Transgender and gender diverse (TGD) adolescents
experience 4-18 times higher rates of anxiety, 4-23 times higher rates of
depression, 11-54 times higher rates of suicidal ideation, and 2-5 times higher
rates of suicide attempts compared to their cisgender peers. Importantly, parents/guardians
(i.e., caregivers) can have a significant impact on TGD adolescent mental
health, with recent research suggesting that caregiver support and acceptance are
associated with a 30-40% reduction in these mental health concerns.
Community-based support groups are common practice
with TGD adolescents and families. However, group intervention programs that
work specifically with caregivers are rare, and existing programs have not been
formally evaluated. Therefore, the goal of this project is to evaluate TRANSforming
Families: Embracing Change with Teens, a virtual,
multi-family program that was developed by mental health providers in the
Seattle Children’s Gender Clinic (SCGC), to understand its impact on caregiver support
and acceptance and adolescent mental health. This partnership between SCGC
mental health providers and researchers will represent one of the first formal
evaluations of a group intervention program for caregivers of TGD adolescents, the
results of which can inform future implementation and evaluation of this
program in pediatric gender clinics across the United States.
Medication nonadherence is common among patients with serious mental illness, including schizophrenia. The use of long-acting injectable antipsychotics (LAIAs) for schizophrenia is an evidence-based practice that improves medication adherence, decreases symptomatic recurrence and reduces hospitalizations. However, patients and clinicians often face several challenges in access and coordination resulting in the underutilization of LAIAs in care.
Administering LAIAs at community pharmacies could potentially increase accessibility, reduce barriers for treatment and improve patient outcomes. This project aims to assess the fit or compatibility of LAIA administration in community pharmacies. We will survey community pharmacy staff and behavioral healthcare providers in Washington State to assess the acceptability, appropriateness and feasibility of LAIA administration in community pharmacies. If LAIA administration at community pharmacies is found to be a good fit, the next steps will be to develop strategies to support implementation. A scalable and adoptable model for administering LAIAs at community pharmacies could have substantial impacts on public health through increasing access to treatment and expanding behavioral health services at the community level and in rural areas.
Individuals with serious persistent mental illness (SPMI) and their families and communities face significant challenges during psychiatric hospitalization. Persons with SPMI and their supporters express a need for enhanced communication from their behavioral healthcare teams during these pivotal periods of time where symptoms are new or intense. Yet, a substantial number of mental health providers have limited training in communicating complex topics such as diagnosis and prognosis. This can lead to providers avoiding essential conversations; individuals with SPMI can be unheard or excluded from participating in treatment planning.
This educational initiative seeks to craft an innovative curriculum for psychiatry residents focused on person-centered communication skills. Drawing from proven communication training frameworks within palliative care, the training will equip residents with strategies such as: utilizing person-centered language; conducting family meetings; delivering diagnostic and prognostic information. The curriculum will be developed with guidance from individuals with lived experienced of SPMI and their supporters. Moreover, the project will deliver a dedicated online portal featuring educational materials, recorded presentations, role-play scripts, and communication guides. Tools, such as self-assessment and evaluation rubrics, will be created to evaluate efficacy.
Early intervention can significantly improve the trajectory of a young adult at risk for psychosis. Specialized treatment programs for youth at risk are associated with reduced symptoms and relapse risk and increased functioning. Family caregivers play a critical role in facilitating treatment engagement and recovery, but too often they lack the support they need. Specialty psychosis services providing psychoeducation for family members are expanding but still difficult to access. Caregivers face many barriers to care: limited providers and session time availability, long travel times, or patient ambivalence about treatment. As a result, a minority of youth with early psychosis have caregivers that have accessed standard-of-care family interventions.
To address these gaps, our team developed Bolster, a mobile health (mHealth) app designed to provide psychoeducation, communication coaching, and self-care support to caregivers to youth at risk for psychosis. In preliminary work, Bolster was feasible to deliver, acceptable to caregivers, and showed promising efficacy. However, mHealth interventions that are supplemented by a human clinical support have higher engagement and effectiveness than those that are purely self-guided. To optimally implement mHealth for early psychosis caregivers, there is a need for development of this clinical workforce.
