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Aman Chopra: Folks, welcome back to another episode of the "I AM GPH" podcast." Have we ever heard about this term called implementation science or what does that even mean in mental health psychology? Well, today's guest is an expert in that space as we have John Pateña. John is an expert in public health and counseling psychology, currently serving as the implementation science specialist at Montefiore Health System. With extensive experience in global mental health and the adaptation of evidence-based interventions, he's passionately focused on improving healthcare delivery and outcomes both locally and internationally. By the way, you must have seen some awesome DrPH students come on our episodes before. John, as well is a DrPH student who's gonna be the first candidate in the class of 2025. We can't wait to hear all about his journey. John Pateña, welcome to the "I AM GPH" podcast.
John Pateña: Thanks, Aman, this is so cool to be here. Really appreciate this opportunity.
Aman Chopra: We're really excited to talk to you. Let's kick things off very, very lightly, mental health. What is global mental health?
John Pateña: Yeah, so mental health, such an easy topic to kind of talk about. So when we think about when overall health, right? There's the kind of physical health and then the mental health, so how one is doing, how one is feeling. And within kind of the global context, mental health is talked about and perceived differently within different cultures and different contexts. So within like the US setting or Western setting, I would say for the most part, mental health is something that we do talk about. We say things like we're experiencing stress. We're experiencing a difficult time kind of getting through something. But in other cultures, in other contexts, it's really hard to talk about it. So on that global scale, how do we kind of approach this really big topic of mental health accounting for that cultural competence and for those different kind of barriers and kind of stigma to talking about how one's doing with themselves?
Aman Chopra: So is that where the concept of mental health intervention comes in, where you're intervening into a system that is not recognizing it in a way? Or is it something more than that?
John Pateña: Yeah, no, it's definitely a part of it, right? So if we think about mental health treatment in its purest form, the first thing that comes to mind is one-on-one therapy. So you're talking to a psychiatrist, psychologist, social worker, et cetera, that is helping you kind of in a one-on-one setting and it dives really deeply into what's going on, how can that person kind of help the person that needs that support? And when we think about mental health interventions, we want to take it a step back. So we think about a community approach, we think about the prevention of kind of mental health conditions, mental health illness. And to me, the most interesting thing around mental health interventions is this concept of task-sharing mental health interventions. So if we think about professionals who are trained in mental health, so that's again, psychiatrists, psychologists, et cetera, they can delegate or hand off some of their work in mental health treatment to what we would call non-mental health specialists. So that would be a community health worker, village health workers, other healthcare providers who aren't trained in mental health stuff. And to me, that is where I think, from a public health standpoint, how can we really tackle the issue of mental health and using these mental health interventions?
Aman Chopra: I've never heard it from a community standpoint where I always think these roles are very delegated. And when you say community health, so what does that look like for someone that is gonna experience a community health worker supporting with mental health? What could that look like in your eyes?
John Pateña: Yeah, definitely, so if we think about even here in the US and in kind of global settings, there are kind of people in the community that are just trusted. So that can be kind of the matriarch of the community, the patriarch of the community. Folks that, in some of the work that I do, they're called the grandmothers or the grannies of the community. These are folks that because of their role within that specific community, people can kind of trust them. They know that they can talk to them about anything. Task-sharing wants to leverage that kind of dynamic and relationship and say great, let's train these trusted community folks within kind of this mental health treatment kind of intervention. So then what it looks like for let's say a community member who is experiencing some struggle, they would go to this trusted individual and say, "I've been having a difficult time with this," or, "I don't know how to talk about this." And with the training that a mental health intervention would provide, those trusted community health workers would say, "Great, I can help you. I can provide this level of support." And that community health worker, they now play this kind of triage role a little bit, right? So it's how do I recognize that someone might need more support so that me refer them to the psychologists, the psychiatrists within the community? Or at what point do I say you know what? By doing this kind of task-sharing thing, I can help them in this capacity more so than they would ever receive if they didn't go to that health worker.
Aman Chopra: It's almost like the role of a mental health counselor has been delegated and how did this even come to life?
