KATHLEEN ELL has conducted extensive research on health care-seeking behavior, major depression, general psychological distress, quality of life and morbidity, and mortality associated with life-threatening illness and chronic illness. A hallmark of her research and numerous publications has been a focus on low-income and ethnically diverse populations.
Ell's research career began in 1971 in public sector care. In her social work practitioner role, Ell observed that depressed coronary care unit patients were more likely to die and conducted a study that was referenced as one of a few studies supporting the 1996 National Institutes of Health depression trial of 3,000 heart patients. Since 1980, Ell has been a principal investigator of five longitudinal studies funded by the Centers for Disease Control, the National Cancer Institute and the National Institute of Mental Health. She is currently co-principal investigator of a Department of Health and Human Services longitudinal study of 1,500 low-income diabetes patients and has two RO1 proposals under review aimed at dissemination, sustainability and integrated uptake of patient-centered safety net care. She has created a community research partnership with the Los Angeles County Department of Health Services (DHS), the second largest U.S. publicly supported safety net care system. Within DHS, results from her work have facilitated current uptake in integrating medical and behavioral health via a pilot program in which the county's Department of Mental Health co-locates graduate social workers within DHS patient-centered medical home community clinics, and an in-place DHS primary care depression care protocol modeled on her previous studies. Her collective body of work has focused on the improvement of community-based services for patients with abnormal cancer screens, individuals diagnosed with clinically significant depression, which is often concurrent with acute and/or chronic medical illness; socio-cultural adaptations aimed at reducing barriers to optimal care receipt; and patient-centered care preferences and uptake, psychological and medical outcomes, and medical provider needs to advance collaborative care models. All of her work has highlighted the effectiveness of diverse and changing roles and skills of social workers and social work assistants in optimizing medical care. Her emerging health information technology application research is also significantly focused on social work clinician preferences, needs and application in real world practice.
In addition to her senior faculty appointment, Ell serves as the behavioral health research director of the Center for Innovation and Research on Veterans and Military Families with principal responsibilities for doctoral student, post-doctorate and faculty mentoring, as well as developing and conducting research on military service and family members. She also holds a research leadership role within the USC Telehealth clinic. Ell is among the directors of the USC Clinical and Translational Science Institute Office of Community Engagement. She has also received NIH-funded minority supplements to provide mentoring and real-world research opportunities for two social work faculty, one psychiatrist, one behavioral scientist and one doctoral student.
She has authored 83 publications, including two books. Ell has long been a strong advocate for increasing social workers' contributions to translational science and randomized clinical trials aimed at significantly advancing evidence-based and interdisciplinary social work practice. To actively promote these agendas, while on leave from the university, she worked at the NIMH and served as the executive director for the Institute for the Advancement of Social Work Research in Washington, D.C. She currently serves on the editorial board of the Journal of the Society of Social Work and Research and the consultant editorial board of the Journal of Consulting and Clinical Psychology.
Over the past 16 years, Ell's comparative effectiveness research routinely examines multiple issues via multiple research methods, such as patient randomization and/or comparison across diverse care systems, and qualitative assessments of patients, providers and organizational decision-makers. This approach has helped to advance the understanding of disparities in care access and uptake by identifying socio-culturally driven patient behavior, collaborative medical and mental health provider behavior, and medical organizational priority-driven aims in the context of cost and cost-effectiveness concerns. For example, patient barriers include difficulty in communicating with medical providers and navigating multiple care/provider systems, culturally influenced stigma, treatment preferences and adherence, managing concurrent chronic medical illness (medication, self-care, pain, anxiety), while simultaneously experiencing ongoing and intermittent social and economic stress. Primary and specialty care providers are time pressured when communicating with behavioral health providers. Despite having disproportionately greater need, safety net organizations have fewer resources to support optimal acute and ongoing follow-up behavioral health care – an issue Ell believes is critical, as health care delivery adopts change in patient-provider communication and collaboration across behavioral and medical providers.
