[BELLS CHIMING] SPEAKER 1: This is a production of Cornell University.
SPEAKER 2: In a September 2012 book talk at Mann Library, Cornell College of Human Ecology professors Elaine Wethington and Rachel Dunifon discuss their new publication, Research for the Public Good, Applying Methods of Translational Research to Improve Human Health and Well-being. Helping to bridge the gaps among research, policy, and practice, the book demonstrates how the emerging methods of translational research can help us develop programs and policies that improve human health and well-being.
This broader more inclusive approach to translational research has gained popularity and is now being promoted by the National Institutes of Health, the Centers for Disease Control, medical centers, and university programs across the United States.
ELAINE WETHINGTON: Thank you for that very warm welcome. And thank you all for coming. This is a tremendous turnout. Rachel has been sitting next to me, I just want you to know her face before she comes up and start talking. We're going to share this presentation, I'm going to start, Rachel's going to spell me, and then I will finish it up.
Start at the beginning, which is the question I always get, what is translational research? And specifically, people want to know how is translational research different from any other type of research? And the answer to that question is obviously not obvious.
In our book, we started with a definition that was really quite broad, and we continued to broaden it as we developed the book. Translational research is a two-way street. And there are three components to translational research that are important.
The first piece is that it links theoretically driven basic research to understanding how to implement interventions, programs, or policies that are intended to improve human health and well-being. It's about theory, and it's about implementation, and it's about practical results.
Translational research also includes the evaluation of interventions and policies for their efficacy and effectiveness. This is, as you know, those of you who have a background in social science, know that efficacy and effectiveness studies are well-established in the scientific literature.
They are not as well-established in social and behavioral research as they are in biomedical research. However, one of the great strengths and opportunities of bringing translational research into the social and behavioral sciences is to explore and to promote the use of efficacy and effectiveness trials in social and behavioral research as part of our evaluation strategies.
And the third piece of translational research is this two-way street part. That is, in fact, rather unique to it, that once you've done your field study, you bring experience back to the field to further develop basic theory and future applications. The two-way street.
The third part is what's considered to be the most innovative in the developing definition of translational research. Our book, it is indeed very yellow. It was published by the American Psychological Association in 2012, we involved 24 different authors in this book. And it was part of a series honoring the legacy of Urie Bronfenbrenner.
Urie practiced translational research before the term was invented. I got the idea for this book when the executive committee of the old Bronfenbrenner Life Course Center met to talk about what the next topic would be for the biennial Urie Bronfenbrenner Conference.
I had taken part with Urie and other researchers in my department on a book called Improving the State of Americans, or rather, The State of Americans. And I coined the term Improving the State of Americans, Prospects of Translational Research in the Social and Behavioral Sciences.
We were funded, as you see, by a number of entities here on campus. I say that Urie did translational research before the term was coined, because he was a researcher in basic developmental psychology, a long-term faculty member of the Department of Human Development, and the Department of Psychology, and he strongly believed that research could be used to improve the lives of Americans.
His research was used in the establishment of Head Start, and through his students, has influenced, very strongly, the development of translational research in the social and behavioral sciences. We had several of them as participants in the book and in the conference.
The book is organized into an introductory chapter on the history and forms of translational research that involve the social and behavioral sciences. It is an attempt to take the term out if its current biomedical identification, and to show how the social and behavioral sciences can intimately involved in promoting translation of basic research to the community and to health.
We have a section also on opportunities and challenges, where, for researchers, we summarized federal funding initiatives extant up to that period of time. The models that are being used to help researchers and people in the field interact with one another effectively, to design translational research projects, a chapter on what training challenges have been and continue to be for researchers who are interested in translational research.
Nobody taught me this in graduate school. Still, nobody teaches you this in graduate school. This is something new, OK. And also, just the general challenges of adapting theory into practice. And then-- and this is my favorite part of the book-- we began collecting from other researchers, pledges that they would write case studies of how they've developed translational research in action through their own research.
And one of the challenges in putting this part of the book together was that I found someone who I thought was doing excellent research translation involving the social and behavioral sciences, and they would argue with me, no, I'm not doing translational research. That's biomedical.
