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Lynch School of Education

Reaching Out About Depression

a brief description

Lisa A. Goodman , Ph.D.
ROAD Evaluator; Resource Advocacy Team
Co-Founder
Professor
Department of Counseling and Developmental Psychology
Lynch School of Education
Boston College
goodmalc@bc.edu

Reaching Out About Depression (ROAD) is an innovative grassroots mental health and organizing project for low-income women with depression in Cambridge, Massachusetts (for a detailed description of ROAD, see Goodman, Littwin, Bohlig, Weintraub, Green, Walker, White, & Ryan, 2007). ROAD addresses not only the symptoms of poor women's depression, but also the socio-cultural conditions and inequalities that influence and exacerbate mental health difficulties. ROAD addresses barriers to personal and community change within impoverished communities by supporting women's efforts to organize themselves and increasing the support and resources women are able to access. It builds on the idea that effective management of depression is essential to enabling low-income women to engage in activism, just as engaging in activism will, in turn, alleviate depression by giving women a sense of agency and control.

ROAD is comprised of two major programs: The Supportive Action Workshop Series (SAWS) provides a setting and structure for an ever-expanding group of low-income women from Cambridge to come together for the purposes of developing a mutual support network, alleviating symptoms of depression, and taking action in their community. The Resource Advocacy Team component of the ROAD program is composed of law and psychology volunteer graduate students, supervised by faculty at two local universities. Each student develops an ongoing relationship with one ROAD participant, and spends two to four hours each week providing emotional and instrumental support to her as she works on whatever issues she chooses to address. Each of these components is described in greater detail in the next few paragraphs.

Supportive Action Workshops

The Supportive Action Workshop Series was created by a "core group" of eight low-income women from Cambridge, representing a broad range of ethnic and racial backgrounds, who met weekly with the Project Director over the course of ROAD's first year of operation. Together, they developed a 12-session interactive workshop series on the topic of depression in the lives of low-income women, and trained themselves to facilitate these workshops for other low-income women in the community. Topics of the two-hour, weekly sessions include: "debunking myths about depression," "the relationship between depression and social and economic inequality," "depression and violence and abuse/safety planning," "parenting and depression," and "substance abuse and depression," to name a few. In addition, this original group determined that in order to further their community organizing mission, facilitators and participants in each workshop series would work together to take action in the community on an issue that affects low-income families struggling with depression. All workshops include a meal and free childcare - critical elements for maintaining attendance and building community.

After creating the workshops and undergoing training as group facilitators, the original "core group" of ROAD members facilitated the first pilot of the workshop series in the fall of 2004, with 10 other low-income women (recruited through fliers and word-of-mouth) in Cambridge serving as participants. As part of the workshop, the group worked with a local coalition (writing letters, talking to neighbors, and visiting politicians) to protest welfare cuts the governor had proposed.

All women who completed that first ROAD workshop series were invited to join the core group as facilitators for the second round of workshops. Importantly, every woman who participated elected to either become a facilitator or to remain a part of the ROAD community by taking the workshops again. Since then, ROAD has continued to conduct two or sometimes three workshop series each year.  Next year, we plan to begin to conduct several workshop series simultaneously, given the high demand for them. Bringing an increasing number of workshop series to the wider community in this way is ROAD's primary means of expanding its supportive action network.

Resource Advocacy Team

ROAD's second component is the Resource Advocacy Team, which uses a model of advocacy we have developed called Relationship Centered Advocacy (formerly known as Feminist Relational Advocacy). Here, counseling and/or law graduate students work with ROAD facilitators and participants to help alleviate their acute crises (e.g. threatened evictions, loss of benefits, debt, layoffs, health problems, or parenting difficulties), achieve their short- and long-term goals, as they define them, and support the workshop's community action component. Because they are supervised by law school and counseling faculty (who contribute their time to ROAD), the students are effective in integrating emotional and instrumental support functions.(For a more in-depth discussion of the advocacy model and its impact on participants, see Goodman, Glenn, Bohlig, Banyard, & Borges, 2009; for a discussion of its impact on student advocates, see Weintraub & Goodman, in press).