For over three decades, her research has been highly inter-disciplinary in its approach and structure. This is exemplified in all her past and current studies and her introduction of social work into the initial development of the Clinical Translational Science Institute at USC. Today, her work continues this research trajectory via an extension of her multi-disciplinary research to include the school of engineering, as she engages in studying rapidly emerging technology-enhanced and telehealth care models with the aim of facilitating patient-centered care access and treatment uptake while reducing care costs, improving patient outcomes and advancing provider uptake. Her work has been nationally recognized by the National Cancer Institute and the Agency for Health Research and Quality via selection of her research as being ready for national uptake.
From the start, Dr. Kathleen Ell struggled to decide between a career in nursing and one in social work. While she pursued the latter, Ell has essentially married the two disciplines throughout her prolific research career, focusing on health-care seeking behavior, depression among the terminally ill, and other psychological issues surrounding life-threatening illnesses among low-income and ethnically diverse groups. As a result, her research has paved the way for others seeking to improve health and mental health care for low-income populations.
Ell conducted field work in impoverished neighborhoods as an undergraduate at Valparaiso University and worked as a social work assistant in the basement ward for low-income patients at Barnes Hospital in St. Louis. She visited her first client, an African American woman with leukemia who had no family or friends, every day for three months. “I walked in one day and the bed was empty, and I knew what had happened,” she says. “That was a very clear moment for me. I ran off the ward crying.” The experience sparked her desire to bring solace and comfort to those in pain.
After joining the Los Angeles County + University of Southern California Medical Center, Ell took a brief break to earn her MSW from UCLA in 1966 before returning to the medical center’s coronary care unit, where she noticed that patients with depression seemed to have higher mortality rates. She secured research funding, and the resulting study became one of the earliest reports of the association between death and depression among coronary patients. After USC faculty helped her receive additional training, Ell returned to UCLA to complete her doctorate and became the first social worker to receive research funding from the American Heart Association. In 1993, Ell received a request from the National Institute of Mental Health to serve as an advisor for six months. She stayed for two and a half years and became director of the Institute for the Advancement of Social Work Research, working with Congress to promote social work as a research profession.
A defining characteristic of Ell’s research is its interdisciplinary nature; she often involves physicians and other specialists, such as health economists. A key for Ell is the applicability and uptake of her research. Recent reports have suggested that the gap between developing effective tools and translating them into practice is 15 to 20 years. “We have to do something about getting our research into real-world services,” Ell says. “We have to partner with community organizations and service systems.” To that end, she is involved with the Southern California Clinical and Translational Science Institute, which seeks to speed research into practice.
In addition to taking on informal mentoring roles, Ell works with promising doctoral students and has mentored numerous scholars throughout her career. She is interested in exploring military social work issues, such as post-traumatic stress disorder treatment, as well as linking cancer care with primary health care.
Wells, et al. (in press). "Low-income Cancer Patients in Depression Treatment: Dropouts and Completers." Journal of Behavioral Health Services & Research.
Nedjat-Haiem, F.A., Carrion, I., Lorenz, K.A., Ell, K. & Palinkas, L. (2013). Psychosocial Concerns among Latinas with Life-Limiting Advanced Cancer. Omega. 67, 165-172.
Fann, J., Ell, K. & Sharpe, M. (2012). Integrating Psychosocial Care into Cancer Services. Journal of Clinical Oncology, 30(11), 1178-1186.
Nediat-Haiem, F.A., Carrion, I., Ell, K. & Palinkas, L. (2012). Navigating the Advanced Cancer Experience of Underserved Latinas. Supportive Care in Cancer, Online First.
Ell, K., Katon, W., Xie, B., Lee, P.J., Kapetanovik, S. & Chou, C.P. (2012). Depression Symptom Deterioration among Predominantly Hispanic Diabetes Patients in Safety Net Care. Psychosomatics, Online First.
Hay, J., Katon, W., Ell, K., Lee, P.J. & Guterman, J. (2012). Cost Effectiveness Analyses of Collaborative Care Management of Depression among Low-Income, Predominantly Hispanics with Diabetes. Value in Health, 15(2), 249-254.
Nedjat-Haiem, F.R., Lorenz, K.A. & Ell, K. (2012). Experiences with Advanced Cancer among Latinas in a Public Health Care System. Journal of Pain and Symptom Management, 43(6), 1013-1024.
