How To Do CAP Research Workshop Series: A DEI Initiative

Session 8: What to do with data - capturing early life adversity and its effects on vulnerable populations

In this session, Dr. Cynthia Rogers shared her career trajectory and its impact on her research. Her work centers on how social determinants of health impact vulnerable and marginalized populations in both clinical and research settings. These investigations include an emphasis on assessing the role of psychosocial stressors, including maternal experiences of racial discrimination, maternal mental health, and dysfunctional parenting in affecting the development of the neonatal brain and contributing to childhood psychiatric disorders.

Dr. Roger’s journey began at Harvard University where she majored in psychology, completing an honors thesis on the brain basis of mental health. After graduation, she worked as a research assistant at a UCSF lab focused on PTSD. Then, she pursued research electives during medical school, residency, and fellowship, culminating in her interest on the impact of early adversity on childhood disorders, leading to her starting the “Perinatal Behavioral Health Services” focused on treating the mental health of parents in the NICU, and her research studies on premature neonates and long term outcomes. She shared that although she wasn’t initially planning to work in perinatal mental health, she became involved after finding the field interesting and clinically challenging. Her personal background also informed her interest in the social-emotional development of children, and she felt growing up with peers across the SES spectrum influenced her work today. Her current lab, the Washington University Neonatal Development Research (WUNDER) Lab, investigates neural and social mechanisms underlying neurodevelopmental impairments in children, including structural and functional connectivity in preterm neonates, as well as the role of social adversity on neurodevelopmental outcomes. Regarding designing a research study, Dr. Rogers suggests that one must first decide the question to ask, then choose validated and applicable measures and methods for the study. She highlighted the importance of cohort diversity, longitudinal data acquisition, and participant burden when designing the study. She also noted that a database must ensure data is accuracy and quality, to help score the data measures with fidelity. Finally, during data analysis, identifying learnable skills versus those to reach out to collaborators for can be immensely helpful.

During the Q&A, Dr. Rogers suggested that case reports/series are great ways to get started writing papers. She encouraged finding established projects that one can help with, and initiating quality improvement projects for learning data analyses. If possible, she also shared that research electives are helpful for dedicated time to learn specific research skills.

When recruiting and retaining participants, Dr. Rogers championed treating patients with respect and providing tangible benefits including sharing assessment results, community resources, and transportation. She also focuses on approaching their strengths and not their risks or vulnerabilities. She described her work week as a mix of research, administrative tasks, and clinical services. She also combines her work with advocacy, through testifying at local, state, and federal levels on the impact of social determinants of health on patients, and policies that may benefit vulnerable populations. Finally, she notes that it is important to balance personal life with professional aspirations, even if it means setting boundaries with mentors and peers. Most importantly, Dr. Roger stresses the importance of self-care to be better able to care for all her patients.

Pearls

1. Align your clinical work and your research focus.
2. You need more than 1 mentor: you need clinical and research mentors.
3. Clinical research is a team sport: find several collaborators.
4. Your official training may end but learning does not.
5. Let your passion and interests guide you.

Session 7: Maternal early adversity, internal working models, & perinatal substance use: What a long strange trip it's been...

In this workshop, Dr. Aviva Olsavsky addressed the inherent limitations in research, emphasizing the importance of acknowledging these constraints to improve the validity and applicability of research findings.

Dr. Olsavsky shared her inspiring journey as the first woman in her family to attend college, complete graduate school, and become a medical doctor. She discussed her winding journey of first working on Wall Street but finding the environment egodystonic, which led her to pursue a career in medicine and research. She emphasized the importance of pursuing career goals that align with personal values, rather than following societal pressures, which can lead to burnout. Her decision to leave her financial success at Wall Street and follow her passion serves as a testament to prioritizing personal fulfillment over societal pressure.

Dr. Olsavsky also spoke about not closing doors for oneself due to perceived financial constraints. She recounted her initial fears about affording college and medical school, and navigating these challenges by pursuing financial aids and viewing her education as an investment rather than an overwhelming financial stress. She encouraged trainees to pursue their dreams despite societal barriers, noting that dedication will attract supports along the way.

