Partnering with Libraries to Address Teen Mental Health with Ashley Knapp, PhD and Robert Simmons, MA

“If we want to create products that people are actually going to use, we have to think about who we're going to partner with. Community organizations, they've been there. They've cultivated that trust. And also folks in those community organizations, they're experts.”  
— Ashley Knapp, PhD 

• Assistant Professor of Psychiatry and Behavioral Sciences, Medical Social Sciences in the Division of Intervention Science and Preventive Medicine 
• Member of Northwestern University Clinical and Translational Sciences Institute 

“Marginalized folks aren't really heard in general in society, and particularly when it comes to mental health. We created safe spaces where people could actually talk about anxiety, and how it's impacting them, but also what a product would look like that could help them manage anxiety.” 
— Robert Simmons, MA 

• Director of Social Services and Public Safety at Oak Park Public Library 

The number of teens reporting struggles with their mental health has been rising, but resources to help these young people deal with anxiety or depression can be difficult to access, especially for historically underrepresented racial and ethnic adolescents. The Oak Park Public Library in collaboration with investigators at Northwestern University Feinberg School of Medicine has stepped up to meet this need.

This project was recently awarded the 2023 Dr. Virginia Bishop Community Academic Research Partnership Award from the Alliance for Research in Chicagoland Communities. 

• Teen mental health has been in the headlines in recent years as anxiety and depression reported by this group has soared and worsened further during the COVID-19 pandemic. To address this issue, Knapp says scientists need to be innovative and thoughtful in how they get mental health resources to this population and she established the Teen Mental Health Services Within Public Libraries Community Research Partnership. 
• Before collaborating with Knapp’s team, the Oak Park Public Library made efforts to re-envision its community impact, especially concerning local marginalized communities. Out of this effort came their initiative to serve BIPOC teens struggling with mental health, making it a perfect collaborative partner for Knapp and her team.  
• The goal of the Teen Mental Health Services Within Public Libraries Community Research Partnership is to co-adapt an anxiety intervention that is culturally relevant to the teens that are served within the Oak Park Public Library. 
• To pinpoint the best ways to implement this intervention Knapp and Simmons used Consolidated Framework for Implementation Research and interviewed 17 library workers to better understand the everyday landscape of the library, and the ways teens interact with its resources and those who work there. Results of this work were published in a study in Frontiers in Digital Health. 
• Also, interviews with teens who frequent the library yielded illuminating insights. For example, teens mentioned that mental health resources are often missing BIPOC narratives, and that in their experience, most therapists are white and not always culturally sensitive. 
• Knapp says a future mental health resources website will be offered sharing the intervention through self-guided models that will offer coping skills training, local and national mental health resources, as well as testimonials from other teens who have used the service. The hope is that such services can serve as early intervention for young people who might be at risk. 
• Knapp recommends the Alliance for Research in Chicagoland Communities as a valuable resource for scientists to  learn about anti-racism and how well-meaning academic initiatives within communities of color have caused harm in the past. 
• In the future, Knapp and Simmons hope to expand this project to a larger scale, while also raising awareness about the potential for other community organizations to engage in similar initiatives. 

Additional Reading 

• Find out more about The Alliance for Research in Chicagoland Communities  
• Explore current challenges facing teens from the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey. 
• Connect with Knapp on X 
• Read their study in Frontiers in Digital Health
• Learn more about the Oak Park Public Library

Recorded on December 5, 2023.

Target Audience

Academic/Research, Multiple specialties

Learning Objectives

At the conclusion of this activity, participants will be able to:

1. Identify the research interests and initiatives of Feinberg faculty.
2. Discuss new updates in clinical and translational research.

Accreditation Statement

The Northwestern University Feinberg School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement

The Northwestern University Feinberg School of Medicine designates this Enduring Material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Board of Surgery Continuous Certification Program

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement(s) of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

All the relevant financial relationships for these individuals have been mitigated.

CME Credit Opportunity Coming Soon

[00:00:00] Erin Spain, MS: This is Breakthroughs, a podcast from Northwestern University Feinberg School of Medicine. I'm Erin Spain, host of the show. The number of teens reporting struggles with their mental health has been rising, but resources to help these young people deal with anxiety or depression can be difficult to access, especially for historically underrepresented racial and ethnic adolescents. An innovative community partnership between Northwestern Medicine investigators and a local library is laying the groundwork to bring digital mental health resources to teens living in and near the west side of Chicago and suburban Cook County. This project was recently awarded the 2023 Dr. Virginia Bishop Community Academic Research Partnership Award from the Alliance for Research in Chicagoland Communities at this year's Feinberg Research Day. Here with details are Dr. Ashley Knapp, Assistant Professor of Psychiatry and Behavioral Sciences at Northwestern University, Feinberg School of Medicine, and Robert Simmons, director of Social Services and Public Safety at Oak Park Public Library. Welcome to you both. Welcome to the show. 

