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.
Targeted Condition: Substance use disorders/misuse
Mapping SUD treatment in VA using administrative data
The Mapping SUD Treatment in VA Using Administrative Data: Identifying Similarities and Differences Between Women and Men Veterans project is using VA administrative data to evaluate the uptake and receipt of SUD-oriented treatment among all Veterans with a chart diagnosis of SUD enrolled in VHA from FY14 to FY18. Location of care, referral patterns, and characteristics of Veterans obtaining SUD care in different treatment settings will be evaluated stratified by gender.
Re-engineering siloed systems of care through evidence-integrated design thinking
Behavioral health, including suicidal behaviors and problematic substance use, are significant public health concerns and are routinely identified by community health departments as a high priority. However, needed services are highly fragmented across multiple systems (e.g., prevention, primary care, schools). Addressing these urgent public health concerns requires decisionmakers to collaborate and coordinate services. System-level planning efforts tend to fail because adopted models are either not informed by evidence, or policy decisions do not have sufficient community buy-in and are poorly implemented.
To address this gap, our team created a hybrid approach, “System Codesign,” in which researchers and local decisionmakers form a design workgroup and collaborate to create a tailored and sustainable plan to address community public health issues. This partnership approach allows end users to be actively involved in the design process to help ensure that the outcome meets the needs and expectations of the community. The researcher’s role is to locate and synthesize research findings relevant to the community agency’s goals and assist in integrating these principles within real world programming. This new “System Codesign” approach is built from well-established participatory and implementation frameworks and incorporates evidence-informed standards in research into the energy and creativity of design thinking to support local systems. This model is expected to incorporate evidence, innovation, and local relevance into final system products.
Our research team aims to assess the acceptability and feasibility of this “System Codesign” process as a tailored implementation method for tackling complex behavioral healthcare issues. Our aim is to partner with the state Healthcare Authority (HCA) to pilot this approach with a rural Washington community, Grays Harbor County, which has a high prevalence of behavioral health needs. The proposed design workgroup will leverage cross-system participation from behavioral health, justice, law enforcement, faith-based organizations, schools, and community members.
Harm reduction in the context of social distancing
The devastating impacts of the novel coronavirus (COVID-19) epidemic is expected to have impacts on young adults’ mental health and substance use (a population already at high risk). Time is of the essence to provide young adults evidence-based information to reduce risk from alcohol use within the context of COVID-19 epidemic, promote continuation of social distancing while also encouraging pro-social behavior to reduce isolation, and skills to reduce coping- or socially-motivated alcohol use and associated negative consequences. This project aims to develop and examine feasibility and acceptability of a time-sensitive COVID-19-specific personalized normative feedback intervention disseminated via social media that focuses on drinking motivations to cope with distress and/or to enhance social connectedness, as well as to promote engagement in strategies for stress management and increase engagement in social, alcohol-free activities while also practicing social distancing.
Disseminating a user-friendly guide: Advancing the science of intervention adaptation and improving access to evidence-based psychological treatment
Adaptation of evidence-based practices and programs (EBPs) is a necessary component of the implementation process. EBPs must be adapted to function with the constraints of real-world practice settings, providers’ expertise, and patients’ needs. The science of intervention adaptation is hungry for well-defined methods of EBP adaptation to guide decision making. A how-to guide for EBP adaptation titled MODIFI: Making Optimal Decisions for Intervention Flexibility during Implementation, is under development with NIMH funding (F32 MH116623). MODIFI will be disseminated via multiple strategies locally, nationally, and internationally. Dissemination of MODIFI will improve the practice of intervention adaptation by providing practitioners with a how-to guide that is (a) evidence-based, (b) usable, and (c) supported by the expert consensus of implementation practitioners and researchers.
Moms’ Access Project ECHO: Perinatal Psychiatry Case Conference Series
Perinatal Psychiatry Case Conference Series is a CME-accredited program for providers in Washington State who want to improve the mental health of their pregnant and postpartum patients.
Facilitated by a multidisciplinary team including UW Medicine perinatal psychiatrists, obstetrician gynecologists, maternal fetal medicine experts, advanced registered nurse practitioners, therapists and social workers, the program aims to increase frontline provider capacity to address common mental disorders in pregnancy and postpartum. Program format is brief didactic followed by in depth case presentation and discussion.
The Life Enhancing Alcohol-management Program 2.0 (LEAP 2.0)
LEAP 2.0 builds on a longstanding partnership between the UW HaRRT Center and housing first residents, staff, and management of DESC. The pilot program was developed through a community based participatory research framework, and entails low-barrier, community-level, house-wide resident programming—including leadership opportunities, activities, and pathways to recovery. Results from the pilot indicated that LEAP participants reported more engagement in meaningful activities than their control counterparts. Further, higher levels of engagement with the LEAP predicted significant reductions in alcohol use and alcohol-related harm. To build on these promising findings, in LEAP 2.0, we will be conducting a 10-site, cluster-randomized controlled trial to assess LEAPs impact on substance use, health, cost and service utilization, as well as quality of life outcomes.
Project ACE
The objective of this research is to develop and test brief interventions that aim to reduce young adult alcohol misuse by providing personalized feedback regarding alcohol craving. The project involves two phases; one using qualitative methods to inform the intervention development; and a second testing the feasibility, acceptability, and initial efficacy of personalized feedback interventions.
Project Transitions
The transition to adulthood is characterized by many changes in various domains of life (e.g., living situation, education, work, romantic relationships) and some transitions may be more impactful on health than others. Project Transitions is designed to understand not only major life changes (e.g., marriage, parenting), but also the many smaller life changes that occur during young adulthood and the impact on immediate and long-term changes in alcohol use and consequences.
The Teen Identity Project (TIP)
The proposed research aims to qualitatively assess identification with cannabis and develop novel measures of cannabis identity to evaluate as cognitive and developmental risk factors for adolescent cannabis misuse. Findings from the proposed research are intended to improve the prediction of cannabis misuse among adolescents and to potentially identify a novel target for prevention and intervention strategies that aim to reduce cannabis misuse.
