Stephanie Garcia, MPH, a research coordinator with VPI at CHOP.
A note from Rachel K. Myers, PhD: COVID-19 caused us to reflect and learn about how to approach research in ways that enhance equity, access, and maintain engagement and outreach with our community members.
Today we are pleased to welcome a guest blog post from Stephanie Garcia, MPH, a research coordinator with the Violence Prevention Initiative (VPI) and a research associate with PolicyLab at Children’s Hospital of Philadelphia (CHOP).
The COVID-19 pandemic has changed the way we think about nearly everything. As researchers, the last several months have forced us to pause, reflect, and pivot previously established best practices to chart a new course forward.
In my role with VPI, I coordinate the overall administration of the Addressing Community Violence-Related Traumatic Stress in Children Study, which aims to evaluate the effectiveness of a parent-child therapy – Child and Family Traumatic Stress Intervention (CFTSI) – provided soon after a violent, traumatic event, in reducing posttraumatic stress symptoms among assault-injured youth.
For the study, youth-caregiver pairs enrolled in the study receive either CFTSI plus community-focused case management services provided by CHOP’s Violence Intervention Program (VIP) or case management services alone. Integration with the VIP clinical team, from the time youth are screened following an assault-related injury to study closeout 10 months post-injury, has been a key driver of successful participant retention.
Adjusting Research Procedures
In response to the COVID-19 outbreak and pausing all in-person contact, we adjusted our research procedures in various ways, including:
- Virtual follow-up study visits. For families enrolled in the study, we amended our research protocol and transitioned to a fully-virtual process for administering follow-up research measures at 4- and 10-months post enrollment. Since March 2020, we have conducted follow-up measures via video or phone with over 10 youth-caregiver pairs. Impressively, we have maintained 100% completion for all families scheduled to complete measures during this time.
- Provision of video-based mental health treatment. The onset of COVID-19 and restrictions on in-person mental health services represented a potential disruption in treatment for families receiving CFTSI to address posttraumatic stress symptoms in the wake of a violent injury. It was critically important for us to pivot our intervention delivery to a telehealth platform. While we obtained the necessary IRB approval for this study modification, our CFTSI clinicians also led efforts to navigate this new treatment modality and ensure the continuity of care.
- Virtual study enrollment visits. Prior to the pandemic, we conducted all study intake visits in collaboration with a member of the VIP clinical team, to ensure that all necessary information related to both research and enrollment in the VIP program were obtained. At the start of the pandemic, we paused our research enrollment efforts to focus on administering virtual follow-up visits and the intervention for families already enrolled and randomized to receive the study treatment. We recently received approval to enroll new study participants through fully-virtual procedures. As of last week, we successfully completed virtual-enrollment with our first new participant in three months. We look forward to continuing to applyi what we’ve learned to build rapport and alleviate any logistical burdens for newly enrolled families.
Tips for Modifying Research Procedures
Reflecting back on the past three months, we have three primary recommendations when adjusting your research program and procedures to safely maintain research activities during the pandemic:
- Think creatively and don’t underestimate the resourcefulness of your study participants. Early conversations to determine technology-based research operations were filled with hesitancy; we didn’t want to pursue an approach that might create additional barriers to study participation. We recognized that families in our study, a majority of whom reside in under-resourced Philadelphia communities, may face accessibility challenges related to internet connectivity and a reliance on smartphones, rather than a traditional home computers. Over the past three months, we’ve learned that families are willing to navigate virtual study visits and intervention delivery. We completed virtual study visits with families using WebEx by computer or phone, phone call, or a combination of methods.
- Research activities may provide structure and human connection during uncertain times. We were also hesitant to pursue modified research activities that might feel inappropriate given the acute clinical and economic effects of the pandemic in our community. Once initiated, our engagement efforts were met by an exceptional willingness from families to talk with us. We’ve heard that families welcomed the structure of a scheduled “meeting” on their calendar, something for their children to do besides schoolwork and video games, and that our visits provided connection with people outside of their homes.
- Start with small changes and plan for sustainability. Prior to COVID-19, our research team worked hand-in-hand with our VIP clinical team to fully integrate our research and clinical efforts. Therefore, we recognized early on the need to modify what we could for research, such as pausing new enrollments and allowing time for VIP clinicians to focus on shifting to virtual case management. By starting with smaller-scale modifications, we are now able to harness the efficiencies and troubleshooting techniques learned over the past three months and resume study enrollments (virtually) in collaboration with VIP.
The COVID-19 pandemic will have a long lasting impact on the way society functions, and research is no exception. Now more than ever, the research community has an opportunity to address equity issues, leverage technology, and test new communication strategies that may uncover efficiencies to use now and in a post-pandemic era. For our team, one “silver lining” of this pandemic is learning new ways to engage with research participants that reduce barriers to participation (e.g., transportation and in-person visits), which we plan to continue to utilize in the future.
Stay tuned for a future blog on VIP’s switch to virtual case management during the pandemic and the lessons the clinical team has learned during the transition.
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