[00:01:20] Robert Simmons, MA: Thank you. 

[00:01:21] Ashley Knapp, PhD: Thanks for having us. 

[00:01:22] Erin Spain, MS: So, Ashley, can you describe to me the mental health crisis that's really impacting teens today and how your work at Northwestern's aims to help address this problem? 

[00:01:33] Ashley Knapp, PhD: Our kids are struggling. I think we see this in the news. And gosh, I mean, about a quarter of teens experience anxiety and pretty extreme versions of that. But then when the pandemic hit, the numbers just escalated as one can imagine. So I just say, they're struggling, and we really need to be innovative and thoughtful in how we get those resources to them. And I think what we're really trying to do, partnering up with the library, is make sure that whenever we're creating, we're getting those teens in who we want to target or who we think that would really benefit from this intervention 

[00:02:02] Erin Spain, MS: I want to talk a little bit about the Oak Park Library, and Rob, your role in particular. You were the first in-house social worker ever at the Oak Park Library, and at the time you were hired, one of the first social workers ever hired by a library in this country. Tell me about the work that you do, and how the library has really become a place and shifted its role so that it can offer support to teens, especially in mental health and other services in the community. 

[00:02:29] Robert Simmons, MA: Absolutely. So initially in 2016, when I started my role at the library, the executive director at the time really was re-envisioning the overall organization, was re-envisioning how we engage with marginalized folks, particularly around people and families experiencing homelessness, those who were definitely, struggling with substance use disorder and other co-occurring disorders that were at the library. A lot of those challenges were being exhibited as behavioral issues. So, the executive director and a couple of other leadership folks were like, if we wanted different outcomes, and particularly in being able to serve folks, we need to really re-envision and think innovatively about how we serve people experiencing poverty particularly. So that's the initial focus when I started was to really create a framework where we had a referral based model, where now we work with about 41 organizations in the Chicagoland area to refer people. We have a partnership with Rush Medical Center where we provide free mental health assessments and additionally now short-term therapy, six to ten sessions for free. So those both are for free for folks. And then, really shortly after that, about two or three years into it, Dr. Knapp reached out about an awesome opportunity to be able to serve marginalized teens, BIPOC teens, and really look at anxiety and be able to create a digital resource. So, that was fantastic. But, you know, since I've been at the library for eight years, we've really been intentional about how we engage, particularly with people who are marginalized and experiencing poverty. 

[00:04:02] Erin Spain, MS: Tell me what you're seeing on the ground with teens who come into the library. 

[00:04:07] Robert Simmons, MA: Sure. So, we are the library, particularly our main branch is one of the safest spaces for teens. We're right down the street from the high school. Oak Park recently just built a community resource center, so for years, I mean, years, I've been working in the community for almost 20 years. There really were not many spaces where teens could go where there's adults, other peers, supervision, things of that nature. So we get a large influx of teens, particularly during the school year, where they participate in programs, they study, they use all of our digital computers and resources as such. We just built a music studio, a creative studio. So I was really blown away when I first started working in the main branch how important the library is to teens particularly. 

[00:04:51] Erin Spain, MS: Now you've paired up to form the Teen Mental Health Services Within Public Libraries Community Research Partnership. What is happening right now with this partnership? We're going to talk a little bit about a study that has been published. You're laying a lot of groundwork, but tell me what the goal of the partnership is. 

[00:05:07] Ashley Knapp, PhD: The goal of the partnership really is to work together both with library workers like Rob, as well as teen patrons or teens that really frequent the library, and then my team at Northwestern. So the goal is to co-create, kind of co-adapt an anxiety intervention to make it culturally relevant to the teens that are served within the Oak Park Public Library, typically BIPOC teens, also teens that are just from lower resourced areas. And so I think that that's one of the main goals, and really whenever we came together, kind of our Venn diagram, but that was really the middle piece is, we're really passionate about how do we get these tools to those folks because us researchers and science, we've been really bad at it. We've been creating for folks that are white. We've been creating for folks that are mid to high SES and we just haven't done a good job about creating for everyone. We've created tools that are for a specific set of folks. So that's one of the aims. 

[00:05:56] Erin Spain, MS: Together, you've recently published a paper in Frontiers in Digital Health investigating how best to implement these services. Tell me about the study. 

