“I noticed early on in my childhood that there was a disparity between some of the kids I grew up with because of the supports that were afforded to me versus some of the other families that were struggling.”
During her time as an undergraduate at the University of Hawai‘i, Kelsie Okamura studied Psychology because she genuinely wanted to help people. Kelsie grew up in the rural plantation town of Waipahu, on the island of O‘ahu. She could see the sugar mill from her grandparent’s backyard. It was a lower and middle-class community—an environment that could not always promote children’s physical and psychological health.
“I noticed early on in my childhood that there was a disparity between some of the kids I grew up with because of the supports that were afforded to me versus some of the other families that were struggling,” Kelsie said.
Though Kelsie’s interest in Psychology was broad, she quickly found a way to translate her childhood experiences of youth health disparities when she was hired by a Professor as a research assistant studying Cognitive Behavioral Therapy and youth evidence-based practices.
The research clicked with Kelsie, and after she finished her undergraduate studies, she continued with the research, following the professor and the study to UCLA. Kelsie then returned to Hawai’i to earn her Master’s degree and PhD in Psychology, focusing on therapists’ characteristics of evidence-based implementation, such as knowledge. In her post-doctoral fellowship at the University of Pennsylvania, however, Kelsie studied evidence-based implementation from a systems approach, researching the intersection of implementation and policy context. She returned to Hawai‘i in 2017 and is now an Evaluator at Hawai‘i’s Department of Health in the Child and Adolescent Health Mental Division and just finished teaching her first Child Treatment graduate level course at the University of Hawai‘i at Mānoa.
Kelsie is fascinated by Clinical Psychology and community health. Her research has focused mostly on evidence-based practice because of its clinical innovation in implementing treatments for young children and teens in communities nationwide.
“We have these best practices in community health, but often we’re asking a lot of the kid, the ecology and the family around them. Accounting for the context in which some of these practices are being implemented is really important. That’s the thrust behind my research—understanding context and communities and how that impacts implementation.”
Contexts are crucial to providing the right supports through youth psychology, Kelsie says. There are state and city government cultures, social contexts, and organizational and therapist contexts. Most important, though, is the context of an individual child and his or her family. “We’re learning that youth and families are very complex in community mental health. There are many cultures that intersect here—school, friendships, ethnicity, and community. Having a genuine curiosity about youth and family perspectives can help with understanding some of the reasons youth behaviors are maintained and treatment can be tailored to address these challenges. In Hawaii, we have a wonderful amalgamation of cultures and races that influence symptoms, so approaches have to be tailored to meet their needs.”
As part of the 2017 New Connections cohort, Kelsie’s work expands on the systems-based research she conducted at the University of Pennsylvania. Working with an interdisciplinary team of researchers from the University of Pennsylvania, University of San Diego, and the University of Hawai‘i, Kelsie is using systematic review software to summarize the implementation strategies of evidence-based practices in youth mental health systems.
In studying systems across the U.S., Kelsie hopes to empirically “unearth” the best implementation strategies for youth mental health systems. Mental health systems often choose implementation strategies because of political mandates, finances, or proximal factors, but these may not be the treatments that work best within a given system. Kelsie says her research takes a “deeper dive” into where and why systems have worked.
One such system is the state of Washington, which has implemented evidence-based policies on everything from behavioral health to criminal justice. The state implemented the Washington State Institute for Public Policy (WSIPP), which, with attention to evidence-based practices, pinpoints what services work for citizens to craft more effective social policies. For example, in 2012 the WSIPP reviewed its programs in juvenile rehabilitation, child welfare, and child mental health along with national research on evidence-based practices. The state used the information from this review to increase the number of children accessing evidence-based treatment and improve training, data maintenance, and overall program operation. Kelsie says systems like Washington provide a model for policymaking and evidence-based practices.
In a recent paper published in Frontiers in Public Health, Kelsie’s team analyzed the cost effectiveness of implementing evidence-based practices, which can be expensive, as implementation of new practices requires training therapists. Due to their cost, evidence-based practices are not always mandated or incentivized by states, but the cost metric analysis developed by Kelsie’s team identified a range of costs for the implementation of different practices, meaning some less expensive practices can be more easily implemented in systems than previously thought. Kelsie hopes this analysis, along with greater community input, can better inform policymakers and lead to policies that incentivize evidence-based practice more frequently.
“We’re noticing that trauma-focused cognitive behavior therapy has been implemented across various systems, and that likely has to do with Congress and other initiatives,” Kelsie said. “It’s those bigger, systematic, federal changes that trickle down into state and city level systems. It’s nice to see that policy is driving this implementation.”
The National Child Traumatic Stress Network, which was initiated by Congress in 2000 to create trauma informed systems, is the energy behind the recent push for trauma-focused cognitive behavioral therapy. The Philadelphia Alliance for Child Trauma Services (PACTS) has been successful in implementing these treatments, training therapists and increasing rates of screening and diagnosis of PTSD. From 2014 to 2016, the percentage of children with PTSD treated by the PACTS network jumped from four percent to 31 percent. In Hawai‘i, Kealahou Services—which operates under the Hawai‘i Department of Health’s Child and Adolescent Mental Health Division where Kelsie is a lead evaluator—is a leader in trauma-informed and culturally appropriate care for girls struggling with diverse trauma issues and at risk for further victimization. The program’s gender and culturally responsive care has not only improved client outcomes after 6 months but contributed to other Hawaiian health organizations by providing trauma-focused training.
While her New Connections grant has afforded Kelsie the time to focus on this study, it has also helped her identify colleagues with whom she could collaborate, such as with another cohort member from Hawai‘i, Lehua Choy. “It’s nice that we keep in touch. It’s nice to have someone to reach across to.”