Transcript

Derek Smith:

Hello and welcome to Baylor Connections, a conversation series with the people shaping our future. Each week we go in-depth with Baylor leaders, professors, and more, discussing important topics in higher education, research, and student life. I'm Derek Smith and our guest today is Danielle Parrish. Dr. Parrish serves as Professor in Baylor's Diana R. Garland School of Social Work at the school's Houston Campus, a nationally recognized expert in prevention of substance-exposed pregnancies. Dr. Parrish serves young people in the juvenile justice system and beyond.

Derek Smith:

Early in her career as a mental health practitioner, she noticed gaps in care for the overlapping health needs of young women in the juvenile justice system and has dedicated years of scholarship and research to addressing those issues. This past summer she was awarded a $3.1 million grant from the National Institutes of Health to test comprehensive risk reduction intervention efforts for young women. The program is called CHOICES-TEEN, and it's very exciting to get to see this next step in its evolution and it has the potential to change the way, in a lot of positive ways, that young women in the juvenile justice system are served. It's great to have you on the program today and visit with you, Dr. Danielle Parrish. Thanks so much for joining us on the program today.

Danielle Parrish:

Thank you for having me, Derek. It's a pleasure to be here.

Derek Smith:

Well, it's great to have you here. People may recognize you if they've taken a look at Baylor social media, if they're not completely familiar from their work, they might have seen you in our R1 ad campaign from this past fall and continuing to see that. We appreciate you being a part of that through the rigors of photo shoots and interviews and more, but it's really important to highlight your work. So thanks for being a good sport for all of that.

Danielle Parrish:

Well, I really appreciate the opportunity and I'm just completely honored to be a part of that effort.

Derek Smith:

Now, well, you and your colleagues at School of Social Work in Houston and in Waco doing a lot of great research, but I want to ask you as we start off, about the Houston campus, it's a bit of a hidden gem probably to most of us here in Waco. I'm curious, what's unique about the School of Social Works, Houston Campus, and what do you enjoy most about being a part of Baylor there in Houston?

Danielle Parrish:

Houston is either the most diverse city or one of the most diverse cities in the US, depending on what source you look at. What I love about living here is the international diversity and the integrated racial, ethnic diversity in my own neighborhood and among many places in Houston. From a teaching and research perspective, this diversity leads to valuable research opportunities and extremely rich teaching opportunities in the classroom with our students.

Derek Smith:

Every community, certainly Waco presents unique opportunities, but when you talk about Houston, I believe the fourth largest city in the nation as you said, by different measures perhaps the most diverse in the country, what kind of learning lab is that for your students?

Danielle Parrish:

Well, it's an incredible learning lab for our students because they get to learn from one another in the classroom setting. There's great diversity in terms of age, experience, ethnic and racial diversity in our classes, and so they learn from each of other but they also learn from their field placements, which are taking place in one of the most diverse cities in the United States.

Derek Smith:

Visiting with Dr. Danielle Parrish, and let's dive into your work with young people in juvenile justice, in particular, as we dive in, let's sort of set what you do for people and we mentioned it very briefly but stating broadly, how would you describe your research mission and the goals and the work you do?

Danielle Parrish:

My overall mission and goals are to conduct research that supports a rehabilitative and developmentally informed approach with youth who happen to get involved with the juvenile justice system. We've learned clearly that detention can be harmful for youth, and for youth development, and that more detention or incarceration leads to worse outcomes. Therefore diversion-focused community-based treatment and prevention services that are a good fit for this population may prevent these harmful outcomes while also helping to achieve health equity in underserved communities.

Danielle Parrish:

One challenge I've identified in my work, in a recent survey of staff who are working with the juvenile justice system, is the lack of evidence-based services for referred young women, specifically, who present with multiple overlapping health or mental health risk factors. These staff actually express a strong desire and need for more efficacious programming to help these young women improve their health wellbeing and to reduce recidivism. I'm hoping that my work and research, which is done with feedback and input from these youth, will help reduce these risks while also building on their strengths, and that the long term impact of this work will be to increase community-based prevention services that improve adolescent development and wellbeing and increase health equity in society, more broadly.

