Sunday, May 19, 2024

A community worker in The Family Van, a mobile help center serving Boston that uses the Problem Management Plus system. (Photo: The Family Van via Facebook)

Cambridge’s anti-poverty agency, the Cambridge Economic Opportunity Committee, will try to fill a void in mental health services here – in wealthy Cambridge – with a program developed to help people in places such as South America and Africa who are in psychological distress because of war, poverty, violence and other serious adversity and have few mental health resources.

The program, called Problem Management Plus, was designed by the World Health Organization to help people in low- and moderate-income countries cope with psychological hardship stemming from the difficulties in their lives and is not meant to treat people with serious mental illness or imminent plans of suicide. It uses trained community residents, not professionals, to deliver short-term services, though workers may refer clients to professional help if they need it. Studies have shown it reduces anxiety, depression and other signs of emotional distress.

CEOC is one of five community groups in Massachusetts awarded grants by the Blue Cross Blue Shield Massachusetts Foundation to try out the program. Partners in Health, the Boston-based organization that provides medical care in impoverished areas abroad, has employed versions of Problem Management Plus in Peru, Rwanda, Mexico and Malawi since 2016 and will provide technical help to the five organizations. The Family Van, a mobile health clinic operating in low-income neighborhoods in Boston, was one of the earliest agencies to adopt the program, in 2021, with the aid of another grant from the foundation.

Cambridge Economic Opportunity Committee executive director Tina Alu said the organization held “listening sessions” with employees about clients’ needs last year and “the issue of mental health came up a lot.” Staff had been advocating for mental health services “for at least a year,” she said.

Cambridge Economic Opportunity Committee executive director Tina Alu. (Photo: CEOC)

“We know that poverty is a huge life stressor – we hear it every day from the clients who walk through our door. To be able to now provide mental health services for these clients who struggle with their mental health and stress management will be life-changing,” Alu said in a statement announcing the grant. CEOC serves low-wage earners, people with limited English, subsidized housing residents, disabled people and those over 65.

One staff member, community advocate and educator Yemi Kibret, was quoted in the announcement as saying cost and stigma prevent people in the communities that CEOC serves from seeking help for mental health problems. “Many of my clients tell me about their mental health struggles; they trust me and they don’t know where else to turn,” she said.

CEOC is getting $100,000 to plan a program and is eligible for two more years of $150,000 awards to carry it out, Alu said. The agency plans to train three non-clinical employees to help clients. It will get clinical supervision and guidance from De Novo, the Cambridge nonprofit that provides integrated legal and mental health services.

Training for community workers

The model developed by WHO involves five highly structured sessions of 90 minutes each in which trained community workers listen carefully to clients and work with them to reduce “impairment” resulting from their distress. The “helpers,” as they are called in a training manual, together with clients, may tackle practical problems such as unemployment and psychological problems such as depression.

Helpers “teach” clients how to reduce stress with breathing exercises and promote a strategy called “Get Going, Keep Doing” that urges clients to improve their “level of activity” socially and in work to combat depression.

The community workers are urged not to give advice and to respect clients’ choices. They get support from peers who have been trained in supervision.

Answering a behavioral health crisis

WHO said it developed Program Management Plus as a “low-intensity intervention” because millions of people in the world “live in extremely difficult circumstances and suffer emotionally” where more intensive therapeutic supports “are rarely available to those who need them.”

Similarly, Jacquie Anderson, senior director of grants making for the Blue Cross Blue Shield Foundation, said that “given the state of the behavioral health crisis in Massachusetts” the foundation was searching for a community-based way to provide help. The Family Van was also “looking at lots of different models” and in consultation with Partners in Health applied for a grant under the foundation’s special initiatives program in 2021, Anderson said.

Adopting a program built for needy populations abroad is unusual, she said. “Usually you have us as the U.S. exporting our model overseas,” Anderson said. She said the foundation does not consider Program Management Plus a “Band-Aid” that gives less valuable behavioral health services to marginalized communities. “We certainly think about that,” Anderson said. “We do not believe it’s a Band-Aid. Many people have anxiety. They don’t necessarily need a therapist, they need someone to talk to.” And many in the populations that the program targets “don’t want therapy,” she said.

The program also has value because it trains community members to give effective help to clients in psychological distress, something organizations have asked for from the foundation, Anderson said.

Rare U.S. offering

A group passes by Cambridge Economic Opportunity Committee headquarters near Central Square. (Photo: Marc Levy)

The grants to CEOC and the other four community groups may be only the fourth instance of Problem Management Plus in the United States; Anderson said the foundation knows of programs in New York City, Florida and the Family Van adaptation in Boston.

A researcher at the University of Massachusetts at Amherst studied a version of the WHO program as a resource for Bhutanese immigrants, according to a listing on the government’s research site, ClinicalTrials.gov. The study was to enroll 232 people from 116 families, with half getting services under the WHO program and half getting a pamphlet listing mental health and wellness services in their community. Many Bhutanese immigrants have settled in Central Massachusetts.

Anderson said the experiment used a model that’s somewhat different from the WHO program. The foundation gave a grant last year to expand the program to Ukrainian and Afghan refugees, she said. The $50,000 grant went to the university in collaboration with Ascentria Care Alliance in West Springfield and targets refugees resettled in Hampden County, according to the foundation’s website. The listing doesn’t mention Program Management Plus but says the grant will support “an evidence-based intervention to reduce stress, anxiety and depressive symptoms and improve coping skills, self-efficacy, social support and family well-being.”


This post was updated March 10, 2023, to correct a potential award figure.