I'm not-- my research does not count. So quite a few people had to be talked in to actually participating in the book, and thinking through the ways in which their research could contribute to a social and behavioral science translation initiative in the social sciences.
There were four case studies in the book, and a mixed-methods evaluation of Head Start. A really interesting researcher-industry collaboration between faculty members in the Penn State Hotel School, and their School of Human Development and Health, and several hotel chains on ways to manage stress among hotel employees and managers.
Which the interesting sidelight on this is, now the industry is funding the research that came out of this initial project, which was funded by the National Institutes of Health. It's a success to have one's research translation then funded by the very group you're trying to assist. It means it has been useful has been successfully translated.
We also had a chapter on a real success story in research translation involving the field of psychology, how research on memory has been translated into legal and police practice throughout the United States and Europe. A number of researchers have been engaged in that.
And finally, a chapter on the Cornell Institute for Translational Research on Aging, and social integration, CITRA, which is one of the groups that is the basis for our work groups now, in the Bronfenbrenner Center for Translational Research. And so you know who we are, and where they came from, these are our contributors. We involved researchers inside and outside Cornell, representatives from federal funding agencies and health agencies, and as well as faculty and students and researchers from Weill Cornell Medical College.
We think that three key themes emerged from our book. The first of these themes is how important it is in the field of translational research to develop that two-way street. Researchers and consumers of the research have to interact in ways in which they can inform each other, either in a relationship that you call equal, or perhaps equitable.
Not necessarily so much equal, as both the researchers and the consumers of the research, from the community, feel that they are getting something equitable out of this arrangement, and that their voices are heard. And a major message from each of the case studies is just how important it was to have sought the input of community members, practitioners, policymakers, everyone else who's going to be involved in the development, or in the outcome, from the very beginning, in even the most basic sorts of ideas for research design.
And such collaboration-- as I will describe later in one of our case studies we're going to present to you-- such collaboration guarantees that you can go back to that same group of people, be welcomed, and continue in your research association, and continue to develop additional research projects based on that relationship. It's a two way street and it's about relationship building.
The second theme is-- and I've alluded to this already, a bit-- is that there are a number of barriers that social scientists feel for getting involved in translational research. And the major barrier is, as I described it, their belief that they're not doing research translation, because this is biomedical. This is all about developing drugs to treat various sorts of diseases.
And, in fact, my family members who work for Eli Lilly would tell you that's exactly what translational research is. And if you go to the literature on translational research, if you go to the indexes of what translational research is in the published literature, you find that translational research is dominated by pharmaceutical applications, OK, cures for diseases.
A second barrier is that social scientists feel that they do not have the type of training that it takes to be involved in translational research. This goes beyond just the idea that, this is not biomedical, or I'm not doing drug studies, this is, I don't know how to interact with the community.
I don't know how to go out and get a community partner. I don't know how to keep this relationship going. I'm too busy. How do I offer anything of value to them before a study is conducted? How do I convince them that this research project, that I'm proposing that they partner in, was actually going to give them benefit?
It's a huge theme, and one that recurs over and over in our book. But another theme, and ones that we were very happy to showcase in the book, is that there are also out there, we found, a number of other movements in research and in funding priorities by the federal government that are actually now facilitating translational research.
Underpinning all of this, is that there is a very large federal funding initiative housed in the National Institutes of Health and the Centers for Disease Control, primarily, but also it has been integrated into the National Science Foundation.
Parallel to these federal funding initiatives, trying to promote researchers to get together and work in the sort of teams that can conduct research translation, is new developments in methods in the social and behavioral sciences to structure, to standardize, and to make more scientifically-- I'm not going to say scientifically valid, I'm going to say scientifically acceptable. Recognizable to people trained in the scientific methods, mixed-methods that involve qualitative research and evaluation.
These are now recognized in most of the social sciences as making an important contribution, even in developing experimental studies. Also a facilitator for a translational research-- and the federal funding initiatives have a lot to do with this-- is the promotion of collaboration of researchers from different disciplines.
We, here at Cornell, are sort of unique in that we have, on the contract side, a number of multi-disciplinary departments. We structure interdisciplinary interaction into our department life and into the development of research and training for our graduate students.
