Chronic pain is one of the most prevalent and disabling conditions affecting Veterans. One of the Veterans Health Administration’s (VHA’s) most pressing national clinical priorities is to increase access to non- pharmacological pain management and improve the safety of opioid prescribing. The National Pain Management and Opioid Safety Program (PMOP) is implementing virtual interdisciplinary pain management teams, TelePain, to improve access to evidence-based pain care among rural Veterans and those served by smaller VA facilities. The proposed evaluation, developed closely with PMOP, uses a rigorous prospective design to evaluate TelePain’s impact on clinical outcomes for Veterans and costs to VHA, while also evaluating TelePain’s impact on access to care and other implementation outcomes. These findings will provide actionable information to improving ongoing TelePain implementation efforts and inform VHA of the potential sustainability of TelePain as a model of care.
Funding Type: Federal
Patient Readiness for Improvement through Motivation, Engagement, and Decision-making for PTSD (PRIMED-PTSD)
PTSD is one of the most common mental health conditions affecting Veterans and is associated with significant burden. Highly effective treatments exist for PTSD, evidence-based psychotherapies, but very few Veterans receive them. Although VA has trained over 8,500 providers in evidence-based psychotherapies for PTSD over the past 10 years, only 6% of the 650,000 VHA patients with PTSD receive an evidence-based psychotherapy. It is critical that we connect Veterans with our most effective PTSD treatments and that we do so in a way that is Veteran-centered. Shared decision making is a patient-centered approach to choosing healthcare treatment options. It has been shown to increase patients’ motivation for treatment and ability to stay in treatment long enough to get benefit. It has also been shown to help providers align their practice with evidence-based guidelines. This proposal will refine and pilot test a shared decision making intervention for PTSD to be used in VA primary care clinics, where the vast majority of Veterans with PTSD are treated.
Development of an interactive, web-based drinking to cope intervention and tools to assess coping skill utilization
This project will develop and test an interactive web-based intervention with text-message reminders for young adults who drink to cope with negative affect. The intervention will include interactive modules on CBT coping skills, assignments to practice the skills, text-message reminders, and weekly assessments on coping skill utilization and barriers to use. A total of 120 young adults will be randomized to the 4-week, web-based drinking to cope intervention (n=60) or an assessment only control (n=60) and complete a 1- and 3-month follow-up.
Pathways from Chronic Prescription Opioid Use to New Onset Mood Disorder
The proposed research addresses three important objectives including: 1) Can OUD screening be effectively incorporated into primary care mental health screening protocols?; 2) Does implementing Collaborative Care for OUD and mental health disorders improve outcomes?; 3) What implementation strategies are effective at sustaining Collaborative Care programs that concurrently manage mental health disorders and OUD?
Project VERO: Development and Testing of a Personalized Normative Feedback Intervention for Young Adult Vaccine Hesitancy
Project VERO will develop and test a personalized normative feedback intervention to reduce vaccine hesitancy among young adults. Phase one entails rapid prototyping – utilizing concepts from user experience research – to refine the content and design of the brief intervention. The second phase entails an RCT enrolling unvaccinated young adults from around the US to fully test the efficacy of the intervention in terms of vaccine uptake, intentions, and attitudes towards vaccination. This project is conducted in collaboration with Drs. Jennifer Duckworth (Washington State University) and Cynthia Stappenbeck (Georgia State University).
Bipolar disorder measures in clinical care
The goals of this project are to 1) determine which validated bipolar disorder patient-reported symptom measure is most acceptable and helpful to patients and clinicians in clinical care, 2) demonstrate that the preferred measure can be used to monitor outcomes with high fidelity in routine care, and 3) assess the feasibility of comparing effectiveness of measurement-based care (MBC) to usual care in a randomized trial.
A cluster-randomized controlled trial testing the effectiveness of the Life Enhancing Alcohol-management Program (LEAP) for Housing First residents
| People experiencing chronic homelessness comprise a small yet high-morbidity, high-cost subset of the larger homeless population and are disproportionately impacted by alcohol-related harm. This study proposes a cluster randomized controlled trial of an innovative, community-based, and client-driven program known as the LEAP to explore its impact on substance use and quality of life outcomes among individuals with lived experience of homelessness and alcohol use problems living in Housing First settings. Analyses will test LEAP effectiveness in increasing engagement in meaningful activities, decreasing alcohol use, ameliorating both first- and secondhand alcohol-related harm, and improving quality of life for this population. |
Modeling patient mutations in iPSC-derived neurons to reveal cellular mechanisms of schizophrenia
Schizophrenia is a common and devastating neurodevelopmental disorder characterized by genetic heterogeneity. In this project, genes that are disrupted by rare, damaging mutations in individuals with schizophrenia will be evaluated using CRISPRi in iPSCs. Cell lines will be evaluated for phenotypes relevant to schizophrenia. A patient-derived iPSC line will be created that harbors a mutation in one of these genes. This will allow for characterization of the neurobiological consequences of the specific patient mutation in its native genetic background. Families with schizophrenia will be recruited for participation in genetics research to curate a list of genes for future inquiry and collect clinical data that can be used to generate hypotheses about genotype-phenotype connections.
Affective Dynamics Associated with Simultaneous Alcohol and Marijuana Use Outcomes among a High-risk Sample of Young Adults
The proposed F32 aims to conduct a secondary analysis of time-intensive daily data (MPIs: Lee/Patrick; R01AA025037) to elucidate the roles of affect and affective dynamics on simultaneous alcohol and marijuana (SAM) use outcomes among a sample of high-risk adults (N = 409). We will test whether theoretically-relevant affective dynamic processes (affective instability, negative emotion differentiation): (1) are more useful for predicting SAM use and alcohol use than mean level of affect (within- and between-subjects); (2) prospectively predict changes in SAM use and use-related problems over time; and (3) can distinguish SAM use from single substance use patterns, which has direct implications for the personalization and precision of prevention and intervention efforts.
Project Better
The co-occurrence of posttraumatic stress disorder (PTSD) and hazardous drinking (HD) can be particularly devastating; though evidence-based treatments exist, many individuals with this co-occurrence drop out from or do not or cannot access specialty care. Text-messaging is a mode of intervention delivery that is low-cost, low-burden, and accessible to most people; development and testing of self-directed text message interventions that use evidence- and theoretically-based strategies to reduce PTSD and HD symptom burden is highly needed. Such interventions have the potential for great clinical significance via providing additional, novel treatment options that are readily scalable and have wide reach and thus can have a large impact on individual and public health.
