Many new and expecting parents struggle with depression during pregnancy or after having a baby. Depression care for pregnant and postpartum people usually includes talk therapy for the parent, and possibly medications. These services are focused on the parent alone, rather than the parent-child relationship. This project adds a brief parenting support program, called Promoting First Relationships Brief (PFR-B), to depression care in pregnancy and the postpartum period. PFR-B helps parents build a strong bond with their baby by better understanding what their baby needs and feels.
After families complete the six session PFR-B program, we will assess parental mental health, parenting knowledge and confidence, and bonding with their baby. We will also interview participants to understand whether adding a parenting program to usual mental health care is practical, whether parents find it helpful, and how it affects their overall well-being. What we learn will help us plan a larger study to test whether this combined approach works better than standard care alone. The findings may also help shape policies about how perinatal mental health services are delivered, such as relationship-focused support for parents and babies together being a standard part of care.
Patient Population: Adults
Building therapeutic community in adult family homes for people living with severe mental illness: a participant-informed study
This pilot project will explore how principles and practices drawn from therapeutic communities might strengthen the support Adult Family Homes (AFHs) provide for people living with serious mental illness. Therapeutic communities use everyday social life, shared responsibilities, and mutual support as active elements of treatment and recovery. Research on therapeutic communities is promising but limited, particularly for communities serving people living with serious mental illness. Existing TCs in the US are often private-pay, rural, and have limited lengths of stay, features which may make them largely inaccessible for people with limited incomes, those living in urban areas, and those seeking stable long-term homes in which to age in place. This project will explore whether selected practices can be adapted to AFHs to support connection, meaningful participation, autonomy, and well-being.
The research team plans to conduct focus groups in three to five AFHs in urban areas of Washington State to learn how people living with serious mental illness experience community, meaning, and recovery in these homes. To increase the study result’s relevance and incorporate lived experience, the research team will partner two current or former AFH residents and two current or former staff members, who may include owners, to develop focus group questions and shape how information is collected. Building on previous research on therapeutic communities funded by the Garvey Institute, the study will produce a preliminary framework and recommendations identifying practices that appear relevant to AFHs, acceptable to residents and staff, and feasible to develop and test further.
Adapting and testing brief, standalone text message interventions for improving mental health related to perinatal stress and trauma
Our team previously developed brief, self-directed text message interventions that deliver coping skills and support to individuals experiencing mental health problems following exposure to traumatic and destabilizing events. In this project, we will adapt our interventions for patients in the perinatal period. The perinatal period—pregnancy, birth, and postpartum—often includes significant stressors and increased risk for trauma exposure. These stressful experiences can lead to posttraumatic stress, anxiety, and depression, which can, in turn, lead to negative outcomes for the birthing parent and baby. Unfortunately, mental health treatment-seeking during this period is low, suggesting a need for additional intervention approaches. Brief, self-directed text message interventions may be a particularly helpful intervention strategy for patients in the perinatal period as they are accessible, low-burden and can reach patients wherever they are and at the time of their choosing.
This project will adapt our existing supportive and skill-based text message interventions for perinatal patients. We will establish two community advisory boards – one with perinatal patients and one with providers – and will consult with them about how best to modify the messages to best serve perinatal patients’ needs. Then we will conduct a test of the adapted intervention to better understand if perinatal patients use and like the messages and whether the messages help perinatal patients improve their mental health related to stressors and traumatic events. The project is intended to lay the groundwork for the development of an additional, effective, accessible low-burden intervention that supports perinatal mental health.
Collaborative financial decisions: a skills training for family members of adults with serious mental illness
Many adults living with serious mental illness such as schizophrenia or bipolar disorder rely on a family member to help manage their money. Family members may serve as an official Social Security payee or help informally with bills and benefits. Good money management support can lower the chances of hospitalization, homelessness, and falling prey to financial exploitation and scams. But being a family money manager is hard. Caregivers often struggle with how to talk about money with their loved one or how to set protective limits without causing resentment, conflict, and strained relationships. Despite how common and demanding this role is, family members get very little guidance on how to do it well.
This project will build and test a self-paced online training that teaches family money managers how to make collaborative financial decisions with their loved ones that encourages autonomy, independence and mutual trust. We will use pre-and post-surveys to test whether family money managers find the training useful and accessible and if it increases their knowledge and skills in collaborative financial decision-making. Those findings will be used to improve the course and lay the groundwork for a larger study to test whether the training reduces family stress and conflict, reduces caregiver burden, and supports a loved one’s recovery. The training plus financial planning guidance unique to the financial challenges faced by caregivers of adults with serious mental illness will be housed on the Family and Caregiver Training and Support (FACTS) Program website housed in the UW Department of Psychiatry and Behavioral Sciences.
From discharge plans to recovery plans
Leaving a psychiatric hospital can mark the end of a mental health crisis, but it does not necessarily mean a person has gotten their life back. Someone may leave the hospital with improved symptoms, medications, and follow-up appointments, yet still struggle to rebuild daily routines, reconnect with loved ones, return to work or school, or regain independence. Hospital discharge planning focuses on treatment and safety, but often leaves a fundamental question unanswered: How can we help people rebuild the lives they want to live?