But most universities don't have such structured means of bringing researchers from different disciplines together. But it's clear that bringing researchers together from different disciplines is a fundamental for translational research because of what you have to do. And finally, a facilitator is an established university community connection that engages the public.
And we here at Cornell are fortunate to have Cooperative Extension, and, in fact, you find that many of the well-developed translational research projects in the United States, now involving social scientists, are working through Cooperative Extension, or through either established Cooperative Extension, or Cooperative Extension-like communication structures. And dissemination structures at their universities.
In fact, something like Cooperative Extension had to be developed at many medical centers in order to develop translational research centers. Now how did translational research develop? Maybe I got a little bit ahead of the audience here.
But think about, well, one of the things that we've done-- well, one of the things that we did in describing what translational research is and developing a unique social and behavioral science definition, is that we went back to what had been identified as the beginnings of translational research. Translational research just wasn't invented in the year 2000.
It was actually developed gradually, through researchers at the National Institutes of Health and the Centers for Disease Control, who were engaged in the war on cancer in 1970s. You can see the roots of the biomedical translational research movement going back to the Nixon administration. The involvement of communities of people who had the disease getting involved in the research priorities.
And HIV prevention initiatives in the 1980s and 1990s were informed by a consumer driven perspective on where the research should go, how quickly the research should move, and what the targets of interventions should be. And the specific diseases and behaviors that should be targeted.
Now what's interesting about this, in the subsequent establishment of translational research as a research initiative in the National Institutes of Health, is that in the 1970s, '80s and '90s, social and behavioral scientists were explicitly engaged in translational research, particularly cancer researchers, they were invited in into research on HIV prevention.
They were invited into research on aging. Mental health services, at the National Institutes of Health. They were there, they were already embedded there. Nevertheless-- and this is where the confusion about translational research being entirely biomedical comes from-- when former NIH director, Elias Zerhouni, transformed the research priorities of NIH after the year 2000 in the NIH roadmap. He did not mention social and behavioral sciences.
He defined the priorities of the National Institutes of Health as basically biomedical. He divided translation research into two pieces. The first, which is called T1, is the use of basic biomedical discoveries to create new evidence-based clinical applications and treatments. OK, these are the drug studies. Let's discover the drugs.
And then, translation 2, which is the research that was intended to bring these discoveries more quickly into the improvement of people's health, into treatments and to improve public health. Research intended to speed up the application of new evidence-based treatments, and applying them to public health, which always tends to have a rather large lag.
It's also interesting that after Zerhouni published his first paper on the NIH roadmap in 2003, an Institute of Medicine panel that he helped found added social science, almost immediately, into the biomedical model, as a target, or as a method for speeding up the translation of research into public health.
In 2003, this panel explicitly said that it would be very important to understand medical decision-making, how patients make decisions, and how physicians make decisions to give certain types of treatments to certain types of patients.
In the year 2000, and another physician researcher argued that the ultimate outcome should be public health improvement, and the narrowing of health disparities in the United States. And said that all of these things, these sorts of activities involve not medical research, but what social and behavioral scientists could do.
The same 2007 message was repeated on panel after panel, even panels doing research on genetic research. Like, we don't understand why-- we have to understand how people will understand this genetic information we give them.
How will people use genetic medicine? What will the impact on public health actually be? How do we diffuse knowledge across complex systems? How do we implement interventions successfully? And how do we get the public to understand what this research is about?
In our book, we were much influenced by an article that was published in 2011, by Drolet and Lorenzi, once again for another group-- another panel that was impaneled by the federal government to-- keep improving the definition of what translational research is.
And what Drolet and Lorenzi did was they abandoned this T1, T2, two stages of translational research idea entirely, and put the focus on what are the activities? What are the activities that move a scientific finding along all the different development stages to an actual public health impact?
How does that scientific finding become? How does it get applied to human health? Even If it's applied to human health, how do you then apply it in a trial or an intervention in the population? To make sure that what you are proposing is effective in a large portion of the population, once you've established that that works, and that it's effective with the population, how do you get people to use it? Diffusion.
And finally, how all that works into having an impact on public health. Essentially, what they were describing was a multi-disciplinary approach involving social scientists. They also suggested that everything in the process-- here I redraw a picture, in a way I think that is a little bit more understandable as to what the continuum actually means.