Wells, A., Palinkas, L.A., Qui, X., Ell, K. & Palinkas, L. (2011). Cancer patients’ perspectives on discontinuing depression treatment: the “drop out” phenomenon. Patient Preference & Adherence, 5, 465-470.
Ell, K., Katon, W., Xie, B. & Lee, P.J. (2011). One Year Post Collaborative Depression Care Trial Outcomes among Predominantly Hispanic Diabetes Safety Net Patients. General Hospital Psychiatry, 33(5), 436-442.
Ell, K., Xie, B., Quinn, D., Kapetanovik, S., Lee, P.J., Wells, A. & Chou, C.P. (2011). Collaborative Depression Care among Low-income, Minority Cancer Patients: 1-Year Post-Intervention Sustained Depression Improvement or Recurrence and Trial Attrition. Psychiatric Services, 62, 162-170.
Palinkas, L.A., Ell, K., Hansen, M., Cabassa, L. & Wells, A. (2011). Sustainability of Collaborative Care Interventions in Primary Care Settings.Journal of Social Work, 11, 99-117.
Ell, K., Lee, P.J. & Xie, B. (2010). Depression Care for Low-Income, Minority, Safety Net Clinic Populations with Co-Morbid Illnes. Research on Social Work Practice, Online First.
Ell, K., Katon, W., Xie, B., Lee, P.J., Kapetanovik, S., Guterman, J. & Chou, C.P. (2010). Collaborative Care Management of Major Depression among Low-Income, Predominantly Hispanics with Diabetes: A Randomized Controlled Trial. Diabetes Care, 33, 706-713.
Ell, K., Aranda, M., Xie, B. & Lee, P. (2010). Collaborative Depression Treatment in Older and Younger Adults with Physical Illness: Pooled Comparative Analysis of Three Randomized Clinical Trials. American Journal of Geriatric Psychiatry, 18, 520-530.
Ell, K., Vourlekis, B., Xie, B., Nedjat-Haiem, F., Lee, P.J., Muderspach, L., Russell, C. & Palinkas, L. (2009). Cancer Treatment Adherence among Low-Income Women with Breast or Gynecologic Cancer: A Randomized Controlled Trial of Patient Navigation. Cancer, 115(9), 4606-4615.
Ell, K., Katon, W., Cabassa, L., Xie, B., Lee, P.J., Kapetanovik, S. & Guterman, J. (2009). Depression and Diabetes among Low-Income Hispanics: Design Elements of a Socio-Culturally Adapted Collaborative Care Model Randomized Controlled Trial. International Journal of Psychiatry in Medicine, 39(2), 113-132.
Ell, K., Xie, B. & Lee, P.J. (2009). In Reply: The Impact of Collaborative Care Management of Depression among Patients with Cancer. Journal of Clinical Oncology, 27(10), 1730-1731.
Ell, K., Xie, B., Quon, B., Quinn, D.I., Dwight-Johnson, M. & Lee, P.J. (2008). Randomized Controlled Trial of Collaborative Care Management of Depression among Low-income Patients with Cancer. Journal of Clinical Oncology, 26(27), 4488-4496.
Cabassa, L.J., Hansen, M.C., Palinkas, L.A. & Ell, K. (2008). Azúcar y Nervios: Explanatory Models and Treatment Experiences of Hispanics with Diabetes and Depression. Social Science & Medicine, 66(12), 2413-2414.
Ell, K., Xie, B., Wells, A., Nedjat-Haim, F., Lee, P.J. & Vourlekis, B. (2008). Economic Stress among Low-Income Women with Cancer: Effects on Quality of Life. Cancer, 112(3), 616-625.
Vourlekis, B. & Ell, K. (2007). Best Practice Case Management for Improved Medical Adherence. Social Work in Health Care, 44, 161-177.
Ell, K., Quon, B., Quinn, D., Dwight-Johnson, M., Wells, A., Lee, P.J. & Xie, B. (2007). Improving Treatment of Depression among Low-Income Patients with Cancer: The Design of the ADAPt-C Study. General Hospital Psychiatry, 29(3), 223-31.
