This study, funded as part of the Robert Wood Johnson Foundation’s Systems for Action research program, evaluates the feasibility of the Youth Wellness Hub as a hyper-local community governance model for integrating delivery and financing systems for youth behavioral health and wellness services. The Youth Wellness Hub combines three social policy tools that are separately promising or well-supported in the research literature: community governance; public health education campaigns; and service network coordination through fiscal blending. The study uses a mixed-methods approach to assess feasibility of the model as tested in Tacoma, Washington, including surveys and interviews with community organizations together with a network analysis of these organizations. The study is conducted by the University of Washington in collaboration with the Excelsior Center for Health and Wellness, the Safe Streets Coalition, and other community partners.
Targeted Condition: General Mental Well-Being
Needs Assessment for Supporting Technology use and Harm Reduction (STaHR Study)
The proposed study entails a needs assessment to develop a program for Supporting Technology use and Harm Reduction (STaHR) among HF residents with lived experience of homelessness and substance use. This study will qualitatively explore HF residents’ technology literacy as well as their perspectives on barriers and facilitators to the use of technology, broadly, and for harm-reduction service provision. Then, with a community advisory board (CAB) made up of HF residents, staff, and management, we will inform and provide recommendations to HF management and leadership ways to improve HF resident technology use and engagement with online harm-reduction services.
eHaRT-A: adapting an in-person harm reduction for alcohol intervention into a telehealth platform
The unprecedented global pandemic has highlighted the digital divide and limited access to alcohol-related treatments among marginalized communities, specifically individuals with lived experience of homelessness. In line with the NIAAA health initiative seeking to integrate technology-based interventions among vulnerable populations, this study directly addresses this mission by proposing innovative methods (i.e., user-centered design + a community based participatory research framework) to adapt an in-person harm reduction for alcohol (HaRT-A) intervention into a telehealth platform (eHaRT-A) that can then be tested and successfully implemented into low-barrier Housing First settings. As healthcare continues to move more services online, it is essential to understand ways to successfully adapt and implement rigorously tested telehealth treatment services for marginalized communities to ameliorate alcohol-related harms.
eHaRT-A
The unprecedented global pandemic has highlighted the digital divide and limited access to alcohol-related treatments among marginalized communities, specifically individuals with lived experience of homelessness. In line with the NIAAA health initiative seeking to integrate technology-based interventions among vulnerable populations, this study directly addresses this mission by proposing innovative methods (i.e., user-centered design + a community based participatory research framework) to adapt an in-person harm reduction for alcohol (HaRT-A) intervention into a telehealth platform (eHaRT-A) that can then be tested and successfully implemented into low-barrier Housing First settings. As healthcare continues to move more services online, it is essential to understand ways to successfully adapt and implement rigorously tested telehealth treatment services for marginalized communities to ameliorate alcohol-related harms.
Identifying and treating loneliness in young adults in primary care
Loneliness, defined as the feeling of insufficient personal relationships, affects over 20% of young adults. Those with loneliness are more depressed and anxious and have poorer educational outcomes. Cognitive behavioral therapy and social navigation can successfully treat loneliness but previous studies have mostly looked at older adults.
The objective of this study is to demonstrate the feasibility of identifying and alleviating loneliness in young adults identified in primary care practices. This project will screen young adults ages 18-25 presenting in primary care for loneliness and pilot the interventions of cognitive behavioral therapy and social navigation for those who test positive for loneliness.
Optimizing mental health first-aid programming for sport coaches
Many sport organizations are increasingly vocal about the importance of athlete mental health. Helping organizations move beyond rhetoric to improved athlete wellbeing and safety requires evidence-based resources that are setting-appropriate and feasibly implemented.
This project will develop and obtain feasibility and acceptability data on “Time Out for Mental Health”—a mental health first aid training for sport coaches. This will be accomplished by adapting an existing evidence-based mental health first aid resource to the coach role and sport setting, working closely with a small group of coach partners. The team will focus on ensuring the training is considered useful and feasible by coaches who work in resource deprived school and community-settings given the heightened needs and challenges of youth in such settings, and will train coaches to deliver “Time Out for Mental Health”—to build organizational capacity. “Time Out for Mental Health”—has the potential to strengthen connections between sports organizations and school- and community-based mental health services for millions of adolescents as more than half of high school students play at least one organized school or community sport.
