This project examines the acceptability and feasibility of policy codesign process to help three regions in Washington develop their own local strategy to improve crisis response for people who use drugs, focusing on calls with law enforcement. Policy codesign is an evidence-based approach that aims to develop policies from “the ground up” that are tailored to community needs and promote region ownership. Design team members include local law enforcement, people with lived experience of substance use and legal involvement, and service providers.
Geographic Area: Washington
A study to verify the clinical benefit of aducanumab in participants with early Alzheimer’s disease (ENVISION)
The primary objective of this study is to verify the clinical benefit of monthly doses of aducanumab in slowing cognitive and functional impairment as measured by changes in the Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) score as compared with placebo in participants with early Alzheimer’s disease.
A Study of Donanemab in participants with early Alzheimer’s disease (TRAILBLAZER-ALZ 2)
The reason for this study is to see how safe and effective the study drug donanemab is in participants with early Alzheimer’s disease.
Developing a cannabis intervention for young adults with psychosis
Up to one-third of young people experiencing early psychosis use cannabis, and one in four meet criteria for a cannabis use disorder. Cannabis use is associated with multiple negative outcomes, including relapse, rehospitalization, increased psychotic symptoms and reduced treatment engagement and medication adherence. Psychosis relapse is a particularly devastating and costly outcome, leading to greater disability and accounting for $37 billion in healthcare costs per year. Cannabis is considered the most preventable cause of psychosis relapse. Despite this, no effective cannabis-reduction intervention has been developed for this population.
This study will address the urgent need for an effective cannabis-reduction intervention for this high-risk population by adapting a gold-standard treatment, Motivational Enhancement Therapy (MET), for youth and young adults living with psychosis. A tailored cannabis intervention and provider manual will be developed and evaluated for feasibility and acceptability. This novel intervention has the potential to mitigate the costly impact of psychosis on public health systems and ultimately improve psychosis outcomes among young people living in Washington State.
Developing a pediatric telebehavioral health consultation model for emergency departments
As rates of pediatric mental health emergencies have skyrocketed over the last decade – and even more so since the Covid-19 pandemic – the number of youth staying in emergency departments (EDs) and medical units while awaiting inpatient psychiatric care or stabilization (i.e., “boarding”) has reached unprecedented levels. The massive surges in patient volume, coupled with widespread staff shortages and lack of staff expertise in treating mental health, are overwhelming ED and hospital resources. This causes dangerous or even life-threatening delays in care for youth populations in greatest need of medical and psychiatric treatment. Prolonged ED stays not only delay necessary mental health care, but they can cause additional trauma and distress for youth already in crisis. While the boarding crisis affects all hospitals and EDs, it poses an even greater challenge to community EDs that lack on-site mental health specialists and/or pediatric providers.
To address the boarding crisis, this project will pilot a model in which a multidisciplinary team of mental health clinicians at Seattle Children’s Hospital provides telebehavioral health consultation to community EDs in Western Washington to guide care for youth who are boarding. The primary goals of this model are (1) to improve timeliness of mental health care and reduce length of stay for youth boarding in community EDs, and (2) to support ED staff in providing more developmentally appropriate and evidence-informed mental healthcare. The Seattle Children’s team will provide case consultation to ED providers and staff, including support with decisions about hospitalization, medication treatment, behavioral interventions and case management services. The team will also deliver practical trainings to community ED staff to build their internal capacity to care for boarding youth. If this initiative is successful, additional funding could expand ED telebehavioral health consultation services statewide, with a focus on rural communities.
Using teen Mental Health First Aid to address mental health inequity among school youth
Over 2.5 million US adolescents struggle with mental health challenges, and multiracial adolescents are at greatest risk due to limited access to mental health programs. As roughly half of lifetime mental disorders have their first onset by mid-adolescence, it is vital to promote help-seeking for prevention and early intervention during this important developmental stage.
This project will test the implementation of an evidence-based mental illness prevention program — teen Mental Health First Aid (tMHFA) — in a diverse and underserved school district to facilitate help seeking among teens aged 16-18. While tMHFA has a proven track record of effectively enhancing knowledge of mental health problems, reducing stigma and promoting help-seeking behaviors, its efficacy across dimensions of race and ethnicity is underexamined in the US.
Academic (UW & SMART Center), education (Tacoma Public Schools) and behavioral health organization (MultiCare) stakeholders will address this gap by conducting a mixed-methods study with 1) focus groups to obtain diverse teens aged 15-18 opinions about facilitators and barriers in help-seeking; and 2) longitudinal data collection to examine the impact of the innovative tMHFA’s potential to address help-seeking barriers across dimensions of race and ethnicity. The findings of this project will guide both the revisions to the program to improve its efficacy and the scaling of this program to support government legislation to expand service delivery to other schools and to rural areas across the state.
