 00:01:32,993 --> 00:01:35,629 RESEARCH RESULTING IN THE 40 00:01:35,629 --> 00:01:38,131 FORMATION OF THE AFRICAN 41 00:01:38,131 --> 00:01:39,533 ASSOCIATION FOR HEALTH 42 00:01:39,533 --> 00:01:40,400 PROFESSIONS, EDUCATION AND 43 00:01:40,400 --> 00:01:41,034 RESEARCH. 44 00:01:41,034 --> 00:01:43,203 HE ALSO FOCUSSED ON EFFORTS TO 45 00:01:43,203 --> 00:01:45,005 INCREASE EQUITY IN GLOBAL HEALTH 46 00:01:45,005 --> 00:01:46,540 RESEARCH AND BUILD GLOBAL 47 00:01:46,540 --> 00:01:47,507 CAPACITY FOR PANDEMIC 48 00:01:47,507 --> 00:01:49,242 PREPAREDNESS. 49 00:01:49,242 --> 00:01:55,282 IT'S A VERY IMPRESSIVE BIO. 50 00:01:55,282 --> 00:01:56,416 AFTER EARNING HIS M.D. HE 51 00:01:56,416 --> 00:01:59,152 COMPLETED HIS INTERNAL MEDICAL 52 00:01:59,152 --> 00:02:03,056 RESIDENCY IN INFECTIOUS DISEASE 53 00:02:03,056 --> 00:02:04,691 FELLOWSHIP AT JOHNS HOPKINS 54 00:02:04,691 --> 00:02:08,795 HOSPITAL AND REMAINED BORT BOARD 55 00:02:08,795 --> 00:02:11,565 CERTIFIED AND PART OF THE 56 00:02:11,565 --> 00:02:13,700 INFECTIOUS DISEASE SOCIETY OF 57 00:02:13,700 --> 00:02:15,469 AMERICA AND PUBLISHED 58 00:02:15,469 --> 00:02:17,237 PEER-REVIEWED ARTICLES AND BOOK 59 00:02:17,237 --> 00:02:19,539 CHAPTERS AND SERVED ON THE OF 60 00:02:19,539 --> 00:02:22,009 SEXUALLY TRANSMITTED DISEASES. 61 00:02:22,009 --> 00:02:25,912 HE BEGAN AS A PEACE CORPS 62 00:02:25,912 --> 00:02:26,913 VOLUNTEER HELPING DEVELOP 63 00:02:26,913 --> 00:02:27,981 FISHERIES WHICH ARE STILL 64 00:02:27,981 --> 00:02:28,882 PRODUCTIVE TODAY. 65 00:02:28,882 --> 00:02:31,818 HE RECEIVED NUMEROUS AWARDS 66 00:02:31,818 --> 00:02:32,786 INCLUDING THE NIH DIRECTOR'S 67 00:02:32,786 --> 00:02:37,758 GROUP AWARD FOR PILOTING AN 68 00:02:37,758 --> 00:02:39,393 NIH-CHINA OFFICE AND 69 00:02:39,393 --> 00:02:41,795 U.S. EMBASSY IN BEIJING TO 70 00:02:41,795 --> 00:02:44,197 SUPPORT INVESTMENT IN CHINA AND 71 00:02:44,197 --> 00:02:48,902 THE DISTINGUISHED SERVICE METAL 72 00:02:48,902 --> 00:02:49,836 FOR CAREER RESPONDING TO 73 00:02:49,836 --> 00:02:51,972 HIV/AIDS AND OTHER INFECTIOUS 74 00:02:51,972 --> 00:02:54,908 DISEASE THREATS IN BUILDING 75 00:02:54,908 --> 00:02:58,945 CAPACITY WORLDWIDE AND THE 76 00:02:58,945 --> 00:03:02,916 PRESIDENTIAL UNIT CITATION FOR 77 00:03:02,916 --> 00:03:04,584 COURAGE IN PERFORMS AND ACTION 78 00:03:04,584 --> 00:03:08,188 TO THE EBOLA OUTBREAK. 79 00:03:08,188 --> 00:03:10,557 THE FOG ARTY INTERNATIONAL 80 00:03:10,557 --> 00:03:12,959 CENTER SUPPORTS AND FACILITATES 81 00:03:12,959 --> 00:03:14,661 GLOBAL HEALTH RESEARCH CONDUCTED 82 00:03:14,661 --> 00:03:15,695 BY U.S. AND INTERNATIONAL 83 00:03:15,695 --> 00:03:17,597 INVESTIGATORS, BUILDING 84 00:03:17,597 --> 00:03:18,532 PARTNERSHIPS BETWEEN HEALTH 85 00:03:18,532 --> 00:03:19,533 RESEARCH INSTITUTIONS IN THE 86 00:03:19,533 --> 00:03:20,867 U.S. AND ABROAD AND TRAINING THE 87 00:03:20,867 --> 00:03:24,071 NEXT GENERATION OF SCIENTISTS TO 88 00:03:24,071 --> 00:03:25,472 ADVANCE GLOBAL HEALTH NEEDS. 89 00:03:25,472 --> 00:03:27,974 PLEASE JOIN ME IN WELCOMING 90 00:03:27,974 --> 00:03:38,285 DR. PETER KILMARX. 91 00:03:46,293 --> 00:03:49,096 >> THANK YOU, CHRISTINA FOR THAT 92 00:03:49,096 --> 00:03:50,831 GENEROUS INTRODUCTION AND THANKS 93 00:03:50,831 --> 00:03:59,973 TO LEO FOR INVITING ME TO SPEAK 94 00:03:59,973 --> 00:04:00,607 THIS MORNING. 95 00:04:00,607 --> 00:04:03,543 I HOPE EVERYONE'S GOOD AND 96 00:04:03,543 --> 00:04:05,545 MENTALLY HEALTHY AND IT WAS 97 00:04:05,545 --> 00:04:07,547 GREAT TO GET TOGETHER LAST 98 00:04:07,547 --> 00:04:08,148 NIGHT. 99 00:04:08,148 --> 00:04:10,684 I'M SURE THOSE ARE HERE ENJOY 100 00:04:10,684 --> 00:04:11,952 BEING TOGETHER AND IN PERSON AND 101 00:04:11,952 --> 00:04:17,157 I UNDERSTAND THERE'S MANY PEOPLE 102 00:04:17,157 --> 00:04:25,766 ONLINE IN SECURITY AND I'M 103 00:04:25,766 --> 00:04:28,201 DELIGHTED TO BE HERE. 104 00:04:28,201 --> 00:04:30,003 NIH IS A GLOBAL INSTITUTION AND 105 00:04:30,003 --> 00:04:32,639 FOGARTY IS VERY DEDICATED TO 106 00:04:32,639 --> 00:04:33,907 MENTAL HEALTH RESEARCH AND 107 00:04:33,907 --> 00:04:34,741 RESEARCH TRAINING. 108 00:04:34,741 --> 00:04:39,513 THOSE ARE MY TWO MAIN MESSAGES 109 00:04:39,513 --> 00:04:45,752 THIS MORNING. 110 00:04:45,752 --> 00:04:46,820 IN SUPPORTING DATA ABOUT NIH 111 00:04:46,820 --> 00:04:48,421 BEING A GLOBAL INSTITUTION. 112 00:04:48,421 --> 00:04:52,325 A FEW YEARS AGO WE LOOKED AT ALL 113 00:04:52,325 --> 00:04:56,763 PUBLICATION INS PUB MED THAT 114 00:04:56,763 --> 00:04:58,131 CITE NIH FUNDING AND HOW MANY 115 00:04:58,131 --> 00:05:01,735 HAVE A NON-U.S. AFFILIATED 116 00:05:01,735 --> 00:05:04,471 CO-AUTHOR AND IT'S 35% OF ALL 117 00:05:04,471 --> 00:05:07,240 NIH FUNDED PUBLICATIONS HAVE A 118 00:05:07,240 --> 00:05:09,042 NON-U.S. AFFILIATED CO-AUTHOR SO 119 00:05:09,042 --> 00:05:10,677 IT'S A GLOBAL ACTIVITY. 120 00:05:10,677 --> 00:05:14,014 THOSE PAPERS THAT HAD A U.S. AND 121 00:05:14,014 --> 00:05:16,016 NON-U.S. CO-AUTHOR HAD A HIGHER 122 00:05:16,016 --> 00:05:17,984 SCIENTIFIC IMPACT THAN THE 123 00:05:17,984 --> 00:05:18,618 PUBLICATIONS THAT HAD 124 00:05:18,618 --> 00:05:20,854 U.S. AUTHORS ONLY. 125 00:05:20,854 --> 00:05:22,856 SO THERE'S A LOT OF GLOBAL 126 00:05:22,856 --> 00:05:23,390 COLLABORATION IN SCIENCE. 127 00:05:23,390 --> 00:05:27,828 YOU CAN SEE ON THE LEFT THE 128 00:05:27,828 --> 00:05:29,162 COUNTRIES MOST REPRESENTED MAYBE 129 00:05:29,162 --> 00:05:31,631 NO SURPRISE, CHINA WAS NUMBER 130 00:05:31,631 --> 00:05:33,066 ONE IN 2017. 131 00:05:33,066 --> 00:05:35,735 THE OTHERS, U.K., CANADA, 132 00:05:35,735 --> 00:05:38,371 GERMANY, ETCETERA, HIGH-INCOME 133 00:05:38,371 --> 00:05:42,809 COUNTRIES AND ON THE RIGHT THE 134 00:05:42,809 --> 00:05:45,745 LOWER INCOME COUNTRIES FUNDED BY 135 00:05:45,745 --> 00:05:51,518 THE NIH INCLUDING BRAZIL, INDIA 136 00:05:51,518 --> 00:05:51,918 AND SOUTH AFRICA. 137 00:05:51,918 --> 00:05:57,224 THEN ANOTHER POINT IS THE GLOBAL 138 00:05:57,224 --> 00:05:59,392 COLLABORATION IS VERY DIVERSE. 139 00:05:59,392 --> 00:06:00,994 INFECTIOUS DISEASE IS NUMBER ONE 140 00:06:00,994 --> 00:06:05,765 AND IF YOU LOOK AT THE NIH 141 00:06:05,765 --> 00:06:09,536 RECORDS THERE'S AN IMPORTANT 142 00:06:09,536 --> 00:06:11,638 WEBSITE WORLD REPORT.NIH.gov 143 00:06:11,638 --> 00:06:13,940 THAT CATALOGS THIS. 144 00:06:13,940 --> 00:06:16,009 THERE'S NEARLY 20,000 IN 2022. 145 00:06:16,009 --> 00:06:17,577 AND NEARLY 20,000 RECORDS OF 146 00:06:17,577 --> 00:06:21,815 FOREIGN COLLABORATIONS FUNDED BY 147 00:06:21,815 --> 00:06:30,423 THE NIH AND NIAD AND HEART, 148 00:06:30,423 --> 00:06:31,391 LUNG, DISEASE AND STROKE AND 149 00:06:31,391 --> 00:06:33,360 NIMH IS A GLOBAL PLAYER IN TERMS 150 00:06:33,360 --> 00:06:37,530 OF THE GLOBAL ACTIVITIES OF NIH. 151 00:06:37,530 --> 00:06:39,633 THIS IS -- THERE'S 24 INSTITUTES 152 00:06:39,633 --> 00:06:42,269 AND CENTERS THAT FUND EXTRAMURAL 153 00:06:42,269 --> 00:06:43,970 COLLABORATION AND EVERY ONE OF 154 00:06:43,970 --> 00:06:46,072 THEM HAS SOME ROLE IN SUPPORTING 155 00:06:46,072 --> 00:06:49,743 GLOBAL COLLABORATION AT NIH. 156 00:06:49,743 --> 00:06:52,412 NOW, LET ME TURN TO THE FOGARTY. 157 00:06:52,412 --> 00:06:55,048 WE HAVE BASICALLY TWO MAIN 158 00:06:55,048 --> 00:06:55,315 MISSIONS. 159 00:06:55,315 --> 00:06:56,950 ONE IS TO SUPPORT ALL THE OTHER 160 00:06:56,950 --> 00:06:59,419 I.C.s AND INSTITUTES AND CENTERS 161 00:06:59,419 --> 00:07:03,556 IN THEIR GLOBAL ACTIVITIES. 162 00:07:03,556 --> 00:07:06,593 WE HAD A RICH AND PRODUCTIVE 163 00:07:06,593 --> 00:07:07,927 PARTNERSHIP WITH NIMH I'LL SAY 164 00:07:07,927 --> 00:07:08,495 MORE ABOUT. 165 00:07:08,495 --> 00:07:12,132 WITH OUR RESOURCES WE FOCUSSED 166 00:07:12,132 --> 00:07:13,433 PRIMARILY ON LOWER-INCOME 167 00:07:13,433 --> 00:07:14,834 COUNTRIES AND I'LL SAY MORE 168 00:07:14,834 --> 00:07:16,736 ABOUT THAT ALSO. 169 00:07:16,736 --> 00:07:20,607 THIS IS OUR NAMESAKE JOHN 170 00:07:20,607 --> 00:07:22,742 FOGARTY A CONGRESSMAN FROM RHODE 171 00:07:22,742 --> 00:07:25,979 ISLAND, ALSO MY HOME STATE AND 172 00:07:25,979 --> 00:07:28,248 HAD A NICE INSPIRATIONAL QUOTE 173 00:07:28,248 --> 00:07:30,050 IN THE '60s SAYING EXPANDED 174 00:07:30,050 --> 00:07:32,719 RESEARCH IS ONE PERHAPS THE ONE 175 00:07:32,719 --> 00:07:34,020 TRULY GLOBAL EFFORT IN WHICH ALL 176 00:07:34,020 --> 00:07:35,522 NATIONS CAN AND WILL JOIN AS 177 00:07:35,522 --> 00:07:36,456 REAL PARTNERS. 178 00:07:36,456 --> 00:07:42,796 SO WE REALLY TAKE THIS 179 00:07:42,796 --> 00:07:44,831 COLLABORATION AND SOCIAL JUSTICE 180 00:07:44,831 --> 00:07:46,633 MESSAGE AS PART OF OUR FOUNDING 181 00:07:46,633 --> 00:07:52,072 ETHOS. 182 00:07:52,072 --> 00:07:54,207 THIS IS THE MONEY SLIDE. 183 00:07:54,207 --> 00:07:59,212 KEY INFORMATION TO CONVEY FIRST 184 00:07:59,212 --> 00:08:01,514 OF ALL TO SAY MANY DIVERSE AREAS 185 00:08:01,514 --> 00:08:03,416 WHERE FOGARTY SUPPORTS GLOBAL 186 00:08:03,416 --> 00:08:04,484 MENTAL HEALTH RESEARCH AND 187 00:08:04,484 --> 00:08:05,852 RESEARCH TRAINING AND ALSO THE 188 00:08:05,852 --> 00:08:08,621 STRONG SUPPORT IN PARTNERSHIP 189 00:08:08,621 --> 00:08:09,923 WITH NIMH THAT'S PART OF THAT 190 00:08:09,923 --> 00:08:10,523 EFFORT. 191 00:08:10,523 --> 00:08:14,928 THIS IS A TOTAL OF $2.7 MILLION 192 00:08:14,928 --> 00:08:17,997 OF CO-FUNDING FROM NIMH FOR 193 00:08:17,997 --> 00:08:21,201 FOGARTY IN THE LAST FISCAL YEAR. 194 00:08:21,201 --> 00:08:22,502 THAT'S IMPORTANT FOR THE 195 00:08:22,502 --> 00:08:23,636 FINANCIAL CONTRIBUTION AND ALSO 196 00:08:23,636 --> 00:08:25,672 PROBABLY MORE IMPORTANT IS JUST 197 00:08:25,672 --> 00:08:27,107 THAT PARTNERSHIP AND PUTTING 198 00:08:27,107 --> 00:08:28,675 TOGETHER OUR NETWORKS OF 199 00:08:28,675 --> 00:08:29,843 INVESTIGATORS AND KEY PART OF 200 00:08:29,843 --> 00:08:31,978 HAVING THIS MEETING IS TO LINK 201 00:08:31,978 --> 00:08:34,247 TOGETHER THE NETWORKS OF FUNDERS 202 00:08:34,247 --> 00:08:36,416 AND INVESTIGATORS TO HAVE EVEN 203 00:08:36,416 --> 00:08:37,050 MORE EFFECTIVE RESEARCH RESEARCH 204 00:08:37,050 --> 00:08:40,086 TRAINING. 205 00:08:40,086 --> 00:08:43,390 BE THE RESEARCH SIDE THE GLOBAL 206 00:08:43,390 --> 00:08:44,591 BRAND DISORDERS RESEARCH PROGRAM 207 00:08:44,591 --> 00:08:47,260 WHICH STARTS AS AN R21 AND ALSO 208 00:08:47,260 --> 00:08:52,198 THERE'S R01 AWARDS PART OF THAT 209 00:08:52,198 --> 00:08:52,532 COLLABORATION. 210 00:08:52,532 --> 00:08:54,501 AND OUR HIV NCD RESEARCH PROGRAM 211 00:08:54,501 --> 00:08:55,735 THAT INCLUDES A LOT OF MENTAL 212 00:08:55,735 --> 00:08:57,937 HEALTH RESEARCH AS PART OF THAT. 213 00:08:57,937 --> 00:08:59,839 THE MOBILE HEALTH RESEARCH HAS 214 00:08:59,839 --> 00:09:02,575 BEEN VERY PRODUCTIVE AND ACTIVE. 215 00:09:02,575 --> 00:09:05,211 AN R21 AND FOR THOSE ACTIVITIES 216 00:09:05,211 --> 00:09:06,980 THAT MEET THEIR MILESTONES 217 00:09:06,980 --> 00:09:08,581 CONVERTS TO AN R33 FOR MORE 218 00:09:08,581 --> 00:09:12,218 YEARS OF FUNDING TO BE ABLE TO 219 00:09:12,218 --> 00:09:13,086 IMPLEMENT THESE GLOBAL HEALTH 220 00:09:13,086 --> 00:09:19,492 INTERVENTIONS AND TECHNOLOGIES. 221 00:09:19,492 --> 00:09:21,928 THERE'S A BIG COMMON FOUND DATA 222 00:09:21,928 --> 00:09:25,265 SIGN IN AFRICA NIMH IS PART OF. 223 00:09:25,265 --> 00:09:27,000 WE ALSO HAVE A RESEARCH PROGRAM 224 00:09:27,000 --> 00:09:31,905 ON STIGMA REDUCTION IN HIV/AIDS 225 00:09:31,905 --> 00:09:33,206 PREVENTION, TREATMENT AND CARE 226 00:09:33,206 --> 00:09:35,375 AND ON THE TRAINING AND CAREER 227 00:09:35,375 --> 00:09:37,944 DEVELOPMENT SIDE WE HAVE OUR NCD 228 00:09:37,944 --> 00:09:41,080 RESEARCH TRAINING PROGRAM, D43 229 00:09:41,080 --> 00:09:41,314 PROGRAM. 230 00:09:41,314 --> 00:09:43,349 HIV RESEARCH TRAINING PROGRAM 231 00:09:43,349 --> 00:09:44,451 WHICH IS QUITE DIVERSE AND 232 00:09:44,451 --> 00:09:46,085 INCLUDES A LOT OF MENTAL HEALTH 233 00:09:46,085 --> 00:09:49,055 RESEARCH TRAINING AS PART OF 234 00:09:49,055 --> 00:09:49,322 THAT. 235 00:09:49,322 --> 00:09:51,491 THE FELLOWS AND SCHOLARS 236 00:09:51,491 --> 00:09:52,125 PROGRAM. 237 00:09:52,125 --> 00:09:55,028 THIS IS A ONE-YEAR MENTORED 238 00:09:55,028 --> 00:09:56,796 RESEARCH OPPORTUNITY FOR STUNTHS 239 00:09:56,796 --> 00:09:58,364 AND DOCTORAL STUDENTS, MEDICAL 240 00:09:58,364 --> 00:10:00,900 OR Ph.D. OR OTHER DOCTORAL 241 00:10:00,900 --> 00:10:02,502 STUDENTS OR FOR POSTDOCS TO HAVE 242 00:10:02,502 --> 00:10:04,771 A ONE-YEAR MENTORED RESEARCH 243 00:10:04,771 --> 00:10:05,505 ACTIVITY AND MEETING WITH A LOT 244 00:10:05,505 --> 00:10:06,840 OF PEOPLE AT THE RECEPTION LAST 245 00:10:06,840 --> 00:10:10,944 NIGHT THEY TOLD ME THEY WERE 246 00:10:10,944 --> 00:10:13,613 FORMER TRAINEES UNDER THE 247 00:10:13,613 --> 00:10:15,515 PROGRAM AND I THINK IT WILL BE 248 00:10:15,515 --> 00:10:19,853 INTERESTING TO THE AUDIENCE THE 249 00:10:19,853 --> 00:10:20,954 EMERGING GLOBAL LEADER PROGRAM 250 00:10:20,954 --> 00:10:24,224 AND THE DOMESTIC K AWARD. 251 00:10:24,224 --> 00:10:26,559 THE ONLY ONE FOR NIH SCIENTISTS 252 00:10:26,559 --> 00:10:27,760 FROM LOW AND MIDDLE INCOME 253 00:10:27,760 --> 00:10:30,029 COUNTRIES ARE ELIGIBLE. 254 00:10:30,029 --> 00:10:33,366 SO IT'S FIVE YEARS OF MENTORED 255 00:10:33,366 --> 00:10:35,735 CAREER DEVELOPMENT SUPPORT FOR 256 00:10:35,735 --> 00:10:38,338 PEOPLE IN LOW AND MIDDLE INCOME 257 00:10:38,338 --> 00:10:39,572 COUNTRIES INCLUDING SOME WITH 258 00:10:39,572 --> 00:10:41,641 MENTAL HEALTH RESEARCH 259 00:10:41,641 --> 00:10:45,211 ACTIVITIES THAT NIMH SUPPORTS. 260 00:10:45,211 --> 00:10:47,747 A FEW EXAMPLES OF SOME OF THESE 261 00:10:47,747 --> 00:10:48,047 ACTIVITIES. 262 00:10:48,047 --> 00:10:50,416 THIS IS ABOUT ADDRESSING MENTAL 263 00:10:50,416 --> 00:10:54,787 HEALTH IN THE U.S. COMMUNITIES. 264 00:10:54,787 --> 00:10:57,056 THESE RESEARCHERS WERE LOOKING 265 00:10:57,056 --> 00:11:00,793 AT MENTAL HEALTH RESEARCH IN 266 00:11:00,793 --> 00:11:04,497 LIBRARY TO SUPPORT DEVELOPMENT 267 00:11:04,497 --> 00:11:06,399 OF THE LIBERIA STRATEGIC HEALTH 268 00:11:06,399 --> 00:11:09,903 PLAN AND SUPPORTING MENTAL 269 00:11:09,903 --> 00:11:13,139 HEALTH EDUCATION AND MENTAL 270 00:11:13,139 --> 00:11:17,410 HEALTH ACTIVITY FOR AFRICANS IN 271 00:11:17,410 --> 00:11:18,411 LOWELL, MASSACHUSETTS UNDER 272 00:11:18,411 --> 00:11:20,280 SCORING THE RECIPROCAL 273 00:11:20,280 --> 00:11:21,681 INNOVATION AND BRIDGING LESSONS 274 00:11:21,681 --> 00:11:22,582 LEARNED FROM AROUND THE WORLD 275 00:11:22,582 --> 00:11:25,919 AND BRINGING THEM BACK TO THE 276 00:11:25,919 --> 00:11:27,053 U.S. WITH OTHER HIGHER INCOME 277 00:11:27,053 --> 00:11:27,320 COUNTRIES. 278 00:11:27,320 --> 00:11:31,925 THIS WAS SUPPORTED THROUGH A K01 279 00:11:31,925 --> 00:11:32,725 AWARD. 280 00:11:32,725 --> 00:11:39,165 SO DR. CORP IS A RESEARCHER WITH 281 00:11:39,165 --> 00:11:42,569 THE K AWARD SUPPORTED BY FOGARTY 282 00:11:42,569 --> 00:11:44,037 AND NIMH. 283 00:11:44,037 --> 00:11:52,011 THIS IS A SCHOLAR. 284 00:11:52,011 --> 00:11:53,279 HER U.S. INSTITUTION WAS 285 00:11:53,279 --> 00:11:54,881 VANDERBILT AND WAS RESEARCHING 286 00:11:54,881 --> 00:11:58,284 MENTAL HEALTH DELIVERY IN KENYA 287 00:11:58,284 --> 00:12:00,186 IN LMICs GENERALLY AND HEAD OF 288 00:12:00,186 --> 00:12:03,289 THE DEPARTMENT OF MENTAL HEALTH 289 00:12:03,289 --> 00:12:05,425 AT THE TEACHING HOSPITAL. 290 00:12:05,425 --> 00:12:08,895 OPPORTUNITIES FOR FOREIGN EARLY 291 00:12:08,895 --> 00:12:11,497 CAREER RESEARCHERS AND THEN 292 00:12:11,497 --> 00:12:14,067 DR. MASNARI IS ONE OF OUR 293 00:12:14,067 --> 00:12:19,505 GRANTEES WORKING IN UKRAINE AND 294 00:12:19,505 --> 00:12:21,341 ALSO SUPPORTED BY JOHNS HOPKINS 295 00:12:21,341 --> 00:12:22,775 AND WAS LOOKING AT THE LANDSCAPE 296 00:12:22,775 --> 00:12:26,512 FOR MENTAL DISORDERS IN UKRAINE 297 00:12:26,512 --> 00:12:27,513 AND EVIDENCE-BASED DIAGNOSTIC 298 00:12:27,513 --> 00:12:29,182 APPROACHES FOR MENTAL DISORDERS 299 00:12:29,182 --> 00:12:30,617 IN UKRAINE AND WITH THE START OF 300 00:12:30,617 --> 00:12:35,488 THE WAR PIVOTED TO LOOK AT THE 301 00:12:35,488 --> 00:12:39,759 CAPACITY FOR SCALING UP MENTAL 302 00:12:39,759 --> 00:12:43,730 HEALTH PROVIDERS IN UKRAINE FUND 303 00:12:43,730 --> 00:12:46,232 FOGARTY AND NIMH AND HER 304 00:12:46,232 --> 00:12:47,500 INSPIRATIONAL QUOTE AND A 305 00:12:47,500 --> 00:12:50,503 TRAVELED TO WARSAW IN JUNE AND 306 00:12:50,503 --> 00:12:53,740 MET WITH ALL OF OUR GRANTEES IN 307 00:12:53,740 --> 00:12:56,242 UKRAINE AND SHE CAPTURED THEIR 308 00:12:56,242 --> 00:12:57,243 SENTIMENT SAYING TO CONTINUE ON 309 00:12:57,243 --> 00:12:59,646 WITH THE WORK IS THE FORM OF 310 00:12:59,646 --> 00:13:02,015 RESISTANCE AND RESILIENCE NOT 311 00:13:02,015 --> 00:13:03,516 SOMETHING INHERITED AND 312 00:13:03,516 --> 00:13:04,484 SOMETHING EARNED BY EXISTING 313 00:13:04,484 --> 00:13:11,491 DURING A TIME WHEN WE SIMPLY 314 00:13:11,491 --> 00:13:12,358 MUST ENDURE. 315 00:13:12,358 --> 00:13:16,663 REMARKABLE WORK LANA AND OTHER 316 00:13:16,663 --> 00:13:24,103 TRAINEES ARE CARRYING IN 317 00:13:24,103 --> 00:13:24,337 UKRAINE. 318 00:13:24,337 --> 00:13:28,274 THERE'S EQUITY IN RESEARCH AND 319 00:13:28,274 --> 00:13:30,677 THERE'S BEEN DISCUSSION ABOUT 320 00:13:30,677 --> 00:13:34,280 DECOLONIZATION AND WE HAVE A 321 00:13:34,280 --> 00:13:36,182 WORKING GROUP FOCUSSED ON 322 00:13:36,182 --> 00:13:37,350 PROMOTING EQUITY IN GLOBAL 323 00:13:37,350 --> 00:13:39,752 HEALTH RESEARCH AND NORTH-SOUTH 324 00:13:39,752 --> 00:13:40,186 PARTNERSHIPS. 325 00:13:40,186 --> 00:13:41,921 WE HAD A REQUEST FOR INFORMATION 326 00:13:41,921 --> 00:13:43,523 LAST YEAR AND HAD 186 RESPONSES 327 00:13:43,523 --> 00:13:45,958 WE TOOK AS A ROBUST RESPONSE 328 00:13:45,958 --> 00:13:47,260 FROM THE COMMUNITY FROM 329 00:13:47,260 --> 00:13:50,363 HIGH-INCOME COUNTRIES AND 330 00:13:50,363 --> 00:13:51,864 LOWER-INCOME COUNTRIES SOME 331 00:13:51,864 --> 00:13:55,501 CRITICAL THEMES EMERGED OUT OF 332 00:13:55,501 --> 00:13:55,702 THAT. 333 00:13:55,702 --> 00:13:59,005 I THINK A KEY ONE WE TALK ABOUT 334 00:13:59,005 --> 00:14:01,274 THE GOLDEN RULE AND HE WHO HAS 335 00:14:01,274 --> 00:14:03,509 THE GOLD MAKES THE RULES AND THE 336 00:14:03,509 --> 00:14:04,344 PARADIGM WE NEED TO GET AWAY 337 00:14:04,344 --> 00:14:07,847 FROM IS FUNDING HIGH-INCOME 338 00:14:07,847 --> 00:14:10,516 COUNTRIES RESEARCHERS AND GO TO 339 00:14:10,516 --> 00:14:11,884 LOW-INCOME COUNTRIES AND SAY 340 00:14:11,884 --> 00:14:13,186 HERE'S MY PROTOCOL DO YOU WANT 341 00:14:13,186 --> 00:14:16,089 TO PARTICIPATE YES OR NO. 342 00:14:16,089 --> 00:14:19,392 THAT'S A DISEM POWERING 343 00:14:19,392 --> 00:14:20,793 RELATIONSHIP VERSUS FUNDING 344 00:14:20,793 --> 00:14:22,095 DIRECTLY RESEARCHERS IN 345 00:14:22,095 --> 00:14:23,496 LOW-INCOME COUNTRIES AND LET 346 00:14:23,496 --> 00:14:26,099 THEM BE IN THE DRIVER'S SEAT IN 347 00:14:26,099 --> 00:14:28,134 MANAGING THE RESOURCES. 348 00:14:28,134 --> 00:14:29,302 THESE NINE INSTITUTES AND 349 00:14:29,302 --> 00:14:31,504 CENTERS WHICH ARE THE MOST 350 00:14:31,504 --> 00:14:34,774 ACTIVE GLOBALLY AT NIH ARE 351 00:14:34,774 --> 00:14:39,512 COMMITTED AND ACTIVE IN TAKING 352 00:14:39,512 --> 00:14:40,847 FINDINGS FORWARD IN 353 00:14:40,847 --> 00:14:41,748 IMPLEMENTATION. 354 00:14:41,748 --> 00:14:43,316 IN SUMMARY, THERE'S A STRONG 355 00:14:43,316 --> 00:14:44,851 COLLABORATION AND SUPPORT 356 00:14:44,851 --> 00:14:48,121 BETWEEN FOGARTY AND NIMH FOR 357 00:14:48,121 --> 00:14:49,722 GLOBAL MENTAL HEALTH RESEARCH 358 00:14:49,722 --> 00:14:51,624 AND RESEARCH AND TRAINING AND 359 00:14:51,624 --> 00:14:52,191 SUPPORTING EQUITY IN THE 360 00:14:52,191 --> 00:14:54,727 RESEARCH PARTNERSHIPS IS GOING 361 00:14:54,727 --> 00:14:57,096 TO BE KEY TO RESILIENCE AND TO 362 00:14:57,096 --> 00:14:59,232 GLOBAL HEALTH RESEARCH AND TO 363 00:14:59,232 --> 00:15:00,366 SOLVING THE MANY CHALLENGES, 364 00:15:00,366 --> 00:15:02,502 HEALTH CHALLENGES THAT WE HAVE 365 00:15:02,502 --> 00:15:02,835 GOING FORWARD. 366 00:15:02,835 --> 00:15:05,438 BIG CONGRATULATIONS TO NIMH AND 367 00:15:05,438 --> 00:15:06,405 PARTNERS FOR THIS MEETING. 368 00:15:06,405 --> 00:15:10,009 IT'S REALLY IMPORTANT TO ADDRESS 369 00:15:10,009 --> 00:15:10,943 THIS GLOBAL AREA AND BRING 370 00:15:10,943 --> 00:15:13,045 PEOPLE TOGETHER THE FUNDERS AND 371 00:15:13,045 --> 00:15:14,447 RESEARCHERS AND TRAINEES. 372 00:15:14,447 --> 00:15:17,617 HAPPY TO PARTICIPATE AND 373 00:15:17,617 --> 00:15:18,718 UNFORTUNATELY I HAVE TO SCOOT TO 374 00:15:18,718 --> 00:15:20,686 ANOTHER SET OF ALL-DAY MEETINGS 375 00:15:20,686 --> 00:15:21,788 BUT HAPPY TO HAVE THIS CHANCE TO 376 00:15:21,788 --> 00:15:22,522 BE HERE. 377 00:15:22,522 --> 00:15:32,698 THANK YOU. 378 00:16:37,096 --> 00:16:38,564 >> GOOD MORNING AND THANK YOU 379 00:16:38,564 --> 00:16:38,831 EVERYONE. 380 00:16:38,831 --> 00:16:40,633 I'LL REQUEST THE PANELISTS TO 381 00:16:40,633 --> 00:16:42,068 PLEASE TAKE THEIR SEATS. 382 00:16:42,068 --> 00:16:44,437 I THINK IT'S A GREAT MORNING 383 00:16:44,437 --> 00:16:50,176 ESPECIALLY IN THE CONTEXT OF 384 00:16:50,176 --> 00:16:52,945 THIS CONFERENCE TAKING PLACE AND 385 00:16:52,945 --> 00:16:57,016 ALSO ABOUT 10 OR 12 YEARS OF 386 00:16:57,016 --> 00:16:59,518 SUCCESSION IN TERMS OF THE 387 00:16:59,518 --> 00:17:01,120 GLOBAL MENTAL HEALTH. 388 00:17:01,120 --> 00:17:03,489 THE CURRENT PANEL WE'RE GOING TO 389 00:17:03,489 --> 00:17:04,790 BE TALKING ABOUT IS ON 390 00:17:04,790 --> 00:17:06,559 STRATIFICATION IN MENTAL HEALTH 391 00:17:06,559 --> 00:17:08,261 AND WHAT PROMISE DOES IT HOLD 392 00:17:08,261 --> 00:17:10,496 FOR GLOBAL MENTAL HEALTH 393 00:17:10,496 --> 00:17:11,397 RESEARCH. 394 00:17:11,397 --> 00:17:13,900 I TAKE A MOMENT TO REFLECT ON 395 00:17:13,900 --> 00:17:15,735 THE JOURNEY THAT GLOBAL MENTAL 396 00:17:15,735 --> 00:17:18,504 HEALTH FIELD HAS TAKEN AND HOW 397 00:17:18,504 --> 00:17:21,307 RELEVANT IS STRATIFICATION IN 398 00:17:21,307 --> 00:17:22,208 MENTAL HEALTH RESEARCH AT THIS 399 00:17:22,208 --> 00:17:24,944 POINT IN TIME. 400 00:17:24,944 --> 00:17:27,513 IF YOU REALIZE THAT THE GLOBAL 401 00:17:27,513 --> 00:17:30,383 HUBS THAT NIMH SUPPORTED THE 402 00:17:30,383 --> 00:17:31,450 SCALE-UP RESEARCH SUPPORTED AND 403 00:17:31,450 --> 00:17:33,152 THE COMMUNITY THAT HAS 404 00:17:33,152 --> 00:17:35,555 CONTRIBUTED TO IT HAS LED US TO 405 00:17:35,555 --> 00:17:38,891 THE POINT WHERE WE KNOW WHAT ARE 406 00:17:38,891 --> 00:17:42,561 THE EFFECTIVE INTERVENTIONS IN 407 00:17:42,561 --> 00:17:43,095 GLOBAL MENTAL HEALTH. 408 00:17:43,095 --> 00:17:50,937 WE DON'T KNOW WHAT WORKS FOR 409 00:17:50,937 --> 00:17:52,104 WHOM, UNDER WHAT CONDITIONS WE 410 00:17:52,104 --> 00:17:54,073 LOOK AT SCALABILITY AND THE 411 00:17:54,073 --> 00:17:55,341 IMPACT OF THOSE INTERVENTIONS. 412 00:17:55,341 --> 00:17:56,909 STRATIFICATION COULD BE ONE OF 413 00:17:56,909 --> 00:18:01,347 THE WAYS THAT CAN HELP US PAY 414 00:18:01,347 --> 00:18:02,381 FORWARD THE AGENDA OF GLOBAL 415 00:18:02,381 --> 00:18:02,915 MENTAL HEALTH RESEARCH. 416 00:18:02,915 --> 00:18:05,751 I'M PRIVILEGED TO HAVE 417 00:18:05,751 --> 00:18:07,520 DISTINGUISHED SPEAKERS WHO ARE 418 00:18:07,520 --> 00:18:14,527 GOING TO BE TALKING ABOUT WHAT 419 00:18:14,527 --> 00:18:16,529 THE FIELD OF MACHINE LEARNING 420 00:18:16,529 --> 00:18:18,564 AND STRATIFICATION TRIALS HAVE 421 00:18:18,564 --> 00:18:20,333 TO OFFER TO THE FIELD OF GLOBAL 422 00:18:20,333 --> 00:18:22,101 MENTAL HEALTH AND PRIVILEGED TO 423 00:18:22,101 --> 00:18:24,337 HAVE THESE DISTINGUISHED GUESTS 424 00:18:24,337 --> 00:18:27,506 WHO HAVE FLOWN IN AND TOOK TIME 425 00:18:27,506 --> 00:18:28,808 FOR THE MEETING BECAUSE THEY 426 00:18:28,808 --> 00:18:30,009 REALIZE HOW IMPORTANT IT IS FOR 427 00:18:30,009 --> 00:18:33,079 THEIR WORK AND THE FIELD OF 428 00:18:33,079 --> 00:18:33,980 GLOBAL MENTAL HEALTH. 429 00:18:33,980 --> 00:18:38,317 I'D LIKE TO INVITE THE CHAIR OF 430 00:18:38,317 --> 00:18:42,822 THE SESSION, PROFESSOR NIKOLAOS 431 00:18:42,822 --> 00:18:46,792 KOUTSOULERIS TO FORMALLY START 432 00:18:46,792 --> 00:18:47,460 THE SESSION. 433 00:18:47,460 --> 00:18:48,160 >> THANK YOU. 434 00:18:48,160 --> 00:18:51,030 THANKS TO THE WELCOME TRUST AND 435 00:18:51,030 --> 00:18:54,734 THE NIH COLLEAGUES FOR MAKING 436 00:18:54,734 --> 00:18:55,701 THIS SESSION POSSIBLE GOOD 437 00:18:55,701 --> 00:18:57,436 MORNING TO ALL OF YOU, 438 00:18:57,436 --> 00:18:58,371 COLLEAGUES TO THE SESSION. 439 00:18:58,371 --> 00:19:02,708 I THINK WE HAVE A NICE ROSTER OF 440 00:19:02,708 --> 00:19:07,947 SPEAKERS AND ALSO ONE COLLEAGUE 441 00:19:07,947 --> 00:19:18,324 ONLINE AND MUNMUN DE CHOUDHURY 442 00:19:18,324 --> 00:19:20,226 AND INTERVENTIONS HAVE 443 00:19:20,226 --> 00:19:21,961 DIFFICULTY WITH THEIR EFFICACY 444 00:19:21,961 --> 00:19:23,095 AND EFFICIENCY AND ONE BIG 445 00:19:23,095 --> 00:19:24,864 CHALLENGE IS HETEROGENEITY OF 446 00:19:24,864 --> 00:19:27,299 THE POPULATIONS OF PATIENTS WITH 447 00:19:27,299 --> 00:19:30,169 DEPRESSION, PATIENTS WITH 448 00:19:30,169 --> 00:19:31,604 PSYCHOSIS AND INDIVIDUALS 449 00:19:31,604 --> 00:19:34,373 USUALLY YOUNG PEOPLE AND I THINK 450 00:19:34,373 --> 00:19:38,110 THIS IS RELEVANT FOR COUNTRIES 451 00:19:38,110 --> 00:19:43,215 AND GLOBAL SOUTH WHERE THE 452 00:19:43,215 --> 00:19:44,316 BIGGEST CHUNK OF THE POPULATION 453 00:19:44,316 --> 00:19:48,287 ARE YOUNG PEOPLE AND THE 454 00:19:48,287 --> 00:19:49,388 CONDITIONS BLEED INTO EACH 455 00:19:49,388 --> 00:19:49,789 OTHER. 456 00:19:49,789 --> 00:19:54,493 THERE'S A GREAT DEAL OF 457 00:19:54,493 --> 00:20:00,099 COMORBIDITIES AND CLINICAL 458 00:20:00,099 --> 00:20:01,167 PHENOTYPES AND DISTINGUISH THOSE 459 00:20:01,167 --> 00:20:05,604 FROM A MENTAL HEALTH CRISIS 460 00:20:05,604 --> 00:20:07,573 WHICH MAY RESOLVE PLACE FOR 461 00:20:07,573 --> 00:20:08,340 NORMAL DEVELOPMENT. 462 00:20:08,340 --> 00:20:11,243 THE HETEROGENEITY, WHERE DOES IT 463 00:20:11,243 --> 00:20:11,811 COME FROM. 464 00:20:11,811 --> 00:20:15,948 ONE KEY ASPECT IS THAT THE 465 00:20:15,948 --> 00:20:18,984 CURRENT SYSTEM THAT HAS BEEN 466 00:20:18,984 --> 00:20:19,685 DEVELOPED WAS DEVELOPED BY 467 00:20:19,685 --> 00:20:22,988 EXPERTS MOST OF THOSE EXPERTS 468 00:20:22,988 --> 00:20:24,423 BEING MALE, WHITE COLLEAGUES 469 00:20:24,423 --> 00:20:26,559 SITTING OR WORKING IN THE 470 00:20:26,559 --> 00:20:31,797 INDUSTRIALALIZED WORLD. 471 00:20:31,797 --> 00:20:34,066 THESE CATEGORIES DO NOT RESPECT 472 00:20:34,066 --> 00:20:36,102 NOT ONLY YOUR GRAPHIC JOURNEY OF 473 00:20:36,102 --> 00:20:37,903 THESE PERSONS THAT SUFFER FROM 474 00:20:37,903 --> 00:20:40,306 MENTAL ILLNESS FROM A LIFESTYLE 475 00:20:40,306 --> 00:20:42,141 PERSPECTIVE BUT ALSO DISREGARD 476 00:20:42,141 --> 00:20:46,512 THE BIOLOGY AND SOCIAL CONTEMPT 477 00:20:46,512 --> 00:20:50,616 IN WHICH THESE JOURNEYS DEVELOP. 478 00:20:50,616 --> 00:20:53,252 PRECISION MEDICINE MAY BE ONE 479 00:20:53,252 --> 00:20:56,889 PRINCIPLE WAY TO OVERCOME THE 480 00:20:56,889 --> 00:20:59,959 CHALLENGE AND WOULD BE USEFUL TO 481 00:20:59,959 --> 00:21:01,093 BECOME A COMPONENT IN THE GLOBAL 482 00:21:01,093 --> 00:21:02,261 MENTAL HEALTH MOVEMENT. 483 00:21:02,261 --> 00:21:05,030 THIS IS WHERE I THINK IT COULD 484 00:21:05,030 --> 00:21:07,533 BE MOST USEFUL IN MENTAL HEALTH 485 00:21:07,533 --> 00:21:09,068 CARE SYSTEMS THAT STRIVE TO 486 00:21:09,068 --> 00:21:11,370 BECOME MORE EFFICIENT TO WORK TO 487 00:21:11,370 --> 00:21:12,805 BE CLINICALLY SCALABLE. 488 00:21:12,805 --> 00:21:14,807 THIS IS WHERE STRATIFICATION OF 489 00:21:14,807 --> 00:21:16,275 PRECISION MEDICINE IS ANOTHER 490 00:21:16,275 --> 00:21:19,345 WORD FOR I THINK IS A SIMILAR 491 00:21:19,345 --> 00:21:20,713 APPROACH COULD PLAY OUT ITS 492 00:21:20,713 --> 00:21:22,548 STRENGTHS PARTICULARLY IN A TIME 493 00:21:22,548 --> 00:21:24,550 WHERE WE HAVE INCREDIBLY GROWING 494 00:21:24,550 --> 00:21:26,485 DENSITY OF INFORMATION BEING 495 00:21:26,485 --> 00:21:28,454 AVAILABLE THAT DESCRIBE THE 496 00:21:28,454 --> 00:21:28,788 INDIVIDUAL. 497 00:21:28,788 --> 00:21:34,026 THINK ABOUT DIGITAL PHENOTYPES 498 00:21:34,026 --> 00:21:35,794 BASED ON SMART PHONES AND 499 00:21:35,794 --> 00:21:38,264 WEARABLES OR ELECTRONIC MEDICAL 500 00:21:38,264 --> 00:21:39,632 RECORDS OR SOCIAL MEDIA AND ALSO 501 00:21:39,632 --> 00:21:43,235 BIOLOGICAL DATA BECOMES MORE 502 00:21:43,235 --> 00:21:44,370 COMMONPLACE THOUGH NOT AT THE 503 00:21:44,370 --> 00:21:46,505 SAME PACE WITH THE SAME LEVEL OF 504 00:21:46,505 --> 00:21:49,575 EQUAL ACCESS. 505 00:21:49,575 --> 00:21:55,214 AND FROM THIS GROWING DENSITY OF 506 00:21:55,214 --> 00:22:01,420 DATA AVAILABLE WE CAN EXTRACT 507 00:22:01,420 --> 00:22:03,722 PREDICTIVE MODELS USING MACHINE 508 00:22:03,722 --> 00:22:04,456 LEARNING OR ARTIFICIAL 509 00:22:04,456 --> 00:22:05,324 INTELLIGENCE. 510 00:22:05,324 --> 00:22:06,759 FOR THE UPCOMING MINUTES I WOULD 511 00:22:06,759 --> 00:22:11,030 LIKE TO INVITE YOU TO CRITICALLY 512 00:22:11,030 --> 00:22:14,500 APPRAISE WHAT THE OPPORTUNITIES 513 00:22:14,500 --> 00:22:17,002 ARE OF THESE THREE POINTS SO 514 00:22:17,002 --> 00:22:20,573 THAT BASICALLY THE DATA ACCESS, 515 00:22:20,573 --> 00:22:25,678 THE MULTI-MODAL POSSIBILITY TO 516 00:22:25,678 --> 00:22:27,213 DESCRIBE INDIVIDUAL AND USING 517 00:22:27,213 --> 00:22:28,514 MACHINE LEARNING TO ANALYZE DATA 518 00:22:28,514 --> 00:22:30,216 OR PREDICTIVE MODEL IN GENERAL. 519 00:22:30,216 --> 00:22:31,984 WHAT ARE THE POTENTIAL BENEFITS 520 00:22:31,984 --> 00:22:34,620 AND WHAT ARE ALSO THE CHALLENGES 521 00:22:34,620 --> 00:22:39,792 IN TERMS OF SUCCESS OF EQUITABLE 522 00:22:39,792 --> 00:22:40,125 CARE. 523 00:22:40,125 --> 00:22:42,828 WITH THAT I'D LIKE TO CLOSE MY 524 00:22:42,828 --> 00:22:43,996 SHORT INTRODUCTION AND HAND OVER 525 00:22:43,996 --> 00:22:44,663 TO MUNMUN. 526 00:22:44,663 --> 00:22:45,531 I HOPE SHE IS ONLINE. 527 00:22:45,531 --> 00:22:54,440 YES. 528 00:22:54,440 --> 00:22:56,575 MUNMUN, HI, GREAT TO SEE YOU. 529 00:22:56,575 --> 00:22:58,510 YOU CAN START. 530 00:22:58,510 --> 00:23:08,754 >> ALL RIGHT. 531 00:23:10,155 --> 00:23:11,824 >> COULD I GET AN OKAY FROM 532 00:23:11,824 --> 00:23:13,158 SOMEONE IF YOU SEE THE SLIDE 533 00:23:13,158 --> 00:23:18,030 SHOW OKAY ON THE ZOOM. 534 00:23:18,030 --> 00:23:20,833 >> YES. 535 00:23:20,833 --> 00:23:23,769 >> THANK YOU VERY MUCH. 536 00:23:23,769 --> 00:23:26,071 AND THANK YOU PROFESSOR. 537 00:23:26,071 --> 00:23:31,510 IT'S MY PLEASURE TO JOIN THIS 538 00:23:31,510 --> 00:23:36,482 MORNING AND APOLOGIES I COULDN'T 539 00:23:36,482 --> 00:23:38,350 BE THERE IN PERSON AND PLEASED 540 00:23:38,350 --> 00:23:39,318 TO REPRESENT THE WORK RELEVANT 541 00:23:39,318 --> 00:23:39,818 TO THE PANEL. 542 00:23:39,818 --> 00:23:42,154 MY TALK OVER THE NEXT FEW 543 00:23:42,154 --> 00:23:45,291 MINUTES WILL COVER SOME BENEFITS 544 00:23:45,291 --> 00:23:47,793 AS WELL AS HARMS AND CHALLENGES 545 00:23:47,793 --> 00:23:49,094 WE HAVE SEEN ARTIFICIAL 546 00:23:49,094 --> 00:23:51,397 INTELLIGENCE BROADLY SPEAKING TO 547 00:23:51,397 --> 00:23:53,966 OFFER IN THE CONTEXT OF MENTAL 548 00:23:53,966 --> 00:23:54,199 HEALTH. 549 00:23:54,199 --> 00:23:57,102 SO IN MANY WAYS THE FIELD OF 550 00:23:57,102 --> 00:23:58,404 MENTAL HEALTH OVER THE PAST 551 00:23:58,404 --> 00:24:02,308 DECADE OR SO HAS BEEN UNDERGOING 552 00:24:02,308 --> 00:24:05,778 WHAT I WOULD SAY A DIGITAL 553 00:24:05,778 --> 00:24:06,145 TRANSFORMATION. 554 00:24:06,145 --> 00:24:08,814 WE HAVE A LOT OF -- WE HAVE SEEN 555 00:24:08,814 --> 00:24:10,516 A LOT OF POTENTIAL OF A.I. IN 556 00:24:10,516 --> 00:24:13,485 GENERAL AND ALSO APPROACHES LIKE 557 00:24:13,485 --> 00:24:15,521 MACHINE LEARNING IN HOW IT IS 558 00:24:15,521 --> 00:24:18,424 TRANSFORMING -- HOW WE DO MENTAL 559 00:24:18,424 --> 00:24:19,525 HEALTH CARE AND HOW IT'S 560 00:24:19,525 --> 00:24:21,360 AVAILABLE TO PEOPLE. 561 00:24:21,360 --> 00:24:24,196 FOR INSTANCE, NOW WE HAVE RICH 562 00:24:24,196 --> 00:24:28,067 BODIES OF RESEARCH APPLIED. 563 00:24:28,067 --> 00:24:35,040 THINGS LIKE ANALYSIS AND NATURAL 564 00:24:35,040 --> 00:24:37,643 LANGUAGE PROCESS TO DETECT TEXT 565 00:24:37,643 --> 00:24:39,345 IN SPEECH AND SOCIAL MEDIA AND 566 00:24:39,345 --> 00:24:42,648 SO ON AND THESE STUDIES HAVE 567 00:24:42,648 --> 00:24:45,084 SHOWN COMPUTATIONAL ANALYSIS OF 568 00:24:45,084 --> 00:24:46,719 DIGITAL DATA CAN ACCURATELY 569 00:24:46,719 --> 00:24:54,460 DETECT MOOD AND EMOTION, SOCIAL 570 00:24:54,460 --> 00:25:02,401 DISENGAGEMENT, COGNITIVE 571 00:25:02,401 --> 00:25:02,701 PROCESSING. 572 00:25:02,701 --> 00:25:04,670 THE IMPLICATIONS OF THESE 573 00:25:04,670 --> 00:25:06,105 STUDIES HAVE BASICALLY RANGE 574 00:25:06,105 --> 00:25:08,207 FROM THE POTENTIAL TO PROVIDE A 575 00:25:08,207 --> 00:25:10,509 VARIETY OF INSIGHTS FOR 576 00:25:10,509 --> 00:25:13,479 APPLICATIONS IN SITUATIONS LIKE 577 00:25:13,479 --> 00:25:14,279 MONITORING PATIENTS TO PAVING 578 00:25:14,279 --> 00:25:17,182 THE WAY FOR EARLY INTERVENTIONS 579 00:25:17,182 --> 00:25:18,784 AMONG PEOPLE AND THE 580 00:25:18,784 --> 00:25:19,618 PERSONALIZED TREATMENT PLANS. 581 00:25:19,618 --> 00:25:22,521 I'LL TALK ABOUT ONLINE TOOLS IN 582 00:25:22,521 --> 00:25:26,125 THIS PRESENTATION. 583 00:25:26,125 --> 00:25:27,326 THAT COULD INCLUDE THINGS LIKE 584 00:25:27,326 --> 00:25:28,761 SOCIAL MEDIA OR OTHER TOOLS THAT 585 00:25:28,761 --> 00:25:31,130 ALLOW PEOPLE TO EXPRESS AND LOOK 586 00:25:31,130 --> 00:25:32,798 FOR INFORMATION AND TAKE A 587 00:25:32,798 --> 00:25:35,401 MOMENT TO INTRODUCE TO YOU SOME 588 00:25:35,401 --> 00:25:36,802 OF THESE BEFORE WE TALK ABOUT 589 00:25:36,802 --> 00:25:38,203 SOME OF THE CHALLENGES THAT WE 590 00:25:38,203 --> 00:25:42,574 HAVE SEEN TO EMERGE HERE. 591 00:25:42,574 --> 00:25:46,945 AND THE REASON I'M TALKING ABOUT 592 00:25:46,945 --> 00:25:51,650 ONLINE TOOLS AND THE USE HAVE 593 00:25:51,650 --> 00:25:52,151 SKRS 594 00:25:52,151 --> 00:25:53,285 SKYROCKETED OVER THE LAST FEW 595 00:25:53,285 --> 00:25:55,487 YEARS WITH OVER 80% OF 596 00:25:55,487 --> 00:25:57,389 U.S. ADULTS USING SOME FORM OF 597 00:25:57,389 --> 00:25:58,791 SOCIAL MEDIA PLATFORM IN THEIR 598 00:25:58,791 --> 00:26:03,996 LIVES PRETTY FREQUENTLY. 599 00:26:03,996 --> 00:26:06,765 I'LL START BY HIGHLIGHTING THE 600 00:26:06,765 --> 00:26:08,067 RESEARCH THAT MY COLLABORATORS 601 00:26:08,067 --> 00:26:11,069 AND MYSELF CONDUCTED ALMOST A 602 00:26:11,069 --> 00:26:15,207 DECADE BACK NOW THAT LAID THE 603 00:26:15,207 --> 00:26:19,244 FOUNDATION FOR RESEARCH AND WE 604 00:26:19,244 --> 00:26:24,049 EXPLORED ONLINE MEDIA AND IF IT 605 00:26:24,049 --> 00:26:25,884 CAN SUPPORT IDENTIFYING 606 00:26:25,884 --> 00:26:28,020 PHENOTYPES AND IF IT COULD BE 607 00:26:28,020 --> 00:26:31,089 ASSOCIATED OR BE PREDICTIVE OF 608 00:26:31,089 --> 00:26:32,825 THE CLINICAL DIAGNOSIS. 609 00:26:32,825 --> 00:26:34,393 WE RECRUITED INDIVIDUALS WHO 610 00:26:34,393 --> 00:26:38,330 CONSENTED TO GIVE US ACCESS TO 611 00:26:38,330 --> 00:26:41,533 THEIR FEEDS AND ALSO TO A MAJOR 612 00:26:41,533 --> 00:26:42,301 DEPRESSION SCREENING 613 00:26:42,301 --> 00:26:44,236 QUESTIONNAIRE WHICH GAVE US 614 00:26:44,236 --> 00:26:46,505 INFORMATION ABOUT THEIR CLINICAL 615 00:26:46,505 --> 00:26:53,512 MAJOR DEPRESSION. 616 00:26:53,512 --> 00:26:54,613 AND UNDERSTAND WHAT KINDS OF 617 00:26:54,613 --> 00:26:58,550 BEHAVIORS AND ENGAGEMENTS AND 618 00:26:58,550 --> 00:27:00,686 ACTIVITIES ON TWITTER COULD BE 619 00:27:00,686 --> 00:27:05,424 INDICATIVE OF THEIR MENTAL 620 00:27:05,424 --> 00:27:06,692 HEALTH CONDITION AND BUILDS TO 621 00:27:06,692 --> 00:27:08,327 PREDICT THE ONSET OF THE ILLNESS 622 00:27:08,327 --> 00:27:09,761 IN THESE INDIVIDUALS AND FOUND 623 00:27:09,761 --> 00:27:13,499 WE COULD BE QUITE SUCCESSFUL IN 624 00:27:13,499 --> 00:27:15,501 PREDICTING THESE KINDS OF 625 00:27:15,501 --> 00:27:20,105 OUTCOMES. 626 00:27:20,105 --> 00:27:22,774 WE ALSO LOOKED AT THE COMMUNITY 627 00:27:22,774 --> 00:27:24,877 LEVEL AND WE LOOKED AT TO WHAT 628 00:27:24,877 --> 00:27:27,546 EXTENT ONLINE ACTIVITIES AGAIN 629 00:27:27,546 --> 00:27:29,848 IN THE CONTEXT OF SOCIAL MEDIA 630 00:27:29,848 --> 00:27:31,416 COULD TELL US THINGS ABOUT 631 00:27:31,416 --> 00:27:32,851 SITUATED COMMUNITIES. 632 00:27:32,851 --> 00:27:34,286 IN THIS CASE BEING COLLEGE 633 00:27:34,286 --> 00:27:34,653 CAMPUSES. 634 00:27:34,653 --> 00:27:36,655 AND ONE APPLICATION WE LOOKED AT 635 00:27:36,655 --> 00:27:39,525 WHERE THIS KIND OF COMMUNITY 636 00:27:39,525 --> 00:27:40,492 LEVEL ASSESSMENT OF MENTAL 637 00:27:40,492 --> 00:27:41,560 HEALTH CAN BE PARTICULARLY 638 00:27:41,560 --> 00:27:43,629 HELPFUL IN THE CONTEXT OF 639 00:27:43,629 --> 00:27:44,930 COMMUNITIES EXPERIENCING CRISIS 640 00:27:44,930 --> 00:27:45,264 EVENTS. 641 00:27:45,264 --> 00:27:49,201 WE LOOKED AT 12 INCIDENTS OF GUN 642 00:27:49,201 --> 00:27:52,504 VIOLENCE AT 12 UNIVERSITIES IN 643 00:27:52,504 --> 00:27:54,706 THE U.S. EXPERIENCED OVER THE 644 00:27:54,706 --> 00:27:57,342 PERIOD OF FIVE YEARS AND EXPLORE 645 00:27:57,342 --> 00:27:59,444 HOW STRESS AND ANXIETY EVOLVES 646 00:27:59,444 --> 00:28:01,813 AROUND THESE EVENTS AND CAN WE 647 00:28:01,813 --> 00:28:06,485 GET AN ASSESSMENT OF THE DRIVERS 648 00:28:06,485 --> 00:28:08,654 OR STRESSORS THAT UNFOLD IN THE 649 00:28:08,654 --> 00:28:10,155 COMMUNITIES AFTER THE EVENTS AND 650 00:28:10,155 --> 00:28:11,256 SOCIAL MEDIA CAN BE A GREAT WAY 651 00:28:11,256 --> 00:28:12,724 TO UNDERSTAND WHAT THE STRESSORS 652 00:28:12,724 --> 00:28:14,927 COULD BE AND HOW DIFFERENT 653 00:28:14,927 --> 00:28:16,194 INCIDENTS OF CRISIS IMPACT THE 654 00:28:16,194 --> 00:28:19,698 MEMBERS OF THE COMMUNITY. 655 00:28:19,698 --> 00:28:21,266 FINALLY, WE ALSO LOOKED AT THE 656 00:28:21,266 --> 00:28:23,202 POPULATION CONTEXT AND THIS WAS 657 00:28:23,202 --> 00:28:25,604 IN THE CONTEXT OF THE COVID-19 658 00:28:25,604 --> 00:28:25,871 PANDEMIC. 659 00:28:25,871 --> 00:28:27,372 OVER THE FIRST 18 MONTHS OF THE 660 00:28:27,372 --> 00:28:29,041 PANDEMIC WE WANTED TO SEE TO 661 00:28:29,041 --> 00:28:31,510 WHAT EXTENT WE CAN UNDERSTAND 662 00:28:31,510 --> 00:28:33,679 THE PSYCHOSOCIAL CONCERNS PEOPLE 663 00:28:33,679 --> 00:28:34,947 WERE EXPERIENCING AT THAT POINT 664 00:28:34,947 --> 00:28:36,748 IN TIME AND THE KINDS OF MENTAL 665 00:28:36,748 --> 00:28:38,016 HEALTH CHALLENGES THEY WERE 666 00:28:38,016 --> 00:28:39,151 UNDERGOING AT THAT MOMENT. 667 00:28:39,151 --> 00:28:42,354 AND WE FOUND THAT IN THESE 18 668 00:28:42,354 --> 00:28:45,223 MONTHS OF THE PANDEMIC WE 669 00:28:45,223 --> 00:28:47,759 OBSERVED HEIGHTENED LEVELS OF A 670 00:28:47,759 --> 00:28:49,261 VARIETY OF MENTAL HEALTH 671 00:28:49,261 --> 00:28:50,195 CONCERNS WHETHER IT'S 672 00:28:50,195 --> 00:28:53,165 DEPRESSION, ANXIETY, STRESS OR 673 00:28:53,165 --> 00:28:54,700 SUICIDAL IDEATION AND 674 00:28:54,700 --> 00:28:57,169 IMPORTANTLY A LOT OF THESE WERE 675 00:28:57,169 --> 00:28:58,870 SIGNIFICANTLY HIGHER THAN THE 676 00:28:58,870 --> 00:29:00,939 LEVELS THAT THE SAME POPULATIONS 677 00:29:00,939 --> 00:29:02,507 EXPERIENCE THE YEAR BEFORE THE 678 00:29:02,507 --> 00:29:04,142 PANDEMIC IN 2019. 679 00:29:04,142 --> 00:29:05,911 BUT NOT JUST THAT SOCIAL MEDIA 680 00:29:05,911 --> 00:29:11,516 AND THE ONLINE PLATFORMS WERE 681 00:29:11,516 --> 00:29:13,452 ALSO PLACES AND TALK ABOUT 682 00:29:13,452 --> 00:29:15,687 MENTAL HEALTH STRUGGLES. 683 00:29:15,687 --> 00:29:18,190 WE SAW HOW SOCIAL MEDIA BECAME 684 00:29:18,190 --> 00:29:22,527 THE PLATFORM WHERE WE WERE 685 00:29:22,527 --> 00:29:26,164 BEGINNING TO SEE NORMALIZATION 686 00:29:26,164 --> 00:29:28,100 OF MENTAL HEALTH ISSUES THAT 687 00:29:28,100 --> 00:29:30,469 CAME WITH THE PANDEMIC AND 688 00:29:30,469 --> 00:29:32,604 PEOPLE LOOKED FOR EMOTIONAL AND 689 00:29:32,604 --> 00:29:33,572 INFORMATIONAL SUPPORT ON THE 690 00:29:33,572 --> 00:29:35,540 RIGHT SIDE OF THE SLIDE. 691 00:29:35,540 --> 00:29:37,943 IN FACT, THOSE SUPPORT-SEEKING 692 00:29:37,943 --> 00:29:40,746 BEHAVIORS ALSO WERE MUCH HIGHER 693 00:29:40,746 --> 00:29:43,515 THAN IN A SIMILAR AMOUNT OF TIME 694 00:29:43,515 --> 00:29:45,450 BEFORE THE PANDEMIC. 695 00:29:45,450 --> 00:29:48,353 SO I WANT TO TURN TO THE 696 00:29:48,353 --> 00:29:49,788 CHALLENGE. 697 00:29:49,788 --> 00:29:53,959 THIS SEEMS PROMISING AND IF 698 00:29:53,959 --> 00:29:56,662 THESE ARE SO PROMISING WHY ARE 699 00:29:56,662 --> 00:29:59,364 WE NOT SEEING THE A.I.-BASED 700 00:29:59,364 --> 00:29:59,665 APPROACHES? 701 00:29:59,665 --> 00:30:02,701 I'LL BE REFLECTING ON THE 702 00:30:02,701 --> 00:30:05,037 IMPEDIMENTS IN THE FORM OF 703 00:30:05,037 --> 00:30:06,338 BIASES AND HARMS SEVERAL 704 00:30:06,338 --> 00:30:08,440 SCHOLARS INCLUDING MYSELF HAVE 705 00:30:08,440 --> 00:30:10,308 SEEN TO EMERGE AND THAT IS A 706 00:30:10,308 --> 00:30:12,310 SIGNIFICANT BARRIER THAT WE HAVE 707 00:30:12,310 --> 00:30:15,814 TO OVERCOME IN ORDER FOR A.I. TO 708 00:30:15,814 --> 00:30:19,851 BE SUCCESSFUL IN THE CONTEXT OF 709 00:30:19,851 --> 00:30:22,120 STRATIFIED PSYCHIATRIC. 710 00:30:22,120 --> 00:30:26,291 LET'S TALK ABOUT VALIDITY OF THE 711 00:30:26,291 --> 00:30:28,593 A.I.-BASED ASSESSMENTS. 712 00:30:28,593 --> 00:30:30,529 WE WANTED TO EXPLORE HOW IS IT 713 00:30:30,529 --> 00:30:33,065 THESE MODELS THESE A.I. 714 00:30:33,065 --> 00:30:34,533 APPROACHES HAVE BEEN BUILT ON 715 00:30:34,533 --> 00:30:35,300 SOCIAL MEDIA DATA? 716 00:30:35,300 --> 00:30:37,269 WHAT KINDS OF SIGNALS HAVE BEEN 717 00:30:37,269 --> 00:30:38,770 LEARNED FROM AND WE FOUND A LOT 718 00:30:38,770 --> 00:30:42,274 OF THE WORK ACTUALLY OFTEN 719 00:30:42,274 --> 00:30:44,009 DOESN'T USE CLINICAL ASSESSMENTS 720 00:30:44,009 --> 00:30:45,143 AS A SOURCE OF INFORMATION TO 721 00:30:45,143 --> 00:30:47,946 BUILD THE MODELS ON BUT RATHER 722 00:30:47,946 --> 00:30:49,481 RELY ON A SET OF PROXIES. 723 00:30:49,481 --> 00:30:52,350 SO WHAT ARE SOME OF THESE 724 00:30:52,350 --> 00:30:52,818 PROXIES? 725 00:30:52,818 --> 00:30:55,187 THEY COULD BE THINGS LIKE PEOPLE 726 00:30:55,187 --> 00:30:57,823 FOLLOW A SUDDEN MENTAL HEALTH 727 00:30:57,823 --> 00:31:00,392 ACCOUNT ON SOCIAL MEDIA OR 728 00:31:00,392 --> 00:31:01,993 LOOKING FOR SUPPORT ON AN ONLINE 729 00:31:01,993 --> 00:31:12,337 COMMUNITY AND SO ON. 730 00:31:17,242 --> 00:31:21,079 AND RELYING ON PROXY COMES AT A 731 00:31:21,079 --> 00:31:21,279 COST. 732 00:31:21,279 --> 00:31:23,381 WE SHOWED COMPARED TO MODELS 733 00:31:23,381 --> 00:31:25,650 THAT ARE TRAINED ON PATIENT 734 00:31:25,650 --> 00:31:27,486 POPULATIONS IN THIS CASE 735 00:31:27,486 --> 00:31:29,554 PATIENTS DIAGNOSED WITH 736 00:31:29,554 --> 00:31:30,422 SCHIZOPHRENIA SPECTRUM DISORDER, 737 00:31:30,422 --> 00:31:32,858 WHEN WE LOOK AT THE PROXIES AND 738 00:31:32,858 --> 00:31:34,993 BUILD A.I. MODELS WITH PROXIES 739 00:31:34,993 --> 00:31:37,262 AS A SOURCE OF GROUND TRUTH, WE 740 00:31:37,262 --> 00:31:40,599 DO PRETTY POORLY WHEN IT COMES 741 00:31:40,599 --> 00:31:41,733 TO THE VID TI. 742 00:31:41,733 --> 00:31:51,409 IT MEANS A LOT OF THESE PROXYIE 743 00:31:51,409 --> 00:31:53,078 BUT MAY NOT BE MEASURING WHAT 744 00:31:53,078 --> 00:31:54,412 THEY INTEND TO MEASURE. 745 00:31:54,412 --> 00:31:56,515 IN THIS CASE THE DIAGNOSIS OF A 746 00:31:56,515 --> 00:31:58,884 SERIOUS MENTAL ILLNESS LIKE 747 00:31:58,884 --> 00:31:59,217 SCHIZOPHRENIA. 748 00:31:59,217 --> 00:32:00,719 SO THERE'S A PROBLEM. 749 00:32:00,719 --> 00:32:03,054 IF YOU WANT THESE MODELS TO BE 750 00:32:03,054 --> 00:32:04,289 SUCCESSFUL AND IMPLEMENTED IN 751 00:32:04,289 --> 00:32:08,760 THE REAL WORLD WE HAVE TO PAY 752 00:32:08,760 --> 00:32:13,198 ATTENTION TO THESE VALIDITY 753 00:32:13,198 --> 00:32:13,431 ISSUES. 754 00:32:13,431 --> 00:32:14,900 THE NEXT CENTER AROUND EFFICACY. 755 00:32:14,900 --> 00:32:19,104 THIS IS EQUALLY IMPORTANT. 756 00:32:19,104 --> 00:32:22,741 WE WANT THE WANT THEM TO WORK 757 00:32:22,741 --> 00:32:27,078 WELL WHEN IMPLEMENTS IN THE 758 00:32:27,078 --> 00:32:27,779 REAL WORLD. 759 00:32:27,779 --> 00:32:30,782 TO UNDERSTAND HOW EFFICACY CAN 760 00:32:30,782 --> 00:32:31,917 BE A PROBLEM IN THE A.I. MODELS 761 00:32:31,917 --> 00:32:33,485 WE HAVE TO UNDERSTAND THE 762 00:32:33,485 --> 00:32:34,519 STRUCTURE AND THE WAY THESE 763 00:32:34,519 --> 00:32:38,323 MODELS WORK. 764 00:32:38,323 --> 00:32:41,092 NORMALLY WHAMZ IS THERE'S AN 765 00:32:41,092 --> 00:32:41,393 INDIVIDUAL. 766 00:32:41,393 --> 00:32:43,628 WE OBTAIN DATA ABOUT THE 767 00:32:43,628 --> 00:32:45,964 INDIVIDUAL AND MAYBE ONLINE DATA 768 00:32:45,964 --> 00:32:51,736 THEY CONSENT TO SHARE WITH THE 769 00:32:51,736 --> 00:32:54,606 TEAM AND HAVE INFORMATION AN 770 00:32:54,606 --> 00:32:55,507 INDIVIDUAL SHARES ABOUT THEIR 771 00:32:55,507 --> 00:33:03,248 MENTAL HEALTH. 772 00:33:03,248 --> 00:33:04,916 AND THAT SHOULD HAVE GOOD 773 00:33:04,916 --> 00:33:05,317 EFFICACY. 774 00:33:05,317 --> 00:33:07,185 WHAT'S THE PROBLEM? 775 00:33:07,185 --> 00:33:08,553 THE PROBLEM IS THAT A LOT OF 776 00:33:08,553 --> 00:33:11,289 THESE ONLINE LANGUAGES ARE NOT 777 00:33:11,289 --> 00:33:11,957 ACTUALLY LEARNING THINGS ABOUT 778 00:33:11,957 --> 00:33:17,095 THE MENTAL HEALTH OF THE PERSON 779 00:33:17,095 --> 00:33:18,797 BUT LEARNING A REPRESENTATION OF 780 00:33:18,797 --> 00:33:19,898 THAT MENTAL HEALTH. 781 00:33:19,898 --> 00:33:22,534 WHAT'S THAT MEAN? 782 00:33:22,534 --> 00:33:26,605 IT MEANS THE REALITY IS THAT 783 00:33:26,605 --> 00:33:28,340 MANY MENTAL HEALTH STATES THEY 784 00:33:28,340 --> 00:33:29,307 HAVE DIFFERENT REPRESENTATIONS 785 00:33:29,307 --> 00:33:30,141 IN OUR MIND. 786 00:33:30,141 --> 00:33:33,044 IF I ASK SOMEONE A QUESTION, 787 00:33:33,044 --> 00:33:34,546 THEY COULD SELF-REPORT WHICH 788 00:33:34,546 --> 00:33:36,581 WOULD BE THEIR PSYCHOLOGICAL 789 00:33:36,581 --> 00:33:37,716 EVALUATION OF THEIR EXPERIENCE, 790 00:33:37,716 --> 00:33:40,018 THEIR STRESS OR ANXIETY OR COULD 791 00:33:40,018 --> 00:33:40,819 BE A PHYSICAL REPRESENTATION OF 792 00:33:40,819 --> 00:33:43,889 THE MENTAL HEALTH STATE WHICH 793 00:33:43,889 --> 00:33:44,923 COULD BE AGAIN FOR THE 794 00:33:44,923 --> 00:33:46,725 EXPERIENCE OF STRESS OR ANXIETY 795 00:33:46,725 --> 00:33:48,627 COULD BE THEIR HEART RATE. 796 00:33:48,627 --> 00:33:52,030 IN MANY WAYS A LOT OF THE MODEL 797 00:33:52,030 --> 00:33:53,832 LEARNING THAT REPRESENTATION AND 798 00:33:53,832 --> 00:33:58,803 THAT CREATES WHAT WE CALL A 799 00:33:58,803 --> 00:34:00,772 SEMANTIC GAP WHEN THERE'S A 800 00:34:00,772 --> 00:34:01,806 SEMANTIC GAP CERTAIN KINDS OF 801 00:34:01,806 --> 00:34:03,408 DATA ARE ONLY GOOD AT LEARNING 802 00:34:03,408 --> 00:34:05,277 CERTAIN KINDS OF ASPECTS OR 803 00:34:05,277 --> 00:34:10,248 REPRESENTATIONS OF THE MENTAL 804 00:34:10,248 --> 00:34:13,285 HEALTH EXPERIENCE IF WE LOOK AT 805 00:34:13,285 --> 00:34:14,686 THE LANGUAGE AND BUILD THE 806 00:34:14,686 --> 00:34:20,425 MODELS WE COULD BE PRETTY GOOD 807 00:34:20,425 --> 00:34:23,828 AT ASSESSING THE MENTAL HEALTH 808 00:34:23,828 --> 00:34:24,396 STATE. 809 00:34:24,396 --> 00:34:27,899 THE PSYCHOLOGICAL NATURE THE 810 00:34:27,899 --> 00:34:29,301 SELF-REPORT OF STRESS OR ANXIETY 811 00:34:29,301 --> 00:34:31,803 BUT NOT SO GOOD IN MEASURING THE 812 00:34:31,803 --> 00:34:33,872 PHYSICAL MANIFESTATION OF MENTAL 813 00:34:33,872 --> 00:34:38,777 HEALTH CHALLENGE. 814 00:34:38,777 --> 00:34:42,580 AS WE THINK ABOUT WE HAVE TO PAY 815 00:34:42,580 --> 00:34:44,149 ATTENTION WHAT IS BEING LEARNED 816 00:34:44,149 --> 00:34:46,418 FROM AND THE REPRESENTATION OF 817 00:34:46,418 --> 00:34:49,621 MENTAL HEALTH WE ARE LEARNING. 818 00:34:49,621 --> 00:34:51,923 THAT'S BECAUSE WE NEED NEED TO 819 00:34:51,923 --> 00:34:55,160 ACCOUNT FOR THE SEMANTIC GAP. 820 00:34:55,160 --> 00:34:58,563 THAT'S TRUE FOR ANY A.I. MODEL 821 00:34:58,563 --> 00:35:03,068 WE BUILD ON DATA. 822 00:35:03,068 --> 00:35:04,603 NEXT ISSUE IS AROUND 823 00:35:04,603 --> 00:35:05,003 GENERALIZABILITY. 824 00:35:05,003 --> 00:35:07,505 THIS SAY QUESTION WE OFTEN ASK 825 00:35:07,505 --> 00:35:09,040 AS RESEARCHERS IN MANY DOMAINS. 826 00:35:09,040 --> 00:35:12,510 IT'S STATED WHEN WE TALK ABOUT 827 00:35:12,510 --> 00:35:13,345 MENTAL HEALTH AND THE 828 00:35:13,345 --> 00:35:16,114 APPLICATION OF A.I. FOR 829 00:35:16,114 --> 00:35:20,685 STRATIFIED PSYCHIATRY. 830 00:35:20,685 --> 00:35:22,921 ONLINE LANGUAGE NOT A MONOLITH. 831 00:35:22,921 --> 00:35:26,424 WE EXPRESS OURSELVES IN 832 00:35:26,424 --> 00:35:27,759 DIFFERENT WAYS ON DIFFERENT 833 00:35:27,759 --> 00:35:29,227 PLATFORMS ON THE INTERNET. 834 00:35:29,227 --> 00:35:31,196 OUR DIFFERENT FACETS ARE 835 00:35:31,196 --> 00:35:33,398 REPRESENTED IN EACH OF THOSE 836 00:35:33,398 --> 00:35:34,399 PLATFORMS AND THEY COULD BE 837 00:35:34,399 --> 00:35:36,768 QUITE DISTINCT FOR EACH OTHER. 838 00:35:36,768 --> 00:35:39,904 IF YOU ARE A LOT OF ARE LINKED 839 00:35:39,904 --> 00:35:41,239 IN AND USE FOR PROFESSIONAL 840 00:35:41,239 --> 00:35:43,675 PURPOSES BUT FACEBOOK MAY BE FOR 841 00:35:43,675 --> 00:35:45,276 PERSONAL PURPOSES AND SO ON. 842 00:35:45,276 --> 00:35:47,512 THE SUM OF THOSE FRAGMENTS IS 843 00:35:47,512 --> 00:35:54,152 WHAT MAKES US THE PERSON WE ARE. 844 00:35:54,152 --> 00:35:56,054 THE CHALLENGE IS IF YOU LOOK AT 845 00:35:56,054 --> 00:35:57,255 EXISTING MODELS OF WORK WE BUILD 846 00:35:57,255 --> 00:35:58,656 THESE ON A SINGLE SOURCE OF DATA 847 00:35:58,656 --> 00:36:00,291 WHICH COULD BE A SINGLE SOURCE 848 00:36:00,291 --> 00:36:01,693 OF ONLINE LANGUAGE THAT COMES 849 00:36:01,693 --> 00:36:03,628 FROM ONE PLATFORM. 850 00:36:03,628 --> 00:36:06,097 AND THAT CREATES A PROBLEM IF 851 00:36:06,097 --> 00:36:10,301 YOU WANT TO GENERALIZE TO OTHER 852 00:36:10,301 --> 00:36:11,336 CONTEXT. 853 00:36:11,336 --> 00:36:12,337 WE COULD BE GENERALIZING TO 854 00:36:12,337 --> 00:36:13,905 OTHER POPULATIONS WHO HAY NOT 855 00:36:13,905 --> 00:36:15,940 USE THE SAME PLATFORM. 856 00:36:15,940 --> 00:36:17,842 WE COULD BE GENERALIZING TO 857 00:36:17,842 --> 00:36:23,214 CONTEXT WHERE OTHER PLATFORMS 858 00:36:23,214 --> 00:36:27,752 MIGHT BE POPULAR OR MIGHT BE 859 00:36:27,752 --> 00:36:28,853 INTERESTED IN GENERALIZING TO 860 00:36:28,853 --> 00:36:32,023 FIVE OR SEVEN YEARS LATER WHERE 861 00:36:32,023 --> 00:36:33,024 THE PERSON HAS MOVED ON FROM THE 862 00:36:33,024 --> 00:36:35,860 PLATFORM AND NO LONGER USES IT. 863 00:36:35,860 --> 00:36:37,696 THIS CREATES CHALLENGE IN 864 00:36:37,696 --> 00:36:41,199 ENSURING THE GENERALIZABILITY OF 865 00:36:41,199 --> 00:36:45,070 THE A.I. MODELS WE BUILT OFTEN 866 00:36:45,070 --> 00:36:46,137 IT'S TIED TO SPECIFIC DATA AT 867 00:36:46,137 --> 00:36:47,939 POINT IN TIME AND FOR THESE TO 868 00:36:47,939 --> 00:36:49,507 WORK MOVING FORWARD WE HAVE TO 869 00:36:49,507 --> 00:36:52,143 THINK HOW WE PULLED TOGETHER THE 870 00:36:52,143 --> 00:36:53,578 FRAGMENTS OF THE INDIVIDUAL THAT 871 00:36:53,578 --> 00:36:55,146 LIE ACROSS THESE DIFFERENT 872 00:36:55,146 --> 00:36:56,281 DIGITAL PLATFORMS IN ORDER TO 873 00:36:56,281 --> 00:36:58,716 GET A WHOLISTIC SENSE OF WHO 874 00:36:58,716 --> 00:37:00,752 THEY ARE AND TO BOLSTER THE 875 00:37:00,752 --> 00:37:03,521 GENERALIZE OF THE ASSESSMENTS 876 00:37:03,521 --> 00:37:06,224 THAT WE MAKE. 877 00:37:06,224 --> 00:37:08,259 FINALLY, I WOULD LIKE TO TALK 878 00:37:08,259 --> 00:37:14,232 ABOUT CREDIBILITY OF THESE A.I. 879 00:37:14,232 --> 00:37:16,468 MODELS OVER THE LAST YEAR OR SO 880 00:37:16,468 --> 00:37:19,504 WE HAVE GOTTEN FAMILIAR WITH 881 00:37:19,504 --> 00:37:21,473 LANGUAGE MODELS. 882 00:37:21,473 --> 00:37:23,575 NOT BECAUSE IT'S A NEW 883 00:37:23,575 --> 00:37:24,442 TECHNOLOGY THAT'S BEEN AROUND 884 00:37:24,442 --> 00:37:26,077 THE LAST FIVE, SEVEN YEARS BUT 885 00:37:26,077 --> 00:37:30,482 WE NOW HAVE A SIMPLE TO USE, 886 00:37:30,482 --> 00:37:31,649 USER-FRIENDLY INTERFACE IN TERMS 887 00:37:31,649 --> 00:37:35,420 OF A TOOL KNOWN AS CHAT GPT. 888 00:37:35,420 --> 00:37:38,056 IT HAS PUT LARGE LANGUAGE MODELS 889 00:37:38,056 --> 00:37:40,358 A TYPE OF GENERATIVE A.I. INTO 890 00:37:40,358 --> 00:37:46,431 THE HANDS OF THE REGULAR PERSON. 891 00:37:46,431 --> 00:37:51,903 THIS HAS CREATED A LOT OF 892 00:37:51,903 --> 00:37:55,507 CONFERENCE LIKE CAN THESE BE A 893 00:37:55,507 --> 00:37:58,543 CHATBOT OR MEET THE TREATMENT 894 00:37:58,543 --> 00:38:07,218 AND CARE GAPS WE SEE IN RESOURCE 895 00:38:07,218 --> 00:38:08,419 CONSTRAINED AREAS AND IS THE 896 00:38:08,419 --> 00:38:10,889 INFORMATION PROVIDED BY THESE 897 00:38:10,889 --> 00:38:15,827 MODELS ACCURATE NORT. 898 00:38:15,827 --> 00:38:20,031 WE FIND IT TURNS OUT THEY MAY 899 00:38:20,031 --> 00:38:23,001 NOT BE AND THE ADVOCATE FOR 900 00:38:23,001 --> 00:38:25,170 LARGE LANGUAGE MODELS TO WORK WE 901 00:38:25,170 --> 00:38:26,638 HAVE INDIVIDUALS FOR WHOM THE 902 00:38:26,638 --> 00:38:32,277 PRIMARY LANGUAGE IS NOT ENGLISH. 903 00:38:32,277 --> 00:38:34,445 HOW WILL THEY BE PERFORMED WHEN 904 00:38:34,445 --> 00:38:37,348 WE INTEND TUESDAY THEM IN 905 00:38:37,348 --> 00:38:41,953 NON-ENGLISH CONTEXT. 906 00:38:41,953 --> 00:38:44,789 WE SEE FOR SPANISH, CHINESE AND 907 00:38:44,789 --> 00:38:46,891 HINDI THE RESPONSES PROVIDED BY 908 00:38:46,891 --> 00:38:49,561 STATE OF THE ART LARGE LANGUAGE 909 00:38:49,561 --> 00:38:52,664 MODELS ARE LESS CORRECT AND LESS 910 00:38:52,664 --> 00:38:58,136 THAN VERIFIABLE WITH 911 00:38:58,136 --> 00:38:58,837 COUNTERPARTS. 912 00:38:58,837 --> 00:39:01,873 WE SEE AN 18% DECREASE IN THE 913 00:39:01,873 --> 00:39:03,241 COMPREHENSIVENESS OF THE ANSWERS 914 00:39:03,241 --> 00:39:05,176 PROVIDED BY LARGE LANGUAGE 915 00:39:05,176 --> 00:39:07,178 MODELS TO TYPICAL HEALTH 916 00:39:07,178 --> 00:39:07,579 QUERIES. 917 00:39:07,579 --> 00:39:10,615 WE FIND THEY'RE LESS CONSISTENT 918 00:39:10,615 --> 00:39:12,016 ACROSS DIFFERENT RUNGS WHEN YOU 919 00:39:12,016 --> 00:39:17,889 ASK THE CHATBOT THE SAME 920 00:39:17,889 --> 00:39:18,523 QUESTI 921 00:39:18,523 --> 00:39:23,761 QUESTIONS AND LESS VERY FINALLY 922 00:39:23,761 --> 00:39:26,798 AND WE LOOKED AT THE QUALITY OF 923 00:39:26,798 --> 00:39:28,499 NON-ENGLISH RESPONSES BY LARGE 924 00:39:28,499 --> 00:39:30,134 LANGUAGE MODELS AND THERE WAS A 925 00:39:30,134 --> 00:39:31,002 SIGNIFICANT DROP IN EVALUATION 926 00:39:31,002 --> 00:39:35,807 WHEN IT COMES TO THE QUALITY AND 927 00:39:35,807 --> 00:39:36,708 CREDIBILITY OF THE INFORMATION 928 00:39:36,708 --> 00:39:38,443 PROVIDED BY THE LARGE LANGUAGE 929 00:39:38,443 --> 00:39:38,676 MODELS. 