John Pateña: So the concept of task-sharing has kind of existed within the public health space because globally there's just not enough kind of healthcare providers. So if we remove mental health for just a second here, right? There's not enough physicians, nurses, the full spectrum of the healthcare team, so this kind of concept of task-sharing has been developed for decades now around how do we utilize available resources that there's not enough to train everyone to be a physician or a nurse, but there's just enough resources to say there's 10 community health workers and one physician. And I think that's where, in my kind of opinion, that's the future of public health, right? How can we really leverage that training model, build on those relationships? It has everything to do with kind of community engagement and how do we kind of get folks rallied together to really help out those who really need that support?
Aman Chopra: What are some places where this has been implemented right now?
John Pateña: Specific intervention is called the Friendship Bench and it's interesting, so there might be this association with that term, Friendship Bench, within the US school setting of placing this bench in the middle of a playground area, finding new friends kind of thing. But within the global mental health setting, it was developed by Dr. Dixon Chibanda based in Zimbabwe back in 2006 and it has been proven to decrease depressive symptoms, decrease anxiety symptoms by implementing this type of intervention. It originated in Zimbabwe. It's now been implemented and scaled up in about 10 other countries throughout Africa, and there's one new study in Vietnam. So it's getting kind of global footing which I think is really, it's exciting and it's this opportunity to say how can we take what we know works like this Friendship Bench intervention and get it wildly spread out?
Aman Chopra: How do you think people will scale this up since you see that it's working and there are so many positive impacts that it's having? How can someone scale this up?
John Pateña: That's the biggest question in implementation science. It's how do we even figure kind of all this out? So if we think about the different, I would say, kind of factors that go into a successful implementation, so let's say that it's based off of at an individual level is the person who is experiencing mental health conditions, are they willing and ready to ask for help? And then let's say that the next level would be is there enough family or community support to say yep, you kind of need some help. Let me help you navigate that health system. Then you add this other layer of is there enough resources in the system? Is there a psychologist? Is there a community health worker? And if you look at the even bigger kind of context of that, what are the health policies in terms of can this individual access those resources? So when we think about how does one implement something successfully, it's targeting all those different layers. So it's complex, it's messy, but in a way, that makes real effective change. So within implementation science, if I were to only address it from one factor, let's say at the individual level, there's interventions that will say let me educate the individual on available resources. Let me educate them that it's okay to talk about mental health. It's only targeting one part of that very complex kind of messy puzzle, so that successful implementation has to be in all those levels and that's what I love about public health. I don't have to be the one that solves all those problems. I'll approach it from kind of one aspect. Then a colleague will approach it from another and another colleague from another perspective, and altogether we're tackling this kind of very complex issue and how to really move that to successful implementation.
Aman Chopra: I've never heard the term implementation science and it seems like what is the best way to change an outcome? What is the best way to do something so it doesn't backfire and there's a science behind it. How did this whole science come to life?
John Pateña: Yeah, so implementation science, it's relatively new, I would say, within the past 30 years or so. And it's the kind of formal study of trying to understand the translation from research into practice meaning we know what works. That's what clinical research is about. We have all these clinical trials. We put in a lot of funding and resources to say does this intervention work? Does this medication work? And there's a lot of resources in that field to figure out we wanna make sure that this is actually effective. But then there's this question around who's actually putting that into the community or into the kind of populations that really need it most. So implementation science, it's this evolution, I would say, of different quality improvement fields, team science fields kind of coming together and saying let's create a taxonomy, a vocabulary around how do we measure implementation success as opposed to measuring effectiveness success. And for me, the way that I love to describe implementation science, the tagline I would say of the field is bridging the know-do gap. So again, there's things that we know and there's things that we do in the community, and implementation science is trying to bridge or narrow that gap. And for me, it's a nice kind of focus area for the doctor of public health because it is about that application of work. It's not about the creating of new research. It's about how do we actually get this to the people that need it most?
Aman Chopra: Yeah, that sounds so specifically, basically make things happen, yeah. Get get it done.
John Pateña: Exactly, we need it. We we need to get things done in the field.
Aman Chopra: Yeah, there's a whole science around that. You mentioned the doctor of public health, the DrPH, all the students I've spoken to from the DrPH, it's a very specific, I wouldn't even say eccentric, but a unique kind of student that goes in. So what drew you to DrPH? How did the DrPH serve your work? Did you know that, did you figure it out? What was your whole experience like?