Is that inside this process of going from one step to another, in order to fulfill the potential of translational research, you have to have continuous feedback and connections between the two ends of the continuum, and within the continuum. that is, if your intervention fails, then you have to go back to basic science.
And if you can't diffuse it to practice, then you have to figure out what was wrong with your intervention, that did not tell you how it was going to diffuse into practice. Why is this practice not accepted? And finally, you can evaluate your diffusion into practice. What if it doesn't have a public health impact? What's that about?
A number of fields of social science research are relevant to this continuum, particularly the activities that move you from one stage to another. I mean, you could argue that even the most basic levels of translational research, from basic science to moving it to thinking about it as a human health application, involves some understanding of organizational theory and communication science.
Everything along the way is dependent on understanding how innovations actually diffuse. Understanding the social ecology in which interventions are done. Interventions are dependent not only on how effective that this particular treatment or program may be, but also on whether you have come up with an effective way to get individuals to change their behavior.
So you need intervention science, you need to understand implementation, you need to understand how to partner with communities, how people learn things. And finally, you need to know how to evaluate it, yourself, or have other people help you do it. And finally, you need policy analysis to help understand why things fail or succeed.
And now I would like to turn it over to Rachel Dunifon.
RACHEL DUNIFON: OK, so I'm going to talk a little bit about something new, Dean Mathios referred to in his comments, that didn't even exist when we had the conference that, as Elaine mentioned, led to the book that we're talking about today.
And that's the establishment of the Bronfenbrenner Center for Translational Research here on campus. And as you'll see, the establishment of the BCTR, as we call it, really addresses a lot of the barriers to translational research that Elaine just highlighted.
So the mission of the Center, as you can see up here, is to expand, strengthen, and speed the connections between cutting edge research on the one hand, and policies and practices that improve human development, health, and well-being, on the other hand. They have a great website, which I encourage you to go check out.
And the center is part of the College of Human Ecology. And the fact that our college is willing to put time and resources into a center like this, really reflects its importance and its centrality to our mission, especially as a land-grant institution for the state of New York. And it's also part of Cornell University's larger vision of public engagement, and the importance of taking what we do here at Cornell and making it relevant to people out in the communities.
John Eckenrode is the director of the BCTR. And this is a little graphic, just showing really what the BCTR is all about, what the BCTR does. So looking at community engagement, first of all. So a key part of the Center is to bring together community members and researchers.
So you can imagine if a researcher might really want to engage with policymakers or practitioners, but literally not know how to do that, or who to contact, and people out in the community might really want to use research in what they do, but don't know where to get it, or who to talk to about that. So a key part of what the center is doing is just bringing those groups together.
Helping people connect with each other, assisting researchers in recruiting subjects from local communities, disseminating research syntheses to people in the communities. So, for example, there's about 200 studies on child care center quality in child development. Well, people out in the community can't read all those hundred studies.
But what the center is doing, for example, is bringing all that research together, synthesizing it in a way that people can read it, and understand it, and digest it. And then bringing that out into the communities.
And the Center's also working with community organizations, just in how to incorporate research into their activities. Another key component of what the Center is doing is investigator support and training. As Elaine mentioned, a lot of people simply don't have the knowledge or resources to conduct translational research.
So, for example, the Center is giving out seed grants to researchers who want to kind of experiment or try something new, and need a little bit of money to do that. They're also providing travel and conference support to people who just want to gear up and develop more tools in translational research research.
The Center is also a think tank for innovation and research translation. There's a series of workshops, seminars, they have a noon lecture series, that really just brings people together to learn from each other, on what people are doing in their applied translational research activities.
The Center is also providing extensive research support services. When you work out in the real world, things can get very messy. And there's a lot of issues with human subjects, and the Institutional Review Board, how to manage and store your data. It's sort of those nuts and bolts that the Center is providing resources on for researchers.
And then [AUDIO OUT] a really big part of what the Center's doing is student engagement. So bringing both graduate and undergraduate students into the research, the translational research process. As was mentioned, a key thing that came up in our book is people saying, you know, I made it all the way through grad school and well into my career, and I still never had anyone work with me on translational research. I never could figure out what it was.