930 00:39:38,676 --> 00:39:42,947 TO WRAP IT UP I REFLECTED OVER 931 00:39:42,947 --> 00:39:44,048 THE LAST FEW MINUTES THE 932 00:39:44,048 --> 00:39:47,118 QUESTIONS WE SEE AND THE 933 00:39:47,118 --> 00:39:49,888 DIFFERENT BIASES AND HARMS WE'D 934 00:39:49,888 --> 00:39:53,358 NEED TO COVER COME. 935 00:39:53,358 --> 00:39:54,859 A.I. PROVIDES A LOT OF POTENTIAL 936 00:39:54,859 --> 00:39:56,594 FOR STRATIFIED PSYCHIATRY BUT 937 00:39:56,594 --> 00:40:00,398 IT'S NOT A PLACE WHERE WE SHOULD 938 00:40:00,398 --> 00:40:01,799 RUSH TO IMPLEMENTATION BUT 939 00:40:01,799 --> 00:40:03,501 PAUSE, REFLECT, UNDERSTAND AND 940 00:40:03,501 --> 00:40:05,536 WORK ON FIXING SOME OF THE 941 00:40:05,536 --> 00:40:07,505 ISSUES THAT ARE TURNING OUT TO 942 00:40:07,505 --> 00:40:10,541 BE AN IMPEDIMENT TO THE USE OF 943 00:40:10,541 --> 00:40:13,978 A.I. IN THE REAL WORLD. 944 00:40:13,978 --> 00:40:14,445 THANK YOU VERY MUCH. 945 00:40:14,445 --> 00:40:24,889 THAT'S ALL I HAVE FOR YOU. 946 00:40:27,292 --> 00:40:28,526 . 947 00:40:28,526 --> 00:40:30,228 THANK YOU. 948 00:40:30,228 --> 00:40:34,565 SHE'S AN ASSOCIATE PROFESSOR AT 949 00:40:34,565 --> 00:40:39,437 GEORGIA TECH AND ANALYZES SOCIAL 950 00:40:39,437 --> 00:40:40,705 MEDIA DATA WITH MACHINE LEARNING 951 00:40:40,705 --> 00:40:43,541 AND REFLECTIVE ON THE PROS AND 952 00:40:43,541 --> 00:40:45,109 CONS OF THIS COMBINATION. 953 00:40:45,109 --> 00:40:50,114 LET US QUICKLY MOVE ON. 954 00:40:50,114 --> 00:40:51,616 THE NEXT SPEAKER IS A PROFESSOR 955 00:40:51,616 --> 00:40:56,020 FOR PSYCHIATRY AT THE KINGS 956 00:40:56,020 --> 00:40:57,722 COLLEGE LONDON AND NEUROSCIENCE. 957 00:40:57,722 --> 00:40:59,691 ONE OF THE MOST PROLIFIC 958 00:40:59,691 --> 00:41:01,626 RESEARCHERS IN THE FIELD OF 959 00:41:01,626 --> 00:41:02,460 EARLY DETECTION AND RECOGNITION 960 00:41:02,460 --> 00:41:07,498 OF PSYCHOSIS AND HAS ALSO DONE 961 00:41:07,498 --> 00:41:09,534 TERRIFIC WORK IN BRINGING OR 962 00:41:09,534 --> 00:41:12,236 DEVELOPING MODELS THAT COULD 963 00:41:12,236 --> 00:41:13,571 ALLOW US TO SCALE EARLY 964 00:41:13,571 --> 00:41:18,676 DETECTION IN DIFFERENT 965 00:41:18,676 --> 00:41:27,285 POPULATIONS. 966 00:41:27,285 --> 00:41:28,820 PAOLO THE STAGE IS YOURS. 967 00:41:28,820 --> 00:41:31,856 >> I'VE BEEN ASKED TO TALK ABOUT 968 00:41:31,856 --> 00:41:32,724 IMPLEMENTATION OF THE GLOBAL 969 00:41:32,724 --> 00:41:35,360 STRATEGY TO SCREEN AND DETECT 970 00:41:35,360 --> 00:41:45,403 EMERGING MENTAL DISORDERS. 971 00:41:45,403 --> 00:41:48,272 I WILL FOCUS ON PSYCHOSIS BUT IT 972 00:41:48,272 --> 00:41:51,109 CAN BE EXTENDED TO OTHER MENTAL 973 00:41:51,109 --> 00:41:51,376 DISORDERS. 974 00:41:51,376 --> 00:41:53,678 I'D LIKE START AND CONCLUDE MY 975 00:41:53,678 --> 00:41:55,880 LECTURE WITH THE PRESENTATION 976 00:41:55,880 --> 00:41:57,382 WITH THE PERSPECTIVE OF THE 977 00:41:57,382 --> 00:41:57,682 EXPERIENCE. 978 00:41:57,682 --> 00:42:01,619 WHAT IS PSYCHOSIS? 979 00:42:01,619 --> 00:42:05,523 WE RECENTLY PRODUCED AN ARTICLE 980 00:42:05,523 --> 00:42:10,862 WITH THE EXPERIENCE OF PSYCHOSIS 981 00:42:10,862 --> 00:42:14,766 AND PSYCHOSIS IS ONE OF THE MOST 982 00:42:14,766 --> 00:42:16,768 PAINFUL AND UPSETTING 983 00:42:16,768 --> 00:42:17,668 EXISTENTIAL EXPERIENCE. 984 00:42:17,668 --> 00:42:23,808 ALIEN TO OUR PATTERNS OF LIFE, 985 00:42:23,808 --> 00:42:26,411 AT THE SAME TIME ENIGMATIC AND 986 00:42:26,411 --> 00:42:26,677 HUMAN. 987 00:42:26,677 --> 00:42:28,312 BECAUSE IT'S ASSOCIATED WITH 988 00:42:28,312 --> 00:42:29,981 HIGH SUBJECTIVE AND PERSONAL 989 00:42:29,981 --> 00:42:31,282 BURDEN IT'S CLEAR WE NEED TO 990 00:42:31,282 --> 00:42:34,318 INTERVENE AND TRY TO IMPROVE 991 00:42:34,318 --> 00:42:37,255 OUTCOMES AND PREVENT PSYCHOSIS 992 00:42:37,255 --> 00:42:39,357 AND THE FIRST STEP IS TO DETECT 993 00:42:39,357 --> 00:42:42,126 AND SCREEN YOUNG PEOPLE WHO MAY 994 00:42:42,126 --> 00:42:43,694 BE ACTUALLY DEVELOPING THE 995 00:42:43,694 --> 00:42:43,995 DISORDER. 996 00:42:43,995 --> 00:42:48,132 FOR 80% OF THE CASES, PSYCHOSIS 997 00:42:48,132 --> 00:42:50,535 TYPICALLY DEVELOPS FROM A 998 00:42:50,535 --> 00:42:56,040 CLINICAL STAGING MODEL AND 999 00:42:56,040 --> 00:42:58,543 EVOLVES AS THE SYMPTOMS 1000 00:42:58,543 --> 00:42:59,510 INTENSIFY UNTIL THE FIRST 1001 00:42:59,510 --> 00:43:00,978 EPISODE OF THE DISORDER. 1002 00:43:00,978 --> 00:43:04,515 TO DATE, WE CAN IDENTIFY YOUNG 1003 00:43:04,515 --> 00:43:07,351 PEOPLE WITH THE SO-CALLED 1004 00:43:07,351 --> 00:43:09,187 CLINICAL HIGH-RISK STATE FOR 1005 00:43:09,187 --> 00:43:09,620 PSYCHOSIS. 1006 00:43:09,620 --> 00:43:13,491 IT'S THE STAGE OF THE 1007 00:43:13,491 --> 00:43:15,126 DEVELOPMENT AND DEVELOPED THE 1008 00:43:15,126 --> 00:43:18,396 FIRST EPISODE OF PSYCHOSIS IF 1009 00:43:18,396 --> 00:43:19,997 THEY DON'T INTERVENE YOU DON'T 1010 00:43:19,997 --> 00:43:22,867 DETECT THEM. 1011 00:43:22,867 --> 00:43:24,569 TYPICALLY THESE PEOPLE PRESENT 1012 00:43:24,569 --> 00:43:26,137 WITH PSYCHOTIC SYMPTOMS. 1013 00:43:26,137 --> 00:43:28,539 THESE ARE THE PATIENTS I TAKE 1014 00:43:28,539 --> 00:43:35,513 CARE OF IN LONDON WITH CLINICAL 1015 00:43:35,513 --> 00:43:37,248 PSYCHOSIS AND HAVE THOUGHTS THAT 1016 00:43:37,248 --> 00:43:38,316 ARE UNUSUAL AND DISCONNECTED 1017 00:43:38,316 --> 00:43:39,016 FROM THE WORLD. 1018 00:43:39,016 --> 00:43:41,118 HOW DO WE DETECT AND SCREEN 1019 00:43:41,118 --> 00:43:42,887 THOSE PROBLEMS IN YOUNG PEOPLE? 1020 00:43:42,887 --> 00:43:45,223 WHAT'S THE MOST EFFICIENT WAY 1021 00:43:45,223 --> 00:43:45,756 AND IN DIFFERENT CLINICAL 1022 00:43:45,756 --> 00:43:50,962 SETTINGS. 1023 00:43:50,962 --> 00:43:53,130 THE DETECTION IS THE FIRST STEP 1024 00:43:53,130 --> 00:43:55,266 FOR EFFECTIVE PREVENTION OF 1025 00:43:55,266 --> 00:43:56,434 PSYCHOSIS. 1026 00:43:56,434 --> 00:43:59,871 ONCE WE ARE ABLE TO DETECT 1027 00:43:59,871 --> 00:44:02,607 FUNCTIONAL IMPAIRMENT AND 1028 00:44:02,607 --> 00:44:03,641 PSYCHOTIC SYSTEMS WE CAN ASSESS 1029 00:44:03,641 --> 00:44:05,610 THEM AND PREDICT THEIR 1030 00:44:05,610 --> 00:44:06,911 LIKELIHOOD OF DEVELOPING 1031 00:44:06,911 --> 00:44:11,949 PSYCHOUS AND THE THIRD COMPONENT 1032 00:44:11,949 --> 00:44:16,287 IS IMPLEMENT PREVENTATIVE 1033 00:44:16,287 --> 00:44:18,122 TREATMENT AND I'LL FOCUS ON 1034 00:44:18,122 --> 00:44:20,091 PEOPLE WITH HIGH RISK FOR 1035 00:44:20,091 --> 00:44:20,358 PSYCHOSIS. 1036 00:44:20,358 --> 00:44:26,297 THE PREVALENCE OF CONDITION IS 1037 00:44:26,297 --> 00:44:27,865 1.7% IN THE GENERAL POPULATION 1038 00:44:27,865 --> 00:44:31,302 AND ABOUT 20% IN CLINICAL 1039 00:44:31,302 --> 00:44:32,036 SAMPLES. 1040 00:44:32,036 --> 00:44:34,138 CLINICAL LIKE YOUNG PEOPLE 1041 00:44:34,138 --> 00:44:34,805 ACCESSING EMERGENCY DEPARTMENTS 1042 00:44:34,805 --> 00:44:36,407 AND VISITING PRIMARY CARE, SO 1043 00:44:36,407 --> 00:44:36,807 FORTH. 1044 00:44:36,807 --> 00:44:38,943 IT'S CLEAR WE NEED TO HAVE TWO 1045 00:44:38,943 --> 00:44:39,911 DIFFERENT COMPLIMENTARY 1046 00:44:39,911 --> 00:44:41,178 APPROACHES TO SCREEN FOR 1047 00:44:41,178 --> 00:44:47,185 EMERGING PSYCH OWES -- 1048 00:44:47,185 --> 00:44:48,953 PSYCHOSIS IN CLINICAL SAMPLES 1049 00:44:48,953 --> 00:44:54,125 AND WHAT I'LL BRIEFLY DISCUSS. 1050 00:44:54,125 --> 00:44:56,994 IN THE COMMUNITY IN OUR CLINIC 1051 00:44:56,994 --> 00:44:58,362 IN LONDON WE HAVE A WEBSITE 1052 00:44:58,362 --> 00:45:03,434 YOUNG PEOPLE CAN ACCESS THE 1053 00:45:03,434 --> 00:45:04,569 WEBSITE AND SELF-REFER FOR 1054 00:45:04,569 --> 00:45:05,269 ASSESSMENT. 1055 00:45:05,269 --> 00:45:10,474 IT'S GOOD BUT NOT VERY EFFICIENT 1056 00:45:10,474 --> 00:45:14,845 AND WE HAVE IMPLEMENTED 1057 00:45:14,845 --> 00:45:16,247 SCREENING FOR YOUNG PEOPLE AND 1058 00:45:16,247 --> 00:45:18,049 THERE'S A GRANT ONGOING AND 1059 00:45:18,049 --> 00:45:19,517 PROJECT CALLED E-DETECTION TOOL 1060 00:45:19,517 --> 00:45:26,123 FOR EMERGING MENTAL DISORDER AND 1061 00:45:26,123 --> 00:45:28,526 FUNDED BY THE TRUST AND WE'RE 1062 00:45:28,526 --> 00:45:30,928 PLANNING TO EXPAND THOSE IN 1063 00:45:30,928 --> 00:45:31,896 OTHER PARTS. 1064 00:45:31,896 --> 00:45:35,700 THIS SCREENING APPROACH IS QUITE 1065 00:45:35,700 --> 00:45:36,200 SIMPLE. 1066 00:45:36,200 --> 00:45:38,302 WE FIRST ADVERTISED ON SOCIAL 1067 00:45:38,302 --> 00:45:39,170 MEDIA AND TARGET YOUNG PEOPLE 1068 00:45:39,170 --> 00:45:42,006 AND TALKED ABOUT MENTAL HEALTH, 1069 00:45:42,006 --> 00:45:46,644 RISK OF DEVELOPING SEVERE MENTAL 1070 00:45:46,644 --> 00:45:48,879 DISORDERS AND WE ADVERTISE ON 1071 00:45:48,879 --> 00:45:51,315 DIFFERENT CHANNELS LIKE 1072 00:45:51,315 --> 00:45:52,850 INSTAGRAM AND COLLEGES AND 1073 00:45:52,850 --> 00:45:54,085 UNIVERSITIES AND TRIED TO INVITE 1074 00:45:54,085 --> 00:46:04,595 PEOPLE TO ACCESS THE PROGRAM. 1075 00:46:12,837 --> 00:46:18,209 AND LOOKING AT THE DEMOGRAPHIC 1076 00:46:18,209 --> 00:46:19,744 RISK FACTORS AND THOSE ARE VALID 1077 00:46:19,744 --> 00:46:21,912 GLOBALLY NOT JUST IN LONDON. 1078 00:46:21,912 --> 00:46:27,351 THEY WERE SET TO COMPLETE A 1079 00:46:27,351 --> 00:46:28,252 SHORT COGNITIVE ASSESSMENT AND 1080 00:46:28,252 --> 00:46:31,022 SHORT SPEECH ACQUISITION AND 1081 00:46:31,022 --> 00:46:32,723 ANALYZING THE DATA AND 1082 00:46:32,723 --> 00:46:35,493 ESTIMATING WHETHER THE RISK OF 1083 00:46:35,493 --> 00:46:37,161 DEVELOPING OR POSSIBLY BEING 1084 00:46:37,161 --> 00:46:39,530 VULNERABLE FOR DEVELOPING 1085 00:46:39,530 --> 00:46:41,565 PSYCHOSIS IS ABOVE A CERTAINLY 1086 00:46:41,565 --> 00:46:41,832 THRESHOLD. 1087 00:46:41,832 --> 00:46:44,168 IF THAT'S THE CASE AN ALERT IS 1088 00:46:44,168 --> 00:46:45,503 BEING GENERATED TO THE RESEARCH 1089 00:46:45,503 --> 00:46:48,072 TEAM AND THE RESEARCH TEAM 1090 00:46:48,072 --> 00:46:49,306 INVITES YOUNG PERSONS TO 1091 00:46:49,306 --> 00:46:51,876 COMPLETE THE FULL CLINICAL 1092 00:46:51,876 --> 00:46:52,610 ASSESSMENT TO CHECK WHETHER 1093 00:46:52,610 --> 00:46:57,515 THEY'RE AT RISK OF DEVELOPING 1094 00:46:57,515 --> 00:46:58,315 PSYCHOSIS. 1095 00:46:58,315 --> 00:47:00,017 AND THERE'S A GAP BETWEEN 1096 00:47:00,017 --> 00:47:01,786 DIGITAL DATA ONLINE AND THE 1097 00:47:01,786 --> 00:47:04,655 CLINICAL ASSESSMENTS PERFORMED 1098 00:47:04,655 --> 00:47:07,158 BY THE GOLD STANDARD AND THAT'S 1099 00:47:07,158 --> 00:47:09,226 WHY WE'RE RUNNING AT A TWO-STAGE 1100 00:47:09,226 --> 00:47:14,432 ASSESSMENT AND ALSO A WAY OF 1101 00:47:14,432 --> 00:47:15,466 MAXIMIZING EFFICIENCY. 1102 00:47:15,466 --> 00:47:19,103 THEN IF THE INDIVIDUAL IS AT THE 1103 00:47:19,103 --> 00:47:20,705 CLINICAL ASSESSMENT STAGE 2 IS 1104 00:47:20,705 --> 00:47:22,540 STILL TESTING FOR BEING AT RISK 1105 00:47:22,540 --> 00:47:25,209 FOR PSYCHOSIS AND THEY'RE 1106 00:47:25,209 --> 00:47:28,612 REFERRED TO THE LOCAL CLINIC. 1107 00:47:28,612 --> 00:47:33,150 IN LONDON AND MOVE ON WITH THE 1108 00:47:33,150 --> 00:47:34,018 PREVENTIVE CARE. 1109 00:47:34,018 --> 00:47:38,923 THIS IS THE APPROACH WE ARE 1110 00:47:38,923 --> 00:47:40,958 IMPLEMENTING FOR DIGITAL SCREENS 1111 00:47:40,958 --> 00:47:43,094 FOR EMERGING VULNERABILITY IN 1112 00:47:43,094 --> 00:47:45,930 THE COMMUNITY AND WHAT'S THE 1113 00:47:45,930 --> 00:47:46,597 COMPLIMENTARY APPROACH FOR 1114 00:47:46,597 --> 00:47:49,967 HEALTH CARE SYSTEM FOR THE 1115 00:47:49,967 --> 00:47:52,536 CLINICAL SAMPLES FOR PEOPLE ALL 1116 00:47:52,536 --> 00:47:53,637 RIGHT UNDER MENTAL HEALTH CARE 1117 00:47:53,637 --> 00:47:56,874 IN SOME WAY. 1118 00:47:56,874 --> 00:47:58,442 WE DEVELOPED A RISK 1119 00:47:58,442 --> 00:47:59,677 STRATIFICATION ALGORITHM WHICH 1120 00:47:59,677 --> 00:48:04,482 IS QUITE FLEXIBLE. 1121 00:48:04,482 --> 00:48:09,453 THE DIFFERENT VERSIONS AND 1122 00:48:09,453 --> 00:48:10,488 FLEXIBILITY IS IMPORTANT IN LOW 1123 00:48:10,488 --> 00:48:14,191 AND MIDDLE INCOME COUNTRIES AND 1124 00:48:14,191 --> 00:48:19,530 THERE'S SOCIO DEMOGRAPHIC 1125 00:48:19,530 --> 00:48:20,798 PREDICTORS AND DIAGNOSIS LIKE 1126 00:48:20,798 --> 00:48:23,434 PRESENTING WITH DEPRESSION AND 1127 00:48:23,434 --> 00:48:28,806 ANXIETY AND THERE'S ALSO MORE 1128 00:48:28,806 --> 00:48:32,343 REFINED AND THERE'S PATHOLOGICAL 1129 00:48:32,343 --> 00:48:32,643 SYMPTOMS. 1130 00:48:32,643 --> 00:48:35,212 THE SYMPTOMS CAN BE ENTERED BY 1131 00:48:35,212 --> 00:48:37,581 THE CLINICIAN WITH AN ONLINE 1132 00:48:37,581 --> 00:48:39,450 WEBSITE OR EXTRACTED 1133 00:48:39,450 --> 00:48:41,285 AUTOMATICALLY FROM THE 1134 00:48:41,285 --> 00:48:43,254 ELECTRONIC HEALTH RECORD IF 1135 00:48:43,254 --> 00:48:44,855 AVAILABLE AND THE ALGORITHM 1136 00:48:44,855 --> 00:48:48,626 PREDICTS DEVELOPING PSYCHOSIS 1137 00:48:48,626 --> 00:48:53,664 OVER TIME WHICH IS FOR EXAMPLE 1138 00:48:53,664 --> 00:48:57,435 UP TO SIX YEARS AND IF IT'S 1139 00:48:57,435 --> 00:48:59,503 ABOVE A CERTAIN THRESHOLD 1140 00:48:59,503 --> 00:49:00,905 CLINICIANS MAY BE PROMPTED TO 1141 00:49:00,905 --> 00:49:01,639 OFFER FURTHER ASSESSMENT AND 1142 00:49:01,639 --> 00:49:03,808 OFFER PREVENTIVE CARE. 1143 00:49:03,808 --> 00:49:05,142 THIS IS ALL GOOD BUT WE HAVE 1144 00:49:05,142 --> 00:49:07,711 LEARNED THAT THE CRUCIAL THING 1145 00:49:07,711 --> 00:49:09,980 IS TO BE ABLE TO IMPLEMENT, 1146 00:49:09,980 --> 00:49:11,515 CERTIFIED AND SCREENING METHODS 1147 00:49:11,515 --> 00:49:12,917 IN REAL-WORLD PRACTICE FOR THE 1148 00:49:12,917 --> 00:49:15,352 BENEFITS OF THE PATIENTS AND THE 1149 00:49:15,352 --> 00:49:19,824 FIRST STEP IS TO DEMONSTRATE THE 1150 00:49:19,824 --> 00:49:23,561 ALGORITHM ARE TRANSPORTABLE AND 1151 00:49:23,561 --> 00:49:25,029 SURVIVE OUTSIDE THE SCREENING 1152 00:49:25,029 --> 00:49:27,131 AND THIS IS REPLICATIONS OF THIS 1153 00:49:27,131 --> 00:49:32,069 PREDICTION MODEL WHICH 1154 00:49:32,069 --> 00:49:37,508 DEMONSTRATED IN THE MORE REFINED 1155 00:49:37,508 --> 00:49:41,579 VERSION AND THE CHALLENGE IS TO 1156 00:49:41,579 --> 00:49:44,148 IMPLEMENT THE MODEL IN 1157 00:49:44,148 --> 00:49:45,249 REAL-WORLD CLINICAL PRACTICE. 1158 00:49:45,249 --> 00:49:50,654 IF WE LOOK AT THE NUMBER OF 1159 00:49:50,654 --> 00:49:52,523 PRECISION MEDICINE ALGORITHM 1160 00:49:52,523 --> 00:49:57,328 ONLY 5% TYPICALLY ARE EXTERNALLY 1161 00:49:57,328 --> 00:50:00,331 VALIDATED AND ONLY A FEW ARE 1162 00:50:00,331 --> 00:50:02,499 REALLY PUTTING INTO PRACTICE. 1163 00:50:02,499 --> 00:50:07,371 SOME OF OF THE CORE PROBLEMS 1164 00:50:07,371 --> 00:50:12,643 SOME OF THE CORE LOGISTIC ISSUES 1165 00:50:12,643 --> 00:50:15,045 NOT ADDRESSED PROPERLY AND 1166 00:50:15,045 --> 00:50:17,214 ETHICAL CHALLENGES OF BRINGING 1167 00:50:17,214 --> 00:50:19,650 PRECISION PSYCHIATRY TO 1168 00:50:19,650 --> 00:50:20,317 REAL-WORLD SCREENING. 1169 00:50:20,317 --> 00:50:22,319 THIS IS SCREENING OF COMMUNITY 1170 00:50:22,319 --> 00:50:23,354 OR HEALTH CARE TRUST IS CRUCIAL. 1171 00:50:23,354 --> 00:50:26,724 THAT'S WHY WE CONNECTED WITH THE 1172 00:50:26,724 --> 00:50:28,826 GLOBAL NETWORK OF PATIENT 1173 00:50:28,826 --> 00:50:29,593 EXPERIENCES THROUGH ANOTHER 1174 00:50:29,593 --> 00:50:33,964 INITIATIVE FUNDED BY THE VETERAN 1175 00:50:33,964 --> 00:50:37,401 COLLEGE OF NEUROPSYCHIC 1176 00:50:37,401 --> 00:50:39,603 PHARMACOLOGY AND COLLABORATED 1177 00:50:39,603 --> 00:50:42,873 WITH THEM A SUSTAINABLE ETHICAL 1178 00:50:42,873 --> 00:50:46,677 GUIDE LANE FOR PSYCHIATRY IN 1179 00:50:46,677 --> 00:50:49,113 CLINICAL PRACTICE AND REWARDING 1180 00:50:49,113 --> 00:50:51,515 EXPERIENCES FROM THE MODEL 1181 00:50:51,515 --> 00:50:52,249 DEVELOPMENT IS CRUCIAL. 1182 00:50:52,249 --> 00:50:55,085 WE THEN CONTINUED WITH THIS WORK 1183 00:50:55,085 --> 00:51:00,057 AND WE WANTED TO IMPLEMENT THE 1184 00:51:00,057 --> 00:51:01,325 ALGORITHM IN CLINICAL CARE IN 1185 00:51:01,325 --> 00:51:03,661 OUR TRUST IN LONDON. 1186 00:51:03,661 --> 00:51:09,800 WE DEVELOPED AN INTERFACE OF 1187 00:51:09,800 --> 00:51:11,735 SCREENING DEVICE FILTERING AND 1188 00:51:11,735 --> 00:51:14,138 CHECK THE PRE INDICATORS 1189 00:51:14,138 --> 00:51:16,540 RECORDED IN THE LOCAL REGISTRY 1190 00:51:16,540 --> 00:51:18,943 AND PLOTTING THE LIKELY HEADLINE 1191 00:51:18,943 --> 00:51:26,383 OF DEVELOPING PSYCHOSIS AND 1192 00:51:26,383 --> 00:51:27,551 DEMONSTRATING CHA WAS FEASIBLE 1193 00:51:27,551 --> 00:51:29,853 TO USE IT PROSPECTIVELY. 1194 00:51:29,853 --> 00:51:33,624 AND THE OUTCOMES OF THE 1195 00:51:33,624 --> 00:51:35,893 IMPLEMENT STUDY WAS WE DEVELOPED 1196 00:51:35,893 --> 00:51:39,129 AND DEPLOYED A GOVERNANCE 1197 00:51:39,129 --> 00:51:39,363 PATHWAY. 1198 00:51:39,363 --> 00:51:43,067 WE HAD ADHERENCE OF CLINICIANS 1199 00:51:43,067 --> 00:51:49,606 AND 77% OF THE CLINICIANS HAD 1200 00:51:49,606 --> 00:51:52,376 RECOMMENDATIONS FROM THE DIGITAL 1201 00:51:52,376 --> 00:51:53,344 SCREENING IN HEALTH CARE AND 1202 00:51:53,344 --> 00:51:56,046 WITH OUTREACH IT WAS CLOSE TO 1203 00:51:56,046 --> 00:51:56,246 85%. 1204 00:51:56,246 --> 00:52:01,885 THIS WAS A PRIMARY OUTCOME OF 1205 00:52:01,885 --> 00:52:12,196 THE STUDY FOR HEALTH CARE TO 1206 00:52:12,196 --> 00:52:17,735 SCREEN AND DETECT AND STRATIFY 1207 00:52:17,735 --> 00:52:22,873 PEOPLE FOR RISK WITH EXPANDING 1208 00:52:22,873 --> 00:52:26,677 THE APPROACH IN OTHER COUNTRIES 1209 00:52:26,677 --> 00:52:29,647 OUTSIDE THE U.K. 1210 00:52:29,647 --> 00:52:32,416 THE OASIS HAS BEEN AWARDED ABOUT 1211 00:52:32,416 --> 00:52:34,485 1,000 APPLICATIONS FOR 1212 00:52:34,485 --> 00:52:35,586 INNOVATION IN COMMUNITY MENTAL 1213 00:52:35,586 --> 00:52:38,088 HEALTH DEMONSTRATING IT'S 1214 00:52:38,088 --> 00:52:39,656 POSSIBLE TO BRING PRECISION 1215 00:52:39,656 --> 00:52:40,691 PSYCHIATRY AND RISK 1216 00:52:40,691 --> 00:52:42,893 STRATIFICATION AND DIGITAL 1217 00:52:42,893 --> 00:52:43,861 SCREENING INTO REAL WORLD 1218 00:52:43,861 --> 00:52:44,628 CLINICAL PRACTICE FOR THE 1219 00:52:44,628 --> 00:52:45,763 BENEFIT OF MANY YOUNG PERSONS. 1220 00:52:45,763 --> 00:52:56,106 THANK YOU VERY MUCH. 1221 00:53:03,280 --> 00:53:04,515 WE'LL KEEP THE QUESTIONS FOR THE 1222 00:53:04,515 --> 00:53:11,021 END AND WOULD LIKE TO INTRODUCE 1223 00:53:11,021 --> 00:53:13,557 VICE PRESIDENT OF RESEARCH AND 1224 00:53:13,557 --> 00:53:15,059 HEADS AN EXCELLENT RESEARCH UNIT 1225 00:53:15,059 --> 00:53:16,994 AT THE CENTER FOR ADDICTION AND 1226 00:53:16,994 --> 00:53:18,395 MENTAL HEALTH RESEARCH IN 1227 00:53:18,395 --> 00:53:18,796 TORONTO. 1228 00:53:18,796 --> 00:53:21,865 HE FOCUSES IN HIS RESEARCH AND 1229 00:53:21,865 --> 00:53:24,268 GROUP ON UNDERSTANDING HOW 1230 00:53:24,268 --> 00:53:25,536 DIFFERENT DATA DOMAINS INTERACT 1231 00:53:25,536 --> 00:53:28,539 WITH EACH OTHER TO PRODUCE 1232 00:53:28,539 --> 00:53:30,574 BASICALLY MENTAL ILLNESSES FROM 1233 00:53:30,574 --> 00:53:32,076 A LIFE SPAN PERSPECTIVE. 1234 00:53:32,076 --> 00:53:33,877 I THINK HE'LL SHOW US WORK ALONG 1235 00:53:33,877 --> 00:53:36,447 THESE LINES AND I'M LOOKING 1236 00:53:36,447 --> 00:53:41,418 FORWARD TO YOUR TALK. 1237 00:53:41,418 --> 00:53:51,662 >> THANK YOU. 1238 00:54:01,772 --> 00:54:02,940 THERE'S STRAIGHTFORWARD FOR 1239 00:54:02,940 --> 00:54:04,508 IMPORTANT CONCEPTUALIZATION HOW 1240 00:54:04,508 --> 00:54:06,076 TO MAKE A DIFFERENCE FOR 1241 00:54:06,076 --> 00:54:06,477 PATIENTS. 1242 00:54:06,477 --> 00:54:10,013 THOUGH THE FOCUS IS ON PRECISION 1243 00:54:10,013 --> 00:54:11,248 MEDICINE IT DOESN'T SIT IN 1244 00:54:11,248 --> 00:54:11,548 ITESLATION. 1245 00:54:11,548 --> 00:54:13,250 WE HEARD ABOUT THE CONNECTION 1246 00:54:13,250 --> 00:54:17,321 BETWEEN PRECISION MEDICINE AND 1247 00:54:17,321 --> 00:54:21,625 HEALTH CARE SYSTEM DEDICATED TO 1248 00:54:21,625 --> 00:54:22,826 IMPROVEMENT THROUGH DATA AND 1249 00:54:22,826 --> 00:54:31,201 CONTINUOUS IMPROVEMENT CYCLES. 1250 00:54:31,201 --> 00:54:32,803 I WANT TO SHOW YOU A COUPLE 1251 00:54:32,803 --> 00:54:35,572 THINGS THAT KEEP ME HONEST. 1252 00:54:35,572 --> 00:54:37,341 THIS IS BUSY SLIDE BUT THE TALKS 1253 00:54:37,341 --> 00:54:44,348 WITH PRECISION MEDICINE AND ANY 1254 00:54:44,348 --> 00:54:47,851 EXPERIENCE HAS BEEN THROUGH 1255 00:54:47,851 --> 00:54:50,087 IMPLEMENTING A MODEL OF CARE OF 1256 00:54:50,087 --> 00:54:53,323 PSYCHOSIS IN SMALLER 1257 00:54:53,323 --> 00:54:53,624 COMMUNITIES. 1258 00:54:53,624 --> 00:54:59,463 AND IMPLEMENTING A MODEL OF CARE 1259 00:54:59,463 --> 00:55:03,567 KNOWN AS NAVIGATE AND SHOWN TO 1260 00:55:03,567 --> 00:55:06,837 BE SUPERIOR FOR THOSE IN THE 1261 00:55:06,837 --> 00:55:13,610 U.S. AND A CLUSTER RANDOMIZED 1262 00:55:13,610 --> 00:55:17,281 EFFECTIVENESS STYLE AND THE 1263 00:55:17,281 --> 00:55:19,983 CHALLENGE IN PSYCHOSIS CARE ARE 1264 00:55:19,983 --> 00:55:21,385 LESS THE INITIAL DECISIONS IN 1265 00:55:21,385 --> 00:55:23,220 THE ACUTE CARE BUT MORE THE 1266 00:55:23,220 --> 00:55:25,989 ELEMENTS OF CARE. 1267 00:55:25,989 --> 00:55:27,124 THERE'S A LOT OF INCONSISTENCY 1268 00:55:27,124 --> 00:55:29,359 IN HOW ELEMENTS OF CARE ARE 1269 00:55:29,359 --> 00:55:31,528 DELIVERED AND THE OUTCOME 1270 00:55:31,528 --> 00:55:34,565 MEASURE IS IMPROVING FIDELITY TO 1271 00:55:34,565 --> 00:55:38,302 THE STANDARD OF CARE AND AFTER 1272 00:55:38,302 --> 00:55:40,337 DOING THIS IN AN ONGOING WAY AND 1273 00:55:40,337 --> 00:55:43,307 SPREAD TO MANY MORE SITES WE 1274 00:55:43,307 --> 00:55:46,210 IMPROVED THE KEY RECOVERY 1275 00:55:46,210 --> 00:55:50,247 ORIENTED ELEMENTS AND SUPPORTING 1276 00:55:50,247 --> 00:55:52,182 EDUCATION AND SUPPORT. 1277 00:55:52,182 --> 00:55:55,886 THOUGH IT'S NOT AN RCT WE HAVE 1278 00:55:55,886 --> 00:55:57,754 THE DATA THE RAISED TRIAL TO 1279 00:55:57,754 --> 00:55:58,589 LOOK AT THE PATIENT-LEVEL 1280 00:55:58,589 --> 00:55:59,923 OUTCOMES AND IMPROVEMENTS IN 1281 00:55:59,923 --> 00:56:00,624 FUNCTIONING OF THE PATIENTS IN 1282 00:56:00,624 --> 00:56:07,097 THE SIX CLINICS. 1283 00:56:07,097 --> 00:56:10,167 WERE IDENTICAL TO THE ACTIVE 1284 00:56:10,167 --> 00:56:11,435 INTERVENTION AND RAISE TRIAL 1285 00:56:11,435 --> 00:56:15,739 SUGGESTING IN A MESSIER PROJECT 1286 00:56:15,739 --> 00:56:18,609 IN THE MIDDLE OF THE PANDEMIC 1287 00:56:18,609 --> 00:56:21,178 PEOPLE WERE ABLE TO IMPROVE WITH 1288 00:56:21,178 --> 00:56:22,913 THE TEAM-BASED CARE DONE IN A 1289 00:56:22,913 --> 00:56:23,947 CONSISTENT WAY AND WHATEVER WE 1290 00:56:23,947 --> 00:56:25,382 DEVELOP IN PRECISION MEDICINE 1291 00:56:25,382 --> 00:56:27,150 HAS TO FOLLOW THIS CONCEPT. 1292 00:56:27,150 --> 00:56:34,524 IT HAS TO BE MANUALIZED AND HAS 1293 00:56:34,524 --> 00:56:37,194 TO BE STANDARDIZED TRAINING AND 1294 00:56:37,194 --> 00:56:38,929 FIDELITY TO THE MODEL AND A LOT 1295 00:56:38,929 --> 00:56:41,231 OF THE WORK WAS INFORMED BY 1296 00:56:41,231 --> 00:56:43,500 PATIENTS AND FAMILIES WITH THE 1297 00:56:43,500 --> 00:56:53,710 WORK WE DO. 1298 00:57:06,890 --> 00:57:09,926 AND LOOKING AT ANTI-PSYCHOTIC 1299 00:57:09,926 --> 00:57:11,328 TREATMENT WHICH IS STILL THE 1300 00:57:11,328 --> 00:57:17,634 MAIN TREATMENT FOR PSYCHOSIS AND 1301 00:57:17,634 --> 00:57:23,106 WE HAVE A MEDICINE WHICH IS 1302 00:57:23,106 --> 00:57:25,175 CRITICAL FOR THE PATIENTS THAT 1303 00:57:25,175 --> 00:57:26,276 DON'T RESPOND AND IT'S BEEN 1304 00:57:26,276 --> 00:57:28,412 ASSOCIATED OVER AND OVER WITH 1305 00:57:28,412 --> 00:57:30,781 REDUCED SUICIDALITY AND DEATH BY 1306 00:57:30,781 --> 00:57:32,649 SUICIDE AND LESS HOSPITALIZATION 1307 00:57:32,649 --> 00:57:33,717 AND BETTER FUNCTIONAL OUTCOMES 1308 00:57:33,717 --> 00:57:34,484 FOR PATIENTS. 1309 00:57:34,484 --> 00:57:36,553 ONE OF THE THINGS WE NEED TO 1310 00:57:36,553 --> 00:57:39,489 CONSIDER AS WE START TO IDENTIFY 1311 00:57:39,489 --> 00:57:41,458 MARKERS THAT MAY BE ASSOCIATED 1312 00:57:41,458 --> 00:57:42,693 WITH TREATMENT RESPONSE OR OTHER 1313 00:57:42,693 --> 00:57:45,729 KINDS OF CLINICAL OUTCOMES IS TO 1314 00:57:45,729 --> 00:57:47,597 EVALUATE THE MARKERS IN CLINICAL 1315 00:57:47,597 --> 00:57:47,964 TRIALS. 1316 00:57:47,964 --> 00:57:53,236 ONE CHALLENGE IN OUR FIELD HAS 1317 00:57:53,236 --> 00:57:58,875 BEEN WHEN WE HAVE THE BIOLOGICAL 1318 00:57:58,875 --> 00:57:59,543 SCIENCES AND IMPLEMENTATION 1319 00:57:59,543 --> 00:58:00,844 HEALTH SCIENCES OVER THERE BUT 1320 00:58:00,844 --> 00:58:03,380 THEY'RE NEVER CONNECTED. 1321 00:58:03,380 --> 00:58:06,116 EVEN THE SCIENTISTS WHO WORK IN 1322 00:58:06,116 --> 00:58:06,983 BOTH AREAS DON'T TYPICALLY WORK 1323 00:58:06,983 --> 00:58:08,652 TOGETHER AND HAVE TO CONNECT THE 1324 00:58:08,652 --> 00:58:09,820 TWO AREAS MUCH BETTER. 1325 00:58:09,820 --> 00:58:11,521 AS WE DEVELOP THINGS IN THE 1326 00:58:11,521 --> 00:58:12,422 PRECISION MEDICINE FIELD LET'S 1327 00:58:12,422 --> 00:58:15,659 TEST THEM AND TRY THEM OUT. 1328 00:58:15,659 --> 00:58:18,161 THEY MAY NOT WORK BUT IF YOU 1329 00:58:18,161 --> 00:58:19,296 HAVE THE BIOMARKER AND IT GUIDES 1330 00:58:19,296 --> 00:58:21,298 YOUR DECISION MAKING IS THAT 1331 00:58:21,298 --> 00:58:22,999 BETTER THAN USUAL CARE? 1332 00:58:22,999 --> 00:58:26,336 IT'S AN EMPIRICAL QUESTION THAT 1333 00:58:26,336 --> 00:58:29,306 DESERVES TESTING, THEN A STUDY 1334 00:58:29,306 --> 00:58:30,741 COULD FOLLOW TO EVALUATE WHETHER 1335 00:58:30,741 --> 00:58:36,480 IT CAN CHANGE CLINICAL PRACTICE. 1336 00:58:36,480 --> 00:58:38,682 HERE'S THE HEART OF THE TALK AND 1337 00:58:38,682 --> 00:58:42,552 IT'S ABOUT THINKING ABOUT MENTAL 1338 00:58:42,552 --> 00:58:44,721 ILLNESS FROM A LIFE SPAN 1339 00:58:44,721 --> 00:58:46,323 PERSPECTIVE AND ALSO 1340 00:58:46,323 --> 00:58:47,524 ACKNOWLEDGING AND YOU MAY HAVE 1341 00:58:47,524 --> 00:58:49,326 SEEN AN ARTICLE RECENTLY IN 1342 00:58:49,326 --> 00:58:50,827 PSYCHIATRY AND IF YOU DIDN'T 1343 00:58:50,827 --> 00:58:52,529 IT'S WORTH TAKING A LOOK AT A 1344 00:58:52,529 --> 00:58:55,499 BUNCH OF PSYCHIATRISTS AND SAID 1345 00:58:55,499 --> 00:58:57,601 YOUTH MENTAL HEALTH IS MENTAL 1346 00:58:57,601 --> 00:58:59,102 HEALTH AND LOOKED AT THE ONSET 1347 00:58:59,102 --> 00:59:01,405 OF MOST OF OUR MENTAL DISORDERS. 1348 00:59:01,405 --> 00:59:03,440 THEY'RE ALMOST ALL IN 1349 00:59:03,440 --> 00:59:04,908 ADOLESCENTS OR EARLY ADULTHOOD 1350 00:59:04,908 --> 00:59:06,443 AND THE BURDEN OF DISEASE FROM 1351 00:59:06,443 --> 00:59:08,011 THE MENTAL DISORDERS IS VERY 1352 00:59:08,011 --> 00:59:11,681 HIGH AT THIS TIME OF LIFE. 1353 00:59:11,681 --> 00:59:12,816 AND CERTAINLY IN MANY COUNTRIES 1354 00:59:12,816 --> 00:59:14,384 NOT ALL COUNTRIES WHERE 1355 00:59:14,384 --> 00:59:15,519 INFECTIOUS DISEASE IS A REAL 1356 00:59:15,519 --> 00:59:17,187 CHALLENGE BUT MANY COUNTRIES IS 1357 00:59:17,187 --> 00:59:19,423 THE TOP CAUSE OF DISABILITY IN 1358 00:59:19,423 --> 00:59:21,425 YOUNG PEOPLE, MENTAL DISORDERS. 1359 00:59:21,425 --> 00:59:23,527 BUT WHAT'S INTERESTING ABOUT 1360 00:59:23,527 --> 00:59:25,862 MENTAL ILLNESS IS THERE'S PEAK 1361 00:59:25,862 --> 00:59:27,497 WINDOWS OF ONSET AT DIFFERENT 1362 00:59:27,497 --> 00:59:29,599 POINTS IN THE LIFE SPAN AND THIS 1363 00:59:29,599 --> 00:59:32,436 MAY ARTICULATE THAT. 1364 00:59:32,436 --> 00:59:33,837 THERE'S ALSO WINDOWS WHERE EARLY 1365 00:59:33,837 --> 00:59:34,538 INTERVENTION MAY BE PARTICULARLY 1366 00:59:34,538 --> 00:59:40,277 HELPFUL. 1367 00:59:40,277 --> 00:59:43,280 WHAT WE'RE ALSO LEARNING THAT 1368 00:59:43,280 --> 00:59:44,281 REQUIRES A DIFFERENT PERSPECTIVE 1369 00:59:44,281 --> 00:59:46,249 IS HAVING A MENTAL ILLNESS AT 1370 00:59:46,249 --> 00:59:50,353 ONE TIME POINT IN THE LIFE SPAN 1371 00:59:50,353 --> 00:59:53,990 MAY INCREASE DEVELOPING MENTAL 1372 00:59:53,990 --> 00:59:59,162 ILLNESS AT ANOTHER TIME SPAN AND 1373 00:59:59,162 --> 01:00:01,531 THIS SHOWS PEOPLE WITH AUTISM 1374 01:00:01,531 --> 01:00:03,233 HAVE AN ODDS RATIO FIVE SO SIX 1375 01:00:03,233 --> 01:00:13,276 OF DEVELOPING SCHIZOPHRENIA OR 1376 01:00:13,276 --> 01:00:15,512 ANOTHER DISORDER. 1377 01:00:15,512 --> 01:00:17,814 THIS IS FROM THE PHILADELPHIA 1378 01:00:17,814 --> 01:00:21,117 DEVELOPMENT COHORT LOOKING AT 1379 01:00:21,117 --> 01:00:21,618 THE SYMPTOMS. 1380 01:00:21,618 --> 01:00:23,253 A NICE DESCRIPTION OF WHAT 1381 01:00:23,253 --> 01:00:24,821 PSYCHOSIS MAY BE LIKE. 1382 01:00:24,821 --> 01:00:27,057 IT'S NOT A PSYCHOTIC DISORDER 1383 01:00:27,057 --> 01:00:30,227 BUT A PARANOID IDEA OR SOME 1384 01:00:30,227 --> 01:00:31,495 DISORDERED THINKING OR 1385 01:00:31,495 --> 01:00:33,630 EXPERIENCING A VOICE BUT NOT A 1386 01:00:33,630 --> 01:00:34,464 FULL-BLOWN ILLNESS. 1387 01:00:34,464 --> 01:00:36,366 WHAT'S FASCINATING THOUGH IS 1388 01:00:36,366 --> 01:00:38,001 THAT CHILDREN AND YOUTH WHO 1389 01:00:38,001 --> 01:00:39,536 ALREADY HAD A MENTAL ILLNESS 1390 01:00:39,536 --> 01:00:42,939 WERE MORE LIKELY TO HAVE THOSE 1391 01:00:42,939 --> 01:00:44,441 IMPAIRMENTS INCLUDING THOSE WHO 1392 01:00:44,441 --> 01:00:47,244 DID NOT HAVE A MENTAL ILLNESS 1393 01:00:47,244 --> 01:00:49,079 SUGGESTING THE PRESENCE OF 1394 01:00:49,079 --> 01:00:50,347 MENTAL DISORDER IN YOUNG PEOPLE 1395 01:00:50,347 --> 01:00:54,451 IN AND OF ITSELF CREATES RISK 1396 01:00:54,451 --> 01:00:56,386 FOR NEW PROBLEMS AND THESE ARE 1397 01:00:56,386 --> 01:00:58,255 NOT BENIGN THINGS. 1398 01:00:58,255 --> 01:01:00,590 THEY'RE ASSOCIATED WITH POOR 1399 01:01:00,590 --> 01:01:01,892 COGNITION AND SUICIDALITY. 1400 01:01:01,892 --> 01:01:03,894 HAVING DIMENSIONAL THINGS THERE 1401 01:01:03,894 --> 01:01:06,496 WHICH MAY OR MAY NOT BE EARLY 1402 01:01:06,496 --> 01:01:09,599 INDICATE INDICATORS OF RISK FOR 1403 01:01:09,599 --> 01:01:12,969 PSYCHOTIC DISORDER ARE HIGHLY 1404 01:01:12,969 --> 01:01:13,870 PROBLEMATIC AND CAUSE DISTRESS 1405 01:01:13,870 --> 01:01:22,312 IN CHILDREN AND YOUTH. 1406 01:01:22,312 --> 01:01:25,515 CONG CONCEPTS OF PREVENTION AND 1407 01:01:25,515 --> 01:01:27,617 I'M NOT A CHILD PSYCHOLOGIST BUT 1408 01:01:27,617 --> 01:01:30,787 A CONVERTED ONE BECAUSE OF THE 1409 01:01:30,787 --> 01:01:31,955 DATA AND WORK WE'RE TRAINING 1410 01:01:31,955 --> 01:01:32,589 TOWARD. 1411 01:01:32,589 --> 01:01:37,160 I WAS TRAINED IN GERIATRICS 1412 01:01:37,160 --> 01:01:37,460 ORIGINALLY. 1413 01:01:37,460 --> 01:01:38,428 HERE'S SYSTEMS DATA THE KAISER 1414 01:01:38,428 --> 01:01:43,466 SYSTEM AND WE HAVE DATA FROM THE 1415 01:01:43,466 --> 01:01:44,901 ONTARIO SYSTEM AND I CAN TELL 1416 01:01:44,901 --> 01:01:48,471 YOU THE DATA ARE IDENTICAL BUT 1417 01:01:48,471 --> 01:01:52,142 OURS ARE UNDER REVIEW. 1418 01:01:52,142 --> 01:01:53,710 IN CALIFORNIA, 74% OF PEOPLE WHO 1419 01:01:53,710 --> 01:01:55,912 HAD A FIRST PSYCHOTIC EPISODE 1420 01:01:55,912 --> 01:01:58,548 HAD ALREADY PRESENTED FOR MENTAL 1421 01:01:58,548 --> 01:01:59,449 HEALTH PROBLEMS. 1422 01:01:59,449 --> 01:02:01,851 THAT'S A BIG NUMBER. 1423 01:02:01,851 --> 01:02:05,889 THAT'S THREE-QUARTERS OF PEOPLE 1424 01:02:05,889 --> 01:02:06,823 ALREADY ASKING FOR PEOPLE BUT 1425 01:02:06,823 --> 01:02:08,758 NOT FOR PSYCHOSIS. 1426 01:02:08,758 --> 01:02:10,927 WE LOOK AT THE PIECE BELOW THE 1427 01:02:10,927 --> 01:02:12,495 HIGHLIGHTED AREA AND ASKING FOR 1428 01:02:12,495 --> 01:02:15,332 HELP FOR DEPRESSION, ANXIETY, 1429 01:02:15,332 --> 01:02:16,766 ADHD AND OTHER PROBLEMS. 1430 01:02:16,766 --> 01:02:18,902 THESE ARE WHAT ARE CALLED 1431 01:02:18,902 --> 01:02:21,037 HETEROTIPIC CHANGES. 1432 01:02:21,037 --> 01:02:23,506 KIDS WITH ONE DISORDER WHO THEN 1433 01:02:23,506 --> 01:02:25,108 DEVELOP ANOTHER DISORDER. 1434 01:02:25,108 --> 01:02:27,844 AND ONE OF THE CHALLENGES IN I 1435 01:02:27,844 --> 01:02:29,546 THINK SOME OF THE CURRENT 1436 01:02:29,546 --> 01:02:30,347 PARADIGMS AROUND PREVENTION 1437 01:02:30,347 --> 01:02:34,451 WHERE THERE'S BEEN A BIG FOCUS 1438 01:02:34,451 --> 01:02:39,522 IN CLINICAL HIGH RISK AND 1439 01:02:39,522 --> 01:02:40,123 HOPEFU 1440 01:02:40,123 --> 01:02:40,790 HOPEFULLY THIS WILL PROVOKE TALK 1441 01:02:40,790 --> 01:02:41,825 BECAUSE THERE'S BEEN 1442 01:02:41,825 --> 01:02:42,926 COMMUNITY-BASED SAMPLING AND 1443 01:02:42,926 --> 01:02:46,796 MADE IT HARD TO ASCERTAIN A LOT 1444 01:02:46,796 --> 01:02:51,768 OF THE CASES. 1445 01:02:51,768 --> 01:02:57,007 AND THERE WERE RECRUITS AND THEY 1446 01:02:57,007 --> 01:03:00,944 WORKED SO HARD TO RECRUIT THE 1447 01:03:00,944 --> 01:03:07,117 HIGH-RISK PATIENTS AND SHE'S 1448 01:03:07,117 --> 01:03:09,586 LIKE WHERE ARE ALL THE PEOPLE. 1449 01:03:09,586 --> 01:03:11,221 MAYBE THEY'RE IN YOUTH MENTAL 1450 01:03:11,221 --> 01:03:17,627 HEALTH CLINICS OR PRESENTING TO 1451 01:03:17,627 --> 01:03:19,696 THEIR COUNSELOR ALL ALONG. 1452 01:03:19,696 --> 01:03:24,734 SO I THINK THIS MOTION THAT THE 1453 01:03:24,734 --> 01:03:27,404 PREMORBID PHASE IS A NEWER 1454 01:03:27,404 --> 01:03:29,305 SYMPTOM PHASE MAY BE TRUE WHEN 1455 01:03:29,305 --> 01:03:30,940 YOU THINK OF PSYCHOTIC DISORDERS 1456 01:03:30,940 --> 01:03:33,276 BUT NOT WHEN YOU THINK OF 1457 01:03:33,276 --> 01:03:35,512 ILLNESS WITH 74% OF THOSE 1458 01:03:35,512 --> 01:03:37,113 PATIENTS OR PEOPLE WITH A 1459 01:03:37,113 --> 01:03:38,081 PSYCHOTIC EPISODE ARE 1460 01:03:38,081 --> 01:03:40,216 EXPERIENCING OTHER FORMS OF 1461 01:03:40,216 --> 01:03:42,318 MENTAL ILLNESS AND OPENS UP ALL 1462 01:03:42,318 --> 01:03:43,953 SORTS OF FASCINATING QUESTIONS. 1463 01:03:43,953 --> 01:03:45,822 WHAT ARE THE TRAJECTORIES AND 1464 01:03:45,822 --> 01:03:47,891 PATHWAYS TO PSYCHOSIS FOR PEOPLE 1465 01:03:47,891 --> 01:03:49,192 WHO YOUNGER PEOPLE WITH AUTISM 1466 01:03:49,192 --> 01:03:52,228 OR DEPRESSION OR OTHER PROBLEMS. 1467 01:03:52,228 --> 01:03:55,465 WHAT ABOUT THIS IS LIKE A REAL 1468 01:03:55,465 --> 01:03:57,967 AMBITIOUS THING AND ASPIRATIONAL 1469 01:03:57,967 --> 01:04:01,438 IDEA, WHAT IF YOU EFFECTIVELY 1470 01:04:01,438 --> 01:04:03,106 TREATED THAT IN A 13-YEAR-OLD 1471 01:04:03,106 --> 01:04:05,608 WOULD NOT NOT ONLY HELP THEM IN 1472 01:04:05,608 --> 01:04:07,210 THE MOMENT BUT PREVENT THEIR 1473 01:04:07,210 --> 01:04:07,911 PSYCHOSIS LATER? 1474 01:04:07,911 --> 01:04:09,145 THESE ARE FASCINATING QUESTIONS 1475 01:04:09,145 --> 01:04:14,484 WHEN YOU THINK OF STRATIFICATION 1476 01:04:14,484 --> 01:04:16,453 ARE ONES WE SHOULD EXAMINE AND 1477 01:04:16,453 --> 01:04:19,122 THINK ABOUT AND ONE WAY TO 1478 01:04:19,122 --> 01:04:20,957 ADDRESS THIS IN TORONTO ONE OF 1479 01:04:20,957 --> 01:04:23,993 THE MULTICULTURAL CITIES IS 1480 01:04:23,993 --> 01:04:25,995 THROUGH THE TORONTO YOUTH COHORT 1481 01:04:25,995 --> 01:04:26,396 STUDY. 1482 01:04:26,396 --> 01:04:28,231 WE'LL TALK ABOUT THE DESIGN AND 1483 01:04:28,231 --> 01:04:29,265 PROTOCOL BECAUSE WE JUST 1484 01:04:29,265 --> 01:04:29,532 STARTED. 1485 01:04:29,532 --> 01:04:31,768 THIS IS REALLY A RESPONSE TO THE 1486 01:04:31,768 --> 01:04:34,871 ISSUE WHICH IS THAT THERE'S MANY 1487 01:04:34,871 --> 01:04:38,074 MANY AMAZING POPULATION COHORTS 1488 01:04:38,074 --> 01:04:40,577 LIKE THE PNC AND COGNITIVE 1489 01:04:40,577 --> 01:04:42,245 DEVELOPMENT COHORT THAT'S 1490 01:04:42,245 --> 01:04:43,780 HAPPENING AND OTHER COHORTS 1491 01:04:43,780 --> 01:04:45,682 AROUND THE WORLD OF CHILDREN AND 1492 01:04:45,682 --> 01:04:51,955 YOUTH LEGENDARY AND FAMOUS BUT 1493 01:04:51,955 --> 01:04:53,523 STILL IN THE POPULATION 1494 01:04:53,523 --> 01:04:54,557 COMMUNITY SPHERE. 1495 01:04:54,557 --> 01:04:56,092 THEY'RE NOT NECESSARILY SAMPLES 1496 01:04:56,092 --> 01:04:59,162 AND THE DATA I SHOWED YOU THAT 1497 01:04:59,162 --> 01:05:00,830 IS SHOWING YOU AGAIN WHAT THE 1498 01:05:00,830 --> 01:05:04,000 RISK PROFILES MAYBE AND WHAT 1499 01:05:04,000 --> 01:05:06,703 ABOUT A PROSPECTIVE STUDY OF 1500 01:05:06,703 --> 01:05:07,437 CHILDREN AND YOUTH ALREADY 1501 01:05:07,437 --> 01:05:08,972 RECEIVING MENTAL HEALTH SERVICE 1502 01:05:08,972 --> 01:05:11,608 TO TRY TO STRATIFY THEIR RISK 1503 01:05:11,608 --> 01:05:14,944 PATHWAYS AND STRATIFY AND 1504 01:05:14,944 --> 01:05:17,781 PROVIDE CLINICAL TRIALS HOW TO 1505 01:05:17,781 --> 01:05:20,850 MODERATE OR PREVENT WORSE 1506 01:05:20,850 --> 01:05:21,551 OUTCOMES OVER TIME. 1507 01:05:21,551 --> 01:05:23,219 HERE'S THE DESIGN OF OUR STUDY. 1508 01:05:23,219 --> 01:05:25,955 WE WORKED HARD TO TRY TO MIRROR 1509 01:05:25,955 --> 01:05:28,792 OUR ASSESSMENT SCHEDULES AND THE 1510 01:05:28,792 --> 01:05:30,527 ASSESSMENTS WE CHOSE ARE 1511 01:05:30,527 --> 01:05:32,762 COMPLICATED. 1512 01:05:32,762 --> 01:05:35,365 YOU CAN IMAGINE WITH A TEAM OF 1513 01:05:35,365 --> 01:05:37,433 OVER 100 SCIENTISTS EVERYONE HAS 1514 01:05:37,433 --> 01:05:39,002 THEIR WAY OF DOING THINGS AND WE 1515 01:05:39,002 --> 01:05:40,670 WERE TRYING TO BE DISCIPLINED TO 1516 01:05:40,670 --> 01:05:42,005 MIRROR OUR ASSESSMENT IN THE 1517 01:05:42,005 --> 01:05:43,973 CLINICAL POPULATION TO OTHER 1518 01:05:43,973 --> 01:05:46,409 POPULATION-BASED COHORTS SUCH AS 1519 01:05:46,409 --> 01:05:49,078 THE ABCD STUDY. 1520 01:05:49,078 --> 01:05:53,616 THE OTHER THING WE PAY ATTENTION 1521 01:05:53,616 --> 01:05:56,286 TO IS THE THIRD LINE AND WE HAVE 1522 01:05:56,286 --> 01:06:01,324 ENVIRONMENTAL DATA LIKE POSTAL 1523 01:06:01,324 --> 01:06:02,525 CODES TO UNDERSTAND NEIGHBORHOOD 1524 01:06:02,525 --> 01:06:03,726 DEVELOP. 1525 01:06:03,726 --> 01:06:05,528 AN THERE'S A RICH PIPELINE AND 1526 01:06:05,528 --> 01:06:07,497 THERE'S A CORE ISSUE FOR MANY 1527 01:06:07,497 --> 01:06:14,137 FOLKS HERE. 1528 01:06:14,137 --> 01:06:16,039 NOT JUST IN OUR OWN HOSPITAL 1529 01:06:16,039 --> 01:06:18,441 FROM OUR OWN ELECTRONIC HEALTH 1530 01:06:18,441 --> 01:06:20,243 RECORD BUT IF A PATIENT GETS 1531 01:06:20,243 --> 01:06:22,378 SICK AND GETS HOSPITALIZED THREE 1532 01:06:22,378 --> 01:06:24,447 HOURS AWAY, WE WON'T KNOW THAT 1533 01:06:24,447 --> 01:06:26,316 IN REAL TIME BUT WHEN WE LOOK AT 1534 01:06:26,316 --> 01:06:27,417 THE DATA AS SOON AS PEOPLE 1535 01:06:27,417 --> 01:06:29,118 CONSENT TO HAVE THEIR DATA 1536 01:06:29,118 --> 01:06:30,286 LINKED THAT WAY AND WE'LL BE 1537 01:06:30,286 --> 01:06:31,487 ABLE TO KNOW THAT INFORMATION 1538 01:06:31,487 --> 01:06:35,358 TOO. 1539 01:06:35,358 --> 01:06:37,727 SCIENTIFICALLY SPEAKING, THERE'S 1540 01:06:37,727 --> 01:06:40,129 FIVE DIFFERENT SCIENTIFIC 1541 01:06:40,129 --> 01:06:41,331 CONCEPTS WE FRAME THEM AS 1542 01:06:41,331 --> 01:06:42,699 PROJECTS BUT IT'S ALL ONE BIG 1543 01:06:42,699 --> 01:06:42,899 STUDY. 1544 01:06:42,899 --> 01:06:46,035 ONE TEAM IS REALLY FOCUSSED ON 1545 01:06:46,035 --> 01:06:46,736 THE CLINICAL RESEARCH OUTCOMES 1546 01:06:46,736 --> 01:06:48,805 OF PSYCHOSIS. 1547 01:06:48,805 --> 01:06:57,580 OTHER KINDS OF SYSTEM -- 1548 01:06:57,580 --> 01:06:58,147 SYMPTOM-RELATED DATA. 1549 01:06:58,147 --> 01:07:00,483 THESE ARE COMING TO OUR CLINIC 1550 01:07:00,483 --> 01:07:01,150 FOR ANY REASON. 1551 01:07:01,150 --> 01:07:02,252 YOU'LL SEE A LITTLE BIT ABOUT 1552 01:07:02,252 --> 01:07:05,955 THEM IN A MOMENT. 1553 01:07:05,955 --> 01:07:06,890 COGNITION, AND GETTING REPORT 1554 01:07:06,890 --> 01:07:10,059 CARDS FROM SCHOOL TO THE EXTENT 1555 01:07:10,059 --> 01:07:11,561 POSSIBLE AND SCHOOL PERFORMS IS 1556 01:07:11,561 --> 01:07:13,229 A CRITICAL OUTCOME MEASURE. 1557 01:07:13,229 --> 01:07:17,901 PROJECT THREE IS OUR BIOLOGICAL 1558 01:07:17,901 --> 01:07:18,701 DATA PROJECT. 1559 01:07:18,701 --> 01:07:20,003 PROJECT 4 IS SERVICE USE AND 1560 01:07:20,003 --> 01:07:21,471 COST TO THE SYSTEM. 1561 01:07:21,471 --> 01:07:23,339 IF YOU HAVE PROFILE A WHAT ARE 1562 01:07:23,339 --> 01:07:26,943 THE HEALTH CARE COSTS ASSOCIATED 1563 01:07:26,943 --> 01:07:29,345 WITH YOUR PROFILE AND 5 IS A 1564 01:07:29,345 --> 01:07:30,179 DATA INTEGRATION PROJECT WHICH 1565 01:07:30,179 --> 01:07:32,649 IS HOW DO WE INTEGRATE DIFFERENT 1566 01:07:32,649 --> 01:07:34,517 LEVELS OF ANALYSIS TO CREATE 1567 01:07:34,517 --> 01:07:36,119 PERSON-CENTERED MODELS OF 1568 01:07:36,119 --> 01:07:36,386 OUTCOME? 1569 01:07:36,386 --> 01:07:39,789 AND THIS IS SORT OF LIKE A 1570 01:07:39,789 --> 01:07:42,825 SIMPLE GRAPHIC AND THIS COULD 1571 01:07:42,825 --> 01:07:44,594 GIVE PSYCHOSIS RISK BUT COULD BE 1572 01:07:44,594 --> 01:07:45,728 ABOUT BRAIN DEVELOPMENT, HEALTH 1573 01:07:45,728 --> 01:07:46,996 CARE COSTS AND LOOKING AT THE 1574 01:07:46,996 --> 01:07:51,100 DIFFERENT TRAJECTORIES. 1575 01:07:51,100 --> 01:07:53,369 SO FAR WITH RECRUITED A LITTLE 1576 01:07:53,369 --> 01:07:55,038 OVER 600 PEOPLE. 1577 01:07:55,038 --> 01:07:56,806 I DIDN'T MENTION THE AGE RANGE 1578 01:07:56,806 --> 01:07:58,574 IS 11 TO 24 TO TRY TO CAPTURE 1579 01:07:58,574 --> 01:08:01,611 THE CRITICAL WINDOW OF TIME THAT 1580 01:08:01,611 --> 01:08:04,147 RELATES TO THE HIGHEST BURDEN OF 1581 01:08:04,147 --> 01:08:07,450 MENTAL DISORDER IN THE LIFE SPAN 1582 01:08:07,450 --> 01:08:08,885 AND ALSO AT LEAST ACROSS THE 1583 01:08:08,885 --> 01:08:10,353 FIVE YEARS OF THE PROJECT OR 1584 01:08:10,353 --> 01:08:13,389 MORE WHAT THE WINDOW IS FOR 1585 01:08:13,389 --> 01:08:14,290 PSYCHOSIS. 1586 01:08:14,290 --> 01:08:15,625 IT'S SPLIT IN TERMS OF AGE 1587 01:08:15,625 --> 01:08:24,400 DISTRIBUTION. 1588 01:08:24,400 --> 01:08:25,868 WE HAVE THREE PAPERS THAT 1589 01:08:25,868 --> 01:08:28,137 DESCRIBE THE PROTOCOL TO THIS 1590 01:08:28,137 --> 01:08:31,874 WORK AND A SNAPSHOT CROSS 1591 01:08:31,874 --> 01:08:32,175 SECTIONALLY. 1592 01:08:32,175 --> 01:08:35,511 WE DID A STOP TO THE DATA 1593 01:08:35,511 --> 01:08:38,481 CLEANING IN FEBRUARY FIRST AND 1594 01:08:38,481 --> 01:08:40,016 WE WANTED TO GET A SNAPSHOT OF 1595 01:08:40,016 --> 01:08:43,019 WHAT WAS GOING ON AND TO GIVE US 1596 01:08:43,019 --> 01:08:44,420 A REALITY CHECK OF WHAT WE WERE 1597 01:08:44,420 --> 01:08:45,088 UP TO. 1598 01:08:45,088 --> 01:08:49,225 ONE OF THE STRIKING THINGS IS 1599 01:08:49,225 --> 01:08:50,760 THE MEDIAN NUMBER OF DIAGNOSIS 1600 01:08:50,760 --> 01:08:51,728 WAS 3.5. 1601 01:08:51,728 --> 01:08:55,098 PEOPLE ARE NOT SEEKING MENTAL 1602 01:08:55,098 --> 01:08:57,266 HEALTH CARE FOR FUN. 1603 01:08:57,266 --> 01:08:59,502 THEY'RE COMING IN AND THERE'S 1604 01:08:59,502 --> 01:09:02,805 ALREADY SIGNIFICANT BURDEN OF 1605 01:09:02,805 --> 01:09:05,375 DISEASE. 1606 01:09:05,675 --> 01:09:07,443 80% HAVE ANXIETY OR A MOOD 1607 01:09:07,443 --> 01:09:08,678 DISORDER AND WHEN YOUNG PEOPLE 1608 01:09:08,678 --> 01:09:12,682 COME IN TO THE EMERGENCY ROOM 1609 01:09:12,682 --> 01:09:16,386 THAT'S WHAT'S PROBLEMATIC FOR 1610 01:09:16,386 --> 01:09:16,586 THEM. 1611 01:09:16,586 --> 01:09:19,255 I'LL FEELING LOW, DISTRESS, 1612 01:09:19,255 --> 01:09:21,524 ANXIOUS, DYSREGULATED. 1613 01:09:21,524 --> 01:09:24,360 THEY COULD HAVE A 1614 01:09:24,360 --> 01:09:25,561 NEURODEVELOPMENTAL DISORDER OR 1615 01:09:25,561 --> 01:09:26,696 ANOTHER PROBLEM. 1616 01:09:26,696 --> 01:09:28,731 45% REPORTED SUICIDAL THINKING 1617 01:09:28,731 --> 01:09:31,434 AND OTHER KINDS OF SUICIDAL RISK 1618 01:09:31,434 --> 01:09:33,436 AND ALMOST 50% SO IN THE 1619 01:09:33,436 --> 01:09:35,338 POPULATION-BASED COHORTS IN THIS 1620 01:09:35,338 --> 01:09:37,140 TIME OF LIFE IT'S STRIKING 1621 01:09:37,140 --> 01:09:39,942 BECAUSE IT'S QUITE HIGH. 1622 01:09:39,942 --> 01:09:42,745 USUALL 1623 01:09:42,745 --> 01:09:48,384 USUALLY 10% TO 20% REPORT 1624 01:09:48,384 --> 01:09:52,622 DYNAMICS AND IN THIS POMP ALMOST 1625 01:09:52,622 --> 01:10:01,130 AUTO -- 50% REPORTED A DISORDER 1626 01:10:01,130 --> 01:10:04,600 AND MANY ARE EXPERIENCING IS 1627 01:10:04,600 --> 01:10:07,503 SOME CHALLENGE IN THEIR THINKING 1628 01:10:07,503 --> 01:10:09,372 AND PERCEPTION AND ETHNIC 1629 01:10:09,372 --> 01:10:14,077 DIVERSITY AS WELL. 1630 01:10:14,077 --> 01:10:15,511 THE OTHER THING THAT WAS 1631 01:10:15,511 --> 01:10:17,447 STRIKING WAS IN A CLINICAL 1632 01:10:17,447 --> 01:10:19,482 SAMPLING AND WE WORKED WITH THE 1633 01:10:19,482 --> 01:10:21,017 POPULATION-BASED SAMPLE THERE'S 1634 01:10:21,017 --> 01:10:22,051 CONCERN ABOUT THE BIOLOGICAL 1635 01:10:22,051 --> 01:10:24,220 DATA AND THE QUALITY OF THE DATA 1636 01:10:24,220 --> 01:10:26,055 FROM PEOPLE WHO HAVE EXPERIENCED 1637 01:10:26,055 --> 01:10:31,828 MORE MENTAL ILLNESS IN AN MRI. 1638 01:10:31,828 --> 01:10:33,563 WE'RE NOT FINDING THIS IN OUR 1639 01:10:33,563 --> 01:10:34,797 DATA AND PEOPLE ARE JUST AS 1640 01:10:34,797 --> 01:10:36,232 LIKELY TO AGREE TO DO OTHER 1641 01:10:36,232 --> 01:10:40,136 PROCEDURES WHICH IS REALLY 1642 01:10:40,136 --> 01:10:40,403 IMPORTANT. 1643 01:10:40,403 --> 01:10:42,105 IT'S SURPRISING IN A GOOD WAY 1644 01:10:42,105 --> 01:10:44,173 AND ONE BIG REASON IS WE ENGAGED 1645 01:10:44,173 --> 01:10:46,242 YOUNG PEOPLE IN THEIR CAREGIVERS 1646 01:10:46,242 --> 01:10:49,846 AS PARTNERS IN THE RESEARCH FROM 1647 01:10:49,846 --> 01:10:53,916 THE BEGINNING AND MANY DO THE 1648 01:10:53,916 --> 01:10:55,885 WORK IN THE SERVICES SPACE. 1649 01:10:55,885 --> 01:10:58,521 IT'S MUCH LESS TYPICAL AS WE 1650 01:10:58,521 --> 01:11:00,523 MOVE UPSTREAM BRIDGING THE 1651 01:11:00,523 --> 01:11:01,591 BIOMEDICAL SPACE WITH THE 1652 01:11:01,591 --> 01:11:04,560 SERVICE SPACE. 1653 01:11:04,560 --> 01:11:05,695 WE'VE BEEN PLEASANTLY SURPRISED 1654 01:11:05,695 --> 01:11:07,497 AND IT'S BEEN A RICH EXPERIENCE 1655 01:11:07,497 --> 01:11:10,299 AND IT'S ALLOWED US TO PUSH AND 1656 01:11:10,299 --> 01:11:12,034 CHANGE OUR PROTOCOL AND CHANGE 1657 01:11:12,034 --> 01:11:16,739 LANGUAGE THAT PEOPLE DIDN'T LIKE 1658 01:11:16,739 --> 01:11:24,080 THAT MAY BE OTHER RESEARCHERS 1659 01:11:24,080 --> 01:11:25,848 THOUGHT WAS OKAY AND MAKING 1660 01:11:25,848 --> 01:11:27,517 SITUATIONS MORE COMFORTABLE OR 1661 01:11:27,517 --> 01:11:30,520 DOABLE. 1662 01:11:30,520 --> 01:11:32,288 FOR INSTANCE, ONE OF THE THINGS 1663 01:11:32,288 --> 01:11:34,023 WE DID WAS TO GET A T-SHIRT WITH 1664 01:11:34,023 --> 01:11:36,025 A PICTURE OF THEIR OWN BRAIN FOR 1665 01:11:36,025 --> 01:11:37,960 THOSE GETTING A SCAN AND THEY 1666 01:11:37,960 --> 01:11:39,128 LOVED THAT. 1667 01:11:39,128 --> 01:11:42,165 ONE OF THE MOST HEARTWARMING 1668 01:11:42,165 --> 01:11:43,933 THINGS IS SOME KIDS COME INTO 1669 01:11:43,933 --> 01:11:46,135 CLINIC WITH THEIR T-SHIRT ON. 1670 01:11:46,135 --> 01:11:47,303 IT'S PRETTY AMAZING. 1671 01:11:47,303 --> 01:11:49,071 THAT'S THEIR IDEA NOT THE ERS. 1672 01:11:49,071 --> 01:11:51,874 IN A FIVE-YEAR STUDY AND SOME 1673 01:11:51,874 --> 01:11:54,243 KIDS WILL GET QUITE ILL IT WILL 1674 01:11:54,243 --> 01:11:55,211 BE CRITICAL TO THINK OF 1675 01:11:55,211 --> 01:11:55,912 RETENTION. 1676 01:11:55,912 --> 01:11:57,813 WE DON'T WANT TO LOSE EVERYONE 1677 01:11:57,813 --> 01:11:58,581 BECAUSE WE'RE NOT BEING THOUGHT. 1678 01:11:58,581 --> 01:12:03,820 IN OUR INTENTION. 1679 01:12:03,820 --> 01:12:06,789 WE HOPE TO GET AT DIFFERENT 1680 01:12:06,789 --> 01:12:07,723 YOUTH EXPERIENCING MENTAL 1681 01:12:07,723 --> 01:12:09,325 ILLNESS AND IDENTIFY RISK, WHO 1682 01:12:09,325 --> 01:12:15,131 IS AT HIGHEST RISK FOR PSYCHOSIS 1683 01:12:15,131 --> 01:12:15,932 AND OTHER PROBLEMS. 1684 01:12:15,932 --> 01:12:19,101 RUN CLINICAL TRIALS TO ADDRESS 1685 01:12:19,101 --> 01:12:22,538 THESE ISSUES PARTICULARLY FROM A 1686 01:12:22,538 --> 01:12:24,106 PREVEN 1687 01:12:24,106 --> 01:12:24,740 PREVENTION-BASED PERSPECTIVE AND 1688 01:12:24,740 --> 01:12:30,279 NOT PRESENTING A PROBLEM BUT 1689 01:12:30,279 --> 01:12:31,214 PREVENTION OF FUTURE PROBLEMS 1690 01:12:31,214 --> 01:12:32,682 AND WE'VE ENGAGED YOUNG PEOPLE 1691 01:12:32,682 --> 01:12:33,883 WITH LIVED EXPERIENCE AND 1692 01:12:33,883 --> 01:12:41,123 FAMILIES AND SERVICE PROVIDERS. 1693 01:12:41,123 --> 01:12:43,492 AND THE FINAL SLIDE IS THIS 1694 01:12:43,492 --> 01:12:46,495 INITIAL COHORT IS SUPPORTIVE OF 1695 01:12:46,495 --> 01:12:48,764 ADDITIONAL FUNDING TO DO THIS 1696 01:12:48,764 --> 01:12:50,566 OTHER CENTERS IN OUR 1697 01:12:50,566 --> 01:12:51,934 JURISDICTION AND BUILD WHAT'S 1698 01:12:51,934 --> 01:12:55,404 CALLED A MASTER OBSERVATIONAL 1699 01:12:55,404 --> 01:12:56,772 TRIAL A CONCEPT FROM CANCER AND 1700 01:12:56,772 --> 01:12:59,175 THE STRATIFICATION BY RECRUIT 1701 01:12:59,175 --> 01:13:01,711 COHORT OF PEOPLE AND GIVING US 1702 01:13:01,711 --> 01:13:02,812 THE OPPORTUNITY TO STRATIFY 1703 01:13:02,812 --> 01:13:04,447 DIFFERENT PATIENTS OR PEOPLE IN 1704 01:13:04,447 --> 01:13:06,816 THE COHORT INTO DIFFERENT 1705 01:13:06,816 --> 01:13:08,150 CLINICAL TRIALS AS ARE NEEDED 1706 01:13:08,150 --> 01:13:09,118 FOR THEIR PRESENTING PROBLEM. 1707 01:13:09,118 --> 01:13:12,088 THAT'S WHAT THE PURPOSE OF THIS 1708 01:13:12,088 --> 01:13:13,789 FOLLOW-UP PROJECT IS GOING TO BE 1709 01:13:13,789 --> 01:13:15,358 AS ONE PROJECT GROWS IT WILL 1710 01:13:15,358 --> 01:13:17,860 FEED INTO ANOTHER PROJECT FROM A 1711 01:13:17,860 --> 01:13:19,262 CLINICAL TRIAL POINT OF VIEW. 1712 01:13:19,262 --> 01:13:23,232 THERE'S MANY PEOPLE INVOLVED IN 1713 01:13:23,232 --> 01:13:24,500 THE PROJECT AND I JUST WANTED TO 1714 01:13:24,500 --> 01:13:27,670 ACKNOWLEDGE THEM ALL. 1715 01:13:27,670 --> 01:13:37,847 THANK YOU. 1716 01:14:13,316 --> 01:14:18,020 >> THE SPEAKER FOR TODAY, MARK 1717 01:14:18,020 --> 01:14:22,325 VAN OMMEREN WANTED TO SHARE HIS 1718 01:14:22,325 --> 01:14:27,463 THOUGHTS ON THE STRATIFICATION 1719 01:14:27,463 --> 01:14:36,272 APPROACH. 1720 01:14:36,272 --> 01:14:38,040 >> HEAD OF THE MENTAL HEALTH 1721 01:14:38,040 --> 01:14:39,508 UNIT NOT THE DIRECT BUT HONORED 1722 01:14:39,508 --> 01:14:46,649 TO SOMETIMES BE CONFUSED. 1723 01:14:46,649 --> 01:14:48,084 I'M PLEASED TO SPEAK WITH QUA 1724 01:14:48,084 --> 01:14:53,255 ALL PRESENTED AND THE COLLEAGUES 1725 01:14:53,255 --> 01:14:58,527 ONLINE THANK YOU SO MUCH. 1726 01:14:58,527 --> 01:15:04,400 WHEN YOU THINK OF MANY OF US 1727 01:15:04,400 --> 01:15:08,337 HAVE BEEN INVOLVED IN RESEARCH 1728 01:15:08,337 --> 01:15:10,906 PRIORITY EXERCISES AND A KEY 1729 01:15:10,906 --> 01:15:12,274 QUESTION IN RESEARCH WHEN YOU 1730 01:15:12,274 --> 01:15:18,047 ARE A PARTICIPANT IN SUCH AN 1731 01:15:18,047 --> 01:15:19,715 EXERCISE, THERE'S USUALLY THE 1732 01:15:19,715 --> 01:15:20,850 MOMENT THINK OF THE RESEARCH 1733 01:15:20,850 --> 01:15:23,819 QUESTION THAT CAN BE ANSWERED IN 1734 01:15:23,819 --> 01:15:26,422 THE UPCOMING YEARS IN THE NEXT 1735 01:15:26,422 --> 01:15:27,656 MONTHS OR HOWEVER, LONG. 1736 01:15:27,656 --> 01:15:29,291 THE RESEARCH QUESTION YOU CAN 1737 01:15:29,291 --> 01:15:30,059 ANSWER IN SIX MONTHS IS 1738 01:15:30,059 --> 01:15:30,726 DIFFERENT YOU CAN ANSWER IN FIVE 1739 01:15:30,726 --> 01:15:40,836 YEARS. 1740 01:15:42,037 --> 01:15:44,306 AND THERE'S A CURE FOR 1741 01:15:44,306 --> 01:15:44,640 SCHIZOPHRENIA. 1742 01:15:44,640 --> 01:15:47,009 THAT WOULD BE SURPRISING FOR 1743 01:15:47,009 --> 01:15:48,411 PEOPLE TO THINK IT'S A 1744 01:15:48,411 --> 01:15:49,578 REASONABLE RESEARCH QUESTION. 1745 01:15:49,578 --> 01:15:54,650 THERE'S OTHER RESEARCH QUESTIONS 1746 01:15:54,650 --> 01:16:05,061 AND SO WHEN OBSERVE THE 1747 01:16:14,303 --> 01:16:16,138 DISCUSSION ON MORE BASIC SCIENCE 1748 01:16:16,138 --> 01:16:17,106 MECHANISMS THIS IS WHAT ALWAYS 1749 01:16:17,106 --> 01:16:19,275 COMES TO MY MIND. 1750 01:16:19,275 --> 01:16:26,782 WHAT HOW WILL IT TAKE TO HAVE AN 1751 01:16:26,782 --> 01:16:32,388 ANSWER. 1752 01:16:32,388 --> 01:16:34,590 YOU'RE GOVERNED BY COUNTRIES AND 1753 01:16:34,590 --> 01:16:36,158 ASKING QUESTIONS THE KINDS OF 1754 01:16:36,158 --> 01:16:37,326 QUESTIONS WE GET FROM COUNTRIES 1755 01:16:37,326 --> 01:16:38,928 ARE WHAT CAN WE DO NOW? 1756 01:16:38,928 --> 01:16:40,830 WHAT KNOWLEDGE DO WE HAVE NOW 1757 01:16:40,830 --> 01:16:45,234 THAT WE CAN IMPLEMENT? 1758 01:16:45,234 --> 01:16:50,639 THE KIND OF RESEARCH WE PROMOTE 1759 01:16:50,639 --> 01:17:00,149 IS IMPLEMENTATION SCIENCE AND 1760 01:17:00,149 --> 01:17:01,817 W.H.O. TELLS US A LOT OF THINGS 1761 01:17:01,817 --> 01:17:02,218 WORK. 1762 01:17:02,218 --> 01:17:06,021 HOW DO WE MAKE IT WORK? 1763 01:17:06,021 --> 01:17:16,398 IT'S A SHORTER AGENDA. 1764 01:17:19,068 --> 01:17:28,377 AND SHOULD HAVE THE APPLIED 1765 01:17:28,377 --> 01:17:28,744 IMPLEMENTATION. 1766 01:17:28,744 --> 01:17:38,921 THERE'S AN ISSUE WITH THEM. 1767 01:17:38,921 --> 01:17:40,055 THE QUESTION OF THE PANEL IS 1768 01:17:40,055 --> 01:17:46,562 WHAT IS PRECISION MEDICINE AND 1769 01:17:46,562 --> 01:17:54,103 TRANSLATION PSYCHIATRY WITH 1770 01:17:54,103 --> 01:17:55,371 GLOBAL HEALTH. 1771 01:17:55,371 --> 01:18:00,843 FIRST, IF WE'RE TALKING ABOUT 1772 01:18:00,843 --> 01:18:06,582 STRATIFICATION WE'RE TALKING 1773 01:18:06,582 --> 01:18:08,717 ABOUT POPULATIONS WORLDWIDE. 1774 01:18:08,717 --> 01:18:12,955 AND THE WORLD IS MORE AND MORE A 1775 01:18:12,955 --> 01:18:13,589 GLOBAL PLACE. 1776 01:18:13,589 --> 01:18:16,191 PEOPLE IN ONE COUNTRY ARE ALSO 1777 01:18:16,191 --> 01:18:22,031 OFTEN IN OTHER COUNTRIES. 1778 01:18:22,031 --> 01:18:26,402 SECOND IS A QUESTION OF MORE 1779 01:18:26,402 --> 01:18:27,970 MORAL QUESTION OF CAPACITY 1780 01:18:27,970 --> 01:18:32,241 BUILDING. 1781 01:18:32,241 --> 01:18:33,375 CAPACITIES SHOULD BE BUILT 1782 01:18:33,375 --> 01:18:33,676 EVERYWHERE. 1783 01:18:33,676 --> 01:18:34,910 THERE'S A QUESTION OF COST AND 1784 01:18:34,910 --> 01:18:40,482 RESEARCH QUESTIONS AND YOU CAN 1785 01:18:40,482 --> 01:18:46,188 GO FURTHER WITH YOUR RESEARCH 1786 01:18:46,188 --> 01:18:52,528 DOLLAR OR POUND IN CERTAIN 1787 01:18:52,528 --> 01:19:03,072 HIGH-INCOME COUNTRIES AND OVER 1788 01:19:03,572 --> 01:19:06,475 ALL I WOULD ARGUE IT'S EXTREMELY 1789 01:19:06,475 --> 01:19:07,443 IMPORTANT TO HAVE THE RESEARCH 1790 01:19:07,443 --> 01:19:12,448 YOU'RE DOING AND HAVE IT 1791 01:19:12,448 --> 01:19:19,722 OCCURRING AROUND THE WORLD. 1792 01:19:19,722 --> 01:19:25,594 AT THE W.H.O. WE DO 1793 01:19:25,594 --> 01:19:27,997 INTERVENTIONS AND WE CALL TRANS 1794 01:19:27,997 --> 01:19:33,135 DIAGNOSTIC AND ALMOST 1795 01:19:33,135 --> 01:19:33,435 ADIAGNOSTIC. 1796 01:19:33,435 --> 01:19:38,140 WE HAVE THEM DISTRESSED AND HOPE 1797 01:19:38,140 --> 01:19:40,609 AS MANY PEOPLE WE SEE HOW MANY 1798 01:19:40,609 --> 01:19:44,613 PEOPLE CAN BENEFIT FROM THAT AND 1799 01:19:44,613 --> 01:19:47,149 FOR RIGHT NOW WHAT WE SHOULD 1800 01:19:47,149 --> 01:19:49,285 HELP PEOPLE WITH NEXT COUPLE 1801 01:19:49,285 --> 01:19:51,587 YEARS IS ABSOLUTELY DERIVED 1802 01:19:51,587 --> 01:19:52,821 THROUGH WHAT PEOPLE NEED TO 1803 01:19:52,821 --> 01:19:58,627 HAVE. 1804 01:19:58,627 --> 01:20:01,230 THINK OF THE DATA AND WE DID A 1805 01:20:01,230 --> 01:20:02,998 WORLD MENTAL HEALTH AND LOOKED 1806 01:20:02,998 --> 01:20:03,899 AT THE COVERAGE AND TREATMENT 1807 01:20:03,899 --> 01:20:13,976 GAP. 1808 01:20:17,980 --> 01:20:20,683 TWO OF THREE PEOPLE AROUND THE 1809 01:20:20,683 --> 01:20:26,255 WORLD ARE IN NEED DUE TO 1810 01:20:26,255 --> 01:20:28,123 PSYCHOSIS. 