She presented the key research concept of the “working model,” which refers to the mental representation of one's relationship with a primary caregiver that serves as a template for future relationships. She provided examples of how children with difficult early experience develop abnormal caregiver relationships, accompanied by long-term changes in amygdala activity and emotional processing. This extended to affects of childhood violence on adulthood maternal response to infant cues, with important implications of transgenerational trauma.

Dr. Olsavsky emphasized the importance of mentorship from those willing to share both their successes and failures, normalize the difficulty of the grant submission process, understand that not all high-quality proposals are awarded, and encourage persistence in the face of rejections. She noted finding ways to "turn off" is critical for mental well-being and sustaining a long-term sense of fulfillment in both personal lives and career goals. Similar to this point, she shared it is okay to not pursue research if it does not align with one's goals, especially in regards to one's value of being supportive and considerate to one's partner in life.

Regarding equity, she shared the importance of transparency and informed consent when working with research participants, especially in regards to perinatal substance use. She also advocated for a trauma-informed approach, highlighting Maslow's Hierarchy of Needs to consider individuals' priorities for physiological and emotional safety.

Pearls

1. Acknowledge Limitations: Recognize the inherent limitations in research to improve findings’ validity and applicability.
2. Persistence in Grant Applications: Many grants may go unfunded, but persistence and repeated efforts can eventually lead to significant funding.
3. Transparency and Ethics: Ensure transparency and informed consent in research, especially when dealing with sensitive data like prenatal exposure or substance use.
4. Pursue Personal Fulfillment: Follow careers and goals that align with personal values and interests to avoid burnout and achieve long-term satisfaction.
5. Keep Doors Open: Do not close doors due to perceived financial constraints; dedication and hard work will attract support and opportunities.

Session 6: A path to integration of clinical care and research in health disparities

Dr. Tobón shared her own experience as an immigrant, and acculturation challenges that shaped her research focus on immigrant health, aiming to address the silos in clinical care. She highlighted the impact of interweaving her identity, academic experiences, and interests in community involvement on her research journey. She began research as an undergraduate for financial support, and found her passion in neuroscience. Despite feeling isolated as a Latina, she persisted, applying for and securing opportunities like the National Institute of Health (NIH) undergraduate program, which gave her a sense of belonging and support. Following her community interest, she also engaged in advocacy through programs like Programa Salud as a bilingual volunteer, and collaborated with peers to make an impact through leadership roles in organizations such as the Latin Medical Student Association (LMSA).

Her interest in addressing racial implicit biases in psychiatry eventually led her to work on projects related to Latina and Black mothers. With research and community experiences under her belt, she took on leadership roles in diversity and inclusion, curriculum development, and mentoring. Her journey reflects a commitment to using community and clinical experiences to inform research, disseminating evidence-based practices, and reducing health disparities in perinatal mental health. She highlighted the art of balance, including different priorities (family, well-being/mental health, work, clinical), multitasking, juggling with minority stress and impostor syndrome, and stress from obtaining funding.

Dr. Tobón believes the path of research is rarely linear, but individual perspective is critical: there is no “right” or “wrong” way, and one can contribute as a collaborator, principal investigator, consultant, etc. Additionally, she highlighted the importance of connections - mentors, strategists, connectors, opportunity givers, etc., with these being bidirectional relationships. There is more to being “successful” in research than meets the eye. The community can support you while you also lift others up in the village.

Finally, she shared many research resources for early-career professionals or trainees, including grants like the AACAP Research Grant, Yale Internal Research Grants, APA SAMHSA Minority Fellowship Program, Loan Repayment Program, and institutional internal grants. She mentioned various ways to stay informed of opportunities, such as listservs, mentors and colleagues, online search platforms, participating in AACAP's DEI emerging leaders fellowship, and Twitter, X, and Instagram communities.

