Our project will seek to identify factors associated with gaps in transitions of care for psychiatric inpatients who presented with substance-induced psychosis (SIP) for the first time. We will analyze historical electronic health record data of patients who were treated for psychosis at Harborview Medical Center. We will test the hypotheses that (1) treatment with long-acting injectable antipsychotics (LAI) and referrals to outpatient behavioral health are lower for patients diagnosed with first-episode SIP compared to those diagnosed with first-episode psychosis and that (2) patients diagnosed with first-episode SIP will have worse post-discharge outcomes (rehospitalization, ED utilization), in part due to lower use of LAI.
Targeted Condition: Psychosis
Developing an artificial intelligence digital navigator system to support patients’ use of technology-based interventions
The objective of this project is to leverage Artificial Intelligence (AI) to create COACH: an on-device AI-driven digital navigator system that will support patients’ effective use of Digital Mental Health Technologies. We aim to: 1. Develop a prototype chatbot-based digital navigator; 2. Conduct preliminary evaluation of the system including lab-based usability testing with healthy participants and “red-team” stress testing with project confederates.
Optimizing telemental health with live artificial intelligence clinical scaffolding and feedback
This project aims to develop a clinical scaffolding system to enhance telemental health care by providing real-time coaching and actionable suggestions during video-based sessions. Modeled after live supervision methodologies, it supports clinicians by identifying intervention targets and offering text-based coaching prompts to guide care. Unlike automated chatbots, this approach enables clinicians to adapt suggestions to patient needs, balancing automation with oversight for safer AI-supported mental healthcare. The proposed in-session support will facilitate efficient implementation of strategies and clinician skill development. This project seeks to enhance data privacy by processing all data on-device and avoiding external data transfers.
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.
Pilot of an inpatient Family Bridger Model to support families with loved ones who experience psychosis
Despite treatment advances, psychotic disorders remain among the costliest and most disabling conditions worldwide. One of the best ways to help those experiencing psychosis is to involve their families in treatment. Empirical evidence suggests that family interventions for psychosis confer numerous benefits for both families and their loved ones who experience psychosis. However, behavioral health providers experience multiple barriers to engaging families in treatment, resulting in poor accessibility to family interventions for psychosis and worse outcomes for families and their loved ones alike. For example, families who receive no family interventions for psychosis experience higher rates of stress, burnout, depression, anxiety, caregiver burden, relationship strain, and inadequate social support. These outcomes are further compounded during their loved one’s hospitalization.
Family peer specialists are family members with lived experience who have received specialized training to assist other families with a loved one with mental illness. Such models have been found to improve both patient and family outcomes. One such promising model is a Family Bridger program. Modeled after the Peer Bridger program, we previously piloted a Family Bridger program that deployed family peer specialists to support families who have a loved one with psychosis by providing emotional support, education, advocacy, resource brokerage, and skill-building while their loved one was engaged in an early psychosis outpatient program. For this project, we propose to meet the following specific aims: (1) adapt the Family Bridger program for an inpatient setting, and (2) evaluate the feasibility, acceptability, appropriateness, and preliminary effectiveness of Family Bridgers in an inpatient setting.
Development of an mHealth support specialist for early psychosis caregivers in Washington State
Early intervention can significantly improve the trajectory of a young adult at risk for psychosis. Specialized treatment programs for youth at risk are associated with reduced symptoms and relapse risk and increased functioning. Family caregivers play a critical role in facilitating treatment engagement and recovery, but too often they lack the support they need. Specialty psychosis services providing psychoeducation for family members are expanding but still difficult to access. Caregivers face many barriers to care: limited providers and session time availability, long travel times, or patient ambivalence about treatment. As a result, a minority of youth with early psychosis have caregivers that have accessed standard-of-care family interventions.