Reducing barriers to accessing mental health care using a web-based program for young adults
Most young adults with mental health (e.g., depression, anxiety) or substance use disorders do not receive treatment. Untreated mental health and substance use can be associated with impairments in social relationships, overall functioning and suicide. National data indicate that almost half of young adults with symptoms of a mental health disorder reported they needed mental health care in the past year but did not access those services. Barriers to accessing mental health care include stigma, not knowing where to go, lack of transportation and cost.
This project aims to develop a personalized web-based program for young adults to reduce self-reported barriers and increase motivation to access mental health and substance use services. Investigators will work with clinicians and young adults to develop strategies and solutions to address the identified barriers. The team will work with a community advisory board to develop program content that will be further refined through focus groups and individual interviews with young adults and clinicians. From this, the team will develop the web-based program which will serve as the first step needed to establish a larger program of research focused on reducing barriers and increasing access to mental health care to improve young adult well-being.
Using neurocomputational modeling to track memory decline
The most salient and debilitating aspect of dementia is memory loss. Unfortunately, memory loss is also the most difficult to quantify because it relies on doctor-administered tests that cannot be repeated very often. Without frequent and accurate measurements, it is difficult for clinicians to make reliable diagnoses, for patients and their caretakers to prepare in advance and for researchers to better understand the relationship between brain changes and cognitive decline.
This project will recruit 100 patients who are just beginning to experience memory loss as well as 100 healthy controls. Their memory function will be measured weekly through a brief, online test that can be accessed through any device and performed in less than 10 minutes. Data from the test will be fed to a computer model that simulates how fast memories fade in each patient’s brain, and the parameter that represents each patient’s speed of forgetting will be tracked over time. While the model simulates the patient, it also adapts the difficulty of the weekly task, ensuring it remains engaging but doable as memory declines.
The weekly estimates will provide the first, detailed trajectories of how fast memory declines over time in healthy aging and in different forms of dementia. The trajectory of the rate of forgetting will be used to analyze MRI data, producing precise associations between different types of memory loss and different types of brain damage.
Improving patient-focused, population-informed care in clinical neurosciences
UW Medicine has amassed detailed patient treatment and business data in its electronic medical record (EMR). This information is a treasure trove that is not used to its full potential for two reasons: 1) For each clinical encounter, only a fraction of the information in the EMR is relevant, and virtually all of the information a clinician engages remains in a format that obscures patterns and trends; and 2) In groups of patients with the same illness, data from the EMR could be used to discern larger trends in the course of the disease or evaluate the effect of practice patterns on patient outcomes. The EMR currently does not provide a way to access this information in an agile way.
We have developed innovative software, “Leaf,” that allows medical providers to access population-based EMR data in real time. Leaf is now used at several academic medical centers nationally. In this project, we will collaborate with the UW Memory and Brain Wellness Center to design and evaluate “dashboards” that visualize how a patient’s history and trajectory compare to other, similar patients. For instance, daily function and cognitive testing data for a person with Alzheimer’s disease, already gathered over the course of several years, could be graphed and compared to the same information from all UW patients with Alzheimer’s disease. We will pilot these dashboards in Leaf and collect patient and provider feedback. We intend to publish our results and make code available as part of the open Leaf platform for rapid dissemination.
Synthesizing position emission tomography (PET) data from MRI using deep learning
Positron emission tomography (PET) is an imaging technique that uses radioactive substances to visualize and assess the brain function. Apart from its heavy use in clinical oncology, PET is widely used in a variety of other conditions such as various neurological, psychiatric, neuropsychological, and cognitive disorders and is the gold standard for assessing neurodegeneration. In particular, PET is clinically used to distinguish Alzheimer’s disease from other dementias and assess the disease progression. Despite its clinical importance, PET imaging encounters barriers because of limited availability, expense and radiation exposure.
This project seeks to address this barrier to brain health using artificial intelligence to predict PET brain images from magnetic resonance imaging (MRI) data. Such a method would be extremely beneficial in clinical settings because unlike PET, MRI is widely available, non-invasive and relatively inexpensive. The approach essentially turns an MRI scanner into a PET scanner, opening up this technology to sites and applications in which PET is either unavailable or infeasible. Doing so would give millions of people access to initial screens for Alzheimer’s disease, assessment of disease progression and an easy way to monitor treatment.
