This mentored career development award funded the conduct of two studies to inform efforts to disseminate and implement contingency management (CM): 1) a mixed-method study of CM attitudes and practices among personnel at a nationwide sampling of 16 community-based opioid treatment programs; and 2) a pilot type III hybrid effectiveness/implementation trial examining strategies for implementing CM programming customized to local OTP needs/resources.
Geographic Area: National
Latinx Health in Rural Areas (Project LAHRA)
This project aims to examine health disparities in substance use and factors influencing the health and well-being of Latinx youth residing in rural and small-town communities of the United States, a growing but understudied and underserved population.
Using technology to scale Caring Contacts and reduce suicide
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.
The RECOVER study: testing online platforms to identify patients with persistent post-COVID symptoms
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.
Bolster: Development and testing of a caregiver-facing mobile health intervention to reduce duration of untreated psychosis
This project aims to develop and test a mobile health (mHealth) intervention designed for caregivers of young adults with early psychosis who are unengaged in services, and specifically to examine whether it can help aid caregiver treatment facilitation.
Alcohol and addiction Research Domain Criteria (AARDoC) and alcohol use disorder recovery
This project will integrate and analyze datasets from multisite clinical trials of alcohol use disorder treatments to understand alcohol addiction research domain criteria (AARDoC) phenotypes and biopsychosocial predictors of alcohol use disorder recovery up to three and ten years following treatment.
Communication and Recovery Enhancement (CARE) clinical trial
This study aims to refine and test a brief intervention (CARE) that aims to promote recovery in recent sexual assault survivors. CARE is delivered to supporters of sexual assault survivors (e.g., friends, family members, romantic partners), with or without the survivor present. It aims to encourage conversations about the assault and decrease negative reactions by the supporter. In stage 1 of this study, we will conduct feedback sessions with 8-10 dyads of survivors and their supporters to finalize the intervention materials. In stage 2, we will conduct a pilot clinical trial of CARE with 60 dyads, who will be randomized to dyadic intervention, supporter-only intervention, or waitlist control.
Beliefs and Attitudes for Successful Implementation in Schools (BASIS)
The goal of this study is to adapt and test the feasibility and potential efficacy of a theory-driven pre-implementation intervention to address individual-level barriers to evidence-based practice (EBP) implementation – Beliefs and Attitudes for Successful Implementation in Schools (BASIS) – designed to improve school-based mental health providers’ implementation of EBP. The BASIS-T project will develop a teacher-focused pre-implementation motivation enhancement intervention that will be tested in the context of universal social, emotional, and behavioral program implementation.
Project THRIVE pilot
This study involved developing and preliminarily testing a new app to prevent PTSD and alcohol misuse following recent sexual assault.
Understanding mental health problems and health risk behaviors among LGBT Veterans
LGBT Veterans have faced a long history of stigma, discrimination, and exclusionary policies that were intended to exclude them from military service. Despite recent shifts in policy and increased staff trainings, existing evidence suggests that this group is at high risk for health disparities, particularly with respect to mental health and health risk behaviors. While informative, the research to date has been limited in several respects: cross-sectional designs, collapsing LGBT subgroups, severe lack of data on some subgroups, problems with identifying a comparison group, and lack of data on risk and protective factors and care experiences. This prospective cohort study will fill these gaps, recruiting and conducting surveys online with 1,600 Veterans to identify health disparities, test a conceptual model of prospective risk and protective factors, and assess VA utilization, barriers to care, and treatment preferences. Data from this study will inform future intervention efforts to achieve health equity for LGBT Veterans.