[00:06:05] Ashley Knapp, PhD: So with the most recent publication, this is kind of the foundation that we were hoping to lay. And what we did was we interviewed 17 library workers. They ranged from the board of trustees to the executive director, directors, managers, as well as front facing workers, so those folks that you see when you come into the library, as well as those that have just direct contact with teens, which actually are front facing workers as well, but teen services folks too. And the goal was just, how do we kind of understand the landscape of the library? We don't really think about, okay, what is the workflow? Are we going to put more burden on the people if they have to administer the intervention? So it was just really to get to know what's your workflow. When do you interact with teens? When do you engage teens? What do you hear that they struggle with anxiety? What kind of tools do you already have? Because as Rob spoke, gosh, they've been thinking about this for way longer than we have and really been putting the mental health resources there. So what's already there and then what could we do, to complement this? And so what we used was the Consolidated Framework for Implementation Research. So we use that in order just to think about, okay, what are called determinants? What are the barriers and facilitators? So, for barriers, what are things that are there that are decreasing access or making it kind of hard for teens to access mental health or just mental health at the library in particular? And then facilitators, so what are things that are already there that we could really use to optimize both access, but then also just the clinical benefit from the intervention. And we found out so many fun things, and one of them, was it seems that it would be the digital health intervention is really what was wanted by the teens and would fit really well. Because I think in the digital mental health world, we think a lot about, okay, well, digital isn't always the answer. Sometimes non-digits are. So what we learned through this is, actually, this may be a great way to reach teens and the library has resources in order to connect them to that. And then what we also found out were some barriers. What we found is the community, there was some pushback from the more adult community of should the library, is it even their place to help with mental health? So I think why I want to know this at the beginning and why it's such wonderful information is we want to think about that and, and okay, let's get those community members in and let's hear that. What do you know, what are they afraid of moving forward? So I think that's where we just kind of came in and wanted to lay the groundwork of what's there that, you know, that we may need to think about and think of strategies to overcome or what's there that we can really optimize and use. 

[00:08:23] Erin Spain, MS: What are digital mental health services, and why is this a good match for this age group? 

[00:08:28] Ashley Knapp, PhD: So what we know about teens right now is about, almost a hundred percent, have access to smartphones. And so what we're thinking is with the digital part of it, whether it be on the computer or laptop, desktop or their phones, it's just a really good way to get to them. That's how the digital came in. And then the connection with the library is the library offers so many free digital resources. So they have laptops, they have free broadband. They have all these things to check out. So it just seemed like a really nice connection, a). Just to really get at the teen to be where they're at. But then also, let's say that those teens maybe not have consistent access to a smartphone or to broadband, the library could provide that. While we were doing the interviews too, we also did community advisory boards that we were able to team up with two teen investigators. It was so fun. What I love about teens, they tell you how it is, that's why I love working with them. And we knew this, but what was nice to hear this was that the mental health resources for teens aren't sufficient. They said there's really missing BIPOC narrative, especially teen BIPOC narrative, from the current mental health narratives out there. And also the therapist that they said, they're like, they're primarily white. And even if they're white, they're just not culturally sensitive when chatting. So what we really learned from this population was just the resources don't fit them, and then from the interviews, we really got skills. Teens wanted coping skills. So all those wonderful pieces of information we've been putting together over the past couple of years, and we'll have a really skills focused website intervention to help teens cope. 

[00:09:54] Erin Spain, MS: Rob, tell me what it was like for you partnering with Ashley on this project. 

[00:09:58] Robert Simmons, MA: it has been amazing working with Ashley and also just Northwestern overall. When Ashley and I initially spoke, I was excited about not only the accessibility part of creating something where, through our digital platform, teens could use, but this was also an opportunity to engage with the community internally and externally, to really talk about some of the challenges, hearing from teens, hearing from people in the community, having advisory boards where we're actually talking about and examining the importance of tools and introducing something that will help teens really manage anxiety. What I really appreciated about Ashley initially is that in talking about how this would be integrated is the engagement strategy. That's the most important thing that really stood out to me. Ashley has participated in programming. She mentioned the interviews with teens and staff. And, just the engagement piece. Marginalized folks aren't really heard in general in society. And particularly around when it comes to mental health. So, it wasn't taboo. It wasn't, you know, we created safe spaces where people could actually talk about, you know, anxiety, how it's impacting them, but also what a product would look like that they would be able to help them manage anxiety. 

[00:11:12] Erin Spain, MS: And Rob, were you able to use some of those nuggets to help you with the work that you're currently doing? 