1811 01:20:28,123 --> 01:20:35,898 AND CLEARLY THE DIAGNOSTIC IS 1812 01:20:35,898 --> 01:20:36,865 APPROACH IS NOT ENOUGH. 1813 01:20:36,865 --> 01:20:37,332 WE CAN DO MUCH BETTER. 1814 01:20:37,332 --> 01:20:43,105 THANK YOU. 1815 01:20:43,105 --> 01:20:44,106 >> EXCELLENT, MARK. 1816 01:20:44,106 --> 01:20:44,907 THANK YOU FOR YOUR CONTRIBUTION 1817 01:20:44,907 --> 01:20:46,275 AND CRITICAL THOUGHTS ON THIS. 1818 01:20:46,275 --> 01:20:52,581 I THINK WE HAVE TIME FOR A FEW 1819 01:20:52,581 --> 01:20:52,848 QUESTIONS. 1820 01:20:52,848 --> 01:20:55,217 NOT TOO MANY BUT ARE THERE 1821 01:20:55,217 --> 01:20:57,086 COMMENTS OR QUESTIONS FROM THE 1822 01:20:57,086 --> 01:20:57,352 AUDIENCE? 1823 01:20:57,352 --> 01:20:59,188 IF YOU CAN GO TO THE MICROPHONES 1824 01:20:59,188 --> 01:21:09,498 IN BOTH CORRIDORS. 1825 01:21:09,732 --> 01:21:11,767 >> I'M FROM HOLLAND. 1826 01:21:11,767 --> 01:21:18,207 I HAVE A QUESTION FOR YOU. 1827 01:21:18,207 --> 01:21:19,408 PAOLO, YOU TALKED ABOUT CHILDREN 1828 01:21:19,408 --> 01:21:21,477 ARE AT RISK FOR PSYCHOSIS AND 1829 01:21:21,477 --> 01:21:25,347 ALSO IN THE PAST AT RISK FOR 1830 01:21:25,347 --> 01:21:25,948 DEPRESSION AND THERE'S SOME 1831 01:21:25,948 --> 01:21:31,387 RELATION THERE OVER TIME. 1832 01:21:31,387 --> 01:21:32,888 DO YOU BELIEVE THE SECOND 1833 01:21:32,888 --> 01:21:34,423 DISORDER THE RISK IS RAISED BY 1834 01:21:34,423 --> 01:21:36,692 THE FIRST DISORDER OR IS THERE 1835 01:21:36,692 --> 01:21:38,861 AN UNDERLYING CAUSE THAT LEADS 1836 01:21:38,861 --> 01:21:39,762 TO BOTH? 1837 01:21:39,762 --> 01:21:40,763 PERHAPS SOCIAL DETERMINATE OR 1838 01:21:40,763 --> 01:21:41,296 SOMETHING YOU'VE SEEN IN 1839 01:21:41,296 --> 01:21:51,473 PATIENTS? 1840 01:21:54,543 --> 01:21:58,547 >> I THINK WE LEARNED PSYCHOSIS 1841 01:21:58,547 --> 01:22:03,152 CAN EMERGE FROM DIFFERENT 1842 01:22:03,152 --> 01:22:04,753 PSYCHOLOGICAL DIMENSIONS AND NOT 1843 01:22:04,753 --> 01:22:11,393 PSYCHOSIS SEPARATE FROM EARLY 1844 01:22:11,393 --> 01:22:16,999 STAGE OF NEURODEVELOPMENT 1845 01:22:16,999 --> 01:22:17,933 DISORDER AND THINGS CAN GET 1846 01:22:17,933 --> 01:22:19,735 BLURRED AND OVERLAPPING AND IF 1847 01:22:19,735 --> 01:22:21,637 WE WANT TO BE PRAGMATIC AND TRY 1848 01:22:21,637 --> 01:22:26,275 TO PREVENT SCHIZOPHRENIA IN ANY 1849 01:22:26,275 --> 01:22:27,676 SCENARIO WE WANT TO MAXIMIZE OUR 1850 01:22:27,676 --> 01:22:29,545 ABILITY TO DO THAT TO THE VAST 1851 01:22:29,545 --> 01:22:30,112 MAJORITY OF YOUNG PEOPLE AT 1852 01:22:30,112 --> 01:22:38,821 RISK. 1853 01:22:38,821 --> 01:22:42,324 SOME MAY HAVE COMMON MENTAL 1854 01:22:42,324 --> 01:22:42,991 DISORDER, DEPRESSION, SUBSTANCE 1855 01:22:42,991 --> 01:22:49,565 MISUSE. 1856 01:22:49,565 --> 01:22:50,899 AND THERE'S A COMBINATION OF 1857 01:22:50,899 --> 01:22:54,303 RISK FACTORS AND THE MORE THE 1858 01:22:54,303 --> 01:22:55,337 RISK AND WILL DEVELOP PSYCHOTIC 1859 01:22:55,337 --> 01:23:04,246 CONDITIONS. 1860 01:23:04,246 --> 01:23:06,014 THE EMERGING DISORDERS ACROSS 1861 01:23:06,014 --> 01:23:10,586 THE STATES AND MENTAL HEALTH 1862 01:23:10,586 --> 01:23:11,220 SERVICES AND EMERGENCY 1863 01:23:11,220 --> 01:23:14,256 DEPARTMENTS PRIMARY CARE IS A 1864 01:23:14,256 --> 01:23:16,558 WAY OF BOOSTING OUR ABILITY TO 1865 01:23:16,558 --> 01:23:18,093 DIAGNOSIS INDIVIDUALS AND IF YOU 1866 01:23:18,093 --> 01:23:19,895 WANT TO LOOK AT SPECIFIC NUMBERS 1867 01:23:19,895 --> 01:23:21,730 THERE'S META-ANALYSIS AND 1868 01:23:21,730 --> 01:23:23,866 REPORTING ON SPECIFIC RISK, FOR 1869 01:23:23,866 --> 01:23:26,535 EXAMPLE, OF THE LIKELY OF 1870 01:23:26,535 --> 01:23:29,872 DEVELOPING PSYCHOSIS FROM A 1871 01:23:29,872 --> 01:23:38,413 PRECEDING DEPRESSION OR BIPOLAR 1872 01:23:38,413 --> 01:23:47,856 DISORDER. 1873 01:23:47,856 --> 01:23:50,425 >> I THINK LIKE LET'S TAKE A 1874 01:23:50,425 --> 01:23:52,895 YOUNG PERSON WITH ADHD IT'S 1875 01:23:52,895 --> 01:23:54,696 ASSOCIATED WITH A FOUR-FOLD 1876 01:23:54,696 --> 01:23:56,632 INCREASE OF DEVELOPING PSYCHOSIS 1877 01:23:56,632 --> 01:23:57,566 AS AN ADULT. 1878 01:23:57,566 --> 01:24:00,135 WE ALSO HAVE GENETIC STUDIES 1879 01:24:00,135 --> 01:24:01,603 THERE'S SOME SHARED RISK GENES 1880 01:24:01,603 --> 01:24:04,273 BETWEEN ADHD AND SCHIZOPHRENIA. 1881 01:24:04,273 --> 01:24:06,808 SOME PEOPLE MAY BE UNLUCKY AND 1882 01:24:06,808 --> 01:24:09,578 HAVE ADHD AND DEVELOP PSYCHOSIS 1883 01:24:09,578 --> 01:24:09,845 LATER. 1884 01:24:09,845 --> 01:24:12,314 ON THE OTHER HAND IF YOU THINK 1885 01:24:12,314 --> 01:24:17,185 OF SOMEONE WITH ADHD WHO MAY BE 1886 01:24:17,185 --> 01:24:18,587 IMPULSIVE OR RISK TAKE AND MAY 1887 01:24:18,587 --> 01:24:19,955 GO OUT AND DECIDE TO USE 1888 01:24:19,955 --> 01:24:21,823 CANNABIS OR COCAINE BECAUSE IT'S 1889 01:24:21,823 --> 01:24:23,926 FUN AND THEN YOU'RE POURING 1890 01:24:23,926 --> 01:24:26,328 GASOLINE ON A VULNERABLE BRAIN. 1891 01:24:26,328 --> 01:24:28,297 MAYBE THEY WOULDN'T HAVE GOTTEN 1892 01:24:28,297 --> 01:24:29,898 PSYCHOSIS BUT YOU THROW THAT IN 1893 01:24:29,898 --> 01:24:30,399 THE MIX. 1894 01:24:30,399 --> 01:24:35,604 I THINK THERE'S DIFFERENT 1895 01:24:35,604 --> 01:24:37,839 PATHWAYS TO GET THERE AND 1896 01:24:37,839 --> 01:24:41,777 SOMETIMES IT'S PRE DETERMINED 1897 01:24:41,777 --> 01:24:44,046 AND OTHERS TIMES NOT AND OTHER 1898 01:24:44,046 --> 01:24:45,113 SOCIAL DETERMINATES OF HEALTH 1899 01:24:45,113 --> 01:24:47,516 AND RISK FACTORS ON TOP OF A 1900 01:24:47,516 --> 01:24:48,150 VULNERABLE KID THAT LEADS THEM 1901 01:24:48,150 --> 01:24:58,393 TO PSYCHOSIS. 1902 01:25:00,896 --> 01:25:02,097 >> ANY QUESTION IS FOR EVERYBODY 1903 01:25:02,097 --> 01:25:03,865 ON THE PANEL, I'M A CLINICIAN 1904 01:25:03,865 --> 01:25:06,835 AND A WONDER IF FOR YOU GUYS IN 1905 01:25:06,835 --> 01:25:11,673 DETERMINING THESE FACTORS FOR 1906 01:25:11,673 --> 01:25:13,575 PSYCHOSIS IF YOU DO 1907 01:25:13,575 --> 01:25:14,242 INTERDISCIPLINARY WORK BECAUSE I 1908 01:25:14,242 --> 01:25:17,379 HAVE CLIENTS THAT HAVE GOTTEN 1909 01:25:17,379 --> 01:25:19,514 INDUCED FROM PSYCHOSIS FROM 1910 01:25:19,514 --> 01:25:24,553 NUTRITIONAL IMBALANCES AND HAVE 1911 01:25:24,553 --> 01:25:29,324 CLIENTS WITH PSYCHOSIS DUE TO 1912 01:25:29,324 --> 01:25:34,629 DRUGS AND OTHER THEORIES PLAY A 1913 01:25:34,629 --> 01:25:40,402 ROLE IN THE AUTONOMIC SYMPTOMS 1914 01:25:40,402 --> 01:25:43,171 AND THERE'S SO MANY FACTORS THAT 1915 01:25:43,171 --> 01:25:44,706 CAN CONTRIBUTE TO PSYCHOSIS 1916 01:25:44,706 --> 01:25:54,950 SPECIFICALLY. 1917 01:26:00,455 --> 01:26:05,427 >> RESEARCH AND EVIDENCE SHOWS 1918 01:26:05,427 --> 01:26:08,196 THERE'S SUB TYPES OF THE 1919 01:26:08,196 --> 01:26:09,664 CONUNDRUM THAT CAN CAUSE 1920 01:26:09,664 --> 01:26:10,265 PSYCHOSIS. 1921 01:26:10,265 --> 01:26:12,734 I TAKE MARK'S VIEW SERIOUSLY. 1922 01:26:12,734 --> 01:26:19,808 THIS IS SCIENCE AT THE MOMENT. 1923 01:26:19,808 --> 01:26:21,043 SCIENCE FROM THE INDUSTRIALIZED 1924 01:26:21,043 --> 01:26:21,243 WORLD. 1925 01:26:21,243 --> 01:26:27,382 WE HAVE POOR INSIGHT INTO HOW 1926 01:26:27,382 --> 01:26:28,884 THE COMPLEXITY MAPS INTO OTHER 1927 01:26:28,884 --> 01:26:31,019 MIDDLE INCOME COUNTRIES BECAUSE 1928 01:26:31,019 --> 01:26:32,621 THERE'S A SCARCITY OF EVIDENCE 1929 01:26:32,621 --> 01:26:34,056 OF LONGITUDINAL STUDIES 1930 01:26:34,056 --> 01:26:40,162 CONDUCTED IN THE SETTINGS. 1931 01:26:40,162 --> 01:26:42,798 IT'S SCIENCE IT'S STILL NOT 1932 01:26:42,798 --> 01:26:45,867 ACTIONABLE BUT THERE'S AS PAOLO 1933 01:26:45,867 --> 01:26:47,135 SHOWED GOOD WAYS OF DOING 1934 01:26:47,135 --> 01:26:47,702 STRATIFICATION WITH WHAT WE 1935 01:26:47,702 --> 01:26:51,373 ALREADY HAVE. 1936 01:26:51,373 --> 01:26:54,543 DETECTING DESPITE ALL THE 1937 01:26:54,543 --> 01:26:58,580 COMPLEXITY AND SIGNAL OF RISK 1938 01:26:58,580 --> 01:27:00,882 EARLY ON BUT TO CONTINUE ALONG 1939 01:27:00,882 --> 01:27:02,617 TO THE LINES YOU RAISED 1940 01:27:02,617 --> 01:27:02,884 BASICALLY. 1941 01:27:02,884 --> 01:27:05,320 HAVE YOU SHOWN THERE'S AN 1942 01:27:05,320 --> 01:27:10,992 ALGORITHM THAT PREDICTS LY WELL 1943 01:27:10,992 --> 01:27:17,232 THE INDIVIDUAL RISK. 1944 01:27:17,232 --> 01:27:19,401 WHAT DO YOU DO WITH THAT? 1945 01:27:19,401 --> 01:27:24,873 IF IT'S SENSITIVE IT WILL PICK 1946 01:27:24,873 --> 01:27:26,942 UP RISK ACROSS SWATHS OF THE 1947 01:27:26,942 --> 01:27:27,242 POPULATION. 1948 01:27:27,242 --> 01:27:34,049 WHAT DO YOU ED FOR A LOW AND 1949 01:27:34,049 --> 01:27:36,218 MIDDLE INCOME SETTING TO DO WITH 1950 01:27:36,218 --> 01:27:38,053 THAT SIGNAL IF THERE'S SCARCITY 1951 01:27:38,053 --> 01:27:39,087 OF RESOURCES? 1952 01:27:39,087 --> 01:27:42,023 >> YES, THIS KIND OF DIGITAL 1953 01:27:42,023 --> 01:27:42,791 SCREENING APPROACHES THAT 1954 01:27:42,791 --> 01:27:45,427 CAPTURE THE FACTORS AND THE 1955 01:27:45,427 --> 01:27:47,229 CAUSES FOR PSYCHOSIS ARE ALL 1956 01:27:47,229 --> 01:27:47,863 FACTORS. 1957 01:27:47,863 --> 01:27:51,533 IT'S A PRAGMATIC SYSTEM SYSTEMIC 1958 01:27:51,533 --> 01:27:54,536 APPROACH TO DETECT VULNERABILITY 1959 01:27:54,536 --> 01:27:56,538 INCLUDING THE RISK FACTORS. 1960 01:27:56,538 --> 01:27:58,273 THERE'S A BALANCE BETWEEN 1961 01:27:58,273 --> 01:27:59,508 SENSITIVITY AND SPECIFICITY 1962 01:27:59,508 --> 01:28:05,347 AROUND 90% SO IT'S OKAY WE'RE 1963 01:28:05,347 --> 01:28:09,251 TRYING TO IMPROVE THAT WE'RE NOT 1964 01:28:09,251 --> 01:28:11,686 BEING INUNDATED BY TOO MANY 1965 01:28:11,686 --> 01:28:14,256 CASES AND IT'S USEFUL TO BE USED 1966 01:28:14,256 --> 01:28:15,223 IN THE COMMUNITY. 1967 01:28:15,223 --> 01:28:19,494 AND THE RISK IS WITHOUT 1968 01:28:19,494 --> 01:28:21,263 SCREENING THERE WILL BE CASES 1969 01:28:21,263 --> 01:28:25,500 WITH YOUNG PEOPLE DEVELOPING 1970 01:28:25,500 --> 01:28:27,102 PSYCHOSIS WITHOUT PROPER 1971 01:28:27,102 --> 01:28:30,505 DIAGNOSIS AND TREATMENT AND THE 1972 01:28:30,505 --> 01:28:32,741 DURATION OF UNTREATED PSYCHOSIS 1973 01:28:32,741 --> 01:28:34,776 IF YOU LOOK AT BIPOLAR DISORDER 1974 01:28:34,776 --> 01:28:40,749 IT TAKES 10 YEARS TO GET A 1975 01:28:40,749 --> 01:28:42,684 DIAGNOSIS IN THE U.K. 1976 01:28:42,684 --> 01:28:45,120 AND CAPTURING EMERGING 1977 01:28:45,120 --> 01:28:45,387 DISORDERS. 1978 01:28:45,387 --> 01:28:52,394 AND THAT'S THE APPROACH AND 1979 01:28:52,394 --> 01:28:54,162 STRAIGHT BETWEEN POST POSITIVES 1980 01:28:54,162 --> 01:28:55,497 AND NEGATIVES. 1981 01:28:55,497 --> 01:28:57,766 >> CAN I FOLLOW-UP? 1982 01:28:57,766 --> 01:29:02,103 YOU HAVE A WIDE RANGE OF MENTAL 1983 01:29:02,103 --> 01:29:04,673 DISORDERS, BIPOLAR AND PTSD 1984 01:29:04,673 --> 01:29:06,842 INCLUDING HALLUCINATIONS AND 1985 01:29:06,842 --> 01:29:07,142 PSYCHOSIS. 1986 01:29:07,142 --> 01:29:12,080 MY QUESTION WOULD BE IS THERE'S 1987 01:29:12,080 --> 01:29:15,150 RESEARCH TO SHOW MISDIAGNOSIS 1988 01:29:15,150 --> 01:29:16,918 BECAUSE OF THE EFFECTS OF TRAUMA 1989 01:29:16,918 --> 01:29:17,752 ON THE BODY. 1990 01:29:17,752 --> 01:29:21,790 I'M WONDERING HOW YOU GUYS ARE 1991 01:29:21,790 --> 01:29:23,091 IMPLEMENTING DIFFERENT FIELD OF 1992 01:29:23,091 --> 01:29:25,093 OF PEOPLE DOING SPECIFIC STUDIES 1993 01:29:25,093 --> 01:29:26,561 TO COME UP WITH MORE ACCURATE 1994 01:29:26,561 --> 01:29:37,105 TOOLS AND ASSESSMENTS FOR THAT. 1995 01:29:37,973 --> 01:29:39,774 >> THE FIRST SLIDE I PRESENT WAS 1996 01:29:39,774 --> 01:29:41,543 THE TEAM-BASED MODEL OF CARE FOR 1997 01:29:41,543 --> 01:29:42,510 PEOPLE WITH PSYCHOSIS. 1998 01:29:42,510 --> 01:29:43,912 WHEN YOU HAVE THAT YOU NEED A 1999 01:29:43,912 --> 01:29:48,817 TEAM IF YOU HAVE THE RESOURCES. 2000 01:29:48,817 --> 01:29:53,488 ONE OF THE CONSIDERATIONS IS 2001 01:29:53,488 --> 01:29:55,290 STEP-CARE MODEL IN TERMS OF LESS 2002 01:29:55,290 --> 01:29:56,992 SPECIFIC TO THE DIAGNOSIS AND 2003 01:29:56,992 --> 01:30:00,595 MORE THE INTENSIVITY OF ME. 2004 01:30:00,595 --> 01:30:01,329 THE NAVIGATE MODEL THAT SUPPORTS 2005 01:30:01,329 --> 01:30:03,398 EDUCATION AND EMPLOYMENT, FAMILY 2006 01:30:03,398 --> 01:30:06,201 SUPPORT AND INDIVIDUAL 2007 01:30:06,201 --> 01:30:08,737 RESILIENCE AND MEDICATION. 2008 01:30:08,737 --> 01:30:11,806 ANY SEVERELY ILL 16, 17-YEAR-OLD 2009 01:30:11,806 --> 01:30:13,909 WOULD BENEFIT AND WE'RE TRYING 2010 01:30:13,909 --> 01:30:16,611 TO ADOPT THAT BUT ADAPT IT IN A 2011 01:30:16,611 --> 01:30:17,545 STEPPED WAY BECAUSE WE DON'T 2012 01:30:17,545 --> 01:30:19,481 HAVE THE RESOURCES TO DO IT FOR 2013 01:30:19,481 --> 01:30:23,018 EVERYONE BUT I THINK FOR THAT 2014 01:30:23,018 --> 01:30:24,119 BOTTOM 20% YOU'RE DESCRIBING 2015 01:30:24,119 --> 01:30:26,054 COULD BENEFIT FROM A TEAM-BASED 2016 01:30:26,054 --> 01:30:27,489 MODEL LIKE THAT AND HAVE YOU 2017 01:30:27,489 --> 01:30:29,924 LIGHTER TOUCHES AS YOU GO UP. 2018 01:30:29,924 --> 01:30:33,862 AND WE HAVE TO BUILD A SYSTEM 2019 01:30:33,862 --> 01:30:34,663 DESIGN IF WE'RE GOING TO TAKE 2020 01:30:34,663 --> 01:30:38,099 CARE OF EVERYONE. 2021 01:30:38,099 --> 01:30:39,968 >> THANK YOU, ARISTOTLE. 2022 01:30:39,968 --> 01:30:46,508 I THINK WE'RE END AT THE 2023 01:30:46,508 --> 01:30:46,741 SESSION. 2024 01:30:46,741 --> 01:30:50,278 CLOSING WORDS FROM MUSMUN. 2025 01:30:50,278 --> 01:30:53,548 >> WE KNOW THE FIELD OF GLOBAL 2026 01:30:53,548 --> 01:30:55,350 MENTAL HEALTH IS AT THE POINT WE 2027 01:30:55,350 --> 01:30:58,987 WANT TO REFINE AND NOW THE 2028 01:30:58,987 --> 01:31:01,523 STRATIFICATIONS. 2029 01:31:01,523 --> 01:31:04,592 WHEN WE THINK OF THIS IT'S NOT 2030 01:31:04,592 --> 01:31:05,694 FOR GLOBAL MENTAL HEALTH BUT 2031 01:31:05,694 --> 01:31:08,897 FROM THE PRESENTATIONS WE CAN 2032 01:31:08,897 --> 01:31:13,435 SEE IT'S CROSS-DISCIPLINARY AND 2033 01:31:13,435 --> 01:31:14,302 SCALABLE AND THE IMPLEMENTATION 2034 01:31:14,302 --> 01:31:15,603 RESEARCH STUDIES THE MENTAL 2035 01:31:15,603 --> 01:31:18,073 HEALTH FOLKS ARE ENGAGED IN LEND 2036 01:31:18,073 --> 01:31:20,976 TO THE METHODOLOGIES AND TOOLS 2037 01:31:20,976 --> 01:31:24,446 AND TACTICS CERTIFICATION HAS TO 2038 01:31:24,446 --> 01:31:26,948 OFFER AND OPEN NEW DOORS FOR THE 2039 01:31:26,948 --> 01:31:29,384 INTERVENTIONS THAT WE NEED IN 2040 01:31:29,384 --> 01:31:31,186 GLOBAL MENTAL HEALTH. 2041 01:31:31,186 --> 01:31:32,487 A BIG ROUND OF APPLAUSE FOR THE 2042 01:31:32,487 --> 01:31:41,830 PANELISTS. 2043 01:31:41,830 --> 01:31:44,632 I AM VERY HONORED TO WELCOME 2044 01:31:44,632 --> 01:31:50,271 THE STAGE, PROFESSORS. 2045 01:31:50,271 --> 01:31:51,506 WHEN I WAS TRAINED IN MEDICINE E 2046 01:31:51,506 --> 01:31:53,875 90s, I USED TO THINK THAT 2047 01:31:53,875 --> 01:31:57,112 RANDOMIZED CONTROL TRIALS AND TS 2048 01:31:57,112 --> 01:31:59,581 OVERALL, WERE EXCLUSIVELY DONE N 2049 01:31:59,581 --> 01:32:01,149 MEDICINE AND MENTAL HEALTH. 2050 01:32:01,149 --> 01:32:11,626 OVER TIME, THAT HAS CHANGED. 2051 01:32:17,899 --> 01:32:25,874 -- TO ALLEVIATE POVERTY. 2052 01:32:25,874 --> 01:32:28,977 SHE RECEIVED [ INAUDIBLE ] 2053 01:32:28,977 --> 01:32:31,980 AND MICHAEL KRAMER. 2054 01:32:31,980 --> 01:32:34,716 PROFESSOR DEFLOW IS PROFESSOR AE 2055 01:32:34,716 --> 01:32:37,652 MASSACHUSETTS INSTITUTE OF TECHY 2056 01:32:37,652 --> 01:32:40,422 IN POVERTY ALLEVIATION AND 2057 01:32:40,422 --> 01:32:41,322 DEVELOPMENTAL ECONOMICS. 2058 01:32:41,322 --> 01:32:43,291 OUR HOST OF THE SECOND GLOBAL ML 2059 01:32:43,291 --> 01:32:45,860 HEALTH CONVERSATIONS IS PROFESSR 2060 01:32:45,860 --> 01:32:47,495 BENJAMIN COOK. 2061 01:32:47,495 --> 01:32:51,166 PROFESSOR COOK WAS RECENTLY PROD 2062 01:32:51,166 --> 01:32:53,301 TO FULL PROFESSOR AT THE DEPARTT 2063 01:32:53,301 --> 01:32:55,170 OF PSYCHIATRY AT HARVARD MEDICAL 2064 01:32:55,170 --> 01:32:55,403 SCHOOL. 2065 01:32:55,403 --> 01:32:59,340 HE HOLDS A PH.D. IN HEALTH POLIY 2066 01:32:59,340 --> 01:33:04,679 FROM HARVARD AS WELL AND HE DIRS 2067 01:33:04,679 --> 01:33:08,183 THE CENTER FOR EQUITY RESEARCH N 2068 01:33:08,183 --> 01:33:08,516 BOSTON. 2069 01:33:08,516 --> 01:33:11,119 HE IS A HEALTH SERVICES RESEARCR 2070 01:33:11,119 --> 01:33:15,023 WHO WORKS PRIMARILY IN HEALTH 2071 01:33:15,023 --> 01:33:16,157 DISPARITIES USING A MIX OF 2072 01:33:16,157 --> 01:33:19,594 QUALITATIVE AND QUANTITATIVE MES 2073 01:33:19,594 --> 01:33:22,430 AND EMPLOYS A LOT OF BIG DATA. 2074 01:33:22,430 --> 01:33:26,034 SO, I WILL LET YOU, BENJAMIN, TT 2075 01:33:26,034 --> 01:33:26,234 AWAY. 2076 01:33:26,234 --> 01:33:27,035 THANK YOU VERY MUCH FOR BEING H. 2077 01:33:27,035 --> 01:33:35,910 AND THANK YOU PROFESSOR, FOR BEG 2078 01:33:35,910 --> 01:33:39,180 HERE. 2079 01:33:39,180 --> 01:33:41,282 >> I HAVE TO REALLY GET INTO ITE 2080 01:33:41,282 --> 01:33:45,487 A LEAD SINGER OF A ROCK BAND. 2081 01:33:45,487 --> 01:33:45,687 OKAY. 2082 01:33:45,687 --> 01:33:46,387 GREAT TO BE HERE. 2083 01:33:46,387 --> 01:33:53,194 SO NICE TO HAVE THE TIME TO TALH 2084 01:33:53,194 --> 01:33:53,661 YOU. 2085 01:33:53,661 --> 01:33:55,730 SO, WE HAVE BEEN ASKED TO DO A 2086 01:33:55,730 --> 01:33:56,731 FIRESIDE CHAT. 2087 01:33:56,731 --> 01:33:58,967 THIS IS GOING TO BE A LITTLE MOE 2088 01:33:58,967 --> 01:33:59,234 INFORMAL. 2089 01:33:59,234 --> 01:34:01,069 I WAS TOLD THAT THIS SHOULD LOOA 2090 01:34:01,069 --> 01:34:05,139 LITTLE BIT LIKE THE SHOW, INSIDE 2091 01:34:05,139 --> 01:34:06,140 ACTOR'S STUDIO. 2092 01:34:06,140 --> 01:34:07,408 THIS GUY, JAMES LIPTON. 2093 01:34:07,408 --> 01:34:09,077 SO I WENT ON LINE BECAUSE I HAVT 2094 01:34:09,077 --> 01:34:10,745 SEEN THE SHOW. 2095 01:34:10,745 --> 01:34:13,815 AND HE INTERVIEWS PEOPLE LIKE 2096 01:34:13,815 --> 01:34:16,317 MICHELLE PHEIFFER AND ROBERT DEO 2097 01:34:16,317 --> 01:34:18,586 AND SO -- THAT'S HOW THIS IS GOO 2098 01:34:18,586 --> 01:34:19,287 GO. 2099 01:34:19,287 --> 01:34:20,722 WE'RE GOING TO DO SOMETHING LIKE 2100 01:34:20,722 --> 01:34:29,364 INSIDE THE ACTOR'S STUDIO AND IL 2101 01:34:29,364 --> 01:34:29,764 PLAY JAMES LIPTON. 2102 01:34:29,764 --> 01:34:30,899 WHY DON'T WE START. 2103 01:34:30,899 --> 01:34:32,934 I'M GOING ASK QUESTIONS AND WE'L 2104 01:34:32,934 --> 01:34:35,436 HAVE ABOUT 10 MINUTES AT THE ENF 2105 01:34:35,436 --> 01:34:40,375 THIS TO ASK SOME MORE QUESTIONSF 2106 01:34:40,375 --> 01:34:40,742 ESTER. 2107 01:34:40,742 --> 01:34:43,878 SO I WANTED TO START TO ASK A 2108 01:34:43,878 --> 01:34:45,647 QUESTION A LITTLE BIT ABOUT YOUR 2109 01:34:45,647 --> 01:34:45,947 BACKGROUND. 2110 01:34:45,947 --> 01:34:48,650 YOU'RE AN ECONOMIST. 2111 01:34:48,650 --> 01:34:49,717 AND I DON'T THINK THERE ARE GOIO 2112 01:34:49,717 --> 01:34:52,654 BE MANY ECONOMISTS IN THE ROOM,E 2113 01:34:52,654 --> 01:34:53,888 SOME WHO TRAINED IN HEALTH ECONS 2114 01:34:53,888 --> 01:34:58,760 AND SOME ECONOMISTS ARE HERE. 2115 01:34:58,760 --> 01:34:58,960 YES. 2116 01:34:58,960 --> 01:35:02,797 AND SO I WANTED TO MAKE SURE THE 2117 01:35:02,797 --> 01:35:04,666 ARE KIND OF ON THE SAME PAGE ABT 2118 01:35:04,666 --> 01:35:06,868 YOUR BACKGROUND AND TO MERGE THT 2119 01:35:06,868 --> 01:35:07,769 WITH SOME OF THE EXPERIENCE HERF 2120 01:35:07,769 --> 01:35:11,039 THE CLINICIANS AND THE 2121 01:35:11,039 --> 01:35:11,673 EPIDEMIOLOGISTS AND WILL MENTAL 2122 01:35:11,673 --> 01:35:13,575 HEALTH SERVICES RESEARCHERS THAE 2123 01:35:13,575 --> 01:35:14,242 COMING. 2124 01:35:14,242 --> 01:35:16,711 AND I THOUGHT I'D START BY READG 2125 01:35:16,711 --> 01:35:17,845 SOMETHING FROM THE RECENT BOOK T 2126 01:35:17,845 --> 01:35:21,282 YOU PUBLISHED ON GOOD ECONOMICSN 2127 01:35:21,282 --> 01:35:26,854 BAD PLACES. 2128 01:35:26,854 --> 01:35:31,392 AND WHAT YOU SAID WAS, ECONOMISE 2129 01:35:31,392 --> 01:35:32,093 MORE LIKE PLUMBERS THAN PHYSICI. 2130 01:35:32,093 --> 01:35:34,829 WE SOLVE PROBLEMS WITH A COMBINN 2131 01:35:34,829 --> 01:35:37,398 OF IN TUITION GROUNDED IN SCIEN, 2132 01:35:37,398 --> 01:35:38,132 SOME GUESSWORK AIDED BY EXPERIEE 2133 01:35:38,132 --> 01:35:42,537 AND A BUNCH OF PURE TRIAL AND E. 2134 01:35:42,537 --> 01:35:46,074 SO I'M NO PLUMBER BUT I PLUMBEDW 2135 01:35:46,074 --> 01:35:48,743 SINKS AND TOILETS IN MY DAY, ANI 2136 01:35:48,743 --> 01:35:50,678 KNOW THAT IT'S A LOT OF WORK. 2137 01:35:50,678 --> 01:35:54,015 IT'S VERY REWARDING, ALSO. 2138 01:35:54,015 --> 01:35:55,984 SO I WONDER IF WE COULD START T. 2139 01:35:55,984 --> 01:35:58,419 WHY IS AN ECONOMIST LIKE A PLUMR 2140 01:35:58,419 --> 01:36:00,588 AND TELL US, MAYBE, ABOUT YOUR 2141 01:36:00,588 --> 01:36:02,090 EDUCATIONAL BACKGROUND AND HOW I 2142 01:36:02,090 --> 01:36:03,825 DON'T THINK MOST TRADITIONAL 2143 01:36:03,825 --> 01:36:06,160 ECONOMISTS WOULD CALL THEMSELVES 2144 01:36:06,160 --> 01:36:07,328 PLUMBERS, OR MAYBE THEY WOULD. 2145 01:36:07,328 --> 01:36:10,031 IF YOU'LL TRACK US THROUGH THAT. 2146 01:36:10,031 --> 01:36:10,565 >> THANK YOU VERY MUCH. 2147 01:36:10,565 --> 01:36:17,438 THANK YOU FOR HAVING ME HERE. 2148 01:36:17,438 --> 01:36:20,675 SO I THINK THE PLUMBING -- A LOF 2149 01:36:20,675 --> 01:36:22,910 PEOPLE I DO NOT THINK WANT TO TK 2150 01:36:22,910 --> 01:36:24,078 OF THEMSELVES AS PLUMBERS. 2151 01:36:24,078 --> 01:36:26,447 SO I THINK THAT'S A GOOD THING. 2152 01:36:26,447 --> 01:36:31,319 SO I BECAME AN ECONOMIST BECAUSE 2153 01:36:31,319 --> 01:36:32,687 MOMENT THAT I REALIZED THAT IT D 2154 01:36:32,687 --> 01:36:38,593 BE A WAY TO REALLY MAKE A MEANIL 2155 01:36:38,593 --> 01:36:39,861 CHANGE FOR THE BETTER IN THE LIF 2156 01:36:39,861 --> 01:36:40,628 VERY MANY PEOPLE. 2157 01:36:40,628 --> 01:36:44,866 SO I DID BECOME AN ECONOMIST WIE 2158 01:36:44,866 --> 01:36:48,136 HOPE AND THE AMBITION OF IMPROVG 2159 01:36:48,136 --> 01:36:50,738 PROGRAMS AND POLICIES THAT AFFEE 2160 01:36:50,738 --> 01:36:51,873 POOR IN THE WORLD. 2161 01:36:51,873 --> 01:36:53,574 AND BEFORE THAT, I WAS NOT PLANG 2162 01:36:53,574 --> 01:36:55,176 TO BE AN ECONOMIST. 2163 01:36:55,176 --> 01:36:56,778 WHEN YOU REALIZED IT COULD BE AY 2164 01:36:56,778 --> 01:36:59,614 TO DO THAT, THAT'S WHEN I BECAME 2165 01:36:59,614 --> 01:36:59,914 INTERESTED. 2166 01:36:59,914 --> 01:37:04,352 SO IN I A SENSE, I WAS ALWAYS IS 2167 01:37:04,352 --> 01:37:06,854 PROFESSION, SO I STARTED IN THIS 2168 01:37:06,854 --> 01:37:08,356 PROFESSION IN ORDER TO GET TO AE 2169 01:37:08,356 --> 01:37:13,661 OF BEING USEFUL AND DEVELOPING L 2170 01:37:13,661 --> 01:37:16,597 INTERVENTIONS AND HELPING OTHERS 2171 01:37:16,597 --> 01:37:19,133 DEVELOPING AND IMPLEMENTING USEL 2172 01:37:19,133 --> 01:37:19,701 INTERVENTIONS. 2173 01:37:19,701 --> 01:37:24,472 AND WHEN YOU DO THAT, YOU REALIE 2174 01:37:24,472 --> 01:37:29,177 THAT THERE IS -- THAT THE WORLDG 2175 01:37:29,177 --> 01:37:34,716 A -- PLACE, THERE IS SO MUCH WET 2176 01:37:34,716 --> 01:37:36,551 UNDERSTAND ABOUT THE CIRCUMSTANS 2177 01:37:36,551 --> 01:37:38,086 ABOUT WHICH PEOPLE LIVES AND ABT 2178 01:37:38,086 --> 01:37:41,622 WHAT MOTIVATES THEIR ACTIONS ORE 2179 01:37:41,622 --> 01:37:44,659 ACTIONS OF OTHERS AROUND THEM AW 2180 01:37:44,659 --> 01:37:46,060 IT INTERACTS WITH THE ENVIRONME, 2181 01:37:46,060 --> 01:37:48,229 PHYSICALLY OR SOCIALLY. 2182 01:37:48,229 --> 01:37:51,799 THE ONLY THING YOU CAN DO -- THT 2183 01:37:51,799 --> 01:37:53,101 THEORY IS ONLY GOING TO TAKE YOO 2184 01:37:53,101 --> 01:37:53,267 FAR. 2185 01:37:53,267 --> 01:37:56,571 AND THE ONLY THING YOU CAN DO AN 2186 01:37:56,571 --> 01:38:00,641 GOVERNMENT OR NGOS TO TO PUT YOR 2187 01:38:00,641 --> 01:38:02,510 BEST FOOT FORWARD IN DESIGNING A 2188 01:38:02,510 --> 01:38:03,978 PROGRAM AND THEN HOPE THAT IT'SG 2189 01:38:03,978 --> 01:38:06,114 TO LEAD TO A GOOD OUTCOME. 2190 01:38:06,114 --> 01:38:08,716 BUT YOU CAN'T POSSIBLY HAVE FIGD 2191 01:38:08,716 --> 01:38:09,283 OUT EVERYTHING. 2192 01:38:09,283 --> 01:38:11,085 AND SO THAT'S WHERE THE PLUMBIND 2193 01:38:11,085 --> 01:38:13,955 ENERGY COMES FROM, WHICH IS WHEA 2194 01:38:13,955 --> 01:38:16,457 PLUMBER COMES TO YOUR HOUSE ANDY 2195 01:38:16,457 --> 01:38:19,627 LOOK AT THE PROBLEM, THEY HAVE N 2196 01:38:19,627 --> 01:38:21,162 TUITION FOR WHAT THE PROBLEM MIT 2197 01:38:21,162 --> 01:38:21,896 BE. 2198 01:38:21,896 --> 01:38:24,065 THAT IN TUITION IS NOT RANDOM. 2199 01:38:24,065 --> 01:38:28,169 IT'S GROUNDED IN THEORY, THEY MY 2200 01:38:28,169 --> 01:38:28,870 HAVE LEARNED IN PAST EXPERIENCER 2201 01:38:28,870 --> 01:38:29,103 SCHOOL. 2202 01:38:29,103 --> 01:38:31,139 BUT ULTIMATELY IT'S UNLIKELY TOR 2203 01:38:31,139 --> 01:38:33,107 ALL THE POSSIBLE CONTINGENCIES. 2204 01:38:33,107 --> 01:38:34,475 THEY ARE GOING TO TRY SOMETHINGD 2205 01:38:34,475 --> 01:38:35,810 THEN SEE IF IT WORKS. 2206 01:38:35,810 --> 01:38:37,245 AND IF IT DOESN'T WORK, THEY ARE 2207 01:38:37,245 --> 01:38:39,580 GOING TO TRY SOMETHING ELSE. 2208 01:38:39,580 --> 01:38:41,749 AND I THINK THAT'S THE ATTITUDET 2209 01:38:41,749 --> 01:38:43,718 A LOT EVER ECONOMISTS SHOULD HAD 2210 01:38:43,718 --> 01:38:47,421 THAT'S THE ATTITUDE THAT I HAVEN 2211 01:38:47,421 --> 01:38:49,690 ECONOMIST, WHICH IS WHY I KIND Y 2212 01:38:49,690 --> 01:38:51,926 TO START FROM THE BEST POSSIBLE 2213 01:38:51,926 --> 01:38:53,661 UNDERSTANDING OF WHAT MIGHT WORO 2214 01:38:53,661 --> 01:38:54,896 SOLVE A PARTICULAR PROBLEM. 2215 01:38:54,896 --> 01:38:56,063 IT COULD BE A MENTAL HEALTH PROM 2216 01:38:56,063 --> 01:38:58,132 SINCE WE ARE IN THIS ROOM T COUE 2217 01:38:58,132 --> 01:38:59,033 AN ECONOMIC ISSUE. 2218 01:38:59,033 --> 01:39:02,470 IT COULD BE AN EDUCATION ISSUE R 2219 01:39:02,470 --> 01:39:03,104 ANYTHING. 2220 01:39:03,104 --> 01:39:05,439 AND THEN ALWAYS I LEARN FROM THE 2221 01:39:05,439 --> 01:39:08,042 POSSIBILITY THAT YOU HAVE MISSEE 2222 01:39:08,042 --> 01:39:11,913 DETAIL WHICH TURNS OUT TO BE CRL 2223 01:39:11,913 --> 01:39:13,614 AND THEREFORE THE INTERVENTION D 2224 01:39:13,614 --> 01:39:16,184 HAVE TO BE RE-THOUGHT. 2225 01:39:16,184 --> 01:39:19,454 >> AND IT'S A GREAT ANALOGY AND 2226 01:39:19,454 --> 01:39:21,088 REALLY WORKS, I THINK. 2227 01:39:21,088 --> 01:39:24,258 IS THERE SOMETHING ABOUT ECONOMC 2228 01:39:24,258 --> 01:39:27,495 THEORY AND THE TRAINING THAT YOU 2229 01:39:27,495 --> 01:39:30,798 RECEIVED IN ECONOMIC THEORY THAT 2230 01:39:30,798 --> 01:39:32,834 HELPS US TO UNDERSTAND MENTAL HH 2231 01:39:32,834 --> 01:39:35,069 AND THINKING ABOUT APPLYING THE 2232 01:39:35,069 --> 01:39:38,039 DIFFERENT WAYS THAT THE PRODUCTN 2233 01:39:38,039 --> 01:39:40,808 FUNCTIONS AND THINGS LIKE THAT. 2234 01:39:40,808 --> 01:39:43,411 WHERE DOES MENTAL HEALTH FIT INH 2235 01:39:43,411 --> 01:39:47,114 THAT AND IN YOUR TRAINING, HOW D 2236 01:39:47,114 --> 01:39:49,383 A TRADITIONAL ECONOMIST FIT MENL 2237 01:39:49,383 --> 01:39:53,888 HEALTH INTO THEIR FRAMEWORKS ANN 2238 01:39:53,888 --> 01:39:56,858 WHAT WAYS HAVE YOU KIND OF LEARD 2239 01:39:56,858 --> 01:39:58,926 ABOUT MENTAL HEALTH GIVEN YOUR 2240 01:39:58,926 --> 01:39:59,193 TRAINING? 2241 01:39:59,193 --> 01:40:01,729 >> SO I THINK IT'S ONLY RELATIVY 2242 01:40:01,729 --> 01:40:03,097 RECENTLY THAT ECONOMISTS HAVE SD 2243 01:40:03,097 --> 01:40:09,036 TO BECOME INTERESTED IN MENTAL 2244 01:40:09,036 --> 01:40:09,270 HEALTH. 2245 01:40:09,270 --> 01:40:11,272 AND IT'S BEEN A LONG TIME SINCE 2246 01:40:11,272 --> 01:40:12,440 ECONOMISTS HAVE BEEN INTERESTEDN 2247 01:40:12,440 --> 01:40:17,812 WORKING WITH PSYCHOLOGISTS AND 2248 01:40:17,812 --> 01:40:19,981 INCORPORATING SOME FUNDAMENTAL 2249 01:40:19,981 --> 01:40:23,985 LIMITATION OF THE HUMAN PSYCHE O 2250 01:40:23,985 --> 01:40:24,752 UNDERSTAND BETTER BEHAVIORS. 2251 01:40:24,752 --> 01:40:26,654 IT'S BEEN A LONG TIME SINCE 2252 01:40:26,654 --> 01:40:28,522 ECONOMISTS HAVE NOT NECESSARILY 2253 01:40:28,522 --> 01:40:30,057 ASSUMING PERFECTLY RATIONAL BEHR 2254 01:40:30,057 --> 01:40:34,095 AND SO ON AND SO FORTH. 2255 01:40:34,095 --> 01:40:38,466 BUT I THINK IT WAS MAYBE THE PLE 2256 01:40:38,466 --> 01:40:40,768 THAT WAS GIVEN TO PSYCHOLOGY AND 2257 01:40:40,768 --> 01:40:45,940 ECONOMICS FOR A WHILE, WAS MORET 2258 01:40:45,940 --> 01:40:47,575 THIS -- THE HUMAN BEINGS ARE SUH 2259 01:40:47,575 --> 01:40:49,710 THAT, FOR EXAMPLE, THEY GIVE MOE 2260 01:40:49,710 --> 01:40:51,245 IMPORTANCE TO THE PRESENT THAN E 2261 01:40:51,245 --> 01:40:53,080 FUTURE IN A WAY THAT IS NOT COHT 2262 01:40:53,080 --> 01:40:53,781 OF OUR TIME. 2263 01:40:53,781 --> 01:40:56,851 WE NEED TO TAKE THAT INTO ACCOU. 2264 01:40:56,851 --> 01:41:00,121 HUMAN BEINGS ARE SUCH THAT THERS 2265 01:41:00,121 --> 01:41:03,090 ONLY SO MANY PIECES IN THEIR BRT 2266 01:41:03,090 --> 01:41:04,759 ANY GIVEN TIME AND THAT WILL LED 2267 01:41:04,759 --> 01:41:06,594 THEM TO FORGET IMPORTANT DETAIL. 2268 01:41:06,594 --> 01:41:11,899 SO IN A SENSE, THE INCORPORATIOF 2269 01:41:11,899 --> 01:41:14,702 PSYCHOLOGY WAS MORE INSTRUMENTAO 2270 01:41:14,702 --> 01:41:17,138 UNDERSTAND THE BEHAVIOR BETTER,E 2271 01:41:17,138 --> 01:41:19,473 ECONOMIC BEHAVIOR BETTER. 2272 01:41:19,473 --> 01:41:21,776 BUT WHAT I THINK HAS HAPPENED OS 2273 01:41:21,776 --> 01:41:24,979 IN THE PROCESS OF HAPPENING, ISO 2274 01:41:24,979 --> 01:41:25,780 THINGS. 2275 01:41:25,780 --> 01:41:30,051 NUMBER 1 SILENT RELATION THAT ML 2276 01:41:30,051 --> 01:41:34,555 HEALTH -- IS THE RELATE THAT MEL 2277 01:41:34,555 --> 01:41:35,156 HEALTH IS VALUABLE IN ITSELF. 2278 01:41:35,156 --> 01:41:42,296 WE THINK OF UTILITY BUT MENTAL H 2279 01:41:42,296 --> 01:41:45,733 IS NOT A GO TO AN END BUT IT ISO 2280 01:41:45,733 --> 01:41:46,734 THE END. 2281 01:41:46,734 --> 01:41:49,804 MORE AND MORE PEOPLE ARE REALIZG 2282 01:41:49,804 --> 01:41:52,139 HAVING SATISFIED TO USE OUTCOMES 2283 01:41:52,139 --> 01:41:53,941 RELATED TO MENTAL HEALTH AS THE 2284 01:41:53,941 --> 01:41:54,842 DEFINED OUTCOME. 2285 01:41:54,842 --> 01:41:56,043 NOT AS SOMETHING ELSE. 2286 01:41:56,043 --> 01:41:57,712 THAT'S ONE PART OF IT. 2287 01:41:57,712 --> 01:42:01,048 AND IN THE PROCESS OF DOING THA, 2288 01:42:01,048 --> 01:42:04,018 REALIZING FROM MY CORNER OF THE 2289 01:42:04,018 --> 01:42:07,021 SPACE, THANKS TO WORK LIKE -- FR 2290 01:42:07,021 --> 01:42:11,859 EXAMPLE, THOSE IN THE ROOM, THAN 2291 01:42:11,859 --> 01:42:14,762 POORER COUNTRIES, MENTAL HEALTH 2292 01:42:14,762 --> 01:42:17,932 PROBLEMS ARE SO MUCH WORSE. 2293 01:42:17,932 --> 01:42:23,704 AND IN PARTICULAR, BEING POOR, S 2294 01:42:23,704 --> 01:42:25,606 PEOPLE MISERABLE. 2295 01:42:25,606 --> 01:42:29,410 AND IN AND OF ITSELF, THAT'S BA. 2296 01:42:29,410 --> 01:42:32,313 AND THEREFORE WHEN WE THINK ABOT 2297 01:42:32,313 --> 01:42:34,215 INTERVENTION THAT ARE MEANT TO 2298 01:42:34,215 --> 01:42:36,217 ALLEVIATE THE CONDITIONS OF POV, 2299 01:42:36,217 --> 01:42:38,219 WE CAN THINK OF MENTAL HEALTH AS 2300 01:42:38,219 --> 01:42:40,154 SOMETHING THAT IS DESIRABLE OUTE 2301 01:42:40,154 --> 01:42:41,822 TO ACHIEVE. 2302 01:42:41,822 --> 01:42:44,091 REGARDLESS OF WHETHER IT THEN LS 2303 01:42:44,091 --> 01:42:47,094 TO MORE ECONOMIC WELL-BEING. 2304 01:42:47,094 --> 01:42:47,595 THAT'S THE FIRST THING. 2305 01:42:47,595 --> 01:42:48,696 AND THE SECOND THING THAT IS ALO 2306 01:42:48,696 --> 01:42:52,500 HAPPENING IS REALIZING THE FUNCL 2307 01:42:52,500 --> 01:42:56,303 IMPACT OF MENTAL HEALTH POTENTIY 2308 01:42:56,303 --> 01:43:02,843 ON PEOPLE'S ABILITY TO BE IN THE 2309 01:43:02,843 --> 01:43:03,144 WORLD. 2310 01:43:03,144 --> 01:43:05,212 THAT IS THE FIRST KIND OF WALK E 2311 01:43:05,212 --> 01:43:06,580 LIMITATION OF PSYCHOLOGY AND HOW 2312 01:43:06,580 --> 01:43:08,749 PEOPLE BEHAVE. 2313 01:43:08,749 --> 01:43:11,519 WITH THE FOCUS ON THE MENTAL HEH 2314 01:43:11,519 --> 01:43:14,422 ASPECT AND NOT JUST -- SO WHAT S 2315 01:43:14,422 --> 01:43:17,191 SOMEONE WITH DEPRESSION, HOW DOS 2316 01:43:17,191 --> 01:43:23,564 THAT AFFECT THEIR ABILITY TO BEN 2317 01:43:23,564 --> 01:43:26,700 THE WORLD AND GO ABOUT THEIR RER 2318 01:43:26,700 --> 01:43:28,702 BUSINESS, EARN MONEY AND SO ON. 2319 01:43:28,702 --> 01:43:30,905 HOW ANXIETY, DEPRESSION, STRESSD 2320 01:43:30,905 --> 01:43:32,873 SO ON. 2321 01:43:32,873 --> 01:43:36,277 SO THESE TWO THINGS, I THINK, BE 2322 01:43:36,277 --> 01:43:40,848 OF MUCH GREATER INTEREST IN ASSG 2323 01:43:40,848 --> 01:43:43,551 IN PART OF THE -- AND IN MY OWNK 2324 01:43:43,551 --> 01:43:47,054 IN THE LAST LET'S SAY 5-10 YEAR. 2325 01:43:47,054 --> 01:43:50,524 SO IT IS VERY YOUNG. 2326 01:43:50,524 --> 01:43:52,393 >> I APPRECIATE THAT BEING ON TE 2327 01:43:52,393 --> 01:43:55,162 LEFT AND RIGHT-HAND SIDE OF THE 2328 01:43:55,162 --> 01:43:57,064 PRODUCTION FUNCTION OF MENTAL H. 2329 01:43:57,064 --> 01:44:02,336 I WANTED TO MAKE SURE WE TALK AT 2330 01:44:02,336 --> 01:44:05,339 JAY POWELL, THE POVERTY ACTION . 2331 01:44:05,339 --> 01:44:08,943 THIS IS AN INCREDIBLY IMPORTANTB 2332 01:44:08,943 --> 01:44:11,245 IN THE FIELD FOR GROUNDING ECONC 2333 01:44:11,245 --> 01:44:20,321 THEORY AND RIGOROUS FIELD WORK D 2334 01:44:20,321 --> 01:44:20,955 EXTREMELY INFLUENTIAL IN PUSHING 2335 01:44:20,955 --> 01:44:21,989 PUBLIC POLICY AROUND THE WORLD D 2336 01:44:21,989 --> 01:44:22,389 ABROAD. 2337 01:44:22,389 --> 01:44:24,959 CAN YOU TALK ABOUT THE GENESIS Y 2338 01:44:24,959 --> 01:44:27,862 POWELL AND MAYBE A LITTLE BIT AT 2339 01:44:27,862 --> 01:44:29,897 THE MISSION AND WHY IT'S SO GOOT 2340 01:44:29,897 --> 01:44:32,333 CHANGING -- WHY IT'S BEEN SUCCEL 2341 01:44:32,333 --> 01:44:35,369 AT CHANGING POLICY AS OPPOSED TT 2342 01:44:35,369 --> 01:44:36,203 MAKING STUDIES? 2343 01:44:36,203 --> 01:44:38,105 >> YES, SO JAY POWELL, YOU CAN 2344 01:44:38,105 --> 01:44:43,410 CHARACTERIZE IT AS A LAB BUT --H 2345 01:44:43,410 --> 01:44:45,546 YOU MIGHT -- [ INAUDIBLE ] 2346 01:44:45,546 --> 01:44:47,381 ACTION LAB SO YOU MIGHT THINK IA 2347 01:44:47,381 --> 01:44:47,615 LAB. 2348 01:44:47,615 --> 01:44:50,117 IT IS IN SOME WAYS BUT IN OTHERS 2349 01:44:50,117 --> 01:44:53,487 IT'S MORE LIKE A NETWORK OR A 2350 01:44:53,487 --> 01:44:53,754 MOVEMENT. 2351 01:44:53,754 --> 01:44:55,956 SO IT'S REALLY A NETWORK OF 2352 01:44:55,956 --> 01:44:58,893 RESEARCHERS WHO ARE USING RANDOD 2353 01:44:58,893 --> 01:45:02,396 CONTROL TRIALS TO STUDY QUESTIOS 2354 01:45:02,396 --> 01:45:05,099 RELATEDDED TO POVERTY AROU AROUE 2355 01:45:05,099 --> 01:45:08,769 WORLD IN THE U.S. AND ELSE WEAR. 2356 01:45:08,769 --> 01:45:11,672 I'M SAYING REALITY TO POVERTY AE 2357 01:45:11,672 --> 01:45:13,440 WELCOME THE ENVIRONMENT AND WE 2358 01:45:13,440 --> 01:45:15,075 WELCOME PURE HEALTH QUESTIONS TT 2359 01:45:15,075 --> 01:45:16,877 CAN AFFECT PEOPLE WHO ARE NOT TT 2360 01:45:16,877 --> 01:45:17,077 POOR. 2361 01:45:17,077 --> 01:45:19,680 BUT MOSTLY IT'S ABOUT IMPROVINGE 2362 01:45:19,680 --> 01:45:23,717 LIFE OF THE POOR. 2363 01:45:23,717 --> 01:45:24,985 WHY IT'S BEEN SUCCESSFUL? 2364 01:45:24,985 --> 01:45:27,054 I THINK THE MAIN REASON WHY IS S 2365 01:45:27,054 --> 01:45:30,824 NOTION OF MOVEMENT, WHICH IT WAS 2366 01:45:30,824 --> 01:45:32,092 NEVER ABOUT THE RESEARCH OF SOME 2367 01:45:32,092 --> 01:45:33,827 IN PARTICULAR. 2368 01:45:33,827 --> 01:45:38,966 IT WAS ALWAYS AND STILL IS TO TS 2369 01:45:38,966 --> 01:45:42,169 DAY REALLY FOCUSED ON EMPOWERING 2370 01:45:42,169 --> 01:45:44,538 PEOPLE TO CONDUCT THEIR OWN WOR. 2371 01:45:44,538 --> 01:45:50,344 AND IN THIS WAY, IT HAS A MUSHRG 2372 01:45:50,344 --> 01:45:51,845 CAPACITY BECAUSE THE ONLY CLARIF 2373 01:45:51,845 --> 01:45:55,616 VISION THAT I EVER HAD WITH REST 2374 01:45:55,616 --> 01:46:00,087 TO THIS IS WE ARE ABOUT ON THE - 2375 01:46:00,087 --> 01:46:02,489 CONTROL TRIALS AND WE ARE ABOUT 2376 01:46:02,489 --> 01:46:03,390 POVERTY. 2377 01:46:03,390 --> 01:46:04,625 AND OTHER THAN THAT, PEOPLE SHOE 2378 01:46:04,625 --> 01:46:09,697 ABLE TO DO WHATEVER IT IS THEY . 2379 01:46:09,697 --> 01:46:12,499 AND THIS IS THE WORK TO BRANCH N 2380 01:46:12,499 --> 01:46:14,034 ANY NUMBER OF DIRECTIONS. 2381 01:46:14,034 --> 01:46:18,472 AND TO WORK WITH MANY PARTNERS O 2382 01:46:18,472 --> 01:46:19,840 ARE DOING WORK ACROSS-THE-BOARD. 2383 01:46:19,840 --> 01:46:26,814 FOR EXAMPLE, IF WE TAKE THIS MEL 2384 01:46:26,814 --> 01:46:29,450 HEALTH SPACE, HAVING THE 2385 01:46:29,450 --> 01:46:32,253 INFRASTRUCTURE, WE HAVE A VERY E 2386 01:46:32,253 --> 01:46:33,387 PRESENCE IN INDIA AND THE 2387 01:46:33,387 --> 01:46:36,991 INFRASTRUCTURE OF INDIA IS ALLOO 2388 01:46:36,991 --> 01:46:44,565 TAKE THE WORK OF OTHERS TO KIND- 2389 01:46:44,565 --> 01:46:44,965 HOW WOULD I SAY? 2390 01:46:44,965 --> 01:46:46,533 EXPAND ON IT. 2391 01:46:46,533 --> 01:46:50,271 SO FOLLOW LONGER-TERM IMPACT OF 2392 01:46:50,271 --> 01:46:55,342 INTERVENTION THAT HAVE BEEN DONN 2393 01:46:55,342 --> 01:46:57,945 THE PAST LIKE WORK -- OF TAKING 2394 01:46:57,945 --> 01:47:00,114 INTERVENTION AND THEN TRYING THN 2395 01:47:00,114 --> 01:47:01,749 ANOTHER PLACE AND WHAT WE ARE TG 2396 01:47:01,749 --> 01:47:04,418 TO DO -- WHICH IS TAKING A COGNE 2397 01:47:04,418 --> 01:47:08,322 BEHAVIOR THERAPY INTERVENTION AD 2398 01:47:08,322 --> 01:47:12,359 KIND OF TRY TO MAKE IT -- EMBEDT 2399 01:47:12,359 --> 01:47:14,762 INTO A GOVERNMENT PROGRAM, WHICU 2400 01:47:14,762 --> 01:47:19,733 COULDN'T DO WITHOUT HAVING 10 YS 2401 01:47:19,733 --> 01:47:21,769 OF RELATIONSHIP WITH THE GOVERNT 2402 01:47:21,769 --> 01:47:25,673 THAT WE KNOW EVERYONE UP AND DON 2403 01:47:25,673 --> 01:47:29,510 WITHOUT PAYING A LOT OF PHYSICAL 2404 01:47:29,510 --> 01:47:31,078 PRESENCE, WITHOUT HAVING BEEN 2405 01:47:31,078 --> 01:47:33,547 STUDYING MORE PEOPLE FOR MANY Y. 2406 01:47:33,547 --> 01:47:39,720 AND WITHOUT HAVING OF COURSE THE 2407 01:47:39,720 --> 01:47:42,489 INTELLECTUAL RIGOR AND CAPACITYF 2408 01:47:42,489 --> 01:47:43,757 THE RESEARCHERS. 2409 01:47:43,757 --> 01:47:45,893 SO THAT'S AN EXAMPLE OF THE 2410 01:47:45,893 --> 01:47:46,193 NETWORKING. 2411 01:47:46,193 --> 01:47:47,895 YOU HAVE THE GOVERNMENT PIECE. 2412 01:47:47,895 --> 01:47:50,030 YOU HAVE THE INFRASTRUCTURE IN E 2413 01:47:50,030 --> 01:47:56,603 AND YOU HAVE THE INTELLECTUAL I. 2414 01:47:56,603 --> 01:47:57,972 >> THAT'S GREAT. 2415 01:47:57,972 --> 01:48:06,313 IT'S BEEN EXTREMELY SUCCESSFUL. 2416 01:48:06,313 --> 01:48:07,981 I WAS THINKING ABOUT HOW TO BUID 2417 01:48:07,981 --> 01:48:09,950 NETWORKS LIKE THAT AND HOW OFTEN 2418 01:48:09,950 --> 01:48:12,019 THERE ARE DISINCENT I WAS TO DOT 2419 01:48:12,019 --> 01:48:17,057 IN ACADEMIA, GIVEN WE ARE OFTEN 2420 01:48:17,057 --> 01:48:19,927 JUDGED BY OUR INDIRECTS AND THEY 2421 01:48:19,927 --> 01:48:21,695 THAT WE BRING INTO OUR INSTITUT. 2422 01:48:21,695 --> 01:48:25,232 YOU HAVE DONE SO WELL IN CREATIG 2423 01:48:25,232 --> 01:48:31,438 THESE NETWORKS IN BLOWING UP THD 2424 01:48:31,438 --> 01:48:32,806 ACADEMIC SYSTEM. 2425 01:48:32,806 --> 01:48:36,510 LOTS OF PEOPLE NOW GO ON TO HAVE 2426 01:48:36,510 --> 01:48:37,111 INDETECTIVES ACROSS MULTIPLE 2427 01:48:37,111 --> 01:48:38,412 INSTITUTIONS AND NOT TO MENTIONE 2428 01:48:38,412 --> 01:48:40,381 RESEARCH THAT YOU HAVE ACROSS TE 2429 01:48:40,381 --> 01:48:40,614 WORLD. 2430 01:48:40,614 --> 01:48:43,150 DO YOU HAVE SOME ADVICE ABOUT T, 2431 01:48:43,150 --> 01:48:45,185 ABOUT HOW, WHEN WE ARE IN OUR S, 2432 01:48:45,185 --> 01:48:47,588 HOW DO WE CREATE NETWORKS AND HW 2433 01:48:47,588 --> 01:48:50,224 HAVE YOU BEEN SO SUCCESSFUL IN G 2434 01:48:50,224 --> 01:48:50,424 THAT? 2435 01:48:50,424 --> 01:48:51,558 >> I THINK THAT IS WHAT WE THIN. 2436 01:48:51,558 --> 01:48:55,195 THAT IF WE ARE GOING TO -- WE HO 2437 01:48:55,195 --> 01:48:57,531 DEVELOP OUR OWN RESEARCH WORK BR 2438 01:48:57,531 --> 01:49:02,102 OUR OWN GOOD. 2439 01:49:02,102 --> 01:49:02,503 BUT IT'S NOT TRUE. 2440 01:49:02,503 --> 01:49:05,439 THE REASON WHY WE HAVE A NETWORM 2441 01:49:05,439 --> 01:49:09,109 THE BEGINNING AND OUR INITIAL NK 2442 01:49:09,109 --> 01:49:10,778 WAS 8 PEOPLE AND OUR INITIAL FUG 2443 01:49:10,778 --> 01:49:13,046 WAS 300,000 DOLLARS OVER THREE . 2444 01:49:13,046 --> 01:49:16,750 SO IT STARTED SMALL. 2445 01:49:16,750 --> 01:49:22,923 BUT I THINK IT'S TRUE THAT THE 2446 01:49:22,923 --> 01:49:25,492 INSTINCT WOULD HAVE BEEN -- [ 2447 01:49:25,492 --> 01:49:25,793 INAUDIBLE ] 2448 01:49:25,793 --> 01:49:27,428 LAB MANAGER AND RUN MORE OF MY 2449 01:49:27,428 --> 01:49:27,728 EXPERIMENTS. 2450 01:49:27,728 --> 01:49:31,231 THAT'S NOT WHAT WE WANTED TO DO 2451 01:49:31,231 --> 01:49:37,137 BECAUSE WE, BEING ME AND OTHERSN 2452 01:49:37,137 --> 01:49:40,107 WE STARTED WE DIDN'T HAVE THE -- 2453 01:49:40,107 --> 01:49:41,742 THAT'S NOT WHAT WE WANTED TO DO 2454 01:49:41,742 --> 01:49:44,411 BECAUSE WE FELT WE WERE AT THE T 2455 01:49:44,411 --> 01:49:47,548 WHERE WE CAN HAVE ONE OR MORE OO 2456 01:49:47,548 --> 01:49:49,783 MORE EXPERIMENTS BUT WHAT WOULDE 2457 01:49:49,783 --> 01:49:52,219 THE POINT FROM THE POINT OF WHAS 2458 01:49:52,219 --> 01:49:55,255 LIMITING US, IMPROVING THE LIVEF 2459 01:49:55,255 --> 01:49:57,691 VERY MANY PEOPLE. 2460 01:49:57,691 --> 01:50:01,094 IT IS ALWAYS GOING TO BE SO LIM. 2461 01:50:01,094 --> 01:50:04,998 AND WHAT WE NEED TO DO IS TO CRE 2462 01:50:04,998 --> 01:50:06,700 INFRASTRUCTURE TO BRING IN SO MY 2463 01:50:06,700 --> 01:50:08,502 MORE PEOPLE BECAUSE CLEARLY WE D 2464 01:50:08,502 --> 01:50:10,838 SEE THAT THERE WAS INTEREST IN G 2465 01:50:10,838 --> 01:50:15,442 THIS WORK BUT ALSO A LOT OF APP 2466 01:50:15,442 --> 01:50:16,477 REHENSION AND LIMITATION BECAUSS 2467 01:50:16,477 --> 01:50:17,878 COMPLICATED AND COSTS MONEY ANDS 2468 01:50:17,878 --> 01:50:18,078 TIME. 2469 01:50:18,078 --> 01:50:19,546 AND A LOT OF THE YOUNG RESEARCHT 2470 01:50:19,546 --> 01:50:21,381 THE TIME, THEY WERE WONDERING WR 2471 01:50:21,381 --> 01:50:23,717 IT WAS SOMETHING WISE TO DO FOR 2472 01:50:23,717 --> 01:50:25,385 TENURE AND SO ON. 2473 01:50:25,385 --> 01:50:28,822 SO WE THOUGHT IF WE COULD HELP 2474 01:50:28,822 --> 01:50:30,824 ALLEVIATING THOSE PRACTICAL PROS 2475 01:50:30,824 --> 01:50:33,427 THAT THEY HAVE AT THE SCALE THAE 2476 01:50:33,427 --> 01:50:35,462 CAN, WITH THE MONEY WE HAVE FOR, 2477 01:50:35,462 --> 01:50:37,965 IT'S GOING TO BUILD ON EACH OTHD 2478 01:50:37,965 --> 01:50:39,666 IT'S GOING TO CREATE -- I DON'TT 2479 01:50:39,666 --> 01:50:45,038 TO TELL YOU, WE ARE EXACTLY 20. 2480 01:50:45,038 --> 01:50:46,540 SO I DON'T WANT TO SAY THAT 20 S 2481 01:50:46,540 --> 01:50:49,543 AGO I HAD THE VISION OF THE SCAE 2482 01:50:49,543 --> 01:50:50,511 THAT WE WOULD HAVE TODAY. 2483 01:50:50,511 --> 01:50:53,146 BUT AT LEAST I HAD THE VISION TT 2484 01:50:53,146 --> 01:50:56,717 NOTHING I CAN DO IF IN MY OWN WS 2485 01:50:56,717 --> 01:50:58,719 GOING TO BE GOOD ENOUGH FOR THEE 2486 01:50:58,719 --> 01:51:01,054 OF THE PROBLEM THAT IS IN FRONTF 2487 01:51:01,054 --> 01:51:01,321 ME. 2488 01:51:01,321 --> 01:51:04,625 BUT IF WE CAN -- IF I CAN EMPOWR 2489 01:51:04,625 --> 01:51:06,627 OTHER PEOPLE TO DO IT WHO IN TUN 2490 01:51:06,627 --> 01:51:07,961 WILL EMPOWER OTHER PEOPLE TO DOT 2491 01:51:07,961 --> 01:51:10,464 AND SO ON, THEN MAYBE WE CAN MAA 2492 01:51:10,464 --> 01:51:11,932 DENT IN THE PROBLEM. 2493 01:51:11,932 --> 01:51:14,568 AND THE TRUTH IS THAT I'VE DONE 2494 01:51:14,568 --> 01:51:15,068 PRETTY WELL FOR MYSELF. 2495 01:51:15,068 --> 01:51:18,071 SO IT'S NOT THAT IT WAS A BAD -S 2496 01:51:18,071 --> 01:51:22,109 NOT THAT IT WAS A BAD SELFISH 2497 01:51:22,109 --> 01:51:22,376 DECISION. 2498 01:51:22,376 --> 01:51:24,845 SO SOMETIMES I WANT TO HOPE THAT 2499 01:51:24,845 --> 01:51:29,149 WAS NOT THE IMPETUS BUT I THINKU 2500 01:51:29,149 --> 01:51:33,620 SEE THAT AGAIN AND AGAIN IS THAT 2501 01:51:33,620 --> 01:51:36,990 SOMETIMES THINKING ABOUT NOT THE 2502 01:51:36,990 --> 01:51:40,294 IMAGE, THAT LINE OF TOMORROW ORE 2503 01:51:40,294 --> 01:51:43,030 IMMEDIATE VALUE OF DOING SOMETHG 2504 01:51:43,030 --> 01:51:47,034 FOR YOUR OWN PURPOSE, PUBLISH WB 2505 01:51:47,034 --> 01:51:49,636 PAPER OR JUST THIS ONE FIELD. 2506 01:51:49,636 --> 01:51:53,974 IT WILL HELP EVEN IN YOUR OWN CR 2507 01:51:53,974 --> 01:51:56,510 TOO, STEP BACK AND SEE HOW CAN U 2508 01:51:56,510 --> 01:51:57,945 BRING MORE PEOPLE? 2509 01:51:57,945 --> 01:51:59,947 HOW CAN YOU CREATE EXCITEMENT AD 2510 01:51:59,947 --> 01:52:03,417 WHAT YOU'RE DOING AND SO ON? 2511 01:52:03,417 --> 01:52:05,419 >> VERY INSPIRATIONAL. 2512 01:52:05,419 --> 01:52:07,487 THAT'S GOOD FOR FOLKS LIKE US WN 2513 01:52:07,487 --> 01:52:10,390 BE WRAPPED UP IN OUR OWN SILOS. 2514 01:52:10,390 --> 01:52:11,391 THAT'S THE RIGHT MESSAGE. 2515 01:52:11,391 --> 01:52:13,460 I WANTED TO GET BACK TO THINKING 2516 01:52:13,460 --> 01:52:16,830 ABOUT RANDOMIZED TRIALS AND 2517 01:52:16,830 --> 01:52:17,731 RANDOMIZED CONTROL TRIALS. 2518 01:52:17,731 --> 01:52:20,434 IN THE BOOK THAT YOU JUST WROTED 2519 01:52:20,434 --> 01:52:21,969 ECONOMICS FOR HARD TIMES, YOU TL 2520 01:52:21,969 --> 01:52:26,006 SOME OF THE HISTORY OF THE EARLH 2521 01:52:26,006 --> 01:52:29,276 TRANSFER RANDOMIZED TRIALS IN NW 2522 01:52:29,276 --> 01:52:30,811 JERSEY AND SOME OF THE OTHERS TT 2523 01:52:30,811 --> 01:52:33,113 HAPPENED IN THE U.S. AND IT'S JT 2524 01:52:33,113 --> 01:52:35,148 VERY COMPELLING. 2525 01:52:35,148 --> 01:52:37,150 THE IDEA THAT YOU CAN TAKE A 2526 01:52:37,150 --> 01:52:38,685 RANDOMIZED CONTROL TRIAL, THE GD 2527 01:52:38,685 --> 01:52:41,555 STANDARD IN CLINICAL TRIALS, INO 2528 01:52:41,555 --> 01:52:43,423 SOCIAL SITUATIONS. 2529 01:52:43,423 --> 01:52:46,093 I WONDER IF YOU TALK TO US SOMEE 2530 01:52:46,093 --> 01:52:47,894 ABOUT THE STRENGTH AND WHAT THAT 2531 01:52:47,894 --> 01:52:50,030 MEANS IN SOCIAL INNOVATION 2532 01:52:50,030 --> 01:52:52,299 SITUATIONS, BUT ALSO THE WEAKNE. 2533 01:52:52,299 --> 01:52:55,302 I THINK A LOT OF PEOPLE WILL SA, 2534 01:52:55,302 --> 01:52:56,803 WELL, THERE IS GOING TO BE COMMY 2535 01:52:56,803 --> 01:52:59,640 RESISTANCE TO RANDOMIZATION. 2536 01:52:59,640 --> 01:53:01,375 THERE WILL BE -- IT WILL TAKE AG 2537 01:53:01,375 --> 01:53:05,979 TIME TO GET COMMUNITY BUY IN FON 2538 01:53:05,979 --> 01:53:06,146 RCT. 2539 01:53:06,146 --> 01:53:08,015 YOU GAIN TRUST DEALING WITH POL, 2540 01:53:08,015 --> 01:53:09,349 THE FUNDING OF IT. 2541 01:53:09,349 --> 01:53:12,085 SO I WONDERED IF YOU WOULD TALKT 2542 01:53:12,085 --> 01:53:14,254 SOME OF THOSE -- WHAT PEOPLE MIT 2543 01:53:14,254 --> 01:53:16,657 THINK OF AS LIMITATIONS WHEN DOG 2544 01:53:16,657 --> 01:53:19,893 THESE BROADER RCTs. 2545 01:53:19,893 --> 01:53:23,664 BUT ALSO THE STRENGTHS OF THE R. 2546 01:53:23,664 --> 01:53:25,332 >> SO I THINK THE STRENGTHS RELO 2547 01:53:25,332 --> 01:53:26,767 THE QUESTION THAT IS WE STARTED. 2548 01:53:26,767 --> 01:53:33,240 IF YOU LIVE IN A WORLD WHERE YOE 2549 01:53:33,240 --> 01:53:35,175 NO IDEA -- WHEN YOU PUT YOUR BET 2550 01:53:35,175 --> 01:53:37,911 FOOT FORWARD, YOU BEING A POLICR 2551 01:53:37,911 --> 01:53:40,147 OR ANYONE WITH A POSSIBLE 2552 01:53:40,147 --> 01:53:42,816 INTERVENTION, ACADEMIC, POLICYM, 2553 01:53:42,816 --> 01:53:43,250 SOMEONE FROM AN NGO. 2554 01:53:43,250 --> 01:53:45,619 IF YOU LIVE IN A WORLD WHERE YOW 2555 01:53:45,619 --> 01:53:47,054 THAT THERE IS SO MANY THINGS THU 2556 01:53:47,054 --> 01:53:48,622 DON'T CONTROL AND DON'T EVEN 2557 01:53:48,622 --> 01:53:50,257 UNDERSTAND AND HAVEN'T EVEN BEEN 2558 01:53:50,257 --> 01:53:58,965 TRAINED TO PAY ATTENTION TO THA- 2559 01:53:58,965 --> 01:54:02,035 IN INTERVENTION, THAT SEEMS TO E 2560 01:54:02,035 --> 01:54:03,537 REALLY HYPE FOR RANDOMIZED CONTL 2561 01:54:03,537 --> 01:54:05,939 TRIALS BECAUSE -- YOU HAVE NO IA 2562 01:54:05,939 --> 01:54:08,308 MOST OF THE THINGS THAT YOU'RE G 2563 01:54:08,308 --> 01:54:11,211 WHETHER IT MIGHT WORK OR NOT WO. 2564 01:54:11,211 --> 01:54:18,051 SO THEN, YOU WANT TO TRY THEM OD 2565 01:54:18,051 --> 01:54:21,288 THEN USUALLY IT'S NOT POSSIBLE Y 2566 01:54:21,288 --> 01:54:24,357 TO SCALE THE INTERVENTION 2567 01:54:24,357 --> 01:54:26,793 IMMEDIATELY, NOR DESIRABLE. 2568 01:54:26,793 --> 01:54:30,831 SO USUALLY YOU NEED A PILOT ANY. 2569 01:54:30,831 --> 01:54:32,733 SO, IT'S KIND OF DOESN'T ADD MUN 2570 01:54:32,733 --> 01:54:36,636 TERMS OF COMPLEXITY TO DO IT INY 2571 01:54:36,636 --> 01:54:38,638 THAT YOU CAN LEARN FROM IT AND N 2572 01:54:38,638 --> 01:54:41,007 MOVE ON FROM THAT. 2573 01:54:41,007 --> 01:54:45,879 SO THAT'S THE KIND OF RATIONAL. 2574 01:54:45,879 --> 01:54:47,981 AND WE WERE WORKING A LOT IN HEH 2575 01:54:47,981 --> 01:54:49,616 AND EDUCATION BECAUSE I THINK IS 2576 01:54:49,616 --> 01:54:53,787 THE CLOSEST ANALOGY TO UNDERSTAD 2577 01:54:53,787 --> 01:54:56,056 THEN PROGRESSIVELY, IT APPEARED 2578 01:54:56,056 --> 01:54:59,526 THANKS TO THIS NETWORK STRUCTURT 2579 01:54:59,526 --> 01:55:03,296 YOU CAN -- STUFF WE DIDN'T THINK 2580 01:55:03,296 --> 01:55:06,400 ABOUT, GIVING CASH TO PEOPLE IN 2581 01:55:06,400 --> 01:55:07,400 RANDOMIZED FASHION. 2582 01:55:07,400 --> 01:55:10,403 DIDN'T THINK YOU COULD REALLY DE 2583 01:55:10,403 --> 01:55:11,638 20 YEARS AGO I THOUGHT THERE WOE 2584 01:55:11,638 --> 01:55:13,707 ISSUES OF OTHER PEOPLE BEING UPT 2585 01:55:13,707 --> 01:55:17,110 AND SO ON. 2586 01:55:17,110 --> 01:55:18,211 SO THAT'S THE RATIONAL. 2587 01:55:18,211 --> 01:55:19,546 THE RESISTANCE. 2588 01:55:19,546 --> 01:55:23,550 SO YOU SPOKE ABOUT LIMITATIONS T 2589 01:55:23,550 --> 01:55:25,519 YOU -- AND NOW BOTH LIMITATIONSD 2590 01:55:25,519 --> 01:55:25,852 RESISTANCE. 2591 01:55:25,852 --> 01:55:29,523 SO THE RESISTANCE ARE MUCH LESSN 2592 01:55:29,523 --> 01:55:31,491 YOU MIGHT IMAGINE. 2593 01:55:31,491 --> 01:55:34,761 BECAUSE ONCE YOU EXPLAIN WHAT IT 2594 01:55:34,761 --> 01:55:36,129 EXPLAINED AND PEOPLE UNDERSTAND. 2595 01:55:36,129 --> 01:55:40,867 PEOPLE IN COMMUNITIES PERFECTLY 2596 01:55:40,867 --> 01:55:41,568 UNDERSTAND THAT THERE ARE SO MAY 2597 01:55:41,568 --> 01:55:44,004 THINGS THAT THEY GET OR DON'T GD 2598 01:55:44,004 --> 01:55:46,072 USUALLY IT'S FOR NOT VERY GOOD 2599 01:55:46,072 --> 01:55:46,506 REASONS. 2600 01:55:46,506 --> 01:55:48,508 AND IF YOU'RE GOING TO BE NOT CD 2601 01:55:48,508 --> 01:55:52,679 BY A PILOT, MAYBE IT'S BETTER YT 2602 01:55:52,679 --> 01:55:53,547 COVER UP NOW BECAUSE WE ARE TRYO 2603 01:55:53,547 --> 01:55:56,616 FIND OUT IF IT WORKS. 2604 01:55:56,616 --> 01:55:57,517 THEN YOU'RE NOT COVERED NOW BECE 2605 01:55:57,517 --> 01:56:04,090 YOU'RE NOT THE NEPHEW OF THE RIT 2606 01:56:04,090 --> 01:56:04,457 UNCLE. 2607 01:56:04,457 --> 01:56:06,526 I'VE NEVER SEEN ANYBODY IN THE 2608 01:56:06,526 --> 01:56:10,230 COMMUNITIES NOT LIKING THE POSI. 2609 01:56:10,230 --> 01:56:18,772 WE HAVE A PROGRAM WHERE WE GIVEH 2610 01:56:18,772 --> 01:56:19,105 [ INAUDIBLE ] 2611 01:56:19,105 --> 01:56:19,940 VERY VALUABLE. 2612 01:56:19,940 --> 01:56:21,908 AND -- SCHOLARSHIP (?) WE IDENTY 2613 01:56:21,908 --> 01:56:25,245 THE KIDS WHO HAVE QUALIFIED FOR 2614 01:56:25,245 --> 01:56:27,514 SECONDARY SCHOOL AND NOT ABLE TO 2615 01:56:27,514 --> 01:56:29,950 ATTEND AND WE RANDOMLY SELECTED. 2616 01:56:29,950 --> 01:56:33,053 AND SOME OF THEM WE GIVE THEM FL 2617 01:56:33,053 --> 01:56:35,755 SCHOLARSHIP TO GO TO SCHOOL. 2618 01:56:35,755 --> 01:56:37,123 YOU THINK THERE WOULD BE RESISTS 2619 01:56:37,123 --> 01:56:37,724 IN THE CONTROL GROUP. 2620 01:56:37,724 --> 01:56:39,492 WE STARTED IN 2008. 2621 01:56:39,492 --> 01:56:44,598 WE ARE STILL SERVING THEM. 2622 01:56:44,598 --> 01:56:49,870 THEY ARE OKAY WITH BEING PART O 2623 01:56:49,870 --> 01:56:51,137 THIS. 2624 01:56:51,137 --> 01:56:54,808 AND THEY UNDERSTAND THAT PART OE 2625 01:56:54,808 --> 01:56:57,143 PLANNING WENT INTO MAKING INTO E 2626 01:56:57,143 --> 01:57:05,118 RATIONAL FOR EXPANDING -- IF THS 2627 01:57:05,118 --> 01:57:07,187 A REASON FOR YOUR EXPERIMENT, IN 2628 01:57:07,187 --> 01:57:10,991 PASS AN IRB, YOU SHOULD BE ABLEO 2629 01:57:10,991 --> 01:57:12,792 EXPLAIN IT TO THE PEOPLE AND IFU 2630 01:57:12,792 --> 01:57:15,362 CAN NOT, THEN MAYBE THERE IS A 2631 01:57:15,362 --> 01:57:16,596 PROBLEM WITH THE EXPERIMENT. 2632 01:57:16,596 --> 01:57:19,132 THERE ARE ALSO LIMITATIONS, HARO 2633 01:57:19,132 --> 01:57:19,833 RANDOMIZE THAN OTHERS. 2634 01:57:19,833 --> 01:57:22,903 THERE ARE ALWAYS PROBLEMS SO 2635 01:57:22,903 --> 01:57:25,805 PARTICULARLY PROBLEMS SO LARGE T 2636 01:57:25,805 --> 01:57:28,875 YOU HAVE -- YOU DON'T HAVE -- TE 2637 01:57:28,875 --> 01:57:31,244 IS A LONG WAY BETWEEN WHAT YOU 2638 01:57:31,244 --> 01:57:32,979 INTENDED TO DO AND WHAT HAPPENSN 2639 01:57:32,979 --> 01:57:33,346 REALITY. 2640 01:57:33,346 --> 01:57:36,316 SO IT MAKES INTERPRETATION MORE 2641 01:57:36,316 --> 01:57:36,883 COMPLICATED. 2642 01:57:36,883 --> 01:57:38,451 SOMETIMES THERE ARE SPILL OVERSO 2643 01:57:38,451 --> 01:57:40,120 IT'S DIFFICULT TO INTERPRET THE. 2644 01:57:40,120 --> 01:57:43,823 BUT ALSO OF THIS WE THINK WE HAE 2645 01:57:43,823 --> 01:57:46,893 LEARNED AND ALSO TO KIND OF TAKN 2646 01:57:46,893 --> 01:57:49,329 THIS PART OF WHAT IT IS IN THE . 2647 01:57:49,329 --> 01:57:52,032 SO THE BIG DIFFERENCE BETWEEN AT 2648 01:57:52,032 --> 01:57:56,136 OF THE TRIALS THAT SOME OF YOU E 2649 01:57:56,136 --> 01:57:58,505 MIGHT DO WHICH ARE VERY CONTROL, 2650 01:57:58,505 --> 01:57:59,773 VERY SMALL, WELL UNDERSTOOD ANDT 2651 01:57:59,773 --> 01:58:02,075 WE MIGHT DO, WHICH IS VERY 2652 01:58:02,075 --> 01:58:06,713 LARGE-SCALE, GOVERNMENT PARTNERS 2653 01:58:06,713 --> 01:58:10,517 THAT WE DON'T GET THE PURITY OFA 2654 01:58:10,517 --> 01:58:14,354 MECHANISM BUT WE GET SOMETHING - 2655 01:58:14,354 --> 01:58:17,457 WHAT WOULD HAPPEN IN THE -- ANDN 2656 01:58:17,457 --> 01:58:20,060 YOU HAVE LESS MAYBE THEORETICAL 2657 01:58:20,060 --> 01:58:22,662 LESSONS TO DERIVE BUT THEY ARE L 2658 01:58:22,662 --> 01:58:28,668 IMMEDIATE APPLICATION OF THE RE. 2659 01:58:28,668 --> 01:58:29,836 AND REALLY PEOPLE ARE ALL OVER E 2660 01:58:29,836 --> 01:58:31,738 RANGE OF DOING THINGS VERY, VERY 2661 01:58:31,738 --> 01:58:36,009 CONTROLLED THAT MIGHT NOT BE SUR 2662 01:58:36,009 --> 01:58:36,910 VALIDATED OR NOT VERY, VERY 2663 01:58:36,910 --> 01:58:41,648 CONTROLLED AND HAVE MORE EXTENDD 2664 01:58:41,648 --> 01:58:45,685 VALIDATION -- [ INAUDIBLE ] 2665 01:58:45,685 --> 01:58:47,320 MU COMBINE THE EXPERIMENT WITH 2666 01:58:47,320 --> 01:58:56,963 QUALITATIVE WORK TO KNOW WHAT 2667 01:58:56,963 --> 01:58:57,230 HAPPENED. 2668 01:58:57,230 --> 01:58:58,531 >> IT'S INTERESTING. 2669 01:58:58,531 --> 01:59:00,700 IT'S SO INTERESTING TO HEAR YOU. 2670 01:59:00,700 --> 01:59:03,436 I THINK WE HAVE ENCOUNTERED A LF 2671 01:59:03,436 --> 01:59:07,707 RESISTANCE TRYING TO DO RANDOMID 2672 01:59:07,707 --> 01:59:11,011 CONTROL TRIALS WITH NARROW SCOPN 2673 01:59:11,011 --> 01:59:12,412 UNDER RESOURCED COMMUNITIES. 