The COVID-19 pandemic facilitated simultaneous paradigm shifts in healthcare delivery: virtual care (telehealth and videoconferencing) and the need for “Whole Person” healthcare that targets mind, body, and spirit, per recent US Surgeon General1 and National Academy of Medicine2 calls-to-action. The pandemic also highlighted treatment delivery inequities involving rural Veterans. The current proposal will address these trends, assessing virtual VA Whole Health care use in Primary Care-Mental Health Integration (PC-MHI) for rural and non-rural Veterans with chronic pain and co-occurring posttraumatic stress disorder (PTSD).
Practice Type: Outpatient
Behaviors and Executive Skills in T21 (BEST21)
We are conducting a study to understand the role of problem-solving in challenging behaviors for children with Down syndrome so that we can better understand the development of and treat these behaviors. If you agree to participate, this study will involve questionnaires, some of which may be completed at home. You would also attend an in-person visit that involves measuring your child’s naturally-occurring brain activity with EEG as well as cognitive assessments. We would schedule your visit around your schedule to the best of our ability and we can schedule this visit in a location that is convenient for you (UW, home visits, etc.). Participants will receive an $80 gift card to thank them for their time.
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.
Establishing a direct clinical – law enforcement partnership to address dementia crisis intervention across WA state
Although medical care and law enforcement may intersect in an emergency situation, cross-communication and mutual education opportunities prior to the critical tipping point are currently sorely lacking. Our innovative partnership seeks to address these gaps by determining the specific steps dementia clinicians and law enforcement in WA state can take together to improve community health.
For Phase I of this project, we are initiating a direct collaboration between clinicians and law enforcement for dementia crisis intervention, in order to establish appropriate safety measures to be enacted in WA communities. An essential component of ensuring lasting impact can only be achieved by determining the local availability, usability, and effectiveness of proposed safety interventions.
UW dementia specialists will partner with law enforcement across Washington state to jointly identify the resources necessary for effective dementia crisis response. We seek to bridge the gap between medical care and community safety concerns, specifically at a crisis point when a community member feels compelled to summon law enforcement due to perceived significant threat or lack of awareness of other, more appropriate resources. We will conduct interviews with clinicians, police departments, and community stakeholders, review police call logs, and perform ride alongs. The information gathered will be analyzed for major themes related to knowledge and resource gaps, as well as any existing solutions. Three crisis response priorities will be identified, and corresponding “safety packet” content will be outlined in preparation for community partnership input, local adaptations, and ultimately state-wide dissemination.
Adopting a lifespan approach for ADHD management
ADHD is common, heritable and impairing. As recognition of the negative functional impacts associated with ADHD in adulthood has grown and stigma around the diagnosis has diminished, demand for ADHD care across the lifespan has increased.
This project will begin foundational work to inform the development of a family-focused lifespan clinic at UW serving adults and children with ADHD. For such a program to be effective, equitable, and sustainable, we must clarify the true needs of individuals living with ADHD as well as the professionals caring for them. We will convene four groups of key community partners: (1) Adults with ADHD whose children have ADHD, (2) Adolescents with ADHD, (3) Mental health professionals representing the fields of psychiatry, psychology, psychiatry advanced practice nursing, school-based counseling, (4) Primary care providers. Results will guide program development and illuminate future research opportunities.
Assessing need and acceptability of a family intervention for individuals with Opioid Use Disorder
Many people love someone who uses substances in a harmful way and want to help that person. Family members and friends often are key supports in people seeking and staying engaged in treatment and services. At the same time, family members and friends feel like they lack the skills or support to help their loved one effectively. This may be especially true for opioid use disorder, where the strongest evidence for treatment is for medication for opioid use disorder, but families and friends don’t know how to help their loved ones access and stay on these life-saving medications.
Our study will talk with people who are getting medications to treat opioid use disorder and ask about the involvement of their family members and friends in their lives and recovery. We will reach out to these key supports to ask how they would want to do a group-based program to help them develop skills and knowledge to support their loved one’s care. These groups would be delivered by nurses with specialized training in opioid use disorder and treatment. Group content will be based on an existing, evidence-based treatment designed for family members and will help people understand the role of medications in treating opioid use disorder and teach skills to support their loved one.
Evaluation and dissemination of the TRANSforming Families: Embracing Change with Teens Therapy Group
Transgender and gender diverse (TGD) adolescents experience 4-18 times higher rates of anxiety, 4-23 times higher rates of depression, 11-54 times higher rates of suicidal ideation, and 2-5 times higher rates of suicide attempts compared to their cisgender peers. Importantly, parents/guardians (i.e., caregivers) can have a significant impact on TGD adolescent mental health, with recent research suggesting that caregiver support and acceptance are associated with a 30-40% reduction in these mental health concerns.
Community-based support groups are common practice with TGD adolescents and families. However, group intervention programs that work specifically with caregivers are rare, and existing programs have not been formally evaluated. Therefore, the goal of this project is to evaluate TRANSforming Families: Embracing Change with Teens, a virtual, multi-family program that was developed by mental health providers in the Seattle Children’s Gender Clinic (SCGC), to understand its impact on caregiver support and acceptance and adolescent mental health. This partnership between SCGC mental health providers and researchers will represent one of the first formal evaluations of a group intervention program for caregivers of TGD adolescents, the results of which can inform future implementation and evaluation of this program in pediatric gender clinics across the United States.
Partnering with community pharmacies to enhance access to long-acting injectable antipsychotics in Washington State
Medication nonadherence is common among patients with serious mental illness, including schizophrenia. The use of long-acting injectable antipsychotics (LAIAs) for schizophrenia is an evidence-based practice that improves medication adherence, decreases symptomatic recurrence and reduces hospitalizations. However, patients and clinicians often face several challenges in access and coordination resulting in the underutilization of LAIAs in care.
Administering LAIAs at community pharmacies could potentially increase accessibility, reduce barriers for treatment and improve patient outcomes. This project aims to assess the fit or compatibility of LAIA administration in community pharmacies. We will survey community pharmacy staff and behavioral healthcare providers in Washington State to assess the acceptability, appropriateness and feasibility of LAIA administration in community pharmacies. If LAIA administration at community pharmacies is found to be a good fit, the next steps will be to develop strategies to support implementation. A scalable and adoptable model for administering LAIAs at community pharmacies could have substantial impacts on public health through increasing access to treatment and expanding behavioral health services at the community level and in rural areas.
Examining the cross-cultural applicability of the Spanish PMQ-9: a comparative validation study
The purpose of this project is to enhance the usefulness and cultural relevance of the Spanish version of the PMQ-9, a questionnaire that assesses manic symptoms in individuals with bipolar disorder.
Immune changes with neuropsychiatric symptoms in dementia
Though the focus of most research on dementia is the pathogenesis of cognitive deficits, neuropsychiatric symptoms (NPS) are identified in >90% of those afflicted, resulting in hastened cognitive decline, worsened general health, reduced patient and caregiver quality of life, sooner institutionalization, and increased mortality. Affective symptoms, including depression, are the most common NPS in Alzheimer’s Disease (AD), and are present in over half of patients. Using the in-depth clinical phenotyping of participants in the National Alzheimer’s Coordinating Center (NACC) with matched plasma samples, we propose to determine the correlation between select cytokines/chemokines and T-cell differentiation with depression in dementia.