So by bringing people in early, we're hoping to address that issue. There's over 25 undergraduates involved in research at the Center, as well as a lot of graduate students. There's courses and workshops for them on translational research.
We partner with Cornell Cooperative Extension in a summer internship program for students who want to get placed out in the communities, but connected to research on campus, and really see that bridge in action. And then hiring grad students to do work in the Center.
So you can see that the BCTR really addresses many of the challenges that were highlighted in the book. And it's a really exciting opportunity to move translational research forward. And, I think, really puts Cornell on the map, as being in the forefront of doing that.
It addresses the lack of representation of social and behavioral sciences in the translational process, a lack of training in translational research, a need for multi-disciplinary approaches, and it links researchers in communities.
So I just want to quickly talk about a specific example of translational research from my own work. And this is the topic of grandparents raising grandchildren. And this is really a great example, I think, of translational research as a two-way street.
So when I got to Cornell, I had done a lot of research on children's living arrangements, and how, for example, growing up in a single parent family might influence child development, but I had never heard of grandparents raising grandchildren, never thought about it.
I have a research and extension appointment here at Cornell. So as soon as I got here, I went out and started talking to people in the community, extension educators, policymakers, and all they wanted to talk about was grandparents raising grandchildren.
So finally, it started to click in for me, and I realized there was a real need out there in the community. And so that really highlights the importance, to me, of going out and listening to what people have to say. And that opens up new doors as a researcher.
Just, really quickly, about the topic, about 2% of all kids are being raised by their grandparents, with no parent living in the household. It's much higher among African-American children. And I did some basic research before I got started on this, and looked at what other people had done.
And I found some evidence that these families have some real strengths, but a lot of needs that weren't really being addressed currently. And that there was a real lack of research, especially on teenagers who were being raised by their grandparents.
So I was really fortunate in this to receive a five-year grant from the William T. Grant Foundation Scholars Program. And one of the other contributors to our book, Rob Crosnoe, from the University of Texas, wrote in his chapter for the book, he also received one of those grants.
And he wrote about how important that was for him, as his development as someone who was able to conduct applied translational research. And I had the same experience. It's a grant that gives faculty the time and money to take risks to do something different, and to push themselves in a new direction.
And it's very rare that we're given the opportunity to do that, especially as a more junior scholar. And the foundation is really committed to translational research. It's something they highly value. And this is an example of how some innovative funding can really change people's careers and push their research in new directions.
I conducted in-person interviews with 59 pairs of grandparents and the teenagers they were raising. And I have to acknowledge my colleague, Kim Kopko, who traveled all across the state with me conducting these interviews. And this was a collaborative research project throughout.
We collaborated with members of the community throughout this project. Specifically, community educators who were working with families in which grandparents were raising grandchildren. So talking to those community educators helped us even think about what questions we want to ask these families as we developed our data collection tools.
We worked with them to recruit families. So instead of us kind of going out, and just cold calling people or showing up on their doors, these community educators reached out and helped us explain the importance of the study, and bring the families in, so that we could talk to them.
As we've started to analyze the data, and some things look kind of interesting or unusual to us, we talk to the community educators, and they help us understand what we're seeing. And then we're working with them to feed the results of our research back into the community with a series of research briefs and reports that help disseminate the research out there.
So I'm just going to really quickly tell you a little bit about what we've found. I'll just describe-- I'll leave that up there, but not necessarily read it out loud, just so you can learn a little bit about who we who we surveyed. And just to point out one thing that really jumped out at us is that 80% of the youth we interviewed had siblings who weren't living in their household. So there's some very complex living arrangements in these families.
We asked people to explain why the child wasn't living with their parent, and why they had come to live with their grandparent. We got a lot of different reasons for that. But really, the main theme was that it wasn't us a situation when social service agencies stepped in and said you have to-- we're removing this child from the home. It's more a situation where the parent had voluntarily gave up the child for whatever reason. Often related to them having a new partner who wasn't so keen on having that kid in the household.
