For her DNP clinical scholarship project, Danielle Njeri screened residents at DOORWAYS to develop a quantitative measure of rates of depression. The results of her study and information from her literature review helped provide fodder for DOORWAYS staff when planning and funding a new facility that will contain mental health services. (Photo submitted by Danielle Njeri)

Danielle Njeri was delighted when she heard that the Missouri Foundation for Health had awarded a three-year $1.4 million grant to DOORWAYS.

That was mostly because the University of Missouri­–St. Louis graduate knew the nonprofit, which houses and supports HIV/AIDS patients and families in St. Louis, would receive some much-deserved funding for the residents she’d helped care for while working toward her Doctor of Nursing Practice degree from the College of Nursing.

But a small part of her joy was because research that Njeri had had completed while at DOORWAYS was instrumental in uncovering needs and solutions that helped direct the grant request.

“I was part of it, and that’s cool,” she said, “But I’m thrilled that the individuals that DOORWAYS helps, that they provide housing to, will also have access to mental health resources, which is so needed to help further improve their quality of life.”

In 2019, she conducted that research with DOORWAYS for her DNP clinical scholarship project, “Depression in HIV-positive Individuals Living in a Residential Housing Community.” Now the radiology education coordinator at Emory University Hospital in Atlanta, Njeri’s UMSL degree and work with DOORWAYS was an important step toward her goal of chronic disease prevention through education.

Njeri started out as a medical assistant but soon found she enjoyed being hands-on and wanted to do more patient care. She enrolled at the Lutheran School of Nursing, became an RN and began working at the DePaul Health Center while studying for her BSN at Central Methodist University.

After two years at DePaul, Njeri transferred to the cardiac catherization lab at Barnes-Jewish St. Peters Hospital and, a year later, became a radiology nurse supervisor over the interventional radiology department at DePaul.

Through those work experiences, Njeri developed a passion for leadership and education – especially in the African American community – and a recommendation from her husband, an alumnus, made her look to UMSL for her DNP.

“I’ve treated patients who were in their 20s and 30s with end stage renal disease, patients who had no idea that blood pressure could affect their kidneys, that diabetes could affect their kidneys, affect their eyesight, put them at risk for stroke or heart attack,” she said. “Seeing that in the hospital really drove me to want to become a nurse practitioner because I wanted to help prevent patients from being admitted to the hospital with chronic diseases that could have been preventable with proper education.”

The workload of the DNP program was challenging, but Njeri found the experience to be invaluable. She chose the family nurse practitioner track and found mentors in faculty members such as DNP Program Director and Associate Teaching Professor Laura Kuensting, Interim Associate Dean for Academic Programs and Associate Teaching Professor Natalie Murphy and Faculty Fellow for Community Engagement and Assistant Professor Sheila Grigsby.

When it came time to select her project, Njeri took her passion for education and discovered DOORWAYS. She was drawn to the nonprofit’s mission to provide housing and wraparound support to HIV-positive individuals.

“Most people living with HIV are also living with other chronic diseases,” she said. “It is not uncommon for mental illness to be one of them. I thought that DOORWAYS would be a great place to be able to reach out to individuals who were disenfranchised and let them know that somebody cares and to educate them on things that I didn’t learn about until I became a nurse.”

With many years of experience serving people living below the Federal Poverty Level – often reporting zero income at intake – DOORWAYS leaders knew a significant number of the residents suffered from depression, but they needed someone to officially confirm the extent of need through a quantitative study. That’s where Njeri and her project came in.

In May 2019, she held meetings at the seven residential facilities. She gave a short education segment about mental health and screened participants for depression using a patient health questionnaire. Of the attendants, 21 agreed to participate in the screening and 12 – 57 percent – reported depressive symptoms.

Njeri wasn’t surprised by her results, but she was struck by their importance.

“With any chronic disease, not just HIV, depressive symptoms or depression can affect how compliant you are to take meditation,” she said. “Chronic stress on the body can actually decrease our bodies’ immune system, our ability to fight viruses and infections. For individuals who are HIV positive, they already have a weakened immune system. On top of that, the individuals who were part of my research project were primarily African American, they were homeless and they live in poverty. If you take all of that into consideration, even without the HIV, that’s already enough to exert pressure on mental health.”

DOORWAYS Chief Program Officer and master’s degreed social worker Pat Plumley and her colleagues had been wanting to provide more mental health services for residents through the creation of a new facility and onsite program. Receiving Njeri’s results and robust literature review provided confirmation of the value and need for expanded mental health services.

To accommodate the new programming and staff, DOORWAYS launched an agency expansion plan. On Nov. 18, it broke ground on a new campus with 50 one- and two-bedroom apartments to house up to 112 people. Program offices will be located onsite to remove navigational and access barriers to services, which will now be able to expand to include comprehensive mental health screening and counseling where the clients live. Through partnerships, clients will also have access to 24/7 crisis intervention services, support groups, medical case management, pharmacy assistance, employment services, self-development programming, food security resources and more.

“For over 32 years, we have been helping clients stabilize their lives and improve health outcomes with housing and resources to meet basic needs,” Plumley said. “Danielle’s study validated that mental health services must now be included as an essential building block for stability. We believe more clients will reach undetectable viral status – making HIV un-transmittable – if they are able to sustain their treatment plan and self-care program. That is impossible when challenged by untreated mental health issues.”

Though Njeri’s part in that project is over, it’s far from the end for her. She plans on continuing to do work in research advocating and educating others, using methods learned through the course of her DNP to do so.

“When it comes to the African American community with chronic diseases, or even just disenfranchised communities, I lean into more research,” she said. “It’s something that I’m very, very passionate about. I definitely will not stop.”