Key to the success of the Resource Advocacy Team model is the one-on-one relationships established between the students and their ROAD partners. Each student/advocate works intensively with one ROAD woman over the course of one year. The advocates meet weekly with their ROAD partners at the partners' homes or at other easily accessible settings. In addition, they meet at various relevant community agencies so that the students can provide advocacy, emotional support, or practical help to their partners as the women attempts to navigate the traditional social services system. Not only do these relationships become fairly intimate, they also remain truly collaborative, leaving room for the voices, values, and perspectives of both the advocate and the partner. Unlike in traditional social services, the student-advocates approach their work with their ROAD partners with maximum flexibility, as unencumbered as possible by preconceived notions of what is an "appropriate" goal or strategy for achieving it. The advocates' are trained simply to listen to their ROAD partners as they talk about their lives, and to reflect back to them their own framing of their difficulties. Then, both the advocates and their ROAD partners bring their own experience and knowledge to the table in order to develop a mutually acceptable plan for addressing the partners' needs.

Advisory Board and Project Manager

Both the Workshop Series and the Resource Advocacy Team are supported by two sets of actors. First, ROAD is guided by an Advisory Board, an interdisciplinary group of women, including community activists, mental health professionals, academics, and ROAD facilitators who have helped to develop, and sustain ROAD and its participants. Advisory Board members have embraced a wide array of roles including evaluators, consultants, volunteer supervisors, providers of information, and organizers. Second, ROAD has one paid staff member, the Project Manager, who co-created ROAD with the facilitators themselves, and now handles ROAD's management and support functions, such as budgeting, volunteer and participant recruitment, workshop support, and development.

Evaluation

Congruent with the collaborative ideology that forms the backbone of ROAD, we are using a participatory research model for our evaluation. Dr. Goodman and three Boston College doctoral students (who contribute their time) have worked closely with ROAD facilitators to design a three-part evaluation that can assess (1) the impact of the workshops on participants over time; (2) the impact of the Resource Team on its participants over time; and (3) the impact of the ROAD program on the community over time.

Our multiple methods approach is employing focus groups, survey administration, and open-ended qualitative interviews. Using these methods, we are measuring the following outcomes:

  • On the individual level, we are assessing the impact of ROAD on participants' levels of depression and hope; quality of emotional support from peers; access to instrumental support from peers and community agencies; level of self-confidence and leadership capacity; and willingness and ability to engage in activism.
     
  • At the group level, we are assessing participants' sense of collective empowerment

  • At the community level, we are assessing the extent to which ROAD activism has generated more effective resources for all low-income women and families struggling with depression in this community.

Although we are still in the midst of this participatory evaluation, informal feedback and a first round of interviews indicates that the ROAD workshops and advocacy provide a desperately needed opportunity for participants to develop the skills and confidence required to take charge of their lives and make change in their communities through activism. One woman dealing with recent trauma and grief credits ROAD with "helping me move back into the world". Another woman claimed that ROAD "makes depression into an active thing, rather than a passive one. Your negativity can be turned into something positive." In addition to reporting reduced levels of depression and a greater sense of empowerment over the course of involvement with ROAD, many women have been able to create substantive changes in their lives by, for example, re-entering the workforce, combating obesity through a new exercise program, or applying to go back to school. Moreover, whereas it is often difficult for poor women to remain in mental health treatment , most of the women who come to a ROAD workshop end up staying, and about half become facilitators.

We have already published a chapter describing ROAD and some of these outcomes in more detail, as well as several articles on advocates’ and their partners’ experiences with the advocacy component of ROAD (available upon request). By publishing information about the theory, praxis, and outcomes of ROAD, we hope to disseminate this model to other communities.

Goodman, L.A., Littwin, A., Bohlig, A., Weintraub, S.R., Green, A. Walker, J., White, L. and Ryan, N. (2007). Applying feminist theory to community practice: A case example of a multi-level empowerment intervention for low-income women with depression. In E. Aldarando (Ed.), Promoting social justice through mental health practice (pp. 265-290). Florence, Kentucky: Lawrence Erlbaum Associates.

Goodman, L.A., Glenn, C., Bohlig, A., Banyard, V. & Borges, A.M. (2009). Feminist relational advocacy: Processes and outcomes from the perspective of low-income women with depression. The Counseling Psychologist, 848-876.

Weintraub, S. & Goodman, L.A. (in press). Working with and for: Student advocates’ experience of Relationship Centered Advocacy with low-income women (in press). American Journal of Orthopsychiatry.