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What Happened Next? Kawi Professors tackle mental health issues at home and abroad

Posted October 12, 2017
Wietse Tol (second from left) joins some of the community health workers he works with in the Peter C. Alderman Foundation's Maternal Mental Health Program in Uganda. Wietse Tol (second from left) joins some of the community health workers he works with in the Peter C. Alderman Foundation's Maternal Mental Health Program in Uganda.

"The concept of trauma underlies many of the disorders we see in individuals and communities worldwide," said Ali A. Kawi, DrPH (SPH '65) in 2012, shortly after Hopkins announced that W. Hall Wendel, Jr., had established a professorship in his honor.

The three-year term professorship in the Bloomberg School of Public Health supports promising junior faculty whose research examines the role trauma plays in mental health — an enduring interest of Kawi's over his distinguished career. The inaugural recipients, Wietse Tol and Tamar Mendelson, have started a tradition of handing off a green, hardbound copy of Kawi's dissertation — titled "A Study of the Association of Factors of Pregnancy, Parturition, and the Neonatal Period with the Development of Reading Disorders as a Neuropsychiatric Problem in Childhood" — to one another, a tangible reminder of the name with which their work will be associated.

Tol specializes in mental health needs and interventions in post-conflict regions of Africa and Asia. Mendelson, who currently holds the chair, works closer to home, in Baltimore, where she develops and evaluates mental health programs for youth, mothers, and parents in low-income and urban environments. Both shared updates with Rising about how funding from the Kawi Professorship has advanced their work and their ability to impact lives around the world.

Wietse Tol, Kawi Professor 2012-2015

Why did maternal mental health become a focus of your research agenda?

In public health, we want to stop the transmission of adversity across generations, and maternal mental health is the starting point for many problems women, but also their children, may develop.

How did the Kawi Professorship impact your work in this area of Uganda?

My research — through the Peter C. Alderman Foundation (PCAF), the NGO I also work for, and the Ugandan Ministry of Health — has focused on finding out how women themselves, and the health workers who help them, talk about mental health. We took our time developing a program that uses the right words and interventions to reach them. Right now, we are providing those services to the community and assessing them.

[Editor's Note: According to the latest quarterly report Tol provided us, the PCAF Maternal Mental Health program's psychoeducation interventions produced a decrease in depression symptoms in more than 78 percent of the women involved. Interventions led to increased functioning — defined as the ability to complete daily work and social activities — in nearly 80 percent of women.]

Does this work have applications beyond Uganda?

Perhaps not in terms of the exact services, because you need to adapt your services to fit the context. But the steps we took developing the program — starting with an open-ended needs assessment and asking people to say, in their own words, what their priorities are — can be easily transferred to other situations, including conflict-affected settings. We ourselves are doing that to expand the maternal mental health program to other places in Uganda.

What has the Kawi Professorship done for you, personally?

Over the course of my work, I have become really interested in the prevention of mental health problems as opposed to my earlier focus on treatments. The Kawi Professorship allowed me to start switching gears and take the time to get to know more about prevention in the field of global mental health. The Kawi Professorship has also allowed me to continue to do my research while keeping a strong foot in the world of practice — something I feel adds to the research I do at Johns Hopkins.

Tamar Mendelson, Kawi Professor 2016-present

What are the primary aims of your research?

I develop and adapt preventive interventions for mothers and youth, mostly in underserved urban areas, with the goal of promoting mental health. Some of my work is in schools, and some in obstetrics or neonatal care facilities. I'm particularly interested in the application of mindfulness strategies in these settings.

What's a project that the Kawi Professorship's funding has helped you push forward?

A colleague and I have developed mindfulness-based interventions for parents with infants in neonatal intensive care units. The program is delivered on MP3 files with a video introduction. We learned that parents in NICUs are often too busy to take part in in-person groups or meetings, so this seemed like a good alternative.

Why is the mental health of NICU parents important?

Existing data show that NICU parents are at high risk for depression, anxiety, and trauma. Those can have effects on parenting, infant attachment, and childhood mental health outcomes down the road. When we interviewed parents and providers in the Hopkins NICU, we learned that parents' experiences are a roller-coaster ride, and they feel they have little control. So learning how to tolerate and manage painful emotions may be incredibly helpful for these parents, perhaps even more helpful than training in traditional problem-solving skills. Mindfulness seemed like a great fit for fulfilling that need.

Where do you hope to be, with this study and overall in your career, when you pass the Kawi thesis to the next chair?

Right now, we have a paper under review about the NICU mindfulness intervention, and it looks like we may get funding from the NIH to develop this further. But my overarching goal, for this and other aspects of my research, is to create interventions that are sustainable and that we can actually embed in service systems. Can we integrate these interventions in schools, clinics, and other places that serve moms, kids, and families? Can they be widely shared and scaled up? Can they continue to thrive on their own?

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