2674 01:59:12,412 --> 01:59:13,413 COMMUNITY MEMBERS WOULD SAY YOUE 2675 01:59:13,413 --> 01:59:15,949 GOING TO DENY HALF OF THESE THEE 2676 01:59:15,949 --> 01:59:17,817 RESOURCES THAT HAVE YOU BUT IT S 2677 01:59:17,817 --> 01:59:22,756 LIKE THERE IS A COMMUNICATION, Y 2678 01:59:22,756 --> 01:59:26,026 GOOD COMMUNICATION ABOUT WHAT 2679 01:59:26,026 --> 01:59:27,927 EQUIPOISE IS, WHAT ARE THE END S 2680 01:59:27,927 --> 01:59:31,331 FOR THE COMMUNITY AND THOSE TYPF 2681 01:59:31,331 --> 01:59:32,332 THINGS THAT REALLY HELP. 2682 01:59:32,332 --> 01:59:36,736 >> WHAT WE PROVIDE IS LESS, 2683 01:59:36,736 --> 01:59:38,905 OBVIOUSLY -- THEY FEEL IT'S [ 2684 01:59:38,905 --> 01:59:39,272 INAUDIBLE ] 2685 01:59:39,272 --> 01:59:41,508 >> AND IT SOUNDS LIKE YOU MAINTN 2686 01:59:41,508 --> 01:59:41,941 THAT CONTROL GROUP. 2687 01:59:41,941 --> 01:59:43,343 IT'S NOT LIKE YOU'RE GIVING THEM 2688 01:59:43,343 --> 01:59:44,944 NOTHING BUT YOU CONTINUE TO STAN 2689 01:59:44,944 --> 01:59:48,681 TOUCH WITH THEM. 2690 01:59:48,681 --> 01:59:49,416 >> YES, SO FOR EXAMPLE IN THE GA 2691 01:59:49,416 --> 01:59:51,117 EXAMPLE, WE GIVE THEM A CELL PHE 2692 01:59:51,117 --> 01:59:54,487 BECAUSE WE WANT TO STAY IN TOUCH 2693 01:59:54,487 --> 01:59:56,089 THEM AND WE KEEP IN TOUCH WITH M 2694 01:59:56,089 --> 02:00:00,860 AND TALK TO THEM. 2695 02:00:00,860 --> 02:00:04,831 WE RE-UP -- IT'S REALLY NOT A LT 2696 02:00:04,831 --> 02:00:11,738 THEY ARE KIND OF PART OF THE PR. 2697 02:00:11,738 --> 02:00:13,273 WHICH SHAPES THE RESULTS. 2698 02:00:13,273 --> 02:00:14,941 >> RECENTLY PUBLISHED PAPER WE E 2699 02:00:14,941 --> 02:00:21,347 TALKING ABOUT THE PAPER THAT YOD 2700 02:00:21,347 --> 02:00:24,617 OTHERS PUBLISHED ABOUT LOOKING E 2701 02:00:24,617 --> 02:00:26,119 EFFECTS OF COGNITIVE BEHAVIORAL 2702 02:00:26,119 --> 02:00:27,520 THERAPY, CBT, AND CASH TRANSFERN 2703 02:00:27,520 --> 02:00:31,991 OLDER PERSONS LIVING ALONE IN I. 2704 02:00:31,991 --> 02:00:33,993 I WONDER, AS YOU WERE SAYING, YW 2705 02:00:33,993 --> 02:00:36,529 MADE MENTAL HEALTH KIND OF AN OE 2706 02:00:36,529 --> 02:00:36,863 HERE. 2707 02:00:36,863 --> 02:00:40,166 I WONDER IF THERE ARE SOME OTHER 2708 02:00:40,166 --> 02:00:40,400 LESSONS? 2709 02:00:40,400 --> 02:00:41,234 IS THERE SOMETHING UNIQUE ABOUT 2710 02:00:41,234 --> 02:00:43,303 MENTAL HEALTH AS AB OUTCOME? 2711 02:00:43,303 --> 02:00:45,572 SOMETHING ABOUT THE CONTEXT OR R 2712 02:00:45,572 --> 02:00:47,140 CONSIDERATIONS RELATED TO NOW HG 2713 02:00:47,140 --> 02:00:48,842 MENTAL HEALTH AS AN OUTCOME THAT 2714 02:00:48,842 --> 02:00:50,743 SURPRISED YOU? 2715 02:00:50,743 --> 02:00:51,711 OR WAS NEW? 2716 02:00:51,711 --> 02:00:54,214 ANYTHING LIKE THAT? 2717 02:00:54,214 --> 02:00:57,150 >> SO THIS PARTICULAR PROJECT CE 2718 02:00:57,150 --> 02:01:00,019 OUT OF THIS WORK I HAVE BEEN DOG 2719 02:01:00,019 --> 02:01:02,355 FOR A WHILE, JUST STAYED IN THEH 2720 02:01:02,355 --> 02:01:07,527 OF INDIA, QUITE WEALTHY BY INDIN 2721 02:01:07,527 --> 02:01:11,231 STATES, WHICH HAS ALSO BEEN VERT 2722 02:01:11,231 --> 02:01:11,931 DEMOGRAPHIC TRANSITION SEVERAL S 2723 02:01:11,931 --> 02:01:13,233 AGO NOW. 2724 02:01:13,233 --> 02:01:18,171 AND WE STARTED COLLECTING A PANF 2725 02:01:18,171 --> 02:01:21,040 OLDER PEOPLE SIMILAR TO THE 2726 02:01:21,040 --> 02:01:22,742 RETIREMENT SURVEY. 2727 02:01:22,742 --> 02:01:26,713 THE WE DID A CENSUS TO FIND OUTO 2728 02:01:26,713 --> 02:01:29,516 ARE THE OLD PEOPLE, WHERE THEY O 2729 02:01:29,516 --> 02:01:30,150 SAMPLE FROM THEM. 2730 02:01:30,150 --> 02:01:34,020 AND WE HAD IN THE CENSUS, 1-6 OR 2731 02:01:34,020 --> 02:01:36,890 PERSON IN THE STATE LIVE ENTIREY 2732 02:01:36,890 --> 02:01:37,557 ALONE. 2733 02:01:37,557 --> 02:01:39,626 AND MOST OF THE PEOPLE WILL LIVE 2734 02:01:39,626 --> 02:01:42,929 ENTIRELY ALONE ARE WOMEN. 2735 02:01:42,929 --> 02:01:44,497 AND THEN THAT SURPRISED OUR 2736 02:01:44,497 --> 02:01:47,500 GOVERNMENT PARTNER A LOT BECAUSY 2737 02:01:47,500 --> 02:01:50,036 HAD THIS VIEW THAT NO ONE IN INA 2738 02:01:50,036 --> 02:01:51,905 LIVES ALONE. 2739 02:01:51,905 --> 02:01:53,806 BECAUSE YOU SHOULD LIVE WITH YOR 2740 02:01:53,806 --> 02:01:55,575 EXTENDED FAMILY. 2741 02:01:55,575 --> 02:01:56,309 YOU SHOULD EXCEPT IF YOU DON'T,E 2742 02:01:56,309 --> 02:01:58,578 A LOT OF PEOPLE DO NOT. 2743 02:01:58,578 --> 02:02:01,014 WOMEN, MAYBE HAD VERY FEW KIDS,E 2744 02:02:01,014 --> 02:02:02,615 ONLY ONE AND THEY MY GREATED ORT 2745 02:02:02,615 --> 02:02:04,851 HAD A SON AND THEY CANNOT -- ORA 2746 02:02:04,851 --> 02:02:06,886 DAUGHTER AND THEY CAN'T LIVE WIE 2747 02:02:06,886 --> 02:02:08,188 DAUGHTER BECAUSE YOU DON'T LIVEH 2748 02:02:08,188 --> 02:02:10,023 YOUR SON ANYMORE OR SOME SUCH. 2749 02:02:10,023 --> 02:02:18,831 SO WE STARTED FOLLOWING THIS GRP 2750 02:02:18,831 --> 02:02:20,333 PURPOSEFULLY OF THESE OLDER PEOE 2751 02:02:20,333 --> 02:02:22,969 LIVING ALONE AND WE REALIZED IN 2752 02:02:22,969 --> 02:02:24,571 COLLECTING MENTAL HEALTH DATA -- 2753 02:02:24,571 --> 02:02:27,941 INITIALLY WE WERE GOING TO DO A- 2754 02:02:27,941 --> 02:02:29,409 PENSION BECAUSE A LOT OF THESE E 2755 02:02:29,409 --> 02:02:32,178 ARE ELIGIBLE FOR A PENSION THATY 2756 02:02:32,178 --> 02:02:32,879 DON'T GET BAUDS THEY DON'T KNOWW 2757 02:02:32,879 --> 02:02:38,084 TO APPLY AND -- BECAUSE -- PAYRL 2758 02:02:38,084 --> 02:02:39,852 CUTS AND NOT GIVING THE PENSION. 2759 02:02:39,852 --> 02:02:41,321 SO ULTIMATELY IT WAS GOING TO BA 2760 02:02:41,321 --> 02:02:42,522 PENSION PAPER. 2761 02:02:42,522 --> 02:02:44,524 BUT THEN WE REALIZED WHEN WE WEE 2762 02:02:44,524 --> 02:02:47,727 DOING SURVEY AFTER SURVEY, HOW 2763 02:02:47,727 --> 02:02:50,096 MISERABLE THESE PEOPLE LIVING AE 2764 02:02:50,096 --> 02:02:50,296 WERE. 2765 02:02:50,296 --> 02:02:51,965 VERY POOR MENTAL HEALTH. 2766 02:02:51,965 --> 02:02:54,133 THEIR MENTAL HEALTH DECLINED ASY 2767 02:02:54,133 --> 02:02:56,302 AGE, FASTER THAN OTHER PEOPLE TE 2768 02:02:56,302 --> 02:02:58,204 SAME AGE AND HEALTH CONDITIONS. 2769 02:02:58,204 --> 02:02:59,839 THEIR PHYSICAL DECLINE IS FASTED 2770 02:02:59,839 --> 02:03:05,612 THEIR COGNITIVE DECLINE IS FAST. 2771 02:03:05,612 --> 02:03:07,780 AND THEY ALSO ARE EXTREMELY ISO. 2772 02:03:07,780 --> 02:03:11,884 YOU TALK ABOUT LONELINESS IN TH. 2773 02:03:11,884 --> 02:03:13,553 SOME OF THESE PEOPLE HAVEN'T SPN 2774 02:03:13,553 --> 02:03:14,787 TO ANYONE IN WEEKS. 2775 02:03:14,787 --> 02:03:16,456 AND SO THE FACT THAT THE GOVERNT 2776 02:03:16,456 --> 02:03:19,726 DIDN'T EVEN KNOW ABOUT THEM IN Y 2777 02:03:19,726 --> 02:03:21,794 THAT THEY DON'T HAVE SPACE IN TE 2778 02:03:21,794 --> 02:03:22,161 POLICY SPACE. 2779 02:03:22,161 --> 02:03:24,764 SO WE DECIDED WE BETTER DO SOMEG 2780 02:03:24,764 --> 02:03:27,066 AND BEFORE COVID, JUST BEFORE C, 2781 02:03:27,066 --> 02:03:33,072 WE HAD DECIDED WE WOULD HIRE --E 2782 02:03:33,072 --> 02:03:34,173 COLLEGE STUDENTS WHO WOULD GO AD 2783 02:03:34,173 --> 02:03:36,809 TALK TO THESE OLD PEOPLE AND CRE 2784 02:03:36,809 --> 02:03:38,711 LIKE A SOCIAL LINKS. 2785 02:03:38,711 --> 02:03:40,380 WE WERE ABOUT TO START THIS THE 2786 02:03:40,380 --> 02:03:46,019 PROJECT IN FEBRUARY OF 2020 ANDE 2787 02:03:46,019 --> 02:03:49,455 THING WE DIDN'T SEE WAS COVID H. 2788 02:03:49,455 --> 02:03:51,491 MY ONE MOMENT OF LOU SIDDITY IS 2789 02:03:51,491 --> 02:03:54,560 BEFORE THE WHOLE WORLD SHUT DOW, 2790 02:03:54,560 --> 02:03:56,562 MAYBE WAS THAT THING INSIDE US T 2791 02:03:56,562 --> 02:03:59,432 A VERY GOOD IDEA TO SEND PEOPLE 2792 02:03:59,432 --> 02:04:02,568 FROMVILLAGE TOVILLAGE GOING TO D 2793 02:04:02,568 --> 02:04:03,603 PEOPLE TO OLD PEOPLE AND WE SHOT 2794 02:04:03,603 --> 02:04:04,837 DO THIS PROJECT. 2795 02:04:04,837 --> 02:04:06,939 SO WE SCUTTLED IT BEFORE WE HAD. 2796 02:04:06,939 --> 02:04:09,342 AND THE NICE ADVANTAGE OF THAT E 2797 02:04:09,342 --> 02:04:12,679 SHIFTED AND WE DECIDED TO SHIFTN 2798 02:04:12,679 --> 02:04:14,180 BECAUSE WE GOT MORE WORRIED ABOE 2799 02:04:14,180 --> 02:04:16,382 MENTAL HEALTH OF THESE PEOPLE NN 2800 02:04:16,382 --> 02:04:20,186 ADDITION, THEY ARE KIND OF 2801 02:04:20,186 --> 02:04:20,953 OPPORTUNITY FOR DISEASE. 2802 02:04:20,953 --> 02:04:25,625 WE SHIFTED IT TO THIS COGNITIVE 2803 02:04:25,625 --> 02:04:25,858 THERAPY. 2804 02:04:25,858 --> 02:04:33,533 WE WERE WORKING WITH A PSYCHOLOT 2805 02:04:33,533 --> 02:04:34,233 WHO WAS KIND OF BUILDING THE WHE 2806 02:04:34,233 --> 02:04:35,368 INTERVENTION WITH COLLEGE STUDEO 2807 02:04:35,368 --> 02:04:39,439 SHE SHIFTED GEARS AND STARTED 2808 02:04:39,439 --> 02:04:48,981 WRITING, ADAPTING MODULES THAT D 2809 02:04:48,981 --> 02:04:50,183 WE LAUNCHED THAT INTERVENTION. 2810 02:04:50,183 --> 02:04:52,418 ONE OF THE SAME, WE DID LEARN AT 2811 02:04:52,418 --> 02:04:55,788 MENTAL HEALTH AS AN OUTCOME IS S 2812 02:04:55,788 --> 02:04:58,725 VERY DIFFICULT TO MEASURE VERY 2813 02:04:58,725 --> 02:04:59,559 RELIABLY. 2814 02:04:59,559 --> 02:05:00,727 AND IN PARTICULAR WITH MEN. 2815 02:05:00,727 --> 02:05:04,330 SO WHAT WE HAD A BASELINE IS THR 2816 02:05:04,330 --> 02:05:05,665 MEN WERE SO HAPPY. 2817 02:05:05,665 --> 02:05:16,275 THEY WERE JUMPING FOR JOY AND HO 2818 02:05:16,476 --> 02:05:16,642 PROBLEM. 2819 02:05:16,642 --> 02:05:17,343 AND WHAT IS INTERESTING IS THATE 2820 02:05:17,343 --> 02:05:18,077 COGNITIVE BEHAVIORAL -- FOR WOMD 2821 02:05:18,077 --> 02:05:19,812 HARMFUL FOR MEN AND WOMEN. 2822 02:05:19,812 --> 02:05:22,148 WHAT I SUSPECT ALTHOUGH I DON'TW 2823 02:05:22,148 --> 02:05:24,083 FOR A FACT, IS THEY WENT FROM HG 2824 02:05:24,083 --> 02:05:26,452 NO PROBLEM WHATSOEVER, THANK YOY 2825 02:05:26,452 --> 02:05:29,322 MUCH, TO KIND OF REALIZING WHATR 2826 02:05:29,322 --> 02:05:31,090 ISSUES MIGHT BE AND ONE OF THE S 2827 02:05:31,090 --> 02:05:33,025 I LEARNED ABOUT MENTAL HEALTH IM 2828 02:05:33,025 --> 02:05:36,729 NOT VERY SURE WE ARE COMPLETELYD 2829 02:05:36,729 --> 02:05:42,969 OF PERFECT WITH THE PHQ9 AND OTR 2830 02:05:42,969 --> 02:05:43,703 SELF-REPORTED MEASURES, PARTICUY 2831 02:05:43,703 --> 02:05:44,604 IN THIS POPULATION. 2832 02:05:44,604 --> 02:05:49,075 SO NOW WE HAVE TO DO SOMETHING 2833 02:05:49,075 --> 02:05:49,876 IN-PERSON WITH THE GOVERNMENT, H 2834 02:05:49,876 --> 02:05:54,881 THE FRONT LINE WORKER BEING TRA. 2835 02:05:54,881 --> 02:05:56,182 PILOTING THIS AT THE MOMENT. 2836 02:05:56,182 --> 02:05:58,050 AND FORTUNATELY WE DECIDED NOT O 2837 02:05:58,050 --> 02:06:02,422 WORK WITH THE MEN BECAUSE THIS 2838 02:06:02,422 --> 02:06:06,392 MEASUREMENT IS VERY DIFFICULT TO 2839 02:06:06,392 --> 02:06:09,862 SURMOUNT AND WE HAVE WOMEN IN -- 2840 02:06:09,862 --> 02:06:10,163 DEPARTMENT. 2841 02:06:10,163 --> 02:06:13,699 AND THE OTHER THING IS WE ARE GG 2842 02:06:13,699 --> 02:06:18,971 TO SEND PSYCHOLOGIST FOR LONG 2843 02:06:18,971 --> 02:06:23,176 ASSESSMENTS TO SEE WHETHER THER 2844 02:06:23,176 --> 02:06:25,178 IS -- HOW -- THIS IS SOMETHING M 2845 02:06:25,178 --> 02:06:28,114 SURE YOU KNOW MUCH BETTER THAN , 2846 02:06:28,114 --> 02:06:31,050 BUT KIND OF A COUNTER SETTING. 2847 02:06:31,050 --> 02:06:36,456 >> WE WERE TALKING EARLIER ABOUW 2848 02:06:36,456 --> 02:06:39,158 THE CASH TRANSFERS WERE PART OFT 2849 02:06:39,158 --> 02:06:43,963 SO CBT, SHOULD WE BE CONSIDERINH 2850 02:06:43,963 --> 02:06:45,364 TRANSFERS AS MENTAL HEALTH 2851 02:06:45,364 --> 02:06:47,266 INTERVENTIONS? 2852 02:06:47,266 --> 02:06:47,633 >> DEFINITELY. 2853 02:06:47,633 --> 02:06:49,168 IT'S WHAT I WAS TALKING -- POOR 2854 02:06:49,168 --> 02:06:52,305 PEOPLE AND WE HAVE DONE A DESCRE 2855 02:06:52,305 --> 02:06:55,975 STUDY FROM SEVERAL COUNTRIES WIH 2856 02:06:55,975 --> 02:06:58,611 SURVEYS AND IN THE U.S. AS PEOPE 2857 02:06:58,611 --> 02:07:01,347 BECOME OLDER, THEIR MENTAL HEALH 2858 02:07:01,347 --> 02:07:06,319 SITUATION STABILIZES OR IMPROVE. 2859 02:07:06,319 --> 02:07:10,590 BUT WE FOUND IN THE LOWER NEW ED 2860 02:07:10,590 --> 02:07:13,392 COUNTRIES, IT GOES DOWN AND DOWD 2861 02:07:13,392 --> 02:07:13,659 DOWN. 2862 02:07:13,659 --> 02:07:17,430 AND SO AS PEOPLE AGE AND RESOURS 2863 02:07:17,430 --> 02:07:18,764 DWINDLE, THEIR MENTAL HEALTH BES 2864 02:07:18,764 --> 02:07:23,503 SO BAD. 2865 02:07:23,503 --> 02:07:25,638 AND SIMPLY IT'S VERY OLD-FASHIOD 2866 02:07:25,638 --> 02:07:30,510 BUT SIMPLY RELAXING SOME OF THE 2867 02:07:30,510 --> 02:07:32,345 REAL -- THAT THEY FACE IN SITUAS 2868 02:07:32,345 --> 02:07:35,348 WHERE THERE IS NO PENSIONS AND E 2869 02:07:35,348 --> 02:07:40,853 IS NO HEALTH INSURANCE AND SO O. 2870 02:07:40,853 --> 02:07:44,090 REALLY SHOULD BE EXPECTED TO HED 2871 02:07:44,090 --> 02:07:48,761 I THINK IN GENERAL, IT'S BEEN FD 2872 02:07:48,761 --> 02:07:51,697 THAT CASH OR ECONOMIC INTERVENTF 2873 02:07:51,697 --> 02:07:53,599 VALUES CAN HELP PEOPLE'S MENTAL 2874 02:07:53,599 --> 02:07:57,136 HEALTH AND THE CBT PAPER WE FOUD 2875 02:07:57,136 --> 02:08:01,774 CASH TO BE MORE EFFECTIVE THAN T 2876 02:08:01,774 --> 02:08:02,975 BECAUSE IT'S CHEAPER TO DO CASHN 2877 02:08:02,975 --> 02:08:04,310 TO DO CBT. 2878 02:08:04,310 --> 02:08:08,915 SO AS A RESULT OF THIS ONE, IT D 2879 02:08:08,915 --> 02:08:10,583 BE MADE MORE CHEAPER AND SO ON. 2880 02:08:10,583 --> 02:08:13,352 I DON'T SEE THIS AS WE SHOULD JO 2881 02:08:13,352 --> 02:08:14,520 CASH AND FORGET ABOUT ANYTHING E 2882 02:08:14,520 --> 02:08:19,492 AT ALL BUT IT DOES SUGGEST THATE 2883 02:08:19,492 --> 02:08:22,028 CAN THINK ABOUT ECONOMIC 2884 02:08:22,028 --> 02:08:24,397 INTERVENTIONS AS MENTAL HEALTH 2885 02:08:24,397 --> 02:08:25,097 INTERVENTION AS WELL. 2886 02:08:25,097 --> 02:08:29,835 I WORKED A LOT FOR PEOPLE WHO AE 2887 02:08:29,835 --> 02:08:31,003 EXTREMELY POOR AND FOR THAT THES 2888 02:08:31,003 --> 02:08:35,174 A PROGRAM THAT WAS INITIATED IN 2889 02:08:35,174 --> 02:08:38,544 BANGLADESH ON PROVIDING ASSETS D 2890 02:08:38,544 --> 02:08:40,546 SOME TRAINING IN THE ASSETS TO Y 2891 02:08:40,546 --> 02:08:47,486 KIND OF INTENSE INTERVENTIONS. 2892 02:08:47,486 --> 02:08:48,087 BUT IT HAS LONG TERM IMPACTS. 2893 02:08:48,087 --> 02:08:48,754 WE HAVE BEEN FIGURING NOW FOR 15 2894 02:08:48,754 --> 02:08:50,022 YEARS AND THEY ARE STILL DOING H 2895 02:08:50,022 --> 02:08:54,126 BETTER IF THEY HAVE THE INTERVE. 2896 02:08:54,126 --> 02:08:55,928 AND ONE OF THE CHANNEL I'M VERYE 2897 02:08:55,928 --> 02:08:58,864 IS THE FACT THAT YOU TAKE PEOPLO 2898 02:08:58,864 --> 02:09:00,399 ARE LIVING IN HOPELESS SITUATIOD 2899 02:09:00,399 --> 02:09:04,003 YOU ARE GIVING THEM HOPE. 2900 02:09:04,003 --> 02:09:05,438 IN THE FORM OF ASSET AND HELP YU 2901 02:09:05,438 --> 02:09:07,173 TAKE CARE OF THIS ASSET AND ASSG 2902 02:09:07,173 --> 02:09:09,575 YOU YOU CAN DO IT. 2903 02:09:09,575 --> 02:09:12,478 THIS IS SOMETHING YOU DON'T HAVO 2904 02:09:12,478 --> 02:09:15,181 LIVE IN THIS -- ON THE EDGE OF S 2905 02:09:15,181 --> 02:09:16,015 EXTREME POVERTY. 2906 02:09:16,015 --> 02:09:17,450 YOU CAN RUN A BUSINESS. 2907 02:09:17,450 --> 02:09:20,419 A LOT OF PEOPLE THINK THAT NO, Y 2908 02:09:20,419 --> 02:09:20,653 CANNOT. 2909 02:09:20,653 --> 02:09:23,422 WHATEVER HAPPENS IN THEIR LIFE S 2910 02:09:23,422 --> 02:09:27,293 MADE THEM INCAPABLE OF DOING TH. 2911 02:09:27,293 --> 02:09:30,329 AND IT'S JUST NOT TRUTHFUL AT A. 2912 02:09:30,329 --> 02:09:33,933 SO I THINK THAT'S ALL THAT MAKE- 2913 02:09:33,933 --> 02:09:37,536 ECONOMIC INTERVENTION, CASH OR R 2914 02:09:37,536 --> 02:09:40,439 CONCEPTS AND PROGRAMS AND SHOULE 2915 02:09:40,439 --> 02:09:44,977 PART OF THE MENTAL HEALTH TOOLK. 2916 02:09:44,977 --> 02:09:47,313 AND ONE QUESTION THAT I THINK IN 2917 02:09:47,313 --> 02:09:50,583 IS HOW DOES IT INTERACT WITH EXT 2918 02:09:50,583 --> 02:09:54,420 MENTAL HEALTH INTERVENTIONS SUCS 2919 02:09:54,420 --> 02:09:58,691 ACTIVE BEHAVIOR INTERVENTION -- 2920 02:09:58,691 --> 02:10:01,627 DEPENDS FROM STUDY TO STUDY. 2921 02:10:01,627 --> 02:10:06,999 IN GHANA, [ INAUDIBLE ] 2922 02:10:06,999 --> 02:10:10,536 ARE DOING GROUP SESSION OF COGNE 2923 02:10:10,536 --> 02:10:11,604 BEHAVIORAL INTERVENTION IN 2924 02:10:11,604 --> 02:10:12,972 COMBINATION WITH CASH INTERVENTN 2925 02:10:12,972 --> 02:10:15,341 AND THEY ARE SPECTACULARLY POSIE 2926 02:10:15,341 --> 02:10:17,309 EFFECT AT VERY LOW COST BECAUSES 2927 02:10:17,309 --> 02:10:17,877 A GROUP. 2928 02:10:17,877 --> 02:10:20,546 SO I THINK THIS IS POTENTIAL. 2929 02:10:20,546 --> 02:10:24,984 THERE IS A LOT OF INTERESTING NS 2930 02:10:24,984 --> 02:10:27,119 TO FOLLOW. 2931 02:10:27,119 --> 02:10:28,821 >> I WANT TO GIVE SOME TIME FORS 2932 02:10:28,821 --> 02:10:32,692 TO ASK QUESTIONS. 2933 02:10:32,692 --> 02:10:34,293 FOR YOU ALL AS WELL, I WANTED TK 2934 02:10:34,293 --> 02:10:36,462 ONE MORE QUESTION BEFORE WE OPET 2935 02:10:36,462 --> 02:10:36,629 UP. 2936 02:10:36,629 --> 02:10:42,068 AND THINKING ABOUT THE FUTURE AY 2937 02:10:42,068 --> 02:10:43,936 POWELL AND YOUR WORK GOING FORWD 2938 02:10:43,936 --> 02:10:48,908 AND THE THING THAT WAS ON MY MIN 2939 02:10:48,908 --> 02:10:49,942 READING THE CHAPTER ON IMMIGRATN 2940 02:10:49,942 --> 02:10:51,510 YOUR BOOK WAS THINKING ABOUT CLE 2941 02:10:51,510 --> 02:10:53,713 CHANGE AND THE LESSONS THAT WE E 2942 02:10:53,713 --> 02:10:55,514 LEARNED FROM THE RCTs THAT YOU L 2943 02:10:55,514 --> 02:10:58,484 HAVE DONE AND WHETHER CLIMATE CE 2944 02:10:58,484 --> 02:11:00,519 WILL CHANGE SOME OF THAT. 2945 02:11:00,519 --> 02:11:02,221 AS AN EXAMPLE, I THINK A LOT OFE 2946 02:11:02,221 --> 02:11:07,193 DATA SHOWS THAT IMMIGRATION FOR 2947 02:11:07,193 --> 02:11:10,663 REASONS -- I FORGET THE TERM --E 2948 02:11:10,663 --> 02:11:12,898 SHARK'S TEETH ARE BEING IN THE H 2949 02:11:12,898 --> 02:11:14,867 OF THE SHARK IS WHAT DRIVES PEOO 2950 02:11:14,867 --> 02:11:16,736 LEAVE, NOT JUST HIGHER WAGES 2951 02:11:16,736 --> 02:11:17,169 SOMEWHERE ELSE. 2952 02:11:17,169 --> 02:11:20,639 BUT THERE IS THE POSSIBILITY OFS 2953 02:11:20,639 --> 02:11:22,241 MIGRATION BECAUSE OF CLIMATE CH. 2954 02:11:22,241 --> 02:11:25,511 AND I WONDER IF YOU ANTICIPATE E 2955 02:11:25,511 --> 02:11:27,046 OF THESE LESSONS NOT WORKING ASL 2956 02:11:27,046 --> 02:11:29,615 IN THE FUTURE BECAUSE OF CLIMATE 2957 02:11:29,615 --> 02:11:32,952 CHANGE OR OTHER THINGS WE SHOULE 2958 02:11:32,952 --> 02:11:35,488 CANNING ABOUT AS SCIENTISTS THAU 2959 02:11:35,488 --> 02:11:37,323 HAVE BEEN FORECASTING OR THINKIG 2960 02:11:37,323 --> 02:11:38,624 ABOUT AS CLIMATE CHANGE STARTS O 2961 02:11:38,624 --> 02:11:41,093 IMPACT ALL OF THE SOCIAL PROGRAD 2962 02:11:41,093 --> 02:11:43,028 THE WAYS WE ARE GOING TO BE LIVN 2963 02:11:43,028 --> 02:11:43,763 THE WORLD. 2964 02:11:43,763 --> 02:11:45,598 >> SO THAT'S A VERY GOOD TIME TK 2965 02:11:45,598 --> 02:11:50,069 THIS QUESTION BECAUSE AS I SAIDI 2966 02:11:50,069 --> 02:11:59,044 HAVE BEEN THINKING ABOUT WHERE L 2967 02:11:59,044 --> 02:11:59,812 WE BE BEYOND. 2968 02:11:59,812 --> 02:12:03,082 SO I THINK YOU ARE CORRECT THAT 2969 02:12:03,082 --> 02:12:07,653 CLIMATE CHANGE IS A BIG ELEPHANN 2970 02:12:07,653 --> 02:12:08,554 THE ROOM. 2971 02:12:08,554 --> 02:12:10,022 I THINK CLIMATE CHANGE DOESN'T T 2972 02:12:10,022 --> 02:12:12,892 AFFECT THE RESULTS OF THE RESEAH 2973 02:12:12,892 --> 02:12:15,227 THAT WILL BE A SMALL ISSUE. 2974 02:12:15,227 --> 02:12:20,666 I THINK IT AFFECTS -- IT'S GOOD- 2975 02:12:20,666 --> 02:12:23,602 THE VERY CONSIDERABLE GAINS THAE 2976 02:12:23,602 --> 02:12:25,004 BEEN EXPERIENCED IN POVERTY IN E 2977 02:12:25,004 --> 02:12:26,338 LAST FEW YEARS. 2978 02:12:26,338 --> 02:12:30,042 SO IN THE LAST 20 YEARS, A LOT - 2979 02:12:30,042 --> 02:12:33,913 IN THE WORLD THE LIFE OF THE POS 2980 02:12:33,913 --> 02:12:35,047 NOT -- GENERALLY THINGS HAVE 2981 02:12:35,047 --> 02:12:37,082 IMPROVED. 2982 02:12:37,082 --> 02:12:41,687 MORTALITY HAS BEEN DIVIDED INTO 2983 02:12:41,687 --> 02:12:42,655 ALMOST EVERY SCHOOL. 2984 02:12:42,655 --> 02:12:46,058 POVERTY REALLY DECLINED A LOT UR 2985 02:12:46,058 --> 02:12:46,458 COVID. 2986 02:12:46,458 --> 02:12:48,527 THAT DECLINED STOPPED AFTER COV. 2987 02:12:48,527 --> 02:12:53,732 BUT MOVING -- SO COVID AND THENE 2988 02:12:53,732 --> 02:12:58,470 FOLLOWING CRISIS HAVE STOPPED TT 2989 02:12:58,470 --> 02:13:03,142 PROGRESS BUT THERE ARE TIMES VEY 2990 02:13:03,142 --> 02:13:03,409 GOOD. 2991 02:13:03,409 --> 02:13:06,378 CLIMATE CHANGE COULD CHANGE ALLF 2992 02:13:06,378 --> 02:13:08,147 THAT BECAUSE IT TURNS OUT THAT E 2993 02:13:08,147 --> 02:13:10,115 COUNTRIES IN WHICH A LOT OF THER 2994 02:13:10,115 --> 02:13:12,418 PEOPLE LIVE ARE IN PLACES THAT E 2995 02:13:12,418 --> 02:13:18,657 ALREADY HOT AND THAT THE AFFECTF 2996 02:13:18,657 --> 02:13:20,259 WARMER CLIMATE IS NOT LINEAR. 2997 02:13:20,259 --> 02:13:22,661 AND THOSE PLACES WHERE A LOT OF 2998 02:13:22,661 --> 02:13:26,599 PEOPLE LIVE, IN AFRICA, SOUTH A, 2999 02:13:26,599 --> 02:13:30,436 IN THE NORTH OF LATIN AMERICA, S 3000 02:13:30,436 --> 02:13:32,238 IS EXPERIENCING MORE AND MORE OE 3001 02:13:32,238 --> 02:13:35,341 DAYS NOT CONDUCIVE TO HUMAN LIF. 3002 02:13:35,341 --> 02:13:39,111 AND EVEN IN THE ABSENCE OF 3003 02:13:39,111 --> 02:13:41,347 CATASTROPHES, HEAT IS GOING TO L 3004 02:13:41,347 --> 02:13:42,281 PEOPLE. 3005 02:13:42,281 --> 02:13:45,117 IT'S ESTIMATED THAT THE INCREASN 3006 02:13:45,117 --> 02:13:50,222 MORTALITY BY 2100 IS GOING TO GS 3007 02:13:50,222 --> 02:13:52,358 73 400,000 JUST FROM ONE -- WHIS 3008 02:13:52,358 --> 02:13:56,829 MORE THAN ALL OF THE INFECTIOUS 3009 02:13:56,829 --> 02:13:57,930 DISEASE TO TODAY COMBINED. 3010 02:13:57,930 --> 02:14:00,699 THIS THE IS ALL GOING TO BE IN R 3011 02:14:00,699 --> 02:14:00,966 COUNTRIES. 3012 02:14:00,966 --> 02:14:03,936 NONE OF THE -- CLIMATE CHANGE IT 3013 02:14:03,936 --> 02:14:13,112 GOING TO KILL ANYBODY IN THE --O 3014 02:14:13,112 --> 02:14:14,546 THAT'S REALLY CHANGING THE LANDE 3015 02:14:14,546 --> 02:14:16,081 AND WE DON'T HAVE ENOUGH. 3016 02:14:16,081 --> 02:14:17,449 WE DON'T KNOW ENOUGH. 3017 02:14:17,449 --> 02:14:20,319 WE DON'T KNOW NEARLY ENOUGH OF T 3018 02:14:20,319 --> 02:14:23,055 WILL HELP PEOPLE TO ADAPT AND BE 3019 02:14:23,055 --> 02:14:23,322 RESILIENT. 3020 02:14:23,322 --> 02:14:26,492 HOW WE CAN MITIGATE IN THE POOR 3021 02:14:26,492 --> 02:14:28,193 COUNTRIES MOSTLY AND SO ON. 3022 02:14:28,193 --> 02:14:32,231 SO I THINK THAT IS HUGE, HUGE H. 3023 02:14:32,231 --> 02:14:36,268 AND OF COURSE THE POLICY AGENDAS 3024 02:14:36,268 --> 02:14:36,535 WELL. 3025 02:14:36,535 --> 02:14:38,771 THE OTHER THING I WOULD SAY IN S 3026 02:14:38,771 --> 02:14:43,475 OF WHERE I SEE AND WHERE I WOULE 3027 02:14:43,475 --> 02:14:47,980 TO SEE BY 2030, I WOULD LIKE --E 3028 02:14:47,980 --> 02:14:49,882 LESS IMPORTANT IN 30 THAN IT ISW 3029 02:14:49,882 --> 02:14:52,685 IN PROPORTION TO THE AMOUNT OF K 3030 02:14:52,685 --> 02:14:53,752 THAT IS BEING DONE. 3031 02:14:53,752 --> 02:14:58,590 LET ME EXPLAIN HOW I MEAN THAT. 3032 02:14:58,590 --> 02:14:59,425 FROM THE BEGINNING WE WERE ABOUT 3033 02:14:59,425 --> 02:15:01,393 CREATING A NETWORK, CREATING A 3034 02:15:01,393 --> 02:15:06,598 MOVEMENT AND SO WE STARTED FRIDY 3035 02:15:06,598 --> 02:15:09,134 EXPANDING FROM -- RIGHT NOW MOSF 3036 02:15:09,134 --> 02:15:14,039 THE EXPANSION HAS BEEN IN -- BUO 3037 02:15:14,039 --> 02:15:17,910 BE ABLE TO DO THIS WILL, WE NEED 3038 02:15:17,910 --> 02:15:25,751 RESEARCHERS MORE EQUIPPED AND 3039 02:15:25,751 --> 02:15:28,387 CONNECTED SO THEY CAN DO THEIR N 3040 02:15:28,387 --> 02:15:30,556 RESEARCH AND POLICYMAKERS AS WE. 3041 02:15:30,556 --> 02:15:34,793 THE BIG -- I SEE THE BIG CAPACIY 3042 02:15:34,793 --> 02:15:37,796 POTENTIAL FOR EXPANSION TODAY IO 3043 02:15:37,796 --> 02:15:41,934 CREATE MUCH MORE -- IN WORKING H 3044 02:15:41,934 --> 02:15:43,535 UNIVERSITIES AND NETWORKING THEN 3045 02:15:43,535 --> 02:15:46,505 THE SAME WAY WE NETWORKED WITH 3046 02:15:46,505 --> 02:15:48,374 RESEARCHERS TAKING ONE STEP FURR 3047 02:15:48,374 --> 02:15:52,211 AT THE UNIVERSITY LEVEL AND WITY 3048 02:15:52,211 --> 02:15:52,678 MORE PARTNERS. 3049 02:15:52,678 --> 02:15:57,282 AND THEN KIND OF BUILDING ON THO 3050 02:15:57,282 --> 02:16:03,489 CREATE A CONNECTION OF OPPORTUNS 3051 02:16:03,489 --> 02:16:04,523 AND I THINK THAT CAN HELP IN CRG 3052 02:16:04,523 --> 02:16:05,824 A HUGE AMOUNT OF WORK THAT IS GG 3053 02:16:05,824 --> 02:16:11,797 TO BE NEEDED TO THINK ABOUT CLIE 3054 02:16:11,797 --> 02:16:15,968 CHANGE AND ALL THE OTHER ISSUESL 3055 02:16:15,968 --> 02:16:16,602 WITH US. 3056 02:16:16,602 --> 02:16:16,969 >> THANK YOU. 3057 02:16:16,969 --> 02:16:19,371 JUST THE RIGHT VISION FOR WHAT'O 3058 02:16:19,371 --> 02:16:19,705 COME. 3059 02:16:19,705 --> 02:16:21,540 WHY DON'T I OPEN IT UP AND PLEAE 3060 02:16:21,540 --> 02:16:23,375 FIND YOUR WAY TO THE MICROPHONEF 3061 02:16:23,375 --> 02:16:25,577 YOU HAVE A QUESTION. 3062 02:16:25,577 --> 02:16:27,179 YES, IF YOU WOULDN'T MIND COMINO 3063 02:16:27,179 --> 02:16:30,416 THE MIC AND ASKING YOUR QUESTION 3064 02:16:30,416 --> 02:16:32,651 THERE. 3065 02:16:32,651 --> 02:16:36,588 GO AHEAD. 3066 02:16:36,588 --> 02:16:38,290 >> A COMMENT AND A QUESTION. 3067 02:16:38,290 --> 02:16:41,627 SO THE COMMENT IS -- MY NAME ISA 3068 02:16:41,627 --> 02:16:43,896 AND I'M WITH PSYCHIATRY AND ALSO 3069 02:16:43,896 --> 02:16:47,766 PATIENT RESEARCHER AMONG OTHER 3070 02:16:47,766 --> 02:16:48,000 THINGS. 3071 02:16:48,000 --> 02:16:50,002 THIS IS A BIT OF AN ELEPHANT INE 3072 02:16:50,002 --> 02:16:53,539 ROOM, WE KEEP TALKING ABOUT SOCL 3073 02:16:53,539 --> 02:16:55,607 DETERMINANTS AND MAYBE IT RELATS 3074 02:16:55,607 --> 02:16:58,444 WELL AS WHEN TALKING BELL CASH 3075 02:16:58,444 --> 02:16:59,445 TRANSFERS. 3076 02:16:59,445 --> 02:17:01,213 ISN'T THE REAL QUESTION NOT SOCL 3077 02:17:01,213 --> 02:17:02,714 DETERMINANTS BUT POLITICAL 3078 02:17:02,714 --> 02:17:03,048 DETERMINANTS? 3079 02:17:03,048 --> 02:17:05,017 AND PEOPLE ARE NOT POOR OUT OF 3080 02:17:05,017 --> 02:17:05,517 DESIGN. 3081 02:17:05,517 --> 02:17:07,553 THEY ARE POOR BECAUSE OF THE DEN 3082 02:17:07,553 --> 02:17:10,556 OF POLITICS. 3083 02:17:10,556 --> 02:17:13,092 SO MAYBE WE NEED STOP TALKING AT 3084 02:17:13,092 --> 02:17:14,560 SOCIAL DETERMINANTS BUT THE POLL 3085 02:17:14,560 --> 02:17:16,462 DECISIONS WHICH ARE MADE ON BEHF 3086 02:17:16,462 --> 02:17:18,363 PEOPLE WHICH HAVE AN IMPACT ON 3087 02:17:18,363 --> 02:17:18,597 PEOPLE. 3088 02:17:18,597 --> 02:17:20,532 AND THAT'S AN ECONOMY QUESTION M 3089 02:17:20,532 --> 02:17:25,471 MY PERSPECTIVE AS A LAYPERSON. 3090 02:17:25,471 --> 02:17:26,939 MY QUESTION IS ALSO, THIS HAS TO 3091 02:17:26,939 --> 02:17:31,009 WITH THE DESIGN OF YOUR RCTs. 3092 02:17:31,009 --> 02:17:32,578 AND I WAS WONDERING IN ORDER TO 3093 02:17:32,578 --> 02:17:35,581 COUNTER ACT THE FACT WITH DEALIG 3094 02:17:35,581 --> 02:17:36,315 WITH VERY LARGE SAMPLES, WHICH E 3095 02:17:36,315 --> 02:17:40,219 NATURE OF RCTs, DO YOU INVOLVE 3096 02:17:40,219 --> 02:17:41,453 PEOPLE SO PATIENTS NOTICE THE PC 3097 02:17:41,453 --> 02:17:45,023 IN THE DESIGN OF YOUR RCTs? 3098 02:17:45,023 --> 02:17:49,128 BECAUSE THAT WOULD HELP. 3099 02:17:49,128 --> 02:17:54,500 THANK YOU. 3100 02:17:54,500 --> 02:17:56,335 >> YOU WANT TO TAKE A COUPLE OTR 3101 02:17:56,335 --> 02:17:56,602 QUESTIONS? 3102 02:17:56,602 --> 02:18:00,606 I THINK WE PROBABLY ONLY HAVE TE 3103 02:18:00,606 --> 02:18:02,641 FOR THREE TOTAL. 3104 02:18:02,641 --> 02:18:04,877 MAYBE GO TO THIS SIDE AND THIS . 3105 02:18:04,877 --> 02:18:08,614 YOU'RE KEEPING TRACK OF ALL OF ? 3106 02:18:08,614 --> 02:18:09,681 OKAY. 3107 02:18:09,681 --> 02:18:10,549 GO AHEAD. 3108 02:18:10,549 --> 02:18:11,316 >> THANK YOU MY NAME IS LAUREN D 3109 02:18:11,316 --> 02:18:13,585 I'M A DOCTORAL STUDENT AT JOHNS 3110 02:18:13,585 --> 02:18:13,952 HOPKINS. 3111 02:18:13,952 --> 02:18:16,288 I WAS CURIOUS TO ASK ABOUT YOUR 3112 02:18:16,288 --> 02:18:19,458 APPROACH TO RCS IN PARTICULAR WH 3113 02:18:19,458 --> 02:18:19,758 JAY POWELL. 3114 02:18:19,758 --> 02:18:21,193 I CERTAINLY APPRECIATED THE 3115 02:18:21,193 --> 02:18:22,794 FOUNDATIONAL WORK YOU HAVE DONED 3116 02:18:22,794 --> 02:18:24,163 THE GRADUATION APPROACH. 3117 02:18:24,163 --> 02:18:26,231 WE ARE LOOKING AT THAT IN 3118 02:18:26,231 --> 02:18:26,999 HUMANITARIAN CONTEXT AND RECOGNG 3119 02:18:26,999 --> 02:18:28,100 THE VALUE OF THAT. 3120 02:18:28,100 --> 02:18:31,170 I'M CURIOUS ABOUT YOUR PERSPECTN 3121 02:18:31,170 --> 02:18:33,105 USING OTHER KINDS OF COMPLEX CAL 3122 02:18:33,105 --> 02:18:35,274 INFERENCE APPROACHES USING 3123 02:18:35,274 --> 02:18:36,441 OBSERVATIONAL DATA TO ASSESS OTR 3124 02:18:36,441 --> 02:18:39,545 TYPES OF INTERVENTIONS AND PERHS 3125 02:18:39,545 --> 02:18:40,579 POLICIES IN PARTICULAR. 3126 02:18:40,579 --> 02:18:43,315 SO IF IT'S NOT FEASIBLE TO RANDE 3127 02:18:43,315 --> 02:18:44,483 AT A CERTAIN LEVEL OR PERHAPS IN 3128 02:18:44,483 --> 02:18:46,118 ORDER TO TAKE ADVANTAGE OF EXISG 3129 02:18:46,118 --> 02:18:48,120 DATA THAT WEREN'T COLLECTED WITN 3130 02:18:48,120 --> 02:18:49,621 ARE. 3131 02:18:49,621 --> 02:18:54,459 CT FRAMEWORK, I WAS CURIOUS IF E 3132 02:18:54,459 --> 02:18:57,930 WAS TAKING THAT APPROACH IN THEY 3133 02:18:57,930 --> 02:18:58,163 POWELL? 3134 02:18:58,163 --> 02:18:58,430 THANK YOU. 3135 02:18:58,430 --> 02:19:00,399 >> THANK YOU FOR A GREAT TALK. 3136 02:19:00,399 --> 02:19:04,336 I'M AT THE UNIVERSITY OF ZIMM BY 3137 02:19:04,336 --> 02:19:05,537 AND HARVARD MEDICAL SCHOOL. 3138 02:19:05,537 --> 02:19:07,906 I WAS WONDERING IF YOU COULD TAK 3139 02:19:07,906 --> 02:19:12,644 MORE BROADLY ABOUT UNIVERSAL BAC 3140 02:19:12,644 --> 02:19:13,812 INCOME AS A POSSIBILITY AND THEN 3141 02:19:13,812 --> 02:19:17,149 MICROFINANCE AND HOW YOU THINK T 3142 02:19:17,149 --> 02:19:20,385 THE DIFFERENCE BETWEEN THOSE TYF 3143 02:19:20,385 --> 02:19:21,653 INTERVENTIONS WITHIN THE POVERTY 3144 02:19:21,653 --> 02:19:25,791 SPACE AS THEY RELATE TO MENTAL 3145 02:19:25,791 --> 02:19:26,024 HEALTH. 3146 02:19:26,024 --> 02:19:28,493 >> I'LL TAKE THE THREE QUESTIOND 3147 02:19:28,493 --> 02:19:29,828 MAYBE THE FIRST TWO ARE RELATED. 3148 02:19:29,828 --> 02:19:33,232 SO THE POLITICAL DETERMINANTS, , 3149 02:19:33,232 --> 02:19:33,765 TRUE. 3150 02:19:33,765 --> 02:19:35,434 POLITICS IS IMPORTANT. 3151 02:19:35,434 --> 02:19:39,171 A LOT OF HARD WORK, SOMETIMES PE 3152 02:19:39,171 --> 02:19:41,607 SAY ALL OF THESE DETAILS BECAUSL 3153 02:19:41,607 --> 02:19:42,774 OF THAT MATTERS IS POLITICAL 3154 02:19:42,774 --> 02:19:45,210 STRUCTURE AND EVEN THOUGH POLITS 3155 02:19:45,210 --> 02:19:47,713 INVOLVED I AGREE WITH THE SECOND 3156 02:19:47,713 --> 02:19:48,914 COMMENT IN TWO WAYS. 3157 02:19:48,914 --> 02:19:51,416 FIRST THERE IS A LOT THAT GOES N 3158 02:19:51,416 --> 02:19:52,985 PRETTY GOOD POLITICAL ENVIRONME. 3159 02:19:52,985 --> 02:19:55,587 SO EVEN THERE YOU HAVE - EVEN OE 3160 02:19:55,587 --> 02:19:59,291 POLITICS IS OKAY, YOU HAVE SO MH 3161 02:19:59,291 --> 02:20:02,060 THAT GOES WRONG BECAUSE OF OTHER 3162 02:20:02,060 --> 02:20:03,595 THINGS LIKE IGNORANCE, BECAUSE T 3163 02:20:03,595 --> 02:20:05,264 BEING CLOSE TO THE FIELD, BECAUE 3164 02:20:05,264 --> 02:20:07,699 DESPITE THE BEST INTENTION, JUST 3165 02:20:07,699 --> 02:20:08,667 FINDING THE BEST POLICIES. 3166 02:20:08,667 --> 02:20:12,204 SO THERE IS A TON OF SCOPE WITHN 3167 02:20:12,204 --> 02:20:12,471 POLITICS. 3168 02:20:12,471 --> 02:20:15,841 AND EVEN THE POLITICS ITSELF, IS 3169 02:20:15,841 --> 02:20:18,910 IS USEFUL TO SEE IT AS 10,000 FT 3170 02:20:18,910 --> 02:20:21,280 LEVEL BUT SOMETIMES IT'S USEFULO 3171 02:20:21,280 --> 02:20:24,149 SEE AT A VERY LOCAL LEVEL, WHICS 3172 02:20:24,149 --> 02:20:26,151 POLITICS BECOME, HOW DO YOU RUN 3173 02:20:26,151 --> 02:20:26,518 ELECTIONS? 3174 02:20:26,518 --> 02:20:27,853 WHO GETS TO VOTE? 3175 02:20:27,853 --> 02:20:32,991 WHO GETS TO -- WHO GETS TO BE A 3176 02:20:32,991 --> 02:20:33,258 CANDIDATE? 3177 02:20:33,258 --> 02:20:35,360 WHO WANTS TO BE A CANDIDATE? 3178 02:20:35,360 --> 02:20:36,328 CAN WE GET MORE PEOPLE? 3179 02:20:36,328 --> 02:20:38,297 SO POLITICS BECOME A SUBJECT OF 3180 02:20:38,297 --> 02:20:41,700 INQUIRY IN A WAY THAT IS PROTEC. 3181 02:20:41,700 --> 02:20:49,708 IF YOU SEE IT FROM THE SMALLER . 3182 02:20:49,708 --> 02:20:53,979 THE QUESTION -- [ INAUDIBLE ] 3183 02:20:53,979 --> 02:20:58,617 NON-RANDOMIZED WORK FROM TIME T 3184 02:20:58,617 --> 02:20:58,817 TIME. 3185 02:20:58,817 --> 02:20:59,584 JAY POWELL ITSELF IS ABOUT 3186 02:20:59,584 --> 02:21:00,686 RANDOMIZATION BECAUSE IT'S VERY 3187 02:21:00,686 --> 02:21:03,455 USEFUL TO HAVE A MISSION. 3188 02:21:03,455 --> 02:21:05,290 BUT THERE IS PLENTY OF SCOPE FOS 3189 02:21:05,290 --> 02:21:09,294 NON RANDOMIZED METHODS AS WELL. 3190 02:21:09,294 --> 02:21:11,763 THE HISTORY, TO STUDY THINGS YON 3191 02:21:11,763 --> 02:21:17,135 NOT RANDOMIZE, MONETARY POLICY D 3192 02:21:17,135 --> 02:21:18,971 LARGE INSTITUTIONAL QUESTIONS. 3193 02:21:18,971 --> 02:21:20,973 SO BE MY GUEST. 3194 02:21:20,973 --> 02:21:23,508 I DO THINK THAT THE EXISTENCE OF 3195 02:21:23,508 --> 02:21:25,510 RANDOMIZED CONTROL TRIALS HAS FA 3196 02:21:25,510 --> 02:21:27,779 VERY HUGE DISCIPLINING DEVICE ON 3197 02:21:27,779 --> 02:21:29,781 THESE OTHER METHODS BECAUSE NOWU 3198 02:21:29,781 --> 02:21:32,651 CAN ALWAYS ASK YOURSELF IF I CAN 3199 02:21:32,651 --> 02:21:34,720 RANDOMIZE, WHAT WOULD I DO? 3200 02:21:34,720 --> 02:21:40,192 THAT DOES HELP IN CANDIDATES. 3201 02:21:40,192 --> 02:21:41,793 IN TERMS OF THE -- INVOLVING 3202 02:21:41,793 --> 02:21:42,327 COMMUNITIES IN THE TRIAL. 3203 02:21:42,327 --> 02:21:44,463 FOR US IT'S VERY, VERY MUCH THEY 3204 02:21:44,463 --> 02:21:48,600 IN WHICH WE WORK WITH NGOs SO IS 3205 02:21:48,600 --> 02:21:50,268 ACTIVISTS. 3206 02:21:50,268 --> 02:21:54,906 SO IT'S NOT NECESSARILY THE LOW- 3207 02:21:54,906 --> 02:21:56,842 THE POOR PEOPLE THEMSELVES ALTHH 3208 02:21:56,842 --> 02:21:58,210 THEY OFTEN GET INVOLVED IN THE 3209 02:21:58,210 --> 02:22:00,679 DEFINITION OF PROGRAMS, BUT IT'S 3210 02:22:00,679 --> 02:22:01,913 DEFINITELY THE TYPE OF WORK WITH 3211 02:22:01,913 --> 02:22:02,114 THEM. 3212 02:22:02,114 --> 02:22:10,055 I SHOULD SAY THAT WE HAVE -- WEE 3213 02:22:10,055 --> 02:22:11,823 DOING THIS. 3214 02:22:11,823 --> 02:22:13,859 FOR THE MORNING PANEL SESSION I 3215 02:22:13,859 --> 02:22:15,761 REALLY WANTED POOR PEOPLE TO BEN 3216 02:22:15,761 --> 02:22:18,563 THE SEAT AND NOT RESEARCHERS. 3217 02:22:18,563 --> 02:22:22,634 AND I'M NOT FULLY SUCCEEDED BECE 3218 02:22:22,634 --> 02:22:23,668 GETTING THERE HAS BEEN A NIGHTME 3219 02:22:23,668 --> 02:22:25,337 BUT I PARTLY SUCCEEDED. 3220 02:22:25,337 --> 02:22:27,906 AND THIS IS VERY MUCH WITH THISN 3221 02:22:27,906 --> 02:22:28,240 MIND. 3222 02:22:28,240 --> 02:22:31,510 WE SHOULD DO MORE OF THAT AND KF 3223 02:22:31,510 --> 02:22:32,744 LEARN FROM PEOPLE AND HOW CAN WE 3224 02:22:32,744 --> 02:22:35,847 LEARN FROM PEOPLE? 3225 02:22:35,847 --> 02:22:39,151 SO THAT'S A FIRST STEP IN GOINGN 3226 02:22:39,151 --> 02:22:39,718 THIS DIRECTION. 3227 02:22:39,718 --> 02:22:46,324 AND ON UBI, SO WE TOOK ABOUT --T 3228 02:22:46,324 --> 02:22:51,430 WE PROPOSED IS UNIVERSAL VERY BC 3229 02:22:51,430 --> 02:22:53,565 INCOME SO THERE SHOULD BE A FLA. 3230 02:22:53,565 --> 02:22:56,501 NOBODY SHOULD FIT IN THE WORLD T 3231 02:22:56,501 --> 02:22:58,103 THEY COULD NOT HAVE ENOUGH FOODO 3232 02:22:58,103 --> 02:22:59,938 FEED THEIR CHILDREN. 3233 02:22:59,938 --> 02:23:00,939 AND THAT IN POOR COUNTRIES THATN 3234 02:23:00,939 --> 02:23:06,144 BE ACHIEVED BY MAKING -- COULD E 3235 02:23:06,144 --> 02:23:09,281 ACHIEVED BY ASSURING PEOPLE HAVE 3236 02:23:09,281 --> 02:23:12,951 RIGHT EVERY MONTH TO AN ALLOCATN 3237 02:23:12,951 --> 02:23:14,619 FOR THAT MONTH IN A WAY THAT ISY 3238 02:23:14,619 --> 02:23:18,223 AND THAT IT WOULD GO A LONG WAYO 3239 02:23:18,223 --> 02:23:22,427 REMOVING SOME STRESS AND ANXIETR 3240 02:23:22,427 --> 02:23:23,161 PEOPLE'S ACTIVITIES. 3241 02:23:23,161 --> 02:23:26,631 IN THE RICHER COUNTRIES, I MUCHS 3242 02:23:26,631 --> 02:23:28,633 SEE THE POINT FOR BASIC INCOME 3243 02:23:28,633 --> 02:23:31,803 BECAUSE TO GIVE THE MINIMUM WILE 3244 02:23:31,803 --> 02:23:34,106 SO EXPENSIVE THAT IT WOULD TAKEY 3245 02:23:34,106 --> 02:23:38,076 A LOT OF OTHER PROGRAMS AND ON E 3246 02:23:38,076 --> 02:23:39,077 CONTRARY, AT THE LEVEL TIME, WEE 3247 02:23:39,077 --> 02:23:42,080 A LOT OF INFORMATION ON PEOPLE U 3248 02:23:42,080 --> 02:23:46,651 CAN TARGET YOUR -- TWO PEOPLE WO 3249 02:23:46,651 --> 02:23:50,222 NEED IT AS OPPOSED TO SHOWERING 3250 02:23:50,222 --> 02:23:52,190 EVERYONE WITH MONEY WHICH WOULDE 3251 02:23:52,190 --> 02:23:56,428 NOTHING FOR A LOT OF PEOPLE ANDT 3252 02:23:56,428 --> 02:23:58,230 ENOUGH FOR PEOPLE WHO NEED IT. 3253 02:23:58,230 --> 02:24:02,834 SO I WOULD SAY WE WOULD GIVE MOO 3254 02:24:02,834 --> 02:24:04,569 FEWER PEOPLE. 3255 02:24:04,569 --> 02:24:05,937 >> WE BETTER STOP THERE. 3256 02:24:05,937 --> 02:24:08,140 THANK YOU ESTER. 3257 02:24:08,140 --> 02:24:09,407 CONGRATULATIONS AND THANK YOU FL 3258 02:24:09,407 --> 02:24:11,009 YOUR WORK. 3259 02:24:11,009 --> 02:24:11,643 >> THANK YOU. 3260 02:24:11,643 --> 02:24:12,711 [ APPLAUSE ] 3261 02:24:12,711 --> 02:24:14,012 >> I SHOULD ADD IN CONCLUSION TT 3262 02:24:14,012 --> 02:24:16,148 THERE ARE A LOT OF PEOPLE WHO WD 3263 02:24:16,148 --> 02:24:18,683 WORK WITH A LOT OF YOU. 3264 02:24:18,683 --> 02:24:29,060 SO PLEASE BE IN TOUCH. 3265 02:26:04,956 --> 02:26:06,024 >> IS THIS ON? 3266 02:26:06,024 --> 02:26:06,591 HELLO, EVERYONE. 3267 02:26:06,591 --> 02:26:09,227 I HAVE THE PLEASURE OF INTRODUCG 3268 02:26:09,227 --> 02:26:11,596 OUR NEXT KEYNOTE SPEAKER. 3269 02:26:11,596 --> 02:26:14,132 SO WE'VE HAD A WONDERFUL CONFERE 3270 02:26:14,132 --> 02:26:16,534 FOCUSED ON SOCIAL DETERMINANTS. 3271 02:26:16,534 --> 02:26:18,203 YOU JUST HEARD SOME CONVERSATION 3272 02:26:18,203 --> 02:26:19,371 ABOUT IT. 3273 02:26:19,371 --> 02:26:21,973 AND IT'S VERY APPROPRIATE THAT 3274 02:26:21,973 --> 02:26:23,041 DR. CRICK LUND IS GOING TO SPEAN 3275 02:26:23,041 --> 02:26:25,010 SOCIAL DETERMINANTS OF MENTAL H. 3276 02:26:25,010 --> 02:26:28,279 HE IS A CLINICAL PSYCHOLOGIST WH 3277 02:26:28,279 --> 02:26:30,782 THE APPOINTMENTS AT KING'S COLL, 3278 02:26:30,782 --> 02:26:33,118 LONDON AS WELL AS THE UNIVERSITF 3279 02:26:33,118 --> 02:26:34,052 CAPETOWN. 3280 02:26:34,052 --> 02:26:36,755 HIS SCHOLARSHIP SPANS WORK ON PY 3281 02:26:36,755 --> 02:26:39,090 ALLEVIATION AND LMICs, 3282 02:26:39,090 --> 02:26:41,626 STRENGTHENING MENTAL HEALTH SERS 3283 02:26:41,626 --> 02:26:42,827 AND SYSTEMS AND INTEGRATION OF L 3284 02:26:42,827 --> 02:26:46,931 HEALTH SERVICES WITH OTHER 3285 02:26:46,931 --> 02:26:47,666 NON-COMMUNICABLE DISEASES AS WES 3286 02:26:47,666 --> 02:26:50,602 MANY OTHER TOPICS. 3287 02:26:50,602 --> 02:26:52,837 SO HE HAS SERVED ON NUMEROUS EXT 3288 02:26:52,837 --> 02:26:55,073 ADVISORY BOARDS INCLUDING ONE FE 3289 02:26:55,073 --> 02:26:58,243 W.H.O.'S SOCIAL DETERMINANTS OF 3290 02:26:58,243 --> 02:26:58,476 HEALTH. 3291 02:26:58,476 --> 02:27:03,248 AND ALL AROUND I THINK HE'S AN N 3292 02:27:03,248 --> 02:27:03,748 INCREDIBLE SCIENTIST. 3293 02:27:03,748 --> 02:27:05,684 SO PLEASED HE IS HERE. 3294 02:27:05,684 --> 02:27:12,991 SO PLEASE JOIN ME IN WELCOMING 3295 02:27:12,991 --> 02:27:56,328 DR. LUND. 3296 02:27:56,328 --> 02:27:57,296 GOOD AFTERNOON, EVERYONE. 3297 02:27:57,296 --> 02:27:58,230 THANK YOU VERY MUCH FOR THE 3298 02:27:58,230 --> 02:27:58,831 INVITATION TO SPEAK. 3299 02:27:58,831 --> 02:28:02,201 IT IS A GREAT HONOR TO BE HERE 3300 02:28:02,201 --> 02:28:03,769 AND I A TOUGH ACT TO FOLLOW. 3301 02:28:03,769 --> 02:28:08,474 IT WAS WONDERFUL TO HEAR ESTER. 3302 02:28:08,474 --> 02:28:12,010 SO IT'S BEEN SUCH A PLEASURE 3303 02:28:12,010 --> 02:28:12,845 THIS LAST COUPLE OF DAYS 3304 02:28:12,845 --> 02:28:14,046 RECONNECTING WITH SO MANY OLD 3305 02:28:14,046 --> 02:28:15,214 FRIENDS AND REALLY GETTING A 3306 02:28:15,214 --> 02:28:16,381 SENSE OF HOW VIBRANT OUR GLOBAL 3307 02:28:16,381 --> 02:28:18,684 MENTAL HEALTH COMMUNITY IS. 3308 02:28:18,684 --> 02:28:20,018 AND TODAY MY TALK, I REALLY 3309 02:28:20,018 --> 02:28:22,488 WANTED TO TALK ABOUT HOW WE CAN 3310 02:28:22,488 --> 02:28:23,088 FURTHER DIVERSIFY SOME OF THE 3311 02:28:23,088 --> 02:28:25,090 WORK WE DO IN THE NAME OF GLOBAL 3312 02:28:25,090 --> 02:28:26,325 MENTAL HEALTH TO THINK ABOUT HOW 3313 02:28:26,325 --> 02:28:27,626 WE DESIGN INTERVENTIONS TO 3314 02:28:27,626 --> 02:28:28,694 ADDRESS THE SOCIAL DETERMINANTS 3315 02:28:28,694 --> 02:28:31,263 OF MENTAL HEALTH. 3316 02:28:31,263 --> 02:28:32,965 I THINK WE HAVE JUST HEARD VERY 3317 02:28:32,965 --> 02:28:35,334 ELOQUENTLY FROM ESTER ON THE 3318 02:28:35,334 --> 02:28:36,435 ENORMOUS WORK THEY HAVE DONE IN 3319 02:28:36,435 --> 02:28:37,636 CASH TRANSFERS AND POVERTY 3320 02:28:37,636 --> 02:28:39,972 ALLEVIATION PROGRAMS AND HOW 3321 02:28:39,972 --> 02:28:41,874 THEY ARE STARTING TO INVESTIGATE 3322 02:28:41,874 --> 02:28:43,141 THE MENTAL HEALTH IMPACTS OF 3323 02:28:43,141 --> 02:28:44,943 SOME OF THESE PROGRAMS. 3324 02:28:44,943 --> 02:28:46,211 AND I THINK THERE IS AN 3325 02:28:46,211 --> 02:28:47,279 OPPORTUNITY TO MEET SOMEWHERE IN 3326 02:28:47,279 --> 02:28:48,480 THE MIDDLE HERE WHERE THOSE OF 3327 02:28:48,480 --> 02:28:49,715 US IN WORKING IN GLOBAL MENTAL 3328 02:28:49,715 --> 02:28:51,450 HEALTH CAN PERHAPS BE DOING MORE 3329 02:28:51,450 --> 02:28:58,156 TO EVALUATE INTERVENTIONS TO 3330 02:28:58,156 --> 02:28:59,558 ADDRESS THE SOCIAL AND ECONOMIC 3331 02:28:59,558 --> 02:29:00,158 ADVERSITIES THAT DRIVE MENTAL 3332 02:29:00,158 --> 02:29:00,792 HEALTH PROBLEMS IN OUR 3333 02:29:00,792 --> 02:29:01,527 POPULATIONS. 3334 02:29:01,527 --> 02:29:02,561 SO THAT IS THE FOCUS OF MY TALK 3335 02:29:02,561 --> 02:29:03,962 TODAY. 3336 02:29:03,962 --> 02:29:04,997 HERE IS AN OUTLINE. 3337 02:29:04,997 --> 02:29:06,932 I'M GOING TO START OFF BY 3338 02:29:06,932 --> 02:29:07,633 TELLING YOU A STORY OF ONE 3339 02:29:07,633 --> 02:29:08,800 INDIVIDUAL TO GIVE YOU A SENSE 3340 02:29:08,800 --> 02:29:11,470 OF HOW THESE SOCIAL AND ECONOMIC 3341 02:29:11,470 --> 02:29:12,838 DRIVERS INFLUENCE THE MENTAL 3342 02:29:12,838 --> 02:29:20,812 HEALTH OF INDIVIDUALS. 3343 02:29:20,812 --> 02:29:21,813 AND THEN I'LL SHARE A FRAMEWORK 3344 02:29:21,813 --> 02:29:23,248 THAT WE DEVELOPED FOR THE SOCIAL 3345 02:29:23,248 --> 02:29:24,483 DETERMINANTS OF MENTAL HEALTH AS 3346 02:29:24,483 --> 02:29:25,117 PART OF THE COMMISSION ON GLOBAL 3347 02:29:25,117 --> 02:29:26,351 MENTAL HEALTH AND SUSTAINABLE 3348 02:29:26,351 --> 02:29:27,486 DEVELOPMENT IN 2018. 3349 02:29:27,486 --> 02:29:28,620 AND THEN TALK A LITTLE BIT ABOUT 3350 02:29:28,620 --> 02:29:29,655 HOW WE CAN POTENTIALLY GO ABOUT 3351 02:29:29,655 --> 02:29:30,789 INTERVENING TO ADDRESS SOME OF 3352 02:29:30,789 --> 02:29:32,224 THESE SOCIAL DETERMINANTS. 3353 02:29:32,224 --> 02:29:33,392 I'LL TOUCH ON SOME OF THE 3354 02:29:33,392 --> 02:29:34,893 CHALLENGES IN THIS FIELD BUT 3355 02:29:34,893 --> 02:29:35,961 ALSO WHAT I THINK ARE SOME 3356 02:29:35,961 --> 02:29:38,564 REALLY EXCITING OPPORTUNITIES 3357 02:29:38,564 --> 02:29:39,498 AND POTENTIAL APPROACHES AND 3358 02:29:39,498 --> 02:29:41,667 I'LL ILLUSTRATE THIS WITH SOME 3359 02:29:41,667 --> 02:29:42,534 EXAMPLES OF CURRENT WORK WE ARE 3360 02:29:42,534 --> 02:29:49,374 INVOLVED IN. 3361 02:29:49,374 --> 02:29:50,342 AND THROUGH THE CHANCE PROJECT. 3362 02:29:50,342 --> 02:29:51,310 AND I'LL SHARE WITH YOU SOME 3363 02:29:51,310 --> 02:29:52,311 IDEAS FOR RESEARCH PRIORITIES 3364 02:29:52,311 --> 02:29:53,879 GOING FORWARD AND SOME OF THE 3365 02:29:53,879 --> 02:29:57,449 POLICY CHALLENGES THAT THIS 3366 02:29:57,449 --> 02:29:58,450 BROADENED RESEARCH AGENDA NOW 3367 02:29:58,450 --> 02:30:00,519 OPENS UP FOR US. 3368 02:30:00,519 --> 02:30:10,095 SO THESE PICTURES ARE TAKEN FROM 3369 02:30:10,095 --> 02:30:10,929 A LARGE TOWNSHIP SETTLEMENT ON 3370 02:30:10,929 --> 02:30:12,264 THE OUTSKIRTS OF CAPETOWN ABOUT 3371 02:30:12,264 --> 02:30:13,532 20 KILOMETERS FROM WHERE I LIVE 3372 02:30:13,532 --> 02:30:13,832 AND WORK. 3373 02:30:13,832 --> 02:30:17,369 AND WE CONDUCTED A RANDOMIZED 3374 02:30:17,369 --> 02:30:18,136 CONTROL TRIAL HERE FROM 3375 02:30:18,136 --> 02:30:19,838 2011-2016. 3376 02:30:19,838 --> 02:30:25,877 WE WERE EVALUATING THE 3377 02:30:25,877 --> 02:30:26,945 EFFECTIVENESS OF A TASK-SHARING 3378 02:30:26,945 --> 02:30:27,879 PSYCHOLOGICAL COUNSELING 3379 02:30:27,879 --> 02:30:28,780 INTERVENTION DELIVERED BY 3380 02:30:28,780 --> 02:30:29,948 COMMUNITY HEALTH WORKERS FOR 3381 02:30:29,948 --> 02:30:30,949 PERINATAL DEPRESSION. 3382 02:30:30,949 --> 02:30:32,351 NOW AS PART OF THIS WORK, WE 3383 02:30:32,351 --> 02:30:34,586 CONDUCTED A LOT OF FORMATIVE, 3384 02:30:34,586 --> 02:30:37,189 QUALITATIVE RESEARCH ASKING 3385 02:30:37,189 --> 02:30:37,789 ANTI-NATAL AND POSTNATAL WOMEN 3386 02:30:37,789 --> 02:30:40,559 ABOUT THEIR EXPERIENCE OF 3387 02:30:40,559 --> 02:30:41,994 DEPRESSION. 3388 02:30:41,994 --> 02:30:46,865 AND WE APPROACHED WOMEN LIKE 3389 02:30:46,865 --> 02:30:53,138 THIS WOMAN, WHO WE SHALL CALL 3390 02:30:53,138 --> 02:30:53,905 MANDY TO DESCRIBE WHAT THE TERMS 3391 02:30:53,905 --> 02:30:55,440 THEY USED TO UNDERSTAND 3392 02:30:55,440 --> 02:30:56,008 DEPRESSION BUT ALSO WHAT DID 3393 02:30:56,008 --> 02:30:57,042 THEY THINK WERE SOME OF THE MAIN 3394 02:30:57,042 --> 02:30:57,909 CAUSES OF DEPRESSION IN THEIR 3395 02:30:57,909 --> 02:30:59,011 LIVES. 3396 02:30:59,011 --> 02:31:01,113 THE STORIES THAT CAME OUT HAD 3397 02:31:01,113 --> 02:31:02,014 ILLUSTRATIONS OF A WHOLE RANGE 3398 02:31:02,014 --> 02:31:03,715 OF SOCIAL AND ECONOMIC 3399 02:31:03,715 --> 02:31:06,518 ADVERSITIES. 3400 02:31:06,518 --> 02:31:09,788 INADEQUATE WATER AND SANITATION. 3401 02:31:09,788 --> 02:31:15,193 POOR HOUSING, AS YOU CAN SEE 3402 02:31:15,193 --> 02:31:16,762 FROM THESE IMAGES, HIGH LEVELS 3403 02:31:16,762 --> 02:31:18,063 OF INEQUALITY WITH SOUTH AFRICA 3404 02:31:18,063 --> 02:31:18,764 BEING ONE OF THE MOST UNEQUAL 3405 02:31:18,764 --> 02:31:20,999 COUNTRIES IN THE WORLD. 3406 02:31:20,999 --> 02:31:22,601 VIOLENCE, GENDER-BASED VIOLENCE 3407 02:31:22,601 --> 02:31:24,436 ENDEMIC FROM THIS COMMUNITY. 3408 02:31:24,436 --> 02:31:25,604 HIGH LEVELS OF FOOD INSECURITY. 3409 02:31:25,604 --> 02:31:28,607 VERY HIGH UNEMPLOYMENT RATES. 3410 02:31:28,607 --> 02:31:30,208 AND ALSO MIGRATION, MANY WOMEN 3411 02:31:30,208 --> 02:31:31,410 HAD MIGRATED FROM THE RURALLINE 3412 02:31:31,410 --> 02:31:32,010 CAPE TO THE WESTERN CAPE TO 3413 02:31:32,010 --> 02:31:36,715 CAPETOWN IN SEARCH OF WORK AND 3414 02:31:36,715 --> 02:31:37,816 THINGS HAD NOT WORKED OUT FOR 3415 02:31:37,816 --> 02:31:38,450 THEM AS WELL AS THEY HAD HOPED 3416 02:31:38,450 --> 02:31:40,052 THEY MIGHT. 3417 02:31:40,052 --> 02:31:44,589 IT WAS VERY DIFFICULT TO 3418 02:31:44,589 --> 02:31:45,724 DISENTANGLE IN USING WESTERN 3419 02:31:45,724 --> 02:31:47,526 DIAGNOSTIC TOOLS IDENTIFY AS 3420 02:31:47,526 --> 02:31:48,860 DEPRESSION FROM EVERY SOCIAL AND 3421 02:31:48,860 --> 02:31:59,204 ECONOMIC ADVERSITY. 3422 02:32:02,307 --> 02:32:03,108 WHY COULDN'T BE BE DOING MORE TO 3423 02:32:03,108 --> 02:32:04,242 ADDRESS THE SOCIAL AND ECONOMIC 3424 02:32:04,242 --> 02:32:05,510 DETERMINANTS AS A WAY OF 3425 02:32:05,510 --> 02:32:07,446 PREVENTING AND POTENTIALLY 3426 02:32:07,446 --> 02:32:11,516 TREATING DEPRESSION. 3427 02:32:11,516 --> 02:32:12,718 AND SO, IF WE LOOK AT THE 3428 02:32:12,718 --> 02:32:14,586 EPIDEMIOLOGICAL EVIDENCE IT 3429 02:32:14,586 --> 02:32:16,054 SUPPORTS HER EXPERIENCE. 3430 02:32:16,054 --> 02:32:18,090 THIS IS DATA FROM A LARGE 3431 02:32:18,090 --> 02:32:20,225 SYSTEMATIC REVIEW WE PUBLISHED 3432 02:32:20,225 --> 02:32:22,294 IN 2010 LOOKING AT THE 3433 02:32:22,294 --> 02:32:23,929 ASSOCIATIONS BETWEEN POVERTY AND 3434 02:32:23,929 --> 02:32:25,464 COMMON MENTAL DISORDERS, 3435 02:32:25,464 --> 02:32:28,467 DEPRESSION AND ANXIETY AND 3436 02:32:28,467 --> 02:32:29,901 DISORDERS IN LOW AND 3437 02:32:29,901 --> 02:32:32,270 MIDDLE-INCOME COUNTRIES. 3438 02:32:32,270 --> 02:32:33,605 WE INCLUDED 115 STUDIES IN THIS 3439 02:32:33,605 --> 02:32:35,073 REVIEW AND THERE WAS 76 3440 02:32:35,073 --> 02:32:37,375 COMMUNITY-BASED STUDIES. 3441 02:32:37,375 --> 02:32:38,577 THE VAST MAJORITY SHOWED A 3442 02:32:38,577 --> 02:32:40,645 STATISTICALLY SIGNIFICANT 3443 02:32:40,645 --> 02:32:42,247 ASSOCIATION BETWEEN DIVERSE 3444 02:32:42,247 --> 02:32:44,249 MEASURES OF POVERTY AND COMMON 3445 02:32:44,249 --> 02:32:45,851 MENTAL DISORDERS. 3446 02:32:45,851 --> 02:32:47,419 POVERTY WAS STRONGLY ASSOCIATED 3447 02:32:47,419 --> 02:32:49,221 WITH HIGHER RATES OF COMMON 3448 02:32:49,221 --> 02:32:50,689 MENTAL DISORDERS ACROSS AGE 3449 02:32:50,689 --> 02:32:57,829 RANGES IN RURAL AND URBAN AREAS. 3450 02:32:57,829 --> 02:32:58,997 IT WAS ASSOCIATED WITH INCREASED 3451 02:32:58,997 --> 02:33:00,098 PREVALENCE, INCREASED SEVERITY, 3452 02:33:00,098 --> 02:33:01,399 LONGER COURSE AND WORSE OUTCOME. 3453 02:33:01,399 --> 02:33:03,401 REALLY QUITE A COMPELLING CASE 3454 02:33:03,401 --> 02:33:04,970 THAT POVERTY AND COMMON MENTAL 3455 02:33:04,970 --> 02:33:06,271 DISORDERS WERE VERY STRONGLY 3456 02:33:06,271 --> 02:33:07,939 ASSOCIATED. 3457 02:33:07,939 --> 02:33:09,608 AND THIS ASSOCIATION WAS EVEN 3458 02:33:09,608 --> 02:33:11,076 STRONGER IN THE CASE OF STUDIES 3459 02:33:11,076 --> 02:33:14,846 THAT DID MULTIVARIATE ANALYSIS. 3460 02:33:14,846 --> 02:33:17,582 SO A LOT OF THOSE EARLY DATA 3461 02:33:17,582 --> 02:33:19,351 WERE CROSS SECTIONAL IN NATURE 3462 02:33:19,351 --> 02:33:20,552 AND IT'S VERY DIFFICULT TO 3463 02:33:20,552 --> 02:33:21,686 DISENTANGLE WHICH COMES FIRST. 3464 02:33:21,686 --> 02:33:22,387 ARE PEOPLE DEPRESS BECAUSE THEY 3465 02:33:22,387 --> 02:33:23,722 ARE POOR OR POOR BECAUSE THEY 3466 02:33:23,722 --> 02:33:26,892 ARE DEPRESSED? 3467 02:33:26,892 --> 02:33:30,796 FROM RECENT WORK, AND THIS IS A 3468 02:33:30,796 --> 02:33:32,697 PAPER PUBLISHED IN SCIENCE. 3469 02:33:32,697 --> 02:33:33,899 MORE EVIDENCE ABOUT THESE CAUSAL 3470 02:33:33,899 --> 02:33:35,033 MECHANISMS LINKING POVERTY AND 3471 02:33:35,033 --> 02:33:37,435 MENTAL HEALTH. 3472 02:33:37,435 --> 02:33:39,938 AND ESSENTIALLY, THE 3473 02:33:39,938 --> 02:33:41,706 RELATIONSHIP IS BIDIRECTIONAL. 3474 02:33:41,706 --> 02:33:42,741 SO ON THE ONE HAND WE HAVE WHAT 3475 02:33:42,741 --> 02:33:46,311 IS OFTEN REFERRED TO AS THE 3476 02:33:46,311 --> 02:33:47,078 SOCIAL CAUSATION PATHWAY BY 3477 02:33:47,078 --> 02:33:48,914 WHICH LIVING IN CIRCUMSTANCES OF 3478 02:33:48,914 --> 02:33:51,349 POVERTY CAUSES MENTAL ILLNESS 3479 02:33:51,349 --> 02:33:53,885 THROUGH A NUMBER OF MECHANISMS. 3480 02:33:53,885 --> 02:33:56,221 THESE INCLUDE WORRIES AND 3481 02:33:56,221 --> 02:33:58,290 UNCERTAINTY, ENVIRONMENTAL 3482 02:33:58,290 --> 02:34:01,259 FACTORS, PHYSICAL HEALTH 3483 02:34:01,259 --> 02:34:01,993 PROBLEMS, WHICH ARE MORE 3484 02:34:01,993 --> 02:34:03,195 PREVALENT AMONG POORER 3485 02:34:03,195 --> 02:34:04,362 COMMUNITIES AND CO-MORBID MENTAL 3486 02:34:04,362 --> 02:34:06,565 HEALTH CONSEQUENCES. 3487 02:34:06,565 --> 02:34:08,233 EARLY LIFE CONDITIONS AND 3488 02:34:08,233 --> 02:34:11,269 EXPOSURES, TRAUMA, VIOLENCE AND 3489 02:34:11,269 --> 02:34:13,605 CRIME AND SOCIAL STATUS, SHAME 3490 02:34:13,605 --> 02:34:14,639 AND ISOLATION ALL DRIVE AN 3491 02:34:14,639 --> 02:34:17,108 INCREASED RISK FOR A RANGE OF 3492 02:34:17,108 --> 02:34:17,642 MENTAL HEALTH PROBLEMS, IN 3493 02:34:17,642 --> 02:34:18,610 PARTICULAR DEPRESSION AND 3494 02:34:18,610 --> 02:34:21,713 ANXIETY. 3495 02:34:21,713 --> 02:34:22,647 BUT THE RELATIONSHIP ALSO WORKS 3496 02:34:22,647 --> 02:34:24,549 IN THE OTHER DIRECTION AND THIS 3497 02:34:24,549 --> 02:34:25,517 IS OFTEN WHAT IS REFERRED TO AS 3498 02:34:25,517 --> 02:34:26,685 THE SOCIAL DRIFT PATHWAY. 3499 02:34:26,685 --> 02:34:29,354 SO LIVING WITH A MENTAL ILLNESS 3500 02:34:29,354 --> 02:34:29,855 IMPEDES ONE'S COGNITIVE 3501 02:34:29,855 --> 02:34:30,922 FUNCTIONING. 3502 02:34:30,922 --> 02:34:38,496 IT HAS AN EFFECT ON ONE'S 3503 02:34:38,496 --> 02:34:39,130 BELIEFS ABOUT ONE'S SELF AND THE 3504 02:34:39,130 --> 02:34:39,898 FUTURE. 3505 02:34:39,898 --> 02:34:40,632 IT HAS AN IMPACT ON YOUR 3506 02:34:40,632 --> 02:34:41,800 PREFERENCES ESPECIALLY YOUR 3507 02:34:41,800 --> 02:34:43,869 TIME-RELATED PREFERENCES. 3508 02:34:43,869 --> 02:34:44,970 THE DISABILITY ASSOCIATED LIVING 3509 02:34:44,970 --> 02:34:46,171 WITH A MENTAL ILLNESS HAS 3510 02:34:46,171 --> 02:34:47,572 IMPACTS ON LABOR SUPPLY AND 3511 02:34:47,572 --> 02:34:49,140 PRODUCTIVITY. 3512 02:34:49,140 --> 02:34:56,414 STIGMA OF LIVING WITH A 3513 02:34:56,414 --> 02:34:57,082 ILLNESS EXCLUDES YOU FROM 3514 02:34:57,082 --> 02:34:58,350 INCOME-GENERATING OPPORTUNITIES. 3515 02:34:58,350 --> 02:34:59,284 AND ONE TENDS TO SPEND MORE ON 3516 02:34:59,284 --> 02:35:00,185 HEALTH CARE GENERALLY, NOT JUST 3517 02:35:00,185 --> 02:35:01,052 MENTAL HEALTH WHEN YOU'RE LIVING 3518 02:35:01,052 --> 02:35:02,220 WITH A MENTAL ILLNESS. 3519 02:35:02,220 --> 02:35:03,288 AND WOMEN'S EMPOWERMENT IS 3520 02:35:03,288 --> 02:35:04,389 PARTICULARLY AFFECTED BY A 3521 02:35:04,389 --> 02:35:05,724 MENTAL ILLNESS AND 3522 02:35:05,724 --> 02:35:08,026 INTERGENERATIONAL EFFECTS. 3523 02:35:08,026 --> 02:35:09,694 IT'S QUITE STRONG AND EMERGING 3524 02:35:09,694 --> 02:35:10,896 EVIDENCE THAT LIVING WITH A 3525 02:35:10,896 --> 02:35:11,897 MENTAL ILLNESS HAS IMPACT ON 3526 02:35:11,897 --> 02:35:13,064 IMPOVERISHING THE NEXT 3527 02:35:13,064 --> 02:35:17,402 GENERATION. 3528 02:35:17,402 --> 02:35:18,737 SO THESE REALITIES OF THE SOCIAL 3529 02:35:18,737 --> 02:35:19,905 DETERMINANTS OF MENTAL HEALTH 3530 02:35:19,905 --> 02:35:21,640 ARE GETTING INCREASING 3531 02:35:21,640 --> 02:35:22,974 INTERNATIONAL RECOGNITION. 3532 02:35:22,974 --> 02:35:25,210 THERE HAVE BEEN A NUMBER OF 3533 02:35:25,210 --> 02:35:26,444 LANDMARK REPORTS INCLUDING 3534 02:35:26,444 --> 02:35:27,445 COMING OUT OF THE W.H.O. 3535 02:35:27,445 --> 02:35:31,116 COMMISSION ON THE SOCIAL 3536 02:35:31,116 --> 02:35:31,783 DETERMINANTS OF HEALTH, WHICH 3537 02:35:31,783 --> 02:35:32,651 INCLUDED A CHAPTER ON MENTAL 3538 02:35:32,651 --> 02:35:33,752 HEALTH. 3539 02:35:33,752 --> 02:35:35,654 THERE WAS THE W.H.O. MENTAL 3540 02:35:35,654 --> 02:35:39,391 HEALTH AND DEVELOPMENT REPORT IN 3541 02:35:39,391 --> 02:35:41,126 2010 AND THIS REPORT BY THE 3542 02:35:41,126 --> 02:35:42,661 FOUNDATION AND W.H.O. PUBLISHED 3543 02:35:42,661 --> 02:35:44,296 ON THE SOCIAL DETERMINANTS OF 3544 02:35:44,296 --> 02:35:49,301 MENTAL HEALTH IN 2014. 