Geographic Area: Seattle/Puget Sound

Implementing contingency management in a supportive housing context to promote resident well-being

Mental health and substance use disorders carry complex needs of living that are often poorly-served by our health systems, which result in immense societal costs. This has prompted federal recognition of supportive housing among the vital conditions that support the long-term recovery and resilience of our citizenry. Supportive housing offers safe living environs where residents access services such as harm reduction supplies and referral to recovery-oriented activities like peer support groups and workplace re-entry programs. To maximize the benefit that residents experience from such services, behavioral health staff working in supportive housing contexts should implement useful psychosocial therapies to spur greater service utilization by residents.

One such therapy that has proven useful among persons with mental health and substance use disorders is contingency management (CM), in which one earns tangible rewards for demonstrating desired behaviors like attending a support group, taking a prescribed medication or completing workplace re-entry paperwork. Given the robust and reliable therapeutic impacts of CM, there is much to be gained from its implementation in supportive housing environs. For several years, the project lead Dr. Hartzler and his team at the UW Center for Advancing Addiction Health Services (CAAHS) have provided comprehensive technical assistance to regional treatment settings to facilitate design and successful implementation of sustainable CM programming. Also, UW project collaborators Drs. Fockele and Leyde have built working relationships with Downtown Emergency Services Center (DESC) while exploring interest in CM among its staff and residents. This convergence of acute community need, an experienced team offering technical assistance and an established academic-community partnership highlights an opportunity in which CM will be implemented in DESC-governed supportive housing facilities to increase resident utilization of beneficial services.      

Biomarkers in the retina for prognosticating mental health treatments (BRIGHT)

This clinical trial is designed to pilot an electroretinogram (ERG) biomarker for predicting treatment response to SSRIs in PTSD. Serotonergic brain centers project to the retina, and ERG allows assessment of brain serotonergic signals via retinal signals. In this study we are characterizing the ERG waveform in veterans with PTSD before and after SSRI administration. Patients then enter an open label phase of the study, with those who have initiated an SSRI through routine medication management invited back for a follow up study visit. This pilot data will: 1)be valuable as a feasibility study for assessing the practical application of ERG in the setting of a mental health clinic and 2)serve as a foundation for a long-term goal of developing physiologic biomarkers to match veterans to corresponding pharmacological treatments in PTSD and other mental health disorders.

Real-world Experiences of Alcohol and Cognitions over Time (REACT)

The overall aim of the REACT Study is to create and assess smartphone-based cognitive tasks to examine how acute alcohol intoxication affects attention. First, we will adapt laboratory-based cognitive tasks for use on smartphones. To maximize usability, feedback will be gathered in rapid prototyping interviews with young adults. Then, we will evaluate the adapted smartphone tasks in two settings: (1) a controlled laboratory session in which young adults are administered a standard dose of alcohol, and (2) real-world drinking experiences over eight weekends, as measured with phone surveys and a wrist-based alcohol biosensor. Findings are expected to clarify the role of alcohol-related attentional narrowing in real-world behaviors. Results will be used to inform the development of just-in-time adaptive interventions to prevent alcohol-related consequences.

Needs Assessment for Supporting Technology use and Harm Reduction (STaHR Study)

The proposed study entails a needs assessment to develop a program for Supporting Technology use and Harm Reduction (STaHR) among HF residents with lived experience of homelessness and substance use. This study will qualitatively explore HF residents’ technology literacy as well as their perspectives on barriers and facilitators to the use of technology, broadly, and for harm-reduction service provision. Then, with a community advisory board (CAB) made up of HF residents, staff, and management, we will inform and provide recommendations to HF management and leadership ways to improve HF resident technology use and engagement with online harm-reduction services.

eHaRT-A: adapting an in-person harm reduction for alcohol intervention into a telehealth platform

The unprecedented global pandemic has highlighted the digital divide and limited access to alcohol-related treatments among marginalized communities, specifically individuals with lived experience of homelessness. In line with the NIAAA health initiative seeking to integrate technology-based interventions among vulnerable populations, this study directly addresses this mission by proposing innovative methods (i.e., user-centered design + a community based participatory research framework) to adapt an in-person harm reduction for alcohol (HaRT-A) intervention into a telehealth platform (eHaRT-A) that can then be tested and successfully implemented into low-barrier Housing First settings. As healthcare continues to move more services online, it is essential to understand ways to successfully adapt and implement rigorously tested telehealth treatment services for marginalized communities to ameliorate alcohol-related harms.

eHaRT-A

The unprecedented global pandemic has highlighted the digital divide and limited access to alcohol-related treatments among marginalized communities, specifically individuals with lived experience of homelessness. In line with the NIAAA health initiative seeking to integrate technology-based interventions among vulnerable populations, this study directly addresses this mission by proposing innovative methods (i.e., user-centered design + a community based participatory research framework) to adapt an in-person harm reduction for alcohol (HaRT-A) intervention into a telehealth platform (eHaRT-A) that can then be tested and successfully implemented into low-barrier Housing First settings. As healthcare continues to move more services online, it is essential to understand ways to successfully adapt and implement rigorously tested telehealth treatment services for marginalized communities to ameliorate alcohol-related harms.

Evaluation of an asynchronous remote communities approach to behavioral activation for depressed adolescents

In an effort to address the significant challenges in access to and engagement with evidence-based psychosocial interventions for adolescent depression, the proposed research is piloting the use of Asynchronous Remote Communities (ARC) supported behavioral activation (BA) to treat adolescent depression. We aim to 1) build and conduct usability testing on a functional and robust ActivaTeen platform that will satisfy the needs of mental health clinicians and adolescent patients and 2) test the feasibility, usability, and change in proposed target mechanisms (therapist alliance, timeliness of intervention, social belongingness, and engagement) and outcomes of BA+ActivaTeen compared to BA treatment only within a moderately-sized randomized control trial conducted within Seattle Children’s Hospital outpatient psychiatry clinic.