Ernst P. Larson Professor of Health, Poverty and Ethnicity,
University of Southern California School of Social Work
Hallmarks of Dr. Ell’s career are her significant creativity, testing and subsequent impact in activating new integrated patient-centered behavioral and medical care models and her outstanding record of creating interdisciplinary health research. Her nationally and internationally recognized research has addressed two overarching scientific questions: 1) how is the mind and body linked in acute, chronic and life-threatening illness, quality of life and mortality; and 2) how can access to health care, patient self-care and treatment activation and adherence, and health outcomes be improved.
Her studies have focused on cancer patient screening and navigation of multiple medical providers among low-income ethnic minority women; the detection and integrated treatment of depression among older adults receiving home health care services within highly diverse community care systems; improving access and adherence to cancer treatment for low-income Latinas; trans-disciplinary collaborative team care to detect and treat depression among low-income minority patients with cancer or diabetes (the first large scale trials with public safety net patients); and a patient navigation intervention to improve access and adherence to cancer treatment among low-income minority women. Each of these studies are aimed at testing health care interventions within “real world” care systems that have been actively partnered across discipline researchers, care providers, and organizational systems, most frequently the Los Angeles County Department of Health Services, the second largest US safety net care system.
Over the past 18 years, she has received over $17 million in federal funding. Dr. Ell’s research confirms that patient self-care management and treatment adherence are influenced by individual choice, cultural beliefs, stigma concerns, practical barriers and physical health in combination with contextual supports and barriers. Generally, low-income patients have fewer resources to support self-care management and psychosocial treatment participation (e.g., missed work time, transportation clinic and child care costs), plus language/literacy barriers in communication with providers. Culturally-normative patterns of physical and psychological symptom definition, response, and help-seeking are critical antecedents of self-management behavior and care utilization, but are not independent of powerful environmental and care provider/system factors. For example, among Hispanics, depression treatment is more effective if aligned with recognition of contextual stress-related needs and cultural values. Thus, she provides patients literacy, educationally, and culturally adapted materials such a comic fotonovelas.
Dr. Ell has 97 publications, including two books, and has conducted numerous national meeting presentations. Her intervention models include a package of intervention protocols, training materials, cultural competency materials, and organizational manuals.
Questions & Answers
Adaptations could be made in line with diverse populations needs.
Yes. The specific audiences include the following: Oncologists, Nurse Practitioners, Registered Nurses, Psychiatrists, Community Health Worker Programs, Affordable Care Act and Patient-Centered Medical Homes.
No, assuming relevant adaptations are made. For example, palliative care patients and their family members and providers will need specific additional palliative care adaptations.
Bilingual providers if the targeted population prefers/needs the native language and literacy consideration.
a) Focus on methods/technologies to activate communication across team providers.
b) Ensure that depressed patients receive post-acute ongoing depression monitoring as recurrence/worsening symptoms is not rare, and needs to be identified and acted on by providers.
The specific evaluation tools that would be appropriate for practitioners when they evaluate this program are provided on the RTIPs website.
We completed a study of 1406 diabetes patients in a large safety net care system in which 30% had clinically significant depression at baseline. This study aimed at testing automated depression symptom monitoring telephone calls and the application of technology facilitated multiple team provider communication. We also conducted a PCORI funded randomized clinical trial of safety net care patients with clinically significant depression and concurrent illness, including diabetes, coronary heart disease and heart failure. In the intervention group, bilingual community health worker promotoras provide: a) assistance in patient self-care management of depression and concurrent illness, and b) refer patients to clinic physicians, nurse practitioners and social workers when need indicated.