3545 02:35:49,301 --> 02:35:49,901 SO WHAT DO WE MEAN BY SOCIAL 3546 02:35:49,901 --> 02:35:51,503 DETERMINANTS? 3547 02:35:51,503 --> 02:35:52,370 I THINK IT'S IMPORTANT TO GET 3548 02:35:52,370 --> 02:35:53,939 SOME OF THE CONCEPTUAL BUILDING 3549 02:35:53,939 --> 02:35:55,607 BLOCKS RIGHT HERE. 3550 02:35:55,607 --> 02:35:59,210 THIS IS A DEFINITION THAT WE 3551 02:35:59,210 --> 02:36:00,011 DEVELOPED AS PART OF THE 3552 02:36:00,011 --> 02:36:01,079 COMMISSION ON GLOBAL MENTAL 3553 02:36:01,079 --> 02:36:04,482 HEALTH AND SUSTAINABLE 3554 02:36:04,482 --> 02:36:05,483 DEVELOPMENT IN 2018. 3555 02:36:05,483 --> 02:36:06,785 AND WE SAID, SOCIAL DETERMINANTS 3556 02:36:06,785 --> 02:36:09,654 REFER TO THE SOCIAL AND ECONOMIC 3557 02:36:09,654 --> 02:36:17,729 CONDITIONS THAT HAVE A DIRECT 3558 02:36:17,729 --> 02:36:18,530 PREVELANCE AND SEVERITY OF 3559 02:36:18,530 --> 02:36:19,197 MENTAL DISORDERS IN MALES AND 3560 02:36:19,197 --> 02:36:20,865 FEMALES ACROSS THE LIFE COURSE. 3561 02:36:20,865 --> 02:36:21,900 AND THREE REALLY IMPORTANT 3562 02:36:21,900 --> 02:36:22,767 ASPECTS. 3563 02:36:22,767 --> 02:36:24,769 FIRST OF ALL THE STRUCTURAL 3564 02:36:24,769 --> 02:36:26,104 SOCIAL AND ECONOMIC ARRANGEMENTS 3565 02:36:26,104 --> 02:36:28,306 WHICH CONFER ADVANTAGE OR 3566 02:36:28,306 --> 02:36:31,443 DISADVANTAGE ON SOME. 3567 02:36:31,443 --> 02:36:32,310 THE DIFFERENTIAL EXPOSURE TO 3568 02:36:32,310 --> 02:36:33,878 ADVERSE LIFE EVENTS, WHICH IS 3569 02:36:33,878 --> 02:36:35,981 OFTEN QUITE STRONGLY ASSOCIATED 3570 02:36:35,981 --> 02:36:37,115 WITH WHERE YOU ARE POSITIONED 3571 02:36:37,115 --> 02:36:39,684 SOCIALLY AND ECONOMICALLY. 3572 02:36:39,684 --> 02:36:40,986 AND OFTEN THE SPECIFIC 3573 02:36:40,986 --> 02:36:43,054 CONDITIONS OF VULNERABILITY OR 3574 02:36:43,054 --> 02:36:43,989 RESILIENCE THAT THE COMBINATION 3575 02:36:43,989 --> 02:36:45,457 OF THESE ARRANGEMENTS AND 3576 02:36:45,457 --> 02:36:47,959 EXPOSURES PRODUCE. 3577 02:36:47,959 --> 02:36:50,729 SO QUITE ROBUST EVIDENCE NOW 3578 02:36:50,729 --> 02:36:52,030 THAT THE EFFECTS OF SOCIAL AND 3579 02:36:52,030 --> 02:36:53,898 ECONOMIC ADVERSITY ON 3580 02:36:53,898 --> 02:36:55,934 DEPRESSION, FOR EXAMPLE, IS 3581 02:36:55,934 --> 02:36:56,935 EXACERBATED BY THE INCREASED 3582 02:36:56,935 --> 02:36:58,737 RISK FOR MORE SEVERE AND MORE 3583 02:36:58,737 --> 02:37:00,405 FREQUENT ADVERSE LIFE EVENTS. 3584 02:37:00,405 --> 02:37:01,439 THESE ARE VERY CLOSELY 3585 02:37:01,439 --> 02:37:06,111 INTERTWINED. 3586 02:37:06,111 --> 02:37:07,645 AS PART OF THIS WORK, WE 3587 02:37:07,645 --> 02:37:09,214 DEVELOPED A FRAMEWORK TO REALLY 3588 02:37:09,214 --> 02:37:09,981 TRY TO MAKE SENSE OF THE COMPLEX 3589 02:37:09,981 --> 02:37:12,050 ARRAY OF SOCIAL AND ECONOMIC 3590 02:37:12,050 --> 02:37:13,284 FACTORS THAT HAVE A BEARING ON 3591 02:37:13,284 --> 02:37:14,652 THE MENTAL HEALTH OF 3592 02:37:14,652 --> 02:37:16,121 POPULATIONS. 3593 02:37:16,121 --> 02:37:23,361 WHAT WE DID WAS, WE CONDUCTED A 3594 02:37:23,361 --> 02:37:24,095 LARGE SYSTEMATIC VIEW OF 3595 02:37:24,095 --> 02:37:27,599 REVIEWS. 3596 02:37:27,599 --> 02:37:28,099 AND THERE WERE 289 VIEWS 3597 02:37:28,099 --> 02:37:29,300 INCLUDED IN OUR REVIEW. 3598 02:37:29,300 --> 02:37:29,901 AND WE TOOK THE DATA AND WE 3599 02:37:29,901 --> 02:37:30,802 TRIED TO MAKE SENSE OF IT IN 3600 02:37:30,802 --> 02:37:32,103 TERMS OF FIVE MAIN DOMAINS. 3601 02:37:32,103 --> 02:37:34,406 SO THERE IS THE DEMOGRAPHIC 3602 02:37:34,406 --> 02:37:35,040 DOMAIN, THE ECONOMIC DOMAIN, THE 3603 02:37:35,040 --> 02:37:36,074 NEIGHBORHOOD DOMAIN WHICH REFERS 3604 02:37:36,074 --> 02:37:37,308 TO THE CHARACTERISTICS OF THE 3605 02:37:37,308 --> 02:37:38,910 NEIGHBORHOOD OR THE COMMUNITY IN 3606 02:37:38,910 --> 02:37:40,378 WHICH YOU LIVE OVER AND ABOVE 3607 02:37:40,378 --> 02:37:41,579 THE CHARACTERISTICS OF THE 3608 02:37:41,579 --> 02:37:42,881 INDIVIDUALS WHO LIVE IN THAT 3609 02:37:42,881 --> 02:37:44,849 NEIGHBORHOOD. 3610 02:37:44,849 --> 02:37:46,584 THE ENVIRONMENTAL EVENTS DOMAIN, 3611 02:37:46,584 --> 02:37:48,787 WHICH INCLUDES THE NATURAL 3612 02:37:48,787 --> 02:37:50,989 DISASTERS, WAR AND CONFLICT, 3613 02:37:50,989 --> 02:37:52,690 CLIMATE CHANGE AND SO ON. 3614 02:37:52,690 --> 02:37:53,525 AND THEN THE SOCIAL AND CULTURAL 3615 02:37:53,525 --> 02:37:57,228 DOMAIN. 3616 02:37:57,228 --> 02:37:58,963 AND EACH OF THESE DOMAINS SOCIAL 3617 02:37:58,963 --> 02:38:00,465 DETERMINANTS EXERT INFLUENCE ON 3618 02:38:00,465 --> 02:38:02,434 MENTAL HEALTH THROUGHOUT THE 3619 02:38:02,434 --> 02:38:05,170 LIFE COURSE THROUGH A 3620 02:38:05,170 --> 02:38:06,504 COMBINATION OF DISTAL AND MORE 3621 02:38:06,504 --> 02:38:08,807 PROXIMAL FACTORS. 3622 02:38:08,807 --> 02:38:10,708 SO FOR EXAMPLE, IF WE TAKE THE 3623 02:38:10,708 --> 02:38:12,210 ECONOMIC DOMAIN, THE EFFECT OF 3624 02:38:12,210 --> 02:38:20,185 ECONOMIC RECESSIONS SUCH AS THAT 3625 02:38:20,185 --> 02:38:20,985 ASSOCIATED WITH COVID, EXERTS 3626 02:38:20,985 --> 02:38:22,620 INFLUENCE ON THE MENTAL HEALTH 3627 02:38:22,620 --> 02:38:24,189 OF INDIVIDUALS THROUGH THEIR 3628 02:38:24,189 --> 02:38:25,723 EXPERIENCE OF REDUCED INCOME OR 3629 02:38:25,723 --> 02:38:27,759 UNPREDICTABLE INCOME, INCREASED 3630 02:38:27,759 --> 02:38:28,960 DEBT, ERODED ASSETS, FINANCIAL 3631 02:38:28,960 --> 02:38:32,097 STRAIN AND SO ON. 3632 02:38:32,097 --> 02:38:33,498 AND VERY IMPORTANTLY, THESE 3633 02:38:33,498 --> 02:38:34,866 SOCIAL AND ECONOMIC FACTORS 3634 02:38:34,866 --> 02:38:37,302 INTERACT WITH A RANGE OF GENETIC 3635 02:38:37,302 --> 02:38:38,703 RISK FACTORS TO PRODUCE MENTAL 3636 02:38:38,703 --> 02:38:39,671 HEALTH RESILIENCE OR MENTAL 3637 02:38:39,671 --> 02:38:41,206 HEALTH CONDITIONS OVER THE LIFE 3638 02:38:41,206 --> 02:38:45,210 COURSE. 3639 02:38:45,210 --> 02:38:46,044 AND CRITICALLY, THERE ARE 3640 02:38:46,044 --> 02:38:47,145 IMPORTANT DEVELOPMENTAL LIFE 3641 02:38:47,145 --> 02:38:49,280 STAGES, FOR EXAMPLE, DURING THE 3642 02:38:49,280 --> 02:38:50,849 PERINATAL PERIOD, EARLY INFANCY, 3643 02:38:50,849 --> 02:38:53,451 ADOLESCENCE AND OLD AGE. 3644 02:38:53,451 --> 02:38:55,353 IN WHICH THESE EFFECTS OF THESE 3645 02:38:55,353 --> 02:38:57,689 SOCIAL DETERMINANTS BECOME 3646 02:38:57,689 --> 02:39:01,726 PARTICULARLY EXAGGERATED. 3647 02:39:01,726 --> 02:39:03,828 AND ALL OF THIS IS EVEN MORE 3648 02:39:03,828 --> 02:39:05,730 RELEVANT IN THE COVID ERA. 3649 02:39:05,730 --> 02:39:08,299 WE HAVE SEEN 71 TO 100 MILLION 3650 02:39:08,299 --> 02:39:09,634 PEOPLE DRIVEN INTO EXTREME 3651 02:39:09,634 --> 02:39:10,735 POVERTY ACCORDING TO WORLD BANK 3652 02:39:10,735 --> 02:39:12,437 ESTIMATES. 3653 02:39:12,437 --> 02:39:14,639 WIDENING INCOME AND INEQUALITY 3654 02:39:14,639 --> 02:39:15,840 WITH INCREASING RESOURCES 3655 02:39:15,840 --> 02:39:16,941 CONCENTRATED IN THE HANDS OF A 3656 02:39:16,941 --> 02:39:18,376 SMALLER AND SMALLER MINORITY OF 3657 02:39:18,376 --> 02:39:21,546 THE WORLD'S POPULATION. 3658 02:39:21,546 --> 02:39:22,914 INCREASED FOOD INSECURITY AND 3659 02:39:22,914 --> 02:39:25,049 INCREASED GENDER-BASED VIOLENCE. 3660 02:39:25,049 --> 02:39:26,751 THESE ARE KNOWN RISK FACTORS. 3661 02:39:26,751 --> 02:39:32,223 COVID ACTED LIKE A PRESSURE 3662 02:39:32,223 --> 02:39:35,059 COOKER TO EXACERBATE THE EFFECTS 3663 02:39:35,059 --> 02:39:35,760 OF THESE SOCIAL DETERMINANTS ON 3664 02:39:35,760 --> 02:39:37,262 MENTAL HEALTH. 3665 02:39:37,262 --> 02:39:39,898 AND ONE CONSEQUENCE WAS, WE SAW 3666 02:39:39,898 --> 02:39:40,932 DURING THE PANDEMIC A 25% 3667 02:39:40,932 --> 02:39:42,100 INCREASE IN THE GLOBAL 3668 02:39:42,100 --> 02:39:43,334 PREVALENCE OF ANXIETY DISORDERS 3669 02:39:43,334 --> 02:39:45,203 DURING THE PANDEMIC. 3670 02:39:45,203 --> 02:39:46,371 SO IT'S CLEAR THIS IS A COMPLEX 3671 02:39:46,371 --> 02:39:47,505 PICTURE AS YOU CAN SEE, THERE IS 3672 02:39:47,505 --> 02:39:49,574 A LOT OF HETEROGENEITY ACROSS 3673 02:39:49,574 --> 02:39:51,075 COUNTRIES AROUND THE WORLD BUT 3674 02:39:51,075 --> 02:39:55,647 THE SOCIAL AND ECONOMIC DRIVERS 3675 02:39:55,647 --> 02:39:56,281 ARE ALREADY VERY, VERY IMPORTANT 3676 02:39:56,281 --> 02:40:00,652 IN THIS PICTURE. 3677 02:40:00,652 --> 02:40:01,653 SO THIS THEN BRINGS OR BEGS THE 3678 02:40:01,653 --> 02:40:03,121 QUESTION AND BRINGS ME TO THE 3679 02:40:03,121 --> 02:40:05,290 MAIN FOCUS OF MY TALK TODAY 3680 02:40:05,290 --> 02:40:06,291 WHICH IS REALLY HOW DO WE GO 3681 02:40:06,291 --> 02:40:07,525 ABOUT INTERVENING TO ADDRESS 3682 02:40:07,525 --> 02:40:09,327 THESE SOCIAL DETERMINANTS? 3683 02:40:09,327 --> 02:40:10,795 ISN'T THERE MORE WE COULD BE 3684 02:40:10,795 --> 02:40:12,931 DOING TO TRY TO ADDRESS SOME OF 3685 02:40:12,931 --> 02:40:14,832 THESE UPSTREAM DRIVERS AND 3686 02:40:14,832 --> 02:40:15,400 EXAMINE THEIR MENTAL HEALTH 3687 02:40:15,400 --> 02:40:21,272 IMPACTS? 3688 02:40:21,272 --> 02:40:23,641 JUST BEFORE THE COVID PANDEMIC 3689 02:40:23,641 --> 02:40:24,275 BROKE IN 2020, EARLY 2020, THERE 3690 02:40:24,275 --> 02:40:30,281 WAS A MEETING CONVENED BY THE 3691 02:40:30,281 --> 02:40:37,989 ACADEMY OF MEDICAL SCIENCES AND 3692 02:40:37,989 --> 02:40:39,224 THE INTERACADEMY PARTNERSHIP ON 3693 02:40:39,224 --> 02:40:39,958 THE SOCIAL DETERMINANTS OF 3694 02:40:39,958 --> 02:40:41,025 MENTAL HEALTH. 3695 02:40:41,025 --> 02:40:42,060 WE MENTIONED LONDON IN 3696 02:40:42,060 --> 02:40:43,194 OCTOBER/NOVEMBER OF 2019. 3697 02:40:43,194 --> 02:40:44,362 AND THE TASK THAT WE PUT TO THE 3698 02:40:44,362 --> 02:40:45,697 GROUP WAS REPRESENTING AROUND 21 3699 02:40:45,697 --> 02:40:47,332 LOW AND MIDDLE-INCOME COUNTRIES 3700 02:40:47,332 --> 02:40:48,666 RECRUITED THROUGH THE ECONOMIES 3701 02:40:48,666 --> 02:40:49,567 OF SCIENCE AND NETWORKS. 3702 02:40:49,567 --> 02:40:50,735 IT WAS TO TRY TO COME UP WITH 3703 02:40:50,735 --> 02:40:51,536 IDEAS AROUND POTENTIAL 3704 02:40:51,536 --> 02:40:52,503 INTERVENTIONS AND WE USED THE 3705 02:40:52,503 --> 02:40:54,005 SAME FRAMEWORK. 3706 02:40:54,005 --> 02:40:55,139 WE USED THE FIVE DOMAINS, 3707 02:40:55,139 --> 02:40:56,741 DEMOGRAPHIC, ECONOMIC, 3708 02:40:56,741 --> 02:40:58,142 NEIGHBORHOOD, ENVIRONMENTAL 3709 02:40:58,142 --> 02:40:59,043 EVENTS AND SOCIAL AND CULTURAL 3710 02:40:59,043 --> 02:41:00,979 DOMAINS. 3711 02:41:00,979 --> 02:41:02,146 AND WE ASKED THE GROUP TO COME 3712 02:41:02,146 --> 02:41:03,281 UP WITH IDEAS AROUND FIRST OF 3713 02:41:03,281 --> 02:41:05,250 ALL, RESEARCH PRIORITIES FOR 3714 02:41:05,250 --> 02:41:06,918 EACH OF THESE DOMAINS, AND 3715 02:41:06,918 --> 02:41:07,986 PARTICULARLY WHAT ARE THE 3716 02:41:07,986 --> 02:41:10,355 POTENTIAL CANDIDATE 3717 02:41:10,355 --> 02:41:11,656 INTERVENTIONS BASED ON THE 3718 02:41:11,656 --> 02:41:13,057 EVIDENCE THAT WE CURRENTLY HAVE, 3719 02:41:13,057 --> 02:41:14,359 WHICH COULD HAVE A SUBSTANTIAL 3720 02:41:14,359 --> 02:41:18,963 POPULATION IMPACT. 3721 02:41:18,963 --> 02:41:20,331 AND THESE ARE SOME OF THE IDEAS 3722 02:41:20,331 --> 02:41:22,800 THAT THE GROUP CAME UP WITH. 3723 02:41:22,800 --> 02:41:24,168 IN THE DEMOGRAPHIC DOMAIN, 3724 02:41:24,168 --> 02:41:25,570 REDUCED GENDER-BASED VIOLENCE IS 3725 02:41:25,570 --> 02:41:28,239 AN OBVIOUS CANDIDATE. 3726 02:41:28,239 --> 02:41:29,674 REDUCED CHILD MILD TREATMENT IS 3727 02:41:29,674 --> 02:41:37,548 LONG HANGING FRUIT TO HAVE 3728 02:41:37,548 --> 02:41:38,182 SUBSTANTIAL POPULATION LEVEL 3729 02:41:38,182 --> 02:41:38,950 IMPACTS. 3730 02:41:38,950 --> 02:41:39,884 IN THE ECONOMIC DOMAIN, SOCIAL 3731 02:41:39,884 --> 02:41:40,618 PROTECTION PROGRAMS LIKE CASH 3732 02:41:40,618 --> 02:41:41,686 TRANSFERS. 3733 02:41:41,686 --> 02:41:42,654 IN THE NEIGHBORHOOD DOMAIN, 3734 02:41:42,654 --> 02:41:44,555 URBAN RENEWAL PROGRAMS. 3735 02:41:44,555 --> 02:41:45,456 IN THE ENVIRONMENTAL AND EVENTS 3736 02:41:45,456 --> 02:41:48,026 DOMAIN, IMPROVE DISASTER 3737 02:41:48,026 --> 02:41:50,595 RESPONSIVENESS AND MITIGATING 3738 02:41:50,595 --> 02:41:51,195 THE EFFECTS OF CLIMATE CHANGE 3739 02:41:51,195 --> 02:41:52,497 AND IN THE SOCIAL AND CULTURAL 3740 02:41:52,497 --> 02:41:54,098 DOMAIN, INTERVENTIONS THAT BUILD 3741 02:41:54,098 --> 02:41:56,100 SOCIAL CAPITAL AND TRUST AND 3742 02:41:56,100 --> 02:41:57,769 STRENGTHEN EDUCATION. 3743 02:41:57,769 --> 02:41:59,304 EDUCATION IS A MAJOR PREDICTOR 3744 02:41:59,304 --> 02:42:03,007 OF LIFELONG MENTAL HEALTH. 3745 02:42:03,007 --> 02:42:04,876 AND SO FAR THERE SEEMS TO BE 3746 02:42:04,876 --> 02:42:06,177 QUITE ENCOURAGING EVIDENCE THAT 3747 02:42:06,177 --> 02:42:07,445 SOME OF THESE INTERVENTIONS 3748 02:42:07,445 --> 02:42:07,979 REALLY DO WORK AND DO HAVE 3749 02:42:07,979 --> 02:42:11,282 MENTAL HEALTH BENEFITS. 3750 02:42:11,282 --> 02:42:16,587 IT WAS INTERESTING TO HEAR ESTER 3751 02:42:16,587 --> 02:42:20,825 SPEAKING ABOUT THIS EARLIER ON. 3752 02:42:20,825 --> 02:42:21,726 THIS IS A LARGE SYSTEMATIC 3753 02:42:21,726 --> 02:42:22,593 REVIEW OF META-ANALYSIS THAT WAS 3754 02:42:22,593 --> 02:42:23,594 PUBLISHED IN NATURE HUMAN 3755 02:42:23,594 --> 02:42:24,996 BEHAVIOR JUST A YEAR AGO BY JOHN 3756 02:42:24,996 --> 02:42:25,897 McGUIRE AND COLLEAGUES. 3757 02:42:25,897 --> 02:42:26,898 AND THEY SHOWED REALLY QUITE A 3758 02:42:26,898 --> 02:42:28,433 COMPELLING PICTURE THAT CASH 3759 02:42:28,433 --> 02:42:30,201 TRANSFERS IN LOW AND 3760 02:42:30,201 --> 02:42:32,737 MIDDLE-INCOME COUNTRIES HAD AN 3761 02:42:32,737 --> 02:42:36,307 EFFECT SIZE OF .13 ON SUBJECT 3762 02:42:36,307 --> 02:42:42,447 WELL-BEING OUTCOMES AND .07 ON 3763 02:42:42,447 --> 02:42:43,414 MENTAL HEALTH OUTCOMES. 3764 02:42:43,414 --> 02:42:44,349 SO THESE MAY NOT BE BIG EFFECT 3765 02:42:44,349 --> 02:42:45,183 SIZES THAT WE ARE THINKING ABOUT 3766 02:42:45,183 --> 02:42:45,950 CLINICAL TRIALS BUT IF WE THINK 3767 02:42:45,950 --> 02:42:50,355 ABOUT THE POTENTIAL FOR 3768 02:42:50,355 --> 02:42:51,689 POPULATION-LEVEL IMPACT, IT 3769 02:42:51,689 --> 02:42:52,390 REALLY IS MASSIVE. 3770 02:42:52,390 --> 02:42:53,257 AND THERE IS A LOT THAT COULD BE 3771 02:42:53,257 --> 02:42:54,058 DONE TO THINK ABOUT HOW THESE 3772 02:42:54,058 --> 02:42:55,193 COULD BE POTENTIATED TO TRY TO 3773 02:42:55,193 --> 02:42:57,829 IMPROVE MENTAL HEALTH OUTCOMES. 3774 02:42:57,829 --> 02:43:05,536 SO FAR SO GOOD. 3775 02:43:05,536 --> 02:43:06,337 WE KNOW A LOT ABOUT THE SOCIAL 3776 02:43:06,337 --> 02:43:07,271 AND ECONOMIC DRIVERS OF MENTAL 3777 02:43:07,271 --> 02:43:08,139 HEALTH. 3778 02:43:08,139 --> 02:43:09,240 WE THINK THERE IS SOMETHING WE 3779 02:43:09,240 --> 02:43:10,074 COULD POTENTIALLY BE DOING TO 3780 02:43:10,074 --> 02:43:11,442 DEVELOP INTERVENTIONS TO ADDRESS 3781 02:43:11,442 --> 02:43:12,410 THOSE SOCIAL DETERMINANTS. 3782 02:43:12,410 --> 02:43:13,745 BUT WHEN WE START TO THINK ABOUT 3783 02:43:13,745 --> 02:43:15,346 HOW WE COULD DESIGN AND EVALUATE 3784 02:43:15,346 --> 02:43:17,081 THESE INTERVENTIONS, SOME QUITE 3785 02:43:17,081 --> 02:43:19,650 MAJOR CHALLENGES EMERGE. 3786 02:43:19,650 --> 02:43:20,918 THE FIRST IS THAT THE 3787 02:43:20,918 --> 02:43:22,320 INTERVENTIONS THAT WE TRY TO 3788 02:43:22,320 --> 02:43:23,421 MOUNT ARE OFTEN QUITE DISTAL TO 3789 02:43:23,421 --> 02:43:27,024 THE MENTAL HEALTH OUTCOME. 3790 02:43:27,024 --> 02:43:29,394 IF WE WERE TO LAUNCH URBAN 3791 02:43:29,394 --> 02:43:30,895 RENEWAL PROGRAM TO IMPROVE 3792 02:43:30,895 --> 02:43:35,066 HOUSING IN INFORMAL SETTLEMENTS, 3793 02:43:35,066 --> 02:43:35,900 THERE ARE A NUMBER OF VARIABLES 3794 02:43:35,900 --> 02:43:36,801 MAY IMPACT ON THE OUTCOME AND 3795 02:43:36,801 --> 02:43:39,036 THAT WE HOPE TO ACHIEVE. 3796 02:43:39,036 --> 02:43:40,805 SECONDLY AND RELATED TO THIS, 3797 02:43:40,805 --> 02:43:42,607 THE MECHANISMS BY WHICH THESE 3798 02:43:42,607 --> 02:43:43,574 SOCIAL INTERVENTIONS INFLUENCE 3799 02:43:43,574 --> 02:43:44,809 MENTAL HEALTH ARE ALREADY POORLY 3800 02:43:44,809 --> 02:43:46,310 UNDERSTOOD. 3801 02:43:46,310 --> 02:43:47,812 WE DON'T REALLY KNOW HOW CASH 3802 02:43:47,812 --> 02:43:49,614 TRANSFERS GET INTO THE 3803 02:43:49,614 --> 02:43:50,982 NEUROPATHWAYS OF THE BRAIN TO 3804 02:43:50,982 --> 02:43:52,683 REDUCE DEPRESSION AND ANXIETY 3805 02:43:52,683 --> 02:43:55,820 AMONG PEOPLE. 3806 02:43:55,820 --> 02:43:57,989 THIRDLY, AND I'M GLAD SOMEONE 3807 02:43:57,989 --> 02:43:59,090 RAISED THIS IN THE PREVIOUS 3808 02:43:59,090 --> 02:43:59,424 SESSION. 3809 02:43:59,424 --> 02:44:00,992 THESE ARE OFTEN COMPLEX 3810 02:44:00,992 --> 02:44:01,626 POLITICAL AND STRUCTURAL 3811 02:44:01,626 --> 02:44:03,261 CHALLENGES. 3812 02:44:03,261 --> 02:44:05,062 IT'S OFTEN VERY DIFFICULT TO 3813 02:44:05,062 --> 02:44:08,566 BRING ABOUT SUBSTANTIAL CHANGES. 3814 02:44:08,566 --> 02:44:10,234 FOURTH, WE OFTEN WILL NEED 3815 02:44:10,234 --> 02:44:12,937 INTERDISCIPLINARY APPROACHES. 3816 02:44:12,937 --> 02:44:14,872 OFTEN WITHIN MENTAL HEALTH WE 3817 02:44:14,872 --> 02:44:16,607 WORK WITHIN OUR OWN SILOS. 3818 02:44:16,607 --> 02:44:22,213 IF WE WANT TO DESIGN EFFECTIVE 3819 02:44:22,213 --> 02:44:23,080 SOCIAL POLICY INTERVENTIONS WE 3820 02:44:23,080 --> 02:44:24,215 NEED TO WORK ACROSS A NUMBER OF 3821 02:44:24,215 --> 02:44:27,118 DIFFERENT SECTORS INCLUDING A 3822 02:44:27,118 --> 02:44:27,718 VERY PROACTIVE WAY AND LIVED 3823 02:44:27,718 --> 02:44:37,929 EXPERIENCE. 3824 02:44:39,630 --> 02:44:40,565 THE EVALUATION OF THE MENTAL 3825 02:44:40,565 --> 02:44:42,266 HEALTH OUTCOMES AND VALIDATION 3826 02:44:42,266 --> 02:44:44,602 OF MENTAL HEALTH OUTCOME 3827 02:44:44,602 --> 02:44:45,870 MEASURES HASN'T REALLY KEPT PACE 3828 02:44:45,870 --> 02:44:49,474 AND THERE IS A BIG GAP THERE. 3829 02:44:49,474 --> 02:44:51,676 THERE ARE REALLY IMPORTANT 3830 02:44:51,676 --> 02:44:52,844 CHALLENGES AROUND WHO GETS TO BE 3831 02:44:52,844 --> 02:44:55,146 IN THE CONTROL GROUP AND HOW DO 3832 02:44:55,146 --> 02:44:57,482 YOU DENY PEOPLE IN THE CONTROL 3833 02:44:57,482 --> 02:44:58,683 GROUP AND INTERVENTION WHERE 3834 02:44:58,683 --> 02:45:01,052 THERE IS A CLEAR NEED FOR THAT? 3835 02:45:01,052 --> 02:45:04,489 FOR EXAMPLE IN THE CASE OF CASH 3836 02:45:04,489 --> 02:45:07,058 TRANSFERS OR FOOD SECURITY 3837 02:45:07,058 --> 02:45:07,391 INTERVENTIONS. 3838 02:45:07,391 --> 02:45:09,460 AND FINALLY, THIS FIELD REALLY 3839 02:45:09,460 --> 02:45:12,363 PRESENTS A NUMBER OF NEW 3840 02:45:12,363 --> 02:45:13,498 CHALLENGES TO RESEARCH FUNDERS. 3841 02:45:13,498 --> 02:45:15,666 IT REQUIRES FUNDERS TO GET OUT 3842 02:45:15,666 --> 02:45:17,668 OF THEIR DISCIPLINARY SILOS TO 3843 02:45:17,668 --> 02:45:19,871 THINK IN A MUCH MORE 3844 02:45:19,871 --> 02:45:22,006 INTERDISCIPLINARY WAY AND TO 3845 02:45:22,006 --> 02:45:23,608 CONVENE INTERDISCIPLINARY REVIEW 3846 02:45:23,608 --> 02:45:28,212 PANELS TO BE ABLE TO ASSIST 3847 02:45:28,212 --> 02:45:30,515 FUNDING APPLICATIONS. 3848 02:45:30,515 --> 02:45:31,616 HAVING SAID ALL OF THAT, I THINK 3849 02:45:31,616 --> 02:45:33,150 THERE ARE A NUMBER OF QUITE 3850 02:45:33,150 --> 02:45:34,619 EXCITING POTENTIAL APPROACHES, 3851 02:45:34,619 --> 02:45:38,122 AND I WANT TO RUN YOU THROUGH 3852 02:45:38,122 --> 02:45:39,023 SOME INITIAL IDEAS. 3853 02:45:39,023 --> 02:45:40,525 I PUT THESE TOGETHER IN A PAPER 3854 02:45:40,525 --> 02:45:43,027 WHICH WE JUST RECENTLY PUBLISHED 3855 02:45:43,027 --> 02:45:44,262 IN BEHAVIORAL RESEARCH THERAPY. 3856 02:45:44,262 --> 02:45:46,397 IF YOU WANT TO READ MORE, PLEASE 3857 02:45:46,397 --> 02:45:48,032 HAVE A LOOK AT THAT PAPER AND I 3858 02:45:48,032 --> 02:45:49,567 WOULD BE INTERESTED TO HEAR YOUR 3859 02:45:49,567 --> 02:45:49,834 THOUGHTS. 3860 02:45:49,834 --> 02:45:51,802 I THINK THE FIRST STEP IS TO TRY 3861 02:45:51,802 --> 02:45:53,704 AND BUILD MORE ROBUST 3862 02:45:53,704 --> 02:45:55,606 THEORETICAL MODELS OF HOW WE 3863 02:45:55,606 --> 02:45:56,807 THINK PARTICULAR SOCIAL AND 3864 02:45:56,807 --> 02:45:58,809 ECONOMIC ADVERSITIES LEAD TO 3865 02:45:58,809 --> 02:45:59,610 PARTICULAR MENTAL HEALTH 3866 02:45:59,610 --> 02:45:59,877 OUTCOMES. 3867 02:45:59,877 --> 02:46:03,614 AND TO REALLY TRY AND DEVELOP 3868 02:46:03,614 --> 02:46:06,517 VERY CLEARLY IDENTIFIED CAUSAL 3869 02:46:06,517 --> 02:46:06,817 MECHANISMS. 3870 02:46:06,817 --> 02:46:08,719 THE SECOND STEP IS THEN TO TEST 3871 02:46:08,719 --> 02:46:10,821 THESE SPECIFIC MECHANISMS IN 3872 02:46:10,821 --> 02:46:12,823 THESE HYPOTHESIZED CAUSAL 3873 02:46:12,823 --> 02:46:15,526 PATHWAYS AND TO INCLUDE THESE 3874 02:46:15,526 --> 02:46:17,061 MEDIATION ANALYSIS IN THE DESIGN 3875 02:46:17,061 --> 02:46:17,728 OF OUR TRIALS. 3876 02:46:17,728 --> 02:46:20,431 AND THE THIRD IS TO POOL DATA 3877 02:46:20,431 --> 02:46:22,767 ACROSS MULTIPLE SITES BECAUSE 3878 02:46:22,767 --> 02:46:23,701 CONTEXT REALLY MATTERS AND HAS 3879 02:46:23,701 --> 02:46:26,037 HUGE IMPACT ON THESE KINDS OF 3880 02:46:26,037 --> 02:46:27,204 INTERVENTIONS ON HOW WE DELIVER 3881 02:46:27,204 --> 02:46:30,808 THEM AND MEASURE THEIR IMPACTS. 3882 02:46:30,808 --> 02:46:36,086 SO LET ME TRY TO UNPACK THIS A 3883 02:46:36,086 --> 02:46:37,688 THE CURRENT PROJECT I'M GOING TL 3884 02:46:37,688 --> 02:46:41,091 YOU MORE ABOUT IN A MOMENT. 3885 02:46:41,091 --> 02:46:42,693 THIS IS ABOUT THE LINKS BETWEEN 3886 02:46:42,693 --> 02:46:48,899 POVERTY AND SELF-REGULATION. 3887 02:46:48,899 --> 02:46:50,000 SO ELIAS AND HANSON GO THROUGH A 3888 02:46:50,000 --> 02:46:52,769 PROCESS OF REVIEWING THE LITERAE 3889 02:46:52,769 --> 02:46:55,572 IN SELF-REGULATION, INCLUDING 3890 02:46:55,572 --> 02:46:58,108 REACTIONIVE SIGNALS AND SAILIANT 3891 02:46:58,108 --> 02:46:59,877 EVALUATION, INTERPRETATION, STIS 3892 02:46:59,877 --> 02:47:02,412 GENERALIZATION AND CONTEXTURAL 3893 02:47:02,412 --> 02:47:04,815 PROCESSING AS WELL AS MORE TOP-N 3894 02:47:04,815 --> 02:47:06,683 ELEMENTS OF CONTROL FOR EXAMPLE 3895 02:47:06,683 --> 02:47:09,486 DECISION-MAKING, EMOTIONAL REGUN 3896 02:47:09,486 --> 02:47:11,321 AND EXECUTIVE ATTENTION. 3897 02:47:11,321 --> 02:47:13,090 AND THEN MAP SOME OF THE 3898 02:47:13,090 --> 02:47:14,691 NEUROCORRELATES OF THESE PATHWAD 3899 02:47:14,691 --> 02:47:17,294 ALSO MAPPED THE WAY IN WHICH THE 3900 02:47:17,294 --> 02:47:19,796 DIFFERENT TOP-DOWN AND BOTTOM-UP 3901 02:47:19,796 --> 02:47:21,899 MECHANISMS ARE IMPACTED BY POVEY 3902 02:47:21,899 --> 02:47:25,202 AND IN TURN HOW THEY PREDICT VAS 3903 02:47:25,202 --> 02:47:29,306 FORMS OF PSYCHOPATHOLOGY. 3904 02:47:29,306 --> 02:47:30,807 THIS IS HELPFUL FOR US TO THINKT 3905 02:47:30,807 --> 02:47:33,010 HOW TO TEST THESE MECHANISMS. 3906 02:47:33,010 --> 02:47:36,213 SO IF FOR EXAMPLE, WE WERE TO DN 3907 02:47:36,213 --> 02:47:38,115 AN INTERVENTION TO DELIVER CASH 3908 02:47:38,115 --> 02:47:40,217 TRANSFERS FOR REFUGEE YOUTH, ANE 3909 02:47:40,217 --> 02:47:42,686 WANTED TO ACHIEVE AN OUTCOME OF 3910 02:47:42,686 --> 02:47:45,722 PREVENTING DEPRESSION, WE COULD 3911 02:47:45,722 --> 02:47:46,990 POTENTIALLY HYPOTHESIZED THAT 3912 02:47:46,990 --> 02:47:49,092 NEUROPSYCHOLOGICAL MECHANISMS OF 3913 02:47:49,092 --> 02:47:51,428 SELF-REGULATION ARE LYING ALONGS 3914 02:47:51,428 --> 02:47:52,296 CAUSAL PATHWAY. 3915 02:47:52,296 --> 02:47:55,832 BUT IF WE REALLY WANTED TO TEST 3916 02:47:55,832 --> 02:47:57,000 WHETHER THERE ARE INVOLVED 3917 02:47:57,000 --> 02:47:58,035 MECHANISTICALLY, WE NEED TO INCE 3918 02:47:58,035 --> 02:48:00,804 THIS KIND OF MEDIATION ANALYSISN 3919 02:48:00,804 --> 02:48:03,140 THE TRIALS THAT WE CONDUCT. 3920 02:48:03,140 --> 02:48:05,475 FOR EXAMPLE, IN SOME OF THESE PS 3921 02:48:05,475 --> 02:48:07,911 COME FROM WORK THAT WAS DONE ON 3922 02:48:07,911 --> 02:48:08,412 PSYCHOTHERAPY TRIALS. 3923 02:48:08,412 --> 02:48:10,714 WE NEED TO FIRST OF ALL HAVE A 3924 02:48:10,714 --> 02:48:12,616 TEMPORAL RELATIONSHIP BETWEEN TE 3925 02:48:12,616 --> 02:48:13,817 MEDIATOR AND THE OUTCOME AND BEN 3926 02:48:13,817 --> 02:48:16,887 THE EXPOSURE AND THE MEDIATOR. 3927 02:48:16,887 --> 02:48:18,922 THERE NEEDS TO BE A CLEAR DOSE 3928 02:48:18,922 --> 02:48:20,190 RESPONSE ASSOCIATION BETWEEN THE 3929 02:48:20,190 --> 02:48:22,392 MEDIATOR AND THE OUTCOME THAT WE 3930 02:48:22,392 --> 02:48:22,793 MEASURING. 3931 02:48:22,793 --> 02:48:25,495 WE NEED TO CONTROL FOR THIRD 3932 02:48:25,495 --> 02:48:26,597 VARIABLES IN THE RELATIONSHIP BH 3933 02:48:26,597 --> 02:48:28,999 BETWEEN THE INTERVENTION AND THE 3934 02:48:28,999 --> 02:48:30,600 MEDIATOR AND IN TURN BETWEEN THE 3935 02:48:30,600 --> 02:48:31,635 MEDIATOR AND THE OUTCOME. 3936 02:48:31,635 --> 02:48:33,437 AND WE NEED TO HAVE ROBUST 3937 02:48:33,437 --> 02:48:34,204 EXPERIMENTAL DESIGNS. 3938 02:48:34,204 --> 02:48:35,906 WE NEED TO BE ADEQUATELY POWEREO 3939 02:48:35,906 --> 02:48:38,408 BE ABLE TO MEASURE THESE EFFECTD 3940 02:48:38,408 --> 02:48:40,610 FINALLY, WE NEED TO HAVE A STROG 3941 02:48:40,610 --> 02:48:42,212 THEORETICAL FRAMEWORK WHICH UNDS 3942 02:48:42,212 --> 02:48:43,480 ALL OF THIS. 3943 02:48:43,480 --> 02:48:45,415 SO THIS GIVES US SOME POTENTIALS 3944 02:48:45,415 --> 02:48:48,418 ABOUT WHERE WE CAN DEVELOP TARGO 3945 02:48:48,418 --> 02:48:50,087 STRENGTHEN THE IMPACTS OF 3946 02:48:50,087 --> 02:48:52,289 INTERVENTIONS THAT ARE ADDRESSED 3947 02:48:52,289 --> 02:48:55,325 UPSTREAM SOCIAL AND ECONOMIC 3948 02:48:55,325 --> 02:48:55,659 DETERMINANTS. 3949 02:48:55,659 --> 02:48:56,927 AND THEN OF COURSE IT'S REALLY 3950 02:48:56,927 --> 02:48:59,296 IMPORTANT THAT WE POOL AND SHARA 3951 02:48:59,296 --> 02:49:00,397 AS FAR AS POSSIBLE. 3952 02:49:00,397 --> 02:49:03,500 IT REQUIRES A HIGH LEVEL OF CONS 3953 02:49:03,500 --> 02:49:06,603 BETWEEN RESEARCH GROUPS ON PLAUE 3954 02:49:06,603 --> 02:49:07,704 PATHWAYS AND MEASURES. 3955 02:49:07,704 --> 02:49:10,540 REALLY INSPIRING TO HEAR ESTER 3956 02:49:10,540 --> 02:49:11,375 SPEAKING ABOUT THE NETWORK. 3957 02:49:11,375 --> 02:49:14,711 I THINK THERE IS ENORMOUS POTENL 3958 02:49:14,711 --> 02:49:17,014 FOR US TO DEVELOP NETWORKS WITHR 3959 02:49:17,014 --> 02:49:18,115 GLOBAL MENTAL HEALTH GROUPS AROD 3960 02:49:18,115 --> 02:49:20,417 POOLING DATA ON INTERVENTIONS TO 3961 02:49:20,417 --> 02:49:22,219 ADDRESS SOCIAL DETERMINANTS. 3962 02:49:22,219 --> 02:49:23,820 AND THE THIS MEANS ALSO A HIGH L 3963 02:49:23,820 --> 02:49:27,324 OF COOPERATION ACROSS SCIENCE 3964 02:49:27,324 --> 02:49:27,691 INTERNATIONALLY. 3965 02:49:27,691 --> 02:49:30,894 CONTEXT REALLY MATTERS AND 3966 02:49:30,894 --> 02:49:33,430 INTERDISCIPLINARY IS REALLY 3967 02:49:33,430 --> 02:49:33,697 IMPORTANT. 3968 02:49:33,697 --> 02:49:35,432 THIS THEN RAISES THE QUESTION, H 3969 02:49:35,432 --> 02:49:37,000 SOCIAL DETERMINANTS SHOULD I TAT 3970 02:49:37,000 --> 02:49:40,804 IF I'M THINKING ABOUT THE WHOLE 3971 02:49:40,804 --> 02:49:42,906 PLETHORA OF POTENTIAL TARGET 3972 02:49:42,906 --> 02:49:43,240 INTERVENTIONS? 3973 02:49:43,240 --> 02:49:46,243 HERE ARE SOME POTENTIAL CRITERIR 3974 02:49:46,243 --> 02:49:46,576 CONSIDERATION. 3975 02:49:46,576 --> 02:49:47,411 FIRST OF ALL IT'S REALLY IMPORTT 3976 02:49:47,411 --> 02:49:49,212 THAT THERE IS A PLAUSIBLE MECHA. 3977 02:49:49,212 --> 02:49:50,947 WE NEED TO BE ABLE TO HAVE A ROT 3978 02:49:50,947 --> 02:49:53,483 CASE FOR WHY WE THINK A PARTICUR 3979 02:49:53,483 --> 02:49:55,318 INTERVENTION MIGHT YIELD A PARTR 3980 02:49:55,318 --> 02:49:57,320 MENTAL HEALTH OUTCOME. 3981 02:49:57,320 --> 02:49:59,322 SECONDLY, IT NEEDS TO BE FEASIBO 3982 02:49:59,322 --> 02:50:01,825 INTERVENE AND WE NEED GOOD COMMY 3983 02:50:01,825 --> 02:50:03,627 PARTICIPATION AND BUY IN FROM PY 3984 02:50:03,627 --> 02:50:06,730 STAKEHOLDERS TO MAKE THAT POSSI. 3985 02:50:06,730 --> 02:50:08,632 THIRD THERE SHOULD BE A MEASURAE 3986 02:50:08,632 --> 02:50:10,934 OUTCOME AND THE OUTCOME SHOULD E 3987 02:50:10,934 --> 02:50:13,336 VALID, CULTURALLY VALID AND REL. 3988 02:50:13,336 --> 02:50:15,238 AND THERE NEEDS TO BE THE POTENL 3989 02:50:15,238 --> 02:50:18,642 FOR SUBSTANTIAL POPULATION IMPA. 3990 02:50:18,642 --> 02:50:21,244 OUR FINDINGS SHOULD BE GENERALIE 3991 02:50:21,244 --> 02:50:24,247 AND SUSTAINABLE. 3992 02:50:24,247 --> 02:50:25,916 I WANT TO SHARE WITH YOU A COUPF 3993 02:50:25,916 --> 02:50:28,552 EXAMPLES OF STUDIES WE ARE INVOD 3994 02:50:28,552 --> 02:50:31,121 IN AT THE MOMENT WHICH I HOPE WL 3995 02:50:31,121 --> 02:50:33,457 ILLUSTRATE SOME OF THESE POTENTL 3996 02:50:33,457 --> 02:50:34,224 APPROACHES. 3997 02:50:34,224 --> 02:50:36,226 THE FIRST IS THE CHANCE OF 6 ST. 3998 02:50:36,226 --> 02:50:39,663 THIS IS LED BY SARAH EVANS VAS T 3999 02:50:39,663 --> 02:50:40,964 THE LONDON SCHOOL OF ECONOMICS. 4000 02:50:40,964 --> 02:50:42,332 AND WE HAVE BEEN EXPLORING THE 4001 02:50:42,332 --> 02:50:44,134 EFFECTS OF CASH TRANSFERS ON MEL 4002 02:50:44,134 --> 02:50:46,937 HEALTH AND LIFE CHANCES OF YOUNG 4003 02:50:46,937 --> 02:50:49,339 PEOPLE IN SIX LOW AND MIDDLE-INE 4004 02:50:49,339 --> 02:50:49,606 COUNTRIES. 4005 02:50:49,606 --> 02:50:53,510 SO BRAZIL, COLUMBIA, MEXICO, LI, 4006 02:50:53,510 --> 02:50:56,947 MALAWI AND SOUTH AFRICA. 4007 02:50:56,947 --> 02:50:59,382 AND WE ARE USING EXISTING COHORT 4008 02:50:59,382 --> 02:50:59,683 DATASETS. 4009 02:50:59,683 --> 02:51:02,185 NOT ALL ARE RANDOMIZED CONTROL 4010 02:51:02,185 --> 02:51:02,452 TRIALS. 4011 02:51:02,452 --> 02:51:05,355 WE TRIED TO USE OTHER METHODS LE 4012 02:51:05,355 --> 02:51:07,891 INSTRUMENTAL VARIABLE ANALYSIS D 4013 02:51:07,891 --> 02:51:09,159 REGRESSION CONTINUOUS DESIGNS TY 4014 02:51:09,159 --> 02:51:10,694 TO CONTROL FOR CONFOUNDING. 4015 02:51:10,694 --> 02:51:13,764 AND OUR APPROACH WAS TO REALLY A 4016 02:51:13,764 --> 02:51:15,766 COMBINATION OF QUALITATIVE WORKE 4017 02:51:15,766 --> 02:51:19,069 CONDUCTED INTERVIEWS AND FOCUS P 4018 02:51:19,069 --> 02:51:21,872 DISCUSSIONS WITH YOUNG PEOPLE, H 4019 02:51:21,872 --> 02:51:23,874 FAMILIES IN RECEIPT OF CASH TRAR 4020 02:51:23,874 --> 02:51:25,675 PROGRAMS, WITH PROFESSIONALS IND 4021 02:51:25,675 --> 02:51:28,745 IN ADMINISTERING THESE CASH TRAR 4022 02:51:28,745 --> 02:51:29,112 PROGRAMS. 4023 02:51:29,112 --> 02:51:31,381 WE DID QUANTITATIVE ANALYSIS ASI 4024 02:51:31,381 --> 02:51:34,084 MENTIONED, OF EXISTING LONGITUDL 4025 02:51:34,084 --> 02:51:34,351 DATASETS. 4026 02:51:34,351 --> 02:51:36,386 AND WE CONDUCTED STAKEHOLDER 4027 02:51:36,386 --> 02:51:38,755 WORKSHOPS WITH POLICYMAKERS IN E 4028 02:51:38,755 --> 02:51:40,223 OF THE COUNTRIES TO GET A SENSEF 4029 02:51:40,223 --> 02:51:42,893 SOME OF THE POLICY OPTIONS AND E 4030 02:51:42,893 --> 02:51:44,995 APPETITE FOR ASSESSING MENTAL HH 4031 02:51:44,995 --> 02:51:46,863 OUTCOMES OF CASH TRANSFER PROGRS 4032 02:51:46,863 --> 02:51:48,365 AND WHETHER THESE COULD BE ENHAD 4033 02:51:48,365 --> 02:51:50,967 IN SOME WAY. 4034 02:51:50,967 --> 02:51:52,769 AND THE WORK IS ONGOING. 4035 02:51:52,769 --> 02:51:54,871 WE HAVEN'T PUBLISHED ALL THE FIS 4036 02:51:54,871 --> 02:51:55,071 YET. 4037 02:51:55,071 --> 02:51:57,174 WHAT WE TRIED TO DO IS IDENTIFYE 4038 02:51:57,174 --> 02:51:58,975 POTENTIAL MECHANISMS BY WHICH CH 4039 02:51:58,975 --> 02:52:00,877 TRANSFERS AS FAR AS THESE PROGRS 4040 02:52:00,877 --> 02:52:02,579 ARE CONCERNED, YIELD MENTAL HEAH 4041 02:52:02,579 --> 02:52:04,981 OUTCOMES AND HOW THE EFFECTS OFE 4042 02:52:04,981 --> 02:52:08,185 CASH TRANSFER PROGRAMS COULD BE 4043 02:52:08,185 --> 02:52:10,187 POTENTIATED TO IMPROVE THE MENTL 4044 02:52:10,187 --> 02:52:12,088 HEALTH AND LIFE CHANCES OF YOUNG 4045 02:52:12,088 --> 02:52:15,091 PEOPLE IN THESE SETTINGS. 4046 02:52:15,091 --> 02:52:16,359 THE SECOND EXAMPLE I WANT TO THE 4047 02:52:16,359 --> 02:52:19,296 SHARE WITH IS A WELCOME TRUST FD 4048 02:52:19,296 --> 02:52:22,065 COLLABORATIVE AWARD, CALLED ALI. 4049 02:52:22,065 --> 02:52:23,967 IMPROVING ADOLESCENT MENTAL HEAY 4050 02:52:23,967 --> 02:52:26,102 REDUCING THE IMPACT OF POVERTY. 4051 02:52:26,102 --> 02:52:28,638 AND WE ARE WORKING IN COLUMBIA D 4052 02:52:28,638 --> 02:52:31,107 SOUTH AFRICA AND IN NEPAL. 4053 02:52:31,107 --> 02:52:34,044 AND WE CONCENTRATING IN CIRCUMSS 4054 02:52:34,044 --> 02:52:35,178 OF URBAN POVERTY. 4055 02:52:35,178 --> 02:52:38,048 SO WORKING IN BOGOTA AND COLUMB, 4056 02:52:38,048 --> 02:52:40,884 CAPETOWN IN SOUTH AFRICA AND 4057 02:52:40,884 --> 02:52:42,986 KATHMANDU IN NEPAL. 4058 02:52:42,986 --> 02:52:44,888 MARK JORDANS IS CO-PI OF THIS PT 4059 02:52:44,888 --> 02:52:46,690 TOGETHER WITH MYSELF. 4060 02:52:46,690 --> 02:52:49,392 AND OUR MAIN HYPOTHESIS IS 4061 02:52:49,392 --> 02:52:51,361 MULTIDIMENSIONAL POVERTY INCREAS 4062 02:52:51,361 --> 02:52:55,332 THE INCIDENCE OF DEPRESSION AND 4063 02:52:55,332 --> 02:52:57,000 ANXIETY AMONG ADOLESCENTS DIRECY 4064 02:52:57,000 --> 02:53:00,203 AND MEDIATED THROUGH SELF-REGUL. 4065 02:53:00,203 --> 02:53:03,206 AND BY SELF-REGULATION, WE MEANE 4066 02:53:03,206 --> 02:53:07,110 CAPACITY TO SET GOALS AND TO MAN 4067 02:53:07,110 --> 02:53:09,713 GOAL-DIRECTED BEHAVIOR DESPITE 4068 02:53:09,713 --> 02:53:11,014 EMOTIONALLY SALIENT AND CHALLENG 4069 02:53:11,014 --> 02:53:11,314 ENVIRONMENT. 4070 02:53:11,314 --> 02:53:13,216 SO WE DESIGNED AN INTERVENTION H 4071 02:53:13,216 --> 02:53:15,919 HAS AN ANTIPOVERTY COMPONENT TOR 4072 02:53:15,919 --> 02:53:17,687 WITH INTERVENTION WHICH HAS A 4073 02:53:17,687 --> 02:53:19,522 COMPONENT TO STRENGTHEN 4074 02:53:19,522 --> 02:53:22,325 SELF-REGULATION SKILLS AMONG 4075 02:53:22,325 --> 02:53:24,361 ADOLESCENTS. 4076 02:53:24,361 --> 02:53:26,296 AND THIS IS A ROUGH ILLUSTRATIOF 4077 02:53:26,296 --> 02:53:27,397 THE OVERALL STUDY DESIGN. 4078 02:53:27,397 --> 02:53:29,299 SO IMPORTANTLY HOOTS A PILOT 4079 02:53:29,299 --> 02:53:30,000 RANDOMIZED CONTROL TRIAL. 4080 02:53:30,000 --> 02:53:31,601 WE ARE NOT GOING TO BE ADEQUATEY 4081 02:53:31,601 --> 02:53:34,604 POWERED TO ASSIST THE IMPACT OFE 4082 02:53:34,604 --> 02:53:34,938 INTERVENTION. 4083 02:53:34,938 --> 02:53:38,642 THERE ARE ONLY 240 ADOLESCENTS N 4084 02:53:38,642 --> 02:53:39,142 EACH COUNTRY. 4085 02:53:39,142 --> 02:53:41,511 THE IDEA IS TO TEST THE FEASIBIY 4086 02:53:41,511 --> 02:53:43,813 AND ACCEPTABILITY OF THE INTERVN 4087 02:53:43,813 --> 02:53:46,349 AND THE FEASIBILITY AND ACCESSIY 4088 02:53:46,349 --> 02:53:48,218 OF THE INSTRUMENTATION WITH A VO 4089 02:53:48,218 --> 02:53:50,920 APPLY FOR A FULLY-POWERED RANDOD 4090 02:53:50,920 --> 02:53:51,521 CONTROL TRIAL. 4091 02:53:51,521 --> 02:53:53,723 SO LET ME JUST SEE IF I CAN WALU 4092 02:53:53,723 --> 02:53:55,692 THROUGH THE DESIGN HERE. 4093 02:53:55,692 --> 02:53:58,595 FROM LEFT TO RIGHT, WE ARE ASSEG 4094 02:53:58,595 --> 02:54:00,563 ADOLESCENTS FOR INCLUSION BASEDN 4095 02:54:00,563 --> 02:54:03,133 FIRST OF ALL, LIVING IN CIRCUMSS 4096 02:54:03,133 --> 02:54:05,201 OF MULTIDIMENSIONAL POVERTY IN H 4097 02:54:05,201 --> 02:54:06,403 OF THE THREE COUNTRIES. 4098 02:54:06,403 --> 02:54:10,540 AND SECONDLY, SCORING HIGH RISKN 4099 02:54:10,540 --> 02:54:13,310 THE IDEA RISK SCORE WHICH IS A 4100 02:54:13,310 --> 02:54:15,812 COMPOSITE RISK INDEX TO IDENTIFK 4101 02:54:15,812 --> 02:54:19,215 FOR DEPRESSION IN ADOLESCENTS. 4102 02:54:19,215 --> 02:54:22,419 WE WILL EXCLUDE ADOLESCENTS WHOE 4103 02:54:22,419 --> 02:54:25,555 ABOVE CATEGORICAL THRESHOLD ON E 4104 02:54:25,555 --> 02:54:27,223 PHQA OR GAD 7, IN OTHER WORDS TE 4105 02:54:27,223 --> 02:54:29,726 WHO ARE DEPRESSED OR ANXIOUS AT 4106 02:54:29,726 --> 02:54:30,994 BASELINE WILL BE EXCLUDED BECAUE 4107 02:54:30,994 --> 02:54:32,395 ARE INTERESTED IN INCIDENTS. 4108 02:54:32,395 --> 02:54:34,731 WE WANT TO MEASURE THE NUMBER OW 4109 02:54:34,731 --> 02:54:35,732 CASES OVER TIME. 4110 02:54:35,732 --> 02:54:37,934 AND WE ALSO EXCLUDE ADOLESCENTSO 4111 02:54:37,934 --> 02:54:38,835 ARE LOW RISK. 4112 02:54:38,835 --> 02:54:41,338 SO THE ONES WE ARE INTERESTED IE 4113 02:54:41,338 --> 02:54:43,707 THE GREEN FIGURES AND THEN WE WL 4114 02:54:43,707 --> 02:54:46,409 RANDOMIZE THEM TO ONE OF FOUR AS 4115 02:54:46,409 --> 02:54:50,447 AND IT'S A CLUSTER TRIAL SO THE 4116 02:54:50,447 --> 02:54:51,614 RANDOMIZATION IS SCHOOLS. 4117 02:54:51,614 --> 02:54:54,718 THE FIRST ARM WILL RECEIVE AN 4118 02:54:54,718 --> 02:54:56,219 ANTIPOVERTY INTERVENTION WHICH 4119 02:54:56,219 --> 02:54:57,320 INCLUDES CASH TRANSFERS, TWO-THS 4120 02:54:57,320 --> 02:54:59,522 OF WHICH WILL GO TO THE HOUSEHOD 4121 02:54:59,522 --> 02:55:02,125 1/3 OF WHICH WILL GO TO THE 4122 02:55:02,125 --> 02:55:03,426 ADOLESCENT THEMSELVES. 4123 02:55:03,426 --> 02:55:05,328 AND TOGETHER WITH THE CASH TRANS 4124 02:55:05,328 --> 02:55:10,734 WE ARE PROVIDING FINANCIAL EDUC, 4125 02:55:10,734 --> 02:55:13,136 INFORMATION ON NEGOTIATION SKILD 4126 02:55:13,136 --> 02:55:14,804 ALSO INFORMATION ON YOUR EARNINF 4127 02:55:14,804 --> 02:55:16,639 YOU STAY IN SCHOOL FOR LONGER 4128 02:55:16,639 --> 02:55:18,508 COMPARED TO IF YOU DROP OUT EAR. 4129 02:55:18,508 --> 02:55:21,811 SO THAT'S THE ANTIPOVERTY 4130 02:55:21,811 --> 02:55:22,145 INTERVENTION. 4131 02:55:22,145 --> 02:55:24,080 THE SECOND ARM IS A SELF-REGULAN 4132 02:55:24,080 --> 02:55:26,316 INTERVENTION WHICH IS A GROUP-BD 4133 02:55:26,316 --> 02:55:26,649 INTERVENTION. 4134 02:55:26,649 --> 02:55:29,853 ALL INTERVENTIONS ARE GROUP-BAS. 4135 02:55:29,853 --> 02:55:31,755 AND IT'S FACILITATED BY A YOUTH 4136 02:55:31,755 --> 02:55:33,890 COACH, SOMEONE BETWEEN THE AGE 8 4137 02:55:33,890 --> 02:55:35,125 AND 30 FROM THE SAME COMMUNITY T 4138 02:55:35,125 --> 02:55:37,627 THE ADOLESCENTS ARE LIVING IN. 4139 02:55:37,627 --> 02:55:40,330 IT STARTS WITH REALLY TRYING TOD 4140 02:55:40,330 --> 02:55:42,232 A CULTURE OF TRUST WITHIN THE G. 4141 02:55:42,232 --> 02:55:45,034 THE GROUPS ARE AROUND 15 ADOLESS 4142 02:55:45,034 --> 02:55:45,235 EACH. 4143 02:55:45,235 --> 02:55:47,537 AND THEN BASED ON EXPERIENCES OF 4144 02:55:47,537 --> 02:55:50,340 BUILDING TRUST AND DEVELOPING SL 4145 02:55:50,340 --> 02:55:52,042 COMMUNICATION SKILLS, WE ARE 4146 02:55:52,042 --> 02:55:54,844 INCLUDING SKILLS AROUND EMOTIONL 4147 02:55:54,844 --> 02:55:58,148 REGULATION AND PROBLEM-SOLVING. 4148 02:55:58,148 --> 02:56:00,050 AND THEN THE THIRD ARM IS TO COE 4149 02:56:00,050 --> 02:56:02,185 THE ANTIPOVERTY AND THE 4150 02:56:02,185 --> 02:56:03,920 SELF-REGULATION INTERVENTIONS. 4151 02:56:03,920 --> 02:56:06,256 AND THE FOURTH ARM IS A CONTROL. 4152 02:56:06,256 --> 02:56:09,426 SO AS I MENTIONED, PRIMARY OUTCS 4153 02:56:09,426 --> 02:56:11,861 THE INCIDENTS OF DEPRESSION OR 4154 02:56:11,861 --> 02:56:14,564 ANXIETY ACROSS THE STUDY ARMS AI 4155 02:56:14,564 --> 02:56:18,068 JUST WANTED TO GIVE YOU A SENSEF 4156 02:56:18,068 --> 02:56:19,569 THE MEASURES WE ARE USING BECAUT 4157 02:56:19,569 --> 02:56:22,472 GOES BACK TO MY POINT EARLIER AT 4158 02:56:22,472 --> 02:56:22,872 MEDIATORS. 4159 02:56:22,872 --> 02:56:24,374 THE PRIMARY OUTCOMES ARE DEPRESN 4160 02:56:24,374 --> 02:56:26,576 AND ANXIETY. 4161 02:56:26,576 --> 02:56:30,580 BUT WE'VE DEVELOPED A WHOLE LOTF 4162 02:56:30,580 --> 02:56:33,483 MEDIATOR MEASURES OR ADAPTED TH, 4163 02:56:33,483 --> 02:56:34,684 INCLUDING THE WHO THAT? 4164 02:56:34,684 --> 02:56:36,786 THE DIFFICULT IN EMOTION REGULAN 4165 02:56:36,786 --> 02:56:39,088 SCALE SHORT FORM, CHILD HOPE SC, 4166 02:56:39,088 --> 02:56:41,758 AND THEN SOME NEUROPSYCHOLOGICAL 4167 02:56:41,758 --> 02:56:42,192 TESTS. 4168 02:56:42,192 --> 02:56:47,664 THE BALLOON ANALOGUE RISK TAKING 4169 02:56:47,664 --> 02:56:51,868 TASK, THE EMOTION GO-NO-GO, ANDY 4170 02:56:51,868 --> 02:56:53,703 GRATIFICATION TASK. 4171 02:56:53,703 --> 02:56:55,572 WE ARE ALSO MEASURING HEART RATE 4172 02:56:55,572 --> 02:56:56,973 VARIABILITY AS A BIOMARKER. 4173 02:56:56,973 --> 02:56:59,075 AND THEN THERE ARE A NUMBER OF 4174 02:56:59,075 --> 02:57:00,877 SECONDARY OUTCOMES RELATED TO SP 4175 02:57:00,877 --> 02:57:02,879 AND SOCIAL AND ECONOMIC OUTCOMER 4176 02:57:02,879 --> 02:57:06,483 THE CHILDREN AND FOR THEIR PARE. 4177 02:57:06,483 --> 02:57:08,785 AND THIS IS THE WONDERFUL ALIVE. 4178 02:57:08,785 --> 02:57:10,753 THIS THE IS OUR MOST RECENT ANNL 4179 02:57:10,753 --> 02:57:13,289 MEETING IN BOGOTA IN MARCH OF TS 4180 02:57:13,289 --> 02:57:14,757 YEAR. 4181 02:57:14,757 --> 02:57:16,192 VERY MUCH ALIVE. 4182 02:57:16,192 --> 02:57:17,861 AND IT'S JUST -- THE OTHER REALY 4183 02:57:17,861 --> 02:57:19,195 EXCITING THING ABOUT THIS PROJES 4184 02:57:19,195 --> 02:57:21,998 BEEN THE VERY ACTIVE INVOLVEMENF 4185 02:57:21,998 --> 02:57:22,765 ADOLESCENTS IN THE PROCESS. 4186 02:57:22,765 --> 02:57:25,902 SO WE HAVE AN ADOLESCENT ADVISOY 4187 02:57:25,902 --> 02:57:28,338 GROUP IN EACH COUNTRY AND AS PAF 4188 02:57:28,338 --> 02:57:30,640 THE PROJECT, WE ARE EVALUATING E 4189 02:57:30,640 --> 02:57:32,208 PROCESS OF ADOLESCENTS BEING END 4190 02:57:32,208 --> 02:57:35,278 IN THE STUDY THEMSELVES AND 4191 02:57:35,278 --> 02:57:36,179 INFLUENCING THE DESIGN. 4192 02:57:36,179 --> 02:57:39,149 WE RUN THESE ADD LES ONLY ADVISY 4193 02:57:39,149 --> 02:57:39,983 GROUPS APPROXIMATELY EVERY TWO S 4194 02:57:39,983 --> 02:57:43,086 AND INCREDIBLY ENERGIZING AND 4195 02:57:43,086 --> 02:57:44,387 INFORMATIVE BOTH IN DESIGNING TE 4196 02:57:44,387 --> 02:57:45,989 INTERVENTION AND ALSO IN DESIGNG 4197 02:57:45,989 --> 02:57:51,794 OUR EVALUATION APPROACH. 4198 02:57:51,794 --> 02:57:53,463 SO, WHERE COULD THIS POTENTIALLD 4199 02:57:53,463 --> 02:57:56,332 IF WE WERE TO, AS A FIELD OF GLL 4200 02:57:56,332 --> 02:57:58,902 MENTAL HEALTH PRACTITIONERS DO E 4201 02:57:58,902 --> 02:58:00,904 WORK IN DESIGNING INTERVENTIONSO 4202 02:58:00,904 --> 02:58:02,005 ADDRESS SOCIAL DETERMINANTS? 4203 02:58:02,005 --> 02:58:03,806 WHAT ARE THE KINDS OF RESEARCH 4204 02:58:03,806 --> 02:58:06,509 QUESTIONS WE COULD BE POTENTIALY 4205 02:58:06,509 --> 02:58:06,776 EXPLORING? 4206 02:58:06,776 --> 02:58:08,378 I THINK THERE IS A LOT OF POTENL 4207 02:58:08,378 --> 02:58:10,880 TO DO MORE LONGITUDINAL 4208 02:58:10,880 --> 02:58:11,714 EPIDEMIOLOGICAL WORK. 4209 02:58:11,714 --> 02:58:13,483 THERE HAS BEEN VERY INTERESTING 4210 02:58:13,483 --> 02:58:16,185 WELCOME TRUST FUNDED LANDSCAPINF 4211 02:58:16,185 --> 02:58:17,453 LONGITUDINAL DATASETS RECENTLY I 4212 02:58:17,453 --> 02:58:19,222 THINK THERE IS A RICH DATA SOURE 4213 02:58:19,222 --> 02:58:20,990 THERE BUT THERE IS MORE WE COULE 4214 02:58:20,990 --> 02:58:22,692 DOING TO MEASURE THE 4215 02:58:22,692 --> 02:58:24,360 INTERGENERATIONAL TRANSMISSION F 4216 02:58:24,360 --> 02:58:25,995 POVERTY AND MENTAL ILLNESS TO EE 4217 02:58:25,995 --> 02:58:28,598 THE MECHANISMS OF POVERTY AND ML 4218 02:58:28,598 --> 02:58:30,400 HEALTH OVER TIME, AND ALSO VERY 4219 02:58:30,400 --> 02:58:32,502 IMPORTANTLY THE LINKS BETWEEN G, 4220 02:58:32,502 --> 02:58:33,703 POVERTY AND MENTAL HEALTH ACROSE 4221 02:58:33,703 --> 02:58:36,306 LIFE COURSE, INCLUDING GENETIC, 4222 02:58:36,306 --> 02:58:38,107 BIOLOGICAL AND SOCIOECONOMIC RIK 4223 02:58:38,107 --> 02:58:40,810 FACTORS BRINGING PEOPLE TOGETHEM 4224 02:58:40,810 --> 02:58:42,011 MULTIPLE DISCIPLINES. 4225 02:58:42,011 --> 02:58:45,315 SO THAT'S ON THE DESCRIPTIVE SI. 4226 02:58:45,315 --> 02:58:46,783 I ALSO THINK THERE IS ENORMOUS 4227 02:58:46,783 --> 02:58:48,918 POTENTIAL FOR US TO BE DOING MOE 4228 02:58:48,918 --> 02:58:50,486 INTERVENTION RESEARCH TO ADDRESS 4229 02:58:50,486 --> 02:58:51,788 PROXIMAL MECHANISMS LIKE CASH 4230 02:58:51,788 --> 02:58:53,923 TRANSFERS AND THINKING MORE ABOW 4231 02:58:53,923 --> 02:58:55,592 THEY CAN BE DESIGNED TO IMPROVEE 4232 02:58:55,592 --> 02:58:58,294 MENTAL HEALTH OUTCOMES OF PEOPLO 4233 02:58:58,294 --> 02:58:59,295 RECEIVE THEM. 4234 02:58:59,295 --> 02:59:02,198 BUT ALSO TARGETING MORE DISTAL 4235 02:59:02,198 --> 02:59:02,465 MECHANISM. 4236 02:59:02,465 --> 02:59:04,400 FOR EXAMPLE THE IMPACT OF LIVING 4237 02:59:04,400 --> 02:59:04,734 ENVIRONMENTS. 4238 02:59:04,734 --> 02:59:06,502 WE HAVE BEEN HEARING A LOT ABOUT 4239 02:59:06,502 --> 02:59:08,304 CLIMATE CHANGE AND MIGRATION. 4240 02:59:08,304 --> 02:59:10,807 WE ARE ALREADY ON THE THRESHOLDA 4241 02:59:10,807 --> 02:59:15,745 NEW ERA FOR US IN TERMS OF RISKA 4242 02:59:15,745 --> 02:59:18,047 RANGE OF SOCIAL AND ECONOMIC DRS 4243 02:59:18,047 --> 02:59:20,416 IN THE CONTEXT OF CLIMATE CHANGD 4244 02:59:20,416 --> 02:59:20,683 MIGRATION. 4245 02:59:20,683 --> 02:59:22,085 AND I THINK THERE IS A LOT MOREE 4246 02:59:22,085 --> 02:59:24,721 COULD BE DOING TO TRY AND IMPROR 4247 02:59:24,721 --> 02:59:27,423 RESILIENCE AND RESPONSIVENESS TO 4248 02:59:27,423 --> 02:59:30,126 THESE CIRCUMSTANCES. 4249 02:59:30,126 --> 02:59:32,562 AND THEN IN TERMS OF A POLICY A, 4250 02:59:32,562 --> 02:59:34,097 I THINK THIS DOES POTENTIALLY RA 4251 02:59:34,097 --> 02:59:35,732 WHOLE LOT OF NEW COMPLICATIONS R 4252 02:59:35,732 --> 02:59:35,898 US. 4253 02:59:35,898 --> 02:59:37,934 I THINK FOR MANY OF US, WE HAVEN 4254 02:59:37,934 --> 02:59:39,836 INVOLVED IN ADVOCATING FOR THE 4255 02:59:39,836 --> 02:59:43,573 SCALING UP OF MENTAL HEALTH SERS 4256 02:59:43,573 --> 02:59:45,441 BY GOVERNMENTS ESPECIALLY IN LOR 4257 02:59:45,441 --> 02:59:46,542 AND MIDDLE-INCOME COUNTRIES. 4258 02:59:46,542 --> 02:59:49,012 DONE A LOT OF WORK OF IMPROVINGE 4259 02:59:49,012 --> 02:59:51,581 EFFECTIVENESS OF THESE INTERVEN, 4260 02:59:51,581 --> 02:59:53,149 ESPECIALLY IN LOW-RESOURCE SETT. 4261 02:59:53,149 --> 02:59:55,251 IF WE ARE THINKING ABOUT THE BRR 4262 02:59:55,251 --> 02:59:57,220 AGENDA OF THE SOCIAL AND ECONOMC 4263 02:59:57,220 --> 02:59:59,022 DETERMINANTS, THIS MAKES IT A BR 4264 02:59:59,022 --> 03:00:02,025 POLICY AGENDA AS WELL. 4265 03:00:02,025 --> 03:00:06,229 SO, IT'S VERY EXCITING THAT GOAF 4266 03:00:06,229 --> 03:00:07,263 THE SUSTAINABLE DEVELOPMENT GOA, 4267 03:00:07,263 --> 03:00:08,398 MENTAL HEALTH IS NOT INCLUDED BF 4268 03:00:08,398 --> 03:00:11,834 WE ARE TAKING A SOCIAL DETERMINS 4269 03:00:11,834 --> 03:00:13,736 PERSPECTIVE, MANY OF THESE OTHEE 4270 03:00:13,736 --> 03:00:17,840 ALSO POTENTIALLY RELEVANT FOR ML 4271 03:00:17,840 --> 03:00:18,541 HEALTH. 4272 03:00:18,541 --> 03:00:20,343 AND THIS COMPLICATES THE POLICY 4273 03:00:20,343 --> 03:00:20,643 MESSAGE. 4274 03:00:20,643 --> 03:00:24,447 NOT JUST SIMPLE POLICY MESSAGE F 4275 03:00:24,447 --> 03:00:25,615 ADVOCATING FOR BETTER TREATMENTR 4276 03:00:25,615 --> 03:00:26,215 SCALING UP TREATMENTS. 4277 03:00:26,215 --> 03:00:28,518 IT'S ALSO POLICY MESSAGE OF HOWN 4278 03:00:28,518 --> 03:00:30,520 WE IMPROVE LIVING ENVIRONMENTS O 4279 03:00:30,520 --> 03:00:31,921 IMPROVE THE MENTAL HEALTH AND 4280 03:00:31,921 --> 03:00:33,723 WELL-BEING OF POPULATIONS AND 4281 03:00:33,723 --> 03:00:35,725 REDUCING INEQUITIES IN THE 4282 03:00:35,725 --> 03:00:38,661 DISTRIBUTION OF MENTAL HEALTH. 4283 03:00:38,661 --> 03:00:41,164 SO IN A SENSE, THE POLICY OPTIOS 4284 03:00:41,164 --> 03:00:42,231 COULD BE INVESTING IN MENTAL HEH 4285 03:00:42,231 --> 03:00:44,033 CARE OR INVESTING IN INTERVENTIS 4286 03:00:44,033 --> 03:00:45,835 THAT ARE ADDRESSED SOCIAL 4287 03:00:45,835 --> 03:00:47,136 DETERMINANTS OF MENTAL HEALTH AI 4288 03:00:47,136 --> 03:00:48,237 THINK I WOULD ARGUE VERY STRONGY 4289 03:00:48,237 --> 03:00:50,840 THAT WE NEED A VERY BROAD-BASEDE 4290 03:00:50,840 --> 03:00:53,843 OF SOCIETY APPROACH WITH 4291 03:00:53,843 --> 03:00:55,445 INTERVENTIONS THAT ADDRESS BOTHE 4292 03:00:55,445 --> 03:00:59,449 CAUSES AND THE CONSEQUENCES OF L 4293 03:00:59,449 --> 03:00:59,682 ILLNESS. 4294 03:00:59,682 --> 03:01:01,651 AND IN CASE WE NEED ANYMORE MORE 4295 03:01:01,651 --> 03:01:02,785 CONVINCING ABOUT THE IMPORTANCEF 4296 03:01:02,785 --> 03:01:04,821 MENTAL HEALTH CARE, THIS IS SOMA 4297 03:01:04,821 --> 03:01:06,823 FROM THE SYSTEMATIC REVIEW AND 4298 03:01:06,823 --> 03:01:08,658 META-ANALYSIS WE ARE HOPING TO 4299 03:01:08,658 --> 03:01:09,659 PUBLISH SOON. 4300 03:01:09,659 --> 03:01:12,462 WE LOOKED AT THE ECONOMIC IMPACF 4301 03:01:12,462 --> 03:01:15,364 39 RANDOMIZED CONTROL TRIALS WHE 4302 03:01:15,364 --> 03:01:17,366 ARE EVALUATING MENTAL HEALTH 4303 03:01:17,366 --> 03:01:17,700 INTERVENTIONS. 4304 03:01:17,700 --> 03:01:19,969 THESE INCLUDED A RANGE OF 4305 03:01:19,969 --> 03:01:21,070 PSYCHOSOCIAL AND PHARMACOLOGICAL 4306 03:01:21,070 --> 03:01:23,172 TRIALS AND WE FOUND QUITE SIGNIT 4307 03:01:23,172 --> 03:01:26,008 EFFECTS ON LABOR MARKET OUTCOMES 4308 03:01:26,008 --> 03:01:28,578 AROUND 1.6 STANDARD DEVIATION FR 4309 03:01:28,578 --> 03:01:31,180 PSYCHOSOCIAL INTERVENTIONS FOR N 4310 03:01:31,180 --> 03:01:33,683 MENTAL DISORDERS AND AROUND .3 O 4311 03:01:33,683 --> 03:01:36,285 STANDARD DEVIATIONS ON LABOR MAT 4312 03:01:36,285 --> 03:01:38,654 OUTCOMES FOR SEVERE MENTAL ILLN. 4313 03:01:38,654 --> 03:01:40,390 THIS THE IS COMPELLING ECONOMIC 4314 03:01:40,390 --> 03:01:42,058 REASONS TO INVEST MORE IN MENTAL 4315 03:01:42,058 --> 03:01:42,592 HEALTH. 4316 03:01:42,592 --> 03:01:45,161 I HOPE I'M CONVEYING, THIS IS NN 4317 03:01:45,161 --> 03:01:45,595 EITHER-OR SITUATION. 4318 03:01:45,595 --> 03:01:46,596 WE NEED TO ADDRESS SOCIAL 4319 03:01:46,596 --> 03:01:49,198 DETERMINANTS AND WE ALSO NEED TE 4320 03:01:49,198 --> 03:01:50,066 SCALING UP MENTAL HEALTH CARE AD 4321 03:01:50,066 --> 03:01:52,468 THAT REMAINS VERY MUCH UNFINISHD 4322 03:01:52,468 --> 03:01:53,102 BUSINESS. 4323 03:01:53,102 --> 03:01:54,771 INTERESTINGLY, ON THE RIGHT HERU 4324 03:01:54,771 --> 03:01:56,873 CAN SEE THIS IS SOME ANALYSIS AI 4325 03:01:56,873 --> 03:01:59,275 WANTED TO GIVE A SHOUT OUT TO KE 4326 03:01:59,275 --> 03:02:01,277 AND MARK WHO HAVE DONE SOME AMAG 4327 03:02:01,277 --> 03:02:05,381 HEAVY LIFTING ON THE ANALYSIS FR 4328 03:02:05,381 --> 03:02:07,383 THIS META-ANALYSIS. 4329 03:02:07,383 --> 03:02:10,086 SO, WHAT WE DID WAS LOOKED AT TE 4330 03:02:10,086 --> 03:02:11,487 ASSOCIATIONS BETWEEN THE EFFECTE 4331 03:02:11,487 --> 03:02:13,389 ON THE MENTAL HEALTH OUTCOME ANE 4332 03:02:13,389 --> 03:02:15,691 LABOR MARKET OUTCOME AND IT'S A 4333 03:02:15,691 --> 03:02:17,693 FAIRLY LINEAR ASSOCIATION, WHICH 4334 03:02:17,693 --> 03:02:20,196 IMPLIES THAT THE MECHANISM BY WH 4335 03:02:20,196 --> 03:02:22,064 THESE MENTAL HEALTH TREATMENTS D 4336 03:02:22,064 --> 03:02:24,200 THESE ECONOMIC BENEFITS SEEMS TE 4337 03:02:24,200 --> 03:02:26,035 THROUGH IMPROVED MENTAL HEALTH D 4338 03:02:26,035 --> 03:02:27,303 IMPROVED FUNCTIONS. 4339 03:02:27,303 --> 03:02:29,972 SO VERY EXCITING AND CONFIRMINGT 4340 03:02:29,972 --> 03:02:33,876 OF THE EVIDENCE ABOUT THE CYCLIL 4341 03:02:33,876 --> 03:02:34,577 BIDIRECTIONAL RELATIONSHIP BETWN 4342 03:02:34,577 --> 03:02:36,479 POVERTY AND MENTAL HEALTH AND TE 4343 03:02:36,479 --> 03:02:38,181 OPPORTUNITIES FOR INTERVENING AH 4344 03:02:38,181 --> 03:02:40,883 ENDS OF THAT CYCLE. 4345 03:02:40,883 --> 03:02:43,186 SO TO CONCLUDE, I THINK I HOPE E 4346 03:02:43,186 --> 03:02:44,887 BEEN ABLE TO SHOW YOU THAT SOCIL 4347 03:02:44,887 --> 03:02:46,355 DETERMINANTS REALLY PLAY A PROFD 4348 03:02:46,355 --> 03:02:48,591 ROLE IN CASE YOU DIDN'T NEED MOE 4349 03:02:48,591 --> 03:02:50,092 CONVINCING IN SHAPING THE MENTAL 4350 03:02:50,092 --> 03:02:51,994 HEALTH OF POPULATIONS AND IT'S Y 4351 03:02:51,994 --> 03:02:53,796 VITAL THAT WE INTERVENE EARLY TO 4352 03:02:53,796 --> 03:02:56,432 ADDRESS THESE SOCIAL DETERMINAN. 4353 03:02:56,432 --> 03:02:58,234 AND I THINK DESPITE THE MANY 4354 03:02:58,234 --> 03:03:00,403 CHALLENGES, I THINK THERE ARE AO 4355 03:03:00,403 --> 03:03:02,405 MANY OPPORTUNITIES FOR THESE KIF 4356 03:03:02,405 --> 03:03:02,738 INTERVENTIONS. 4357 03:03:02,738 --> 03:03:04,874 WE NEED TO IDENTIFY MECHANISMS D 4358 03:03:04,874 --> 03:03:05,808 INTERVENTION TARGETS. 4359 03:03:05,808 --> 03:03:08,578 IT'S NOT JUST ABOUT MOUNTING A L 4360 03:03:08,578 --> 03:03:10,580 PROGRAM OR A PARTICULAR ECONOMIC 4361 03:03:10,580 --> 03:03:11,314 INTERVENTION. 4362 03:03:11,314 --> 03:03:12,715 IT'S ABOUT BEING REALLY CLEAR AT 4363 03:03:12,715 --> 03:03:14,884 THE CAUSAL PATHWAY BY WHICH WE K 4364 03:03:14,884 --> 03:03:17,286 THE SOCIAL INTERVENTIONS WOULD D 4365 03:03:17,286 --> 03:03:19,422 A PARTICULAR MENTAL HEALTH OUTC. 4366 03:03:19,422 --> 03:03:22,792 AND OF COURSE THIS REQUIRES 4367 03:03:22,792 --> 03:03:23,359 INTERDISCIPLINARY APPROVES. 4368 03:03:23,359 --> 03:03:25,194 IT REQUIRES ACTIVE COMMUNITY 4369 03:03:25,194 --> 03:03:27,897 PARTICIPATION AND EMPOWERMENT, 4370 03:03:27,897 --> 03:03:30,099 INVOLVEMENT OF PEOPLE WITH LIVED 4371 03:03:30,099 --> 03:03:32,401 EXPERIENCE, AND COMMITMENT FROM 4372 03:03:32,401 --> 03:03:34,503 GOVERNMENTS, PRIVATE SECTOR AND 4373 03:03:34,503 --> 03:03:35,805 INTERNATIONAL DEVELOPMENT AGENC, 4374 03:03:35,805 --> 03:03:38,007 ALONGSIDE THIS ONGOING AGENDA OF 4375 03:03:38,007 --> 03:03:40,109 SCALING UP MENTAL HEALTH CARE. 4376 03:03:40,109 --> 03:03:41,310 SO THANK YOU VERY MUCH. 4377 03:03:41,310 --> 03:03:45,414 I JUST WANT TO ACKNOWLEDGE THE 4378 03:03:45,414 --> 03:03:46,582 COINVESTIGATORS ON THE STUDIES D 4379 03:03:46,582 --> 03:03:49,118 SEVERAL OF WHOM ARE IN THE ROOM 4380 03:03:49,118 --> 03:03:49,385 TODAY. 4381 03:03:49,385 --> 03:03:51,120 AND ALSO TO ACKNOWLEDGE THE FUNS 4382 03:03:51,120 --> 03:03:53,189 WHO HAVE SUPPORTED ALL OF THIS K 4383 03:03:53,189 --> 03:03:54,824 OVER THE YEARS. 4384 03:03:54,824 --> 03:03:56,225 THANK YOU VERY MUCH, INDEED. 4385 03:03:56,225 --> 03:04:06,002 [ APPLAUSE ] 4386 03:04:06,002 --> 03:04:08,905 I HAVE BEEN TOLD THERE IS TIME R 4387 03:04:08,905 --> 03:04:17,980 QUESTIONS IF ANYONE HAS ANY -- R 4388 03:04:17,980 --> 03:04:21,317 COMMENTS. 4389 03:04:21,317 --> 03:04:23,386 >> HERE WE GO. 4390 03:04:23,386 --> 03:04:27,223 HI, I'M RACHEL, A PH.D. STUDENTN 4391 03:04:27,223 --> 03:04:27,757 HEALTH SERVICES RESEARCH. 4392 03:04:27,757 --> 03:04:29,992 I KNOW YOU MENTIONED SELF-REGULN 4393 03:04:29,992 --> 03:04:32,695 A GOOD BIT AS KNOW UNDERLYING 4394 03:04:32,695 --> 03:04:34,263 MECHANISM FOR POTENTIALLY MEDIAG 4395 03:04:34,263 --> 03:04:37,033 LIKE ANXIETY, DEPRESSION, COMMON 4396 03:04:37,033 --> 03:04:39,368 MENTAL DISORDERS. 4397 03:04:39,368 --> 03:04:40,369 AND YOU LINKED THAT TO PARTICULR 4398 03:04:40,369 --> 03:04:43,506 SOCIAL DETERMINANTS OF HEALTH AD 4399 03:04:43,506 --> 03:04:47,109 OF A PATHWAY. 4400 03:04:47,109 --> 03:04:50,613 ARE THERE PATHWAYS OR ARE THERE 4401 03:04:50,613 --> 03:04:51,747 MEDIATORS OTHER THAN SELF-REGULN 4402 03:04:51,747 --> 03:04:54,116 THAT HAVE CAUGHT YOUR ATTENTIONS 4403 03:04:54,116 --> 03:04:57,520 POTENTIAL, LIKE, KIND OF CAUSAL 4404 03:04:57,520 --> 03:04:59,021 PATHWAYS FOR CODs? 4405 03:04:59,021 --> 03:05:01,424 >> I THINK THERE ARE A NUMBER OF 4406 03:05:01,424 --> 03:05:02,391 OTHER POTENTIAL MEDIATORS. 