Chronic pain is one of the most prevalent and disabling conditions affecting Veterans. One of the Veterans Health Administration’s (VHA’s) most pressing national clinical priorities is to increase access to non- pharmacological pain management and improve the safety of opioid prescribing. The National Pain Management and Opioid Safety Program (PMOP) is implementing virtual interdisciplinary pain management teams, TelePain, to improve access to evidence-based pain care among rural Veterans and those served by smaller VA facilities. The proposed evaluation, developed closely with PMOP, uses a rigorous prospective design to evaluate TelePain’s impact on clinical outcomes for Veterans and costs to VHA, while also evaluating TelePain’s impact on access to care and other implementation outcomes. These findings will provide actionable information to improving ongoing TelePain implementation efforts and inform VHA of the potential sustainability of TelePain as a model of care.
Patient Population: Adults
Patient Readiness for Improvement through Motivation, Engagement, and Decision-making for PTSD (PRIMED-PTSD)
PTSD is one of the most common mental health conditions affecting Veterans and is associated with significant burden. Highly effective treatments exist for PTSD, evidence-based psychotherapies, but very few Veterans receive them. Although VA has trained over 8,500 providers in evidence-based psychotherapies for PTSD over the past 10 years, only 6% of the 650,000 VHA patients with PTSD receive an evidence-based psychotherapy. It is critical that we connect Veterans with our most effective PTSD treatments and that we do so in a way that is Veteran-centered. Shared decision making is a patient-centered approach to choosing healthcare treatment options. It has been shown to increase patients’ motivation for treatment and ability to stay in treatment long enough to get benefit. It has also been shown to help providers align their practice with evidence-based guidelines. This proposal will refine and pilot test a shared decision making intervention for PTSD to be used in VA primary care clinics, where the vast majority of Veterans with PTSD are treated.
Impact of the Preventing Addiction-Related Suicide (PARS) Intervention on patients who receive community-based addiction treatment
Persons with substance use disorders are 5-10 times more likely to die by suicide than the general public. Recognizing this, Rick Ries, MD, Katherine (Kate) Comtois, PhD, MPH, and the UW Center for Suicide Prevention and Recovery (CSPAR) staff developed the first and only suicide prevention intervention successfully developed with and tested in community addiction treatment centers. The primary outcomes of the multisite PARS clinical published in JAMA Network Open in April 2022. Led by Dr. Ries, Kevin Hallgren, PhD, Amanda Kerbrat, LICSW, and Yanni Chang, MD, this project will fund a more detailed secondary analyses to better characterize which patients respond best to the PARS intervention, which in turn will help inform intervention improvements.
Role of criminal defense attorneys in suicide prevention following defendant arrest
This study will explore the role that criminal defense attorneys could play in reducing risk of suicide amongst recently arrested criminal defendants. Suicide is the leading cause of death in jails and the period after recent arrest may be a particularly vulnerable time for suicide. For many persons with recent arrest, their attorney is one of only a small number of persons that they encounter in the days following arrest. This proposal aims to better understand the experience of the criminal defense attorney in working with clients who have suicidal thinking or behavior; training they have received in the past; desired training (such as suicide risk identification, trauma-informed care, resources); and challenges in disclosures in light of their professional responsibility to preserve client confidences.
Suicide risk screening in acute and intensive care at a Level 1 Trauma Center
Patients hospitalized for medical, surgical, or traumatic injury reasons at Harborview Medical Center are universally screened for suicide risk. The present research will advance knowledge about the practices occurring at this large healthcare institution serving the public and social safety net population and set the groundwork necessary for conducting future research designed to improve services not only at Harborview but at similar institutions across the U.S. A team led by Doyanne Darnell, PhD, and Imara West (Research Scientist at Data Quest) will capture population-level electronic health record (EHR) data on suicide screening rates and outcomes among medically hospitalized patients for a 1-year period and gain insight into the context of the data captured through focus groups with acute/intensive care nurses.
Using routine alcohol screening measures to identify 1-year risk of suicidal ideation, intent, and planning within a large primary care system in Washington
This study will use a large population-based primary care sample in Washington state to understand how heavy alcohol use and alcohol use disorder symptoms contribute to suicidal thoughts. This study will allow examination of how different levels of alcohol use can predict short term risk of suicidality and allow us to better identify and support patients at risk of suicide in the primary care setting.
Consumer perspectives of online & in-person suicide prevention strategies
This study will explore which interventions people with lived experience of suicide find acceptable (e.g., different types of in-person and telehealth care, web-based, text message, app, etc.), who should be the agent to deliver the intervention, and what concerns would they have in having social media and search data used for risk identification and then intervention. These findings have the potential to impact how suicide prevention strategies are brought to scale in a way that is seen as acceptable and appropriate to patients at risk for suicide
Pathways from Chronic Prescription Opioid Use to New Onset Mood Disorder
The proposed research addresses three important objectives including: 1) Can OUD screening be effectively incorporated into primary care mental health screening protocols?; 2) Does implementing Collaborative Care for OUD and mental health disorders improve outcomes?; 3) What implementation strategies are effective at sustaining Collaborative Care programs that concurrently manage mental health disorders and OUD?
Bipolar disorder measures in clinical care
The goals of this project are to 1) determine which validated bipolar disorder patient-reported symptom measure is most acceptable and helpful to patients and clinicians in clinical care, 2) demonstrate that the preferred measure can be used to monitor outcomes with high fidelity in routine care, and 3) assess the feasibility of comparing effectiveness of measurement-based care (MBC) to usual care in a randomized trial.
A cluster-randomized controlled trial testing the effectiveness of the Life Enhancing Alcohol-management Program (LEAP) for Housing First residents
| People experiencing chronic homelessness comprise a small yet high-morbidity, high-cost subset of the larger homeless population and are disproportionately impacted by alcohol-related harm. This study proposes a cluster randomized controlled trial of an innovative, community-based, and client-driven program known as the LEAP to explore its impact on substance use and quality of life outcomes among individuals with lived experience of homelessness and alcohol use problems living in Housing First settings. Analyses will test LEAP effectiveness in increasing engagement in meaningful activities, decreasing alcohol use, ameliorating both first- and secondhand alcohol-related harm, and improving quality of life for this population. |
