Practice Type: Outpatient

Evaluating Lifelines4Moms (ELM) Study

Perinatal depression affects 10-15% of pregnant and postpartum individuals, with detrimental impacts on both parent and infant. In response to this, our department developed a perinatal consultation line for providers, PAL for Moms, to increase access to specialty perinatal psychiatric expertise and care.  The purpose of the Evaluating Lifeline4Moms (ELM) is to assess comparative effectiveness of PAL for Moms and other perinatal psychiatry access and referral programs in addressing maternal depression.

As a community-engaged research endeavor, ELM has convened patient advocates, policy experts, and perinatal clinicians, who oversee the study as partners and advisors. Over a period of three years, the research team will characterize the components, implementation timelines, and state policy contexts of access and referral programs; evaluate the reach and implementation of these programs; and examine the comparative effects on access to and quality of mental health treatment among Medicaid-insured perinatal individuals.

Brain Injury Rehabilitation: Improving the Transition Experience (BRITE)

Moderate to severe traumatic brain injury (TBI) is a common cause of long-term disability. Persons with TBI receiving care in inpatient rehabilitation facilities (IRFs) are at risk for rehospitalization, poor community reintegration, family stress, and other unfavorable outcomes. In a six-center randomized pragmatic comparative effectiveness study, we compare the effectiveness of two methods for transition from IRF to the community. The Rehabilitation Discharge Plan (RDP) includes patient/ family education and referrals for continued care. The Rehabilitation Transition Plan (RTP) provides RDP plus individualized, manualized care management via phone or videoconference. 900 patients will be randomized, with caregivers also invited to participate. Assessed outcomes include societal participation, quality of life, caregiver well-being, and use of healthcare resources at 6-months and 12-months post-discharge.

Using technology to optimize Collaborative Care management of depression in urban and rural cancer centers (SCOPE)

This project aims to improve the treatment of depression in cancer patients. Up to 25% of people with cancer will become clinically depressed, significantly affecting their quality of life, functioning, and ability to tolerate cancer treatment. Unfortunately, about 75% of cancer patients with depression do not receive adequate treatment, and patients in rural settings are even less likely to receive adequate care. This study uses a human-centered design approach to develop, build, and test a web and mobile platform to enhance the implementation and fidelity of collaborative care management (CoCM) of depression for patients being treated at urban and rural cancer centers. In Phase I, patient-facing web and mobile applications and a clinician facing website will be developed. In Phase II, the technology-enhanced system will be compared to usual CoCM in a pragmatic effectiveness-implementation randomized controlled trial.

Preventing addiction related suicide

To evaluate the use of an existing selective suicide prevention intervention, Preventing Addiction Related Suicide (PARS), for use with Veterans by: 1) adapting and tailoring content to Veteran populations and 2) conducting an open trial within a VA substance use disorder intensive outpatient program.

Evaluating the Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) Program

The Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) program is a national VA initiative which aims to improve access to treatment medications for opioid use disorder (OUD) in primary care, pain management, and mental health clinics. The Seattle CESATE is conducting ongoing evaluations of SCOUTT to understand providers’ perspectives on the initiative and the outcomes for Veteran participants. Project aims also include to: assess patient retention in and compliance with SCOUTT, assess changes in number of waivered and prescribing providers, retention in and compliance with stepped care, and identify barriers and facilitators to implementing, sustaining and spreading OUD care.

Development of F-18-Labeled Radiotracers for PET Imaging of Brain Alpha1A Adrenoceptor: A Tool for Precision Medicine in PTSD

Prazosin, a drug that prevents the neurotransmitter norepinephrine from binding to its alpha1 receptor (alpha1-AR) subtype has shown efficacy in reducing PTSD symptoms in most, but not all, studies of trauma-exposed Service Members, Veterans, and civilians. However, it is not effective in all patients and its use is complicated by variability in effective doses, a short duration of action, and frequent orthostatic hypotension at dose initiation.

We propose to develop a fluorine-18-labeled radiotracer for PET imaging of brain alpha1A-ARs (implicated in the pathophysiology of PTSD) in human subjects so as to create a PET-based method to identify alpha1A-AR blocking drugs that are more broadly effective and lack the shortcomings of prazosin. Displacement of radiotracer binding by drug candidates will allow assessment of their actions at brain alpha1A-ARs and facilitate the development of novel PTSD therapeutics.

Does the microbiome play a role in adverse outcomes following mTBI and PTSD?

The proposed research will be a preliminary investigation into the potential association between microbiota abundance, hormone levels, peripheral inflammation and current symptoms (psychiatric and cognitive) in Veterans with and without a history of mild traumatic brain injury (mTBI). This work has the potential to form a new line of research that could ultimately provide new treatment options for individuals who have persisting symptoms following mTBI.