And then these often overlapped with these other reasons, like substance abuse, neglect that was not as severe to get the child protective services involved, sometimes parental incarceration. But one thing that's really important to note, is these living arrangements are often informal. And so the grandparents are constantly struggling to sort of have determined what their legal responsibility is for that grandchild. And it's always somewhat in flux, which is a really difficult situation for them.
And this is just an example of what I'm calling this parent sort voluntarily giving up the child. That's pretty emblematic of what we would see. So here's a grandmother saying of why her grandson is living with her, "His birth mother signed off on him when he was four, after she and my son divorced. He went with my son for eight years, and that was just horrible.
My son didn't take care of him and then they--" that's her son and his new partner, "had two more children and they were the precious little girls. And max just got shoved by the wayside. And then when he was 13, they just called us one night and said, 'Max isn't going to live here anymore, come and get him, he's out.'" And that's not atypical. Every story is different, but that's not atypical for the situations that we saw.
So we're bringing together evidence we got from surveying both the grandparents and the grandchildren, videos that we made of them interacting together, to try to understand the nature of their relationship, as well as open-ended questions that we asked of the grandparent. And we're doing some mixed-method analyzes, the ultimate goal of which is to inform programs for grandparents raising their grandchildren.
So I'm just going to go-- I'm not going to touch on all of this right now, but the main key finding that has really sort of surprised us, but have very interesting, is that the youth we've studied are still very much in touch with their parents, and the parents still play a really important role in their lives, even though they're not living with them.
The parents often live very close by and the youth see them a lot. And sometimes that's fine, sometimes the parents are like a friendly aunt or uncle, or an older sibling, in their relationship. But oftentimes, the interactions with the parents are very complicated and disruptive for the child.
Parents try to undermine what the grandparents are doing with the rules. They might try to lure the kids away, they sometimes move in and out of kids' lives in very erratic ways that are very disruptive for the kids. And one thing we've been trying to look at is how the relationship that the child has with his or her parent influences the relationship that he's able to form with his or her grandparent.
And what we've found is the youth that are really struggling with that relationship with their parent are also having a hard time, when we look at those videotapes of how they communicate, interact with their grandparent, that grandparent-grandchild relationship isn't going so well either.
On the other hand, there's a group of youth who really just written off their parent. They've got this very cynical view of who their parent is and what they can do. And those youth actually tend to have a very much more positive relationship with their grandparent.
So here's a grandmother just talking about how the anger that her grandson has toward his parents has played out in her relationship with him, even to the point of some violence, in this example. And here's an example of a youth, who's developed this very cynical view.
You know, my parents were horrible, but at least I've got you, Grandma. Which, to hear a kid say that is hard, but perhaps that's actually a healthy reaction for him to have. And then, just really quickly, I have a video here of a girl who, her mother lives right next door and she sees her mom every day.
She's been raised by her grandmother since she was an infant, but she's talking here about how she doesn't call her mom, "Mommy," because her mother wasn't there for her. And she really calls her grandmother, "Mom."
SPEAKER 3: Yeah, that's the best thing, that's why I love being with her. That's the best thing about living with grandparents. Like, we have a stronger-- I have a stronger bond with her than my mother. I don't even call my mother "Mommy." She's my mother. Because she's been there for me my whole life. That's why she's my mother.
Can't call nobody mommy that wasn't there my whole life. She has been there my whole life, so she's my mother. The hardest thing-- Well, it's not even what hard mean, to have everything's good. Everything's good between us. Like I said, the only thing hard is about everybody else not accepting the fact in the family.
RACHEL DUNIFON: And if you were to watch the rest of the video, I mean the grandmother just kind of glowing, she's so happy. And they just had a really-- the one complaint that they have about their life is that other people are jealous about how close they are. So I think it's a really nice example of just sort of the complicated dynamics, and how some of them have resolved that.
I'm going to go through this just quickly, and go to the end, about what we're doing now with this research. So we're trying to, as I mentioned, take this research and put it back out there, so that community people who work with grandparents raising grandchildren can use it and inform the work that they do.
We found a lot of things related to parenting teenagers that the grandparents really struggle with. And so we've developed an enhancement to an existing curriculum for grandparents raising grandchildren, that really focuses on those issues specifically.
For example, we found a lot of grandparents really baffled about the technology that their teenagers were using, to the extent that the teens were really potentially having some dangerous situations. So we tried to increase their knowledge about knowledge about that.