Derek Smith:

Dr. Parrish, what is it about serving young people in the juvenile justice system that particularly speaks to you, that really kind of led to your calling in this?

Danielle Parrish:

I was drawn to social work more generally due to a desire to empower and support underserved, often forgotten, individuals in society. I knew I wanted to work with children and families, but my passion for helping young people referred to the juvenile justice system emerged after being placed in my second MSW Field Placement at the juvenile detention center in Fresno, California. The kids I worked with there had so many strengths, so much potential and were at a pivotal point in their lives where they could make important decisions about their future, yet many were also struggling with so many challenges, difficult family dynamics and conflict, gang involvement, difficulty in school, or with educational disabilities, substance use, abuse, trauma exposure, mental health symptoms, and in young women in particular, high rates of pregnancy. These high rates of pregnancy were obvious, at least a third were visibly pregnant at any one time on the girls unit.

Danielle Parrish:

I knew that if we could just reach these young men and women and offer necessary services, it could have a huge impact on their development and future health and functioning in society. However, there were just never enough services to address these needs and this really stood out to me, and the few services that were provided were offered in silos, substance use treatment separate from mental health treatment separate from family therapy. Having so many things offered separately made many of these services not feasible to access for them, and overlapping all of that, were these challenges with transportation and time for many of these families. This experience was very pivotal for me and really highlighted a need that I really couldn't forget and that I wanted to focus on to improve these services and improve the conditions for these youth.

Derek Smith:

Dr. Parrish you mentioned silos, and it seems like there were a lot of very earnest to diligent people providing care but it was maybe regimented a bit, to hear you describe that, how much has eradicating those silos and kind of integrating different streams of care, how much has that idea shaped your approach to the work you've done?

Danielle Parrish:

Yeah. A big part of my work is looking at ways that we can make services more efficient and more integrated so that when we have these opportunities to engage these youth and these families that we use that time in the most effective way that we can, and that we recognize those barriers. And so a lot of my work focuses on how do we integrate technology to make services more accessible and how can we bundle things together so that we can have the most benefit with the time we have with them?

Derek Smith:

Well, you've been building towards this and the grant that we're going to talk more about for a while now, but let's talk about CHOICES-TEEN. We mentioned that at the top of the program, what is CHOICES-TEEN, and when did you be first become involved with that organization?

Danielle Parrish:

CHOICES-TEEN is actually an adaptation of the original CHOICES intervention that was developed originally by Dr. Mary Velasquez and her team through a line of research funded by the Centers for Disease Control and Prevention to reduce the risk of substance-exposed pregnancy, specifically alcohol-exposed pregnancy, initially. I was very fortunate to have the opportunity to work under Dr. Velasquez's mentorship during my postdoc at UT Austin in the Health Behavior Research and Training Institute there. During my work there, I helped coordinate a CDC-funded, randomized controlled trial to test the efficacy of the CHOICES intervention for adult women. This particular study looked at the adaptation of this intervention from four to two sessions, so it was getting more efficient, and it was targeting not only alcohol-exposed pregnancy, but nicotine-exposed pregnancy, and this study took place in Houston, in the Harris Health System here.

Danielle Parrish:

It was a perfect move for me to continue my work with this team as a co-investigator after I took my first faculty position at the University of Houston, and then and I continued in my collaboration with this amazing team and many new team members that I met in the Texas Medical Center on future CDC and NIH-funded grants, including a large randomized trial funded by NIAAA to compare the efficacy of a counselor-delivered choices intervention to a tablet-based choices intervention in the Harris Health System, Dr. Velasquez was the PI on that, and then my own NIH, NIDA-funded R3 pilot study to adapt choices for younger women in interfacing with the juvenile justice system. That was really pivotal on the current study that I'm doing now, because that laid the groundwork for the R1 application that we're currently implementing.

