Funding Type: Internal

Re-engineering siloed systems of care through evidence-integrated design thinking

Behavioral health, including suicidal behaviors and problematic substance use, are significant public health concerns and are routinely identified by community health departments as a high priority. However, needed services are highly fragmented across multiple systems (e.g., prevention, primary care, schools). Addressing these urgent public health concerns requires decisionmakers to collaborate and coordinate services. System-level planning efforts tend to fail because adopted models are either not informed by evidence, or policy decisions do not have sufficient community buy-in and are poorly implemented.

To address this gap, our team created a hybrid approach, “System Codesign,” in which researchers and local decisionmakers form a design workgroup and collaborate to create a tailored and sustainable plan to address community public health issues. This partnership approach allows end users to be actively involved in the design process to help ensure that the outcome meets the needs and expectations of the community. The researcher’s role is to locate and synthesize research findings relevant to the community agency’s goals and assist in integrating these principles within real world programming. This new “System Codesign” approach is built from well-established participatory and implementation frameworks and incorporates evidence-informed standards in research into the energy and creativity of design thinking to support local systems. This model is expected to incorporate evidence, innovation, and local relevance into final system products.

Our research team aims to assess the acceptability and feasibility of this “System Codesign” process as a tailored implementation method for tackling complex behavioral healthcare issues. Our aim is to partner with the state Healthcare Authority (HCA) to pilot this approach with a rural Washington community, Grays Harbor County, which has a high prevalence of behavioral health needs. The proposed design workgroup will leverage cross-system participation from behavioral health, justice, law enforcement, faith-based organizations, schools, and community members.

Harm reduction in the context of social distancing

The devastating impacts of the novel coronavirus (COVID-19) epidemic is expected to have impacts on young adults’ mental health and substance use (a population already at high risk).  Time is of the essence to provide young adults evidence-based information to reduce risk from alcohol use within the context of COVID-19 epidemic, promote continuation of social distancing while also encouraging pro-social behavior to reduce isolation, and skills to reduce coping- or socially-motivated alcohol use and associated negative consequences. This project aims to develop and examine feasibility and acceptability of a time-sensitive COVID-19-specific personalized normative feedback intervention disseminated via social media that focuses on drinking motivations to cope with distress and/or to enhance social connectedness, as well as to promote engagement in strategies for stress management and increase engagement in social, alcohol-free activities while also practicing social distancing. 

Disseminating a user-friendly guide: Advancing the science of intervention adaptation and improving access to evidence-based psychological treatment

Adaptation of evidence-based practices and programs (EBPs) is a necessary component of the implementation process. EBPs must be adapted to function with the constraints of real-world practice settings, providers’ expertise, and patients’ needs. The science of intervention adaptation is hungry for well-defined methods of EBP adaptation to guide decision making. A how-to guide for EBP adaptation titled MODIFI: Making Optimal Decisions for Intervention Flexibility during Implementation, is under development with NIMH funding (F32 MH116623). MODIFI will be disseminated via multiple strategies locally, nationally, and internationally. Dissemination of MODIFI will improve the practice of intervention adaptation by providing practitioners with a how-to guide that is (a) evidence-based, (b) usable, and (c) supported by the expert consensus of implementation practitioners and researchers.