[00:11:17] Robert Simmons, MA: Oh, absolutely. Even, still like working with the teen services department, we are a restorative justice library. We have a restorative justice conference coming up, our fourth annual one, but really talking about how to integrate conversations around mental health, how to really, you know, have programming and things that we do that really focus around restorative justice, and then also mental health support and programs. I think there's such an overlap when it comes to how to address harm to someone, peace circles and things of that nature. There are some mental health components to that, but also having larger conversations of how we can really have programming that will introduce more of a mental health focus, accompanied with the restorative justice practices that we use. That's so important. So I'm so proud of that. 

[00:12:04] Erin Spain, MS: Now you've mentioned that the digital mental health services that you think will be provided in the future through this partnership could be a website. What would happen on this website? Do you know what we can expect next? 

[00:12:15] Ashley Knapp, PhD: So we're working with software designers right now. The kind of big basic overview will be skills because that's really what teens wanted. What skills can you teach me in the moment that I can use later, or maybe in the moment when I'm really stressed, I can go on this website. So it'll be really, really skills based. Another big component that came out of the interviews from library workers and teen patrons was teen specific and culturally relevant additional mental health resources. My team is, oh gosh, that's so thankful for my research team. Miguel Herrera gets a huge shout out. Emily Mischel. So what we've been doing over the past couple of years is putting together local and national mental health resources. So there'll also be that. And then something that we've been recently thinking about is testimonials. So teens really wanted a social aspect to this. So teens are going to write testimonials of how they experience anxiety, what's been helpful for as they cope. And what we've learned from literature is that it's really helpful to relate and to feel seen. So that will also be a component of it. 

[00:13:07] Erin Spain, MS: So there might be assessment tools. There won't be like live person to person interaction necessarily. 

[00:13:13] Ashley Knapp, PhD: Yeah, exactly. So it will be self guided. And I think that's going to be the fun thing to research. One thing with digital mental health, what we're seeing is that there's high engagement at the beginning of like one session, but we don't really see engagement past that session. So I think what we're trying to do is, could we do a campaign with the library or could we do a research day? So I think that's what we're trying to think about right now is, a). how do we maybe even just match the, okay, they may only come to this one time or if they do decide to go on to the other because I think there'll be like four or five modules or four or five videos, how can we get them to engage in that? What's pretty fun is we've been talking about rewards that are kind of internal to the library. So, teens will accrue points from completing modules or doing a testimony, and then maybe they could cash those points in for things that are pretty hot at the library. And Rob can speak better to this, but laptops or I know the recording studio is like really popular among teens. So that's what we've also been trying to think about engagement wise. 

[00:14:06] Erin Spain, MS: And Ashley, really, this could be early intervention because while cognitive behavioral therapy and medication are often evidence-based go-to treatments, sometimes just knowing these skills and how to manage your wellness can be that early intervention that a child needs. 

[00:14:23] Ashley Knapp, PhD: Exactly, exactly. And, that's actually what we're hoping for is this isn't a treatment. There won't be therapists, you know, therapists involved, but we're hoping this is a tool. What we know is so many folks, let's say, have insurance or aren't able to get a mental health appointment, there's so much waiting time involved, so could it be during that waiting time? Or maybe they just need a little booster of, oh yeah, this is how, the box breathing, this is how, I forgot about this. So I think that's what we're really trying to do and I think it's so perfect, too, for the public library. It's not treatment, but it's a tool out there because there's just waiting, or there's just not many people that actually can get into treatment. 

[00:14:57] Erin Spain, MS: Tell me about the support that you've had from your colleagues at Northwestern, at Feinberg. Implementation science is a research pillar. It's becoming very important to the work that we're doing. How do we address this research to practice gap? It's becoming an important issue. Tell me about the response from your colleagues. 

[00:15:16] Ashley Knapp, PhD: it's been really fun. I feel like we're living our childhood dreams of working with libraries, because we're all nerds here. It's been really fun, and I think what the discussions have been about is, Oh yeah, how can we think more innovatively about where we put that. As you said, the research to practice gap, I call it a chasm. It's just, it's crazy how long it takes to get evidence-based resources into practice and as well as how very few get into practice. And as Rob said, there has been this shift in libraries where they are providing mental health resources for a while, and understanding that's what the real patron need is, and libraries have stepped up. They've really met that need. 

[00:15:49] Erin Spain, MS: And Rob, what's your hope for this project going forward? What do you want to see it do? And how do you want to see it help the teens that you serve? 