During the Q&A, Dr. Tobón shared that to balance clinical and research duties effectively, it's crucial to seek support. Coordinating schedules and finding protected time is essential, given the significant time commitment of both work. Integrating tasks and avoiding taking on too many disparate projects helps maintain balance. Research can make a difference in advocacy, and advocacy efforts can influence policy at various levels, such as participating in advocacy days or consulting with legislators.

Pearls

1. Find your inner passion from personal and clinical experiences.
2. Advocacy can be learned by doing it, and research can make a difference in your way of advocating.
3. The path to health disparities research is not linear.
4. Mentorship makes an impact, and it is bidirectional.
5. Collaboration is key for good quality research.

Session 5: Safeguarding the mental health of diverse youth - linking research to policy and advocacy

In this session, two inspiring early career psychiatrists, Dr. Simon and Dr. Turban, shared how they transform their passion for diverse youth mental health into policy and advocacy through their research endeavors.

Session 5 Summary & Pearls

Dr. Kevin Simon shared his journey of intertwining his roles in research, policy, and clinical practice to address the social determinants of mental health in Boston. His involvement with the city and nonprofits to utilize ARPA funding for enhancing the Boston Police Department's approach to behavioral health stood out as a testament to his commitment to mental health equity. Dr. Simon emphasized the value of continual learning and the importance of diverse mentorship in pushing boundaries and expanding perspectives. He also emphasized that the identification of pertinent questions through observation of the world around him and the experiences of his patients is a key to generating impactful research. Finally, he discusses how actively engaging with multidisciplinary departments can broaden the discourse on mental health and support ally organizations in securing funding for diverse initiatives, thereby contributing to the expansion of the behavioral health workforce. As an additional advice, Dr. Simon recommended the book "Essentialism, the Pursuit of Less," to focus on impactful work.

Dr. Jack Turban shared his journey in researching trans youth mental health. He described his research journey as meandering, shaped by personal experiences of stigma, patients he met over the years, and chance opportunities. One meaningful mentor led him to explore research on transgender children, allowing him to discover his passion for child and adolescent psychiatry. He highlighted how his passion led to substantial contributions in the field, notably through his AACAP funding-supported work with large-scale surveys. Dr. Turban shared insights on the importance of educating the public through op-ed writing, and the significance of securing pilot awards and considering diverse methodologies in research. His advice on career trajectory and the impact of research reiterated the non-linear nature of career paths and the necessity of working on research questions driven by one's passion to sustain a research career.

During the Q&A, Dr. Simon highlighted the often-unspoken aspect of research that involves a significant amount of effort. He stressed the importance of deriving enjoyment from one's work, as this enthusiasm is crucial for sustaining research endeavors. When asked what advice they have for medical students, both Dr. Simon and Dr. Turban again emphasized the significance of pursuing one's passion and cautioned against taking on projects solely for resume enhancement. They underscored the value of being able to decline to participate in too many projects in order to focus on quality, which can greatly enhance the impact of one's work. Additionally, they encouraged students to believe in their work, even in the face of criticism. Finally, they emphasized the benefits of setting goals and creating an outline for one's own research before finding a mentor, which can help ensure that the research is personally meaningful.

Top 5 Pearls

1. Embrace Continual Learning: Maintain the mindset of a learner to truly understand and engage with patients. (Dr. Kevin Simon).
2. Diverse Mentorship: Seek mentors from various backgrounds to challenge and broaden your thinking (Dr. Kevin Simon).
3. Non-Linear Career Path: Embrace flexibility and don't stress over a fixed path (Dr. Jack Turban).
4. Impactful Research: Focus on research topics that feel important and meaningful to you (Dr. Jack Turban).
5. Research Dissemination: Learn to effectively communicate research to the public, to maximize the impact of your work (Dr. Jack Turban).

Session 4: A journey in infant psychiatry research, focusing on syndemic effects on Black families

In Session 4, Dr. Wanjiku Njoroge outlines her journey to becoming a robust clinician-scientist and leading expert in culturally informed approaches to the psychiatric assessment of young children and their families.

