Cognitive Behavioral Therapy for psychosis (CBTp) is a time-limited, structured form of talk therapy that is indicated for individuals who experience distress related to psychotic symptoms. Although evidence demonstrates effectiveness in enhancing care and outcomes for clients with psychosis, CBTp is not widely available in the United States. The UW SPIRIT Lab in the Department of Psychiatry & Behavioral Sciences (PI: Sarah Kopelovich, PhD) applies evidence-based implementation and dissemination strategies such as blended learning, train and trainer, Project ECHO, longitudinal consultation to agencies, supervisors, and practitioners, fidelity assessment and monitoring, and sustaining the first CBTp Provider Network in the United States. The CBTp workforce development project aims to sustain and expand access to CBTp across publicly-funded behavioral health settings in Washington State.
Practice Type: Hospital
Developing a digital training resource for clinicians learning CBT for psychosis (CBTpro)
The Cognitive Behavioral Therapy Training Study will rigorously test CBTpro — a novel tool that uses spoken language technologies and conversational Artificial Intelligence to train behavioral health practitioners in Cognitive Behavioral Therapy. We conducted a 2-week field trial, followed by a Randomized Clinical Trail in community mental health agencies to evaluate both learner and client outcomes. The study aims to expand global access to CBT training to students and practitioners, support quality psychological treatments for clients with a range of behavioral health disorders (including Serious Mental Illness), and support ongoing clinical quality assurance in routine care settings.
Evaluation of an asynchronous remote communities approach to behavioral activation for depressed adolescents
In an effort to address the significant challenges in access to and engagement with evidence-based psychosocial interventions for adolescent depression, the proposed research is piloting the use of Asynchronous Remote Communities (ARC) supported behavioral activation (BA) to treat adolescent depression. We aim to 1) build and conduct usability testing on a functional and robust ActivaTeen platform that will satisfy the needs of mental health clinicians and adolescent patients and 2) test the feasibility, usability, and change in proposed target mechanisms (therapist alliance, timeliness of intervention, social belongingness, and engagement) and outcomes of BA+ActivaTeen compared to BA treatment only within a moderately-sized randomized control trial conducted within Seattle Children’s Hospital outpatient psychiatry clinic.
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.
Noninvasive tracking of intracranial pressure to improve care of traumatic brain injury
Following severe cases of traumatic brain injury (TBI), the brain can swell, leading to elevations in intracranial pressure (ICP). Patients who develop high ICP following severe TBI are more likely to have poor neurologic recovery from their injury, and control of ICP likely contributes to improved outcomes. ICP detection and management is typically guided by invasive monitors placed through the skull and into the injured brain. These devices are highly accurate and reliable, but they are also expensive and expose the patient to rare but potentially serious risks. This is problematic because as few as one-third of patients are found to have elevated ICP, even when the best available evidence is used to guide their placement.
Using ultrasound to measure optic nerve sheath diameter (ONSD) could be an inexpensive, noninvasive and reliable means of monitoring ICP. Located behind the eye, the optic nerve sheath surrounds the nerve carrying visual signals to the brain. Increases in intracranial pressure are transmitted into this conduit, causing it to dilate. Ultrasound-measured ONSD has been shown to correlate with ICP in many neurologic conditions, including TBI, but it has not been systematically evaluated as a screening or a monitoring tool.
This study will routinely measure ONSD in patients undergoing invasive ICP monitoring for severe traumatic brain injury at Harborview Medical Center. The goal is to determine whether ONSD measurement with ultrasound can be combined with readily available clinical data to improve the prediction of elevated ICP, and to assess whether it can be used to monitor ICP during a patient’s hospital stay. If successful, ONSD measurement could have a significant impact on TBI care in both high and low resource settings.
Opioid prescription and use following traumatic brain injury
Traumatic brain injury (TBI) is common in the United States with 2.87 million emergency department visits related to TBI per year. Chronic pain is a frequent complaint following TBI, with more than half of patients reporting pain. Individuals with TBI are often prescribed opioids for pain following their injury, but unfortunately may be especially vulnerable to post-injury alcohol and drug use problems.
Despite increased opioid prescriptions and risk factors for this population, there are no clinical practice guidelines for opioid prescription following TBI and limited published research. The project seeks to address this knowledge gap by using routinely collected clinical data from several different data sources to examine when and how opioids are prescribed following TBI in a community-based population.
This complete picture of opioid prescription following TBI may reveal trends of higher opioid prescription for specific subpopulations or areas of healthcare. Through understanding the trajectory of opioid prescription following TBI, we will be able to identify the scope of the problem and the most appropriate time points for intervention. Ultimately this project will provide the foundation for new approaches to reduce opioid prescription in the clinical management of TBI.
Developing a resource toolkit for clinician survivors of suicide loss
This project will develop a resource toolkit for clinician survivors of suicide loss. For clinicians, the death of a patient by suicide is a dreaded event and can be more distressing than death and dying encountered in other clinical situations. In response to patient suicide, some clinician survivors experience emotional and psychological distress that may reach clinical levels and negative and sometimes persisting effects on professional practice. Building on existing reference materials, we will develop a toolkit of resources to guide and support faculty, clinical staff and trainee clinician-survivors affiliated with the department hospitals. These resources would address educational, emotional, administrative and spiritual needs of clinician-survivors.
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.
Collaborative care for perinatal mental health – the LAMMHA project
Los Angeles Maternal Mental Health Access (LAMMHA) is a five year program (2022 – 2027) funded by The California Health Care Foundation (CHCF) to support health centers in Los Angeles to identify and treat common perinatal mental disorders (CPMD) and reduce the risk of suicide. The LAMMHA initiative is a collaboration between Community Clinic Association of Los Angeles County (CCALAC), Elevation Health Partners (EHP), Maternal Mental Health Now (MMHN), Concert Health and the Department of Psychiatry and Behavioral Sciences at the University of Washington. Co-created with Los Angeles community stakeholders, the LAMMHA program currently offers Los Angeles County providers and community clinics two different levels of support to improve perinatal mental health care.
For more information and/or to apply for the program, please visit the CCALAC LAMMHA page: https://ccalac.org/los-angeles-maternal-mental-health-access-lammha/.
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. |
