Current Projects

MGH ChelseaImplementation of Cognitive Processing Therapy for PTSD in Diverse Communities
Chelsea, MA

Posttraumatic stress disorder (PTSD) may develop after an individual is exposed to one or more traumatic events, resulting in symptoms such as flashbacks, uncontrollable physical reactions, and avoidance of memories relating to the trauma. An effective, evidenced-based treatment for PTSD is cognitive processing therapy (CPT), a type of talk therapy that focuses on how distorted or upsetting thoughts influence ones behaviors. While it is known that this treatment is effective, it has yet to be tested in community health settings. Our goal is to close this gap between the science behind evidence-based treatments and practice.

Our study takes place in community mental health centers (CMHC) at MGH Chelsea – located in one of the most impoverished zip codes in Massachusetts.  66% of the patients at MGH Chelsea are Latino and 30% only speak Spanish.  Many of these patients experience a multitude of health issues, life stressors, and varying degrees of trauma.  These factors all contribute to the barriers preventing this population from receiving adequate healthcare services. Until recently, no providers had been trained in any evidence-based treatments for PTSD.

Our first aim with this study is to identify some of the provider barriers related to the implementation of CPT in these diverse CMHCs. The next step is to identify stakeholders’ views of the barriers impacting the implementation of CPT and to further adapt intervention methods and materials with various providers and patients in both English and Spanish. We then will train community health workers on CPT and conduct a pilot test of the modified CPT in order to begin to analyze patient outcomes.

Our National Institute of Health (NIH)-funded study is currently wrapping up year two out of our five year grant. We are gathering both qualitative data, such as provider and patient interviews, as well as quantitative data, such as self-report questionnaires. In the end, we hope to bridge the gap between research and practice involving providers, patients, and stakeholders in modifying CPT to fit the community needs.

North SuffolkUse of CPT in a Community Health Center: Can Providers Learn Evidence-Based Treatments without Formal Training?
Chelsea, MA

Through the analysis of qualitative and quantitative data, we intend to determine the unique challenges and facilitators of implementing CPT at the North Suffolk Mental Health Association in Chelsea, MA. The goal of this study is to determine if providers in community health settings such as North Suffolk are able to learn and implement evidence-based treatments with only the provided protocol materials and no formal training. The ultimate goal of this study is to better adapt CPT and the CPT training to the needs of the community and the providers. In the future, we will continue to work with North Suffolk in implementing EBTs for the variety of mental health issues their patients face.

Future Projects

Patient Barriers to Treatment and Symptoms of PTSD and Depression at MGH Chelsea HealthCare Center
We are interested in uncovering patient-identified barriers to treatment at MGH Chelsea HealthCare Center.  Our goal is to improve the quality of care based on patient feedback. Our study design includes the patients throughout the entire process.  The study is currently in IRB-approval phase.

Research Patient Data Registry (RPDR)
The Partner’s RPDR is a centralized clinical data registry containing medical records of over six million patients.  We will be conducting several public health studies utilizing this rich database to answer large-scale questions related to health disparities.  We intend to use this data to both influence future directions of our research as well as make a strong case for the need for policy and practice-level changes in addressing mental illness across diverse populations.  This study is currently under design.

Acuity of Mental Health at MGH Chelsea
The study will take place at MGH Chelsea and at MGH main campus.  It is currently in the pre-initiative and planning phase.

Integration of Mental Health and Primary Care Services
We believe in the importance of recognizing the ways in which mind and body are closely connected.  Our hopes are to better integrate mental health services with primary care.  The study will take place at MGH Chelsea and other locations.  It is currently in the pre-initiative and planning phase.

Praise for Mentorship

I cannot speak highly enough of Dr. Marques’ as a mentor. Dr. Marques has a “learn by doing” mentorship philosophy. As a result, when I worked with her I learned a tremendous amount about each stage of research, because I was directly involved in the process. She took time to train me in the varying tasks I was involved in, and she also had confidence in me to allow me to take the lead on many responsibilities and projects. Moreover, her enthusiasm for her projects is contagious, making working with her exciting and rewarding.

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Training in Cognitive Processing Therapy (CPT) at MGH Chelsea with Dr. Marques was a transformative experience for me in my final year of psychiatry residency. It provided a unique opportunity to master a highly effective evidence-based treatment for PSTD that benefited my patients enormously. The training I received in CPT with Dr. Marques has made me a significantly better clinician, and I noticed dramatic improvements in my patients’ symptoms of PTSD by adhering to the CPT model. CPT is the ideal treatment for traumatized and highly vulnerable community populations, and I will continue to use CPT as my primary treatment for PTSD moving forward as a community psychiatrist. My CPT patients have expressed great gratitude for the access they had to CPT, which helped change their lives through significant alleviation of mental suffering as well as enhancement of daily functioning.

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Did you know…?

  • Only 10% of all evidence-based treatments actually end up being used in community clinics.
  • It takes 15-20 years for evidence-based treatments to reach low-income, diverse communities.
  • Fewer than 1 in 11 Latinos with mental illnesses seek treatment.
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Infographic

For more information about Community Psychiatry PRIDE, click here to view our infographic!