Session 4 Summary & Pearls

Dr. Wanjiku Njoroge outlined her journey to becoming a robust clinician-scientist and leading expert in culturally informed approaches to the psychiatric assessment of young children and their families. Her talk was divided into chapters of her career. She shared finding one experience fortuitously providing a springboard for the next throughout her journey.

She contributed to the mother-toddler dyad Strange Situation Study led by Dr. Mary Ainsworth in college, and continued this interest in medical school by starting a community-based participator research project with her peers, examining adolescent female understanding of reproductive health, and implemented an effective intervention to promote gynecological engagement. The experience was invaluable at teaching her how to run a research project from start to completion, including navigating logistical and bureaucratic challenges, and how persistence can lead to meaningful impact for the community, and bring great personal and professional gratification. As she furthered her training, especially with the in-depth exploration of the Clark doll studies, she grew determined to advocate a lens of cultural framework in the psychiatric assessment of young children, championing the theoretical framework of the effect of the COVID-19 and racism syndemic on the health and wellbeing of Black mothers and children. As a “mixed-methodologist,” she integrates quantitative and qualitative approaches in her work to identify factors contributing to mental health outcomes in marginalized population, in order to discover effective interventions that may improve their conditions.

During the Q&A, Dr. Njoroge was asked about the most optimal career trajectory to become an independent researcher. She noted that there is no singular ideal path to take, while praising the T32 Institutional Grant Program for giving her a solid foundation. Indeed, with her  passions in clinical practice, research, and policy with a broader lens of race and equity, it was unlikely that she could have foreseen her precise route.

Top 5 Pearls

1. Uncertainty in one's career trajectory is normal, and there are multiple ways to achieve one's end goals.
2. Trainees should embrace serendipitous experiences and feel supported to pursue diverse interests and across clinical practice, research, and policy.
3. Clinical research projects need not adhere to one method; mixed methods research involves the integration of quantitative and qualitative methods
4. It’s always the right time; it’s never too late to start a different path.
5. Make sure you have strong mentorship by building networks early -- AACAP is a great space for this.

Session 3: Developing Psychosis Interventions: A Black Perspective

Summary

Dr. Taylor aims to understand the biological mechanisms of psychotic disorders by studying the early stages of psychosis and the roles that oxidative stress, neuroinflammation, and sleep play in symptom progression. He hopes to uncover evidence-based treatment and interventions for psychotic disorders like schizophrenia in youth. His academic journey began at Chamblee High School in Atlanta, Georgia, a city known as the “Black Mecca” due to its significant African American cultural and historical presence. He completed his undergraduate education at Rice University and went on to study at the University of Virginia School of Medicine (2006-2011), where he took a gap year to engage in Applied Epidemiology Research at the Centers for Disease Control and Prevention. This year was pivotal, as he honed his skills in data analysis using SAS and writing research papers. During his residency training at the Yale Child Study Center, he received the AACAP Pilot Research Award. This served as a critical turning point in his career, as the award guided his interest in psychotic disorders and schizophrenia following a loved one’s struggle with schizophrenia and allowed him to channel his grief into a force for positive change. Today, Dr. Taylor leads the Psychosis Prevention Program at Children’s Hospital of Philadelphia, dedicating the majority of his time to researching the biological mechanisms of emerging psychosis. He also oversees the First Episode Psychosis “Coordinating Specialty Care” clinic, addressing the needs of teenagers with schizophrenia or bipolar I disorder in Montgomery County in Philadelphia.