John Pateña: The common theme of my professional life has been picking the field or the degree that's new because the DrPH is relatively new compared to the PhD or kind of other established doctorates that are out there. And when I entered the public health field, I knew that I wanted to make change and I just didn't know quite yet how to, in what capacity how to do that. And after speaking to colleagues who have their DrPH and just seeing what I would say, the next frontier of the public health field, I discovered that the DrPH was this right fit of appreciating research, applying it to realtime practice, and this layer of public health leadership. So if someone were to ask me what distinguishes a DrPH from an MPH or from other kind of doctors within the public health field, it's this desire to be innovative and to not be afraid of change. And sometimes it's scary and sometimes it's this daunting task to make a systems level change in public health because there's so many complex components to it. But what I love about the DrPH and what I've seen in kind of my colleagues, the one kind of trait that aligns with all of us is that we are change makers. We're here to innovate and be the first of everything that we do in our respective fields.
Aman Chopra: Did you get that idea before applying as well? Is that what drew you in here?
John Pateña: It is, yeah, it's one of those things where as I was looking for doctoral-level programs and trying to figure out what the right fit was for me, between the description of the DrPH but also NYU School of Global Public Health, we started the first DrPH program in fall of 2021. So I was part of that inaugural cohort again.
Aman Chopra: Of the DrPH, first off trying some new stuff and also being the first in the program as well.
John Pateña: Exactly, again, that theme of I just wanna be the go-getter of all these different things. But to me, it has been the best professional decision of my life, I think, to have entered the DRP program at NYU at that time because it was around how do we make this change at a global level? NYU, it's the only school of global public health. How do we really kind of utilize future DrPH students and DrPH candidates to make that global change which other programs may not have that ability?
Aman Chopra: And did you always know that you're gonna get into this work of implementation science and global mental health, or did the DrPH take you in that direction?
John Pateña: So I think it starts off with the global mental health component. So I have a dual background in counseling psychology and public health. So I was a mental health counselor kind of doing one-on-one therapy for a few years. I really enjoyed it. It was very fulfilling work, but then there was a part of me that felt it wasn't enough. I was helping at the one-on-one level, I was helping in terms of treatment, and I wanted to kind of shift over to the community approach, helping more people. And then I also wanted to approach it from a prevention standpoint. So instead of just treating mental illness and mental health conditions, how do we prevent it from kind of even happening? So I added this public health lens to my career and my professional identity and I did that for about a decade or so. And then most recently before I started the DrPH program, I entered the kind of global mental health space meaning all the work that I had been doing in terms of developing interventions at the community level, breaking down those barriers and stigma, and doing that within the other kind of cultural context and kind of global components. I didn't realize it at the time when I was kind of applying that a lot of the work that I was doing was implementation science and it was this kind of epiphany moment for me of all of this was leading to this pathway of using the tools and skillsets of implementation science within the kind of topic area of global mental health. And I knew that this was the niche that I wanted to be in. This is where I wanted to make that impact in the public health field.
Aman Chopra: I'm very interested to hear about your experience at the NIH Fogarty International Center. Can you tell me more about that? And I think it's related to the other things you're working on right now as well.
John Pateña: Yeah, absolutely, so as part of the DrPH program, we have to do what's called an advanced applied practice experience. It's essentially a consultancy type of project. So DrpH students work with any type of public health organization and we present them with this opportunity that says we can consult on a project. We can do some high level kind of public health kind of practice work. How can we make this change? So I was fortunate enough to find Fogarty International Center and their whole scope of work is around global health. So advancing the science of global health in terms of training and education and providing a lot of resources for folks that are really interested in this space. The specific topic that Fogarty was interested in when I kind of joined them was this topic around community engagement. How do we utilize or leverage the concept of community engagement to advance implementation outcomes? So if we think about implementation outcomes as how acceptable an intervention is, how feasible is it to be implemented in the community? What does it take in terms of human resources and financial resources to actually get it done? Are there ways that community engagement, this whole field in and of itself within public health, how can we get that to actually advance these outcomes? So the consultation kind of the work that I did was around this strategic plan with Fogarty kind of helping those within Fogarty, asking them where do they want to see community engagement? Is it that we want to create a set of guidelines, a toolkit of how to use community engagement tools to advance implementation science? Is it around kind of vamping up the implementation science side of things and saying we need to focus on implementation within this global setting? By the end of the project, we ended up creating this scoping review that looked at what is currently being done in terms of community engagement and implementation science just globally and trying to figure out some best case examples, right? Of it works really well in this geographic setting with this health topic. But then it would work really well in that setting, can we manualize that? Can we make a toolkit out of that? So in its purest form, that kind of consultancy project was that strategic plan. It was working on identifying how to even think about community engagement and implementation science and now that that project is done, I still work with Fogarty. I still work with them on a monthly basis trying to figure out that next step. And I think for me, the kind of exciting part of all this was it built out my network, and public health students and younger public health professionals, they need to hear this where part of doing the work is building your network of who can you learn from, how can you get connected with organizations? So building out that Fogarty network, I now continue to do that global health work up to this day.