To address these gaps, our team developed Bolster, a mobile health (mHealth) app designed to provide psychoeducation, communication coaching, and self-care support to caregivers to youth at risk for psychosis. In preliminary work, Bolster was feasible to deliver, acceptable to caregivers, and showed promising efficacy. However, mHealth interventions that are supplemented by a human clinical support have higher engagement and effectiveness than those that are purely self-guided. To optimally implement mHealth for early psychosis caregivers, there is a need for development of this clinical workforce.
We propose to develop and pilot an emerging clinical role – the mHealth support specialist (mHSS) – equipped specifically to support caregivers to youth with early psychosis. Specifically, we will (1) develop a training and supervision framework supporting the mHSS for caregivers, (2) test this framework through training and supervising one mHSS, and (3) evaluate this approach as the mHSS provides support to caregivers to young adults with early psychosis throughout Washington State. Delivering this intervention has the potential to greatly expand population access to evidence-based strategies for psychosis. Developing the mHealth support specialist model would make Washington a national leader in scalable digital interventions for caregivers. This study takes a critical step toward realizing that vision.
Acceptability and feasibility of a single-session + digital mental health intervention for people with psychosis on an acute psychiatric inpatient unit
People with psychosis are admitted more frequently to inpatient psychiatric units and have a longer length of stay once admitted compared to those with other psychiatric conditions. Cognitive Behavioral Therapy for psychosis (CBTp) reduces hospital admissions when delivered in outpatient settings and facilitates quicker symptom improvement when delivered in inpatient settings. Despite this, implementation of CBTp is exceedingly rare in practice. The purpose of this study is to test the feasibility and acceptability of a conjoint single-session CBTp intervention + FOCUS digital mental health intervention for people with psychosis admitted to inpatient psychiatry units.
Cognitive-Behavioral Therapy for psychosis workforce development
Cognitive Behavioral Therapy for psychosis (CBTp) is a time-limited, structured form of talk therapy that is indicated for individuals who experience distress related to psychotic symptoms. Although evidence demonstrates effectiveness in enhancing care and outcomes for clients with psychosis, CBTp is not widely available in the United States. The UW SPIRIT Lab in the Department of Psychiatry & Behavioral Sciences (PI: Sarah Kopelovich, PhD) applies evidence-based implementation and dissemination strategies such as blended learning, train and trainer, Project ECHO, longitudinal consultation to agencies, supervisors, and practitioners, fidelity assessment and monitoring, and sustaining the first CBTp Provider Network in the United States. The CBTp workforce development project aims to sustain and expand access to CBTp across publicly-funded behavioral health settings in Washington State.
Developing a digital training resource for clinicians learning CBT for psychosis (CBTpro)
The Cognitive Behavioral Therapy Training Study will rigorously test CBTpro — a novel tool that uses spoken language technologies and conversational Artificial Intelligence to train behavioral health practitioners in Cognitive Behavioral Therapy. We conducted a 2-week field trial, followed by a Randomized Clinical Trail in community mental health agencies to evaluate both learner and client outcomes. The study aims to expand global access to CBT training to students and practitioners, support quality psychological treatments for clients with a range of behavioral health disorders (including Serious Mental Illness), and support ongoing clinical quality assurance in routine care settings.
Developing a cannabis intervention for young adults with psychosis
Up to one-third of young people experiencing early psychosis use cannabis, and one in four meet criteria for a cannabis use disorder. Cannabis use is associated with multiple negative outcomes, including relapse, rehospitalization, increased psychotic symptoms and reduced treatment engagement and medication adherence. Psychosis relapse is a particularly devastating and costly outcome, leading to greater disability and accounting for $37 billion in healthcare costs per year. Cannabis is considered the most preventable cause of psychosis relapse. Despite this, no effective cannabis-reduction intervention has been developed for this population.
This study will address the urgent need for an effective cannabis-reduction intervention for this high-risk population by adapting a gold-standard treatment, Motivational Enhancement Therapy (MET), for youth and young adults living with psychosis. A tailored cannabis intervention and provider manual will be developed and evaluated for feasibility and acceptability. This novel intervention has the potential to mitigate the costly impact of psychosis on public health systems and ultimately improve psychosis outcomes among young people living in Washington State.
