The COVID-19 pandemic facilitated simultaneous paradigm shifts in healthcare delivery: virtual care (telehealth and videoconferencing) and the need for “Whole Person” healthcare that targets mind, body, and spirit, per recent US Surgeon General1 and National Academy of Medicine2 calls-to-action. The pandemic also highlighted treatment delivery inequities involving rural Veterans. The current proposal will address these trends, assessing virtual VA Whole Health care use in Primary Care-Mental Health Integration (PC-MHI) for rural and non-rural Veterans with chronic pain and co-occurring posttraumatic stress disorder (PTSD).
Geographic Area: National
Evaluation of the VHA Acute Pain Service Expansion Program Implementation and Impact
The objective of the project is to evaluate the implementation and impact of the Acute Pain Services Expansion Program (APSEP), an expansion of the independent and formal set of services that provide comprehensive inpatient pain management consultative services and is designed to meet perioperative care needs of veterans receiving inpatient pain management.
Using Large Language Models to identify video platform interactions indicating suicide risk
This project will identify interaction patterns with online video platforms that are indicative of suicide risk, focusing on YouTube and TikTok. Leveraging archival data including over 5 million interaction events collected from participants in previous research, we will use combinations of neural language models to identify suicide-related “like”, “search” and “watch” events. We will then assess the temporal relationships between suicide-related interaction events and suicidal ideation, behavior and mental health challenges reported by these participants. Building on these analyses, we will proceed to model patterns of interaction, differentiating between user-initiated (e.g. search) and algorithm-prompted (e.g. recommended content without a preceding search) content to characterize the ways in which intentional and algorithmically-driven behavior drive exposure to suicide-related content. In addition, we will develop a prototype of a privacy-preserving risk monitoring tool, which will detect interactions with concerning content and leverage light-touch intervention strategies to mitigate its impact.
Making generative AI safe for people with mental health conditions
Hundreds of millions of people are already using Large Language Models (LLMs), including for mental health purposes, which has led to inadvertent harms. Critically, people with mental health conditions may be especially vulnerable to such harms.
In this project, we will develop the first computational framework to systematically quantify and benchmark the risks that LLMs present to people with mental health conditions. Our approach will simulate interactions of hundreds of users and LLMs to evaluate safety across a variety of mental health conditions, demographics, and AI failure modes.
Optimizing telemental health with live artificial intelligence clinical scaffolding and feedback
This project aims to develop a clinical scaffolding system to enhance telemental health care by providing real-time coaching and actionable suggestions during video-based sessions. Modeled after live supervision methodologies, it supports clinicians by identifying intervention targets and offering text-based coaching prompts to guide care. Unlike automated chatbots, this approach enables clinicians to adapt suggestions to patient needs, balancing automation with oversight for safer AI-supported mental healthcare. The proposed in-session support will facilitate efficient implementation of strategies and clinician skill development. This project seeks to enhance data privacy by processing all data on-device and avoiding external data transfers.
Partnering with patients to re-envision psychiatric hospitalization and discharge
We will analyze people’s stories about psychiatric hospitalization, interview people with experiences surrounding psychiatric hospitalization, and co-design with them to identify alternative approaches that would help people care for themselves as they transition out of the hospital. We will build upon our prior work on understanding patients’ challenges and co-designing new systems that help patients transition from psychiatric hospitalizationto self-management. In particular, we will focus on how we could redesign psychiatric hospital systems with the people who have experienced them, identifying patient insights on the knowledge, resources, and self-efficacy they need to help them return to the community.
GATHER: Growing a Tribal Healing Effort through Research
The GATHER initiative aims to: 1) Coordinate a national research network to support tribally led research on etiology and prevention of overdose, substance use, mental health, and pain management. 2) Provide administrative support and shared resources to facilitate the successful completion of N CREW research projects. 3) Provide an administrative infrastructure, intellectual environment, and access to resources and initial support for investigators. 4) Provide research training and access to subject matter experts for investigators, staff, and students in the areas of cognitive, motivational, and behavior therapies, Indigenous approaches to research and healing, and multimodal holistic approaches to prevention and treatment. 5) Serve as a local, national, and international resource for dissemination of information and training to reduce risk in diverse tribal and urban Indian populations.
School-Based Paraeducator Education for Engagement at Recess (SPEER)
The purpose of this study is to compare two implementation strategies for a social engagement intervention that supports autistic children and their non-autistic peers during recess. Remaking Recess has been shown to improve peer engagement for autistic students when implemented by paraeducators during recess. However, without supports, paraeducators face barriers to implementing the intervention well. This study compares paraeducators’ use of Remaking Recess when they receive coaching alone and when they receive coaching along with consultation from school-based teams.
Willow Study
The goal of this study is to understand the impact of stigma on mental health and recovery from trauma in different parts of the country.
Sequenced Treatment Effectiveness for Posttraumatic Stress (STEPS)
The proposed research will determine whether primary care clinics should offer medications or talk therapy first to treat posttraumatic stress. In addition, for patients who do not respond to the first treatment, the STEPS trial will determine what treatment should be offered next. More information on our info sheet.
