It’s said that experience is often the best teacher. Ph.D. student Zach Cooper is using his experience as a clinician to lead groundbreaking research that is garnering noteworthy accolades.
The third-year PhD candidate authored “Effects of Integrated Care Approaches to Address Co-occurring Depression and Diabetes: A Systematic Review and Meta-analysis,” a paper that was recently published in the flagship journal of American Diabetes Association. Cooper has an interest in integrated care (IC), and he’s using knowledge gleaned in his doctoral program to examine the impact of IC models to improve diabetes care for individuals with depression.
The paper aligns with the current work Cooper is completing for his F31 Fellowship with the National Institutes of Health, a grant that kicked off with the new year. The fellowship provides promising doctoral students with state-of-the-art research training. Cooper is leveraging this award to acquire training in clinical trials, diabetes research, implementation science, and advanced statistical modeling..
Cooper’s fellowship, paper and study interests share a common beginning. Before enrolling in a doctoral program, he spent seven years as a behavioral health clinician working in community mental health, substance use, and primary care organizations. This work led to several observations, which ultimately shaped his future research and curiosity.
“I became really interested in increasing access. I knew there were a lot of people who needed behavioral health or mental health care who weren’t coming to mental health clinics or seeing therapists,” said Cooper. “What I was seeing in community mental health was that there were a lot of people that had these medical needs, but they wouldn’t go to their primary care doctor. There was this issue of access in both ways.”
The Writing Process
When Cooper applied to the UGA School of Social Work’s Ph.D. program, he also discovered a call to action for a solution-focused grief therapy association award. He saw that opportunity as a way to learn the grant writing process and further develop his skill set.
Cooper partnered with Associate Dean Orion Mowbray to apply for the $2,000 grant, using Mowbray’s knowledge in methods and experience in the area to pitch a project that addressed depression through solution-focused brief therapy in integrated care settings. The duo received the award in 2022, and it served as a learning experience and precursor to Cooper’s current work.
“I spent the whole summer doing all the things,” Cooper said of the project, which ultimately led to a published work titled, “Addressing depression and comorbid health conditions through solution-focused brief therapy in an integrated care setting: a randomized clinical trial.” “Since I’m a clinical social worker, I have familiarity with patient care. I performed the interventions, recruited the participants, and maintained engagement with participants. It was a crash course into how much work goes into intervention research.”
Cooper advanced his integrated care studies, and has found new related populations to study since that first project with the School of Social Work. For his F31 dissertation work, he identified individuals with Type 1 diabetes as a potential group to study.
“I feel like it is a neglected population of people who have really significant and severe symptoms with Type 1 diabetes itself,” Cooper said. “They really have these complex psychological and social difficulties because of the nature of living with a chronic illness.”
Working with co-sponsors Leslie Johnson and Mohammed Ali from Emory University, he is studying the unique effects of a tailored IC approach for people with Type 1 diabetes. This work has been shaped by his most recent publication which demonstrated that IC approaches improve diabetes outcomes for patients with Type 2 diabetes.
“When people get integrated care, they are better off than when they are getting usual care,” Cooper said. “One thing that surprised me was that it didn’t really matter what type of integrated care model you used. There are a lot of opinions on which models are superior, but there wasn’t a significant difference in terms of outcomes.” Now, Cooper is leveraging the support from his F31 to test whether IC approaches also work for people with Type 1 Diabetes. “You can’t assume that the same intervention that was used for people with Type 2 Diabetes will work for those with Type 1. There is a major research gap where we have not studied these IC approaches for Type 1, and we want to make sure they receive high quality care that meets their unique needs.”
Cooper has been cited in more than a dozen published works since 2020, but his recent systematic review and meta-analysis holds a deeper significance.
“It’s always meaningful,” Cooper said. “Every time you (get published), it feels really gratifying that your peers look at your work and think it is worthy of publishing. This was similar, but even a bit more special because it is a journal that I really look up to, and I keep up with its work and it shapes how I do things.”
A Deeper Project
On top of Cooper’s published study, he’s undergoing additional research in conjunction with his F31 Fellowship award. He assembled a “dream team” of advisors, including Mowbray and two Emory professors, to mentor him through the fellowship and advise him through the process.
The team gave Cooper feedback as he developed a research project for his dissertation. F31 fellowship participants are encouraged not to propose their own clinical trial, so Cooper carved out a component in an existing trial with one of his mentors. He detailed his research proposal for the fellowship, including various training and development opportunities.
Titled “A Process Evaluation of a Pragmatic Randomized Controlled Trial to Promote
Mental Health Among Adults With Type 1 Diabetes,” the study will utilize implementation science methods to analyze the acceptability, fidelity and potential scalability of the care model in primary care settings.
One noteworthy component of Cooper’s fellowship project is its emphasis on change mechanisms. His study will try to pinpoint these mechanisms – a relatively unstudied topic in behavioral science research – and introduce a framework for studying them in a broad array of topics. Additionally, the study hopes to find how these mechanisms impact patient outcomes while identifying methods to enhance patient and provider acceptability.
“It’s tricky in these therapy interventions because it’s not like a pharmacological medicine, where you can clearly point to a single ingredient out of the chemicals that make it up,” Cooper said. “For a long time we’ve looked at ‘does this intervention work,’ but my study really gets at, in terms of mental health treatment, ‘how does the intervention work,’ and ‘what are the intervention components that explain why it is working.”
“There is a lot of interest in developing that – the NIH is very interested in it – because it helps you find more precise components.”
With one of the world’s foremost medical research centers interested in his work, Cooper is laying a foundation for future studies in his interest areas and beyond. Including and protecting under-researched populations is key to his efforts, and he looks forward to reaching an impactful conclusion after his fellowship experience and research end.
Cooper is most excited about completing the dissertation process, particularly with his study’s utilization of Grady Hospital in Atlanta for research. The hospital has a record of working with uninsured and underinsured individuals – populations who are not often included in clinical trials – and the study will break barriers in research representation.
“It’s a two-fold approach to hitting gaps,” Cooper said of his study, which is the first of its kind for its target population. “Adults with Type 1 aren’t really focused on as much in terms of behavioral interventions to support them, even more so if the population is underinsured or of lower socioeconomic status. I think we are going to be able to provide some meaningful data. This is the start – there are many different studies that can be done.”
