Geographic Area: University of Washington

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.

Addressing suicide risk in primary care to reduce youth suicide

Suicide is a leading cause of death among 10- to 24-year-olds in the US, and half of youth who die by suicide contact a primary care provider within one month prior to suicide. Suicide risk screening and access to brief and effective suicide prevention interventions remain an important step in reducing suicide, yet comprehensive suicide prevention pathways focused on youth have not been widely implemented or evaluated in primary care settings, in part due to lack of trained clinicians and time to provide services.

This project aims to address these challenges by developing clinician training and adapting and optimizing a brief, evidence-based suicide intervention, SAFETY- Acute(A), for use in primary care to support the development of an effective and sustainable primary care-based suicide prevention pathway for youth with low to moderate suicide risk.

Monitoring mood symptoms in young adults at-risk for bipolar disorder

The ages of 18-25 years are ‘peak onset’ times of major depression and bipolar disorder. These disorders have different courses and treatments, but diagnosing bipolar disorder is difficult because manic symptoms occur less often than depressive symptoms and many individuals do not recall manic symptoms. A ‘misdiagnosis lag’ of 8-10 years can contribute to prolonged periods of potentially ineffective treatments and suboptimal outcomes such as high symptom burden, relationship problems, educational attainment and occupational functioning.

This project will use remote prospective assessment and monitoring of depressive and manic symptoms in at-risk patients in-between patient visits to increase the ‘data points’ clinicians have when assessing a bipolar disorder diagnosis. This is especially important for people at risk for bipolar disorder (for example those with a family history of bipolar disorder) because manic symptoms can be provoked by first-line medication treatments for major depression. The project will use a new manic symptom measure (the Patient Mania Questionnaire-9) and a commonly used depressive symptom measure (the Patient Health Questionnaire-9) to monitor symptoms, and learn how clinicians and patients use this information clinically.

Improving diagnostic imaging to guide treatment of neuroinflammation

Infection by West Nile Virus can lead to encephalitis, or harmful inflammation of the brain. The immune system is critical for controlling viral replication and spread early in West Nile Virus infection, but persistent immune activation causes encephalitis that can result in brain damage even after the virus has been cleared. Recent pharmacologic advances have produced drugs that modulate the body’s immune response and can control inflammation, but these drugs have not yet been tested in conditions of viral encephalitis. In order for patients to benefit from these therapies, clinicians need tools that help identify when excessive immune activity is causing encephalitis.

The key innovation of this project is the combination of noninvasive imaging with novel immune modulating drugs to improve the diagnosis and treatment of encephalitis. Our central hypothesis is that specialized immune cells known as macrophages are key drivers of encephalitis in West Nile Virus infection, and that preventing their activation will preserve memory and other cognitive functions. Our studies will explore and develop noninvasive positron emission tomography (PET) imaging as a tool for diagnosing brain inflammation. We will test our hypothesis utilizing West Nile Virus infection of mice, which captures the key elements of human disease including encephalitis. This model allows us to evaluate existing diagnostic and therapeutic tools currently used in humans for other purposes, from which we will define new clinical applications. We will thus be poised to translate our findings to human studies defining and treating viral encephalitis.

Workforce Innovation and Leadership in Forensic Mental Health

The Center for Mental Health, Policy, and the Law (CMHPL), through an operations grant, is developing programming in Workforce Innovation and Leadership in Forensic Mental Health to address the forensic mental health workforce shortage.

The CMHPL anticipates the programming will have a direct impact on recruitment and retention of mental health professionals who work in forensic settings, as well as other public sector and psychiatric leadership roles. Through development of high-quality training, mentorship, consultation, and leadership development programming, the CMHPL is growing the number of clinicians with knowledge and aptitude to work with persons involved in the criminal justice system. In turn, this will engender high-quality patient services to improve access and care delivery to persons involved with the justice system and reduce the risk of prolonged or repeated cycles through the system.