Aman Chopra: I love this, I love this. Is this what influenced your dissertation that we were talking about before the cameras came on? What is your dissertation? Did this influence it, what created that?
John Pateña: Yeah, absolutely, so my dissertation, it has everything to do with this kind of global mental health and implementation science kind of intersection. It's specifically looking at how do we, what is the acceptability and feasibility of a task-sharing mental health intervention, so again, utilizing those community health workers, specifically for sickle cell disease patients in Nigeria. So the reason I was interested in that was because I want to be the next kind of task-sharing mental health intervention professional. And I believe that the skills around how to implement that, how to scale that up in different contexts is a transferable skill regardless of the topic area, so whether it be sickle cell disease patients or other health conditions and other geographic locations. In my work around discovering this acceptable and feasibility, a major theme that's coming up is community engagement and this kind of component of how can we engage stakeholders in the communities? How do we involve them at the beginning stages of the process to ultimately lead into this acceptability of that task-sharing intervention?
Aman Chopra: You're doing so much, it still feels like it's within one container and there's so much happening in that container, and you are the manager even though there are other things happening. So I'm sure implementation science sounds like it's one word, but it's so multi-layered in everything you mentioned and I'm sure the listeners might have heard something that is exciting them. Well, I like that part. I like that part. So perhaps I'm gonna challenge you to simplify something. If you had to describe your work to a 4-year-old, what does it do for the world? How would you describe it to a 4-year-old?
John Pateña: Yeah, I love this exercise. So let's see, if I were to describe implementation science, there are things that we know that help people, whether that's medications or programs that will help people feel better, and there's things that we know that we actually do in terms of in the hospital setting, in community settings, and my job is to kind of figure out why we don't do everything that we know that works into those spaces. And there's a lot of components to implementation science. It's not a one-size-fit-all model. It's not a one type of professional. So the same way that there's not one type of public health professional, there's many ways that an implementation science professional can be in that position. And the question that I would ask would be would you want to be an implementation research where you're trying to come up with the method of studying everything that we're talking about? Do you want to be an implementation kind of community professional where your job is to engage with different levels of the community, whether that's the individual level, organizational level, societal level. Do you want to be the person that deals with the policy of implementation? And there's a whole kind of subfield around that and to me, it's interesting. Basically it goes back to the question around what type of public health professional do you wanna be, right? There's so many ways to help. What aligns with your personal values, with how you want to be present in the world and can contribute to the field. It's those kind of same questions for implementation science.
Aman Chopra: I love it, bringing the community to you, everyone. That's John Pateña, John, thanks for sharing this. It's really expanded my mind of how public health is all about community, bringing people together. We're supporting each other. A professional can delegate responsibilities, can teach, and it expands to a much better cause, and I'm excited to see how you identify the fewer things as you conclude your journey at the DrPH.
John Pateña: Thank you so much, really appreciate this.
Aman Chopra: Yeah, really, really happy to have you here. Folks, that's John Pateña, the pioneer in public health work when it comes to community and global mental health. Lots of unique things coming your way and John, thanks for being on the episode.
John Pateña: Thanks so much.
Aman Chopra: We'll see you in the next one, everyone, take care. Like, comment, subscribe, if there's anything you'd like to ask John or share from the episode, put it in the comments down below. We'll see you in the next one.