4407 03:05:02,391 --> 03:05:04,527 I MEAN, WE CAN THINK ABOUT THEMN 4408 03:05:04,527 --> 03:05:06,562 TERMS OF BROAD SOCIAL MEDIATORS. 4409 03:05:06,562 --> 03:05:09,565 SO FOR EXAMPLE, MEDIATORS AROUND 4410 03:05:09,565 --> 03:05:13,202 BUILDING SOCIAL TRUSTS, CREATINE 4411 03:05:13,202 --> 03:05:15,638 ENVIRONMENTS, BUILDING SOCIAL 4412 03:05:15,638 --> 03:05:16,405 CONNECTIONS AND SOCIAL SUPPORTS. 4413 03:05:16,405 --> 03:05:18,841 WE HAVE DONE WORK RECENTLY FROME 4414 03:05:18,841 --> 03:05:21,210 ORIGINAL FIRM TRIAL THAT I MENT, 4415 03:05:21,210 --> 03:05:22,712 LOOKING AT THE EXTENT TO WHICH E 4416 03:05:22,712 --> 03:05:25,848 EFFECT OF FOOD INSECURITY ON 4417 03:05:25,848 --> 03:05:28,751 PERINATAL DEPRESSION AND MODERAY 4418 03:05:28,751 --> 03:05:30,152 SOCIAL SUPPORT AND SOCIAL 4419 03:05:30,152 --> 03:05:30,453 CONNECTIONS. 4420 03:05:30,453 --> 03:05:32,121 SO SOCIAL CONNECTIONS, SOCIAL ST 4421 03:05:32,121 --> 03:05:34,223 CAN OFTEN PLAY A VERY IMPORTANTE 4422 03:05:34,223 --> 03:05:36,726 IN PROTECTING AGAINST THE EFFECF 4423 03:05:36,726 --> 03:05:39,028 SOCIAL AND ECONOMIC ADVERSITY. 4424 03:05:39,028 --> 03:05:39,328 >> GREAT. 4425 03:05:39,328 --> 03:05:45,001 AND TAKING THAT FURTHER, DO YOUK 4426 03:05:45,001 --> 03:05:48,804 MENTAL HEALTH TREATMENT -- SUPPS 4427 03:05:48,804 --> 03:05:50,306 THOSE THINGS AS WELL IN THAT THY 4428 03:05:50,306 --> 03:05:52,842 KIND OF HAVE SIMILAR MENTAL HEAH 4429 03:05:52,842 --> 03:05:55,311 TREATMENT AND SOCIAL DETERMINANS 4430 03:05:55,311 --> 03:05:57,013 WOULD HAVE SIMILAR ROLLS IN PROG 4431 03:05:57,013 --> 03:05:58,948 KIND OF THE SAME MECHANISMS? 4432 03:05:58,948 --> 03:06:00,616 OR DO YOU THINK THERE ARE 4433 03:06:00,616 --> 03:06:02,118 COMPLEMENTARY ROLES THEY WOULD ? 4434 03:06:02,118 --> 03:06:05,021 LIKE HOW DO YOU THINK THAT WOULD 4435 03:06:05,021 --> 03:06:05,287 INTERACT? 4436 03:06:05,287 --> 03:06:06,722 >> I THINK THEY HAVE THE POTENTO 4437 03:06:06,722 --> 03:06:07,223 DO THAT. 4438 03:06:07,223 --> 03:06:09,125 I THINK A LOT DEPENDS ON THE NAE 4439 03:06:09,125 --> 03:06:12,161 OF THE INTERVENTION AND PSYCHOSL 4440 03:06:12,161 --> 03:06:14,764 INTERVENTIONS INCLUDING A SOCIAL 4441 03:06:14,764 --> 03:06:16,265 COMPONENT HAVE THE POTENTIAL FOR 4442 03:06:16,265 --> 03:06:16,966 DOING THAT. 4443 03:06:16,966 --> 03:06:18,768 SO GROUP-BASED INTERVENTIONS FOR 4444 03:06:18,768 --> 03:06:20,936 EXAMPLE, PROVIDE A MEANS OF SOCL 4445 03:06:20,936 --> 03:06:22,972 SUPPORT IN THE CONTEXT OF WHATER 4446 03:06:22,972 --> 03:06:26,175 THE ACTIVE INGREDIENT OF THE 4447 03:06:26,175 --> 03:06:28,177 PSYCHOTHERAPY MIGHT HAPPEN TO B. 4448 03:06:28,177 --> 03:06:29,845 PSYCHOSOCIAL SUPPORT OR 4449 03:06:29,845 --> 03:06:33,382 REHABILITATION PROGRAMS AS AN AT 4450 03:06:33,382 --> 03:06:36,252 TO PHARMACOLOGICAL TREATMENTS HE 4451 03:06:36,252 --> 03:06:37,153 THAT POTENTIAL SOCIAL ROLE. 4452 03:06:37,153 --> 03:06:39,755 SO I THINK A LOT DEPENDS ON HOWE 4453 03:06:39,755 --> 03:06:40,756 INTERVENTIONS ARE DESIGNED BUT Y 4454 03:06:40,756 --> 03:06:43,559 ALSO DO HAVE THAT POTENTIAL. 4455 03:06:43,559 --> 03:06:51,167 >> THANK YOU. 4456 03:06:51,167 --> 03:06:51,834 >> HI, EMORY UNIVERSITY. 4457 03:06:51,834 --> 03:06:54,470 THANK YOU VERY MUCH FOR YOUR 4458 03:06:54,470 --> 03:06:55,905 PRESENTATION, DR. LUND AND I REY 4459 03:06:55,905 --> 03:06:57,973 APPRECIATE YOUR THOUGHTS ON CAUL 4460 03:06:57,973 --> 03:07:00,910 MECHANISM AND YOU ALREADY MENTID 4461 03:07:00,910 --> 03:07:02,945 NEUROPSYCHOLOGY AS ONE SOURCE FR 4462 03:07:02,945 --> 03:07:04,447 HYPOTHESES FOR THOSE CAUSAL PAT. 4463 03:07:04,447 --> 03:07:06,982 AND I WONDERED WHAT ARE YOUR THS 4464 03:07:06,982 --> 03:07:09,385 ON OTHER APPROACHES TO FIGURE OT 4465 03:07:09,385 --> 03:07:10,753 SUCH MECHANISMS? 4466 03:07:10,753 --> 03:07:12,555 FOR INSTANCE QUALITATIVE RESEARH 4467 03:07:12,555 --> 03:07:15,357 METHODS, INCLUDING RANDOM THEOR? 4468 03:07:15,357 --> 03:07:17,126 >> SO QUALITATIVE RESEARCH METHS 4469 03:07:17,126 --> 03:07:18,861 ARE REALLY IMPORTANT IN ALL OF S 4470 03:07:18,861 --> 03:07:19,061 WORK. 4471 03:07:19,061 --> 03:07:20,563 AND IT'S SOMETHING WE SPEND A LF 4472 03:07:20,563 --> 03:07:23,566 TIME DOING IN THE CONTEXT OF THE 4473 03:07:23,566 --> 03:07:24,433 ALLIANCE PROJECT. 4474 03:07:24,433 --> 03:07:25,968 IN THE FIRST PHASE WE HAVE DONET 4475 03:07:25,968 --> 03:07:27,970 OF QUALITATIVE INTERVIEWS WITH 4476 03:07:27,970 --> 03:07:30,406 ADOLESCENTS LIVING IN CIRCUMSTAS 4477 03:07:30,406 --> 03:07:33,442 OF POVERTY IN EACH OF THE THREE 4478 03:07:33,442 --> 03:07:35,878 COUNTRIES ASKING THEM QUESTIONST 4479 03:07:35,878 --> 03:07:37,346 DEPRESSION AND ANXIETY AND IDENY 4480 03:07:37,346 --> 03:07:39,081 THE KINDS OF STRATEGIES THEY USO 4481 03:07:39,081 --> 03:07:41,817 COPE WITH THOSE KINDS OF ADVERS. 4482 03:07:41,817 --> 03:07:44,453 AND THAT'S REALLY BEING INCREDIY 4483 03:07:44,453 --> 03:07:47,089 INFORMATIVE IN TERMS OF DESIGNIR 4484 03:07:47,089 --> 03:07:47,890 SELF-REGULATION INTERVENTION. 4485 03:07:47,890 --> 03:07:49,558 IT'S REALLY PICKED UP ON A LOT F 4486 03:07:49,558 --> 03:07:50,559 THOSE STRATEGIES. 4487 03:07:50,559 --> 03:07:56,065 >> THANK YOU. 4488 03:07:56,065 --> 03:07:59,068 >> HI, THANK YOU FOR YOUR TALK. 4489 03:07:59,068 --> 03:08:01,804 SO I'M WONDERING ABOUT - YOU'RE 4490 03:08:01,804 --> 03:08:03,773 TALKING ABOUT THE FACT THAT THEE 4491 03:08:03,773 --> 03:08:06,175 MIGHT BE SMALL EFFECT SIZES AT E 4492 03:08:06,175 --> 03:08:08,177 POPULATION COULD HAVE MASSIVE I. 4493 03:08:08,177 --> 03:08:09,879 BUT THE INTERVENTIONS WE ARE TAG 4494 03:08:09,879 --> 03:08:12,782 ABOUT TESTING COULD BE VERY DIFT 4495 03:08:12,782 --> 03:08:16,385 TO SCALE COMPARED TO OTHER SOCID 4496 03:08:16,385 --> 03:08:19,388 ECONOMIC POLICIES THAT MIGHT BE 4497 03:08:19,388 --> 03:08:22,491 INFLUENCING THINGS LIKE POVERTYD 4498 03:08:22,491 --> 03:08:23,959 INEQUALITY, THE STRENGTHENING OF 4499 03:08:23,959 --> 03:08:26,962 SOCIAL SAFETY NETS, DISABILITY 4500 03:08:26,962 --> 03:08:29,098 INSURANCE, THE SORT OF MECHANISS 4501 03:08:29,098 --> 03:08:30,900 THAT GOVERNMENTS HAVE AT THEIR 4502 03:08:30,900 --> 03:08:31,167 DISPOSAL. 4503 03:08:31,167 --> 03:08:34,703 SO I'M CURIOUS HOW YOU THINK ABT 4504 03:08:34,703 --> 03:08:37,806 HOW WE POSITION THIS IN TERMS OF 4505 03:08:37,806 --> 03:08:40,176 ADVOCATING FOR POLICY THAT COULD 4506 03:08:40,176 --> 03:08:41,610 INTERVENE IN SOCIAL DETERMINANT? 4507 03:08:41,610 --> 03:08:43,078 >> I THINK THAT IS WHAT I WAS TG 4508 03:08:43,078 --> 03:08:45,714 TO GET AT TOWARDS THE END WAS, I 4509 03:08:45,714 --> 03:08:47,917 THINK THIS PLACESINOUS A REALLY 4510 03:08:47,917 --> 03:08:49,685 IMPORTANT ROLE AS MENTAL HEALTH 4511 03:08:49,685 --> 03:08:51,320 POLICYMAKERS OR RESEARCHERS AND 4512 03:08:51,320 --> 03:08:51,587 ADVOCATES. 4513 03:08:51,587 --> 03:08:53,789 IS TO TRY AND BE MORE ACTIVE INE 4514 03:08:53,789 --> 03:08:57,126 POLICY SPACE, TO BE ADVOCATING E 4515 03:08:57,126 --> 03:08:59,595 FOR SOCIAL JUSTICE, FOR MORE FAR 4516 03:08:59,595 --> 03:09:03,032 REDISTRIBUTION OF WEALTH TO MAKE 4517 03:09:03,032 --> 03:09:03,699 THAT PEOPLE HAVE ACCESS TO HEALH 4518 03:09:03,699 --> 03:09:05,801 CARE THAT IS AFFORDABLE. 4519 03:09:05,801 --> 03:09:07,102 ALL OF THESE SOCIAL AND ECONOMIC 4520 03:09:07,102 --> 03:09:10,472 DRIVERS ARE REALLY IMPORTANT PAF 4521 03:09:10,472 --> 03:09:12,741 THE MENTAL HEALTH POLICY AGENDA. 4522 03:09:12,741 --> 03:09:14,176 ONE OF THE CHALLENGES IN TERMS F 4523 03:09:14,176 --> 03:09:17,613 MENTAL HEALTH POLICY IS WHAT MAN 4524 03:09:17,613 --> 03:09:20,783 REFERS TO AS DIAGONAL -- IF I'M 4525 03:09:20,783 --> 03:09:23,485 SITTING IN A MINISTRY OF HEALTHY 4526 03:09:23,485 --> 03:09:24,987 INVESTMENT IN MENTAL HEALTH WILL 4527 03:09:24,987 --> 03:09:26,822 OFTEN YIELD AN ECONOMIC RETURN R 4528 03:09:26,822 --> 03:09:28,891 ANOTHER SECTOR AT SOME POINT INE 4529 03:09:28,891 --> 03:09:29,191 FUTURE. 4530 03:09:29,191 --> 03:09:32,394 SO IT'S VERY DIFFICULT TO MAKE E 4531 03:09:32,394 --> 03:09:34,096 CASE TO PARTICULAR SECTORS OF 4532 03:09:34,096 --> 03:09:35,998 GOVERNMENT FOR THE BENEFIT OF 4533 03:09:35,998 --> 03:09:36,699 INVESTING IN MENTAL HEALTH WITHN 4534 03:09:36,699 --> 03:09:37,299 THEIR SECTOR. 4535 03:09:37,299 --> 03:09:39,702 AND AGAIN THIS IS WHY A WHOLE OF 4536 03:09:39,702 --> 03:09:41,303 SOCIETY APPROACH IS REALLY IMPO. 4537 03:09:41,303 --> 03:09:43,305 WE NEED TO BE ABLE TO DEMONSTRAE 4538 03:09:43,305 --> 03:09:44,607 IMPACT OF MENTAL HEALTH TREATMEN 4539 03:09:44,607 --> 03:09:46,442 LABOR MARKET PARTICIPATION, FOR 4540 03:09:46,442 --> 03:09:46,809 EXAMPLE. 4541 03:09:46,809 --> 03:09:50,212 WE NEED TO SHOW IF CASH TRANSFES 4542 03:09:50,212 --> 03:09:51,814 COMBINED WITH PSYCHOLOGICAL 4543 03:09:51,814 --> 03:09:54,116 TREATMENTS FOR PERINATAL DEPRESN 4544 03:09:54,116 --> 03:09:56,318 IMPROVE MOTHER INFANT DETACHMEN, 4545 03:09:56,318 --> 03:09:58,621 THAT HAS A WHOLE NUMBER OF OTHER 4546 03:09:58,621 --> 03:10:00,155 POTENTIAL HEALTH AND EDUCATIONAL 4547 03:10:00,155 --> 03:10:01,423 BENEFITS FURTHER DOWN THE LINE. 4548 03:10:01,423 --> 03:10:04,126 AND THERE ARE METHODS FOR EVALUG 4549 03:10:04,126 --> 03:10:06,328 THESE KINDS OF CAUSES AND EFFEC. 4550 03:10:06,328 --> 03:10:08,530 FOR EXAMPLE THE W.H.O. CHOICE M, 4551 03:10:08,530 --> 03:10:11,000 WHICH REALLY LOOKS AT THE INVEST 4552 03:10:11,000 --> 03:10:13,402 IN RELATION TO RETURN ON INVEST, 4553 03:10:13,402 --> 03:10:15,704 BUT ALSO IN RELATION TO STANDARD 4554 03:10:15,704 --> 03:10:18,741 UTILITY MEASURES LIKE DISABILITY 4555 03:10:18,741 --> 03:10:23,012 ADJUSTED LIFE YEARS, AS A RESULA 4556 03:10:23,012 --> 03:10:25,281 PARTICULAR INTERVENTION. 4557 03:10:25,281 --> 03:10:27,683 >> THANK YOU. 4558 03:10:27,683 --> 03:10:30,586 >> THANK YOU FOR A FASCINATING . 4559 03:10:30,586 --> 03:10:34,123 YOU BRING UP SEVERAL QUESTIONS Y 4560 03:10:34,123 --> 03:10:34,590 MIND. 4561 03:10:34,590 --> 03:10:39,328 DURING COVID IN THE UNITED STATE 4562 03:10:39,328 --> 03:10:41,530 HAD A HUGE AMOUNTED OF MENTAL HH 4563 03:10:41,530 --> 03:10:43,599 PROBLEMS WITH YOUNGSTERS WITH SE 4564 03:10:43,599 --> 03:10:46,201 AND DEPRESSION AND SO ON. 4565 03:10:46,201 --> 03:10:49,738 AND I WAS LOOKING AT WHAT YOU LD 4566 03:10:49,738 --> 03:10:51,907 AS SOCIAL DETERMINANTS THINKING 4567 03:10:51,907 --> 03:10:54,610 NOBODY WOULD BE IN A GREAT STATE 4568 03:10:54,610 --> 03:10:56,211 GIVEN THOSE CONDITIONS. 4569 03:10:56,211 --> 03:11:00,215 BUT THERE ARE PEOPLE WHO HAVE TE 4570 03:11:00,215 --> 03:11:02,217 CONDITIONS AND FUNCTION, AND YEE 4571 03:11:02,217 --> 03:11:04,119 HAD PEOPLE WHO HAD ALL OF THE 4572 03:11:04,119 --> 03:11:06,121 POSITIVE THINGS AND YET WERE 4573 03:11:06,121 --> 03:11:08,424 DEPRESSED ENOUGH TO COMMIT SUIC. 4574 03:11:08,424 --> 03:11:10,526 SO, I JUST WONDERED WHETHER YOUE 4575 03:11:10,526 --> 03:11:13,429 TO TAKE CULTURE INTO ACCOUNT? 4576 03:11:13,429 --> 03:11:17,633 AND THEN I STARTED THINKING ABOE 4577 03:11:17,633 --> 03:11:17,900 INTERNET. 4578 03:11:17,900 --> 03:11:19,935 FIRST OF ALL, IT SEEMED TO ME TE 4579 03:11:19,935 --> 03:11:22,304 PEOPLE WOULD BE EXPERIENCING ENS 4580 03:11:22,304 --> 03:11:25,574 AMOUNTS OF SHAME AND LACK OF 4581 03:11:25,574 --> 03:11:25,908 SELF-ESTEEM. 4582 03:11:25,908 --> 03:11:26,742 AND WHAT HAPPENS WHEN THESE PEOE 4583 03:11:26,742 --> 03:11:29,345 ARE NOW LOOKING AT FACEBOOK OR 4584 03:11:29,345 --> 03:11:31,947 INSTAGRAM AND GETTING ALL OF THT 4585 03:11:31,947 --> 03:11:33,549 PRESSURE FROM THE OUTSIDE ON WHT 4586 03:11:33,549 --> 03:11:36,452 THEY SHOULD HAVE OR SHOULD BE OO 4587 03:11:36,452 --> 03:11:37,753 ON? 4588 03:11:37,753 --> 03:11:39,555 I WONDERED IF YOU WOULD BE INTED 4589 03:11:39,555 --> 03:11:42,958 IN EXPANDING YOUR IDEA TO INCLUE 4590 03:11:42,958 --> 03:11:44,460 MORE CULTURAL VALUES? 4591 03:11:44,460 --> 03:11:45,260 >> YES, VERY MUCH. 4592 03:11:45,260 --> 03:11:47,963 AND I THINK CULTURAL VALUES CANE 4593 03:11:47,963 --> 03:11:50,466 POSITIVE OR NEGATIVE MENTAL HEAH 4594 03:11:50,466 --> 03:11:50,799 CONSEQUENCES. 4595 03:11:50,799 --> 03:11:53,569 SO A SENSE OF CULTURAL IDENTITY, 4596 03:11:53,569 --> 03:11:55,738 BELONGING, IS A LOT OF EVIDENCET 4597 03:11:55,738 --> 03:11:58,841 THESE ARE PROTECTIVE FOR THE MEL 4598 03:11:58,841 --> 03:12:00,175 HEALTH POPULATIONS AND IF WE HAA 4599 03:12:00,175 --> 03:12:03,679 SENSE OF WHO WE ARE, WHAT OUR VS 4600 03:12:03,679 --> 03:12:05,647 ARE, HOW OUR LIFESTYLE ALLIANCEH 4601 03:12:05,647 --> 03:12:07,583 OUR VALUES, THESE ARE IMPORTANT 4602 03:12:07,583 --> 03:12:08,951 CULTURAL FACTORS WHICH PROVIDE L 4603 03:12:08,951 --> 03:12:09,952 HEALTH PROTECTION. 4604 03:12:09,952 --> 03:12:12,955 OF COURSE THERE ARE OTHER MORE C 4605 03:12:12,955 --> 03:12:14,623 ELEMENTS OF SPACE ON THE INTERND 4606 03:12:14,623 --> 03:12:16,658 SOCIAL MEDIA WHICH HAVE BEEN SHO 4607 03:12:16,658 --> 03:12:19,395 HAVE NEGATIVE MENTAL HEALTH OUT, 4608 03:12:19,395 --> 03:12:24,199 FOR EXAMPLE, AS THE INTERNET SP. 4609 03:12:24,199 --> 03:12:27,069 SO IT'S A COMPLEX PICTURE AND IK 4610 03:12:27,069 --> 03:12:29,671 WHAT I HOPE I TRIED TO SHOW IS E 4611 03:12:29,671 --> 03:12:31,573 SOCIAL AND ECONOMIC ADVERSITIESE 4612 03:12:31,573 --> 03:12:33,976 IMPACT BUT THEY ARE OBVIOUSLY VY 4613 03:12:33,976 --> 03:12:34,977 HETEROGENOUS ACROSS DIFFERENT 4614 03:12:34,977 --> 03:12:35,778 CULTURES AROUND THE WORLD. 4615 03:12:35,778 --> 03:12:37,880 AND CERTAIN CULTURES CAN HAVE A 4616 03:12:37,880 --> 03:12:39,782 PROTECTIVE ROLE, WHICH IS IS WHT 4617 03:12:39,782 --> 03:12:42,051 THAT FIFTH DIMENSION OR DOMAIN I 4618 03:12:42,051 --> 03:12:42,317 MENTIONED. 4619 03:12:42,317 --> 03:12:43,952 >> THANK YOU. 4620 03:12:43,952 --> 03:12:44,219 EXCELLENT. 4621 03:12:44,219 --> 03:12:54,463 >> THANK YOU. 4622 03:12:54,463 --> 03:12:59,068 ANY OTHER QUESTIONS? 4623 03:12:59,068 --> 03:13:02,471 >> I'D LIKE TO GO BACK TO THE IE 4624 03:13:02,471 --> 03:13:04,440 ABOUT POLITICS BECAUSE I'M THING 4625 03:13:04,440 --> 03:13:08,277 IN THE U.K. WE HAVE NOW A DISCOE 4626 03:13:08,277 --> 03:13:11,880 AROUND IF YOU'RE UNEMPLOYED, IF 4627 03:13:11,880 --> 03:13:13,382 YOU'RE MENTALLYIL, THAT IN ITSES 4628 03:13:13,382 --> 03:13:14,183 A MENTAL ILLNESS. 4629 03:13:14,183 --> 03:13:17,086 THEY WANT TO ADDRESS THIS THROUH 4630 03:13:17,086 --> 03:13:21,123 INTERVENTIONS AND SANCTIONS. 4631 03:13:21,123 --> 03:13:24,660 SO AGAIN, POLITICS DO INFLUENCEE 4632 03:13:24,660 --> 03:13:28,597 SORT OF POLICIES THAT WILL MAKEA 4633 03:13:28,597 --> 03:13:30,899 DIFFERENCE SOMETIMES NEGATIVE, N 4634 03:13:30,899 --> 03:13:31,366 PEOPLE'S LIVES. 4635 03:13:31,366 --> 03:13:33,869 SO WE REALLY NEED TO ADDRESS TH. 4636 03:13:33,869 --> 03:13:35,571 IT REALLY IS THE ELEPHANT IN THE 4637 03:13:35,571 --> 03:13:36,405 ROOM. 4638 03:13:36,405 --> 03:13:36,772 >> ABSOLUTELY. 4639 03:13:36,772 --> 03:13:39,975 I REALLY AGREE AND I THINK A LOF 4640 03:13:39,975 --> 03:13:42,010 THESE SOCIAL INTERVENTIONS ARE 4641 03:13:42,010 --> 03:13:43,178 MOUNTED FROM PARTICULAR POLITICL 4642 03:13:43,178 --> 03:13:45,981 PROGRAMS SO IT'S REALLY IMPORTAE 4643 03:13:45,981 --> 03:13:47,382 ADVOCATE FOR EXAMPLE, FOR BASIC 4644 03:13:47,382 --> 03:13:49,551 INCOME GRANTS AND FOR BASIC FINL 4645 03:13:49,551 --> 03:13:52,287 SECURITY FOR PEOPLE WHO ARE LIVN 4646 03:13:52,287 --> 03:13:54,590 EXTREMELY VULNERABLE CIRCUMSTAN. 4647 03:13:54,590 --> 03:13:56,859 SO IT IS PROFOUNDLY A POLITICALE 4648 03:13:56,859 --> 03:14:03,265 AS WELL AS A SOCIAL AND ECONOMIC 4649 03:14:03,265 --> 03:14:03,465 ISSUE. 4650 03:14:03,465 --> 03:14:05,367 ALL RIGHT, LET'S LEAVE IT AT TH. 4651 03:14:05,367 --> 03:14:11,707 THANK YOU VERY MUCH, INDEED. 4652 03:14:11,707 --> 03:14:13,108 I THINK WE'RE GOING TO GET 4653 03:14:13,108 --> 03:14:13,342 STARTED. 4654 03:14:13,342 --> 03:14:14,576 AND THOSE WHO ARE NOT IN THE 4655 03:14:14,576 --> 03:14:17,746 ROOM CAN TRICKLE IN. 4656 03:14:17,746 --> 03:14:19,381 I THINK I SAID THIS BEFORE. 4657 03:14:19,381 --> 03:14:21,517 I'M HOLLY CAMPBELL-ROSEN WORKING 4658 03:14:21,517 --> 03:14:23,385 IN THE CENTER FOR GLOBAL HEALTH 4659 03:14:23,385 --> 03:14:25,587 RESEARCH AT NIMH AND I'M PLEASED 4660 03:14:25,587 --> 03:14:28,524 TO INTRODUCE THIS LAST PLENARY 4661 03:14:28,524 --> 03:14:28,724 PANEL. 4662 03:14:28,724 --> 03:14:31,193 AS YOU KNOW, IT'S ABOUT 4663 03:14:31,193 --> 03:14:34,129 IMPLEMENTATION SCIENCE AND A LOT 4664 03:14:34,129 --> 03:14:36,298 OF THE WORK DONE SHOWN HERE THE 4665 03:14:36,298 --> 03:14:38,233 LAST FEW DAYS IS USING 4666 03:14:38,233 --> 03:14:39,735 IMPLEMENTATION STRATEGIES AND 4667 03:14:39,735 --> 03:14:42,638 APPROACHES AND IS REALLY KEY TO 4668 03:14:42,638 --> 03:14:44,306 ADVANCING THE FIELD. 4669 03:14:44,306 --> 03:14:48,043 I'LL JUST BE BRIEF AND SAY, 4670 03:14:48,043 --> 03:14:48,610 DR. BRIAN PENCE IS THE CHAIR 4671 03:14:48,610 --> 03:14:50,679 HERE AND HE'S A PROFESSOR OF 4672 03:14:50,679 --> 03:14:51,880 EPIDEMIOLOGY AT THE UNIVERSITY 4673 03:14:51,880 --> 03:14:55,584 OF NORTH CAROLINA. 4674 03:14:55,584 --> 03:14:56,585 AND IMPLEMENTATION SCIENCE IS 4675 03:14:56,585 --> 03:15:00,489 JUST ONE OF THE APPROACHES HE 4676 03:15:00,489 --> 03:15:02,391 USES TO UNDERSTAND HOW TO TREAT 4677 03:15:02,391 --> 03:15:05,994 AND SCALE UP MENTAL HEALTH 4678 03:15:05,994 --> 03:15:06,395 INTERVENTIONS. 4679 03:15:06,395 --> 03:15:09,698 I'LL TURN IT OVER TO YOU AND 4680 03:15:09,698 --> 03:15:12,067 HAVE FUN. 4681 03:15:12,067 --> 03:15:12,701 >> DR. BRIAN PENCE: THANK YOU 4682 03:15:12,701 --> 03:15:14,403 VERY MUCH, HOLLY. 4683 03:15:14,403 --> 03:15:15,604 AND DELIGHTED TO BE HERE FOR 4684 03:15:15,604 --> 03:15:17,306 THIS CLOSING SESSION TO BE 4685 03:15:17,306 --> 03:15:20,809 SHARING THE STAGE WITH MY FELLOW 4686 03:15:20,809 --> 03:15:22,110 PANELISTS FOR A CONVERSATION 4687 03:15:22,110 --> 03:15:25,280 ABOUT THE ROLE OF IMPLEMENTATION 4688 03:15:25,280 --> 03:15:27,516 SCIENCE IN GLOBAL MENTAL HEALTH, 4689 03:15:27,516 --> 03:15:28,517 OPPORTUNITIES, PITFALLS AND 4690 03:15:28,517 --> 03:15:29,718 FUTURE DIRECTIONS. 4691 03:15:29,718 --> 03:15:35,223 I'LL JUST TAKE A MOMENT TO 4692 03:15:35,223 --> 03:15:37,426 INTRODUCE THE PEOPLE ON THE 4693 03:15:37,426 --> 03:15:37,693 STAGE. 4694 03:15:37,693 --> 03:15:39,995 WE HAVE DR. PAMELA COLLINS FROM 4695 03:15:39,995 --> 03:15:42,998 JOHNS HOPKINS UNIVERSITY. 4696 03:15:42,998 --> 03:15:44,800 DR. BILL MILLER ALSO FROM THE 4697 03:15:44,800 --> 03:15:46,702 UNIVERSITY OF NORTH 4698 03:15:46,702 --> 03:15:48,003 CAROLINA-CHAPEL HILL. 4699 03:15:48,003 --> 03:15:49,171 DR. VICTOR MWAPASA FROM THE 4700 03:15:49,171 --> 03:15:53,508 UNIVERSITY OF HEALTH SCIENCES IN 4701 03:15:53,508 --> 03:15:54,309 MALAWI. 4702 03:15:54,309 --> 03:15:56,011 DR. SOUMITRA PATHARE FROM THE 4703 03:15:56,011 --> 03:15:56,845 INDIANA LAW SOCIETY. 4704 03:15:56,845 --> 03:15:57,913 THANK YOU VERY MUCH FOR JOINING 4705 03:15:57,913 --> 03:16:00,816 ME FOR THIS CONVERSATION. 4706 03:16:00,816 --> 03:16:02,618 AND I'LL INVITE YOU IN A MOMENT 4707 03:16:02,618 --> 03:16:05,153 AS WE GET INTO OUR CONVERSATION 4708 03:16:05,153 --> 03:16:06,388 TO MAYBE START EACH OF YOUR 4709 03:16:06,388 --> 03:16:12,427 INITIAL RESPONSES WITH A BRIEF 4710 03:16:12,427 --> 03:16:14,196 DISCUSSION OF YOUR ENGAGEMENT IN 4711 03:16:14,196 --> 03:16:16,498 IMPLEMENTATION SCIENCE RESEARCH 4712 03:16:16,498 --> 03:16:18,700 IN YOUR OWN WORK JUST TO 4713 03:16:18,700 --> 03:16:19,801 CONTEXTUALIZE A LITTLE BIT FOR 4714 03:16:19,801 --> 03:16:22,004 OUR AUDIENCE MEMBERS. 4715 03:16:22,004 --> 03:16:24,206 HOW YOU COME TO THIS WORK. 4716 03:16:24,206 --> 03:16:26,208 BUT JUST TO GIVE A FRAMEWORK FOR 4717 03:16:26,208 --> 03:16:29,645 OUR CONVERSATION TODAY, HOPING 4718 03:16:29,645 --> 03:16:33,015 TO BE INFORMAL DISCUSSION AMONG 4719 03:16:33,015 --> 03:16:36,218 US AND ALSO TO ENGAGE OUR 4720 03:16:36,218 --> 03:16:38,920 AUDIENCE MEMBERS. 4721 03:16:38,920 --> 03:16:40,822 THE FOCUS OF THIS DISCUSSION IS 4722 03:16:40,822 --> 03:16:42,824 TO ADDRESS THE QUESTION, HOW CAN 4723 03:16:42,824 --> 03:16:43,592 IMPLEMENTATION SCIENCE MAXIMIZE 4724 03:16:43,592 --> 03:16:47,729 THE IMPACT OF FUNDING DOLLARS ON 4725 03:16:47,729 --> 03:16:50,632 GLOBAL MENTAL HEALTH? 4726 03:16:50,632 --> 03:16:52,034 WHICH WE CAN THINK OF WHAT IS 4727 03:16:52,034 --> 03:16:53,168 THE ROLE OF IMPLEMENTATION 4728 03:16:53,168 --> 03:16:54,970 SCIENCE IN ADVANCING GLOBAL 4729 03:16:54,970 --> 03:16:57,205 MENTAL HEALTH AND WHAT ARE 4730 03:16:57,205 --> 03:16:58,106 PITFALLS AND SPECIAL 4731 03:16:58,106 --> 03:16:59,808 CONSIDERATIONS FOR DOING 4732 03:16:59,808 --> 03:17:01,843 IMPLEMENTATION SCIENCE WELL? 4733 03:17:01,843 --> 03:17:06,815 SO TO UNPACK THIS OVERARCHING 4734 03:17:06,815 --> 03:17:08,717 QUESTION A LITTLE BIT, THE PANEL 4735 03:17:08,717 --> 03:17:10,018 WILL DISCUSS FOUR QUESTIONS. 4736 03:17:10,018 --> 03:17:12,921 WE'LL START BY TALKING ABOUT WHY 4737 03:17:12,921 --> 03:17:13,622 IMPLEMENTATION SCIENCE? 4738 03:17:13,622 --> 03:17:15,924 WHY IS THIS THE RIGHT TOOL AT 4739 03:17:15,924 --> 03:17:19,628 THIS POINT IN OUR RESPONSE TO 4740 03:17:19,628 --> 03:17:22,130 THE GLOBAL MENTAL HEALTH NEEDS? 4741 03:17:22,130 --> 03:17:23,932 WHAT IS THE IMPORTANCE OF 4742 03:17:23,932 --> 03:17:26,401 CONSIDERING CONTEXT IN DOING 4743 03:17:26,401 --> 03:17:27,736 IMPLEMENTATION SCIENCE RESEARCH? 4744 03:17:27,736 --> 03:17:29,571 WHAT ARE SPECIAL CONSIDERATIONS 4745 03:17:29,571 --> 03:17:31,707 IN THE DESIGN AND CONDUCT OF 4746 03:17:31,707 --> 03:17:34,109 IMPLEMENTATION SCIENCE STUDIES 4747 03:17:34,109 --> 03:17:35,811 AND HOW CAN IMPLEMENTATION 4748 03:17:35,811 --> 03:17:39,147 SCIENCE MAXIMIZE ITS IMPACT? 4749 03:17:39,147 --> 03:17:41,750 BUT BEFORE GETTING INTO THOSE 4750 03:17:41,750 --> 03:17:44,119 DISCUSSION QUESTIONS, I JUST 4751 03:17:44,119 --> 03:17:52,027 WANTED TO TAKE A MOMENT TO SET 4752 03:17:52,027 --> 03:17:54,129 SOME COMMON UNDERSTANDING OF 4753 03:17:54,129 --> 03:17:56,898 WHAT DO WE MEAN BY THE TERM, 4754 03:17:56,898 --> 03:17:58,033 IMPLEMENTATION SCIENCE, AN 4755 03:17:58,033 --> 03:17:59,534 APPROACH WHICH GOES BY DIFFERENT 4756 03:17:59,534 --> 03:18:02,204 NAMES AND LABELS IN DIFFERENT 4757 03:18:02,204 --> 03:18:03,939 PARTS OF THE WORLD. 4758 03:18:03,939 --> 03:18:08,076 SO FOR OUR PURPOSES HERE, 4759 03:18:08,076 --> 03:18:12,414 IMPLEMENTATION SCIENCE IS REFERS 4760 03:18:12,414 --> 03:18:13,115 TO SCIENTIFIC RESEARCH. 4761 03:18:13,115 --> 03:18:15,217 THE GOAL IS TO IDENTIFY THE BEST 4762 03:18:15,217 --> 03:18:18,720 WAYS TO SCALE UP PROVEN 4763 03:18:18,720 --> 03:18:19,054 INTERVENTIONS. 4764 03:18:19,054 --> 03:18:21,323 NOT TO ASSESS EFFICACY, BUT TO 4765 03:18:21,323 --> 03:18:22,924 TAKE AS GIVEN THAT THE EFFICACY 4766 03:18:22,924 --> 03:18:25,327 OF A PARTICULAR TREATMENT MODEL 4767 03:18:25,327 --> 03:18:26,328 HAS BEEN ESTABLISHED AND THE 4768 03:18:26,328 --> 03:18:27,529 QUESTION AT HAND IS, HOW TO 4769 03:18:27,529 --> 03:18:29,831 SCALE UP THAT TREATMENT MODEL IN 4770 03:18:29,831 --> 03:18:31,066 A GIVEN CONTEXT. 4771 03:18:31,066 --> 03:18:32,734 AND SO, AS A RESULT, THESE 4772 03:18:32,734 --> 03:18:34,436 RESEARCH STUDIES ARE TYPICALLY 4773 03:18:34,436 --> 03:18:39,141 NOT STUDYING PATIENT'S HEALTH OR 4774 03:18:39,141 --> 03:18:40,842 PATIENTS THEMSELVES AS THE 4775 03:18:40,842 --> 03:18:43,645 PRIMARY UNIT OF ANALYSIS, 4776 03:18:43,645 --> 03:18:46,114 MEASUREMENT, RANDOMIZATION; BUT 4777 03:18:46,114 --> 03:18:47,783 RATHER ARE TYPICALLY STUDYING 4778 03:18:47,783 --> 03:18:51,753 STAFF, CLINICS, HEALTH SYSTEMS, 4779 03:18:51,753 --> 03:18:53,155 INTERVENTIONS ON STAFF AND 4780 03:18:53,155 --> 03:18:54,890 CLINICS OR HEALTH SYSTEMS. 4781 03:18:54,890 --> 03:18:56,691 IMPLEMENTATION STRATEGIES AT 4782 03:18:56,691 --> 03:18:58,093 THESE LEVELS THAT WE HOPE LEAD 4783 03:18:58,093 --> 03:18:59,761 TO BETTER IMPLEMENTATION. 4784 03:18:59,761 --> 03:19:00,662 TYPICALLY, THESE RESEARCH 4785 03:19:00,662 --> 03:19:02,564 STUDIES ARE NOT FOCUSING ON 4786 03:19:02,564 --> 03:19:05,367 PATIENT HEALTH AS THE PRIMARY 4787 03:19:05,367 --> 03:19:07,769 OUTCOME BUT RATHER FOCUSING ON 4788 03:19:07,769 --> 03:19:10,572 FIDELITY OF THE EVIDENCE-BASED 4789 03:19:10,572 --> 03:19:12,974 TREATMENT MODEL DELIVERY OR 4790 03:19:12,974 --> 03:19:16,678 ADOPTION OF EVIDENCE-BASED 4791 03:19:16,678 --> 03:19:18,079 TREATMENT INTERVENTIONS WITHIN 4792 03:19:18,079 --> 03:19:20,882 THE HEALTH CONTEXT. 4793 03:19:20,882 --> 03:19:22,784 SO, PATIENT HEALTH OUTCOMES MAY 4794 03:19:22,784 --> 03:19:24,653 STILL BE MEASURED AS A 4795 03:19:24,653 --> 03:19:26,054 DOWNSTREAM IMPACT OF ACHIEVING 4796 03:19:26,054 --> 03:19:28,623 HIGHER FIDELITY, ACHIEVING 4797 03:19:28,623 --> 03:19:29,457 IMPLEMENTATION BUT THEY AREN'T 4798 03:19:29,457 --> 03:19:30,859 THE PRIMARY FOCUS. 4799 03:19:30,859 --> 03:19:33,061 AS A RESULT, IF WE ARE STUDYING 4800 03:19:33,061 --> 03:19:35,063 STAFF OR CLINICS OR HEALTH 4801 03:19:35,063 --> 03:19:36,565 SYSTEMS, WE ARE USUALLY 4802 03:19:36,565 --> 03:19:38,667 CONSTRAINED FROM THE PERSPECTIVE 4803 03:19:38,667 --> 03:19:40,168 OF SAMPLE SIZE THE WAY WE 4804 03:19:40,168 --> 03:19:41,870 USUALLY THINK ABOUT THAT 4805 03:19:41,870 --> 03:19:42,204 STATISTICALLY. 4806 03:19:42,204 --> 03:19:43,672 WE MIGHT JUST PRAGMATICALLY 4807 03:19:43,672 --> 03:19:47,175 REALLY ONLY BE ABLE TO WORK WITH 4808 03:19:47,175 --> 03:19:49,878 20 HEALTH DISTRICTS OR 12 HEALTH 4809 03:19:49,878 --> 03:19:52,380 FACILITIES OR A CERTAIN NUMBER 4810 03:19:52,380 --> 03:19:54,983 OF STAFF, RATHER THAN THE POWER 4811 03:19:54,983 --> 03:19:57,185 OF CALCULATION USED FOR 4812 03:19:57,185 --> 03:19:58,487 INDIVIDUALLY-POWERED TRIALS. 4813 03:19:58,487 --> 03:20:00,121 AND THIS TYPICALLY INVOLVES 4814 03:20:00,121 --> 03:20:01,489 SPECIALIZED STATISTICAL METHODS 4815 03:20:01,489 --> 03:20:03,191 TO ADDRESS CLUSTERING AND SMALL 4816 03:20:03,191 --> 03:20:04,593 SAMPLE SIZES. 4817 03:20:04,593 --> 03:20:06,161 SO, THESE ARE -- THIS IS THE 4818 03:20:06,161 --> 03:20:09,164 CONTEXT OF WHAT WE ARE TALKING 4819 03:20:09,164 --> 03:20:11,299 ABOUT IN THIS PANEL, AND IN THIS 4820 03:20:11,299 --> 03:20:13,902 CONTEXT, I'M GOING TO TURN TO MY 4821 03:20:13,902 --> 03:20:16,771 PANEL AND ASK MY OPENING 4822 03:20:16,771 --> 03:20:19,975 QUESTION WHICH IS, WHY 4823 03:20:19,975 --> 03:20:20,475 IMPLEMENTATION SCIENCE? 4824 03:20:20,475 --> 03:20:23,178 SO WHY IS IMPLEMENTATION SCIENCE 4825 03:20:23,178 --> 03:20:25,981 AN IMPORTANT TOOL FOR MOVING THE 4826 03:20:25,981 --> 03:20:27,582 GLOBAL MENTAL HEALTH FIELDS 4827 03:20:27,582 --> 03:20:30,385 FURTHER TOWARDS MAXIMIZING 4828 03:20:30,385 --> 03:20:31,453 IMPACT? 4829 03:20:31,453 --> 03:20:32,187 AND DR. COLLINS, I'LL TURN THE 4830 03:20:32,187 --> 03:20:33,188 QUESTION FIRST TO YOU. 4831 03:20:33,188 --> 03:20:34,856 IF YOU WILL JUST TAKE A MOMENT 4832 03:20:34,856 --> 03:20:37,292 TO TALK ABOUT YOUR ENGAGEMENT IN 4833 03:20:37,292 --> 03:20:38,193 IMPLEMENTATION SCIENCE RESEARCH 4834 03:20:38,193 --> 03:20:41,329 AS YOU LEAD INTO YOUR ANSWER. 4835 03:20:41,329 --> 03:20:44,900 >> THANK YOU, BRIAN. 4836 03:20:44,900 --> 03:20:46,868 SO MY RESEARCH TRAINING REALLY 4837 03:20:46,868 --> 03:20:48,670 BEGAN WITH INTERVENTION 4838 03:20:48,670 --> 03:20:49,304 RESEARCH. 4839 03:20:49,304 --> 03:20:51,506 SO, DEVELOPING INTERVENTIONS IN 4840 03:20:51,506 --> 03:20:54,175 MY CASE, FOCUSED ON HIV 4841 03:20:54,175 --> 03:20:55,977 PREVENTION AMONG PEOPLE LIVING 4842 03:20:55,977 --> 03:20:58,013 WITH SERIOUS MENTAL ILLNESS. 4843 03:20:58,013 --> 03:20:59,381 DEVELOPING INTERVENTIONS, 4844 03:20:59,381 --> 03:21:00,782 TESTING THOSE INTERVENTIONS, 4845 03:21:00,782 --> 03:21:02,484 DOING THE EFFICACY AND THEN 4846 03:21:02,484 --> 03:21:04,185 HOPEFULLY EFFECTIVENESS STUDIES 4847 03:21:04,185 --> 03:21:05,787 THAT BRIAN IS REFERRING TO. 4848 03:21:05,787 --> 03:21:10,191 IT REALLY WASN'T UNTIL I MOVED 4849 03:21:10,191 --> 03:21:11,293 OUT OF THE UNIVERSITY AND CAME 4850 03:21:11,293 --> 03:21:14,596 HERE TO NIMH FOR EIGHT YEARS, 4851 03:21:14,596 --> 03:21:17,999 THAT I BEGAN TO REALLY 4852 03:21:17,999 --> 03:21:18,900 UNDERSTAND IMPLEMENTATION 4853 03:21:18,900 --> 03:21:20,402 SCIENCE AND THE VALUE OF IT. 4854 03:21:20,402 --> 03:21:22,203 AND THAT BEING THE NEXT STEP 4855 03:21:22,203 --> 03:21:23,705 AFTER EFFECTIVENESS RESEARCH. 4856 03:21:23,705 --> 03:21:25,974 HOW DO WE TAKE THINGS TO SCALE? 4857 03:21:25,974 --> 03:21:28,777 SO, LOOKING AT IT MORE FROM THE 4858 03:21:28,777 --> 03:21:30,312 KIND OF SCIENCE POLICY 4859 03:21:30,312 --> 03:21:31,746 PERSPECTIVE THAN ACTUALLY FROM 4860 03:21:31,746 --> 03:21:33,615 THE RESEARCHER PERSPECTIVE, 4861 03:21:33,615 --> 03:21:34,983 FIRST OF ALL. 4862 03:21:34,983 --> 03:21:38,086 BUT SINCE THAT TIME, I'VE BEEN 4863 03:21:38,086 --> 03:21:40,188 INVOLVED IN -- BACK TO ACADEMIA 4864 03:21:40,188 --> 03:21:41,990 AND IMPLEMENTATION SCIENCE IS A 4865 03:21:41,990 --> 03:21:43,692 REAL PRIORITY AND NOW INVOLVED 4866 03:21:43,692 --> 03:21:45,026 IN IMPLEMENTATION SCIENCE 4867 03:21:45,026 --> 03:21:47,095 STUDIES FOCUSING ON -- WE HAVE A 4868 03:21:47,095 --> 03:21:49,397 STUDY FOCUSED ON ADOLESCENTS 4869 03:21:49,397 --> 03:21:52,200 LIVING WITH HIV AND INTEGRATING 4870 03:21:52,200 --> 03:21:54,402 PSYCHOLOGICAL INTERVENTIONS INTO 4871 03:21:54,402 --> 03:21:55,203 REAL-WORLD HIV CARE. 4872 03:21:55,203 --> 03:21:59,207 I THINK ONE OF MY CO-PIs IS IN 4873 03:21:59,207 --> 03:22:01,309 THE AUDIENCE HERE. 4874 03:22:01,309 --> 03:22:02,744 THAT'S MY BACKGROUND IN HOW I 4875 03:22:02,744 --> 03:22:03,612 COME TO THIS. 4876 03:22:03,612 --> 03:22:05,413 AND THE OTHER WAY I COME TO THIS 4877 03:22:05,413 --> 03:22:07,916 IS WHAT I'M GOING TO TALK ABOUT 4878 03:22:07,916 --> 03:22:09,484 NOW, WHICH IS THAT, I WAS 4879 03:22:09,484 --> 03:22:10,719 THINKING OF HOW TO ANSWER THIS 4880 03:22:10,719 --> 03:22:12,320 QUESTION AND I THOUGHT, WOW, CAN 4881 03:22:12,320 --> 03:22:15,623 YOU ACTUALLY IMAGINE COMMUNITIES 4882 03:22:15,623 --> 03:22:19,761 OF HEALTH SYSTEMS THAT CAN 4883 03:22:19,761 --> 03:22:22,864 SUSTAINIBLY DELIVER ACCESSIBLE, 4884 03:22:22,864 --> 03:22:23,898 QUALITY, PREVENTIVE AND 4885 03:22:23,898 --> 03:22:25,500 TREATMENT INTERVENTIONS THAT ARE 4886 03:22:25,500 --> 03:22:27,335 BASED ON THE BEST AVAILABLE 4887 03:22:27,335 --> 03:22:29,104 EVIDENCE FOR THE DIVERSITY OF 4888 03:22:29,104 --> 03:22:32,007 PEOPLE IN YOUR CONTEXT, WHO NEED 4889 03:22:32,007 --> 03:22:33,108 THE CARE? 4890 03:22:33,108 --> 03:22:35,410 AND IF YOU LET THAT VISION OF 4891 03:22:35,410 --> 03:22:37,812 WHAT THAT LOOKS LIKE SIT WITH 4892 03:22:37,812 --> 03:22:39,914 YOU, YOU REALIZE THAT THOSE ARE 4893 03:22:39,914 --> 03:22:40,582 IMPLEMENTATION SCIENCE 4894 03:22:40,582 --> 03:22:40,849 QUESTIONS. 4895 03:22:40,849 --> 03:22:41,916 HOW DO WE GET THERE? 4896 03:22:41,916 --> 03:22:44,419 THIS IS WHAT WE ALL ARE ASPIRING 4897 03:22:44,419 --> 03:22:44,586 FOR. 4898 03:22:44,586 --> 03:22:46,021 HOW DO WE GET THERE. 4899 03:22:46,021 --> 03:22:47,022 WE HAVE INTERVENTIONS THAT WORK 4900 03:22:47,022 --> 03:22:49,224 BUT WE STILL HAVE SIGNIFICANT 4901 03:22:49,224 --> 03:22:51,426 DISPARITIES AND UPTAKE IN 4902 03:22:51,426 --> 03:22:52,594 UTILIZATION OF MENTAL HEALTH 4903 03:22:52,594 --> 03:22:54,529 INTERVENTIONS AND THESE ARE 4904 03:22:54,529 --> 03:22:56,831 APPARENT BY AGE, BY ETHNICITY, 4905 03:22:56,831 --> 03:22:57,732 BY GENDER. 4906 03:22:57,732 --> 03:23:00,001 OTHER DOMAINS DEPENDING ON WHERE 4907 03:23:00,001 --> 03:23:01,302 YOU ARE. 4908 03:23:01,302 --> 03:23:03,638 SO IMPLEMENTATION SCIENCE SHOULD 4909 03:23:03,638 --> 03:23:05,206 HELP GUIDE US TO THE SMARTEST 4910 03:23:05,206 --> 03:23:06,908 WAYS TO TRANSLATE WHAT WE KNOW 4911 03:23:06,908 --> 03:23:08,943 ABOUT THE NEEDS OF POPULATIONS, 4912 03:23:08,943 --> 03:23:11,713 WHAT WE KNOW ABOUT SYSTEMS, TO 4913 03:23:11,713 --> 03:23:13,348 BE ABLE TO ACHIEVE THIS GOAL. 4914 03:23:13,348 --> 03:23:15,216 SO I'M GOING TO TALK ABOUT -- 4915 03:23:15,216 --> 03:23:16,451 AND I THINK IN PARTICULAR, MAYBE 4916 03:23:16,451 --> 03:23:18,720 ONE OF THE BIG CHALLENGES OF 4917 03:23:18,720 --> 03:23:19,421 IMPLEMENTATION SCIENCE IS 4918 03:23:19,421 --> 03:23:20,989 FIGURING OUT HOW TO DO THAT WITH 4919 03:23:20,989 --> 03:23:22,524 SOME OF THE MOST VULNERABLE 4920 03:23:22,524 --> 03:23:22,991 POPULATIONS. 4921 03:23:22,991 --> 03:23:24,225 I'M GOING TO TALK ABOUT MY 4922 03:23:24,225 --> 03:23:25,026 EXPERIENCE WORKING WITH ONE OF 4923 03:23:25,026 --> 03:23:26,261 THOSE VULNERABLE POPULATIONS, 4924 03:23:26,261 --> 03:23:31,733 WHICH IS PEOPLE LIVING WITH HIV. 4925 03:23:31,733 --> 03:23:33,034 THE GOOD NEWS IS THAT THIS IS A 4926 03:23:33,034 --> 03:23:34,736 COMMUNITY THAT IS INCREASINGLY 4927 03:23:34,736 --> 03:23:35,470 RECEIVING ACCESS TO MENTAL 4928 03:23:35,470 --> 03:23:39,441 HEALTH SERVICES, IMPORTANT GIVEN 4929 03:23:39,441 --> 03:23:41,910 THE RISK THAT PEOPLE LIVING WITH 4930 03:23:41,910 --> 03:23:43,244 HIV HAVE FOR MENTAL HEALTH 4931 03:23:43,244 --> 03:23:44,913 CONDITIONS, AS A RESULT OF THE 4932 03:23:44,913 --> 03:23:46,648 LIVING WITH A CHRONIC DISEASE, 4933 03:23:46,648 --> 03:23:48,016 AS THE RESULT OF THE EFFECTS OF 4934 03:23:48,016 --> 03:23:50,552 THE VIRUS ON THE BRAIN, AS A 4935 03:23:50,552 --> 03:23:54,489 RESULT OF MANAGING THE KINDS OF 4936 03:23:54,489 --> 03:23:55,190 SOCIAL STRESSORS AND SOCIAL 4937 03:23:55,190 --> 03:23:58,059 CONTEXT THAT PUT PEOPLE AT RISK. 4938 03:23:58,059 --> 03:24:00,161 SO, THERE IS A CLEAR NEED. 4939 03:24:00,161 --> 03:24:01,362 AND FRONT LINE HIV RESEARCHERS 4940 03:24:01,362 --> 03:24:02,964 HAVE KNOWN FOR MANY, MANY YEARS 4941 03:24:02,964 --> 03:24:04,866 THAT PEOPLE WHO ARE RECEIVING 4942 03:24:04,866 --> 03:24:06,968 NEWS OF HIV TEST, FOR MANAGING 4943 03:24:06,968 --> 03:24:09,671 LIFE WITH A STIGMATIZING 4944 03:24:09,671 --> 03:24:11,372 CONDITION, REQUIRES STRONG 4945 03:24:11,372 --> 03:24:12,273 SOCIAL SUPPORT AND OFTEN SUPPORT 4946 03:24:12,273 --> 03:24:12,974 FOR MENTAL HEALTH. 4947 03:24:12,974 --> 03:24:15,009 AND THOSE FOLKS IN THESE CLINICS 4948 03:24:15,009 --> 03:24:16,578 AT THE FRONT LINE HAVE OFTEN 4949 03:24:16,578 --> 03:24:18,980 SAID, WE DON'T HAVE THE SKILLS 4950 03:24:18,980 --> 03:24:20,081 TO DELIVER MENTAL HEALTH 4951 03:24:20,081 --> 03:24:20,615 INTERVENTIONS. 4952 03:24:20,615 --> 03:24:21,850 WE KNOW OUR PATIENTS NEED THIS 4953 03:24:21,850 --> 03:24:23,485 BUT WE DON'T KNOW HOW TO DO 4954 03:24:23,485 --> 03:24:23,751 THIS. 4955 03:24:23,751 --> 03:24:26,387 OVER THE LAST DECADES WE 4956 03:24:26,387 --> 03:24:27,655 ACCUMULATED GOOD EVIDENCE FOR 4957 03:24:27,655 --> 03:24:30,191 WHY IT'S IMPORTANT TO TAKE CARE 4958 03:24:30,191 --> 03:24:31,759 OF PEOPLE'S MENTAL HEALTH NEEDS 4959 03:24:31,759 --> 03:24:32,694 AROUND HIV. 4960 03:24:32,694 --> 03:24:34,262 PEOPLE WHO NEED MENTAL HEALTH 4961 03:24:34,262 --> 03:24:36,664 SERVICES NEED MENTAL HEALTH 4962 03:24:36,664 --> 03:24:36,965 SERVICES. 4963 03:24:36,965 --> 03:24:38,967 AND PEOPLE HAVE ALSO RECOGNIZED, 4964 03:24:38,967 --> 03:24:40,168 WOW, WHEN YOU'RE MANAGING TWO 4965 03:24:40,168 --> 03:24:41,469 DIFFERENT CONDITIONS, YOU REALLY 4966 03:24:41,469 --> 03:24:42,570 HAVE TO TREAT BOTH BECAUSE YOU 4967 03:24:42,570 --> 03:24:44,973 CAN'T REALLY BE SUCCESSFUL IF 4968 03:24:44,973 --> 03:24:47,275 YOU DON'T TREAT BOTH. 4969 03:24:47,275 --> 03:24:48,977 AND DUE TO THE EVIDENCE, DUE TO 4970 03:24:48,977 --> 03:24:52,280 THE ROBUST ADVOCACY NEED FOR 4971 03:24:52,280 --> 03:24:54,682 INTEGRATING CARE, WE HAVE 4972 03:24:54,682 --> 03:24:56,851 ACHIEVED A VICTORY AND THAT IS 4973 03:24:56,851 --> 03:25:00,855 THAT FUNDERS LIKE THE 4974 03:25:00,855 --> 03:25:01,456 PRESIDENT'S EMERGENCY PLAN FOR 4975 03:25:01,456 --> 03:25:02,657 AIDES RELIEF AND MOST RECENTLY 4976 03:25:02,657 --> 03:25:05,193 THE GLOBAL FUND, ARE NOW FUNDING 4977 03:25:05,193 --> 03:25:07,095 THE IMPLEMENTATION OF MENTAL 4978 03:25:07,095 --> 03:25:09,197 HEALTH INTERVENTIONS IN 4979 03:25:09,197 --> 03:25:10,999 REAL-WORLD HIV CARE. 4980 03:25:10,999 --> 03:25:13,701 AND SO, THE IMPLEMENTATION IS 4981 03:25:13,701 --> 03:25:15,770 HAPPENING OFTEN WITHOUT THE 4982 03:25:15,770 --> 03:25:16,804 IMPLEMENTATION SCIENCE 4983 03:25:16,804 --> 03:25:17,772 ACCOMPANYING IT. 4984 03:25:17,772 --> 03:25:20,108 AND IMPLEMENTATION IS COMPLEX. 4985 03:25:20,108 --> 03:25:21,876 SO I'M GOING TO POSE SOME 4986 03:25:21,876 --> 03:25:23,878 QUESTIONS THAT MY COLLEAGUES AND 4987 03:25:23,878 --> 03:25:25,180 I HAVE CONSIDERED IN THE CONTEXT 4988 03:25:25,180 --> 03:25:26,981 OF REAL-WORLD IMPLEMENTATION AND 4989 03:25:26,981 --> 03:25:29,184 I'LL SPEAK FROM MY RECENT 4990 03:25:29,184 --> 03:25:33,154 EXPERIENCES AS THE FORMER 4991 03:25:33,154 --> 03:25:33,755 EXECUTIVE DIRECTOR OF ITECH, A 4992 03:25:33,755 --> 03:25:34,822 PEPFAR IMPLEMENTING PARTNER 4993 03:25:34,822 --> 03:25:36,591 BASED AT THE UNIVERSITY OF 4994 03:25:36,591 --> 03:25:37,158 WASHINGTON. 4995 03:25:37,158 --> 03:25:39,494 AND I HOPE THAT ALL OF YOU CAN 4996 03:25:39,494 --> 03:25:40,795 HELP ANSWER SOME OF THESE 4997 03:25:40,795 --> 03:25:43,698 QUESTIONS AS WE HAVE THIS 4998 03:25:43,698 --> 03:25:44,866 CONVERSATION. 4999 03:25:44,866 --> 03:25:46,000 BUT, WHAT HAPPENS WHEN YOU TAKE 5000 03:25:46,000 --> 03:25:47,869 AN INTERVENTION THAT WE KNOW 5001 03:25:47,869 --> 03:25:50,171 WORKS AND THEN MOVE IT INTO THE 5002 03:25:50,171 --> 03:25:50,672 REAL WORLD? 5003 03:25:50,672 --> 03:25:52,307 MANY OF YOU HAVE ANSWERS TO 5004 03:25:52,307 --> 03:25:52,507 THAT. 5005 03:25:52,507 --> 03:25:54,676 BUT IF WE JUST THINK ABOUT 5006 03:25:54,676 --> 03:25:55,910 PSYCHOLOGICAL INTERVENTIONS FOR 5007 03:25:55,910 --> 03:25:57,712 PEOPLE LIVING WITH HIV, SOME OF 5008 03:25:57,712 --> 03:25:59,214 THE QUESTIONS THAT COME UP ARE, 5009 03:25:59,214 --> 03:26:01,182 WHAT ARE THE BEST DELIVERY 5010 03:26:01,182 --> 03:26:03,418 MODELS FOR AN EVIDENCE-BASED 5011 03:26:03,418 --> 03:26:04,052 PSYCHOLOGICAL INTERVENTION IN 5012 03:26:04,052 --> 03:26:06,588 HIV SERVICES WHEN WEEKLY 5013 03:26:06,588 --> 03:26:08,723 ATTENDANCE IS NOT THE ROUTINE, 5014 03:26:08,723 --> 03:26:09,857 NOT OFTEN ACCEPTABLE OR FEASIBLE 5015 03:26:09,857 --> 03:26:11,693 FOR PEOPLE WHO ARE RECEIVING 5016 03:26:11,693 --> 03:26:13,528 CARE AND YET THAT'S THE WAY 5017 03:26:13,528 --> 03:26:14,596 PEOPLE HAVE BEEN TRAINED TO 5018 03:26:14,596 --> 03:26:16,598 DELIVER THE INTERVENTION. 5019 03:26:16,598 --> 03:26:18,566 IN REAL WORLD IMPLEMENTATION, 5020 03:26:18,566 --> 03:26:19,901 INTERVENTION ADAPTATION DOESN'T 5021 03:26:19,901 --> 03:26:22,503 ALWAYS OCCUR UNDER THE GUIDANCE 5022 03:26:22,503 --> 03:26:24,305 OF THE RESEARCHERS, SCIENTISTS 5023 03:26:24,305 --> 03:26:26,107 WHO DEVELOPED THE INTERVENTION. 5024 03:26:26,107 --> 03:26:29,978 SO, WHAT KIND OF GUIDANCE DO 5025 03:26:29,978 --> 03:26:30,912 NON-SPECIALISTS PUBLIC HEALTH 5026 03:26:30,912 --> 03:26:33,414 PROFESSIONALS NEED TO ADAPT SUCH 5027 03:26:33,414 --> 03:26:34,482 AN INTERVENTION WHILE PRESERVING 5028 03:26:34,482 --> 03:26:36,951 THE ACTIVE INGREDIENTS? 5029 03:26:36,951 --> 03:26:38,753 HOW CAN SUPERVISION THAT 5030 03:26:38,753 --> 03:26:40,588 MAINTAINS FIDELITY AND QUALITY 5031 03:26:40,588 --> 03:26:43,224 BE YOU IS STAINABLY INTEGRATED 5032 03:26:43,224 --> 03:26:44,859 INTO ROUTINE PRACTICE SETTINGS 5033 03:26:44,859 --> 03:26:47,395 IN THE CONTEXT OF A BUSY HIV 5034 03:26:47,395 --> 03:26:47,695 CLINIC. 5035 03:26:47,695 --> 03:26:49,464 AND THEN HOW DOES IMPLEMENTATION 5036 03:26:49,464 --> 03:26:52,567 SCIENCE TACKLE THE COMPLEXITIES 5037 03:26:52,567 --> 03:26:53,334 OF CONTEXT THAT EFFECTS 5038 03:26:53,334 --> 03:26:56,104 STRATEGIES FOR 5039 03:26:56,104 --> 03:26:56,904 REAL-WORLDIVEITATION. 5040 03:26:56,904 --> 03:26:59,007 IN A NATION WILD IMPLEMENTATION, 5041 03:26:59,007 --> 03:27:01,409 SOME MAY BE IN CONFLICT. 5042 03:27:01,409 --> 03:27:03,144 IN DECENTRALIZED GOVERNMENTS 5043 03:27:03,144 --> 03:27:05,747 DIFFERENT PROVINCES MAY HAVE 5044 03:27:05,747 --> 03:27:06,381 DIFFERENT MENTAL HEALTH BUDGETS 5045 03:27:06,381 --> 03:27:07,315 AND THEREFORE THIS IS GOING TO 5046 03:27:07,315 --> 03:27:09,017 EFFECT HOW YOU ULTIMATELY 5047 03:27:09,017 --> 03:27:09,817 IMPLEMENT YOUR MENTAL HEALTH 5048 03:27:09,817 --> 03:27:13,321 SERVICES ESPECIALLY WHEN MENTAL 5049 03:27:13,321 --> 03:27:15,590 HEALTH CARE OUTSIDE OF HIV CARE 5050 03:27:15,590 --> 03:27:16,491 MAY NOT BE AVAILABLE. 5051 03:27:16,491 --> 03:27:18,893 SO THESE ARE A FEW OF THE KINDS 5052 03:27:18,893 --> 03:27:22,797 OF QUESTIONS THAT ARISE IN 5053 03:27:22,797 --> 03:27:23,731 REAL-WORLD IMPLEMENTATION BUT 5054 03:27:23,731 --> 03:27:25,533 THAT ARE THE KINDS OF QUESTIONS 5055 03:27:25,533 --> 03:27:28,303 ALSO THAT IMPLEMENTATION SCIENCE 5056 03:27:28,303 --> 03:27:31,873 IS PREPARED TO ADDRESS. 5057 03:27:31,873 --> 03:27:34,309 >> THANK YOU VERY MUCH, 5058 03:27:34,309 --> 03:27:36,411 DR. COLLINS, FOR YOUR INITIAL 5059 03:27:36,411 --> 03:27:39,414 THOUGHTS AND QUESTIONS. 5060 03:27:39,414 --> 03:27:42,417 DR. MILLER, CAN I INVITE YOU TO 5061 03:27:42,417 --> 03:27:43,518 BRIEFLY DESCRIBE YOUR ENGAGEMENT 5062 03:27:43,518 --> 03:27:45,420 IN THIS SPACE AND WHAT ARE YOUR 5063 03:27:45,420 --> 03:27:46,421 THOUGHTS ON WHY IS 5064 03:27:46,421 --> 03:27:47,622 IMPLEMENTATION SCIENCE THE RIGHT 5065 03:27:47,622 --> 03:27:49,223 TOOL RIGHT NOW? 5066 03:27:49,223 --> 03:27:50,792 >> SURE, THANK YOU. 5067 03:27:50,792 --> 03:27:53,528 SO, AS BRIAN MENTIONED, I'M AN 5068 03:27:53,528 --> 03:27:55,830 INFECTIOUS DISEASES 5069 03:27:55,830 --> 03:27:57,332 EPIDEMIOLOGIST AND TRAINED AS AN 5070 03:27:57,332 --> 03:28:00,935 INFERS DISEASES PHYSICIAN AND 5071 03:28:00,935 --> 03:28:03,004 FOR MUCH OF THE EARLY PART OF MY 5072 03:28:03,004 --> 03:28:06,140 CAREER, I DID A LOT OF WORK WITH 5073 03:28:06,140 --> 03:28:08,009 LOCAL HEALTH DEPARTMENTS, STATE 5074 03:28:08,009 --> 03:28:10,011 HEALTH DEPARTMENTS AND THE CDC 5075 03:28:10,011 --> 03:28:12,714 TRYING TO DO THINGS LIKE FIGURE 5076 03:28:12,714 --> 03:28:16,017 OUT WAYS TO ESTIMATE THINGS LIKE 5077 03:28:16,017 --> 03:28:18,720 CHLAMYDIA PREVALENCE BETTER THAN 5078 03:28:18,720 --> 03:28:20,321 WITH THE INFORMATION THEY HAD 5079 03:28:20,321 --> 03:28:20,588 AVAILABLE. 5080 03:28:20,588 --> 03:28:22,824 AND OVER TIME, I ALSO BEGAN SORT 5081 03:28:22,824 --> 03:28:25,026 OF DOING MORE INTERVENTION WORK 5082 03:28:25,026 --> 03:28:27,996 AND I WAS FORTUNATE TO BE THE 5083 03:28:27,996 --> 03:28:33,201 PROTOCOL CHAIR OF A LARGE STUDY 5084 03:28:33,201 --> 03:28:33,568 CALLED HBTN074. 5085 03:28:33,568 --> 03:28:37,305 HIV PREVENTION TRIALS NETWORK. 5086 03:28:37,305 --> 03:28:37,472 074. 5087 03:28:37,472 --> 03:28:39,140 IT WAS CONDUCTED IN THREE 5088 03:28:39,140 --> 03:28:41,876 COUNTRIES, VIETNAM, INDONESIA 5089 03:28:41,876 --> 03:28:42,977 AND UKRAINE. 5090 03:28:42,977 --> 03:28:46,514 IT WAS A STUDY AMONG -- FOR 5091 03:28:46,514 --> 03:28:48,916 PEOPLE WHO INJECT DRUGS. 5092 03:28:48,916 --> 03:28:51,619 ESSENTIALLY THOSE WHO WERE NEWLY 5093 03:28:51,619 --> 03:28:54,822 DIAGNOSED OR WHO WERE NOT IN HIV 5094 03:28:54,822 --> 03:28:55,023 CARE. 5095 03:28:55,023 --> 03:28:59,127 AND IT WAS A FAIRLY SIMPLE 5096 03:28:59,127 --> 03:29:01,662 INTERVENTION OF SYSTEMS 5097 03:29:01,662 --> 03:29:03,598 NAVIGATION, WHICH WAS JUST TWO 5098 03:29:03,598 --> 03:29:05,466 SESSIONS, AND THEN PSYCHOSOCIAL 5099 03:29:05,466 --> 03:29:06,968 COUNSELING WHICH WAS ALSO TWO 5100 03:29:06,968 --> 03:29:09,570 SESSIONS WITH A FOCUS ON 5101 03:29:09,570 --> 03:29:11,639 PROBLEM-SOLVING AND ESSENTIALLY 5102 03:29:11,639 --> 03:29:13,041 HELPING THEM UNDERSTAND WHAT IT 5103 03:29:13,041 --> 03:29:16,677 WAS GOING TO TAKE TO TAKE THEIR 5104 03:29:16,677 --> 03:29:17,745 ANTI-RETROVIRAL THERAPY. 5105 03:29:17,745 --> 03:29:20,948 THAT STUDY, WHICH WAS INTENDED 5106 03:29:20,948 --> 03:29:24,252 ACTUALLY TO BE A GIANT PILOT 5107 03:29:24,252 --> 03:29:29,357 STUDY, WAS EXTREMELY SUCCESSFUL. 5108 03:29:29,357 --> 03:29:35,263 AND DOUBLED THE RATE OF ART USE, 5109 03:29:35,263 --> 03:29:36,764 REDUCED VIRAL SUPPRESSION OR 5110 03:29:36,764 --> 03:29:39,167 INCREASED VIRAL SUPPRESSION BY 5111 03:29:39,167 --> 03:29:43,237 TWO FOLD, AND SORT OF 5112 03:29:43,237 --> 03:29:44,472 DRAMATICALLY REDUCED DEATH BY 5113 03:29:44,472 --> 03:29:45,273 TWO FOLD. 5114 03:29:45,273 --> 03:29:49,177 AND IT WAS A STUDY THAT NIAID 5115 03:29:49,177 --> 03:29:51,746 DECIDED WAS SO SIGNIFICANT THAT 5116 03:29:51,746 --> 03:29:53,548 THEY COULDN'T -- THAT THEY 5117 03:29:53,548 --> 03:29:55,283 OFFERED THE INTERVENTION TO THE 5118 03:29:55,283 --> 03:29:56,884 REST OF THE PEOPLE THAT HADN'T 5119 03:29:56,884 --> 03:29:59,754 RECEIVED IT, THE CONTROL ARM. 5120 03:29:59,754 --> 03:30:01,756 AND SO, WE LOOKED AT THIS THE 5121 03:30:01,756 --> 03:30:04,358 STUDY AND WE'RE LIKE, THIS 5122 03:30:04,358 --> 03:30:05,193 REALLY WORKS. 5123 03:30:05,193 --> 03:30:07,995 WE CAN'T JUST LEAVE IT HERE. 5124 03:30:07,995 --> 03:30:10,865 SO WE DESIGNED AN IMPLEMENTATION 5125 03:30:10,865 --> 03:30:14,769 SCIENCE TRIAL IN VIETNAM. 5126 03:30:14,769 --> 03:30:16,204 I KNOW DIDDLEY ABOUT 5127 03:30:16,204 --> 03:30:17,505 IMPLEMENTATION SCIENCE. 5128 03:30:17,505 --> 03:30:19,240 AND I SURROUNDED MYSELF WITH 5129 03:30:19,240 --> 03:30:21,742 PEOPLE THAT DID. 5130 03:30:21,742 --> 03:30:23,945 AND WE'RE NOW IN THE MIDST OF 5131 03:30:23,945 --> 03:30:26,547 JUST FINISHING UP A TRIAL THAT 5132 03:30:26,547 --> 03:30:28,983 HAS TAKEN FIVE YEARS AND 42 5133 03:30:28,983 --> 03:30:31,085 CLINICS IN VIETNAM. 5134 03:30:31,085 --> 03:30:33,754 WE HAVEN'T BROKEN THE CODE YET. 5135 03:30:33,754 --> 03:30:35,756 SO I CAN'T TELL YOU THE RESULTS. 5136 03:30:35,756 --> 03:30:37,291 I CAN TELL THAT YOU SOMETHING 5137 03:30:37,291 --> 03:30:37,525 WORKED. 5138 03:30:37,525 --> 03:30:40,461 I DON'T KNOW WHICH ONE FOR SURE, 5139 03:30:40,461 --> 03:30:42,864 BUT SOMETHING WORKED QUITE WELL. 5140 03:30:42,864 --> 03:30:46,467 AND IT JUST WAS REALLY CLEAR TO 5141 03:30:46,467 --> 03:30:48,569 ME THAT WE NEED TO THINK ABOUT 5142 03:30:48,569 --> 03:30:49,670 WHEN WE'RE RIGHT FROM THE START 5143 03:30:49,670 --> 03:30:52,073 OF DESIGNING THE INTERVENTION, 5144 03:30:52,073 --> 03:30:53,574 HOW IS THIS ACTUALLY GOING TO 5145 03:30:53,574 --> 03:30:57,178 PLAY OUT IN THE REAL WORLD? 5146 03:30:57,178 --> 03:31:00,081 AND IT'S NOT EASY BECAUSE 5147 03:31:00,081 --> 03:31:02,650 DEPENDING ON THE CONTEXT AS 5148 03:31:02,650 --> 03:31:03,751 VICTOR WILL TALK ABOUT A LITTLE 5149 03:31:03,751 --> 03:31:05,987 BIT LATER, THINGS THAT WE THINK 5150 03:31:05,987 --> 03:31:09,257 ARE OKAY OR STRAIGHTFORWARD, ARE 5151 03:31:09,257 --> 03:31:09,757 NOT. 5152 03:31:09,757 --> 03:31:10,758 AND WE'LL TALK A LITTLE BIT MORE 5153 03:31:10,758 --> 03:31:12,760 ABOUT THAT WHEN WE TALK ABOUT 5154 03:31:12,760 --> 03:31:17,565 THE DESIGN OF IMPLEMENTATION 5155 03:31:17,565 --> 03:31:17,798 TRIALS. 5156 03:31:17,798 --> 03:31:21,402 BUT FOR ME, IT'S BECOME WHEN I 5157 03:31:21,402 --> 03:31:22,937 THINK ABOUT INTERVENTION, I 5158 03:31:22,937 --> 03:31:25,273 THINK ABOUT HOW IT'S GOING TO 5159 03:31:25,273 --> 03:31:30,077 WORK IN THE REAL WORLD EVERY 5160 03:31:30,077 --> 03:31:30,278 TIME. 5161 03:31:30,278 --> 03:31:32,680 >> THANK YOU. 5162 03:31:32,680 --> 03:31:34,348 AND DR. SOUMITRA PATHARE. 5163 03:31:34,348 --> 03:31:36,083 CAN YOU INTRODUCE YOURSELF 5164 03:31:36,083 --> 03:31:37,585 BRIEFLY AND YOUR WORK IN THIS 5165 03:31:37,585 --> 03:31:39,153 SPACE AND WHAT IS YOUR TAKE ON 5166 03:31:39,153 --> 03:31:39,787 THIS QUESTION? 5167 03:31:39,787 --> 03:31:40,888 WHY IS IMPLEMENTATION SCIENCE 5168 03:31:40,888 --> 03:31:43,991 THE RIGHT TOOL? 5169 03:31:43,991 --> 03:31:45,159 >> THANKS, BRIAN. 5170 03:31:45,159 --> 03:31:47,461 I GOT INTERESTED IN IT ONLY 5171 03:31:47,461 --> 03:31:49,664 BECAUSE I TALKED TO A 5172 03:31:49,664 --> 03:31:49,997 POLICYMAKERS. 5173 03:31:49,997 --> 03:31:52,199 IT'S WHEN I STARTED TALKING TO 5174 03:31:52,199 --> 03:31:52,533 POLICYMAKERS. 5175 03:31:52,533 --> 03:31:53,367 ONE OF THE THINGS THAT STRUCK ME 5176 03:31:53,367 --> 03:31:55,603 IS A LOT OF THESE GREAT 5177 03:31:55,603 --> 03:31:57,271 INNOVATIONS WE COME UP WITH ARE 5178 03:31:57,271 --> 03:31:58,573 NEVER REACH THE POPULATION. 5179 03:31:58,573 --> 03:32:02,109 AND THERE IS LIKE A 15-20 YEAR 5180 03:32:02,109 --> 03:32:04,178 GAP THAT IS NORMAL FOR ANY NEW 5181 03:32:04,178 --> 03:32:06,080 INNOVATION TO ACTUALLY REACH 5182 03:32:06,080 --> 03:32:06,981 SCALE AND REACH POPULATION. 5183 03:32:06,981 --> 03:32:09,183 AND THE QUESTION IS, CAN WE CUT 5184 03:32:09,183 --> 03:32:10,318 THAT SHORT? 5185 03:32:10,318 --> 03:32:14,288 BECAUSE 15-20 YEARS -- SO WHAT 5186 03:32:14,288 --> 03:32:16,290 YOU INVENT TODAY, A WHOLE 5187 03:32:16,290 --> 03:32:17,091 GENERATION WILL NOT GET THE 5188 03:32:17,091 --> 03:32:20,595 BENEFIT OF THAT INVENTION. 5189 03:32:20,595 --> 03:32:22,096 THERE WILL BE BE THE PEOPLE 5190 03:32:22,096 --> 03:32:22,396 AFTERWARDS. 5191 03:32:22,396 --> 03:32:23,698 WHEN YOU'RE TALKING TO 5192 03:32:23,698 --> 03:32:24,632 POLICYMAKERS AND I THINK A LOT 5193 03:32:24,632 --> 03:32:25,900 OF RESEARCHERS LIKE MYSELF WILL 5194 03:32:25,900 --> 03:32:27,902 DO THAT WHICH IS WHEN YOU'RE 5195 03:32:27,902 --> 03:32:30,571 TALKING TO POLICYMAKERS TO SCALE 5196 03:32:30,571 --> 03:32:33,541 UP THINGS, THE SIMPLE THING THAT 5197 03:32:33,541 --> 03:32:35,509 WE ALSO THINK OF IS THAT OUR 5198 03:32:35,509 --> 03:32:36,510 POLICYMAKERS ARE NOT INTERESTED. 5199 03:32:36,510 --> 03:32:38,779 THEY DON'T WANT TO DO IT. 5200 03:32:38,779 --> 03:32:40,982 AND I THOUGHT THE SAME. 5201 03:32:40,982 --> 03:32:43,217 LIKE A BUNCH OF POLICYMAKERS 5202 03:32:43,217 --> 03:32:46,187 DON'T UNDERSTAND WHAT THEY ARE 5203 03:32:46,187 --> 03:32:47,788 DOING AND DON'T -- REALLY NOT 5204 03:32:47,788 --> 03:32:48,889 INTERESTED IN MENTAL HEALTH. 5205 03:32:48,889 --> 03:32:50,491 AND THEN WHEN YOU TALK TO THEM, 5206 03:32:50,491 --> 03:32:52,393 YOU REALIZE AFTER A WHILE, THEY 5207 03:32:52,393 --> 03:32:53,394 HAVE SOME REAL CONCERNS ABOUT 5208 03:32:53,394 --> 03:32:54,595 WHEN YOU SCALE UP. 5209 03:32:54,595 --> 03:32:55,796 HOW IS IT GOING TO HAPPEN? 5210 03:32:55,796 --> 03:32:56,564 WHAT CAN HAPPEN? 5211 03:32:56,564 --> 03:32:58,699 AND SO IT'S NOT JUST A 5212 03:32:58,699 --> 03:32:59,367 HIT-AND-MISS AFFAIR. 5213 03:32:59,367 --> 03:33:01,002 THERE IS A WAY YOU CAN ANSWER 5214 03:33:01,002 --> 03:33:03,404 SOME OF THESE QUESTIONS FOR 5215 03:33:03,404 --> 03:33:04,905 THEM, FOR THEM TO BE ABLE TO 5216 03:33:04,905 --> 03:33:05,706 PLAN BETTER. 5217 03:33:05,706 --> 03:33:09,210 SO THAT'S HOW WE GOT INTO THIS 5218 03:33:09,210 --> 03:33:10,511 WHOLE IMPLEMENTATION SCIENCE 5219 03:33:10,511 --> 03:33:11,145 RESEARCH PROJECT. 5220 03:33:11,145 --> 03:33:13,180 AND I'LL GIVE YOU AN EXAMPLE OF 5221 03:33:13,180 --> 03:33:15,416 ONE WHICH IS ONGOING. 5222 03:33:15,416 --> 03:33:16,784 WE SPOKE TO A STATE GOVERNMENT 5223 03:33:16,784 --> 03:33:19,387 IN INDIA AND SAID, YOU SHOULD 5224 03:33:19,387 --> 03:33:20,788 IMPLEMENT GATEKEEPER TRAINING 5225 03:33:20,788 --> 03:33:23,591 FOR SCHOOLTEACHERS AS A SUICIDE 5226 03:33:23,591 --> 03:33:24,158 PREVENTION MEASURE. 5227 03:33:24,158 --> 03:33:26,994 AND THEY SAID, YES, WE WILL DO 5228 03:33:26,994 --> 03:33:27,495 THAT. 5229 03:33:27,495 --> 03:33:27,662 HOW? 5230 03:33:27,662 --> 03:33:28,996 WHAT ARE THE CHALLENGES IN DOING 5231 03:33:28,996 --> 03:33:29,163 IT? 5232 03:33:29,163 --> 03:33:30,498 AFTER A LOT OF DISCUSSION WITH 5233 03:33:30,498 --> 03:33:32,800 THE POLICYMAKERS, WE DESIGNED A 5234 03:33:32,800 --> 03:33:34,902 TRIAL WHICH HAS THREE ARMS TO 5235 03:33:34,902 --> 03:33:35,102 IT. 5236 03:33:35,102 --> 03:33:37,104 IN ONE ARM, THE GATEKEEPER 5237 03:33:37,104 --> 03:33:39,507 TRAINING IS PROVIDED TO 5238 03:33:39,507 --> 03:33:41,108 SCHOOLTEACHERS JUST AS AN ONLINE 5239 03:33:41,108 --> 03:33:42,610 PROGRAM AND ANOTHER ARM THEY GET 5240 03:33:42,610 --> 03:33:46,414 THE ONLINE PROGRAM PLUS REGULAR 5241 03:33:46,414 --> 03:33:48,516 REFRESHERS, THEY GET THE ONLINE 5242 03:33:48,516 --> 03:33:50,284 PROGRAM THE REFRESHER AND SOME 5243 03:33:50,284 --> 03:33:50,551 MENTORING. 5244 03:33:50,551 --> 03:33:52,386 THE IDEA WAS NOT TO SEE WHICH IS 5245 03:33:52,386 --> 03:33:54,588 MORE EFFECTIVE BUT SIMPLY THE 5246 03:33:54,588 --> 03:33:56,490 OUTCOME MEASURE IS WHICH OF 5247 03:33:56,490 --> 03:34:00,327 THOSE MODELS OF DOING IT WOULD 5248 03:34:00,327 --> 03:34:02,530 RESULT IN TEACHERS DOING WHAT WE 5249 03:34:02,530 --> 03:34:03,898 WANT THEM TO DO, WHICH IS 5250 03:34:03,898 --> 03:34:05,599 IDENTIFY KIDS WHO ARE AT RISK OF 5251 03:34:05,599 --> 03:34:07,268 SUICIDE AND MAKING THE 5252 03:34:07,268 --> 03:34:07,768 APPROPRIATE REFERENCE. 5253 03:34:07,768 --> 03:34:09,737 SO THE OUTCOME IS NOT WHETHER 5254 03:34:09,737 --> 03:34:11,839 SUICIDE RATES GO DOWN OR NOT. 5255 03:34:11,839 --> 03:34:14,542 THE OUTCOME WAS FOCUSED, ARE 5256 03:34:14,542 --> 03:34:16,444 WE -- WHICH MODEL BRINGS ABOUT 5257 03:34:16,444 --> 03:34:17,411 THE BEHAVIOR CHANGE? 5258 03:34:17,411 --> 03:34:19,046 AND THEN POLICYMAKERS SAID 5259 03:34:19,046 --> 03:34:20,448 WHICHEVER ONE WORKS, WE WILL 5260 03:34:20,448 --> 03:34:21,849 ADOPT IT FOR THE WHOLE STATE. 5261 03:34:21,849 --> 03:34:23,551 SO IT'S THOSE KINDS OF QUESTIONS 5262 03:34:23,551 --> 03:34:25,419 THAT I THINK VERY OFTEN 5263 03:34:25,419 --> 03:34:27,254 POLICYMAKERS HAVE AND WHICH I 5264 03:34:27,254 --> 03:34:28,956 THINK IMPLEMENTATION SCIENCE 5265 03:34:28,956 --> 03:34:30,825 RESEARCH CAN START TO ADDRESS. 5266 03:34:30,825 --> 03:34:34,128 THAT'S REALLY -- SO WE 5267 03:34:34,128 --> 03:34:35,830 INCREASINGLY MOVED OVER TO DOING 5268 03:34:35,830 --> 03:34:37,431 ON -- LOOKING AT THAT RATHER 5269 03:34:37,431 --> 03:34:39,133 THAN EFFICACY RESEARCH WORK. 5270 03:34:39,133 --> 03:34:41,669 LOOKING AT HOW WE CAN TAKE SOME 5271 03:34:41,669 --> 03:34:44,171 OF THESE INTERESTING MODELS OF 5272 03:34:44,171 --> 03:34:47,241 CARE AND SCALE THEM UP. 5273 03:34:47,241 --> 03:34:49,744 SO WE REALLY HAVE NOT BEEN DOING 5274 03:34:49,744 --> 03:34:52,747 IN OUR GROUP, NOT BEEN DOING ANY 5275 03:34:52,747 --> 03:34:55,349 PRIMARY EFFICACY STUDIES. 