Haack among GloCal fellows getting into the trenches for global health research

By Andy Evangelista  |  Based on an article originally published by the UC Global Health Institute

They are bright and creative investigators, highly committed to improving world health, but what makes some UCGHI GloCal Health fellows special is their street smarts and ability to get into tough communities and engage the people hardest hit by physical and social ills.

Since 2012, the UCGHI GloCal Health Fellowship program has placed and trained 71 young researchers in Africa, Asia and Latin America to tackle a wide range of public health issues – from HIV, malaria and diabetes to water contamination, family planning and mental health. Another 12 began their international research in July. The fellowships are sponsored by the Fogarty International Center, which is part of the National Institutes of Health.

Fellows from UC campuses and affiliated countries spend nearly a year with UC research partners in low- and middle-income countries. “Among the goals of the program is to strengthen global health networks and build countries’ capacity to tackle their most pressing health issues,” said Craig Cohen, MD, MPH, co-director of UCGHI and director of the GloCal Health Fellowship program.

But the research is “borderless,” said Cohen. Lessons learned – and solutions found – in one country, certainly can apply in many others, including the United States.

In Culiacán, Mexico, the largest city and capital of the northwestern state of Sinaloa, 2016-17 GloCal Health Fellow Lauren Haack, PhD, worked with educators and parents of children with attention and behavioral concerns. The country has one of the highest school dropout rates in the world, and Haack piloted an intervention program so that youth with mental health issues linked to attention deficit hyperactivity/impulsivity disorder (ADHD) are understood, helped, and not shunned.

Paying attention to more than the kids

School-aged children with ADHD exhibit a range of symptoms and behaviors that could turn into serious academic and social impairments at school, home and other settings. As they grow older, studies show, they are at higher risk for school failure, early drop-out, and juvenile delinquency.

Lauren Haack offers a model for helping kids with ADHD: treat their parents, caregivers, and teachers.

As a 2016 GloCal fellow, she piloted a culturally sensitive school-home program for Mexican kids with attention and behavior issues. ADHD affects some 5 to 10 percent of children worldwide. Latino youth, said Haack, are especially hard hit by mental health disparities from poor identification of the condition and lack of services for kids. In Mexico, the school dropout rate in some areas is as high as 50 percent.

Lauren Haack with a dog puppet on her hand

Lauren Haack, PhD, uses Francisco Fresco, a program puppet, to train school personnel in how to model skills for students.  [Photo courtesy UCGHI]

Often, parents of kids with ADHD become frustrated and exhibit negative and ineffective parenting, and conflict between kids and parents runs high. In school, students with ADHD can be inattentive, disorganized, or disruptive, and teachers and administrators may punish rather than manage them.

Haack’s program recruited 32 students in first through fifth grades, along with family members and school personnel in a six-week program. Behavior management efforts were based on a Collaborative Life Skills (CLS) program, developed by her mentor, Linda Pfiffner, PhD, UCSF professor of psychiatry.

Educational videos were shown to parents and teachers, and after viewing, some said “that’s my child and me,” and volunteered for the study, said Haack. The program included student, teacher, and parent skills-building and integrated behavioral programs in the classroom, on the playground and at home.

Parents, for example, learned “positive strategies,” including praise and rewards for completing chores and homework. Teachers used individually designed “daily report cards,” to target and manage behaviors such as turning in homework, following directions, and getting along with others.

In the end, “the outcomes and improvements were significant,” said Haack, who was just recently appointed as an assistant clinical professor of psychiatry at UCSF.

Her co-researchers in Mexico will continue the efforts. “It’s about capacity building," she explained. "Once you train someone, you can replicate, again, and again.”

In San Francisco, Haack and Pfiffner are implementing and studying the CLS program in schools with large numbers of Spanish-speaking children.

She likens the collaborative behavior management approach to making a cake. “Instead of the eggs, sugar and flour, you have kids, parents and teachers,” she said. “Mix them all together and you get something magical.”

Like much of global health research, the sum is greater than the parts.

About UCSF Psychiatry

The UCSF Department of Psychiatry and the Langley Porter Psychiatric Institute are among the nation's foremost resources in the fields of child, adolescent, adult, and geriatric mental health. Together they constitute one of the largest departments in the UCSF School of Medicine and the UCSF Weill Institute for Neurosciences, with a mission focused on research (basic, translational, clinical), teaching, patient care and public service.

UCSF Psychiatry conducts its clinical, educational and research efforts at a variety of locations in Northern California, including UCSF campuses at Parnassus Heights, Mission Bay and Laurel Heights, UCSF Medical Center, UCSF Benioff Children's Hospitals, Zuckerberg San Francisco General Hospital and Trauma Center, the San Francisco VA Health Care System and UCSF Fresno.

About the UCSF Weill Institute for Neurosciences

The UCSF Weill Institute for Neurosciences, established by the extraordinary generosity of Joan and Sanford I. "Sandy" Weill, brings together world-class researchers with top-ranked physicians to solve some of the most complex challenges in the human brain.

The UCSF Weill Institute leverages UCSF’s unrivaled bench-to-bedside excellence in the neurosciences. It unites three UCSF departments—Neurology, Psychiatry, and Neurological Surgery—that are highly esteemed for both patient care and research, as well as the Neuroscience Graduate Program, a cross-disciplinary alliance of nearly 100 UCSF faculty members from 15 basic-science departments, as well as the UCSF Institute for Neurodegenerative Diseases, a multidisciplinary research center focused on finding effective treatments for Alzheimer’s disease, frontotemporal dementia, Parkinson’s disease, and other neurodegenerative disorders.

About UCSF

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises top-ranked hospitals – UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland – and other partner and affiliated hospitals and healthcare providers throughout the Bay Area.