Ell, K., Xie, B., Unützer, J., Lee, P.J. & Aranda, M. (2007). Managing Depression in Home Health Care: A Randomized Clinical Trial. Home Health Care Services Quarterly, 26(3), 81-104.
Ell, K., Vourlekis, B., Lee, P.J. & Xie, B. (2007). Patient Navigation and Case Management Following an Abnormal Cancer Screen: A Randomized Clinical Trial. Preventive Medicine, 44, 26-33.
Zebrack, B.J., Ell, K. & Smith, W.B. (2007). Suicide Risk in Childhood Cancer Survivors. Journal of Clinical Oncology, 25(6), 732-733.
Brekke, J., Ell, K. & Palinkas, L. (2007). Translational Science at the National Institute of Mental Health: Can Social Work Take its Rightful Place?. Research on Social Work Practice, 17, 123-133.
Ell, K. (2006). Depression Care for the Elderly: Reducing Barriers to Evidence Based Practice. Home Health Care Services Quarterly, 25(1-2), 115-48.
Ell, K. & Quon, B. (2006). Depression Management in Cancer Patients.Psychiatric Times, 23(11), 25-28.
Ell, K., Sanchez, K.M., Vourlekis, B. & Leedom, P.J. (2005). Potential Barriers to Access and Adherence to Cancer Treatment and Symptom Management among Low-Income Ethnic Minority Women with Cancer.Psycho-oncology.
Dwight-Johnson, M., Ell, K. & Jiuan-Lee, P. (2005). Can Collaborative Care Address the Needs of Low-income Latinas with Co-morbid Depression and Cancer? Results from a Randomized Pilot Study. Psychosomatics, 46(3), 224-32.
Aisenberg, G. & Ell, K. (2005). Contextualizing Community Violence and its Effects: An Ecological Model of Parent-Child Interdependent Coping. Journal of Interpersonal Violence, 20(7), 855-7.
Ell, K., Sanchez, K., Vourlekis, B., Lee, P.J., Dwight-Johnson, M., Lagomasino, I., Muderspach, L. & Russell, C. (2005). Depression, Correlates of Depression and Receipt of Depression Care Among Low-Income Women With Breast or Gynecological Cancer. Journal of Clinical Oncology, 23(13), 2052-60.
Vourlekis, B., Ell, K. & Padgett, D. (2005). Evidence-based Assessment for Cancer Abnormal Screen Follow-up. Health & Social Work, 30, 98-106.
Ell, K., Unützer, J., Aranda, M., Sanchez, K. & Lee, P.J. (2005). Routine PHQ-9 Depression Screening in Home Health Care: Depression Prevalence, Clinical and Treatment Characteristics. Home Health Care Services Quarterly, 24(4), 1-19.
Ell, K. & Vourlekis, B. (2005). Social Work in Health Care in 2025: The Landscape and Paths to Transformation. Advances in Social Work, 6(1), 182-192.
Ell, K. & Vourlekis, B. (2005). Social Work in Health Care in 2025: The Landscape and Paths to Transformation. In James G. Daly (Eds.) Advances in Social Work: Linking Research, Education and Practice. Indiana: School of Social Work.
Ell, K., Vourlekis, B., Muderspach, L., Nissly, J., Padgett, D., Pineda, D., Sarabia, O. & Lee, P. (2002). Abnormal Cervical Screen Follow-up among Low-income Latinas: Project SAFe. Women’s Health & Gender-Based Medicine, 11, 1-13.
Ell, K., Padgett, D., Vourlekis, B., Nissly, J., Pineda, D., Sarabia, O., Walther, V. & Blumenfeld, S. (2002). Abnormal Mammogram Follow-up: A Pilot Study among Low-Income Women. Cancer Practice, 10, 130-138.
Ell, K., Vourlekis, B., Nissly, J., Padgett, D., Pineda, D. & Walther, V. (2002). Integrating Mental Health Screening and Abnormal Cancer Screening Follow-up: An Intervention to Reach Low-Income Women. Community Mental Health Journal, 38, 311-325.