This project aims to develop a clinical scaffolding system to enhance telemental health care by providing real-time coaching and actionable suggestions during video-based sessions. Modeled after live supervision methodologies, it supports clinicians by identifying intervention targets and offering text-based coaching prompts to guide care. Unlike automated chatbots, this approach enables clinicians to adapt suggestions to patient needs, balancing automation with oversight for safer AI-supported mental healthcare. The proposed in-session support will facilitate efficient implementation of strategies and clinician skill development. This project seeks to enhance data privacy by processing all data on-device and avoiding external data transfers.
Patient Population: Adults
Developing a hospital-based treatment engagement program for Alcohol Use Disorder
Alcohol use disorder (AUD) frequently results in serious illness, injuries, and hospitalizations. Surviving illness or injuries related to alcohol use can motivate behavior change that could be harnessed through treatment engagement for AUD in the hospital; however, in general hospital settings, patients are rarely presented with more than a piece of paper with phone numbers to call for help with their drinking. This project is focused on designing and evaluating a shared decision making approach for AUD treatment in hospitalized patients. We are interviewing people who are hospitalized with complications of AUD to better understand their unique needs and preferences. We are using the knowledge gained from interviews with patients to adapt a paper-based decision aid that was originally designed to help clinic patients think about changing their drinking, and creating an interactive web-based interface, tailored to hospitalized patients. We will then evaluate the use and effectiveness of this new online decision aid for engaging hospitalized patients in AUD treatment. The overarching goal of this research is to more effectively use hospitalizations to bridge individuals to long-term, potentially lifesaving AUD care.
Partnering with patients to re-envision psychiatric hospitalization and discharge
We will analyze people’s stories about psychiatric hospitalization, interview people with experiences surrounding psychiatric hospitalization, and co-design with them to identify alternative approaches that would help people care for themselves as they transition out of the hospital. We will build upon our prior work on understanding patients’ challenges and co-designing new systems that help patients transition from psychiatric hospitalizationto self-management. In particular, we will focus on how we could redesign psychiatric hospital systems with the people who have experienced them, identifying patient insights on the knowledge, resources, and self-efficacy they need to help them return to the community.
GATHER: Growing a Tribal Healing Effort through Research
The GATHER initiative aims to: 1) Coordinate a national research network to support tribally led research on etiology and prevention of overdose, substance use, mental health, and pain management. 2) Provide administrative support and shared resources to facilitate the successful completion of N CREW research projects. 3) Provide an administrative infrastructure, intellectual environment, and access to resources and initial support for investigators. 4) Provide research training and access to subject matter experts for investigators, staff, and students in the areas of cognitive, motivational, and behavior therapies, Indigenous approaches to research and healing, and multimodal holistic approaches to prevention and treatment. 5) Serve as a local, national, and international resource for dissemination of information and training to reduce risk in diverse tribal and urban Indian populations.
CANOE partnership: Cancer Awareness, Navigation, Outreach, and Equitable Indigenous Health Outcomes
The CANOE Partnership: Cancer Awareness, Navigation, Outreach, and Equitable Indigenous Health Outcomes responds to the need to improve cancer outcomes for American Indian and Alaska Native (AI/AN) communities. Our Overall Specific Aims are: (1) Improve rates of cessation of commercial tobacco smoking among a nationally recruited sample of AI/AN adults (Research Project 1); 2) Improve rates of lung cancer screenings among our Tribal partner populations in the Consortium’s catchment area (Research Project 3); 3)Prepare the next generation of researchers in Indigenous cancer equity and provide them with resources to obtain preliminary data to inform future cancer equity research in Indian Country (Pilot Grant Program); and 4) Develop infrastructure to support equitable engagement of Tribal partners and Indigenous Frameworks in cancer research.
Deciphering Mechanisms of ECT Outcomes and Adverse Effects (DECODE)
Electroconvulsive therapy (ECT) is one of the most effective antidepressant non-invasive brain stimulation therapies for adults with major depression. However, a number of patients fail to respond despite adequate trials, and while clinically beneficial, ECT can produce adverse cognitive effects including amnesia, executive dysfunction, and verbal dysfluency.
In this prospective study, we propose the first investigation integrating multiple units of analysis including clinical and cognitive phenotyping, whole-brain neuroimaging, EEG, and E-field modeling to establish the mechanisms underlying ECT-induced antidepressant response (response biomarkers) and cognitive adverse effects (safety biomarkers), as well as to find the “sweet spot” of ECT dosing for optimal antidepressant benefit and cognitive safety. This proposal will result in a paradigm shift from “trial and error” approaches of ECT parameter selection to individualized, precision dosing to improve patient outcomes.
Default mode network impairments in comorbid anxiety and cannabis use disorders
Social anxiety disorder (SAD) is characterized by maladaptive self-focused attention (SFA), which itself is correlated with large scale brain network connectivity impairments. Cannabis use disorder (CUD) is commonly conceptualized as impaired reward processing within the ventral dopaminergic network, however, it is also implicated in connectivity disturbances in other critical cortical circuits. In the current study we will characterize the large scale brain network impairment in comorbid SAD and CUD given commonly overlapping symptoms and population prevalence
Psychosis beyond symptoms: Cognitive and genetic biomarkers of schizophrenia
Schizophrenia is a prevalent, debilitating psychiatric disorder that is diagnosed based on clinical interviews that are subjective and highly variable; in fact, two patients can have no overlapping symptoms and be diagnosed with the same disease. While cardiologists have blood tests to help diagnose heart attacks and oncologists have PET scans to find hidden cancers, psychiatrists don’t have objective diagnostic tests. This proposal will utilize machine learning to analyze cognitive tests, brain electrical activity, and genetic signatures from 1,415 patients with schizophrenia and 1,062 controls to uncover biomarkers of schizophrenia. By incorporating biomarkers into diagnostic standards, psychiatrists could one day order a simple test that could help them confidently diagnose schizophrenia and make better treatment decisions based on quantitative rather than subjective measures.
Exploring the implementation determinants of paraprofessional task-shared mental roles in integrated behavioral care settings in Washington State
The gap between the number of people needing and accessing mental health care has led to the development of new types of mental health providers to help expand access to care. These providers, referred to as paraprofessionals, have typically at most a bachelor’s degree and treat mild and moderate depression and anxiety. However, because the novelty of these roles in the Unites States, little is known about organizational and employee barriers to uptake and implementation. Further, little is known about US patient perspectives on having a paraprofessional mental health provider. The proposed research explores behavioral health employer, behavioral health employee, and patient perspectives on two new paraprofessional roles being deployed in Washington State – the mental health Community Health Worker and the Behavioral Health Support Specialist – to help identify key barriers and facilitators to implementation of these roles.
Validating changes in a primary-care based alcohol use screening instrument for predicting changes in risk for psychiatric acute care utilization
Approximately 20-25% of primary care patients have unhealthy alcohol use, which can have significant impacts on mental health. Screening for unhealthy alcohol use within primary care settings is increasingly used for point-in-time identification of people who could benefit from brief advice or brief interventions. My project will use a large, longitudinal, real-world dataset consisting of electronic health record (EHR) and insurance claims records to test whether longitudinal changes in alcohol screening scores completed by primary care patients as part of routine care are associated with changes in one-year risk for psychiatric acute care utilization (i.e., emergency department visit or hospital encounters primarily for a mental health condition).