[00:15:57] Robert Simmons, MA: So my hope is that, once we have the product ready to go and we want to launch, is that we can actually market it to the community and really engage with the schools, middle schools and high schools, really get the teens involved in the community awareness component around the product. So actually having forums at the library, having team led discussions with key stakeholders and peers about not only the product, but again, appreciation around having a digital tool at Oak Park Public Library that teens could use, managing anxiety and really, again, creating a safe space, but also a safe narrative, right? So around that, community awareness, so people really feel comfortable about even discussing mental health issues. I would like a continuum where we have a comprehensive model where we can actually offer mental health supports, digitally, but also in-person or virtually as well. That's the social impact that I'm hoping for. 

[00:16:52] Erin Spain, MS: So this partnership has been recognized by the Alliance for Research and Chicagoland Communities, a program for the Center for Community Health at Northwestern. You've been recognized with a 2023 award at Research Day that really showcases important work happening in the community. Ashley, what would you like to say about receiving this award, and what information would you like to share with colleagues who have not been involved in community engaged research? 

[00:17:18] Ashley Knapp, PhD: it was an honor. It was an honor to receive it with Rob. And just an honor of the work that we've been doing. We've been working since 2019. We've been working really hard. So it was really cool to see that honored. Everyone needs to do community engaged research. Everyone needs to pivot and do this. I know I'm biased, but if we want to create products that people are actually going to use, we have to think about who we're going to partner with. Community organizations, they've been there. They've cultivated that trust. They're there. And also folks in those community organizations, they're experts. And I think so many times we do this top-down approach where us scientists think we know all the things, and then we put that in intervention and then we scratch our heads when teens don't use it or it doesn't have the clinical benefit.So I guess it's just a call to do better and really get in the community. It takes time. It's off the clock and it's so, so needed and worth it. But I just, the joy that I found from, just Rob, like just our friendship has been so fun. I still chat with a lot of the teens. It's just also really joyful. If I can be selfish. It brings a lot of joy. 

[00:18:17] Erin Spain, MS: Well, and Rob, what would you say to other folks listening and community organizations? Why should they pair up with a scientist like Ashley from Northwestern? 

[00:18:27] Robert Simmons, MA: So for us at the library, being able to partner with a research partner particularly, we really were able to, do deep dives in looking at mental health, and mental health challenges in regards to serving teens. And you mentioned early intervention, that's another goal that I was hoping that would result from this partnership. And again, it's actually quality services and support for free. I'm just ecstatic about that. 

[00:18:51] Ashley Knapp, PhD: I think what has been such a wonderful resource for me, if folks want to be like, oh, where do I even start with community engaged research? ARCC, the Alliance for Research in Chicagoland Communities, that's where I've learned so much. I've learned so much about anti racism. I've learned how, as a white researcher, how do I come into these neighborhoods that have really been abused by research. And how do I take ownership for that, even if I personally didn't do that? Understanding that, yeah, the mistrust is because we've done wrong. We've used people. I've learned all of that from ARCC, and how to approach that. And what to do when I mess up. I've messed up so many times. And what, how do I come back? Also just, learning from the webinars and they also have really wonderful seed grants, just to kind of get started of partnership building seed grants. So the advisory boards and the teen investigators were both paid via this, this seed grant. So I will say, they're some of my favorite colleagues and some of the best humans. 

[00:19:41] Erin Spain, MS: So what are the plans for the future? What can we expect next? 

[00:19:45] Ashley Knapp, PhD: What kind of future directions or what we're thinking is we really want to kind of scale this up. So, what we know about this library, it's very well resourced. So what about libraries that have less resources? What about libraries in rural areas or suburban? So what's so fun is Rob and I are thinking about and taking action to how do we expand this, so once we kind of pilot it in this particular library. 

[00:20:05] Robert Simmons, MA: Ashley and I have, have talked about ways that we can speak at ALA conference or PLA conference, and taking the research and sharing it on the road, right? Information is power, and it's also encouraging for folks that may not have the resources that Oak Park Public Library has. So I get asked a lot, how do you pay for it? How do you leverage your partnerships around how to do some cool projects such as this? So we're going to be intentional about the actual community awareness and really getting in front of some folks to talk about our project. 

[00:20:38] Erin Spain, MS: Well, thank you both so much for coming on the show and talking about this program, which really is unique. I hope it inspires others to do similar work. Thank you so much. 

[00:20:48] Robert Simmons, MA: Thank you. 

[00:20:49] Ashley Knapp, PhD: Thank you so much for having us. 

[00:20:50] Erin Spain, MS: Thanks for listening and be sure to subscribe to this show on Apple Podcasts or wherever you listen to podcasts and rate and review us. Also for medical professionals, this episode of Breakthroughs is available for CME credit. Go to our website, feinberg. northwestern. edu and search CME.