Partnering with the Quinault Indian Nation to develop a community-based contingency management intervention

Indigenous knowledge remains strong in American Indian/Alaska Native (AI/AN) communities despite colonization, postcolonial efforts to assimilate and eradicate AI/AN people, present-day inequities and structural racism. Despite strength and resilience, AI/AN populations have high rates of unintentional overdose and death by suicide. There is an urgent need for evidence-based, culturally responsive approaches to increase protective factors against substance use and mental illness in AI/AN communities.

This study is a partnership between University of Washington researchers and the Quinault Indian Nation’s behavioral health providers and community. We will design a culturally adapted community-based contingency management intervention to increase positive reinforcement for adolescents and young adults at risk for substance use and mental illness. This intervention will focus on community identified target behaviors rather than abstinence. By prioritizing the needs of the community we will develop an intervention that is effective, usable and sustainable.

Family and Caregiver Training and Support Program (FACTS) pilot

We know from decades of research that caregiver involvement, including family and non‐family members, in a patient’s mental health treatment can make a tremendous difference in the trajectory of their loved one’s life by supporting recovery, reducing relapse, and decreasing mental health crises. Family and caregiver involvement also decreases provider stress, improves caregiver well-being, and can lead to lower patient healthcare utilization and costs. But despite their importance, many family members and caregivers struggle to engage in the kind of support that can benefit the patient and themselves. They often lack access to education, resources, or skills to step into this critical role despite a desire to help. Our initiative intends to develop a pilot Family and Caregiver Training and Support Program (FACTS) program that aims to decrease barriers to caregiver involvement and improve caregiver support.

Our team will develop online training that will include an orientation to having a loved one who is psychiatrically hospitalized and will teach families and caregivers practical communication skills while their loved one is in our care. These topics would be relevant regardless of a patient’s diagnosis and will be adapted from existing evidence‐based models. The pilot will be tested with caregivers of patients hospitalized at the new Center for Behavioral Health and Learning and we will proactively integrate input and feedback from participants to inform program improvements along the way.

We will also build a public-facing website to host FACTS training materials as well as mental health information and resources that we will curate for accuracy and reliability. We expect the FACTS pilot content will serve as a foundation for additional offerings that will include diagnosis specific skills trainings as well opportunities for in-person sessions and Family Peer Support programming.

Implementing contingency management in a supportive housing context to promote resident well-being

Mental health and substance use disorders carry complex needs of living that are often poorly-served by our health systems, which result in immense societal costs. This has prompted federal recognition of supportive housing among the vital conditions that support the long-term recovery and resilience of our citizenry. Supportive housing offers safe living environs where residents access services such as harm reduction supplies and referral to recovery-oriented activities like peer support groups and workplace re-entry programs. To maximize the benefit that residents experience from such services, behavioral health staff working in supportive housing contexts should implement useful psychosocial therapies to spur greater service utilization by residents.

One such therapy that has proven useful among persons with mental health and substance use disorders is contingency management (CM), in which one earns tangible rewards for demonstrating desired behaviors like attending a support group, taking a prescribed medication or completing workplace re-entry paperwork. Given the robust and reliable therapeutic impacts of CM, there is much to be gained from its implementation in supportive housing environs. For several years, the project lead Dr. Hartzler and his team at the UW Center for Advancing Addiction Health Services (CAAHS) have provided comprehensive technical assistance to regional treatment settings to facilitate design and successful implementation of sustainable CM programming. Also, UW project collaborators Drs. Fockele and Leyde have built working relationships with Downtown Emergency Services Center (DESC) while exploring interest in CM among its staff and residents. This convergence of acute community need, an experienced team offering technical assistance and an established academic-community partnership highlights an opportunity in which CM will be implemented in DESC-governed supportive housing facilities to increase resident utilization of beneficial services.      

A pilot trial on EMA habit formation behavioral strategies for improving engagement of digital mindfulness interventions among non-suicidal self-injury engagers

Non-suicidal self-injury (NSSI), the purposeful, direct damage of one’s body without the intent to die, is a pervasive public health concern with clinically significant long-term consequences. Mindfulness – a core skill in DBT, an evidence-based treatment for NSSI, is designed to target emotion dysregulation and rumination and may be particularly relevant due to the proliferation of digital mindfulness interventions in recent years. To this end, the goal of this study is to expand the use of ecological momentary assessment (EMA) and to develop and evaluate a program of habit-formation strategies (e.g., SMART-goal setting, reinforcement scheduling) to boost user engagement and treatment effects of DMI. Following a 1-week EMA baseline period, participants (N=40) will be randomized to either TAU (Mindfulness only) or Experimental (Mindfulness + Behavioral Prompts) conditions for a 4-week intervention EMA period.

Alcohol-focused Support of Survivors In Sororities Training (ASSIST)

The purpose of this study is to develop and evaluate a new online program called ASSIST – Alcohol-focused Support of Survivors In Sororities Training. The training is designed to help sorority members learn how to support friends who have had an unwanted sexual experience, both during the initial discussion of the experience and when navigating recovery in the longer-term. This multiphase study involves (1) developing the training in collaboration with students and campus stakeholders, (2) improving the training content and design through individual interviews with sorority members, (3) conducting an open trial of the training within one chapter, and then (4) conducting a pilot cluster randomized trial to evaluate feasibility and initial efficacy of the training. If found to be effective, this training could be widely disseminated and facilitate positive change in social contexts where survivors recover.

Identity, Resilience, and Interconnection after Stress (IRIS)

The IRIS Study is a longitudinal examination of young adults who have experienced an unwanted sexual experience in the past year, and those who have never had an unwanted sexual experience. This study aims to prospectively examine how young adults’ thoughts about a recent unwanted sexual experience are shaped by and influence social relationships and health-related behaviors over time. To do so, this multimethod study involves in-depth interviews, social network assessments, ecological momentary assessments, transdermal alcohol biosensors, and online surveys over one year. This study is conducted by researchers at both the University of Washington and the University of Nebraska-Lincoln.

Health Outcomes of Betting on Sports (Project HOBS)

Project HOBS is examining associations between sports betting, mental health, and substance use among young adults. Surveys are collected bi-weekly for one calendar year (25 follow-ups) and at a distal 15-month follow-up.

PHSKC School Based Health Services

Project includes the design and development of survey instruments for the provider-level skills and agency-level readiness needs assessment and analyzing the data.

PHSKC Planning and Evaluation

Project includes activities surrounding the provision of evaluation, training, and consultation services to PHSKC. These include developing, conducting and analyzing a needs assessment for mental health providers and agency leads to further refine a tier 2/3 model of care. Training and consultation supports will be provided.