Traumatic brain injury (TBI) is a major cause of disability in Washington state and throughout the US. TBI increases the risk and complexity of multiple behavioral health conditions including post traumatic stress disorder, depression, anxiety, irritability, anger/aggression, substance misuse and cognitive impairment. In addition, TBI impairs a person’s ability to manage their health care and increases the risk of unemployment, long-term functional impairment, and caregiver burnout. Successful TBI recovery can depend in large part on access to and engagement in behavioral health treatment. Unfortunately, TBI-focused community resources are scarce and fragmented. Treatment of post-TBI symptoms often falls to community providers who have little support and are under-prepared to manage these complexities. This burden disproportionally affects rural providers who have little access to specialist care at academic centers.
The purpose of this project is to create and assess the use of the ECHO (Extension for Community Healthcare Outcomes) model to provide education and support by experienced TBI experts to community providers who treat persons with TBI. The ECHO model uses both a virtual educational lecture series and patient case discussion to improve provider preparedness to treat patients and improve patient outcomes. We will launch a monthly to bi-monthly program that will train providers from a variety of disciplines and settings in identification and evidence-based behavioral health treatments, web technologies and mobile technologies, and provide detailed case consultation. We will assess the success, reach and impact of our TBI ECHO by collecting and comparing attendee experiences, clinical information and patient outcomes.
This project received two years of additional funding from the Washington State Department of Social and Health Services.
On top of climate change, political divisiveness and cultural turbulence, we have faced the most devastating pandemic since global influenza 100 years ago. The resulting social and economic stresses have manifested as widespread anxiety, a worsening opioid epidemic and the highest suicide rates in decades.
Proven behavioral health strategies like Caring Contacts offer hope. Caring Contacts is a program where suicidal individuals receive periodic letters or text messages from a behavioral health practitioner, creating a connection and showing someone cares. Caring Contacts have reduced suicide deaths, attempts and thoughts of suicide and offer an easy re-connection to healthcare, but behavioral health practitioners are in high demand and short supply and often struggle with prioritizing messages and sending timely replies. By analyzing a patient’s text messages, computerized algorithms can identify indicators of risk and other important information to help behavioral health practitioners with the nature and timing of their responses, allowing one behavioral health practitioner to reach hundreds of suicidal patients.
This project brings together behavioral health care, mobile technologies that people now expect and innovative informatics methods to identify critical signs of suicide risk that busy practitioners may miss. Our team consists of experts in behavioral health, usability and design, artificial intelligence/natural language processing, software engineering, health care information systems and emergency medicine. Our goal is simple: to use technology to provide critical support for those in crisis, and to save lives.
Perinatal mood and anxiety disorders affect one in seven pregnant and postpartum women nationwide, making them the most common complication of pregnancy. Unfortunately, only one in 20 women who need treatment for these conditions actually receives it. This translates to a multigenerational issue, which can negatively affect the mother and child’s long-term physical, emotional and developmental health. It also means an estimated $14.2 billion annually in societal costs in the U.S. alone. While not every perinatal individual with mental health concerns has access to a mental health provider, cell phones and text messaging are ubiquitous. Nonjudgmental support delivered through text messaging may be a low cost approach to reaching women who need emotional support in the perinatal period.
Our project aims to evaluate a text-based mentoring program, the Nurture Program, and assess whether it is possible to support mothers through their third trimester of pregnancy and nine months postpartum and enhance their emotional well-being. The Nurture Program combines the convenience of secure text messaging with the personalization of having a trained peer mentor with whom the mother can develop a trusting relationship. This program also provides resources on child development, connections to local support agencies and suggestions for parent-child bonding and parental wellness activities. Surveyed participants of the Nurture Program consistently report their mentor helped them feel less stressed and more confident in their role as a parent. This study will allow us to measure the impact of this cost-effective approach to promoting perinatal emotional well-being.
After COVID infection, 10-50% of people experience persistent symptoms such as fatigue, palpitations, insomnia, cognitive problems, and headache – often with significant associated distress and functional impairment. The exact combination of symptoms varies from person to person, and it is expected that the specific causes vary from person to person as well.
Because of this variability, the current recommendation is for an evaluation by a multidisciplinary team. This creates a demand on our medical system that far outstrips current resources, and risks exposing patients to long, complex medical evaluations whose results are hard to interpret. In addition, clinical treatment trials that mix patients with similar symptoms but different underlying causes have high failure rates.
To address these challenges, a team of investigators including Rebecca Hendrickson, MD, PhD (Department of Psychiatry and Behavioral Sciences), John Oakley, MD, PhD (Department of Neurology), and Aaron Bunnell, MD (Department of Rehabilitation Medicine) are testing an online platform to identify patients whose pattern of symptoms suggest a particular underlying cause that is common after certain physiologic (i.e. illness or injury) and psychological stressors: increased adrenergic (adrenaline/noradrenaline) signaling in the brain and peripheral nervous system. We will pair this with a smaller number of detailed in-person assessments to validate our symptom-based measures and characterize associated biomarkers.