Danielle Parrish:

Now I'm continuing to work with this amazing dream team, as I call it, on the current grant. Dr. Von Sternberg, who also is at the Health Behavior Research and Training Institute at UT Austin, as Associate Director, is multiple PI on the current project. It's just been wonderful to be involved with this team, and it all kind of came together perfectly in that I knew about these challenges with this particular population having worked with youth in the juvenile justice system before, and then I learned about this intervention, CHOICES, and it just was the perfect fit. I'm so grateful that I was able to do this postdoc with Dr. Valesquez and carry this work forward in a different direction with a new population.

Derek Smith:

Visit with Dr. Danielle Parrish, as we talk about CHOICES, how should those of us, sort of outside of your discipline, think about what's unique about CHOICES as opposed to other interventions that are out there? Obviously this is something that has played a pivotal role in your research, what is it about that, about CHOICES in particular, you especially appreciate?

Danielle Parrish:

The CHOICES intervention and various adaptations of it, such as CHOICES-TEEN are unique in that this intervention targets multiple health risk behaviors at one time among young women of childbearing age. Various iterations have targeted marijuana use, alcohol use, nicotine use, unplanned pregnancy, HIV and STIs or sexually transmitted infections, and then the overlapping risks of these behaviors that can result in substance-exposed pregnancy or HIV, STI-impacted pregnancy. While the primary outcome of interest is preventing substance-exposed pregnancy, a condition that's a 100% preventable, we're also hoping to impact women's health by tailoring the intervention to help women find their own reasons for changing all of these behaviors to improve their health and the intervention's called CHOICES because young women make their own choices about the behaviors they change and how to reduce the risk of substance-exposed pregnancy.

Derek Smith:

This is Baylor Connections. We are visiting with Dr. Danielle Parrish, Professor in Baylor's Diana R. Garland School of Social Work at the school's Houston campus. This summer, she was awarded a $3.1 million National Institutes of Health grant. As we talk about the CHOICES program and testing the efficacy of CHOICES-TEEN, the NIH grant, obviously that's going to be a big shot in the arm for the work you do, and already, in these months since it was awarded, how is that grant impacting your work?

Danielle Parrish:

Wow. I'm just so grateful to have the opportunity to do this work and the NIH grant provides the necessary resources that we need to test the efficacy of the CHOICES-TEEN intervention with young women who have interface with juvenile justice or diversions systems. Having those resources which are required for recruiting and retaining participants, data collection, provision of the intervention by trained staff, technology development, we're going to have a telehealth component, and a mobile health app, and other resources. It would be impossible, without these resources, to do all of those things, so I'm really excited about that. I'm really excited in what all of this work can culminate in, eventually, and that's that we will, if efficacious, we'll be providing one of the first of many gender-responsive programs for this population, hopefully, and thereby filling an important gap of services for this population who has been so underserved when it comes to health and health prevention.

Derek Smith:

What goes into testing the efficacy of this, what's it look like and what kind of timeframe does it take?

Danielle Parrish:

This project is a five-year project and we will be working with Harris County Juvenile Probation through their community probation and diversion services to recruit young women and we'll be looking at the efficacy of the intervention through a randomized controlled trial and collecting data over about a four-year period. It's a long project, but we're really excited to do the work and we're excited to be engaging with this population and learning from them.

Derek Smith:

Dr. Parrish it has sort of a dual benefit, you're helping the young women in the system, you're also giving other practitioners better tools to serve. What does it mean for you to be able to work to provide people who are doing that on-the-ground work with tools that can improve the efficiency and the impact of their work?

Danielle Parrish:

It means so much because I always kind of go back to my experience as a social work practitioner or a mental health clinician being in the field, and what I'm hoping that it will allow us to do is translate something that is truly feasible and truly impactful into real settings so we can help improve lives and I think, as a former practitioner, that was the kind of thing I was looking for, is what is something that we can do that truly has impact and we know it works and it's something that I can actually carry out and people will hopefully show up for and complete?