So we're producing a series of briefs and fact sheets for educators and families focusing on the topics that we're studying right now. We've done a lot of presentations and webinars for community educators, and it's really an ongoing cycle, as we feed what we learn from those communications back into our ongoing research.
OK, now I'll let Elaine talk about her example.
ELAINE WETHINGTON: The Cornell Institute for Translational Research on Aging is what we think of in the Bronfenbrenner Center was sort of a key player in the development of translational research at Cornell. It's funded by the National Institute on Aging, and began in 2003.
And I got involved in it kind of as an accident. Before I came to Cornell, I was in-- and goodness knows how, with this background, I ever got a job in the Department of Human Development at Cornell University, which is all about kids-- but I was the study director for the first national study of social integration among older people, 1981 to '83.
Then I finished my degree in Sociology, and as part of that, I developed a study in the Detroit area. It was one of the first to translate, actually, the version III of the Diagnostic and Statistical Manual of the American Psychiatric Disorders into a study of the social distribution of mental disorders. It eventually became the National Co-morbidity Survey, and the International Mental Health Survey. Which is now in 44 countries, through the director of that.
And when I was an Assistant Professor, Karl Pillemer, who was the director of what was to become CITRA came to me, tapped me on the shoulder, and said, we're going to write a proposal to the National Institute on Aging to establish an Edward R. Roybal Institute here, to do research on social integration among aging people, are you interested?
And I said, sure. This has real world implications, I want to get into it. Well, Karl, and Phyllis were very-- Karl Pillemer and Phyllis Moen, who used to be here, were very successful. And for 10 years, they had a Roybal Center which was called CAGRI.
And it did basic research on social integration among older people, but the really innovative thing about CAGRI was that they took theory and they translated into interventions to improve social integration among older people. They founded, at Kendall, as a pilot, and then in other parts of Ithaca, and around the state, a volunteer corps, which was shown to have positive impacts on the health of older people.
Karl Pillemer developed a peer-to-peer support intervention for caregivers. It was part of this project. Nina Glasgow, in Development Sociology, did a practical project on improving local transportation systems for rural older people.
However in 2003, Karl Pillemer and I agreed that we were not up to date with what the leading edge research and social science at the National Institute of Aging and NIH was really about. And that, in fact, what we should be getting into is something which we could translate more rapidly, and with more community input, interventions that would improve the health and well-being among older residents in New York state.
Karl at that time was partnering with a group of people at Weill Division of Geriatrics, Mark Lachs, and between the two of them, they formed an alliance with the Council on Senior Citizens and Services in New York City, which is a resource and advisory group for 265 senior service agencies in New York City.
And the agencies themselves partnered with the conception of this proposal. This was revolutionary at the time, for something which was done at Cornell. They actually helped us write the proposal, wrote substantial parts of it. They advised on development and implementation strategies of research projects that we planned, that we told we were going to implement in the first years of the proposal.
And most relevant in my case, Karl tapped my shoulder and said, would you write a 10-page proposal about how to do the ideal training and education program to train investigators how to get interested in community based research, and to help them get the skills and the experience to do community based research?
Because, as Karl said, I think opportunities are going to explode for translational research at the National Institutes of Health, and we want to get in there first. So we did. We got funded. We were funded from 2003 to 2009, and then were re-funded in 2009 to 2014, with more of a biomedical focus, for what we were doing.
Now we're doing research on pain in later life, which is a serious untreated, and relatively poorly treated, problem among older people in the United States. And for which there are known non-pharmacological management systems and treatments. That only 2% of the people who are eligible to use them, ever use. That's because it's the big E, it's exercise.
Talking people into how to get exercise. And because CITRA was so successful in New York City, we made a name for ourselves at engaging the community for getting researchers out, and training them to interact with community organizations in a way that produced relationships that lasted over time, made the community partners feel like they were equal or equitable partners in every exchange.
We began to attract collaborators from elsewhere in New York City, from the Clinical and Translational Science Center, which is one of those big NIH roadmap biomedical institutes. From the Columbia School of Public Health, from Hunter College, now, and from Memorial Sloan-Kettering Cancer Center. Sort of the entire Upper East Side, and most of the West Side, too.
