Death by suicide is the 2nd leading cause of death among young adults in the United States. While most patients who die by suicide have had recent contact with their health care providers, the medical delivery system is poorly equipped to address this preventable issue. EMA (ecological momentary assessment) systems show promise as indicators of suicide risk and as a means of enhancing existing resources. However, little is known about how to apply these methods in the context of clinical care. The AMPERE study leverages existing work on EMAs and human-centered design principles to develop and pilot a prototype suicide risk monitoring system to support suicide risk management for adolescents and young adults (ages 16-30) within the UW Medicine Primary Care system.
Practice Type: Primary Care
Evaluating the role of virtual whole health in PC-MHI
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).
Complementary and integrative health stepped care for co-occurring chronic pain and PTSD
The aim of the project is to conduct a pragmatic pilot trial of a CIH-based stepped care approach v. treatment as usual in two primary care settings (one rural and one urban). The pilot trial will focus on feasibility, acceptability, and appropriateness for providers and patients (e.g., randomization, retention, and treatment satisfaction) of the stepped care approach versus usual care (n=30 per site, N=60 total). Primary clinical outcomes are pain interference and PTSD symptoms at 6-months.
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.
CANOE partnership: Cancer Awareness, Navigation, Outreach, and Equitable Indigenous Health Outcomes
The CANOE Partnership: Cancer Awareness, Navigation, Outreach, and Equitable Indigenous Health Outcomes responds to the need to improve cancer outcomes for American Indian and Alaska Native (AI/AN) communities. Our Overall Specific Aims are: (1) Improve rates of cessation of commercial tobacco smoking among a nationally recruited sample of AI/AN adults (Research Project 1); 2) Improve rates of lung cancer screenings among our Tribal partner populations in the Consortium’s catchment area (Research Project 3); 3)Prepare the next generation of researchers in Indigenous cancer equity and provide them with resources to obtain preliminary data to inform future cancer equity research in Indian Country (Pilot Grant Program); and 4) Develop infrastructure to support equitable engagement of Tribal partners and Indigenous Frameworks in cancer research.
Enhancing Suicide Care Monitoring and Intervention in Primary Care
This project outlines a comprehensive two-year initiative aimed at enhancing suicide care services in primary care settings. The project addresses a critical gap in the continuum of care by providing interim crisis support for at-risk patients who are waiting to be connected to specialty mental health. The main objectives of this project are to develop two innovative interventions intended to be delivered in a primary care setting: an adapted caring contacts protocol and a system to provide short-term, centralized remote monitoring of patient’s suicide risk. In designing these interventions, we intend to leverage technology such as digital/online platforms and remote monitoring systems that will support asynchronous patient check-ins. Finding innovative ways to offer support to patients in primary care settings where there is limited clinician time and typically an even more limited behavioral health workforce is imperative to creating a sustainable program. Therefore, our proposal intends to maximize the use of technology and focuses on self-guided and/or automated approaches.
This project uses a co-design approach to develop these interventions, where we will elicit input directly from patients and caregivers on the acceptability, feasibility, and appropriateness of these interventions. We hope this project will improve the timely support and management of suicide risk among primary care patients, ultimately enhancing services in outpatient settings while supporting the Least Restrictive Environment Framework, to enhance patient outcomes, reduce unnecessary referrals to overburdened emergency departments, and promote the overall well-being of patients and their families.
Adapting a brief suicide intervention for pediatric primary care: Enhancing uptake and impact
This project aims to partner with rural, urban, and suburban pediatric primary care practices in Western Washington to improve access and effectiveness of suicide prevention programs through adapting the SAFETY-A intervention for use in primary care settings. This project has the following aims: (1) assess needs of primary care staff, patients, and parents/caregivers for suicide prevention services in primary care, (2) iteratively design and refine a SAFETY-A based suicide prevention model of care prototype for primary care, (3) Pilot test the model of care, compared to treatment as usual, with 3 primary care clinics in rural, urban, and suburban settings.
Adaptation and co-design of a digital intervention for suicide prevention in primary care
Suicide is a leading cause of death among 10-to-24-year-olds. Primary Care (PC) often serves as a trusted resource for adolescents and young adults (AYA) and their families; and routine wellness visits provide important opportunities for early detection of suicide risk. Importantly, nearly half of those who die by suicide contact their PC clinic within one month prior to suicide. Unfortunately, suicide prevention resources for PC are limited, with a particular gap in short-term risk management and intervention services for lower risk patients and patients with STB who are waiting to be connected to specialty mental health care. Furthermore, parents/caregivers (hereafter referred to as parents) represent a key protective factor for suicidal AYA. Yet, few interventions have been developed to leverage parent support and increase parental self-efficacy to prevent AYA suicide. The current project partners with a digital mental health app, iKinnect, to adapt it for use in PC. iKinnect is designed to improve parent and AYA communication and parental selfefficacy to prevent risk behaviors, including suicide behaviors. The tool uses a parent and AYA paired interface and was originally designed for implementation with high-risk youth involved in the juvenile justice system. Intervention components include parent and AYA content including safety planning, skills for emotion management, parent coaching on lethal means restriction, expectation and goal setting, earning/providing rewards and praise, and modeling videos for parents. While promising, the program has yet to be tested with AYA presenting with suicide risk in PC.
Exploring the implementation determinants of paraprofessional task-shared mental roles in integrated behavioral care settings in Washington State
The gap between the number of people needing and accessing mental health care has led to the development of new types of mental health providers to help expand access to care. These providers, referred to as paraprofessionals, have typically at most a bachelor’s degree and treat mild and moderate depression and anxiety. However, because the novelty of these roles in the Unites States, little is known about organizational and employee barriers to uptake and implementation. Further, little is known about US patient perspectives on having a paraprofessional mental health provider. The proposed research explores behavioral health employer, behavioral health employee, and patient perspectives on two new paraprofessional roles being deployed in Washington State – the mental health Community Health Worker and the Behavioral Health Support Specialist – to help identify key barriers and facilitators to implementation of these roles.
Sequenced Treatment Effectiveness for Posttraumatic Stress (STEPS)
The proposed research will determine whether primary care clinics should offer medications or talk therapy first to treat posttraumatic stress. In addition, for patients who do not respond to the first treatment, the STEPS trial will determine what treatment should be offered next. More information on our info sheet.
