With the rise in opioid use disorder (OUD) and overdose, racialized disparities in buprenorphine access and use are a significant concern nationally—studies estimate that Black patients with OUD are 50-60% less likely to access buprenorphine compared to White patients, and similar disparities have also been observed for Hispanic/Latinx patients. COVID-19-related policy changes increased flexibility in the provision of buprenorphine and other effective medications for OUD over telehealth and present an unprecedented opportunity to examine impacts of a structural intervention—relaxed MOUD restrictions—on disparities that result from structural racism and discrimination (SRD). The proposed study, guided by Public Health Critical Race Praxis, will use data from the nation’s largest provider of substance use care and quantitative and qualitative methods to examine the impact of these policy changes on racialized disparities for Black and Hispanic/Latinx patients to inform future policy and interventions to improve equitable care for OUD.
Geographic Area: National
Evaluating the National Implementation of Virtual Interdisciplinary Pain Care Teams – TelePain
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.
Consumer perspectives of online & in-person suicide prevention strategies
This study will explore which interventions people with lived experience of suicide find acceptable (e.g., different types of in-person and telehealth care, web-based, text message, app, etc.), who should be the agent to deliver the intervention, and what concerns would they have in having social media and search data used for risk identification and then intervention. These findings have the potential to impact how suicide prevention strategies are brought to scale in a way that is seen as acceptable and appropriate to patients at risk for suicide
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).
Enhancing engagement with digital mental health care
Although several randomized clinical trials have demonstrated that digital mental health (DMH) tools are highly effective, most consumers do not sustain their use of these tools. The field currently lacks an understanding of DMH tool engagement, how engagement is associated with well-being, and what practices are effective at sustaining engagement. In this partnership between Mental Health America, Talkspace, and the University of Washington (UW), we propose a naturalistic and experimental, theory driven program of research, with the aim of understanding 1) how consumer engagement in self-help and clinician assisted DMH varies and what engagement patterns exist, 2) the association between patterns of engagement and important consumer outcomes, and 3) the effectiveness of personalized strategies for optimal engagement with DMH treatment.
NORTH: Developing a mobile health intervention to support treatment seeking in early psychosis
The proposed research project proposes to develop and test a mobile intervention, Normalizing Orientation to Treatment and Help-Seeking (NORTH) designed to impact knowledge and attitudes to encourage help-seeking among young adults at risk for psychosis. This project involves (1) a needs assessment to understand barriers, interests and preferences related to mHealth and in-person treatment, (2) development, refinement and usability testing of NORTH, and (3) a pilot randomized controlled trial assessing feasibility, acceptability and preliminary efficacy compared to an active control mHealth intervention providing only stress management.
Establishing the Current State of Assertive Community Treatment (ACT) Implementation in the U.S.
This study aims to fill a significant knowledge gap that has impeded empirically-informed implementation and sustainability of high-fidelity Assertive Community Treatment (ACT). Investigators are conducting a survey of ACT stakeholders, including specialty adaptations (e.g., Forensic ACT [FACT]) across all U.S. states and territories, examining the relationship between ACT fidelity and outcomes, and examining contextual factors (e.g., financing and policy) that impact high-fidelity ACT implementation and sustainability.
The ATTEND study for Healthcare Workers and First Responders
Healthcare workers and first responders working during the COVID-19 pandemic have experienced increased exposure to suffering and loss; prolonged work hours; and increased personal risk. Although associated increases in psychiatric symptoms and occupational burnout are well documented, what aspects of the experiences are most strongly associated with negative outcomes over time – and what interventions are most likely to protect healthcare workers and first responders – are poorly understood.
The ATTEND study is designed to address the impact of occupational stress related to working during the COVID-19 pandemic on health care workers and first responders (police, fire, EMTs) through a national longitudinal survey paired with a local interventional clinical trial. The interventional clinical trial is designed to test the impact of treating sleep disruption with prazosin during or shortly after the period of exposure.
State Opioid Response Technical Assistance
This project is contributing to the expanded offering of the Opioid Response Network (ORN), a national partnership of the American Academy of Addiction Psychiatry and the Addiction Technology Transfer Center (ATTC) network, to provide on-demand technical assistance in areas of prevention, treatment, and recovery for care related to opioid and stimulant use disorders.
Opioid State Targeted Response – Technical Assistance for HHS Region 10
This project contributed to the sustained offering of the Opioid Response Network (ORN), a national partnership of the American Academy of Addiction Psychiatry and the Addiction Technology Transfer Center (ATTC) network, to provide on-demand technical assistance in areas of prevention, treatment, and recovery for care related to opioid use disorders.