Adapting a resilience intervention for youth athletes
Youth mental health is in crisis and we do not have adequate providers to treat the current burden of illness. We must identify innovative approaches to support youth mental health that utilize the existing infrastructure and can be administered by non-clinicians. While sports are predominantly a positive outlet for youth, they also bring stressors due to experiences with failure, injury and challenging time commitments, and thus provide an ideal laboratory to develop coping skills for managing stress.
This project aims to build psychological resilience in high school athletes by adapting an intervention developed for youth with chronic illness (PRISM). The intervention will be delivered through the coach via an educational platform with five modules: 1) background/ psychoeducation; 2) creating a supportive team culture; 3) stress management (breathing exercises, visualization and mindfulness); 4) mindset (goal setting, cognitive reframing and meaning making); and 5) fueling the machine (sleep and nutrition). The team will utilize a community-engaged research process to adapt the PRISM approach to an athletic space, using the term “Mentally Strong” to center it in the sport context, and will partner with youth athletes and coaches to ensure the tools we develop support their needs. The Mentally Strong approach has the potential to increase the emotional literacy of a broad swath of high school youth beyond the athletic environment, enhancing their ability to negotiate the acute and chronic stressors they encounter in daily life. The ultimate goal of the project is to prevent the outcomes which occur with negative emotional coping—including depression, anxiety, substance use, burnout, violence, withdrawal from school and even suicide.
Reducing barriers to accessing mental health care using a web-based program for young adults
Most young adults with mental health (e.g., depression, anxiety) or substance use disorders do not receive treatment. Untreated mental health and substance use can be associated with impairments in social relationships, overall functioning and suicide. National data indicate that almost half of young adults with symptoms of a mental health disorder reported they needed mental health care in the past year but did not access those services. Barriers to accessing mental health care include stigma, not knowing where to go, lack of transportation and cost.
This project aims to develop a personalized web-based program for young adults to reduce self-reported barriers and increase motivation to access mental health and substance use services. Investigators will work with clinicians and young adults to develop strategies and solutions to address the identified barriers. The team will work with a community advisory board to develop program content that will be further refined through focus groups and individual interviews with young adults and clinicians. From this, the team will develop the web-based program which will serve as the first step needed to establish a larger program of research focused on reducing barriers and increasing access to mental health care to improve young adult well-being.
Embedded clinical coaching
Using an embedded clinical coaching framework, the Evidence Based Practice Institute (EBPI)/CoLab is promoting the development of quality care expertise within behavioral health agencies to reduce the cost and improve the speed of clinical workforce training. The goal of this project is to move principles of effective behavioral health care more quickly into practice, and to foster agency resilience to workforce turnover. This project is part of a broader Leadership Initiative for Quality.
To develop and eventually implement an embedded clinical coaching model, EBPI/CoLab partnered with multiple organizations in Washington to determine priorities and gather feedback. Through these partnerships, EBPI/CoLab identified key characteristics of an effective clinical coaching model, and incorporated stakeholder feedback to ensure scalability and adaptability. This coaching model includes the development of an asynchronous training for new clinicians, an embedded peer consultation structure, and competency checks through clinician-submitted videos. Through this novel embedded coaching structure, organizations can retain internal expertise and better support a shifting workforce.
Supervisor tools for quality
The Supervisory Tools for Quality initiative recognizes the integral role that clinical supervisors play in supporting behavioral health clinicians’ use of effective practices in community mental health agencies, and aims to leverage this role to improve the scale up and sustained use of quality behavioral health services. Specifically, this project is focused on the development of cost effective, easy to use, and practical strategies to elevate supervision practices. This project is part of a broader Leadership Initiative for Quality.
This initiative involved partnering with supervisors to form a Supervisor Advisory Team. This team worked to provide practical and tangible supports to supervisors in order to improve delivery of quality and effective behavioral health services, and ultimately strengthen outcomes for economically and racially marginalized children and adolescents. This advisory group included experienced supervisors in behavioral health organizations across the state. Geographic regions represented included Bellingham, Bellevue, Lakewood, Spokane, Walla Walla, and Yakima. To date, we have completed three Supervisor Advisory Team meetings.
