Practice Type: Community-Based Organizations

Harnessing the ECHO Model to help Washingtonians with Traumatic Brain Injury (TBI)

Traumatic brain injury (TBI) is a major cause of disability in Washington state and throughout the US. TBI increases the risk and complexity of multiple behavioral health conditions including post traumatic stress disorder, depression, anxiety, irritability, anger/aggression, substance misuse and cognitive impairment. In addition, TBI impairs a person’s ability to manage their health care and increases the risk of unemployment, long-term functional impairment, and caregiver burnout. Successful TBI recovery can depend in large part on access to and engagement in behavioral health treatment. Unfortunately, TBI-focused community resources are scarce and fragmented. Treatment of post-TBI symptoms often falls to community providers who have little support and are under-prepared to manage these complexities. This burden disproportionally affects rural providers who have little access to specialist care at academic centers.

The purpose of this project is to create and assess the use of the ECHO (Extension for Community Healthcare Outcomes) model to provide education and support by experienced TBI experts to community providers who treat persons with TBI. The ECHO model uses both a virtual educational lecture series and patient case discussion to improve provider preparedness to treat patients and improve patient outcomes. We will launch a monthly to bi-monthly program that will train providers from a variety of disciplines and settings in identification and evidence-based behavioral health treatments, web technologies and mobile technologies, and provide detailed case consultation. We will assess the success, reach and impact of our TBI ECHO by collecting and comparing attendee experiences, clinical information and patient outcomes.

This project received two years of additional funding from the Washington State Department of Social and Health Services.

High potency cannabis policy legislative report

Explore and suggest policy solutions in response to the public health challenges of high tetrahydrocannabinol potency cannabis. ADAI will host stakeholder sessions to gain perspectives, seek common ground, evaluate, and assess potential policy solutions culminating in a final recommendation report.

Mobile mental health in community-based organizations: a stepped care approach to women’s mental health

Of every 10 women in rural India, one suffers from a common mental disorder such as depression. For many, depression goes untreated and is associated with increased morbidity and mortality rates. Several factors, specifically for women in rural India, including stigma, lack of provider mental health workforce, and travel times. Therefore, there is an urgent need to improve detection and treatment rates among women without overburdening the scarce mental health resources in rural India. 

The “Mobile Mental Health in Community-Based Organizations: A Stepped Care Approach to Women’s Mental Health” study aims to develop and implement a mobile mental health intervention for women through community-based organizations. The intervention is delivered in a stepped-care approach where women receive different levels of intervention depending on the severity of their mental health needs. 

Lay-delivered behavioral activation in senior centers

This collaborative study with Cornell Medical College and the University of Florida tests the effectiveness of “Do More, Feel Better” (DMFB), a lay health delivered behavioral intervention, in comparison to professionally-delivered Behavioral Activation. The specific aims are to test the effectiveness of “Do More, Feel Better” for depressed older adults on increasing overall activity level and reducing depression symptoms.

Staying in Touch and Engaged Project (STEP)

The “Staying in Touch and Engaged Project” (STEP) aimed to support Housing First residents in staying in touch with researchers and in engaging in meaningful activities during the COVID-19 outbreak and social distancing directives. A 16-week, two-group randomized controlled pilot trial compared remote assessment of substance-use and health-related quality of life assessment paired with immediate versus delayed provision of remotely delivered meaningful activities. The aim of this project was to test whether the meaningful activities package (MAP) engages residents and improves their mood, substance-use outcomes, and physical and mental health-related quality of life.

The project team mailed study invitations to residents in five housing programs (estimated mailed N=538). To date, 32 Housing First residents reached out to consent to participate, responding via mailed consent forms, phone, video conferencing or online survey completion. Of those who consented, 26 have completed baseline assessments, and 11 have completed one-month follow-ups. The study highlighted the difficulties in reaching residents, partly due to the lack of communication technologies.

The team found that the technological divide has grown deeper and more consequential during the pandemic and must be bridged to facilitate social connection, physical and mental health, and basic communication for people marginalized by the lived experience of homelessness and psychiatric, medical and substance use disorder. The team is working to locate additional funds through the UW and WSU to continue participant recruitment and evaluation efforts, achieve the originally proposed sample size and further improve follow-up rates.

Re-engineering siloed systems of care through evidence-integrated design thinking

Behavioral health, including suicidal behaviors and problematic substance use, are significant public health concerns and are routinely identified by community health departments as a high priority. However, needed services are highly fragmented across multiple systems (e.g., prevention, primary care, schools). Addressing these urgent public health concerns requires decisionmakers to collaborate and coordinate services. System-level planning efforts tend to fail because adopted models are either not informed by evidence, or policy decisions do not have sufficient community buy-in and are poorly implemented.

To address this gap, our team created a hybrid approach, “System Codesign,” in which researchers and local decisionmakers form a design workgroup and collaborate to create a tailored and sustainable plan to address community public health issues. This partnership approach allows end users to be actively involved in the design process to help ensure that the outcome meets the needs and expectations of the community. The researcher’s role is to locate and synthesize research findings relevant to the community agency’s goals and assist in integrating these principles within real world programming. This new “System Codesign” approach is built from well-established participatory and implementation frameworks and incorporates evidence-informed standards in research into the energy and creativity of design thinking to support local systems. This model is expected to incorporate evidence, innovation, and local relevance into final system products.

Our research team aims to assess the acceptability and feasibility of this “System Codesign” process as a tailored implementation method for tackling complex behavioral healthcare issues. Our aim is to partner with the state Healthcare Authority (HCA) to pilot this approach with a rural Washington community, Grays Harbor County, which has a high prevalence of behavioral health needs. The proposed design workgroup will leverage cross-system participation from behavioral health, justice, law enforcement, faith-based organizations, schools, and community members.

Disseminating a user-friendly guide: Advancing the science of intervention adaptation and improving access to evidence-based psychological treatment

Adaptation of evidence-based practices and programs (EBPs) is a necessary component of the implementation process. EBPs must be adapted to function with the constraints of real-world practice settings, providers’ expertise, and patients’ needs. The science of intervention adaptation is hungry for well-defined methods of EBP adaptation to guide decision making. A how-to guide for EBP adaptation titled MODIFI: Making Optimal Decisions for Intervention Flexibility during Implementation, is under development with NIMH funding (F32 MH116623). MODIFI will be disseminated via multiple strategies locally, nationally, and internationally. Dissemination of MODIFI will improve the practice of intervention adaptation by providing practitioners with a how-to guide that is (a) evidence-based, (b) usable, and (c) supported by the expert consensus of implementation practitioners and researchers.