Dr. Taylor shared that he does not have any quick tips to learn how to code - a method he utilizes in his research. He recommends taking a year (participating in a Master of Public Health program, a Master of Clinical Research program, T32 track during residency, etc.) to train and learn how to visualize data. He notes that it takes time to learn how to practice as a psychiatrist, and it will similarly take time to learn how to code and work with large sets of data. He also recommends the book Intuitive Biostatistics, which he found helpful while he was at the CDC. Dr. Taylor advises trainees to talk to mentors at their institutions who can help them, be proactive in seeking opportunities including the multiple awards and opportunities offered by AACAP and to utilize resources such as the NIH RePORTER for information on current research grants and projects. He also encourages trainees to bring their unique, much-needed perspectives into the field of child and adolescent psychiatry research to enrich the scientific and clinical landscape.

Dr. Taylor’s identity as a gay African American male and his upbringing in Atlanta have deeply influenced his approach to research and patient care. He highlights the importance of diversity in psychiatric research. He explains how personal and cultural backgrounds can enrich research and patient care to provide perspectives that might otherwise be overlooked. He advocates for the inclusion of diverse populations in research – not only as subjects but as active contributors to the scientific conversation. Emphasizing cultural humility, Dr. Taylor creates safe spaces for African American and LGBTQIA+ patients by honoring the intersectionality of his identity and openly displaying his commitment to an inclusive and welcoming environment. Dr. Taylor also recognizes his role as a community member, addressing the socioeconomic challenges facing the African American community. He views his work as a way of giving back, leveraging his professional skills and personal understanding to make a meaningful difference.

Pearls

• Note the AACAP awards deadlines in advance
• Utilize NIH RePORTER to look up grants
• Folks from diverse backgrounds offer invaluable perspectives
• Establish a bidirectional relationship with minoritized research participants
• Find mentors with shared goals

Session 2: AACAP Research Awardees

In this session, AACAP Research Awardees Drs. Aloi, Brown, and Velez answers questions from trainees about various aspects of starting a research project, including identifying mentors and opportunities, and sustaining a project through completion while balancing other responsibilities.

Session 2 Summary & Pearls

Q: How did you hear about the AACAP awards?
Dr. Aloi: Through a mentor involved with AACAP. I check the AACAP website for anything that might be a good fit.
Dr. Brown: Sharing interests with mentors can allow them to share valuable opportunities. I check the AACAP website; even if you miss a deadline, you can plan ahead for the next award cycle! Network with other researchers and ask about grants or awards they have applied to.
Dr. Velez: Be curious about the different things that AACAP has to offer. I carefully read the e-mails from AACAP for anything of interest.

Q: Tips for finding or connecting with mentors?
Dr. Aloi: My mentor helped connect me with other institutions. Reach out to potential mentors; they are usually open to connections.
Dr. Brown: Put yourself out there. Remember that even if you haven’t done research in the traditional sense, you have skills that can be an asset— being organized, creative, or a good writer can be valuable in a research setting. Express interest; people are open to talking about their research and love to do so! Talk about what you are hoping to build rather than what you have done if you have limited research experience.
Dr. Velez: Engage with organized psychiatry through AACAP and fellowship committees. Networking and creating connections can be important for success in research and personal growth.

Q: For fellows that have fast-tracked into child and adolescent psychiatry, when/how did you get involved with research?
Dr. Brown: Reach out to CAP department members early on. Collaborate with mentors outside of psychiatry. Attend interesting research talks and reach out to speakers.
Dr. Velez: I completed my residency at Boston Medical Center and fast-tracked into CAP. I applied for two grants in my intern year and connected with experienced mentors. Use the resources available to you. Don’t be afraid to take the lead even if you’re early on in training.

Q: What barriers have you encountered when researching specific demographics (i.e. immigrants)? How did you overcome those barriers?
Dr. Aloi: I conducted research at the residential treatment facility for youth with disruptive behavior disorders, so I recruited participants through proximity. Work with people who are connected to the community. You can find data pertaining to populations of interest through the National Institute of Mental Health data archive.
Dr. Brown: Find people with experience and existing connections through community partnerships. Read papers about the population of interest; you can shape your project based on strategies from the literature.
Dr. Velez: My work involves undocumented immigrant children. It was important to be creative and to have the right mentors, as my priority was making the children feel as safe as possible. My mentor helped me anticipate challenges that I might not have foreseen. Throughout the course of the project, you get a better idea of how to approach potential issues in the future. I believe in co-creation of research. It is important to give information obtained from the community, back to the community.