We propose to develop and pilot an emerging clinical role – the
mHealth support specialist (mHSS) – equipped specifically to support caregivers
to youth with early psychosis. Specifically, we will (1) develop a training and
supervision framework supporting the mHSS for caregivers, (2) test this
framework through training and supervising one mHSS, and (3) evaluate this
approach as the mHSS provides support to caregivers to young adults with early
psychosis throughout Washington State. Delivering this intervention has the
potential to greatly expand population access to evidence-based strategies for
psychosis. Developing the mHealth support specialist model would make
Washington a national leader in scalable digital interventions for caregivers.
This study takes a critical step toward realizing that vision.
The CARR study explores trajectories of mental health and social-emotional wellbeing among youth, including those with autism, ADHD, and/or anxiety. Online assessments of social-emotional features from both youth and caregiver perspective take place every 6 months over a 2-year period, with the goal of understanding mental health in the context of the Covid pandemic.
Loneliness, defined as the feeling of insufficient personal
relationships, affects over 20% of young adults. Those with loneliness are more
depressed and anxious and have poorer educational outcomes. Cognitive
behavioral therapy and social navigation can successfully treat loneliness but
previous studies have mostly looked at older adults.
The objective of this study is to demonstrate the
feasibility of identifying and alleviating loneliness in young adults
identified in primary care practices. This project will screen young adults
ages 18-25 presenting in primary care for loneliness and pilot the
interventions of cognitive behavioral therapy and social navigation for those
who test positive for loneliness.
As rates of pediatric mental health emergencies have
skyrocketed over the last decade – and even more so since the Covid-19 pandemic
– the number of youth staying in emergency departments (EDs) and medical units
while awaiting inpatient psychiatric care or stabilization (i.e., “boarding”)
has reached unprecedented levels. The massive surges in patient volume, coupled
with widespread staff shortages and lack of staff expertise in treating mental
health, are overwhelming ED and hospital resources. This causes dangerous or
even life-threatening delays in care for youth populations in greatest need of
medical and psychiatric treatment. Prolonged ED stays not only delay necessary
mental health care, but they can cause additional trauma and distress for youth
already in crisis. While the boarding crisis affects all hospitals and EDs, it
poses an even greater challenge to community EDs that lack on-site mental
health specialists and/or pediatric providers.
To address the boarding crisis, this project will pilot a
model in which a multidisciplinary team of mental health clinicians at Seattle
Children’s Hospital provides telebehavioral health consultation to community
EDs in Western Washington to guide care for youth who are boarding. The primary
goals of this model are (1) to improve timeliness of mental health care and
reduce length of stay for youth boarding in community EDs, and (2) to support
ED staff in providing more developmentally appropriate and evidence-informed
mental healthcare. The Seattle Children’s team will provide case consultation
to ED providers and staff, including support with decisions about
hospitalization, medication treatment, behavioral interventions and case
management services. The team will also deliver practical trainings to
community ED staff to build their internal capacity to care for boarding youth.
If this initiative is successful, additional funding could expand ED
telebehavioral health consultation services statewide, with a focus on rural
communities.
Adolescent depression is one of the most common mental
health concerns during adolescence and can be a cause of significant impairment
across the lifespan, particularly if untreated. Access to evidence-based
psychotherapy is poor and pandemic-related increased demand for services has
greatly worsened access issues, leaving many adolescents without effective and
critically needed treatment. Adolescent depression is often first identified in
primary care, making it the ideal setting for improving early access to
treatment. While treatment by mental health specialists within primary care is
effective, the workforce is not adequate to meet the high demand for services.
Online depression treatment has been shown to be effective and has the added potential to expand
access, particularly given adolescent’s comfort with digital technology.
Importantly, the addition of human coaching alongside online treatments has
been shown to boost engagement and treatment outcomes.
The goal of
this project is to increase early access to evidence-based depression treatment
in primary care settings. The project team will work with adolescents, caregivers
and providers to develop an accessible and engaging online treatment for
delivery in primary care. To support integration and enhance engagement, the
project will also develop a coaching toolkit that can be utilized by a range of
non-mental health specialists, including nurses, medical providers, social
workers and bachelor’s level staff.
