This Hybrid Type 1 Trial will test the effectiveness of MOVE!+UP, a behavioral weight management intervention tailored to address PTSD-based weight loss barriers. The trial will compare MOVE!+UP to VA’s standard weight loss program on weight and PTSD symptom changes. The study also will identify implementation barriers and facilitators to help understand effectiveness findings and inform future implementation.
Funding Type: Federal
Helping Educational Leadership Mobilize Evidence (HELM): an organizational intervention to promote strategic implementation in schools
This project will adapt and test a leadership-focused implementation strategy targeting elementary school principals in buildings where universal social, emotional, and behavioral programs are being implemented.
Development and testing of a research-based Tier 3 Wraparound model for schools
This project will adapt the defined, research-based, Wraparound care coordination model for youth with complex behavioral health needs to the education environment, including training curricula, installation protocols, fidelity measures, and other components. The project will initially convene national experts and local stakeholders who will review and aid in iterative refinement of materials, followed by a small-scale pre-post pilot, and culminating in a small-scale randomized pilot study comparing proximal and distal outcomes for 60 students in 6 elementary schools assigned to the “Tier 3 Wraparound” protocol versus services as usual.
Brain Injury Rehabilitation: Improving the Transition Experience (BRITE)
Moderate to severe traumatic brain injury (TBI) is a common cause of long-term disability. Persons with TBI receiving care in inpatient rehabilitation facilities (IRFs) are at risk for rehospitalization, poor community reintegration, family stress, and other unfavorable outcomes. In a six-center randomized pragmatic comparative effectiveness study, we compare the effectiveness of two methods for transition from IRF to the community. The Rehabilitation Discharge Plan (RDP) includes patient/ family education and referrals for continued care. The Rehabilitation Transition Plan (RTP) provides RDP plus individualized, manualized care management via phone or videoconference. 900 patients will be randomized, with caregivers also invited to participate. Assessed outcomes include societal participation, quality of life, caregiver well-being, and use of healthcare resources at 6-months and 12-months post-discharge.
Using technology to optimize Collaborative Care management of depression in urban and rural cancer centers (SCOPE)
This project aims to improve the treatment of depression in cancer patients. Up to 25% of people with cancer will become clinically depressed, significantly affecting their quality of life, functioning, and ability to tolerate cancer treatment. Unfortunately, about 75% of cancer patients with depression do not receive adequate treatment, and patients in rural settings are even less likely to receive adequate care. This study uses a human-centered design approach to develop, build, and test a web and mobile platform to enhance the implementation and fidelity of collaborative care management (CoCM) of depression for patients being treated at urban and rural cancer centers. In Phase I, patient-facing web and mobile applications and a clinician facing website will be developed. In Phase II, the technology-enhanced system will be compared to usual CoCM in a pragmatic effectiveness-implementation randomized controlled trial.
Impact of medical and recreational marijuana laws on cannabis, opioids and psychiatric medications: national study of VA patients, 2000 – 2024
We will analyze Veterans Health Administration electronic medical record data to determine the effects of medical marijuana laws (MML) and recreational marijuana laws (RML) on cannabis (use and cannabis use disorder); opioids (prescriptions, fatal and non-fatal overdoses, opioid use disorders); and psychotropic medication prescriptions, providing important information on MML and RML effects in VA patients and in others with similar vulnerability factors to researchers, policy makers, health professionals and the public.
Preventing addiction related suicide
To evaluate the use of an existing selective suicide prevention intervention, Preventing Addiction Related Suicide (PARS), for use with Veterans by: 1) adapting and tailoring content to Veteran populations and 2) conducting an open trial within a VA substance use disorder intensive outpatient program.
Evaluating the Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) Program
The Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) program is a national VA initiative which aims to improve access to treatment medications for opioid use disorder (OUD) in primary care, pain management, and mental health clinics. The Seattle CESATE is conducting ongoing evaluations of SCOUTT to understand providers’ perspectives on the initiative and the outcomes for Veteran participants. Project aims also include to: assess patient retention in and compliance with SCOUTT, assess changes in number of waivered and prescribing providers, retention in and compliance with stepped care, and identify barriers and facilitators to implementing, sustaining and spreading OUD care.
Mapping SUD treatment in VA using administrative data
The Mapping SUD Treatment in VA Using Administrative Data: Identifying Similarities and Differences Between Women and Men Veterans project is using VA administrative data to evaluate the uptake and receipt of SUD-oriented treatment among all Veterans with a chart diagnosis of SUD enrolled in VHA from FY14 to FY18. Location of care, referral patterns, and characteristics of Veterans obtaining SUD care in different treatment settings will be evaluated stratified by gender.
Development of F-18-Labeled Radiotracers for PET Imaging of Brain Alpha1A Adrenoceptor: A Tool for Precision Medicine in PTSD
Prazosin, a drug that prevents the neurotransmitter norepinephrine from binding to its alpha1 receptor (alpha1-AR) subtype has shown efficacy in reducing PTSD symptoms in most, but not all, studies of trauma-exposed Service Members, Veterans, and civilians. However, it is not effective in all patients and its use is complicated by variability in effective doses, a short duration of action, and frequent orthostatic hypotension at dose initiation.
We propose to develop a fluorine-18-labeled radiotracer for PET imaging of brain alpha1A-ARs (implicated in the pathophysiology of PTSD) in human subjects so as to create a PET-based method to identify alpha1A-AR blocking drugs that are more broadly effective and lack the shortcomings of prazosin. Displacement of radiotracer binding by drug candidates will allow assessment of their actions at brain alpha1A-ARs and facilitate the development of novel PTSD therapeutics.