Q: How do you divide the time between clinical duties and research?
Dr. Aloi: I had dedicated research time, and I set aside time for clinical duties.
Dr. Brown: Some residency programs will offer a research track with protected research time. You can also take research electives. I found it helpful to plan out tasks ahead of time by breaking it down into smaller, achievable tasks. I scheduled breaks intentionally.
Dr. Velez: I didn’t have time for research during residency. Or fellowship. I’ve learned from mentors to plan tasks ahead of time and balance priorities. I maximize down-time at work while protecting weekend time, and I learned to practice self-care to be able to put energy toward areas of passion.

Q: Advice for someone new to research?
Dr. Aloi: Take new ideas and run with them. Even the most successful researchers have failed – “failure CVs” highlight what they were rejected from more than they were accepted. Rejection is normal; don’t get discouraged by it.
Dr. Brown: Research is about not knowing everything, and it’s okay. You have to get comfortable with failure and not understanding things. This is part of the process. Don’t get discouraged by failure; failures are learning moments that lead you to the right path. Be persistent and learn from your mistakes. I applied for 6 grants in the last 2 years and received 2. If you don’t apply, you definitely won’t get the grant, so put yourself out there!
Dr. Velez: Ask for help from people. Learning is a continuous process without a goal. You have an idea, which is the most important thing. Be curious. Curiosity will enable you to excel and truly enjoy research.

Top 5 Pearls

1. Collaboration, mentorship, and research are important for personal growth.
2. Be intentional when balancing research with clinical duties.
3. Get comfortable with failure. It is part of the process.
4. Put yourself out there.
5. Let your curiosity guide you.

Session 1: Journey in academic medicine: From health services to community partnered research for advancing mental health equity (Dr. Lisa Fortuna)

In this inaugural session, Dr. Fortuna shares her research journey, and discusses the importance of health services and community-partnered research for advancing mental health equity in marginalized populations.

Session 1 Summary & Pearls

During the Q&A for the inaugural How to Do CAP Research Workshop Series, Dr, Lisa Fortuna addressed a variety of topics during her presentation and the Q&A session. Her presentation focused on how mentorship helped her launch her research career and how she developed her niche in child and adolescent psychiatry research. During the Q&A session, attendees asked about how to determine their own research passion. Dr. Fortuna suggested attendees think about what their passion is and, even if it is broad, think about ways to distill that question into research questions — this is one way in which mentorship and formal research training can assist in one’s success as a researcher. Another attendee asked about finding financial support for underfunded or underprioritized research. For this, Dr. Fortuna recommended looking into other foundations, such as the Robert Wood Johnson Foundation, which can provide grants to such projects. In addition, she recommended early-career awards such as the NIH K awards and pilot awards as well as the many AACAP research fellowships.

With her focus on working with minority populations and their community organizations, Dr. Fortuna answered an attendee’s question regarding barriers to research in the Latinx youth and child population. She explained that the most important goal must be to gain trust in the community by providing help, support, and service. This must be done by engaging parents and youth in the research being conducted so that they understand what it means for them to be participating. Another attendee asked about obtaining consent from LGBTQ+ youth in the current turbulent times. Dr. Fortuna emphasized how this is currently impacting her current work with her 4 Youth by Youth project. She suggested obtaining IRB consent waivers in order to waive parental consent so that participating would not be a risk for youth.

Top 5 Pearls

1. Seek mentorship and professional development opportunities.
2. Persist: review, revise, resubmit, repeat.
3. Obtain formal research training, work with a senior researcher, or pursue advanced education. Gain experience in different areas of clinical research.
4. Take opportunities to be a reviewer to see what it’s like on the other side. Also just say yes to opportunities in general.
5. Network, network, network. Connections are vital.