Now there are many things that TRIPLL has done, that I think have been very good, but I think really the crown jewels of CITRA and TRIPLL is that we have, as a group, developed products and manualized them, so that other people can do what we did, OK.
It's not just a matter of Karl Pillemer and me having outgoing personalities and being able to talk to people who work in the community, and make them feel good, it's a matter of how do you actually engage members of the community, leaders of organizations, members of New York City government in dialogue? And keep them engaged in that dialogue to help you develop something new and innovative?
And there were three things that we did that we think have been very innovative. The first is the research to practice consensus conference, which is a manualized seven-step program to engage practitioners in helping you develop a research agenda. And then designing the next steps that you will take, with their collaboration, to develop a scientifically based research study.
It also serves as a way of educating practitioners and community members about what scientific methods are, and why they're not scary at all, and why one might benefit from taking this longer-ranged, more cautious and deliberative approach toward designing an intervention and targeting it to a specific community.
I also developed that mentored pilot and investigator development program. Just, once again, it's a multi-step program and it's about multi-method and multi-step. It's all about educating investigators about community research methods by getting the researchers not only together with the community, but with mentors who are researchers, who have experience in what they want to do, helping them write grant proposals that meet specific sorts of program announcements at public at the National Institutes of Health and getting them funded.
And finally, the third is M-PACE, which was developed by Karl Pillemer and one of his graduate students, and M. Carrington Reed at Weill Cornell Medical College, which is a method to tailor existing evidence-based programs to new populations by engaging communities to help you adapt them.
And people do this all the time, but they don't use a method. This is a method. And it's manualized, so other people can follow it and hopefully get very similar sorts of results, | as well as build stronger relationships in the community and produce better research studies.
In the pilot program, we have so far funded 26 investigators, including Rachel. And it also lead to four other related grants for junior investigators. We are truly translational in that we've involved all the fields that I have up here, it's multi-disciplinary. And more than 75% have resulted in subsequent funding for those investigators, most of it federal.
So it's been a success story for Cornell. I couldn't-- this figure changes all the time, but for those of you interested in what does getting engaged in this do for Cornell, we have probably generated $30 million of additional research funding activity from the federal government as a result of this program, here and Weill.
So the sort of to end on what I hope is a positive note, we took CITRA, we've taken pieces of CITRA, and we tried to grow them into the BCTR. In other words, what the BCTR is about is addressing those barriers that we talked about for getting engaged in translational research.
We've engaged a number of social and behavioral scientists, we have over 50 affiliates, now, for the group. We have training and education for faculty and students. We have a pilot study program. We funded four pilots this year, plus gave startup grants to two young investigators.
And most importantly, we are using the lessons from the network we established in New York City for CITRA and using it as a model to try to transform how researchers at Cornell connect to Cornell Cooperative Extension, and begin thinking of how that organization has resources which can be extremely helpful for developing research projects, such as the one that Rachel just described, and many more in the future.
So ambitious. I thank you for your attention. I know you can't read this, but if you have questions, you can ask me. OK, thank you.
SPEAKER 1: This has been a production of Cornell University, on the web at Cornell.edu.
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Join Elaine Wethington and Rachel Dunifon for a "Chats in the Stacks" talk about their new book "Research for the Public Good: Applying the Methods of Translational Research to Improve Human Health and Well-Being" (Bronfenbrenner Series on the Ecology of Human Development) (American Psychological Association (APA), May 15, 2012).
Helping to bridge the gaps among research, policy, and practice, their book demonstrates how emerging methods of translational research can help us develop programs and policies that improve human health and well-being. This broader, more inclusive approach to translational research has gained popularity and been promoted by the National Institutes of Health, the Centers for Disease Control, medical centers, and university programs.
Elaine Wethington is professor and director of graduate studies in the Department of Human Development at Cornell. She is a specialist in the sociology of mental health, aging, and the life course. Rachel Dunifon is associate professor in the Department of Policy Analysis and Management in the College of Human Ecology, and they are both associate directors in Cornell's Bronfenbrenner Center for Translational Research. Dr. Dunifon's expertise is in the area of child and family policy.