Derek Smith:

These NIH grants they're competitive, and when you talk about the amount of money, $3.1 million, there's a lot of faith they have to put in you and the work you're doing and kind of understanding what it is that you do. What does it mean to you and to your colleagues and partners on this to have this project supported by the NIH?

Danielle Parrish:

It means so much, in particular, I'm just thrilled that this area of research is supported by the priorities of the National Institutes of Health and NIDA, and that our peers found our proposal to be rigorous, innovative, and significant. I'm also really grateful for the generous support that makes this work possible. High quality research requires necessary resources and I'm so excited to do this important work that I hope will improve the health and lives of these young women.

Derek Smith:

Talking to Social Work professor Danielle Parrish, excuse me, here on Baylor at Connections. Dr. Parrish, let's talk about what brought you here to Baylor? How long have you been a part of the Baylor faculty and what was it that drew you here?

Danielle Parrish:

I joined Baylor in 2018, so I've been on faculty now for a little over three years, and I was excited to join Baylor for several reasons. First, I had been very impressed with the faculty and the dean at the Diana R. Garland School of Social Work for a few years, I had met several of their faculty at conferences, and I really loved the collegial culture of the school, you could just really tell there was a caring culture there. Second, I was really impressed with the way Baylor was able to maintain its commitment to both high quality teaching and research, as I'm passionate about both of those things. There are so many supports at Baylor for faculty to develop their teaching and to be excellent teachers, and there are high expectations for this which I also value and you don't always see that in research-intensive universities.

Danielle Parrish:

At the same time, there was a clear commitment to building an R1 institution, and I was excited to join a university that I knew was very intentional about this during this time of growth. It's been clear since I've been here at Baylor that they're not only talking about becoming a Christian Research 1 institution, but there's really an active commitment of resources and structures that are there to help faculty be successful in this process. Finally, as a Christian, it's been a joy to work in an institution that has a Christian commitment and that provides such a caring community, as you're surrounded by others who are pursuing their calling and living their faith. I didn't realize this at the time I came to Baylor, but I'm also really appreciating the high quality students that I've had the opportunity to work with, some of the best over my 21 years of teaching at the PhD level and MSW level.

Danielle Parrish:

It's also been a benefit, for me personally, to work in a place that allows me to integrate all parts of myself, both my intellectual life and my Christian faith, and that even values my family. I was just thinking recently about a recent trip to Baylor with my daughter from Houston and I was on mommy duty and had some things to do and I was getting some head shots done and the photographer invited her to jump into some of the shots, and that's the sort of thing that I don't think happens in other places like it does at Baylor.

Derek Smith:

Into the final moments of the program, to summarize as we wind down, as we envision the future of the work through the grant and really just your research in general, as you look ahead, what are you most excited about undertaking, accomplishing, and then working towards?

Danielle Parrish:

The most exciting part that is driving my current work is discovering whether the intervention, CHOICES-TEEN, is efficacious, and if so, taking it into the real world so that it can help others and have a broad impact.

Derek Smith:

Absolutely. Well, we will look forward to seeing that, seeing the results of your research over the next few years, and it's been fun to celebrate that grant with you as well. Congratulations on that, thanks for taking the time to share with us today and thanks for just sharing us more about your research here on Baylor Connections.

Danielle Parrish:

Thanks so much for having me Derek. It was a pleasure. Thank you for having me.

Derek Smith:

Absolutely. Thanks for coming on. Danielle Parrish Professor in Baylor's Diana R. Garland School of Social Work at the Houston campus, our guest today here on Baylor Connections. I'm Derek Smith. A reminder you can hear this and other programs online at baylor.edu/connections, and you can subscribe to the program on iTunes. Thanks for joining us here on Baylor Connections.