5276 03:34:55,349 --> 03:34:57,651 >> THAT'S A REALLY GREAT 5277 03:34:57,651 --> 03:35:01,655 TRANSITION INTO OUR SECOND 5278 03:35:01,655 --> 03:35:02,656 QUESTION THINKING ABOUT THE 5279 03:35:02,656 --> 03:35:04,658 CONCERNS THAT POLICY MAKERS 5280 03:35:04,658 --> 03:35:06,660 MIGHT BRING ABOUT THE RELEVANCE 5281 03:35:06,660 --> 03:35:09,396 OF CONTEXT FROM A TRANSITIONING 5282 03:35:09,396 --> 03:35:11,832 FROM THE RESEARCH ENVIRONMENT TO 5283 03:35:11,832 --> 03:35:12,266 REAL-WORLDSCALE UP. 5284 03:35:12,266 --> 03:35:14,335 AND BILL, WHAT YOU WERE SAYING A 5285 03:35:14,335 --> 03:35:17,371 MOMENT AGO HOW TO PLAN FOR 5286 03:35:17,371 --> 03:35:19,540 IMPLEMENTATION FROM THE START? 5287 03:35:19,540 --> 03:35:22,076 OUR SECOND QUESTION IS TO THINK 5288 03:35:22,076 --> 03:35:23,377 ABOUT -- WHILE CLASSICAL 5289 03:35:23,377 --> 03:35:24,145 CLINICAL RESEARCH TRIES TO 5290 03:35:24,145 --> 03:35:25,746 CONTROL CONTEXT AS MUCH AS 5291 03:35:25,746 --> 03:35:27,882 POSSIBLE TO GET THE CLEAREST 5292 03:35:27,882 --> 03:35:29,984 SIGNAL OF THE EFFICACY OF THE 5293 03:35:29,984 --> 03:35:30,985 INTERVENTION, ENGAGEMENT WITH 5294 03:35:30,985 --> 03:35:34,455 CONTEXT IS REALLY INESCAPABLE IN 5295 03:35:34,455 --> 03:35:36,290 IMPLEMENTATION SCIENCE. 5296 03:35:36,290 --> 03:35:37,758 SO, DR. VICTOR MWAPASA, THIS 5297 03:35:37,758 --> 03:35:39,560 QUESTION IS TO YOU. 5298 03:35:39,560 --> 03:35:41,295 WHY MUST CONTEXT BE CONSIDERED 5299 03:35:41,295 --> 03:35:43,964 IN DESIGNING AND CONDUCTING 5300 03:35:43,964 --> 03:35:45,366 IMPLEMENTATION SCIENCE RESEARCH, 5301 03:35:45,366 --> 03:35:47,168 HOW SHOULD RESEARCHERS ENGAGE 5302 03:35:47,168 --> 03:35:49,170 WITH CONTEXT TO MAXIMIZE THE 5303 03:35:49,170 --> 03:35:50,538 IMPACT OF THEIR WORK? 5304 03:35:50,538 --> 03:35:51,872 IF YOU WOULD START WITH JUST A 5305 03:35:51,872 --> 03:35:53,440 LITTLE BIT OF ORIENTATION TO 5306 03:35:53,440 --> 03:35:56,177 YOUR WORK IN THIS SPACE. 5307 03:35:56,177 --> 03:35:56,577 >> YES. 5308 03:35:56,577 --> 03:35:59,980 SO I AM A MEDICAL DOCTOR FROM 5309 03:35:59,980 --> 03:36:00,648 MALAWI. 5310 03:36:00,648 --> 03:36:03,150 AND MALAWI HASN'T GOT A LOT OF 5311 03:36:03,150 --> 03:36:03,450 RESOURCES. 5312 03:36:03,450 --> 03:36:05,986 I WAS ACTUALLY THE FIRST GROUP 5313 03:36:05,986 --> 03:36:09,990 OF MA LAWIAIAN DOCTORS BEFORE WE 5314 03:36:09,990 --> 03:36:11,091 DID NOT HAVE MEDICAL SCHOOL. 5315 03:36:11,091 --> 03:36:12,259 SO WE ARE TRAINED IN THE U.K. 5316 03:36:12,259 --> 03:36:13,761 AND THEN AFTER TRAINING WENT 5317 03:36:13,761 --> 03:36:15,763 BACK TO MALAWI. 5318 03:36:15,763 --> 03:36:19,800 THE HEALTH SYSTEM WAS BEING RAN 5319 03:36:19,800 --> 03:36:20,367 BY DASH DOCTORS. 5320 03:36:20,367 --> 03:36:21,669 MY ENGAGEMENT WITH 5321 03:36:21,669 --> 03:36:22,570 IMPLEMENTATION SCIENCE IS BY 5322 03:36:22,570 --> 03:36:27,274 DOING IT BECAUSE I HAVE BEEN AN 5323 03:36:27,274 --> 03:36:31,078 OFFICER FOR TWO LIFE DISTRICTS. 5324 03:36:31,078 --> 03:36:32,780 OFTENTIMES THE SITUATION I MEET 5325 03:36:32,780 --> 03:36:35,082 AS A DISTRICT HEALTH OFFICER IS 5326 03:36:35,082 --> 03:36:37,885 A LOT OF -- GOVERNMENT 5327 03:36:37,885 --> 03:36:39,753 ORGANIZATIONS WOULD COME AND 5328 03:36:39,753 --> 03:36:41,155 SAY, THIS WORKS. 5329 03:36:41,155 --> 03:36:42,790 IMPLEMENT IT TO IMPROVE THE 5330 03:36:42,790 --> 03:36:43,724 SITUATION IN YOUR DISTRICT. 5331 03:36:43,724 --> 03:36:46,293 AT THAT TIME, I WAS IN TRAINING 5332 03:36:46,293 --> 03:36:47,361 IMPLEMENTATION SCIENCE. 5333 03:36:47,361 --> 03:36:49,797 THEN I JUST GO BACK TO MY OFFICE 5334 03:36:49,797 --> 03:36:51,265 TO THINK ABOUT IT, DOES IT WORK 5335 03:36:51,265 --> 03:36:52,600 OR NOT? 5336 03:36:52,600 --> 03:36:54,635 AND THEN I GOT INVOLVED IN THE 5337 03:36:54,635 --> 03:36:57,505 MINISTER OF HEALTH ADVISING WHAT 5338 03:36:57,505 --> 03:36:58,372 EVIDENCE THEY SHOULD SCALE UP 5339 03:36:58,372 --> 03:37:00,574 AND WHAT EVIDENCE THEY 5340 03:37:00,574 --> 03:37:00,841 SHOULDN'T. 5341 03:37:00,841 --> 03:37:03,177 AND TO GIVE YOU A TYPICAL 5342 03:37:03,177 --> 03:37:05,379 EXAMPLE, WE HAD A MENTAL HEALTH 5343 03:37:05,379 --> 03:37:07,181 CONFERENCE HERE AND WE HAVE BEEN 5344 03:37:07,181 --> 03:37:08,949 HEARING ABOUT THE FRIENDSHIP 5345 03:37:08,949 --> 03:37:09,149 BENCH. 5346 03:37:09,149 --> 03:37:10,985 SO I WANT TO GIVE AN EXAMPLE OF 5347 03:37:10,985 --> 03:37:15,589 WHAT I MEANT AS ADDITIONAL. 5348 03:37:15,589 --> 03:37:16,190 THE FRIENDSHIP BENCH YOU KNOW 5349 03:37:16,190 --> 03:37:17,791 ABOUT IT. 5350 03:37:17,791 --> 03:37:21,095 DEVELOPED IN ZIMBABWE 2014 OR 5351 03:37:21,095 --> 03:37:21,262 15. 5352 03:37:21,262 --> 03:37:23,397 IT WAS TOUTED THAT THIS IS GOING 5353 03:37:23,397 --> 03:37:24,999 TO SOLVE THE MENTAL HEALTH GAP. 5354 03:37:24,999 --> 03:37:25,266 WHY? 5355 03:37:25,266 --> 03:37:26,467 BECAUSE MOST OF OUR COUNTRIES 5356 03:37:26,467 --> 03:37:31,839 WHO DON'T HAVE A LOT OF PEOPLE 5357 03:37:31,839 --> 03:37:32,439 IN THE MENTAL HEALTH SPACE. 5358 03:37:32,439 --> 03:37:35,809 AND THE THIS INTERVENTION 5359 03:37:35,809 --> 03:37:39,346 INVOLVED GIVING PROBLEM-SOLVING 5360 03:37:39,346 --> 03:37:43,617 THERAPY DELIVERED BY GRANDMAS, 5361 03:37:43,617 --> 03:37:45,319 THAT DON'T NEED A LOT OF SALARY. 5362 03:37:45,319 --> 03:37:48,022 AND IT INVOLVED LIKE SIX 5363 03:37:48,022 --> 03:37:49,823 SESSIONS OF PROBLEM-SOLVING 5364 03:37:49,823 --> 03:37:50,324 THERAPY. 5365 03:37:50,324 --> 03:37:55,863 AND THEN IN BETWEEN THE THERAPY, 5366 03:37:55,863 --> 03:37:58,098 THEY SENT TO THE PATIENTS AND 5367 03:37:58,098 --> 03:37:58,832 THEN JOIN A PEER GROUP. 5368 03:37:58,832 --> 03:38:02,336 IT WAS TOUTED AS AN EASY 5369 03:38:02,336 --> 03:38:02,937 STRAIGHTFORWARD INTERVENTION 5370 03:38:02,937 --> 03:38:06,240 THAT WILL HELP PEOPLE WITH 5371 03:38:06,240 --> 03:38:07,441 MENTAL DISORDERS. 5372 03:38:07,441 --> 03:38:10,044 THAT WAS 2014 OR 2015. 5373 03:38:10,044 --> 03:38:11,912 AND REDUCE DEPRESSION LEVELS. 5374 03:38:11,912 --> 03:38:13,814 PEOPLE CAME FOR THE SESSIONS. 5375 03:38:13,814 --> 03:38:16,717 IT WORKED BEAUTIFULLY IN 5376 03:38:16,717 --> 03:38:17,217 ZIMBABWE. 5377 03:38:17,217 --> 03:38:19,720 SO THE MALAWI GOVERNMENT SAID 5378 03:38:19,720 --> 03:38:22,623 THAT'S WELL AND GOOD. 5379 03:38:22,623 --> 03:38:24,625 ZIMBABWE -- THIS WAS IN THE 5380 03:38:24,625 --> 03:38:24,858 CAPITOL. 5381 03:38:24,858 --> 03:38:27,127 LET'S TRY TO IMPLEMENT IT IN 5382 03:38:27,127 --> 03:38:31,131 MALAWI WHICH IS JUST LIKE 400 5383 03:38:31,131 --> 03:38:33,100 KILOMETERS AWAY. 5384 03:38:33,100 --> 03:38:35,636 SO THE DOCTOR WITH THE TEAM WE 5385 03:38:35,636 --> 03:38:37,237 ALL WENT AND SAID LET'S 5386 03:38:37,237 --> 03:38:41,108 IMPLEMENT THIS EASY FRIENDSHIP 5387 03:38:41,108 --> 03:38:41,342 BENCH. 5388 03:38:41,342 --> 03:38:45,179 AND THAT WAS IN 2016-2017 OR 5389 03:38:45,179 --> 03:38:46,080 THEREABOUTS. 5390 03:38:46,080 --> 03:38:50,651 THEY IMPLEMENTED IT IN A TYPICAL 5391 03:38:50,651 --> 03:38:53,520 HEALTH FACILITY. 5392 03:38:53,520 --> 03:38:55,322 AND FIRST OF ALL THEY HAD TO 5393 03:38:55,322 --> 03:38:58,392 ADOPT IT BECAUSE THE WAY IT WAS 5394 03:38:58,392 --> 03:38:59,827 DESIGNED IN ZIMBABWE, IT 5395 03:38:59,827 --> 03:39:01,829 INCLUDED THE PROBLEM-SOLVING 5396 03:39:01,829 --> 03:39:02,062 THERAPY. 5397 03:39:02,062 --> 03:39:05,733 IT INCLUDED SENDING SMS TO THE 5398 03:39:05,733 --> 03:39:08,135 PARTICIPANTS, THE CLIENTS, AND 5399 03:39:08,135 --> 03:39:10,838 ALSO JOINING A PEER GROUP. 5400 03:39:10,838 --> 03:39:12,940 BUT WHEN IT LANDED IN MALAWI, A 5401 03:39:12,940 --> 03:39:16,043 DECISION WAS MADE THAT THE SMS 5402 03:39:16,043 --> 03:39:17,277 PART, SENDING A SIMPLE MESSAGE 5403 03:39:17,277 --> 03:39:20,280 PART IS SIMPLY NOT AFFORDABLE IN 5404 03:39:20,280 --> 03:39:24,151 MALAWI BECAUSE BASICALLY THE 5405 03:39:24,151 --> 03:39:25,285 SOCIAL ECONOMIC SITUATION, THE 5406 03:39:25,285 --> 03:39:26,653 HEALTH SYSTEM CANNOT AFFORD 5407 03:39:26,653 --> 03:39:29,657 SENDING MESSAGES TO THE 5408 03:39:29,657 --> 03:39:29,923 PATIENTS. 5409 03:39:29,923 --> 03:39:32,359 THE SECOND ASPECT IS THAT I TOLD 5410 03:39:32,359 --> 03:39:34,561 YOU ZIMBABWE IT WAS BEING 5411 03:39:34,561 --> 03:39:36,463 DELIVERED BY GRANDMAS. 5412 03:39:36,463 --> 03:39:38,465 THE MALAWI GOVERNMENT REALIZED 5413 03:39:38,465 --> 03:39:40,267 THAT YOU SEE THE EDUCATIONAL 5414 03:39:40,267 --> 03:39:42,770 STATUS OF GRANDMAS IN 5415 03:39:42,770 --> 03:39:43,971 ZIMBABWE -- THEY HAVE A GOOD 5416 03:39:43,971 --> 03:39:45,172 EDUCATION SYSTEM. 5417 03:39:45,172 --> 03:39:47,875 IF WE JUST IMPORT IT INTO MALAWI 5418 03:39:47,875 --> 03:39:50,177 AND USE THE GRANDMA AS IN 5419 03:39:50,177 --> 03:39:52,279 MALAWI, THEY ARE NOT AT THAT 5420 03:39:52,279 --> 03:39:53,680 LEVEL TO DELIVER THE 5421 03:39:53,680 --> 03:39:54,014 INTERVENTION. 5422 03:39:54,014 --> 03:39:55,682 SO THEY MADE A MODIFICATION AND 5423 03:39:55,682 --> 03:39:57,785 THEY SAID, NO, THIS IS GOING TO 5424 03:39:57,785 --> 03:40:02,756 BE DELIVERED BY COMMUNITY HEALTH 5425 03:40:02,756 --> 03:40:03,891 CENTERS TO ADJUST THAT. 5426 03:40:03,891 --> 03:40:06,193 SO THE LONG AND SHORT OF IT IS 5427 03:40:06,193 --> 03:40:09,296 THAT WHEN IT WAS TESTED IN 5428 03:40:09,296 --> 03:40:12,900 MALAWI, SUPPOSED TO BE JUST 5429 03:40:12,900 --> 03:40:14,802 TESTED RIGHT AND SCALED UP? 5430 03:40:14,802 --> 03:40:18,372 IT DID NOT WORK. 5431 03:40:18,372 --> 03:40:20,174 REDUCTION IN DEPRESSION, THE 5432 03:40:20,174 --> 03:40:22,776 PEOPLE DID NOT ATTEND THEIR 5433 03:40:22,776 --> 03:40:23,043 SESSIONS. 5434 03:40:23,043 --> 03:40:25,946 THEIR PROBLEM-SOLVING SESSIONS. 5435 03:40:25,946 --> 03:40:30,651 IT WAS IN PEOPLE'S VIEW, THIS 5436 03:40:30,651 --> 03:40:31,285 WONDERFUL FRIENDSHIP BENCH WHICH 5437 03:40:31,285 --> 03:40:33,787 WORKED BEAUTIFULLY TO DECREASE 5438 03:40:33,787 --> 03:40:36,356 DEPRESSION IN ZIMBABWE BY 70%, 5439 03:40:36,356 --> 03:40:40,494 COME TO MALAWI, IT DOESN'T WORK. 5440 03:40:40,494 --> 03:40:42,663 WHEN YOU FIGURE OUT WHY IT NOT 5441 03:40:42,663 --> 03:40:44,498 WORK, THESE ARE SIMPLE THINGS. 5442 03:40:44,498 --> 03:40:47,367 PEOPLE ARE NOT EXPOSED TO 5443 03:40:47,367 --> 03:40:48,502 INTERVENTION. 5444 03:40:48,502 --> 03:40:49,069 WHY? 5445 03:40:49,069 --> 03:40:50,904 BECAUSE THEY DID NOT ATTEMPT THE 5446 03:40:50,904 --> 03:40:53,874 SIX PROBLEM-SOLVING THERAPY. 5447 03:40:53,874 --> 03:40:55,075 THE OTHER THING THE PEOPLE WHO 5448 03:40:55,075 --> 03:40:56,777 WERE DELIVERING THE 5449 03:40:56,777 --> 03:40:57,878 PROBLEM-SOLVING THERAPY, THESE 5450 03:40:57,878 --> 03:41:00,280 WERE THE COMMITTEE HEALTH 5451 03:41:00,280 --> 03:41:00,681 CENTERS. 5452 03:41:00,681 --> 03:41:03,484 IN MALAWI THEY ARE DOING OTHER 5453 03:41:03,484 --> 03:41:04,351 THINGS BESIDES MENTAL HEALTH. 5454 03:41:04,351 --> 03:41:06,987 THEY ARE ALSO DELIVERING 5455 03:41:06,987 --> 03:41:07,321 IMMUNIZATIONS. 5456 03:41:07,321 --> 03:41:12,159 THEY ARE DELIVERING MALARIA 5457 03:41:12,159 --> 03:41:12,426 SCREENING. 5458 03:41:12,426 --> 03:41:15,562 SO TO ASK THEM TO SPEND 45 5459 03:41:15,562 --> 03:41:18,365 MINUTES PER PATIENT FOR SIX 5460 03:41:18,365 --> 03:41:19,466 SESSIONS, THEY SIMPLY DID NOT 5461 03:41:19,466 --> 03:41:20,167 HAVE THE TIME. 5462 03:41:20,167 --> 03:41:21,869 SO AT THAT THE TIME, IT WAS EASY 5463 03:41:21,869 --> 03:41:24,071 FOR THE MINISTER OF HEALTH TO 5464 03:41:24,071 --> 03:41:26,173 SAY, IT'S WRONG. 5465 03:41:26,173 --> 03:41:27,307 FRIENDSHIP BENCH DID NOT WORK. 5466 03:41:27,307 --> 03:41:30,978 BUT THE KEY THING WAS THAT WHY 5467 03:41:30,978 --> 03:41:32,613 WAS THE IMPLEMENTATION STRATEGY 5468 03:41:32,613 --> 03:41:34,915 THAT MALAWI WAS USING. 5469 03:41:34,915 --> 03:41:36,683 SO IT SHOWS THE CONTEXT OF THE 5470 03:41:36,683 --> 03:41:41,255 HEALTH SYSTEM IS VERY IMPORTANT. 5471 03:41:41,255 --> 03:41:44,057 PEOPLE SHOULD SEE THE CONTEXT. 5472 03:41:44,057 --> 03:41:45,692 IS THE CONTEXT OF THE HEALTH 5473 03:41:45,692 --> 03:41:48,996 SYSTEM IN MALAWI SIMILAR TO 5474 03:41:48,996 --> 03:41:49,296 ZIMBABWE? 5475 03:41:49,296 --> 03:41:50,898 THEY DID NOT ATTEND BECAUSE IT 5476 03:41:50,898 --> 03:41:52,966 IS COSTLY TO COME TO THE 5477 03:41:52,966 --> 03:41:54,101 FACILITIES SIX TIMES. 5478 03:41:54,101 --> 03:41:55,169 IT'S COSTLY. 5479 03:41:55,169 --> 03:41:57,070 MALAWI IS FAIRLY POOR. 5480 03:41:57,070 --> 03:41:59,673 SO PEOPLE WAITED OUT AND MAYBE 5481 03:41:59,673 --> 03:42:02,976 NOT ATTEND THESE SESSIONS. 5482 03:42:02,976 --> 03:42:05,979 SO WHEN YOU JUST IMPLEMENT AN 5483 03:42:05,979 --> 03:42:07,281 INTERVENTION, THINK ABOUT THE 5484 03:42:07,281 --> 03:42:09,082 HEALTH SYSTEM CONTEXT AND THINK 5485 03:42:09,082 --> 03:42:11,818 ABOUT THE COMMUNITY, THE SOCIAL 5486 03:42:11,818 --> 03:42:12,786 CONTEXT OTHERWISE YOU'RE GOING 5487 03:42:12,786 --> 03:42:14,788 TO BE DISAPPOINTED. 5488 03:42:14,788 --> 03:42:15,589 THANK YOU. 5489 03:42:15,589 --> 03:42:16,924 >> THANK YOU. 5490 03:42:16,924 --> 03:42:18,492 SO SOME VERY IMPORTANT POINTS 5491 03:42:18,492 --> 03:42:22,296 THERE IN TERMS OF WHAT IS 5492 03:42:22,296 --> 03:42:25,499 INVOLVED IN MOVING AN 5493 03:42:25,499 --> 03:42:27,301 EVIDENCE-BASED INTERVENTION, ONE 5494 03:42:27,301 --> 03:42:28,602 CONTEXT TO ANOTHER, AND WHY IT'S 5495 03:42:28,602 --> 03:42:32,506 SO CRITICAL TO CONSIDER THAT 5496 03:42:32,506 --> 03:42:32,906 CONTEXT. 5497 03:42:32,906 --> 03:42:35,008 WOULD YOU LIKE TO WEIGH IN ON 5498 03:42:35,008 --> 03:42:36,310 THIS QUESTION AS WELL ABOUT WHY 5499 03:42:36,310 --> 03:42:38,111 MUST CONTEXT BE CONSIDERED? 5500 03:42:38,111 --> 03:42:40,614 >> I WAS GOING TO GET IN THERE 5501 03:42:40,614 --> 03:42:42,716 AND BILL MENTIONED ABOUT CONTEXT 5502 03:42:42,716 --> 03:42:44,284 AND I THINK THE CONTEXT NEEDS TO 5503 03:42:44,284 --> 03:42:45,686 BE CONSIDERED WHEN YOU'RE 5504 03:42:45,686 --> 03:42:47,087 DESIGNING IT AND NOT JUST WHEN 5505 03:42:47,087 --> 03:42:50,991 YOU'RE TRYING TO -- I MEAN IF 5506 03:42:50,991 --> 03:42:51,858 YOU WERE DESIGNING FRIENDSHIP 5507 03:42:51,858 --> 03:42:54,027 BENCH FOR MALAWI, YOU WILL HAVE 5508 03:42:54,027 --> 03:42:55,329 CONSIDERED CONTEXT WHEN 5509 03:42:55,329 --> 03:42:56,797 DESIGNING THE INTERVENTION 5510 03:42:56,797 --> 03:42:58,198 ITSELF AND YOU WOULDN'T HAVE 5511 03:42:58,198 --> 03:42:59,299 KIND OF HEARD SOME OF THOSE 5512 03:42:59,299 --> 03:43:00,500 PROBLEMS YOU HAD. 5513 03:43:00,500 --> 03:43:01,835 LIKE LET ME GIVE YOU AN EXAMPLE 5514 03:43:01,835 --> 03:43:03,904 FROM WHAT WE DID IN INDIA. 5515 03:43:03,904 --> 03:43:06,907 IN 2013, THIS IS -- SEEMS LIKE A 5516 03:43:06,907 --> 03:43:08,442 LONG TIME AGO, MORE THAN A 5517 03:43:08,442 --> 03:43:10,410 DECADE AGO, WHEN WE WANTED TO 5518 03:43:10,410 --> 03:43:14,414 LOOK AT HOW YOU COULD USE WHAT 5519 03:43:14,414 --> 03:43:15,616 EVERYONE CALLS STAR SHIFTING OR 5520 03:43:15,616 --> 03:43:17,050 STAR SHARING WORK NOW TO SEE HOW 5521 03:43:17,050 --> 03:43:21,688 WE COULD DO THAT IN THE INDIAN 5522 03:43:21,688 --> 03:43:23,090 CONTEXT USING NON-HEALTH 5523 03:43:23,090 --> 03:43:24,124 PROFESSIONALS TO BE DOING IT. 5524 03:43:24,124 --> 03:43:25,392 AND ONE OF THE THINGS WE 5525 03:43:25,392 --> 03:43:26,693 REALIZED VERY QUICKLY AFTER WE 5526 03:43:26,693 --> 03:43:28,629 STARTED TALKING TO COMMUNITY 5527 03:43:28,629 --> 03:43:30,464 HEALTH WORKERS WAS EXACTLY WHAT 5528 03:43:30,464 --> 03:43:31,265 VICTOR SAID, WHICH IS THE 5529 03:43:31,265 --> 03:43:35,002 COMMUNITY HEALTH WORKERS ARE 5530 03:43:35,002 --> 03:43:36,236 VERY BUSY DOING LOTS OF THINGS 5531 03:43:36,236 --> 03:43:37,237 AND THEY AREN'T NECESSARILY 5532 03:43:37,237 --> 03:43:38,438 GOING TO FIND THE TIME. 5533 03:43:38,438 --> 03:43:40,741 SO WE DESIGNED AN INTERVENTION 5534 03:43:40,741 --> 03:43:42,242 WHICH WAS SLIGHTLY DIFFERENT. 5535 03:43:42,242 --> 03:43:46,146 WE SPOKE TOVILLAGE COUNCILS AND 5536 03:43:46,146 --> 03:43:47,147 HAD VOLUNTEERS FROM THE VILLAGE 5537 03:43:47,147 --> 03:43:48,515 VOLUNTEER TO DO THIS WORK. 5538 03:43:48,515 --> 03:43:51,318 AND THEY VOLUNTEERED FOR FIVE OR 5539 03:43:51,318 --> 03:43:52,319 SIX HOURS OF WORK. 5540 03:43:52,319 --> 03:43:54,021 THEY WERE TRAINED AND THEY WERE 5541 03:43:54,021 --> 03:43:58,325 MONITORED AND MENTORED TO DO IT. 5542 03:43:58,325 --> 03:44:00,160 SO THEY WERE NOT HEALTH WORKERS 5543 03:44:00,160 --> 03:44:05,132 FROM THE COMMUNITY, THEY WERE 5544 03:44:05,132 --> 03:44:07,234 NOT PART OF THE PUBLIC HEALTH 5545 03:44:07,234 --> 03:44:07,467 SYSTEM. 5546 03:44:07,467 --> 03:44:08,835 WE TAPPED INTO WHAT WE CALL 5547 03:44:08,835 --> 03:44:11,905 SOCIAL CAPITAL AND VILLAGES AND 5548 03:44:11,905 --> 03:44:12,639 COMMUNITIES FELT OWNERSHIP OF 5549 03:44:12,639 --> 03:44:13,140 THAT PROBLEM. 5550 03:44:13,140 --> 03:44:17,010 AND STARTING WITH 14 VILLAGES 5551 03:44:17,010 --> 03:44:18,445 AND 100,000 PEOPLE, TODAY THAT 5552 03:44:18,445 --> 03:44:22,049 PROGRAM, WHICH IS NOW EXPANDED 5553 03:44:22,049 --> 03:44:25,619 TO FOUR DISTRICTS, COVERAGES 5554 03:44:25,619 --> 03:44:27,587 ABOUT 6 MILLION PEOPLE. 5555 03:44:27,587 --> 03:44:30,590 WE HAVE ABOUT 1500 OF THESE 5556 03:44:30,590 --> 03:44:33,360 SO-CALLED CHAMPIONS WHO DO THIS 5557 03:44:33,360 --> 03:44:35,595 WORK AND ALONG THE WAY WE HAVE 5558 03:44:35,595 --> 03:44:36,863 DONE A LARGE-STEP RANDOMIZED 5559 03:44:36,863 --> 03:44:39,099 TRIAL ON IT TO SHOW THAT THEY 5560 03:44:39,099 --> 03:44:41,068 ARE AS EFFECTIVE AS ANY OTHER 5561 03:44:41,068 --> 03:44:43,370 COMMUNITY HEALTH WORKER. 5562 03:44:43,370 --> 03:44:44,971 SO THE POINT OF TELLING YOU THIS 5563 03:44:44,971 --> 03:44:47,674 STORY IS NOT TO SAY THAT YOU ARE 5564 03:44:47,674 --> 03:44:48,675 SUCCESSFUL, BUT THE POINT IS TO 5565 03:44:48,675 --> 03:44:50,677 SAY THAT IF YOU'RE GOING TO 5566 03:44:50,677 --> 03:44:53,113 SCALE UP SOME OF THESE 5567 03:44:53,113 --> 03:44:53,714 INTERVENTIONS LIKE FRIENDSHIP 5568 03:44:53,714 --> 03:44:55,682 BENCH OR MANY OF THESE MODELS 5569 03:44:55,682 --> 03:44:57,484 THAT PEOPLE HAVE, YOU REALLY 5570 03:44:57,484 --> 03:44:58,852 NEED TO DESIGN IT FOR THAT 5571 03:44:58,852 --> 03:44:59,086 CONTEXT. 5572 03:44:59,086 --> 03:45:01,088 YOU NEED TO SAY, WHAT IS MY 5573 03:45:01,088 --> 03:45:03,690 CONTEXT AND HOW AM I GOING TO DO 5574 03:45:03,690 --> 03:45:03,890 IT? 5575 03:45:03,890 --> 03:45:06,893 AND IT MIGHT REQUIRE TWEAKING 5576 03:45:06,893 --> 03:45:07,627 THE KIND OF TWEAKS YOU'RE 5577 03:45:07,627 --> 03:45:09,262 TALKING ABOUT, IS THE KIND OF 5578 03:45:09,262 --> 03:45:10,097 TWEAKS WE HAD TO MAKE AT THE 5579 03:45:10,097 --> 03:45:11,865 TIME OF DESIGNING IT. 5580 03:45:11,865 --> 03:45:18,472 AND YOU DO THAT IF YOU WERE NOT 5581 03:45:18,472 --> 03:45:20,340 SOMEBODY WHO IS ONLY FOCUSED ON 5582 03:45:20,340 --> 03:45:21,074 THE EFFICACY WORK. 5583 03:45:21,074 --> 03:45:22,876 IF YOU'RE FOCUSED ON EFFICACY, 5584 03:45:22,876 --> 03:45:24,678 YOU WILL NOT TWEAK IT AT ALL. 5585 03:45:24,678 --> 03:45:26,680 THE WHOLE IDEA OF THE LAW OF 5586 03:45:26,680 --> 03:45:27,881 EFFICACY RESEARCH IS TO NOT 5587 03:45:27,881 --> 03:45:31,284 TWEAK THE CONTEXT. 5588 03:45:31,284 --> 03:45:32,586 CONTEXT AGNOSTIC IN THAT SENSE 5589 03:45:32,586 --> 03:45:34,321 AND YOU'RE TRYING TO DO IT, 5590 03:45:34,321 --> 03:45:35,188 WHICH I DON'T THINK MAKES A LOT 5591 03:45:35,188 --> 03:45:38,358 OF SENSE WHEN YOU COME TO THE 5592 03:45:38,358 --> 03:45:39,192 IMPLEMENTATION SCIENCE END OF 5593 03:45:39,192 --> 03:45:39,693 IT. 5594 03:45:39,693 --> 03:45:41,928 SO I DO THINK IT'S SOMETHING WE 5595 03:45:41,928 --> 03:45:43,897 SHOULD BE LOOKING AT HOW -- AND 5596 03:45:43,897 --> 03:45:45,665 SO THAT IS WHY I THINK MANY OF 5597 03:45:45,665 --> 03:45:48,902 THESE MODELS DON'T TRAVEL VERY 5598 03:45:48,902 --> 03:45:50,704 WELL VERY EASILY. 5599 03:45:50,704 --> 03:45:52,806 THEY WILL -- THEY ARE LOCALIZED 5600 03:45:52,806 --> 03:45:54,708 AND FOR CONTEXT, THEY WORK IN 5601 03:45:54,708 --> 03:45:55,409 THAT CONTEXT. 5602 03:45:55,409 --> 03:45:59,379 THEY HAVE A CODE OF SIMILARITIES 5603 03:45:59,379 --> 03:46:01,214 BUT THE FINAL IS VERY 5604 03:46:01,214 --> 03:46:01,515 CONTEXTURAL. 5605 03:46:01,515 --> 03:46:03,950 I THINK THAT'S HOW IT SHOULD BE. 5606 03:46:03,950 --> 03:46:06,086 >> I WAS GOING TO SAY, I THINK 5607 03:46:06,086 --> 03:46:08,522 AS RESEARCHERS, WE THINK OF 5608 03:46:08,522 --> 03:46:10,290 IMPLEMENTATION SCIENCE AS THE 5609 03:46:10,290 --> 03:46:11,124 PROGRESSION. 5610 03:46:11,124 --> 03:46:12,893 THERE IS EFFICACY AND THERE IS 5611 03:46:12,893 --> 03:46:13,894 EFFECTIVENESS AND THEN 5612 03:46:13,894 --> 03:46:16,196 IMPLEMENTATION SCIENCE. 5613 03:46:16,196 --> 03:46:17,097 BUT I THINK THE EXAMPLE THAT 5614 03:46:17,097 --> 03:46:18,565 YOU'RE GIVING, THE EXPERIENCE 5615 03:46:18,565 --> 03:46:20,700 I'VE HAD IN WORKING IN FIVE 5616 03:46:20,700 --> 03:46:21,501 COUNTRIES THAT ARE GOING 5617 03:46:21,501 --> 03:46:23,770 STRAIGHT TO IMPLEMENTATION IS 5618 03:46:23,770 --> 03:46:25,605 THAT PEOPLE TAKE THE BEST 5619 03:46:25,605 --> 03:46:27,808 AVAILABLE EVIDENCE AND 5620 03:46:27,808 --> 03:46:28,074 IMPLEMENT. 5621 03:46:28,074 --> 03:46:31,378 SO THERE IS A LOT OF STUFF THAT 5622 03:46:31,378 --> 03:46:34,915 IS SKIPPED IN THAT PROCESS. 5623 03:46:34,915 --> 03:46:36,616 AND I THINK YOU END UP IN GLOBAL 5624 03:46:36,616 --> 03:46:38,452 MENTAL HEALTH AS IT IS TODAY, 5625 03:46:38,452 --> 03:46:39,886 ONE OF THE RULES OF RESEARCHERS 5626 03:46:39,886 --> 03:46:42,289 HAS TO BE TO SAY, HOW DO I 5627 03:46:42,289 --> 03:46:45,459 INFORM THESE REAL-WORLD EFFORTS 5628 03:46:45,459 --> 03:46:46,293 THAT ARE HAPPENING, BRING SOME 5629 03:46:46,293 --> 03:46:48,528 OF THESE PRINCIPLES OF SCIENCE 5630 03:46:48,528 --> 03:46:49,729 IN PLACES AND SITUATION THAT IS 5631 03:46:49,729 --> 03:46:51,298 ARE QUITE MESSY BECAUSE IT'S A 5632 03:46:51,298 --> 03:46:52,532 GOVERNMENT THAT IS SAYING, WE 5633 03:46:52,532 --> 03:46:54,201 WANT TO DO THIS. 5634 03:46:54,201 --> 03:46:55,836 IT'S A DONOR THAT IS SAYING WE 5635 03:46:55,836 --> 03:46:57,337 WANT TO DO THIS. 5636 03:46:57,337 --> 03:47:00,006 AND YOU DON'T HAVE THE WONDERFUL 5637 03:47:00,006 --> 03:47:01,408 PROGRESSION THAT HAPPENS WHEN 5638 03:47:01,408 --> 03:47:03,710 YOU ARE FOCUSING ON A RESEARCH 5639 03:47:03,710 --> 03:47:06,913 PROJECT AND NOT A LARGE 5640 03:47:06,913 --> 03:47:09,216 INITIATIVE AT THE COUNTRY LEVEL. 5641 03:47:09,216 --> 03:47:11,184 >> SO THIS CONVERSATION ABOUT 5642 03:47:11,184 --> 03:47:13,820 CONTEXT HAS TOUCHED ON, I THINK, 5643 03:47:13,820 --> 03:47:15,789 ALSO A CONVERSATION ABOUT WHAT 5644 03:47:15,789 --> 03:47:17,891 ARE CORE VERSUS ADAPTABLE 5645 03:47:17,891 --> 03:47:19,526 COMPONENTS, WHICH IS SOMETHING 5646 03:47:19,526 --> 03:47:21,628 THAT WE TALK ABOUT IN THE 5647 03:47:21,628 --> 03:47:22,195 IMPLEMENTATION SCIENCE CLASS 5648 03:47:22,195 --> 03:47:25,098 THAT I TEACH. 5649 03:47:25,098 --> 03:47:29,002 SO THREE OF YOU HAVE SPOKEN 5650 03:47:29,002 --> 03:47:30,303 ABOUT AN INTERVENTION THAT MAY 5651 03:47:30,303 --> 03:47:31,805 HAVE ELEMENTS WHICH CANNOT BE 5652 03:47:31,805 --> 03:47:34,508 MODIFIED WITHOUT REMOVING ITS 5653 03:47:34,508 --> 03:47:36,309 EFFECTIVENESS AND THEN OTHER 5654 03:47:36,309 --> 03:47:37,644 ELEMENTS WHICH CAN BE MODIFIED 5655 03:47:37,644 --> 03:47:39,813 IN ORDER TO SUIT THE CONTEXT, 5656 03:47:39,813 --> 03:47:40,914 AND VICTOR, YOU IDENTIFIED A FEW 5657 03:47:40,914 --> 03:47:43,083 ELEMENTS THAT WERE MODIFIED 5658 03:47:43,083 --> 03:47:44,117 ABOUT THE FRIENDSHIP BENCH 5659 03:47:44,117 --> 03:47:45,151 INTERVENTION IN THE TRANSITION 5660 03:47:45,151 --> 03:47:48,388 TO MALAWI THAT MAY THEN HAVE 5661 03:47:48,388 --> 03:47:50,524 UNDERCUT ITS EFFECTIVENESS. 5662 03:47:50,524 --> 03:47:51,825 AND BEING AT THE IMPLEMENTATION 5663 03:47:51,825 --> 03:47:54,427 STAGE TO DISTINGUISH WHAT ARE 5664 03:47:54,427 --> 03:47:56,396 THOSE CORE COMPONENTS THAT NEED 5665 03:47:56,396 --> 03:47:58,331 TO BE MAINTAINED VERSUS THE 5666 03:47:58,331 --> 03:48:00,166 ADAPTABLE COMPONENTS THAT CAN BE 5667 03:48:00,166 --> 03:48:02,602 MODIFIED TO FIT THE CONTEXT IS A 5668 03:48:02,602 --> 03:48:05,438 CRITICAL PART OF THE 5669 03:48:05,438 --> 03:48:05,772 CONVERSATION. 5670 03:48:05,772 --> 03:48:09,276 I'M GOING TO MAYBE GO OFF SCRIPT 5671 03:48:09,276 --> 03:48:11,378 A LITTLE BIT TO RIP-OFF OF 5672 03:48:11,378 --> 03:48:15,181 PAMELA'S COMMENT AND JUST SAY, 5673 03:48:15,181 --> 03:48:17,450 SO WHAT IS THE ROLE OF 5674 03:48:17,450 --> 03:48:18,518 IMPLEMENTATION SCIENCE RESEARCH 5675 03:48:18,518 --> 03:48:18,718 THEN? 5676 03:48:18,718 --> 03:48:20,220 WE TALKED ABOUT THE FACT WE HAVE 5677 03:48:20,220 --> 03:48:20,921 AN EVIDENCE BASE. 5678 03:48:20,921 --> 03:48:23,957 WE TRY TO IMPLEMENT TOO QUICKLY 5679 03:48:23,957 --> 03:48:25,725 OR INSUFFICIENT UNDERSTANDING 5680 03:48:25,725 --> 03:48:28,895 AND THINGS MIGHT GO AWRY. 5681 03:48:28,895 --> 03:48:30,931 WHAT IS THE LENSE THAT 5682 03:48:30,931 --> 03:48:31,565 IMPLEMENTATION SCIENCE RESEARCH 5683 03:48:31,565 --> 03:48:34,534 BRINGS TO TRY TO KEEP THAT FROM 5684 03:48:34,534 --> 03:48:39,639 HAPPENING? 5685 03:48:39,639 --> 03:48:41,107 OPEN QUESTION. 5686 03:48:41,107 --> 03:48:44,277 NO ONES PICTURE IS ON THE SCREEN 5687 03:48:44,277 --> 03:48:45,645 NOW. 5688 03:48:45,645 --> 03:48:47,714 [ LAUGHS ] 5689 03:48:47,714 --> 03:48:50,817 >> I THINK THAT PART OF THAT 5690 03:48:50,817 --> 03:48:51,718 QUESTION IS -- SO TO ME, THERE 5691 03:48:51,718 --> 03:48:53,119 IS A COUPLE OF ELEMENTS HERE. 5692 03:48:53,119 --> 03:48:56,122 SO IN THE CASE THAT VICTOR 5693 03:48:56,122 --> 03:48:58,224 PROVIDED VERY ELEGANTLY, THERE 5694 03:48:58,224 --> 03:49:00,727 WERE ISSUES WITH THE 5695 03:49:00,727 --> 03:49:03,029 INTERVENTION ITSELF IN TERMS OF 5696 03:49:03,029 --> 03:49:05,398 ITS SUITABILITY FOR MALAWI AS IT 5697 03:49:05,398 --> 03:49:06,733 WAS ORIGINALLY CONSTRUCTED. 5698 03:49:06,733 --> 03:49:09,502 AGAIN IT GOES BACK TO THE CORE 5699 03:49:09,502 --> 03:49:12,105 VERSUS ADAPTABLE COMPONENTS OF 5700 03:49:12,105 --> 03:49:12,639 AN INTERVENTION. 5701 03:49:12,639 --> 03:49:14,407 BUT WHEN YOU TAKE IT ONE STEP 5702 03:49:14,407 --> 03:49:16,509 FURTHER TO WHAT DOES 5703 03:49:16,509 --> 03:49:17,577 IMPLEMENTATION SCIENCE BRING? 5704 03:49:17,577 --> 03:49:20,447 TO ME IT'S A QUESTION OF IF YOU 5705 03:49:20,447 --> 03:49:22,515 HAVE A CLEAR UNDERSTANDING OF 5706 03:49:22,515 --> 03:49:25,652 THOSE CORE COMPONENTS AND THOSE 5707 03:49:25,652 --> 03:49:27,387 ARE SUITABLE TO A PARTICULAR 5708 03:49:27,387 --> 03:49:28,421 CONTEXT, THEN THE QUESTION IS, 5709 03:49:28,421 --> 03:49:32,058 HOW DO YOU DO IT MOST 5710 03:49:32,058 --> 03:49:32,359 EFFECTIVELY? 5711 03:49:32,359 --> 03:49:34,160 HOW DO YOU DO IT MOST 5712 03:49:34,160 --> 03:49:34,461 EFFICIENTLY? 5713 03:49:34,461 --> 03:49:37,964 HOW DO YOU DO IT IN A WAY THAT 5714 03:49:37,964 --> 03:49:41,434 LOSES THE LEAST EFFICACY IN A 5715 03:49:41,434 --> 03:49:41,768 SENSE? 5716 03:49:41,768 --> 03:49:42,669 BECAUSE ALMOST ALWAYS WHEN YOU 5717 03:49:42,669 --> 03:49:45,872 TAKE SOMETHING FROM A PEER 5718 03:49:45,872 --> 03:49:46,773 CLINICAL TRIAL TO THE REAL 5719 03:49:46,773 --> 03:49:48,808 WORLD, THERE WILL BE SOME LOSS 5720 03:49:48,808 --> 03:49:49,909 OF EFFECTIVENESS. 5721 03:49:49,909 --> 03:49:51,244 SO HOW DO YOU DO THAT IN A WAY 5722 03:49:51,244 --> 03:49:53,980 THAT YOU KEEP IT AS CLOSE TO THE 5723 03:49:53,980 --> 03:49:55,649 CLINICAL TRIAL EFFICACY AS YOU 5724 03:49:55,649 --> 03:49:56,182 POSSIBLY CAN? 5725 03:49:56,182 --> 03:49:58,284 AND TO ME, THAT'S WHAT THE 5726 03:49:58,284 --> 03:49:59,185 IMPLEMENTATION SCIENCE QUESTIONS 5727 03:49:59,185 --> 03:49:59,586 ARE. 5728 03:49:59,586 --> 03:50:01,087 IT'S MORE ABOUT IF WE DO IT THIS 5729 03:50:01,087 --> 03:50:04,357 WAY, HOW WELL DO WE DO VERSUS 5730 03:50:04,357 --> 03:50:04,624 THIS WAY? 5731 03:50:04,624 --> 03:50:07,594 AND THAT'S WHY IT GETS IN A 5732 03:50:07,594 --> 03:50:09,362 PRETTY MUDDY SPACE IN TERMS OF 5733 03:50:09,362 --> 03:50:11,164 LIKE WHO THE PARTICIPANTS ARE 5734 03:50:11,164 --> 03:50:13,066 AND THAT SORT OF THING, WHICH 5735 03:50:13,066 --> 03:50:20,440 WE'LL TALK ABOUT IN A LITTLE B 5736 03:50:20,440 --> 03:50:20,607 BIT. 5737 03:50:20,607 --> 03:50:23,276 >> WHEN YOU READ THE CLINICAL 5738 03:50:23,276 --> 03:50:24,778 TRIAL IN ZAMBIA, IN THE 5739 03:50:24,778 --> 03:50:27,147 CONCLUSION SECTION THEY WRITE, 5740 03:50:27,147 --> 03:50:29,949 WE WERE NOT CLEAR WHICH ELEMENT 5741 03:50:29,949 --> 03:50:33,153 OF THIS INTERVENTION ACTUALLY 5742 03:50:33,153 --> 03:50:34,954 REDUCED DEPRESSION. 5743 03:50:34,954 --> 03:50:36,289 REMEMBER THAT THERE WAS 5744 03:50:36,289 --> 03:50:36,589 COUNSELING. 5745 03:50:36,589 --> 03:50:38,758 THERE WAS SMS SENT TO THE 5746 03:50:38,758 --> 03:50:41,528 CLIENTS IN BETWEEN THE SESSIONS 5747 03:50:41,528 --> 03:50:43,596 AND THE JOINING OF A PEER GROUP. 5748 03:50:43,596 --> 03:50:46,800 SO WE HAVE THREE ELEMENTS. 5749 03:50:46,800 --> 03:50:49,169 BUT THE PUBLISHERS, THE 5750 03:50:49,169 --> 03:50:53,573 RESEARCHERS OF THE ORIGINAL DID 5751 03:50:53,573 --> 03:50:56,576 NOT KNOW WHICH OF THE ELEMENTS 5752 03:50:56,576 --> 03:50:57,644 WERE CRITICAL. 5753 03:50:57,644 --> 03:51:00,780 MEANING THAT IF YOU ARE ADAPTING 5754 03:51:00,780 --> 03:51:04,751 IT WHICH PART DO YOU DROP? 5755 03:51:04,751 --> 03:51:05,085 >> EXACTLY. 5756 03:51:05,085 --> 03:51:06,186 >> BUT I DO THINK THAT'S THE 5757 03:51:06,186 --> 03:51:08,188 PLACE FOR IMPLEMENTATION 5758 03:51:08,188 --> 03:51:08,421 SCIENCE. 5759 03:51:08,421 --> 03:51:10,490 SO FOR -- IF YOU COULD HAVE IN 5760 03:51:10,490 --> 03:51:11,391 THE MINISTRY OF HEALTH THIS 5761 03:51:11,391 --> 03:51:14,360 PERSON WHO IS ABLE TO TALK ABOUT 5762 03:51:14,360 --> 03:51:17,564 THE ADAPT OHM, HOW DO WE THINK 5763 03:51:17,564 --> 03:51:20,633 ABOUT ADAPTATION, SYSTEMATICALLY 5764 03:51:20,633 --> 03:51:22,869 AND THEN HOW DO YOU ENABLE THOSE 5765 03:51:22,869 --> 03:51:23,970 PEOPLE WHO ARE GOING TO BE 5766 03:51:23,970 --> 03:51:26,573 ULTIMATELY RESPONSIBLE FOR 5767 03:51:26,573 --> 03:51:29,109 ENSURING THAT THINGS ARE 5768 03:51:29,109 --> 03:51:30,577 IMPLEMENTED WELL TO USE THESE 5769 03:51:30,577 --> 03:51:31,544 SCIENTIFIC PRINCIPLES? 5770 03:51:31,544 --> 03:51:34,581 SO I THINK WE HAVE A ROLE OF 5771 03:51:34,581 --> 03:51:35,682 IDENTIFYING THE SCIENTIFIC 5772 03:51:35,682 --> 03:51:37,851 PRINCIPLES AND TRANSLATING THEM 5773 03:51:37,851 --> 03:51:41,187 FOR USE IN A PUBLIC HEALTH 5774 03:51:41,187 --> 03:51:42,255 CONTEXT. 5775 03:51:42,255 --> 03:51:45,191 >> I THINK IT'S -- I THINK IT'S 5776 03:51:45,191 --> 03:51:47,560 SIMPLER SOMETIMES LIKE USING OUR 5777 03:51:47,560 --> 03:51:49,262 SUICIDE TRAINING, GATEKEEPER 5778 03:51:49,262 --> 03:51:51,297 TRAINING MODEL AS AN EXAMPLE, 5779 03:51:51,297 --> 03:51:53,266 IT'S A SIMPLE QUESTION THAT THE 5780 03:51:53,266 --> 03:51:54,968 POLICYMAKER HAS, IS THAT HOW CAN 5781 03:51:54,968 --> 03:51:57,470 I BE SURE IF I DO THIS TRAINING 5782 03:51:57,470 --> 03:51:59,973 THAT SCHOOLTEACHER IS GOING TO 5783 03:51:59,973 --> 03:52:01,574 IDENTIFY THESE KIDS AND DO WHAT 5784 03:52:01,574 --> 03:52:02,942 THEY ARE SUPPOSED TO DO? 5785 03:52:02,942 --> 03:52:04,310 AND WHAT IS THE BEST WAY TO 5786 03:52:04,310 --> 03:52:05,812 TRAIN THESE SCHOOLTEACHERS? 5787 03:52:05,812 --> 03:52:06,780 THAT'S THE QUESTION. 5788 03:52:06,780 --> 03:52:08,081 THAT'S THE IMPLEMENTER'S 5789 03:52:08,081 --> 03:52:10,683 QUESTION WHICH YOU TAKE AND YOU 5790 03:52:10,683 --> 03:52:12,051 TRY AND DESIGN A WAY BY WHICH 5791 03:52:12,051 --> 03:52:13,720 YOU CAN ANSWER THAT QUESTION 5792 03:52:13,720 --> 03:52:14,554 WITH SOME DATA. 5793 03:52:14,554 --> 03:52:15,688 THAT'S HOW I SEE IT. 5794 03:52:15,688 --> 03:52:17,457 THAT'S HOW I SEE THE ROLE OF 5795 03:52:17,457 --> 03:52:19,359 WHAT WE DO AS IMPLEMENTATION 5796 03:52:19,359 --> 03:52:21,060 SCIENCE, THAT YOU HAVE A 5797 03:52:21,060 --> 03:52:22,362 REAL-WORLD QUESTION AND YOU TAKE 5798 03:52:22,362 --> 03:52:24,364 THAT REAL-WORLD QUESTION AND YOU 5799 03:52:24,364 --> 03:52:26,266 MAKE IT INTO A STUDY OF SOME WAY 5800 03:52:26,266 --> 03:52:27,967 TO TRY AND ANSWER THAT QUESTION. 5801 03:52:27,967 --> 03:52:29,936 SO YOU COULD DO, FOR EXAMPLE, 5802 03:52:29,936 --> 03:52:30,870 YOU COULD DO SOMETHING WHERE YOU 5803 03:52:30,870 --> 03:52:32,972 WANT TO LOOK AT REACH. 5804 03:52:32,972 --> 03:52:34,774 YOU WANT TO SEE IF WE TRAIN 5805 03:52:34,774 --> 03:52:37,477 COMMUNITY HEALTH WORKERS TO 5806 03:52:37,477 --> 03:52:39,679 DELIVER A MENTAL HEALTH 5807 03:52:39,679 --> 03:52:40,480 INTERVENTION, HOW MANY PEOPLE IN 5808 03:52:40,480 --> 03:52:42,282 THE COMMUNITY GET HELPED? 5809 03:52:42,282 --> 03:52:44,584 NOW THAT'S A DIFFERENT QUESTION 5810 03:52:44,584 --> 03:52:47,086 TO SAYING, IF WE TRAIN COMMUNITY 5811 03:52:47,086 --> 03:52:48,454 HEALTH WORKERS, HOW MANY 5812 03:52:48,454 --> 03:52:51,257 COMMUNITY HEALTH WORKERS WILL 5813 03:52:51,257 --> 03:52:52,992 ACTUALLY DELIVER THAT 5814 03:52:52,992 --> 03:52:53,393 INTERVENTION? 5815 03:52:53,393 --> 03:52:55,094 NOW THAT'S A COMPLETELY 5816 03:52:55,094 --> 03:52:55,862 DIFFERENT QUESTION TO THE FIRST 5817 03:52:55,862 --> 03:52:58,398 ONE AND YOU DO A VERY DIFFERENT 5818 03:52:58,398 --> 03:53:00,366 SET OF TRIALS OR STUDIES TO 5819 03:53:00,366 --> 03:53:01,401 ANSWER THOSE TWO QUESTIONS. 5820 03:53:01,401 --> 03:53:03,403 BUT BOTH OF THOSE QUESTIONS ARE 5821 03:53:03,403 --> 03:53:05,905 EXTREMELY IMPORTANT FOR THE 5822 03:53:05,905 --> 03:53:06,206 POLICYMAKER. 5823 03:53:06,206 --> 03:53:07,207 AND YOU NEED TO BE ABLE TO 5824 03:53:07,207 --> 03:53:09,075 ANSWER THOSE QUESTIONS FOR THE 5825 03:53:09,075 --> 03:53:11,211 POLICYMAKER BEFORE THE 5826 03:53:11,211 --> 03:53:13,613 POLICYMAKER FEELS CONFIDENT 5827 03:53:13,613 --> 03:53:15,181 ENOUGH TO COMMIT THEIR FUNDS TO 5828 03:53:15,181 --> 03:53:16,683 DOING WHAT YOU WANT THEM TO DO. 5829 03:53:16,683 --> 03:53:18,718 THEY WANT TO BE SURE THAT IF 5830 03:53:18,718 --> 03:53:20,220 THEY DID THAT, THEY ARE GETTING 5831 03:53:20,220 --> 03:53:21,020 VALUE FOR MONEY. 5832 03:53:21,020 --> 03:53:23,256 THEY ARE GOING TO GET BANG FOR 5833 03:53:23,256 --> 03:53:23,790 THE BUCK. 5834 03:53:23,790 --> 03:53:25,291 AND HOW DO THEY KNOW IF THEY 5835 03:53:25,291 --> 03:53:28,361 TRAIN LOTS OF THESE PEOPLE TO DO 5836 03:53:28,361 --> 03:53:29,596 MENTAL HEALTH WORK, THEY WILL GO 5837 03:53:29,596 --> 03:53:31,197 OUT AND DO THE MENTAL HEALTH 5838 03:53:31,197 --> 03:53:31,497 WORK? 5839 03:53:31,497 --> 03:53:33,533 THAT'S THE KIND OF QUESTIONS WE 5840 03:53:33,533 --> 03:53:34,901 SHOULD BE ASKING AND ANSWERING. 5841 03:53:34,901 --> 03:53:36,302 SO I THINK IMPLEMENTATION 5842 03:53:36,302 --> 03:53:39,205 SCIENCE DOES HAVE A HUGE ROLE TO 5843 03:53:39,205 --> 03:53:41,241 ANSWER REAL-WORLD QUESTIONS 5844 03:53:41,241 --> 03:53:42,876 RATHER THAN THINK ABOUT 5845 03:53:42,876 --> 03:53:44,344 DISCOVERY RESEARCHERS. 5846 03:53:44,344 --> 03:53:46,479 >> SO I THINK WE ARE GETTING 5847 03:53:46,479 --> 03:53:48,081 SOME CONTINUING THEMES AROUND 5848 03:53:48,081 --> 03:53:49,883 HOW TO USE THESE TOOLS TO 5849 03:53:49,883 --> 03:53:51,985 ADDRESS POLICY RELEVANT QUESTION 5850 03:53:51,985 --> 03:53:55,889 THAT IS HELP POLICYMAKERS 5851 03:53:55,889 --> 03:53:59,826 TRANSLATE EVIDENCE BASE INTO 5852 03:53:59,826 --> 03:54:02,128 SCALED UP SERVICE DELIVERY. 5853 03:54:02,128 --> 03:54:03,296 AUDIENCE MIGHT HAVE REALIZED 5854 03:54:03,296 --> 03:54:04,731 YOU'RE GIVING TWICE THE BENEFIT 5855 03:54:04,731 --> 03:54:09,602 OUT OF THIS SESSION BECAUSE THE 5856 03:54:09,602 --> 03:54:10,403 TOP -- THE POINTS THE SPEAKERS 5857 03:54:10,403 --> 03:54:11,604 DECIDE TO MAKE FROM THE STAGE 5858 03:54:11,604 --> 03:54:13,473 DOESN'T NECESSARILY ALIGN WITH 5859 03:54:13,473 --> 03:54:15,508 THE POINTS THEY INTENDED TO MAKE 5860 03:54:15,508 --> 03:54:17,710 WHICH ARE UP ON THE SLIDES. 5861 03:54:17,710 --> 03:54:19,112 SO BOTH YOU GET THEIR 5862 03:54:19,112 --> 03:54:20,813 REFLECTIONS IN PRINT AND THEIR 5863 03:54:20,813 --> 03:54:23,049 OFF THE CUFF REFLECTIONS ORALLY. 5864 03:54:23,049 --> 03:54:23,383 [ LAUGHS ] 5865 03:54:23,383 --> 03:54:25,785 BUT WITH THAT, WE WILL 5866 03:54:25,785 --> 03:54:26,886 TRANSITION TOPICS A LITTLE BIT 5867 03:54:26,886 --> 03:54:28,521 TO TALK ABOUT WHAT ARE SOME OF 5868 03:54:28,521 --> 03:54:32,659 THE COMPLEXITIES THAT A COMPANY 5869 03:54:32,659 --> 03:54:33,359 IMPLEMENTATION SCIENCE RESEARCH 5870 03:54:33,359 --> 03:54:34,861 SPECIFICALLY IN TERMS OF 5871 03:54:34,861 --> 03:54:37,430 THINKING ABOUT DESIGNING AND 5872 03:54:37,430 --> 03:54:38,831 CONDUCTING THESE STUDIES TO BE 5873 03:54:38,831 --> 03:54:40,533 ABLE TO ANSWER THESE QUESTIONS 5874 03:54:40,533 --> 03:54:43,036 THAT WE HAVE BEEN RAISING? 5875 03:54:43,036 --> 03:54:43,436 BILL? 5876 03:54:43,436 --> 03:54:44,504 >> BRIAN, YOU'LL BE HAPPY TO 5877 03:54:44,504 --> 03:54:49,842 KNOW I'M LOOKING AT -- 5878 03:54:49,842 --> 03:54:51,844 [ LAUGHS ] 5879 03:54:51,844 --> 03:54:54,714 SO, DESIGNING IMPLEMENTATION 5880 03:54:54,714 --> 03:54:57,450 SCIENCE STUDIES IS QUITE A 5881 03:54:57,450 --> 03:54:58,551 CHALLENGE IN MANY WAYS. 5882 03:54:58,551 --> 03:55:01,821 IT'S NOT WHAT WE'RE USED TO -- 5883 03:55:01,821 --> 03:55:03,323 INDIVIDUAL INTERVENTIONS AND WE 5884 03:55:03,323 --> 03:55:05,224 ARE ABSOLUTELY VIRTUALLY ALWAYS 5885 03:55:05,224 --> 03:55:07,260 WORKING AT SOME SORT OF CLUSTER 5886 03:55:07,260 --> 03:55:09,696 LEVEL, WHETHER THAT CLUSTER IS A 5887 03:55:09,696 --> 03:55:12,532 PHYSICIAN WHOSE TREATING MANY 5888 03:55:12,532 --> 03:55:14,133 PATIENTS OR WHETHER THAT CLUSTER 5889 03:55:14,133 --> 03:55:17,537 IS A CLINIC OR EVEN A COUNTY OR 5890 03:55:17,537 --> 03:55:19,439 A CITY OR SOMETHING LIKE THAT. 5891 03:55:19,439 --> 03:55:24,744 AND AS A RESULT, YOU HAVE MANY, 5892 03:55:24,744 --> 03:55:26,846 MANY FEWER PARTICIPANTS IN A 5893 03:55:26,846 --> 03:55:27,080 SENSE. 5894 03:55:27,080 --> 03:55:31,451 WHAT I MEAN BY THAT IS, YOU'LL 5895 03:55:31,451 --> 03:55:34,787 HAVE AN N OF 42 IS HUGE IN THE 5896 03:55:34,787 --> 03:55:35,588 IMPLEMENTATION SCIENCE WORLD. 5897 03:55:35,588 --> 03:55:39,559 SO WE WERE REALLY LUCKY IN OUR 5898 03:55:39,559 --> 03:55:42,829 SCALE UP OF HPTN074 TO BE ABLE 5899 03:55:42,829 --> 03:55:44,931 TO DO IT IN 42 CLINICS. 5900 03:55:44,931 --> 03:55:46,733 I JUST LOST MY THING SO I DON'T 5901 03:55:46,733 --> 03:55:49,135 KNOW WHAT ELSE I'M GOING TO SAY. 5902 03:55:49,135 --> 03:55:51,037 THERE WE GO. 5903 03:55:51,037 --> 03:55:55,074 AND WHEREAS IN CONTRAST, BRIAN. 5904 03:55:55,074 --> 03:55:56,542 [ OFF MICROPHONE ] 5905 03:55:56,542 --> 03:55:58,044 >> SO WE DID 10 AND WE THOUGHT 5906 03:55:58,044 --> 03:55:59,946 THAT TOOK A LOT OF WORK AND NOW 5907 03:55:59,946 --> 03:56:02,015 WE'RE DOING 12. 5908 03:56:02,015 --> 03:56:02,849 [ LAUGHS ] 5909 03:56:02,849 --> 03:56:04,050 12 DISTRICTS. 5910 03:56:04,050 --> 03:56:04,450 >> 12 DISTRICTS. 5911 03:56:04,450 --> 03:56:05,551 >> PRETTY COMPLICATED. 5912 03:56:05,551 --> 03:56:06,753 >> YES, EXACTLY. 5913 03:56:06,753 --> 03:56:08,554 >> SCALING UP SERVICES IN 12 5914 03:56:08,554 --> 03:56:09,689 HEALTH DISTRICTS. 5915 03:56:09,689 --> 03:56:11,858 >> IN OUR FOLLOW-UP IN A 5916 03:56:11,858 --> 03:56:15,361 DIFFERENT PROJECT, WHICH IS AN 5917 03:56:15,361 --> 03:56:16,662 ALCOHOL-BASED -- 5918 03:56:16,662 --> 03:56:17,296 ALCOHOL-REDUCTION INTERVENTION 5919 03:56:17,296 --> 03:56:18,331 IS IN 30 CLINICS. 5920 03:56:18,331 --> 03:56:21,667 WE WENT FROM 42 TO THIRT BECAUSE 5921 03:56:21,667 --> 03:56:24,370 42 IS IMPOSSIBLE TO MANAGE -- 5922 03:56:24,370 --> 03:56:24,570 42-30. 5923 03:56:24,570 --> 03:56:25,838 IF YOU THINK ABOUT WHAT YOU'RE 5924 03:56:25,838 --> 03:56:27,140 DOING IN EACH OF THOSE CLINICS, 5925 03:56:27,140 --> 03:56:30,710 YOU'RE TRAINING PEOPLE TO 5926 03:56:30,710 --> 03:56:31,244 DELIVER THIS INTERVENTION. 5927 03:56:31,244 --> 03:56:32,145 SO THE PEOPLE THAT YOU'RE 5928 03:56:32,145 --> 03:56:34,981 ACTUALLY TRYING TO STUDY ARE 5929 03:56:34,981 --> 03:56:35,782 USUALLY THE STAFF. 5930 03:56:35,782 --> 03:56:38,551 AND POTENTIALLY THE CLINIC 5931 03:56:38,551 --> 03:56:39,252 DIRECTORS. 5932 03:56:39,252 --> 03:56:41,954 AND THAT'S A VERY DIFFERENT 5933 03:56:41,954 --> 03:56:44,857 POPULATION THAN WE'RE USED TO 5934 03:56:44,857 --> 03:56:46,859 WORKING WITH. 5935 03:56:46,859 --> 03:56:49,028 AND THEY HAVE OTHER JOBS TO DO. 5936 03:56:49,028 --> 03:56:51,164 THEY ARE TRYING TO, YOU KNOW, 5937 03:56:51,164 --> 03:56:53,966 MANAGE THE REST OF THEIR 5938 03:56:53,966 --> 03:56:56,636 CLINICAL RESPONSIBILITIES. 5939 03:56:56,636 --> 03:56:57,603 TYPICALLY YOU'RE NOT -- YOU 5940 03:56:57,603 --> 03:56:59,639 MIGHT BE GIVING THE CLINIC A 5941 03:56:59,639 --> 03:57:00,706 LITTLE BIT OF FUNDING. 5942 03:57:00,706 --> 03:57:02,775 YOU'RE NOT NECESSARILY PAYING 5943 03:57:02,775 --> 03:57:04,577 THEM DIRECTLY BECAUSE YOU'RE 5944 03:57:04,577 --> 03:57:06,846 TRYING TO REPLICATE THE REAL 5945 03:57:06,846 --> 03:57:08,648 WORLD OF WHERE THE MINISTRY OF 5946 03:57:08,648 --> 03:57:09,782 HEALTH BASICALLY SAYS, YOU'RE 5947 03:57:09,782 --> 03:57:11,350 GOING TO ADD THIS TO YOUR 5948 03:57:11,350 --> 03:57:14,854 REPERTOIRE OF WHAT YOU DO. 5949 03:57:14,854 --> 03:57:16,289 AND THERE IS NO -- LIKE YOU'RE 5950 03:57:16,289 --> 03:57:18,558 GOING TO ADD THIS TO YOUR REP 5951 03:57:18,558 --> 03:57:19,959 PRIOR AND YOU'RE GOING TO GET 5952 03:57:19,959 --> 03:57:23,129 PAID EXTRA TO DO THAT. 5953 03:57:23,129 --> 03:57:25,565 AND SO, SOMETIMES SOME OF THE 5954 03:57:25,565 --> 03:57:26,666 LARGER AGENCIES WILL DO THAT. 5955 03:57:26,666 --> 03:57:27,967 THEY'LL COME IN, THEY'LL PAY 5956 03:57:27,967 --> 03:57:29,769 PEOPLE EXTRA TO DO IT. 5957 03:57:29,769 --> 03:57:31,971 THEY'LL DO IT AND THEN WHEN THE 5958 03:57:31,971 --> 03:57:34,373 AGENCY LEAVES, THE ACTIVITY 5959 03:57:34,373 --> 03:57:34,640 STOPS. 5960 03:57:34,640 --> 03:57:36,142 SO YOU DO HAVE TO TAKE THOSE 5961 03:57:36,142 --> 03:57:40,580 KINDS OF THINGS INTO ACCOUNT AS 5962 03:57:40,580 --> 03:57:40,980 WELL. 5963 03:57:40,980 --> 03:57:42,548 THE OUTCOMES ARE TOTALLY 5964 03:57:42,548 --> 03:57:44,083 DIFFERENT THAN WHAT WE'RE USED 5965 03:57:44,083 --> 03:57:44,484 TO. 5966 03:57:44,484 --> 03:57:46,052 THE OUTCOMES ARE THINGS LIKE 5967 03:57:46,052 --> 03:57:48,087 FIDELITY TO THE INTERVENTION. 5968 03:57:48,087 --> 03:57:51,190 SO FOR OUR STUDIES, FIDELITY IS 5969 03:57:51,190 --> 03:57:53,960 BEING MEASURED BY A COMPOSITE 5970 03:57:53,960 --> 03:57:56,362 INDEX THAT WE CREATED THAT TAKES 5971 03:57:56,362 --> 03:57:58,397 INTO ACCOUNT THE FREQUENCY THAT 5972 03:57:58,397 --> 03:58:01,067 THE NUMBER OF SESSIONS WAS 5973 03:58:01,067 --> 03:58:06,005 COMPLETED COUPLED WITH AN AUDIO 5974 03:58:06,005 --> 03:58:07,974 RECORDING REVIEW OF ESSENTIALLY 5975 03:58:07,974 --> 03:58:13,446 THE QUALITY OF THE COUNCILLING 5976 03:58:13,446 --> 03:58:13,679 SESSION. 5977 03:58:13,679 --> 03:58:15,648 AND WE DON'T REVIEW EVERY SINGLE 5978 03:58:15,648 --> 03:58:17,083 AUDIO RECORDING. 5979 03:58:17,083 --> 03:58:19,185 WE REVIEW A SAMPLE AND THEN YOU 5980 03:58:19,185 --> 03:58:21,187 PUT THAT TOGETHER TO GET A 5981 03:58:21,187 --> 03:58:23,589 CLINIC SCORE TO BE ABLE TO 5982 03:58:23,589 --> 03:58:25,291 COMPARE THE CLINICS IN THE TWO 5983 03:58:25,291 --> 03:58:35,601 ARMS OF THE STUDY. 5984 03:58:39,539 --> 03:58:42,375 IT'S QUITE A CHALLENGE TO THINK 5985 03:58:42,375 --> 03:58:44,577 ABOUT HOW DO YOU DESCRIBE THAT 5986 03:58:44,577 --> 03:58:47,480 FIDELITY OUTCOME IN A WAY THAT 5987 03:58:47,480 --> 03:58:49,582 EVERYONE CAN GRASP AND TAKE AWAY 5988 03:58:49,582 --> 03:58:51,284 IN A MEANINGFUL WAY? 5989 03:58:51,284 --> 03:58:53,753 HOW DO YOU DESCRIBE WHO ARE YOUR 5990 03:58:53,753 --> 03:58:54,086 PARTICIPANTS? 5991 03:58:54,086 --> 03:58:55,888 YES YOU HAVE TO CONSENT EVERY 5992 03:58:55,888 --> 03:58:57,390 PERSON IN ORDER TO GET THEIR 5993 03:58:57,390 --> 03:58:58,491 AUDIO RECORDING. 5994 03:58:58,491 --> 03:58:59,792 BUT THAT'S ALL YOU'RE GETTING 5995 03:58:59,792 --> 03:59:01,727 FROM THEM IS AN AUDIO RECORDING 5996 03:59:01,727 --> 03:59:04,297 THAT YOU'RE ACTUALLY NOT GRADING 5997 03:59:04,297 --> 03:59:04,497 THEM. 5998 03:59:04,497 --> 03:59:06,265 YOU'RE GRADING THE PERSON THAT 5999 03:59:06,265 --> 03:59:08,267 DELIVERED THE AUDIO RECORDING. 6000 03:59:08,267 --> 03:59:10,369 SO, ARE THEY A PARTICIPANT? 6001 03:59:10,369 --> 03:59:12,905 THEY ARE FROM AN IRB 6002 03:59:12,905 --> 03:59:13,206 PERSPECTIVE. 6003 03:59:13,206 --> 03:59:16,475 THEY AREN'T REALLY FROM A TRIAL 6004 03:59:16,475 --> 03:59:16,776 PERSPECTIVE. 6005 03:59:16,776 --> 03:59:18,411 BUT HOW DO YOU THINK ABOUT THAT 6006 03:59:18,411 --> 03:59:21,781 AND HOW DO YOU MANAGE THAT KIND 6007 03:59:21,781 --> 03:59:22,481 OF THING? 6008 03:59:22,481 --> 03:59:27,153 >> I HAVE TO LOOK UP HERE NOW. 6009 03:59:27,153 --> 03:59:28,988 >> THANK YOU. 6010 03:59:28,988 --> 03:59:30,790 >> I'LL ALSO ADD THAT THERE IS 6011 03:59:30,790 --> 03:59:33,392 OFTEN A QUALITATIVE ELEMENT TO 6012 03:59:33,392 --> 03:59:33,559 IT. 6013 03:59:33,559 --> 03:59:35,828 WHEN YOU'RE THINKING ABOUT 6014 03:59:35,828 --> 03:59:38,831 ACCESSIBILITY, SURE WE HAVE 6015 03:59:38,831 --> 03:59:39,999 MEASURES -- ACCEPTABILITY -- 6016 03:59:39,999 --> 03:59:42,235 THEY ARE USUALLY GENERIC. 6017 03:59:42,235 --> 03:59:44,604 THEY AREN'T NECESSARILY LES. 6018 03:59:44,604 --> 03:59:47,039 YOU CAN TAYLOR THEM TO YOUR 6019 03:59:47,039 --> 03:59:48,407 PARTICULAR CIRCUMSTANCES. 6020 03:59:48,407 --> 03:59:50,109 BUT YOU HAVE TO TALK TO PEOPLE 6021 03:59:50,109 --> 03:59:51,544 AND TALK TO THE PEOPLE WHO 6022 03:59:51,544 --> 03:59:52,411 DELIVERED THE INTERVENTION AND 6023 03:59:52,411 --> 03:59:53,846 TO THE PEOPLE WHO RECEIVED THE 6024 03:59:53,846 --> 03:59:54,213 INTERVENTION. 6025 03:59:54,213 --> 03:59:57,116 THOSE ARE TWO DIFFERENT FORMS OF 6026 03:59:57,116 --> 03:59:58,517 ACCEPTABILITY THAT ARE REALLY 6027 03:59:58,517 --> 03:59:59,051 IMPORTANT. 6028 03:59:59,051 --> 04:00:01,020 SO WHEN YOU TAKE ALL OF THESE 6029 04:00:01,020 --> 04:00:03,422 THINGS INTO CONSIDERATION, IT'S 6030 04:00:03,422 --> 04:00:06,525 A QUITE DIFFERENT FEEL FROM A 6031 04:00:06,525 --> 04:00:07,326 TRADITIONAL INTERVENTION TRIAL. 6032 04:00:07,326 --> 04:00:10,529 AND JUST TO GIVE YOU A SENSE OF 6033 04:00:10,529 --> 04:00:13,432 WHAT THE ARMS MIGHT BE, SO IN 6034 04:00:13,432 --> 04:00:15,034 OUR - AUTO ONE I REFERRED TO 6035 04:00:15,034 --> 04:00:19,739 EARLIER, ONE ARM IS JUST SIMPLY 6036 04:00:19,739 --> 04:00:22,041 MAPPING OUT WHAT THE SORT OF 6037 04:00:22,041 --> 04:00:23,542 SUPPORT MECHANISMS WERE FROM A 6038 04:00:23,542 --> 04:00:27,313 VERY SORT OF CENTRALLY-MANAGED 6039 04:00:27,313 --> 04:00:27,613 PERSPECTIVE. 6040 04:00:27,613 --> 04:00:29,215 MUCH LIKE A MINISTRY WOULD 6041 04:00:29,215 --> 04:00:29,815 TYPICALLY DO. 6042 04:00:29,815 --> 04:00:30,850 THEY WOULD SAY YOU NEED TO 6043 04:00:30,850 --> 04:00:31,751 IMPLEMENT THIS. 6044 04:00:31,751 --> 04:00:34,153 THESE ARE YOUR RESOURCES TO 6045 04:00:34,153 --> 04:00:34,854 IMPLEMENT. 6046 04:00:34,854 --> 04:00:37,056 THE INTERVENTION ARM WAS 6047 04:00:37,056 --> 04:00:38,924 BASICALLY TAILORED TO THE CLINIC 6048 04:00:38,924 --> 04:00:42,028 WHERE WE DID SOME VERY FAIRLY 6049 04:00:42,028 --> 04:00:43,362 SIMPLE INTERVIEWS OF PEOPLE IN 6050 04:00:43,362 --> 04:00:45,197 THE CLINIC FOUND OUT WHAT THEIR 6051 04:00:45,197 --> 04:00:47,033 NEEDS WERE, FOUND OUT WHAT THEIR 6052 04:00:47,033 --> 04:00:49,035 CHALLENGES WERE AND THEN A MENU 6053 04:00:49,035 --> 04:00:50,636 OF THINGS THEY COULD PICK FROM 6054 04:00:50,636 --> 04:00:52,638 TO ADD TO THAT. 6055 04:00:52,638 --> 04:00:54,840 SO NOT A LOT MORE TIME AND 6056 04:00:54,840 --> 04:00:56,142 ENERGY BUT SOME. 6057 04:00:56,142 --> 04:00:57,576 AND SO OBVIOUSLY COST WILL BE 6058 04:00:57,576 --> 04:01:03,149 ONE OF OUR OUTCOMES IN ADDITION 6059 04:01:03,149 --> 04:01:05,351 TO THE ACTUAL INTERVENTION. 6060 04:01:05,351 --> 04:01:07,286 AND THEN IN THE OTHER CONTEXT WE 6061 04:01:07,286 --> 04:01:12,224 ARE DOING AN INTERVENTION THAT 6062 04:01:12,224 --> 04:01:14,794 IS AN EXPERIENTIAL ONE WHERE THE 6063 04:01:14,794 --> 04:01:15,461 INTERVENTION ARM UNDERGOES THE 6064 04:01:15,461 --> 04:01:16,562 INTERVENTION TO UNDERSTAND WHAT 6065 04:01:16,562 --> 04:01:18,864 IT FEELS LIKE TO BE THE 6066 04:01:18,864 --> 04:01:20,533 RECIPIENT BEFORE THEY DELIVER 6067 04:01:20,533 --> 04:01:20,833 IT. 6068 04:01:20,833 --> 04:01:23,169 SO THOSE ARE SOME OF THE -- IT'S 6069 04:01:23,169 --> 04:01:26,172 QUITE A DIFFERENT FEEL FROM YOUR 6070 04:01:26,172 --> 04:01:27,340 TYPICAL INTERVENTION AND QUITE 6071 04:01:27,340 --> 04:01:29,775 DIFFICULT FROM A STATISTICAL 6072 04:01:29,775 --> 04:01:30,076 PERSPECTIVE. 6073 04:01:30,076 --> 04:01:32,478 IF YOU EVER HAVE THE FORTUNE TO 6074 04:01:32,478 --> 04:01:34,847 BE WRITING AN IMPLEMENTATION 6075 04:01:34,847 --> 04:01:35,748 SCIENCE GRANT AND SEND IT TO AN 6076 04:01:35,748 --> 04:01:37,550 NIH STUDY SECTION, HOPE AT LEAST 6077 04:01:37,550 --> 04:01:38,884 ONE OR TWO OF THE PEOPLE 6078 04:01:38,884 --> 04:01:40,987 UNDERSTAND SOMETHING ABOUT 6079 04:01:40,987 --> 04:01:41,620 IMPLEMENTATION SCIENCE OTHERWISE 6080 04:01:41,620 --> 04:01:42,755 THEY WILL TELL YOU THAT YOU 6081 04:01:42,755 --> 04:01:45,925 CAN'T DO THAT WITH 30 CLINICS. 6082 04:01:45,925 --> 04:01:47,760 YOU CAN'T HAVE A SAMPLE SIZE OF 6083 04:01:47,760 --> 04:01:47,960 30. 6084 04:01:47,960 --> 04:01:49,662 THAT'S RIDICULOUS. 6085 04:01:49,662 --> 04:01:51,764 SO YOU NEED PEOPLE TO UNDERSTAND 6086 04:01:51,764 --> 04:01:57,169 WHAT YOU'RE TRYING TO DO. 6087 04:01:57,169 --> 04:01:58,871 >> IT'S A REAL CHALLENGE GETTING 6088 04:01:58,871 --> 04:01:59,672 REVIEWERS WHO ARE GOING TO 6089 04:01:59,672 --> 04:02:00,673 UNDERSTAND WHAT YOU'RE TRYING TO 6090 04:02:00,673 --> 04:02:03,175 DO AND YOU GET REVIEWERS WHO 6091 04:02:03,175 --> 04:02:06,245 LARGELY HAVE DONE EFFICACY 6092 04:02:06,245 --> 04:02:07,213 STANDARDS AND THINK WHAT YOU'RE 6093 04:02:07,213 --> 04:02:10,149 DOING IS REALLY A PROBLEM. 6094 04:02:10,149 --> 04:02:12,284 AND EVEN WHEN YOU HAVE PEOPLE ON 6095 04:02:12,284 --> 04:02:14,086 YOUR DSMB THINKING SOMETIMES 6096 04:02:14,086 --> 04:02:15,488 THAT THEY DON'T KNOW WHAT YOU'RE 6097 04:02:15,488 --> 04:02:15,855 DOING. 6098 04:02:15,855 --> 04:02:17,390 LIKE FOR EXAMPLE, ONE OF THE 6099 04:02:17,390 --> 04:02:19,392 TRIALS WE DID, AND WE HAD A VERY 6100 04:02:19,392 --> 04:02:22,194 INTERESTING EXPERIENCE, WAS THIS 6101 04:02:22,194 --> 04:02:23,763 IDEA OF RESTRICTING ACCESS TO 6102 04:02:23,763 --> 04:02:27,400 MEANS IS RECOMMENDED AS A WAY TO 6103 04:02:27,400 --> 04:02:28,067 REDUCING SUICIDE. 6104 04:02:28,067 --> 04:02:29,135 NOW EVERYONE SAYS, WE SHOULD BE 6105 04:02:29,135 --> 04:02:29,668 DOING IT. 6106 04:02:29,668 --> 04:02:32,772 AND SO IN INDIA IT'S PESTICIDE. 6107 04:02:32,772 --> 04:02:33,773 WE THOUGHT WE WOULD TRY THIS OUT 6108 04:02:33,773 --> 04:02:35,141 IN REAL LIFE, WHAT HAPPENS IF 6109 04:02:35,141 --> 04:02:37,676 YOU TRY TO RESTRICT ACCESS TO 6110 04:02:37,676 --> 04:02:37,910 MEANS. 6111 04:02:37,910 --> 04:02:39,578 SO THE METHOD WE CHOSE WAS, WE 6112 04:02:39,578 --> 04:02:42,782 WOULD PUT THESE BOXES, SAFE 6113 04:02:42,782 --> 04:02:47,119 DEPOSIT BOXES IN THE VILLAGE 6114 04:02:47,119 --> 04:02:47,887 COUNSEL AND ENCOURAGE FARMERS TO 6115 04:02:47,887 --> 04:02:49,288 USE THOSE BOXES. 6116 04:02:49,288 --> 04:02:52,691 NOW IN A TYPICAL RCT WHAT YOU 6117 04:02:52,691 --> 04:02:54,693 WOULD DO IS TRY TO GET 100% 6118 04:02:54,693 --> 04:02:55,294 COMPLIANCE WITH THAT. 6119 04:02:55,294 --> 04:03:01,500 YOU WANT TO GET EVERY FARMER 6120 04:03:01,500 --> 04:03:02,902 PUTTING IN THEIR -- INTO THE 6121 04:03:02,902 --> 04:03:04,403 BOXES AND THEN YOU WANT TO SEE 6122 04:03:04,403 --> 04:03:05,404 THE SUICIDE DEATHS GO DOWN. 6123 04:03:05,404 --> 04:03:07,306 IF YOU'RE TRYING TO DO IT IN THE 6124 04:03:07,306 --> 04:03:09,675 REAL WORLD, YOU WANT TO KNOW 6125 04:03:09,675 --> 04:03:11,610 WHAT HAPPENS IN THE REAL WORLD 6126 04:03:11,610 --> 04:03:12,611 WHICH IS THAT HALF OF THE 6127 04:03:12,611 --> 04:03:13,813 FARMERS WILL USE IT HALF OF THE 6128 04:03:13,813 --> 04:03:15,314 TIME AND ANOTHER HALF WILL USE 6129 04:03:15,314 --> 04:03:17,116 IT A QUARTER OF THE TIME OR SOME 6130 04:03:17,116 --> 04:03:18,417 PEOPLE WILL NOT USE IT AT ALL 6131 04:03:18,417 --> 04:03:20,386 AND SOME PEOPLE WILL USE LOTS OF 6132 04:03:20,386 --> 04:03:20,586 IT. 6133 04:03:20,586 --> 04:03:22,087 AND THEN YOU WANT TO SEE DOES IT 6134 04:03:22,087 --> 04:03:24,089 STILL WORK AND HOW DOES IT WORK 6135 04:03:24,089 --> 04:03:25,624 AND HOW MANY PEOPLE ACTUALLY USE 6136 04:03:25,624 --> 04:03:26,892 THE BOXES? 6137 04:03:26,892 --> 04:03:29,261 NOW WHEN YOU PUT IN A GRANT 6138 04:03:29,261 --> 04:03:31,230 PROPOSAL WITH SAY ALL OF THIS, 6139 04:03:31,230 --> 04:03:33,732 THE REVIEWERS FIND IT VERY 6140 04:03:33,732 --> 04:03:34,033 DIFFICULT. 6141 04:03:34,033 --> 04:03:35,134 THIS IS WRONG. 6142 04:03:35,134 --> 04:03:36,402 THIS IS JUST NOT WORKING OUT 6143 04:03:36,402 --> 04:03:37,436 VERY WELL. 6144 04:03:37,436 --> 04:03:39,538 SO I THINK REVIEWERS ALSO NEED 6145 04:03:39,538 --> 04:03:42,408 TO REALLY -- I GET CONCERNED 6146 04:03:42,408 --> 04:03:43,309 THAT VERY OFTEN THE COMMENTS WE 6147 04:03:43,309 --> 04:03:45,544 GET FROM REVIEWERS IF YOU'RE 6148 04:03:45,544 --> 04:03:46,679 PUTTING IN IMPLEMENTATION 6149 04:03:46,679 --> 04:03:47,813 SCIENCE PROPOSAL, YOU THINK THEY 6150 04:03:47,813 --> 04:03:49,215 ARE NOT IMPLEMENTATION SCIENCE 6151 04:03:49,215 --> 04:03:49,515 PEOPLE. 6152 04:03:49,515 --> 04:03:50,416 THEY DIDN'T SEE WHAT WE WERE 6153 04:03:50,416 --> 04:03:51,016 TRYING TO DO. 6154 04:03:51,016 --> 04:03:54,320 THEY THINK THIS IS BAD SCIENCE. 6155 04:03:54,320 --> 04:03:55,921 IT COMES ACROSS AS BAD SCIENCE 6156 04:03:55,921 --> 04:04:00,025 FOR THEM BECAUSE THEY USED TO 6157 04:04:00,025 --> 04:04:00,726 CONTROLLING EVERYTHING. 6158 04:04:00,726 --> 04:04:03,529 SO WHEREAS YOU DON'T WANT TO 6159 04:04:03,529 --> 04:04:06,832 CONTROL -- YOU REALLY DON'T WANT 6160 04:04:06,832 --> 04:04:09,335 TO TRY AND -- YOU DON'T WANT TO 6161 04:04:09,335 --> 04:04:10,236 DO SOMETHING WITH THE FARMERS 6162 04:04:10,236 --> 04:04:13,138 WHO PUSH THEM TO USE IT BECAUSE 6163 04:04:13,138 --> 04:04:15,241 YOU WANT TO SEE WHAT HAPPENED IN 6164 04:04:15,241 --> 04:04:16,842 REAL LIFE. 6165 04:04:16,842 --> 04:04:19,144 >> IT'S AN INTERESTING TENSION 6166 04:04:19,144 --> 04:04:20,746 BECAUSE IN -- WE ARE TRAINED TO 6167 04:04:20,746 --> 04:04:22,648 THINK WE SHOULD BE ENSURING THE 6168 04:04:22,648 --> 04:04:23,749 FIDELITY OF THE INTERVENTION. 