From Discharge Plans to Recovery Plans aims to bridge this gap. We will develop and test a simple approach that helps patients identify what matters most to them and turn those priorities into concrete, achievable steps. Before leaving the hospital, patients will create personalized recovery plans focused on goals such as reconnecting with family, establishing daily routines, or returning to meaningful activities. A brief follow-up after discharge will help patients navigate obstacles and adjust their plans as needed. Working with 30 patients, people with lived experience, and hospital staff, we will explore whether this approach is useful and can be integrated into routine care. Our ultimate goal is to make recovery about more than reducing symptoms – it is about helping people reclaim meaningful, fulfilling lives.
Father mental health during the perinatal period in Washington: formative research to inform a digital intervention
Fathers have significant unmet mental health needs. One in ten fathers experience depression or anxiety during the perinatal period; even more exhibit adverse behaviors like aggression and substance use. Mental health symptoms are exacerbated by financial, social, and familial stressors of parenting. Fathers’ poor mental health adversely impacts their partners, parenting behaviors, and family wellbeing. Yet mental health resources for fathers are scarce and particularly rare in rural, resource-limited areas of Washington.
This project involves formative research to understand fathers’ mental health needs, parenting stressors, care-seeking barriers, and preferences for digital support during the perinatal period. We will convene a novel community advisory board comprised of Washington-based fatherhood stakeholders. We will collect surveys and interviews among diverse fathers recruited via UW Medicine perinatal services and community advisory board organizations to derive a roadmap for novel digital paternal perinatal interventions. Developing a father-specific digital intervention directly informed by fathers could address a gap in Washington family thriving
From cells to circuits: how focused ultrasound changes the brain to improve mental health
Mental health conditions such as depression, anxiety, and post-traumatic stress disorder affect millions of people, and existing treatments do not work for everyone. Focused ultrasound (FUS) is a promising, non-invasive technology that uses sound waves to influence specific areas deep within the brain. However, we still do not fully understand how it affects brain activity and behavior.
Our project will combine advanced neural recording technologies, behavioral assessments, and computer models in non-human primates to study how focused ultrasound affects the brain, from individual cells to large networks. By investigating brain regions involved in emotion, stress, and thinking, we aim to identify how ultrasound can be used most effectively. This work will lay the foundation for developing more precise, personalized treatments for mental health disorders.
Using retinal signals to predict response to transcranial magnetic stimulation
Depression can be difficult to treat, and even effective therapies do not work for everyone. Transcranial magnetic stimulation (TMS) is a noninvasive treatment that can help people whose depression has not improved with medications or psychotherapy, but patients often undergo daily treatments for several weeks before knowing whether it will work for them. At present, clinicians have no objective biological test to help predict who is most likely to benefit.
This project will test whether a simple, noninvasive eye test called an electroretinogram (ERG) can provide an early biological signal of TMS response. Because the retina is part of the nervous system, changes in retinal activity may reflect changes in brain function. The study will measure ERG signals before TMS and early in the treatment course, then compare those changes with improvement in depression symptoms. If successful, this work could help advance psychiatric care from trial and error toward more personalized treatment decisions, allowing patients to receive effective care sooner and helping clinicians use TMS more efficiently.
Developing resources for behavioral health evaluations in petitions for Extreme Risk Protective Orders
An Extreme Risk Protection Order (ERPO) is a civil legal tool that permits courts to temporarily remove firearms from individuals at elevated risk of harming themselves or others. Lethal means restriction has been found to be a useful mechanism to reduce firearm injury and death. In Washington, the judge hearing the ERPO petition makes findings as to evidence supporting the need for an ERPO and whether a behavioral health evaluation is warranted for the individual whose rights are affected, among other things. When a behavioral health evaluation is ordered, there is no direct pathway for the individual to obtain the assessment.
This project seeks to assess the barriers and implementation of mental health assessments ordered by courts in the setting of issuing ERPOs. This project seeks to 1) Explore the recommendations for the proposed scope of the ERPO behavioral health evaluation; and 2) Explore the feasibility of providing state-sponsored trainings to behavioral health evaluators on conducting these assessments and the feasibility of a state-university clinic (or pool of clinicians) able to provide the one-time court ordered assessments for ERPO proceedings.
Benefits of artificial intelligence-supported skills practice for clinicians training in Problem Solving Treatment for depression
This project will assess the benefits of artificial intelligence (AI)-supported skills practice for clinicians receiving training in Problem Solving Treatment (PST) for depression. Standard clinical training models use multiple one-on-one role-plays, audiotape submission and review by experts, and regular group supervision to train clinicians in the necessary behavioral intervention skills. These traditional training methods are both costly for trainers and require significant clinician time. AI-supported skills practice could strengthen standard skills practice and may increase the number of clinicians who successfully complete training and achieve certification in PST.
We will integrate an AI-supported patient simulation practice tool into existing AIMS Center PST training programs. We will seek feedback from clinician trainees on the added value of AI skills practice over the 6-month training period. This work aims to strengthen existing nationally-delivered training programs and improve the training experience and skill set of PST practitioners.