Our results will provide a detailed assessment of the patterns of symptoms caused by high amounts of adrenergic signaling that are seen in persistent post-COVID syndrome, how they change over time, and their association with objective measures of cognition and physiology. The project will provide the information needed to begin clinical treatment trials using existing, well-tolerated treatments that modulate adrenergic signaling. We hope the results will also have strong relevance to other potentially related disorders such as Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia.
Deaths related to the opioid overdose epidemic remain at an all-time high
across the country despite significant efforts to reduce them. There is a
pressing need to support medication treatment for opioid use disorder (OUD) to
help people stay in treatment and reduce the risk of overdose death and other
serious health consequences of untreated addiction. Smartphone-based apps can
facilitate the delivery of an evidence-based approach called contingency
management that incentivizes use of medications for OUD, reduces use of
non-prescribed opioids and improves retention in OUD treatment.
This study will leverage a commercially available smartphone app that can
bring this much-needed behavioral support to patients receiving OUD treatment
in a primary care clinic and in a specialty OUD treatment clinic. The approach
offers a potentially non-labor intensive, cost-effective and highly scalable
means of delivering OUD care.
Although suicide is one of the leading causes of death for people with
substance use disorders (SUDs), no widespread suicide prevention intervention
exists for delivery in community addiction treatment settings. The
effectiveness and feasibility of delivering Preventing Addiction Related
Suicide (PARS), a group-based psychoeducational program that provides
evidence-based suicide prevention and safety strategies, was recently
demonstrated by the UW Center for Suicide Prevention and Recovery.
To enhance widespread implementation and dissemination of PARS, this project
will develop online training and implementation tools. PARS-Web will be created
in collaboration with key state agencies and suicide prevention professionals
to meet the new training requirements for Washington State Chemical Dependency
Professionals. The goal is to integrate PARS as a part of standard care in
addiction treatment agencies nationwide.
Most adults in the US experience a traumatic event at some point in their
lives. Trauma is linked to the development of mental health disorders, increased
suicidality, work and relationship impairment and increased physical health
conditions. Effective treatments exist, but many people don’t receive these
treatments because of a lack of providers who are trained in evidence-based,
trauma-focused treatment, especially those in rural or underserved areas.
This project aims to build, implement and test an ECHO (Extension for
Community Healthcare Outcomes) model for disseminating evidence-based,
trauma-focused care, both psychotherapy and pharmacotherapy approaches, to
providers working with underserved communities in Washington state. The team
will evaluate the impact and reach of the training model, with the goal of
expanding the ECHO approach to improve trauma-informed mental health care
throughout Washington.
Alzheimer’s disease and related dementias (ADRD) affect more than 10% of
adults who are age 65 and older, but the toll of ADRD is most devastating among
older African Americans. COVID-19 widened these disparities; in addition to
being more susceptible to COVID-19 infection and fatalities, older African
Americans are more likely to experience digital and technical inequities. This puts
them at risk for the development/worsening of depression, anxiety, cognitive
impairment and sleep disturbances.
This project will evaluate several traditional and mobile health tools for
remotely monitoring the effects of social isolation on cognition and mental
health in older African Americans with baseline cognitive complaints. By
testing three different strategies, we will identify the most effective,
feasible and subject-preferred approach to collecting cognitive and mental
health data which will help address brain health disparities.
More than a million people in the US sustain a mild traumatic brain injury
(mTBI) every year, and many report difficulties with attention, memory and
other thinking abilities months and even years following their injury. A promising
treatment option is cognitive rehabilitation, but the full-length (20 hours),
in-person intervention is not feasible for many people due to time and
financial constraints.
This study will evaluate a brief (6 hours), virtual cognitive rehabilitation
intervention developed for individuals with persisting cognitive difficulties
after mTBI. We will evaluate several outcomes related to improving patient care
including treatment satisfaction, feasibility of this intervention when using
telehealth and preliminary effectiveness. The proposed treatment aims to
provide the same clinical impact of traditional cognitive rehabilitation while
reducing burden and increasing access.
We aim to determine the accuracy and specificity of Arterial spin labeling (ASL) — a non‐invasive perfusion technique used in MRI to track cerebral blood flow — in measuring vascular and glial‐dependent water transfer to establish whether it is a valuable clinical tool in Alzheimer’s disease. This simple and safe technique, already approved for use in a clinical setting, has potential to circumvent current invasive approaches in human subjects at risk for AD‐related dementias.