6169 04:04:23,749 --> 04:04:25,050 THAT IS THE WHOLE FOCUS OF THE 6170 04:04:25,050 --> 04:04:27,386 RESEARCH TEAM IS TO MAKE SURE 6171 04:04:27,386 --> 04:04:27,953 THE INTERVENTION IS BEING 6172 04:04:27,953 --> 04:04:29,922 DELIVERED THE WAY IT'S SUPPOSED 6173 04:04:29,922 --> 04:04:31,457 TO BE DELIVERED. 6174 04:04:31,457 --> 04:04:32,758 MORE OFTEN IMPLEMENTATION 6175 04:04:32,758 --> 04:04:34,527 SCIENCE, WE STOOD THAT ON ITS 6176 04:04:34,527 --> 04:04:37,363 HEAD AND WE ARE STUDYING THE 6177 04:04:37,363 --> 04:04:38,531 FIDELITY AS THE OUTCOME AND 6178 04:04:38,531 --> 04:04:40,366 WHETHER THE FIDELITY -- WHICH 6179 04:04:40,366 --> 04:04:44,036 STRATEGY LEADS TO HIGHER 6180 04:04:44,036 --> 04:04:45,971 FIDELITY ANTICIPATION WILL LEAD 6181 04:04:45,971 --> 04:04:48,908 TO BETTER PATIENT OUTCOMES. 6182 04:04:48,908 --> 04:04:50,175 >> MANY PEOPLE IN IMPLEMENTATION 6183 04:04:50,175 --> 04:04:51,076 SCIENCE SPACE WILL SAY TO YOU 6184 04:04:51,076 --> 04:04:53,212 THAT IF YOU GOT 100 PERSON 6185 04:04:53,212 --> 04:04:54,680 FIDELITY, THEY DON'T TRUST YOUR 6186 04:04:54,680 --> 04:04:55,981 STUDY AT ALL. 6187 04:04:55,981 --> 04:04:57,082 BECAUSE IT CAN'T BE 6188 04:04:57,082 --> 04:04:58,417 IMPLEMENTATION SCIENCE STUDY. 6189 04:04:58,417 --> 04:05:00,252 IF YOU CALL IT IMPLEMENTATION 6190 04:05:00,252 --> 04:05:02,688 SCIENCE STUDY, YOU COULDN'T HAVE 6191 04:05:02,688 --> 04:05:03,289 100 -- 6192 04:05:03,289 --> 04:05:04,590 >> COULDN'T POSSIBLY REFLECT THE 6193 04:05:04,590 --> 04:05:05,190 REAL WORLD. 6194 04:05:05,190 --> 04:05:06,792 >> CAN I ADD ONE THING TO THAT 6195 04:05:06,792 --> 04:05:08,093 REAL QUICKLY? 6196 04:05:08,093 --> 04:05:09,194 >> YES, PLEASE. 6197 04:05:09,194 --> 04:05:11,697 >> IN VIETNAM OUR STAFF IS 6198 04:05:11,697 --> 04:05:11,997 OUTSTANDING. 6199 04:05:11,997 --> 04:05:14,800 LIKE THEY ARE REALLY GOOD. 6200 04:05:14,800 --> 04:05:18,404 AND ONE OF OUR RESEARCH 6201 04:05:18,404 --> 04:05:20,005 ASSISTANCE IS JUST SO ATTENTIVE 6202 04:05:20,005 --> 04:05:21,440 TO DETAIL. 6203 04:05:21,440 --> 04:05:24,810 AND HAS EXPERIENCE IN EFFICACY 6204 04:05:24,810 --> 04:05:25,277 TRIALS. 6205 04:05:25,277 --> 04:05:27,513 AND WE'RE AFRAID TO ASSIGN HER 6206 04:05:27,513 --> 04:05:29,915 TO THE IMPLEMENTATION TRIAL 6207 04:05:29,915 --> 04:05:31,617 BECAUSE SHE'S GOING TO BE TOO 6208 04:05:31,617 --> 04:05:33,085 EFFECTIVE AT MAKING SURE THAT 6209 04:05:33,085 --> 04:05:35,421 EVERY CLINIC IN BOTH ARMS IS 6210 04:05:35,421 --> 04:05:36,589 DOING EVERYTHING THAT THEY ARE 6211 04:05:36,589 --> 04:05:39,024 SUPPOSED TO DO. 6212 04:05:39,024 --> 04:05:41,093 AND THAT'S NOT GOING TO BE THE 6213 04:05:41,093 --> 04:05:44,630 WAY IT IS IN THE REAL WORLD. 6214 04:05:44,630 --> 04:05:48,167 >> AND IT'S ALSO, HAS A LITTLE 6215 04:05:48,167 --> 04:05:49,802 BIT OF A TENSION -- IF YOU WANT 6216 04:05:49,802 --> 04:05:53,205 TO TALK A LITTLE BIT ABOUT THIS 6217 04:05:53,205 --> 04:05:56,442 ASPECT OF HOW ARE OUR REGULATORY 6218 04:05:56,442 --> 04:05:58,310 MONITORING APPROACHES FOCUS ON 6219 04:05:58,310 --> 04:06:00,412 THESE ENROLLMENT TARGETS AND HOW 6220 04:06:00,412 --> 04:06:02,081 THAT REALITIES TO IMPLEMENTATION 6221 04:06:02,081 --> 04:06:04,116 SCIENCE TRIALS VERSUS STANDARD 6222 04:06:04,116 --> 04:06:04,950 EFFECTIVENESS EFFICACY TRIALS. 6223 04:06:04,950 --> 04:06:07,219 >> I MEAN, YOU KNOW THIS WHOLE 6224 04:06:07,219 --> 04:06:10,823 THING ABOUT RECRUITING PEOPLE 6225 04:06:10,823 --> 04:06:12,825 INTO STUDIES NOW. 6226 04:06:12,825 --> 04:06:15,527 AS YOU SAID, BILL, VERY OFTEN 6227 04:06:15,527 --> 04:06:18,597 THE FOCUS OF THE -- THE UNIT OF 6228 04:06:18,597 --> 04:06:22,501 YOUR RECRUITMENT IS NOT ACTUALLY 6229 04:06:22,501 --> 04:06:23,836 AN INDIVIDUAL IN IMPLEMENTATION 6230 04:06:23,836 --> 04:06:24,069 TRIALS. 6231 04:06:24,069 --> 04:06:26,038 HOW DO WE DO THAT? 6232 04:06:26,038 --> 04:06:27,740 FOR EXAMPLE WITH OUR SUICIDE 6233 04:06:27,740 --> 04:06:31,210 PREVENTION WORK THAT WE WERE 6234 04:06:31,210 --> 04:06:33,145 DOING, A RANDOMIZATION AND THE 6235 04:06:33,145 --> 04:06:35,314 CLUSTER RANDOMIZATION WAS AT THE 6236 04:06:35,314 --> 04:06:36,915 LEVEL OF THE VILLAGES BUT WE 6237 04:06:36,915 --> 04:06:39,218 WILL TO GET VILLAGE COUNSELS TO 6238 04:06:39,218 --> 04:06:39,451 CONSENT. 6239 04:06:39,451 --> 04:06:41,320 AND ONCE THEY CONSENTED, WE PUT 6240 04:06:41,320 --> 04:06:43,722 THESE BOXES IN THERE AND THEN WE 6241 04:06:43,722 --> 04:06:47,726 GOT PEOPLE USING THE BOXES TO 6242 04:06:47,726 --> 04:06:48,427 CONSENT. 6243 04:06:48,427 --> 04:06:50,329 NOW, WHEN YOU'RE LOOKING AT 6244 04:06:50,329 --> 04:06:51,830 ENROLLMENT, WHAT IS ENROLLMENT? 6245 04:06:51,830 --> 04:06:54,433 THE VILLAGES ARE THE ENROLLMENT? 6246 04:06:54,433 --> 04:06:56,135 IS IT THE INDIVIDUALS USING THE 6247 04:06:56,135 --> 04:06:59,938 BOXES THAT IS THE EP ROLEMENT? 6248 04:06:59,938 --> 04:07:03,042 AND WHEN YOU REPORT THE EP 6249 04:07:03,042 --> 04:07:04,443 ROLEMENT, IF NOT EVERYONE IS 6250 04:07:04,443 --> 04:07:06,879 USING THE BOXES, IS THAT BAD? 6251 04:07:06,879 --> 04:07:07,646 IS THAT GOOD? 6252 04:07:07,646 --> 04:07:10,883 A LOT OF THE REGULATORY STUFF IS 6253 04:07:10,883 --> 04:07:12,618 NOT DESIGNED FOR IMPLEMENTATION 6254 04:07:12,618 --> 04:07:14,720 SCIENCE RESEARCH. 6255 04:07:14,720 --> 04:07:16,121 IT'S DESIGNED FOR THE STANDARD 6256 04:07:16,121 --> 04:07:19,758 VERY CONVENTIONAL EFFICACY RCTN 6257 04:07:19,758 --> 04:07:22,227 AND THE PROBLEMS WITH TRIALS.GOV 6258 04:07:22,227 --> 04:07:25,631 KIND OF THING, YOU GET THAT WITH 6259 04:07:25,631 --> 04:07:27,032 REGULARLY -- YOU GET THAT ALL 6260 04:07:27,032 --> 04:07:30,836 THE TIME BECAUSE PEOPLE DON'T 6261 04:07:30,836 --> 04:07:32,037 UNDERSTAND HOW -- YOU'RE NOT 6262 04:07:32,037 --> 04:07:33,739 DOING WELL OR YOU'RE DOING BADLY 6263 04:07:33,739 --> 04:07:35,541 AND HOW DO YOU REPORT TO THE 6264 04:07:35,541 --> 04:07:36,642 REGULATORS WHAT YOU'RE DOING? 6265 04:07:36,642 --> 04:07:39,545 ONE OF THE OTHER PROBLEMS THAT 6266 04:07:39,545 --> 04:07:40,746 HAPPENS WITH IMPLEMENTATION 6267 04:07:40,746 --> 04:07:42,548 SCIENCE AND ESPECIALLY WITH 6268 04:07:42,548 --> 04:07:43,749 SUICIDE RESEARCH, BECAUSE THAT'S 6269 04:07:43,749 --> 04:07:45,651 WHAT WE ENDED UP DOING, IS 6270 04:07:45,651 --> 04:07:48,554 SUICIDE IS AN OUTCOME FOR YOUR 6271 04:07:48,554 --> 04:07:48,954 STUDY. 6272 04:07:48,954 --> 04:07:51,857 PREVENTION OF SUICIDE IS AN 6273 04:07:51,857 --> 04:07:52,091 OUTCOME. 6274 04:07:52,091 --> 04:07:54,426 BUT FOR MANY -- FOR MOST 6275 04:07:54,426 --> 04:07:57,563 RESEARCH, ATTEMPTED SUICIDE OR 6276 04:07:57,563 --> 04:07:59,832 SUICIDE IS A SERIOUS ADVERSE 6277 04:07:59,832 --> 04:08:00,032 EVENT. 6278 04:08:00,032 --> 04:08:01,667 HOW DO YOU DEAL WITH SOMETHING 6279 04:08:01,667 --> 04:08:03,535 BEING A SERIOUS ADVERSE EVENT 6280 04:08:03,535 --> 04:08:05,270 FOR THE PURPOSES OF A TRIAL BUT 6281 04:08:05,270 --> 04:08:06,972 IS AN OUTCOME OF THE PURPOSES OF 6282 04:08:06,972 --> 04:08:08,340 YOUR STUDY AND YOU'RE NEVER 6283 04:08:08,340 --> 04:08:09,708 GOING TO HAVE AN INTERVENTION 6284 04:08:09,708 --> 04:08:11,844 WHICH REDUCES SUICIDE TO ZERO. 6285 04:08:11,844 --> 04:08:13,445 SO YOU CAN'T SAY YOU GOT ONE 6286 04:08:13,445 --> 04:08:15,848 SUICIDE SO THAT'S BAD. 6287 04:08:15,848 --> 04:08:17,850 BECAUSE YOU COULD ALWAYS GET A 6288 04:08:17,850 --> 04:08:21,153 FEW EVEN -- SO A LOT OF THE 6289 04:08:21,153 --> 04:08:22,788 REGULATORY STUFF DOES NOT 6290 04:08:22,788 --> 04:08:25,157 ACTUALLY REALLY UNDERSTAND OR IS 6291 04:08:25,157 --> 04:08:27,259 NOT BEING DESIGNED FOR 6292 04:08:27,259 --> 04:08:28,060 IMPLEMENTATION RESEARCH. 6293 04:08:28,060 --> 04:08:30,262 WE NEED TO REALLY RETHINK HOW 6294 04:08:30,262 --> 04:08:32,965 THAT IS DONE AND HOW CAN IT BE 6295 04:08:32,965 --> 04:08:34,266 DONE DIFFERENTLY AND EVEN 6296 04:08:34,266 --> 04:08:35,134 TRIALS.GOV NEEDS TO PROBABLY 6297 04:08:35,134 --> 04:08:37,970 LOOK AT THIS IN A VERY DIFFERENT 6298 04:08:37,970 --> 04:08:38,270 WAY. 6299 04:08:38,270 --> 04:08:41,473 >> SO AS BILL WAS SAYING, IF 6300 04:08:41,473 --> 04:08:42,674 THE -- IF YOU'RE REPORTING TO 6301 04:08:42,674 --> 04:08:45,244 YOUR FUNDER AND YOUR MONITORING 6302 04:08:45,244 --> 04:08:48,781 BOARD AND YOUR REGULATORY BOARD 6303 04:08:48,781 --> 04:08:50,582 THAT YOUR NUMBERS OF 6304 04:08:50,582 --> 04:08:51,650 PARTICIPANTS ENROLLED BUT THAT 6305 04:08:51,650 --> 04:08:54,086 NUMBER IS A FUNCTION OF THE 6306 04:08:54,086 --> 04:08:56,188 FIDELITY, WHICH IS WHAT YOU'RE 6307 04:08:56,188 --> 04:08:57,489 STUDYING, DO YOU WANT YOUR STUDY 6308 04:08:57,489 --> 04:08:58,690 TEAM TO DO EVERYTHING THEY CAN 6309 04:08:58,690 --> 04:09:00,893 TO MAXIMIZE THAT NUMBER OF 6310 04:09:00,893 --> 04:09:01,894 PARTICIPANTS ENROLLED? 6311 04:09:01,894 --> 04:09:03,095 WHICH THEY'LL DO BY MESSING WITH 6312 04:09:03,095 --> 04:09:04,997 THE FIDELITY, WHICH IS WHAT 6313 04:09:04,997 --> 04:09:06,465 YOU'RE TRYING TO STUDY? 6314 04:09:06,465 --> 04:09:08,200 IT DOES BECOME VERY COMPLICATED. 6315 04:09:08,200 --> 04:09:13,071 SO LET'S TRANSITION TO OUR LAST 6316 04:09:13,071 --> 04:09:13,338 QUESTION. 6317 04:09:13,338 --> 04:09:14,006 AND VICTOR, I'LL TURN THIS FIRST 6318 04:09:14,006 --> 04:09:14,473 TO YOU. 6319 04:09:14,473 --> 04:09:17,376 HOW CAN IMPLEMENTATION RESEARCH 6320 04:09:17,376 --> 04:09:19,778 HAVE MAXIMUM POLICY AND 6321 04:09:19,778 --> 04:09:21,580 COMMUNITY IMPACT? 6322 04:09:21,580 --> 04:09:23,182 >> YES, I THINK IN ALL THESE 6323 04:09:23,182 --> 04:09:24,483 THINGS WE MUST REALIZE THAT WHAT 6324 04:09:24,483 --> 04:09:28,086 WE ARE TRYING TO DO IS TO GET 6325 04:09:28,086 --> 04:09:28,987 PEOPLE BETTER. 6326 04:09:28,987 --> 04:09:32,291 AND EVEN IN THIS CONFERENCE, I 6327 04:09:32,291 --> 04:09:34,693 HAVEN'T HEARD ENOUGH ABOUT THE 6328 04:09:34,693 --> 04:09:35,227 COMMUNITY. 6329 04:09:35,227 --> 04:09:37,596 AND WHAT I HEARD MOSTLY IS THAT 6330 04:09:37,596 --> 04:09:39,798 WE CONSULT THE COMMUNITY. 6331 04:09:39,798 --> 04:09:41,200 CONSULTING THEM TO PARTICIPATE 6332 04:09:41,200 --> 04:09:42,801 IN THE STUDY. 6333 04:09:42,801 --> 04:09:45,237 BUT NOT CONSULTING THEM TO CORE 6334 04:09:45,237 --> 04:09:46,238 DESIGN THE STUDY. 6335 04:09:46,238 --> 04:09:48,507 WHAT DO I MEAN BY CO-DESIGNING 6336 04:09:48,507 --> 04:09:49,808 THE STUDY? 6337 04:09:49,808 --> 04:09:53,579 YOU FIND THAT IN MY CONTEXT, 6338 04:09:53,579 --> 04:09:55,914 MENTAL HEALTH ISSUES COME THE 6339 04:09:55,914 --> 04:09:56,748 WAY PEOPLE THINK ABOUT MENTAL 6340 04:09:56,748 --> 04:09:59,117 HEALTH ISSUES, IN THE NORMAL 6341 04:09:59,117 --> 04:10:01,019 COMMUNITY WHERE I COME FROM, IT 6342 04:10:01,019 --> 04:10:05,123 COMES FROM SUPER NATURAL FORCES. 6343 04:10:05,123 --> 04:10:06,024 WHICH CRAFT. 6344 04:10:06,024 --> 04:10:08,927 A PUNISHMENT FROM GOD. 6345 04:10:08,927 --> 04:10:13,131 THAT'S THE PREVAILING UNDERS 6346 04:10:13,131 --> 04:10:13,465 UNDERSTANDING. 6347 04:10:13,465 --> 04:10:16,535 NOW WHEN WE ARE DESIGNING OUR 6348 04:10:16,535 --> 04:10:17,936 INTERVENTIONS, FROM THE WESTERN 6349 04:10:17,936 --> 04:10:18,937 PERSPECTIVE, WE SAY WE ARE GOING 6350 04:10:18,937 --> 04:10:21,540 TO HAVE A FRIENDSHIP BENCH AND 6351 04:10:21,540 --> 04:10:24,042 GIVE ANTIDEPRESSANT BUT, WE 6352 04:10:24,042 --> 04:10:27,713 DON'T TAKE INTO ACCOUNT THE CORE 6353 04:10:27,713 --> 04:10:28,647 ISSUES IN THE COMMUNITY. 6354 04:10:28,647 --> 04:10:30,649 PEOPLE AS WE SPEAK NOW, ARE 6355 04:10:30,649 --> 04:10:33,552 BEING TREATED WITH NATURAL 6356 04:10:33,552 --> 04:10:34,052 METHODS. 6357 04:10:34,052 --> 04:10:36,822 NOW INTERESTINGLY, IN THE 6358 04:10:36,822 --> 04:10:38,457 FRIENDSHIP BENCH, WE CHOSE 6359 04:10:38,457 --> 04:10:41,360 MOSTLY PSYCHOTHERAPY, SOME 6360 04:10:41,360 --> 04:10:42,995 PEOPLE GOT ANTIDEPRESSANT. 6361 04:10:42,995 --> 04:10:44,830 THERE IS ONE LINE IN THE STUDY 6362 04:10:44,830 --> 04:10:50,269 REPORT THAT 1-10 OF THE STUDY 6363 04:10:50,269 --> 04:10:53,272 PARTICIPANTS SOUGHT HEALING FROM 6364 04:10:53,272 --> 04:10:55,741 A TRADITIONAL HEALER. 6365 04:10:55,741 --> 04:10:56,942 MEANING THAT IN THE REAL 6366 04:10:56,942 --> 04:10:58,143 CONTEXT, PEOPLE ARE GOING TO 6367 04:10:58,143 --> 04:11:01,446 HAVE CO-INTERVENTIONS AND THEY 6368 04:11:01,446 --> 04:11:02,748 THEIR CO-INTERVENTIONS ARE 6369 04:11:02,748 --> 04:11:04,750 MOSTLY THE THINGS WE DO NOT 6370 04:11:04,750 --> 04:11:05,450 MEASURE. 6371 04:11:05,450 --> 04:11:07,552 IN MY CONTEXT, THE MAJORITY OF 6372 04:11:07,552 --> 04:11:09,554 PEOPLE ARE RELIGIOUS. 6373 04:11:09,554 --> 04:11:11,857 SO THEY WILL NOT HAVE A MENTAL 6374 04:11:11,857 --> 04:11:13,025 ILLNESS WITHOUT GOING FOR 6375 04:11:13,025 --> 04:11:13,959 RELIGIOUS HEALING. 6376 04:11:13,959 --> 04:11:16,528 WE LIVE IN VILLAGES SO THEY DO 6377 04:11:16,528 --> 04:11:21,066 NOT HAVE A MENTAL ILLNESS AND 6378 04:11:21,066 --> 04:11:23,268 THE DRIVERS OF MENTAL ILLNESS 6379 04:11:23,268 --> 04:11:26,371 THAT IS SUPPOSED TO BE THINGS 6380 04:11:26,371 --> 04:11:26,738 LIKE WITCHCRAFT. 6381 04:11:26,738 --> 04:11:29,241 SO PEOPLE ARE NOT CRAZY THAT 6382 04:11:29,241 --> 04:11:30,642 DON'T TRY TO TREAT THAT WITH 6383 04:11:30,642 --> 04:11:32,744 JUST MEDICATION FROM THE 6384 04:11:32,744 --> 04:11:35,147 HOSPITAL WITHOUT ACTUALLY 6385 04:11:35,147 --> 04:11:36,548 CONSULTING THEIR SPIRITUAL 6386 04:11:36,548 --> 04:11:39,384 HEALER OR TRADITIONAL HEALER. 6387 04:11:39,384 --> 04:11:41,153 SO WHY NOT THE ISSUES THAT I 6388 04:11:41,153 --> 04:11:42,754 HAVE -- ONE OF THE ISSUES I HAVE 6389 04:11:42,754 --> 04:11:44,756 IS WHEN WE TALK ABOUT 6390 04:11:44,756 --> 04:11:46,758 CO-DESIGNING, IT'S NOT WITH THE 6391 04:11:46,758 --> 04:11:47,025 COMMUNITY. 6392 04:11:47,025 --> 04:11:49,761 IT'S NOT JUST ASKING THEM CAN 6393 04:11:49,761 --> 04:11:52,364 YOU BE PART OF THE DELIVERING 6394 04:11:52,364 --> 04:11:53,432 THE FRIENDSHIP BENCH? 6395 04:11:53,432 --> 04:11:56,535 CO-DESIGNING TO ME MEANS, WHAT 6396 04:11:56,535 --> 04:11:58,470 INTERVENTION THAT YOU HAVE 6397 04:11:58,470 --> 04:12:00,272 TRADITIONALLY WOULD YOU LIKE TO 6398 04:12:00,272 --> 04:12:02,374 BE DELIVERED WITH THIS? 6399 04:12:02,374 --> 04:12:04,676 I HAVE SITUATIONS WHERE PEOPLE 6400 04:12:04,676 --> 04:12:08,447 THAT ARE TREATING PATIENTS OR 6401 04:12:08,447 --> 04:12:10,682 CLIENTS FOR MENTAL ILLNESS, THEY 6402 04:12:10,682 --> 04:12:13,385 WILL ADMONISH CLIENTS FOR USING 6403 04:12:13,385 --> 04:12:14,586 TRADITIONAL METHODS. 6404 04:12:14,586 --> 04:12:16,355 SO, YOU ARE RECEIVING AN 6405 04:12:16,355 --> 04:12:17,656 ANTIDEPRESSANT AND YOU'RE DOING 6406 04:12:17,656 --> 04:12:17,856 THIS? 6407 04:12:17,856 --> 04:12:18,857 YOU WENT TO A HEALER? 6408 04:12:18,857 --> 04:12:19,891 YOU SHOULD NOT DO THAT. 6409 04:12:19,891 --> 04:12:21,593 YOU WENT TO A SPIRITUAL -- YOU 6410 04:12:21,593 --> 04:12:22,894 SHOULD NOT DO THAT. 6411 04:12:22,894 --> 04:12:24,563 I THINK THIS IS THE PART THAT WE 6412 04:12:24,563 --> 04:12:25,564 ARE MISSING. 6413 04:12:25,564 --> 04:12:29,668 IF SOMETHING IS GOING TO BE 6414 04:12:29,668 --> 04:12:30,302 EFFECTIVE, REMEMBER THIS MENTAL 6415 04:12:30,302 --> 04:12:34,006 HEALTH INTERVENTIONS HAVE TO BE 6416 04:12:34,006 --> 04:12:34,873 GIVEN OVER A PERIOD OF TIME. 6417 04:12:34,873 --> 04:12:35,941 IT'S THE COMMUNITY THAT ARE 6418 04:12:35,941 --> 04:12:37,976 GOING TO GIVE THESE 6419 04:12:37,976 --> 04:12:38,477 INTERVENTIONS. 6420 04:12:38,477 --> 04:12:41,580 SURELY YOU CAN'T FORGET ABOUT 6421 04:12:41,580 --> 04:12:43,181 SPIRITUAL HEALING AND 6422 04:12:43,181 --> 04:12:44,282 TRADITIONAL HEALING. 6423 04:12:44,282 --> 04:12:45,917 SO FOR ME, ONE THING THAT IS 6424 04:12:45,917 --> 04:12:50,989 MISSING IN THE CO-DESIGN OF US, 6425 04:12:50,989 --> 04:12:52,324 HOW DID YOU INVOLVE THE 6426 04:12:52,324 --> 04:12:52,691 COMMUNITY? 6427 04:12:52,691 --> 04:12:55,727 THEY PARTICIPATED WITH 6428 04:12:55,727 --> 04:12:57,195 TRANSLATION OF THE LANGUAGE TO 6429 04:12:57,195 --> 04:12:57,662 LOCAL. 6430 04:12:57,662 --> 04:13:00,098 BUT THAT'S NOT ADAPTATION. 6431 04:13:00,098 --> 04:13:02,801 ADAPTATION MEANS, WHAT METHODS 6432 04:13:02,801 --> 04:13:05,504 FOR MANAGING MENTAL ILLNESS IN 6433 04:13:05,504 --> 04:13:07,205 THE COMMUNITY, HAVE YOU 6434 04:13:07,205 --> 04:13:08,473 INCORPORATED INTO YOUR DESIGN? 6435 04:13:08,473 --> 04:13:09,975 SO THAT'S THE PART THAT I THINK 6436 04:13:09,975 --> 04:13:12,277 WHEN YOU TALK ABOUT COMMUNITY 6437 04:13:12,277 --> 04:13:13,779 INVOLVEMENT, WHICH IS VERY 6438 04:13:13,779 --> 04:13:15,280 IMPORTANT, WE DON'T USUALLY 6439 04:13:15,280 --> 04:13:16,281 CONSIDER IT WHEN WE ARE 6440 04:13:16,281 --> 04:13:18,283 DESIGNING OUR STUDIES. 6441 04:13:18,283 --> 04:13:21,486 THE SECOND PART, I WANT TO TALK 6442 04:13:21,486 --> 04:13:22,587 ABOUT POLICY ENGAGEMENT BECAUSE 6443 04:13:22,587 --> 04:13:24,089 AGAIN I HAVE BEEN ASKING THIS 6444 04:13:24,089 --> 04:13:26,191 QUESTION TO MOST OF THE 6445 04:13:26,191 --> 04:13:26,491 PRESENTERS. 6446 04:13:26,491 --> 04:13:28,593 DO YOU CONSULT THE -- YES, YES. 6447 04:13:28,593 --> 04:13:30,729 THEY SAY YOU CAN DO THIS STUDY. 6448 04:13:30,729 --> 04:13:33,598 WHAT DOES IT MEAN POLICY 6449 04:13:33,598 --> 04:13:33,899 ENGAGEMENT? 6450 04:13:33,899 --> 04:13:38,003 IN MOST OF OUR COUNTRIES 6451 04:13:38,003 --> 04:13:38,670 RESOURCE LIMITED COUNTRIES, ONE 6452 04:13:38,670 --> 04:13:41,073 OF THE BIGGEST IMPEDIMENTS IS 6453 04:13:41,073 --> 04:13:43,809 THE HEALTH CARE EXPENDITURE. 6454 04:13:43,809 --> 04:13:47,512 THEY RECOMMEND THAT WE SPEND 86 6455 04:13:47,512 --> 04:13:49,481 DOLLARS PER CAPITA PER YEAR. 6456 04:13:49,481 --> 04:13:51,516 86 DOLLARS PER PERSON PER YEAR! 6457 04:13:51,516 --> 04:13:56,788 NOW IN MALAWI, THE PER CAPITA 6458 04:13:56,788 --> 04:13:58,290 EXPENDITURE PER YEAR IS 65 6459 04:13:58,290 --> 04:13:58,690 DOLLARS. 6460 04:13:58,690 --> 04:14:00,492 IT USED TO BE 40 DOLLARS. 6461 04:14:00,492 --> 04:14:05,397 SO, WHEN WE ARE DESIGNING AN 6462 04:14:05,397 --> 04:14:07,299 INTERVENTION, ONE OF THE THINGS 6463 04:14:07,299 --> 04:14:09,101 THAT ENGAGE WITH THE 6464 04:14:09,101 --> 04:14:10,001 POLICYMAKERS IS, IS THIS GOING 6465 04:14:10,001 --> 04:14:11,203 TO BE IMPLEMENTABLE WITH THE 6466 04:14:11,203 --> 04:14:16,007 RESOURCES THAT YOU HAVE GOT? 6467 04:14:16,007 --> 04:14:17,242 THE COST IS 65 DOLLARS. 6468 04:14:17,242 --> 04:14:20,378 I SAW ONE OF THE POSTERS UP 6469 04:14:20,378 --> 04:14:21,713 THERE - THEY SAID -- THEY WROTE 6470 04:14:21,713 --> 04:14:23,181 A BEAUTIFUL STUDY. 6471 04:14:23,181 --> 04:14:25,417 AND ONE LINE WAS THAT THERE IS 6472 04:14:25,417 --> 04:14:27,452 ZERO PERCENT CHANCE THIS IS 6473 04:14:27,452 --> 04:14:28,620 GOING TO BE SCALED UP IN MALAWI 6474 04:14:28,620 --> 04:14:30,322 BECAUSE IT'S TOO EXPENSIVE. 6475 04:14:30,322 --> 04:14:31,923 THEN I ENGAGED THE PERSON, SO 6476 04:14:31,923 --> 04:14:33,725 WHY ARE YOU DOING THE STUDY IN 6477 04:14:33,725 --> 04:14:35,127 THIS SETTING? 6478 04:14:35,127 --> 04:14:36,828 IF THERE IS 0% CHANCE? 6479 04:14:36,828 --> 04:14:38,897 THE REASON I BELIEVE, IS THE 6480 04:14:38,897 --> 04:14:41,733 STAKEHOLDER ENGAGEMENT, THE 6481 04:14:41,733 --> 04:14:42,734 POLICYMAKERS, WAS NOT 6482 04:14:42,734 --> 04:14:43,034 INTERESTED. 6483 04:14:43,034 --> 04:14:45,737 BECAUSE THE POLICYMAKERS SHOULD 6484 04:14:45,737 --> 04:14:48,406 HAVE KNOWN THAT WITH OUR TOTAL 6485 04:14:48,406 --> 04:14:50,509 HEALTH EXPENDITURE THAT LOW, 6486 04:14:50,509 --> 04:14:52,310 THIS INTERVENTION IS NOT GOING 6487 04:14:52,310 --> 04:14:54,012 TO WORK. 6488 04:14:54,012 --> 04:14:57,949 SO, FOR ME, ENGAGING THE 6489 04:14:57,949 --> 04:14:59,951 POLICYMAKERS SHOULD BE DEEPER. 6490 04:14:59,951 --> 04:15:01,853 AND THEY MUST BE PART OF THE 6491 04:15:01,853 --> 04:15:02,087 DESIGN. 6492 04:15:02,087 --> 04:15:03,855 THEY SHOULD TELL YOU OFFHAND 6493 04:15:03,855 --> 04:15:06,124 THAT YOU WANT TO THE DO THIS 6494 04:15:06,124 --> 04:15:11,429 INTERVENTION, IT WILL REQUIRE -- 6495 04:15:11,429 --> 04:15:13,565 PROCURE SO MANY DRUGS, REQUIRE 6496 04:15:13,565 --> 04:15:15,967 US TO REMODEL THE FACILITY. 6497 04:15:15,967 --> 04:15:16,168 SORRY. 6498 04:15:16,168 --> 04:15:18,370 WE CAN'T IMPLEMENT THIS. 6499 04:15:18,370 --> 04:15:20,872 BUT I SEE A LOT OF INTERVENTIONS 6500 04:15:20,872 --> 04:15:24,643 THAT HAVE BEEN TESTED WITHOUT 6501 04:15:24,643 --> 04:15:25,277 DUE CONSIDERATION OF THE 6502 04:15:25,277 --> 04:15:27,345 RESOURCES THAT ARE AVAILABLE. 6503 04:15:27,345 --> 04:15:29,314 SO FOR ME, I THINK THERE NEEDS 6504 04:15:29,314 --> 04:15:30,649 TO BE A CHANGE IN MIND. 6505 04:15:30,649 --> 04:15:33,451 AND YOU MIGHT ASK WHY IS THAT 6506 04:15:33,451 --> 04:15:34,052 THE CASE? 6507 04:15:34,052 --> 04:15:37,055 AT THE MOMENT MOST OF OUR 6508 04:15:37,055 --> 04:15:39,257 COUNTRIES ARE UNDER IMF 6509 04:15:39,257 --> 04:15:41,159 PROGRAMS. 6510 04:15:41,159 --> 04:15:42,961 THE IMF SAYS YOU CAN NOT 6511 04:15:42,961 --> 04:15:44,462 INCREASE YOUR WORKFORCE SO THERE 6512 04:15:44,462 --> 04:15:46,765 IS NO ROOM FOR YOU TO INCREASE. 6513 04:15:46,765 --> 04:15:50,569 WE ARE GOING THROUGH A 6514 04:15:50,569 --> 04:15:51,970 DEVALUATION NOW, RIGHT? 6515 04:15:51,970 --> 04:15:55,073 SO THE CHANCES THAT OUR 6516 04:15:55,073 --> 04:15:56,875 RESOURCES WILL INCREASE, THE 6517 04:15:56,875 --> 04:15:58,276 CHANCES ARE CLOSE TO ZERO. 6518 04:15:58,276 --> 04:15:59,945 IT MEANS THAT IF WE WANT TO 6519 04:15:59,945 --> 04:16:03,748 SCALE UP INTERVENTIONS, OUR 6520 04:16:03,748 --> 04:16:05,183 ENGAGEMENT WITH THE 6521 04:16:05,183 --> 04:16:06,184 POLICYMAKERS, WE SHOULD BE 6522 04:16:06,184 --> 04:16:08,186 LOOKING AT WHAT RESOURCES DO YOU 6523 04:16:08,186 --> 04:16:08,486 HAVE? 6524 04:16:08,486 --> 04:16:12,691 CAN THIS INTERVENTION I'M TRYING 6525 04:16:12,691 --> 04:16:14,459 TO DESIGN, CAN YOU AFFORD IT? 6526 04:16:14,459 --> 04:16:16,661 AND I THINK WE ARE NOT MOSTLY 6527 04:16:16,661 --> 04:16:17,862 DOING THAT. 6528 04:16:17,862 --> 04:16:20,665 WE ARE SIMPLY DESIGNING THINGS 6529 04:16:20,665 --> 04:16:24,569 TO SAY WE PUBLISHED IN JAMA, 6530 04:16:24,569 --> 04:16:25,770 LANCET, BEAUTIFUL BUT THE 6531 04:16:25,770 --> 04:16:27,372 CHANCES OF IMPLEMENTATION ARE 6532 04:16:27,372 --> 04:16:29,975 CLOSE TO ZERO BECAUSE WE ARE NOT 6533 04:16:29,975 --> 04:16:31,676 ENGAGING THE POLICYMAKERS TO 6534 04:16:31,676 --> 04:16:33,278 LOOK AT THE RESOURCES THAT THEY 6535 04:16:33,278 --> 04:16:33,478 HAVE. 6536 04:16:33,478 --> 04:16:34,346 THANK YOU. 6537 04:16:34,346 --> 04:16:34,980 >> THANK YOU. 6538 04:16:34,980 --> 04:16:40,151 THANK YOU. 6539 04:16:40,151 --> 04:16:42,454 [ APPLAUSE ] 6540 04:16:42,454 --> 04:16:43,788 PAMELA, CAN I INVITE YOU TO 6541 04:16:43,788 --> 04:16:45,390 WEIGH IN ON THIS TOPIC? 6542 04:16:45,390 --> 04:16:47,325 >> YES, I WAS GOING TO TALK 6543 04:16:47,325 --> 04:16:48,093 ABOUT CO-CREATION AS WELL AND I 6544 04:16:48,093 --> 04:16:49,694 THINK YOU SPOKE TO THAT VERY 6545 04:16:49,694 --> 04:16:49,995 WELL. 6546 04:16:49,995 --> 04:16:50,996 I'M GOING TO TALK ABOUT 6547 04:16:50,996 --> 04:16:52,130 SOMETHING ELSE AND THAT'S HOW DO 6548 04:16:52,130 --> 04:16:53,865 WE ACTUALLY COMMUNICATE THE 6549 04:16:53,865 --> 04:16:56,668 RESULTS THAT WE DO HAVE? 6550 04:16:56,668 --> 04:16:59,271 AND WHO ARE WE COMMUNICATING TO? 6551 04:16:59,271 --> 04:17:00,905 HOW FREQUENTLY ARE WE 6552 04:17:00,905 --> 04:17:01,239 COMMUNICATING? 6553 04:17:01,239 --> 04:17:04,776 AND WHAT ARE THE MESSAGES? 6554 04:17:04,776 --> 04:17:07,479 SO WHAT IS MOST RELEVANT TO 6555 04:17:07,479 --> 04:17:09,080 POLICYMAKER OR COMMUNITY MAY NOT 6556 04:17:09,080 --> 04:17:12,684 BE WHAT IS MOST RELEVANT TO JAMA 6557 04:17:12,684 --> 04:17:13,585 OR WHATEVER JOURNAL THAT YOU'RE 6558 04:17:13,585 --> 04:17:15,086 PUBLISHING IN. 6559 04:17:15,086 --> 04:17:17,289 AND SO IT REALLY TRANSLATING THE 6560 04:17:17,289 --> 04:17:19,324 OCTOBERUAL FINDINGS REQUIRES AN 6561 04:17:19,324 --> 04:17:20,325 ADDITIONAL CONSIDERATION OF THE 6562 04:17:20,325 --> 04:17:24,396 DATA AND THE IMPLICATIONS BEYOND 6563 04:17:24,396 --> 04:17:25,597 MIGHT BE PUBLISHED IN A 6564 04:17:25,597 --> 04:17:26,598 SCIENTIFIC PAPER. 6565 04:17:26,598 --> 04:17:27,799 SO, I THINK THE QUESTION IS, HOW 6566 04:17:27,799 --> 04:17:29,100 OFTEN DO WE DO THIS? 6567 04:17:29,100 --> 04:17:30,702 HOW OFTEN DO WE TAKE THE TIME TO 6568 04:17:30,702 --> 04:17:32,604 DO THIS AND HOW OFTEN DO WE SET 6569 04:17:32,604 --> 04:17:34,205 OUT THE STRATEGY FOR 6570 04:17:34,205 --> 04:17:35,106 COMMUNICATION AND THAT 6571 04:17:35,106 --> 04:17:36,408 ENGAGEMENT THAT NEEDS TO HAPPEN 6572 04:17:36,408 --> 04:17:38,310 AFTER THE STUDY IS DONE? 6573 04:17:38,310 --> 04:17:39,911 HOW DO YOU GO BACK TO THE 6574 04:17:39,911 --> 04:17:40,178 COMMUNITY? 6575 04:17:40,178 --> 04:17:44,215 HOW DO YOU GO BACK TO YOUR 6576 04:17:44,215 --> 04:17:46,117 POLICYMAKERS ENSURING THAT THIS 6577 04:17:46,117 --> 04:17:48,520 CAN BE COMMUNICATED IN TERMS OF 6578 04:17:48,520 --> 04:17:50,722 CLEAR RECOMMENDATIONS WHETHER 6579 04:17:50,722 --> 04:17:51,923 THE RECOMMENDATION MIGHT BE NO, 6580 04:17:51,923 --> 04:17:53,224 THIS ISN'T THE BEST THING FOR 6581 04:17:53,224 --> 04:17:54,893 THIS COMMUNITY OR THE 6582 04:17:54,893 --> 04:17:56,194 RECOMMENDATION MAY BE, YES, AND 6583 04:17:56,194 --> 04:17:57,228 HERE IS THE EVIDENCE AND HERE IS 6584 04:17:57,228 --> 04:18:00,532 WHAT YOU CAN DO WITH THAT 6585 04:18:00,532 --> 04:18:01,533 EVIDENCE. 6586 04:18:01,533 --> 04:18:03,335 >> THANK YOU. 6587 04:18:03,335 --> 04:18:03,535 BILL? 6588 04:18:03,535 --> 04:18:04,769 >> I JUST WANT TO SAY IT'S 6589 04:18:04,769 --> 04:18:12,977 ALWAYS REALLY HARD TO FOLLOW 6590 04:18:12,977 --> 04:18:13,211 VICTOR. 6591 04:18:13,211 --> 04:18:14,145 [ LAUGHS ] 6592 04:18:14,145 --> 04:18:17,349 SO I JUST HAD TWO SHORT POINTS. 6593 04:18:17,349 --> 04:18:20,752 ONE IS RELATED TO VICTOR'S POINT 6594 04:18:20,752 --> 04:18:20,985 REALLY. 6595 04:18:20,985 --> 04:18:22,821 IT'S EASY FOR US AS 6596 04:18:22,821 --> 04:18:23,955 INVESTIGATORS TO THE HAVE AN 6597 04:18:23,955 --> 04:18:27,225 IDEA AND JUST WANT TO GO WITH IT 6598 04:18:27,225 --> 04:18:28,860 AND DEVELOP IT AND WRITE A 6599 04:18:28,860 --> 04:18:29,127 GRANT. 6600 04:18:29,127 --> 04:18:31,129 IT'S A LOT HARDER TO TAKE THE 6601 04:18:31,129 --> 04:18:32,764 TIME TO TAKE THAT IDEA AND HAVE 6602 04:18:32,764 --> 04:18:35,367 THE MEANINGFUL CONVERSATIONS 6603 04:18:35,367 --> 04:18:36,234 WITH THE PEOPLE THAT ARE GOING 6604 04:18:36,234 --> 04:18:37,769 TO BE THINKING ABOUT WHETHER 6605 04:18:37,769 --> 04:18:40,338 THIS IS IMPLEMENTABLE IN THE END 6606 04:18:40,338 --> 04:18:41,139 OR NOT. 6607 04:18:41,139 --> 04:18:42,574 AND THE ONLY WAY THAT YOU CAN 6608 04:18:42,574 --> 04:18:45,477 REALLY DO THAT IS IF YOU HAVE 6609 04:18:45,477 --> 04:18:48,079 EXISTING RELATIONSHIPS WITH 6610 04:18:48,079 --> 04:18:49,381 THOSE PEOPLE OVER, TYPICALLY 6611 04:18:49,381 --> 04:18:51,883 OVER A LONG PERIOD OF TIME. 6612 04:18:51,883 --> 04:18:53,752 ONE OF THE REALLY FORTUNATE 6613 04:18:53,752 --> 04:18:56,554 THINGS FOR US IN VIETNAM IS THAT 6614 04:18:56,554 --> 04:18:57,756 MY COLLEAGUES HAVE BEEN WORKING 6615 04:18:57,756 --> 04:19:01,159 THERE FOR 20 YEARS AND THE 6616 04:19:01,159 --> 04:19:03,161 PEOPLE THAT ARE IN THE, WHAT'S 6617 04:19:03,161 --> 04:19:05,263 CALLED THE VAAC, THE AUTHORITY 6618 04:19:05,263 --> 04:19:08,266 THAT IS RESPONSIBLE FOR 6619 04:19:08,266 --> 04:19:10,969 VIETNAM'S HIV CONTROL, ARE LONG 6620 04:19:10,969 --> 04:19:12,670 TERM COLLEAGUES AND ARE OPEN TO 6621 04:19:12,670 --> 04:19:14,572 HEARING WHAT WE HAVE TO SAY. 6622 04:19:14,572 --> 04:19:16,841 AND THEN THEY JUST SAY BACK TO 6623 04:19:16,841 --> 04:19:19,377 US, THAT'S CONSISTENT WITH THIS 6624 04:19:19,377 --> 04:19:20,979 POLICY AND THE MINISTRY OF 6625 04:19:20,979 --> 04:19:22,580 HEALTH OR THEY'LL SAY THAT IT'S 6626 04:19:22,580 --> 04:19:24,382 NOT CONSISTENT WITH ANY EXISTING 6627 04:19:24,382 --> 04:19:24,616 POLICY. 6628 04:19:24,616 --> 04:19:26,885 SO IT DOESN'T REALLY MAKE SENSE 6629 04:19:26,885 --> 04:19:29,287 FOR YOU TO DO THAT. 6630 04:19:29,287 --> 04:19:32,056 AND THAT GIVES US A MUCH GREATER 6631 04:19:32,056 --> 04:19:34,492 HOPE OF MOVING IT FORWARD. 6632 04:19:34,492 --> 04:19:38,396 AND WHAT WE HAVE DONE IN A 6633 04:19:38,396 --> 04:19:40,799 FOGARTY D43, A TRAINING CENTER, 6634 04:19:40,799 --> 04:19:42,500 INCORPORATE THE POLICYMAKERS 6635 04:19:42,500 --> 04:19:45,804 INTO THE IMPLEMENTATION SCIENCE 6636 04:19:45,804 --> 04:19:47,272 TRAINING AND THEY ARE JUST 6637 04:19:47,272 --> 04:19:50,375 SOAKING UP ALL OF THE KNOWLEDGE 6638 04:19:50,375 --> 04:19:51,676 ABOUT WHAT IT MEANS TO THINK 6639 04:19:51,676 --> 04:19:54,679 ABOUT HOW TO IMPLEMENT AND HOW 6640 04:19:54,679 --> 04:19:57,215 TO DO IT STRATEGICALLY AND HOW 6641 04:19:57,215 --> 04:20:00,618 TO SORT OF ASSESS IT. 6642 04:20:00,618 --> 04:20:03,054 AND I'M HOPEFUL THAT WILL HELP 6643 04:20:03,054 --> 04:20:04,222 THE DIALOGUE AND THE DIALOGUE 6644 04:20:04,222 --> 04:20:05,557 THE MORE EARLY CAREER PEOPLE 6645 04:20:05,557 --> 04:20:06,724 BECAUSE THEY WORKED IN SMALL 6646 04:20:06,724 --> 04:20:08,059 GROUPS WHERE THERE IS A 6647 04:20:08,059 --> 04:20:10,528 POLICYMAKER WITH THE ACADEMICS 6648 04:20:10,528 --> 04:20:12,063 WITHIN VIETNAM SORT OF WORKING 6649 04:20:12,063 --> 04:20:14,866 ON THE SAME KIND OF PILOT. 6650 04:20:14,866 --> 04:20:19,037 AND THAT, I HOPE THAT THAT 6651 04:20:19,037 --> 04:20:21,039 CONTINUES LONG AFTER WE'VE SORT 6652 04:20:21,039 --> 04:20:25,443 OF RETIRED FROM OUR ROLE THERE. 6653 04:20:25,443 --> 04:20:26,945 >> THANK YOU, BILL. 6654 04:20:26,945 --> 04:20:29,547 WHAT IS YOUR RESPONSE ABOUT HOW 6655 04:20:29,547 --> 04:20:30,815 IMPLEMENTATION SCIENCE RESEARCH 6656 04:20:30,815 --> 04:20:32,550 CAN MAXIMIZE POLICY AND 6657 04:20:32,550 --> 04:20:33,685 COMMUNITY IMPACT? 6658 04:20:33,685 --> 04:20:35,520 >> I THINK VICTOR AND BILL HAVE 6659 04:20:35,520 --> 04:20:36,354 ALREADY COVERED IT ALL. 6660 04:20:36,354 --> 04:20:37,622 BUT THE POINT I WANTED TO MAKE 6661 04:20:37,622 --> 04:20:40,525 IS THAT IF YOU -- YOU ALWAYS 6662 04:20:40,525 --> 04:20:43,261 COMPLAIN THAT WE DON'T GET 6663 04:20:43,261 --> 04:20:43,728 EVIDENCE-BASED POLICY. 6664 04:20:43,728 --> 04:20:44,529 THAT'S ALWAYS BEEN A PROBLEM 6665 04:20:44,529 --> 04:20:47,532 THAT PEOPLE SAY, POLICYMAKERS 6666 04:20:47,532 --> 04:20:49,334 MAKE POLICY AND DON'T TAKE 6667 04:20:49,334 --> 04:20:50,602 EVIDENCE INTO ACCOUNT. 6668 04:20:50,602 --> 04:20:51,936 WHAT THEY MEAN IS THEY DIDN'T 6669 04:20:51,936 --> 04:20:52,937 CONSIDER YOUR RESEARCH WHEN THEY 6670 04:20:52,937 --> 04:20:54,672 MADE THEIR POLICY. 6671 04:20:54,672 --> 04:20:57,041 BUT MAYBE THE QUESTION WE NEED 6672 04:20:57,041 --> 04:20:58,543 TO ASK OURSELVES IS WHY DOES 6673 04:20:58,543 --> 04:20:59,177 THAT HAPPEN? 6674 04:20:59,177 --> 04:21:01,346 I THINK IMPLEMENTATION SCIENCE 6675 04:21:01,346 --> 04:21:04,482 IS THAT MISSING LINK WHICH COULD 6676 04:21:04,482 --> 04:21:05,350 TAKE YOUR RESEARCH TO BECOME 6677 04:21:05,350 --> 04:21:06,851 PART OF THAT POLICY WHICH HAS 6678 04:21:06,851 --> 04:21:07,385 BEEN DESIGNED. 6679 04:21:07,385 --> 04:21:08,520 AND REALLY THAT IS WHAT WE 6680 04:21:08,520 --> 04:21:10,255 SHOULD BE LOOKING AT 6681 04:21:10,255 --> 04:21:11,256 IMPLEMENTATION RESEARCH AS 6682 04:21:11,256 --> 04:21:12,657 SOMETHING THAT WILL TAKE THE 6683 04:21:12,657 --> 04:21:14,859 STUFF YOU HAVE BEEN DOING TO 6684 04:21:14,859 --> 04:21:15,560 ENSURE INTO POLICY. 6685 04:21:15,560 --> 04:21:18,663 YOU CAN DO THAT IF YOU ACTUALLY 6686 04:21:18,663 --> 04:21:22,066 LET THE POLICYMAKERS DESIGN THE 6687 04:21:22,066 --> 04:21:23,167 STUDY AND DESIGN THE QUESTIONS 6688 04:21:23,167 --> 04:21:25,970 YOU WANT TO ASK. 6689 04:21:25,970 --> 04:21:26,905 RATHER THAN GOING THERE. 6690 04:21:26,905 --> 04:21:28,706 AND I FULLY AGREE WITH VICTOR. 6691 04:21:28,706 --> 04:21:30,475 IF I GO TO POLICYMAKERS AND SAY 6692 04:21:30,475 --> 04:21:32,277 I WANT TO DO THIS STUDY, AND 6693 04:21:32,277 --> 04:21:34,979 THEN SAY PLEASE GO AHEAD. 6694 04:21:34,979 --> 04:21:36,481 ANY SUPPORT YOU NEED WE'LL GIVE 6695 04:21:36,481 --> 04:21:36,814 YOU. 6696 04:21:36,814 --> 04:21:38,316 AND THEY WRITE THE LETTER AND -- 6697 04:21:38,316 --> 04:21:39,984 I CAN TELL YOU ONCE I HAVE DONE 6698 04:21:39,984 --> 04:21:41,886 IT, IF I GO BACK TO THEM AND SAY 6699 04:21:41,886 --> 04:21:43,488 WILL YOU SCALE THIS UP, THIS IS 6700 04:21:43,488 --> 04:21:44,956 VERY EFFECTIVE. 6701 04:21:44,956 --> 04:21:46,824 AND THEY SAY I'LL SCALE IT UP. 6702 04:21:46,824 --> 04:21:48,359 IT WAS JUST A THING I THOUGHT 6703 04:21:48,359 --> 04:21:51,863 YOU WANTED SO I'M HELPING YOU. 6704 04:21:51,863 --> 04:21:52,764 I'M BEING NICE. 6705 04:21:52,764 --> 04:21:54,866 YOU KNOW IF YOU DON'T ENGAGE 6706 04:21:54,866 --> 04:21:56,200 THEM - AUTO BETTER WAY TO DO IT 6707 04:21:56,200 --> 04:21:58,069 IS SAY, WE WANT TO DO SOMETHING 6708 04:21:58,069 --> 04:21:58,870 ABOUT THIS. 6709 04:21:58,870 --> 04:22:00,204 HERE IS AN INTERVENTION. 6710 04:22:00,204 --> 04:22:01,673 WHAT IS THE QUESTION THAT YOU 6711 04:22:01,673 --> 04:22:02,407 WANT ANSWERED? 6712 04:22:02,407 --> 04:22:03,875 WHAT IS THE QUESTION THAT STOPS 6713 04:22:03,875 --> 04:22:06,077 YOU FROM DOING THIS ON A ROUTINE 6714 04:22:06,077 --> 04:22:07,278 REGULAR BASIS? 6715 04:22:07,278 --> 04:22:08,880 AND WHAT ARE YOUR CHALLENGES AND 6716 04:22:08,880 --> 04:22:10,682 LET'S SEE HOW WE CAN HELP YOU 6717 04:22:10,682 --> 04:22:12,283 FIND ANSWERS TO THE QUESTIONS 6718 04:22:12,283 --> 04:22:13,985 THAT BOTHER YOU AS TO WHY YOU'RE 6719 04:22:13,985 --> 04:22:16,487 NOT SCALING THIS UP OR WHAT IT 6720 04:22:16,487 --> 04:22:18,122 WILL TAKE TO SCALE IT UP ACROSS 6721 04:22:18,122 --> 04:22:18,990 A POPULATION. 6722 04:22:18,990 --> 04:22:20,425 I THINK IF YOU DO IT THAT WAY 6723 04:22:20,425 --> 04:22:23,494 AND THEN YOU DESIGN YOUR TRIAL 6724 04:22:23,494 --> 04:22:25,697 OR YOUR RESEARCH AROUND THAT, 6725 04:22:25,697 --> 04:22:26,998 YOU'RE MORE LIKELY TO GET A 6726 04:22:26,998 --> 04:22:28,700 COMMITMENT FROM THEM TO SCALE IT 6727 04:22:28,700 --> 04:22:30,101 UP ONCE THAT IS OVER. 6728 04:22:30,101 --> 04:22:32,303 SO, YOU KNOW, ONE OF THE THINGS 6729 04:22:32,303 --> 04:22:34,205 THAT STRUCK ME AND I'M NOT GOING 6730 04:22:34,205 --> 04:22:38,409 TO TAKE NAMES -- ONE OF THE 6731 04:22:38,409 --> 04:22:39,811 PRESENTATIONS WAS THAT YOU HAD 6732 04:22:39,811 --> 04:22:42,213 THE PERSON WORKING FOR THE 6733 04:22:42,213 --> 04:22:44,482 MINISTRY WHO WAS SAYING WE DID 6734 04:22:44,482 --> 04:22:46,551 THIS AND YES, WE HAVE GOT THESE 6735 04:22:46,551 --> 04:22:47,919 PARTNERS AND POINTING TO THE 6736 04:22:47,919 --> 04:22:48,486 ACADEMIC PARTNERS. 6737 04:22:48,486 --> 04:22:50,254 AND I THINK THAT IS HOW IT 6738 04:22:50,254 --> 04:22:50,822 SHOULD BE. 6739 04:22:50,822 --> 04:22:53,024 NOT THE ACADEMIC PARTNERS 6740 04:22:53,024 --> 04:22:54,425 DRIVING THE SHOW AND THE 6741 04:22:54,425 --> 04:22:56,628 MINISTRY IS THE KIND OF ON THE 6742 04:22:56,628 --> 04:22:56,894 SIDELINES. 6743 04:22:56,894 --> 04:22:58,630 BUT ACTUALLY HAVING PEOPLE 6744 04:22:58,630 --> 04:23:01,466 WITHIN THE POLICYMAKERS TAKING 6745 04:23:01,466 --> 04:23:02,133 COMPLETE I'M AND SAYING THESE 6746 04:23:02,133 --> 04:23:03,801 ARE THE QUESTIONS WE HAVE AND 6747 04:23:03,801 --> 04:23:05,036 THE QUESTIONS WE ANSWERED. 6748 04:23:05,036 --> 04:23:06,938 THE ACADEMIC PARTNERS HELPED US 6749 04:23:06,938 --> 04:23:10,108 DESIGN IT, RUN IT, EVALUATE IT 6750 04:23:10,108 --> 04:23:10,875 AND IT'S ANSWERED OUR QUESTION 6751 04:23:10,875 --> 04:23:12,610 NOW WE ARE GOING TO GO UP AND 6752 04:23:12,610 --> 04:23:14,412 SCALE THIS UP. 6753 04:23:14,412 --> 04:23:18,116 WHICH IS THE IDEAL WAY TO 6754 04:23:18,116 --> 04:23:18,383 IMPLEMENT. 6755 04:23:18,383 --> 04:23:20,251 >> AND I ALSO WOULD SAY, WE 6756 04:23:20,251 --> 04:23:21,819 DON'T UNDERESTIMATE THE POWER OF 6757 04:23:21,819 --> 04:23:23,021 COMMUNITY TO ADVOCATE. 6758 04:23:23,021 --> 04:23:24,122 SO WHEN SOMETHING WORKS FOR 6759 04:23:24,122 --> 04:23:26,824 PEOPLE, THEY ALSO HAVE A ROLE IN 6760 04:23:26,824 --> 04:23:27,725 ADVOCATING TO THEIR POLICY 6761 04:23:27,725 --> 04:23:29,927 MAKERS TO ENSURE THAT THINGS GO 6762 04:23:29,927 --> 04:23:31,229 THE NEXT -- 6763 04:23:31,229 --> 04:23:33,031 >> WHEN I SAY POLICYMAKERS, I 6764 04:23:33,031 --> 04:23:34,098 MEAN STARTING FROM THE VILLAGE. 6765 04:23:34,098 --> 04:23:37,168 LIKE YOU HAVE A VILLAGE COUNSEL, 6766 04:23:37,168 --> 04:23:39,070 THAT IS A POLICYMAKER. 6767 04:23:39,070 --> 04:23:41,205 YOU NEED TO TO THEM AS MUCH AS 6768 04:23:41,205 --> 04:23:43,341 YOU TALK TO SOMEBODY SITTING AT 6769 04:23:43,341 --> 04:23:44,676 THE MINISTRY OF HEALTH IN THE 6770 04:23:44,676 --> 04:23:45,343 CAPITAL CITY. 6771 04:23:45,343 --> 04:23:47,345 YOU REALLY NEED TO TALK TO YOUR 6772 04:23:47,345 --> 04:23:50,448 COMMUNITY AND POLICYMAKERS, THE 6773 04:23:50,448 --> 04:23:52,517 LOCAL POLITICIAN IS AN EQUALLY 6774 04:23:52,517 --> 04:23:53,151 IMPORTANT PERSON. 6775 04:23:53,151 --> 04:23:54,352 YOU SHOULD BE TALKING TO THEM TO 6776 04:23:54,352 --> 04:23:56,754 SAY WHAT ARE THE CHALLENGES? 6777 04:23:56,754 --> 04:23:59,524 AND SO, YES, I MEAN I THINK WE 6778 04:23:59,524 --> 04:24:01,559 FREQUENTLY THINK POLICYMAKERS IS 6779 04:24:01,559 --> 04:24:03,194 JUST SOMEBODY WHO SITS AT THE 6780 04:24:03,194 --> 04:24:05,096 CAPITAL CITY IN THE BIG MINISTRY 6781 04:24:05,096 --> 04:24:06,364 OF HEALTH BUT THERE IS A LOT OF 6782 04:24:06,364 --> 04:24:09,267 PEOPLE ALONG THE WAY, ALONG THE 6783 04:24:09,267 --> 04:24:09,500 PATHWAY. 6784 04:24:09,500 --> 04:24:12,637 I'M SURE -- I KNOW IN MALAWI, OR 6785 04:24:12,637 --> 04:24:13,771 SOME COUNTRIES, FOR EXAMPLE, YOU 6786 04:24:13,771 --> 04:24:15,973 HAVE TO SPEAK TO THE RELIGIOUS 6787 04:24:15,973 --> 04:24:16,941 LEADERS BECAUSE THEY ARE 6788 04:24:16,941 --> 04:24:17,975 IMPORTANT POLICYMAKERS. 6789 04:24:17,975 --> 04:24:19,577 OR YOU HAVE TO SPEAK TO THE 6790 04:24:19,577 --> 04:24:21,245 TRIBAL CHIEFS BECAUSE THEY ARE 6791 04:24:21,245 --> 04:24:22,346 IMPORTANT POLICYMAKERS, AND ASK 6792 04:24:22,346 --> 04:24:23,448 EM THIS THE QUESTION THAT IS 6793 04:24:23,448 --> 04:24:24,348 COME UP. 6794 04:24:24,348 --> 04:24:25,783 AND I THINK THOSE ARE THE KIND 6795 04:24:25,783 --> 04:24:26,884 OF PEOPLE WE SHOULD BE LOOKING 6796 04:24:26,884 --> 04:24:29,053 AT AND NOT JUST SAY WE'LL GO 6797 04:24:29,053 --> 04:24:30,588 MEET THE 60 AND MINISTRY OF 6798 04:24:30,588 --> 04:24:32,757 HEALTH AND WE HAVE PERMISSION TO 6799 04:24:32,757 --> 04:24:33,558 DO THE TRIAL. 6800 04:24:33,558 --> 04:24:35,193 -- SECRETARY AND MINISTRY OF 6801 04:24:35,193 --> 04:24:35,426 HEALTH. 6802 04:24:35,426 --> 04:24:37,361 >> I THINK THIS HAS BEEN A VERY 6803 04:24:37,361 --> 04:24:38,463 RICH CONVERSATION THAT HAS 6804 04:24:38,463 --> 04:24:40,164 RAISED A LOT OF ISSUES JUST 6805 04:24:40,164 --> 04:24:41,766 ABOUT THE COMPLEXITY OF 6806 04:24:41,766 --> 04:24:44,135 IMPLEMENTATION SCIENCE RESEARCH, 6807 04:24:44,135 --> 04:24:44,869 HOW IT STANDS. 6808 04:24:44,869 --> 04:24:48,473 A LOT OF OUR STANDARD RESEARCH 6809 04:24:48,473 --> 04:24:52,744 MODALITIES ON ITS HEAD, BUT YOU 6810 04:24:52,744 --> 04:24:54,979 KNOW, IT'S WITH THE INVESTMENT 6811 04:24:54,979 --> 04:24:58,082 OF TIME AND APPROACH AND 6812 04:24:58,082 --> 04:24:59,884 ENGAGEMENT POSITIONED TO ANSWER 6813 04:24:59,884 --> 04:25:01,085 A VERY IMPORTANT QUESTION THAT 6814 04:25:01,085 --> 04:25:02,687 WILL HELP THE GLOBAL MENTAL 6815 04:25:02,687 --> 04:25:04,388 HEALTH -- THE IMPACT OF THE 6816 04:25:04,388 --> 04:25:05,056 GLOBAL MENTAL HEALTH FIELD TO 6817 04:25:05,056 --> 04:25:05,757 MOVE FORWARD. 6818 04:25:05,757 --> 04:25:08,893 SO WE ARE RIGHT AT TIME. 6819 04:25:08,893 --> 04:25:14,365 SO PLEASE JOIN ME IN -- [ OFF 6820 04:25:14,365 --> 04:25:15,399 MICROPHONE ] 6821 04:25:15,399 --> 04:25:17,502 >> I HAVE BEEN GIVEN STRICT 6822 04:25:17,502 --> 04:25:17,835 INSTRUCTIONS. 6823 04:25:17,835 --> 04:25:19,504 I APOLOGIZE FOR NOT LEAVING TIME 6824 04:25:19,504 --> 04:25:21,873 FOR AUDIENCE PARTICIPATION. 6825 04:25:21,873 --> 04:25:24,709 HOW CAN I SAY NO? 6826 04:25:24,709 --> 04:25:31,482 HOW CAN HOLLY SAY NO? 6827 04:25:31,482 --> 04:25:42,059 >> AUDIENCE MEMBER: [ OFF MIC ] 6828 04:26:12,890 --> 04:26:14,325 >> SO WE REALLY NEED TO START 6829 04:26:14,325 --> 04:26:16,928 THE PRE-WORK. 6830 04:26:16,928 --> 04:26:19,697 IT'S MUCH MORE IMPORTANT THAN 6831 04:26:19,697 --> 04:26:20,531 THE ACTUAL WORK OTHERWISE YOU'RE 6832 04:26:20,531 --> 04:26:22,033 IN A VACUUM. 6833 04:26:22,033 --> 04:26:25,036 SO SUSTAINABILITY AND 6834 04:26:25,036 --> 04:26:26,103 SUSTAINABILITY. 6835 04:26:26,103 --> 04:26:26,904 >> THANK YOU. 6836 04:26:26,904 --> 04:26:29,407 PLEASE JOIN ME IN THANKING OUR 6837 04:26:29,407 --> 04:26:30,741 PANELISTS FOR A VERY RICH 6838 04:26:30,741 --> 04:26:31,542 CONVERSATION ABOUT 6839 04:26:31,542 --> 04:26:39,016 IMPLEMENTATION SCIENCE. 6840 04:26:39,016 --> 04:26:39,951 THANK YOU ALL FOR STICKING WITH 6841 04:26:39,951 --> 04:26:40,351 US. 6842 04:26:40,351 --> 04:26:41,586 WE'VE ALL AGREED THAT WE'RE 6843 04:26:41,586 --> 04:26:44,088 GOING TO KEEP OUR CLOSING 6844 04:26:44,088 --> 04:26:44,956 COMMENTS VERY SHORT. 6845 04:26:44,956 --> 04:26:46,657 BUT WE REALLY WANT TO MAKE SURE 6846 04:26:46,657 --> 04:26:48,326 WE SAY THANK YOU TO ALL OF THE 6847 04:26:48,326 --> 04:26:51,462 PEOPLE WHO CONTRIBUTED TO THIS 6848 04:26:51,462 --> 04:26:51,696 MEETING. 6849 04:26:51,696 --> 04:26:53,931 SO FIRST, I SHOULD INTRODUCE 6850 04:26:53,931 --> 04:26:56,534 MYSELF, I'M SHELLY, THE DEPUTY 6851 04:26:56,534 --> 04:26:57,501 DIRECTOR OF THE NATIONAL 6852 04:26:57,501 --> 04:26:58,369 INSTITUTE OF MENTAL HEALTH. 6853 04:26:58,369 --> 04:26:59,837 IT'S MY PLEASURE TO BE HERE WITH 6854 04:26:59,837 --> 04:27:01,739 YOU TONIGHT AND THE LAST TWO 6855 04:27:01,739 --> 04:27:02,073 DAYS. 6856 04:27:02,073 --> 04:27:03,975 SO FIRST, AS I SAID, WE WANT TO 6857 04:27:03,975 --> 04:27:06,410 MAKE SURE WE DO OUR PROPER THANK 6858 04:27:06,410 --> 04:27:07,044 YOU. 6859 04:27:07,044 --> 04:27:09,146 THANK YOU VERY MUCH TO LEO WHO 6860 04:27:09,146 --> 04:27:10,548 IS OUR DIRECTOR OF THE CENTER 6861 04:27:10,548 --> 04:27:11,182 FOR GLOBAL MENTAL HEALTH 6862 04:27:11,182 --> 04:27:13,885 RESEARCH AT NIMH, WHO REALLY LED 6863 04:27:13,885 --> 04:27:14,619 THIS EFFORT. 6864 04:27:14,619 --> 04:27:19,023 THANK YOU TO HIS OFFICE. 6865 04:27:19,023 --> 04:27:20,491 [ APPLAUSE ] 6866 04:27:20,491 --> 04:27:22,827 TO HOLLY CAMPBELL ROSEN WHO WAS 6867 04:27:22,827 --> 04:27:25,263 OUR NICE MODERATOR THROUGHOUT. 6868 04:27:25,263 --> 04:27:26,964 TO OTHER DIVISION OF AIDS 6869 04:27:26,964 --> 04:27:29,500 RESEARCH STAFF AND TO THE NIMH 6870 04:27:29,500 --> 04:27:31,269 GLOBAL MENTAL HEALTH TEAM THAT 6871 04:27:31,269 --> 04:27:34,639 REPRESENTS ALL OF OUR NIMH 6872 04:27:34,639 --> 04:27:34,872 PEOPLE. 6873 04:27:34,872 --> 04:27:36,307 THANK YOU SO MUCH TO ALL OF OUR 6874 04:27:36,307 --> 04:27:38,609 PARTNERS WHO ARE IN THE ROOM, 6875 04:27:38,609 --> 04:27:40,344 THE W.H.O., WELCOME GRAND 6876 04:27:40,344 --> 04:27:42,446 CHALLENGES CANADA AND THE 6877 04:27:42,446 --> 04:27:43,281 INTERNATIONAL ALLIANCE OF MENTAL 6878 04:27:43,281 --> 04:27:44,482 HEALTH RESEARCH FUNDERS FOR 6879 04:27:44,482 --> 04:27:46,183 HELPING TO PLAN AND SPONSOR THIS 6880 04:27:46,183 --> 04:27:46,417 EVENT. 6881 04:27:46,417 --> 04:27:48,886 THANKS TO OUR CONTRACTORS AND 6882 04:27:48,886 --> 04:27:50,521 OTHER STAFF WHO ACTUALLY MADE 6883 04:27:50,521 --> 04:27:52,423 THIS POSSIBLE WHO GOT THE VENUE, 6884 04:27:52,423 --> 04:27:53,591 WHO HELPED PEOPLE TRAVEL HERE, 6885 04:27:53,591 --> 04:27:56,494 WHO HELD THE AWARD CEREMONY, 6886 04:27:56,494 --> 04:27:56,761 ET CETERA. 6887 04:27:56,761 --> 04:27:59,363 WE THANK YOU VERY MUCH FOR YOUR 6888 04:27:59,363 --> 04:28:00,998 TIME AND PATIENTS WITH 6889 04:28:00,998 --> 04:28:02,500 CHALLENGES WITH MEETINGS. 6890 04:28:02,500 --> 04:28:03,768 THANK YOU VERY MUCH TO THE 6891 04:28:03,768 --> 04:28:04,101 PARTICIPANTS. 6892 04:28:04,101 --> 04:28:06,637 THANK YOU TO THOSE WHO TRAVELED 6893 04:28:06,637 --> 04:28:10,141 HERE FROM LOCAL OR DISTANT 6894 04:28:10,141 --> 04:28:11,042 DESTINATION -- LOCATIONS. 6895 04:28:11,042 --> 04:28:12,877 THANKS FOR TAKING TIME OUT OF 6896 04:28:12,877 --> 04:28:14,278 YOUR BUSY SCHEDULES. 6897 04:28:14,278 --> 04:28:15,212 BUT THANK YOU ALSO TO THE PEOPLE 6898 04:28:15,212 --> 04:28:17,615 WHO ARE JOINING US ON LINE. 6899 04:28:17,615 --> 04:28:18,883 WHILE IT'S FANTASTIC THAT SO 6900 04:28:18,883 --> 04:28:21,719 MANY OF US WERE ABLE TO ENGAGE 6901 04:28:21,719 --> 04:28:24,655 TOGETHER IN PERSON, IT'S ALSO 6902 04:28:24,655 --> 04:28:26,090 FANTASTIC THAT WITH A HYBRID 6903 04:28:26,090 --> 04:28:27,825 MEETING, WE ARE ACTUALLY ABLE TO 6904 04:28:27,825 --> 04:28:31,028 REACH AN ADDITIONAL 250 PEOPLE 6905 04:28:31,028 --> 04:28:32,530 FROM 25 DIFFERENT COUNTRIES 6906 04:28:32,530 --> 04:28:33,230 AROUND THE WORLD. 6907 04:28:33,230 --> 04:28:35,599 SO WHILE WE HAD FUN HERE 6908 04:28:35,599 --> 04:28:38,502 LISTENING TO SEVERAL KEYNOTES, 6909 04:28:38,502 --> 04:28:40,504 SEVERAL FIRESIDE CHATS, PLENARY 6910 04:28:40,504 --> 04:28:42,206 PANELS, SYMPOSIUM, PAPERS AND 6911 04:28:42,206 --> 04:28:44,108 POSTERS, WE HAVE FURTHER 6912 04:28:44,108 --> 04:28:45,209 ENGAGEMENT AROUND THE WORLD. 6913 04:28:45,209 --> 04:28:46,210 AND I JUST WANT TO LEAVE YOU 6914 04:28:46,210 --> 04:28:48,612 WITH A COUPLE OF CLOSING 6915 04:28:48,612 --> 04:28:49,246 COMMENTS. 6916 04:28:49,246 --> 04:28:51,882 I WANT YOU TO KNOW THAT NIMH 6917 04:28:51,882 --> 04:28:54,986 WILL STAY COMMITTED TO THE AREA 6918 04:28:54,986 --> 04:28:57,088 OF GLOBAL MENTAL HEALTH THAT WE 6919 04:28:57,088 --> 04:28:58,422 WANT TO CONTINUE OUR DIALOGUE. 6920 04:28:58,422 --> 04:29:02,159 WE WANT TO CONTINUE OUR 6921 04:29:02,159 --> 04:29:05,296 PARTICIPATION AND FUNDING, 6922 04:29:05,296 --> 04:29:06,931 CAPACITY BUILDING, INNOVATION 6923 04:29:06,931 --> 04:29:08,499 AND RESEARCH AND TRAINING ACROSS 6924 04:29:08,499 --> 04:29:09,133 THE GLOBE. 6925 04:29:09,133 --> 04:29:10,234 WE WANT TO ACKNOWLEDGE THAT 6926 04:29:10,234 --> 04:29:11,936 THERE IS A LOT MORE TO DO AND 6927 04:29:11,936 --> 04:29:13,337 IT'S REALLY GOING TO TAKE ALL OF 6928 04:29:13,337 --> 04:29:15,006 US IN THE ROOM AND THEN SOME, SO 6929 04:29:15,006 --> 04:29:17,842 I REALLY WANT TO ENCOURAGE YOU 6930 04:29:17,842 --> 04:29:20,111 TO GO HOME, REFLECT UPON WHAT 6931 04:29:20,111 --> 04:29:22,613 YOU HAVE HEARD OVER THE LAST 6932 04:29:22,613 --> 04:29:23,547 COUPLE OF DAYS. 6933 04:29:23,547 --> 04:29:24,949 THINK ABOUT IT AND DECIDE HOW 6934 04:29:24,949 --> 04:29:26,851 YOU CAN REALLY INCORPORATE THOSE 6935 04:29:26,851 --> 04:29:29,153 NEW INSIGHTS INTO YOUR FUTURE 6936 04:29:29,153 --> 04:29:29,520 WORK. 6937 04:29:29,520 --> 04:29:32,156 AND LET'S ALSO VOW TOGETHER TO 6938 04:29:32,156 --> 04:29:34,725 STAY CONNECTED TO CONTINUE TO 6939 04:29:34,725 --> 04:29:36,193 COLLABORATE, AS THAT WILL BE 6940 04:29:36,193 --> 04:29:36,460 ESSENTIAL. 6941 04:29:36,460 --> 04:29:37,628 AND THINK ABOUT HOW WE CAN 6942 04:29:37,628 --> 04:29:39,330 FURTHER ENHANCE OUR NETWORKS TO 6943 04:29:39,330 --> 04:29:42,233 GET THE JOB DONE AND MEET THESE 6944 04:29:42,233 --> 04:29:45,436 OBSTACLES AND CHALLENGES THAT WE 6945 04:29:45,436 --> 04:29:45,636 FACE. 6946 04:29:45,636 --> 04:29:47,004 I HAVE HEARD INCREDIBLE 6947 04:29:47,004 --> 04:29:48,739 PROGRESS, INCREDIBLE SUCCESS 6948 04:29:48,739 --> 04:29:49,607 STORIES AND THAT'S ALL BECAUSE 6949 04:29:49,607 --> 04:29:51,642 WE ARE WORKING TOGETHER. 6950 04:29:51,642 --> 04:29:53,244 SO THANKS AGAIN FOR YOUR 6951 04:29:53,244 --> 04:29:53,577 PARTICIPATION. 6952 04:29:53,577 --> 04:29:55,279 IT'S BEEN MY PLEASURE TO SIT AND 6953 04:29:55,279 --> 04:29:56,781 LISTEN AND LEARN FROM ALL OF YOU 6954 04:29:56,781 --> 04:30:01,752 AND I'M GOING TO TURN IT OVER TO 6955 04:30:01,752 --> 04:30:02,953 MY COLLEAGUES. 6956 04:30:02,953 --> 04:30:04,655 >> SO, IN THE SPIRIT OF BEING 6957 04:30:04,655 --> 04:30:07,358 BRIEF, I WILL JUST SAY THAT ON 6958 04:30:07,358 --> 04:30:10,127 BEHALF OF THE ALLIANCE, AND AS 6959 04:30:10,127 --> 04:30:11,595 YOU'RE MAKING YOUR WAY TO YOUR 6960 04:30:11,595 --> 04:30:14,432 HOMES OR NEXT MEETING OR STAYING 6961 04:30:14,432 --> 04:30:16,100 HERE, WE LISTENED REALLY 6962 04:30:16,100 --> 04:30:17,835 CAREFULLY TO YOUR RESEARCH BUT 6963 04:30:17,835 --> 04:30:19,036 ALSO THE QUESTIONS YOU'RE 6964 04:30:19,036 --> 04:30:20,271 SITTING WITH AND THE CONCERNS 6965 04:30:20,271 --> 04:30:21,005 YOU'RE SITTING WITH. 6966 04:30:21,005 --> 04:30:22,773 AND OVER THE NEXT COUPLE OF DAYS 6967 04:30:22,773 --> 04:30:25,376 WE HAVE OUR OWN CONVENING WITH 6968 04:30:25,376 --> 04:30:27,545 MENTAL HEALTH RESEARCH FUNDERS 6969 04:30:27,545 --> 04:30:28,279 AND INTERNATIONAL PARTNERS AND 6970 04:30:28,279 --> 04:30:29,747 WE'LL BE REFLECTING ON SOME OF 6971 04:30:29,747 --> 04:30:33,084 THE SAME TOPICS AND SETTING SOME 6972 04:30:33,084 --> 04:30:34,118 AGENDA PRIORITIES FOR THE NEXT 6973 04:30:34,118 --> 04:30:35,252 FEW MONTHS. 6974 04:30:35,252 --> 04:30:38,823 SO THANK YOU FROM ME AND SAFE 6975 04:30:38,823 --> 04:30:41,192 TRAVELS. 6976 04:30:41,192 --> 04:30:44,528 >> I WILL ALSO KEEP THIS BRIEF. 6977 04:30:44,528 --> 04:30:46,564 SO, FROM CANADA, I WANT TO ALSO 6978 04:30:46,564 --> 04:30:48,365 ECHO THANKS TO ALL OF THE 6979 04:30:48,365 --> 04:30:50,334 PARTNERS, NIMH FOR HOSTING US, 6980 04:30:50,334 --> 04:30:51,635 AND TO ALL OF YOU FOR BEING 6981 04:30:51,635 --> 04:30:52,036 HERE. 6982 04:30:52,036 --> 04:30:52,837 I LEARNED A LOT. 6983 04:30:52,837 --> 04:30:54,505 I'M TAKING SOME THINGS BACK WITH 6984 04:30:54,505 --> 04:30:56,173 ME TO REFLECT ON. 6985 04:30:56,173 --> 04:30:58,375 I THINK ONE OF THE THINGS THAT 6986 04:30:58,375 --> 04:31:00,244 IS SO CLEAR -- IT'S BEEN CLEAR 6987 04:31:00,244 --> 04:31:02,279 OUR COMMUNITY FOR A LONG TIME. 6988 04:31:02,279 --> 04:31:03,981 WHEN YOU RESEARCH MENTAL HEALTH, 6989 04:31:03,981 --> 04:31:05,149 WHEN YOU SEEK TO UNDERSTAND 6990 04:31:05,149 --> 04:31:05,983 MENTAL HEALTH AND ADDRESS MENTAL 6991 04:31:05,983 --> 04:31:06,951 HEALTH, YOU'RE DOING SO MUCH 6992 04:31:06,951 --> 04:31:08,519 MORE THAN IMPACTING A PERSON'S 6993 04:31:08,519 --> 04:31:09,186 MENTAL HEALTH. 6994 04:31:09,186 --> 04:31:11,188 YOU'RE IMPACTING EVERYTHING 6995 04:31:11,188 --> 04:31:12,923 ABOUT THEIR DOMAINS OF 6996 04:31:12,923 --> 04:31:14,024 FUNCTIONING, ABOUT A PERSON, 6997 04:31:14,024 --> 04:31:15,993 ABOUT SOCIETY, ABOUT A COUNTRY. 6998 04:31:15,993 --> 04:31:19,997 AND I THINK THAT THAT'S A STORY 6999 04:31:19,997 --> 04:31:22,466 THAT I THINK -- WE AT JCC CAN DO 7000 04:31:22,466 --> 04:31:23,901 A BETTER JOB OF TELLING AND ONE 7001 04:31:23,901 --> 04:31:25,402 OF THE THINGS I WANT TO TAKE 7002 04:31:25,402 --> 04:31:26,904 AWAY FROM HERE AND THINK ABOUT 7003 04:31:26,904 --> 04:31:28,205 HOW TO INCORPORATE THAT INTO OUR 7004 04:31:28,205 --> 04:31:29,607 WORK FLOW. 7005 04:31:29,607 --> 04:31:31,642 BECAUSE LIKE NIMH, THIS IS A BIG 7006 04:31:31,642 --> 04:31:33,844 AREA OF COMMITMENT, ONE OF OUR 7007 04:31:33,844 --> 04:31:34,979 LARGEST PORTFOLIOS AND REALLY 7008 04:31:34,979 --> 04:31:35,646 BELIEVE IN. 7009 04:31:35,646 --> 04:31:37,381 I HOPE THAT ALL OF YOU HAVE 7010 04:31:37,381 --> 04:31:38,549 INSIGHTS AND REFLECTIONS AND 7011 04:31:38,549 --> 04:31:39,850 THINGS THAT YOU'RE TAKING BACK 7012 04:31:39,850 --> 04:31:41,318 WITH YOU AND INCORPORATING INTO 7013 04:31:41,318 --> 04:31:42,453 YOUR WORK AND THAT WE CAN 7014 04:31:42,453 --> 04:31:45,556 CONTINUE TO DRIVE THIS FORWARD 7015 04:31:45,556 --> 04:31:45,823 TOGETHER. 7016 04:31:45,823 --> 04:31:47,558 I'M REALLY LOOKING FORWARD TO 7017 04:31:47,558 --> 04:31:49,927 FUTURE MEETINGS LIKE THIS BOTH 7018 04:31:49,927 --> 04:31:53,063 HOPEFULLY IN-PERSON AND FOR OUR 7019 04:31:53,063 --> 04:31:54,064 VIRTUAL FRIENDS AS WELL THAT WE 7020 04:31:54,064 --> 04:31:55,766 CAN CONTINUE TO ENGAGE. 7021 04:31:55,766 --> 04:31:58,769 SO THANK YOU. 7022 04:31:58,769 --> 04:32:02,473 >> I'M GOING TO ADD MY THANKS. 7023 04:32:02,473 --> 04:32:03,174 THANKS TO THE NATIONAL MENTAL 7024 04:32:03,174 --> 04:32:05,309 HEALTH FOR HOSTING US. 7025 04:32:05,309 --> 04:32:06,210 ALTHOUGH SOME OF THE QUEUES AND 7026 04:32:06,210 --> 04:32:07,645 LINES WERE CHALLENGING AT TIMES, 7027 04:32:07,645 --> 04:32:09,680 I HAD SOME OF MY BEST 7028 04:32:09,680 --> 04:32:10,548 CONVERSATIONS IN THEM. 7029 04:32:10,548 --> 04:32:12,183 I WANT TO SAY THEY WERE AN ADDED 7030 04:32:12,183 --> 04:32:13,050 BONUS IN THE END. 7031 04:32:13,050 --> 04:32:13,951 SO THANK YOU. 7032 04:32:13,951 --> 04:32:15,853 AND I SUPPOSE WHAT I'M TAKING 7033 04:32:15,853 --> 04:32:18,189 AWAY FROM THIS IS THAT YOU ARE 7034 04:32:18,189 --> 04:32:21,926 AN INSPIRING COMMUNITY. 7035 04:32:21,926 --> 04:32:23,594 I'M PARTICULARLY INSPIRED BY NEW 7036 04:32:23,594 --> 04:32:25,262 VOICES COMING THROUGH FROM EARLY 7037 04:32:25,262 --> 04:32:27,531 CAREER RESEARCHERS, FROM PEOPLE 7038 04:32:27,531 --> 04:32:29,433 COMING FROM DIFFERENT PARTS OF 7039 04:32:29,433 --> 04:32:30,968 LIFE AND DIFFERENT BACKGROUNDS. 7040 04:32:30,968 --> 04:32:32,369 I SUPPOSE WE ARE SPENDING OUR 7041 04:32:32,369 --> 04:32:33,938 TIME HOW CAN WE MAKE SURE WE CAN 7042 04:32:33,938 --> 04:32:35,339 GET MONEY OUT TO YOU. 7043 04:32:35,339 --> 04:32:37,474 HOW CAN WE MAKE SURE THERE ARE 7044 04:32:37,474 --> 04:32:38,008 OPPORTUNITIES FOR YOU. 7045 04:32:38,008 --> 04:32:39,410 WE ARE SITTING HERE WITH THE 7046 04:32:39,410 --> 04:32:39,643 MONEY. 7047 04:32:39,643 --> 04:32:40,878 YOU ARE SITTING THERE WITH THE 7048 04:32:40,878 --> 04:32:42,947 IDEAS AND THE NEED AND WE HAVE 7049 04:32:42,947 --> 04:32:44,448 TO BRING THOSE TWO WORLDS 7050 04:32:44,448 --> 04:32:44,815 TOGETHER. 7051 04:32:44,815 --> 04:32:46,150 ANY IDEAS YOU HAVE FOR US, 7052 04:32:46,150 --> 04:32:47,518 PLEASE E-MAIL US. 7053 04:32:47,518 --> 04:32:49,186 WE HAVE A SUGGESTIONS BOX ON OUR 7054 04:32:49,186 --> 04:32:50,321 WELCOME WEBSITE. 7055 04:32:50,321 --> 04:32:52,089 WE WANT TO HEAR FROM YOU. 7056 04:32:52,089 --> 04:32:53,891 PLEASE STAY IN TOUCH AND SAFE 7057 04:32:53,891 --> 04:32:54,825 TRAVELS. 7058 04:32:54,825 --> 04:32:55,092 THANK YOU. 7059 04:32:55,092 --> 04:33:05,092 [ APPLAUSE ]