The major goal of this project is to evaluate the feasibility and effectiveness of an integrated intervention approach for co-users of marijuana and tobacco who are seeking treatment for tobacco addiction.
Perinatal depression affects 10-20% of pregnant and postpartum individuals, impairing parenting self-efficacy and mother-infant interactions and contributing to negative maternal-child outcomes. This research will test comprehensive perinatal depression treatment, Maternal Infant and Dyadic Care (MInD), which includes a brief version of the Promoting First Relationships parenting intervention implemented within perinatal collaborative care, against perinatal collaborative […]
This research supports the conduct of a Type II hybrid trial, which compares via two-arm RCT features: 1) gold-standard vs. as-needed clinician coaching for school-based interventions over a two-year period, and 2) the clinical effectiveness of TMCU vs. services-as-usual among marijuana-using students.
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 […]
To examine the safety, tolerability, and efficacy of arbaclofen for the treatment of neurodevelopmental impairments in subjects with 16p11.2 deletion
Longstanding gaps between science and practice in schools have contributed to a persistent “last mile” problem in which education research consistently fails to reach the individuals for whom it was intended. Implementation research is an emerging scientific study in education of methods to promote the systematic uptake of research findings and evidence-based programs and practices […]
The reason for this study is to see how safe and effective the study drug donanemab is in participants with early Alzheimer’s disease.
The primary objective of this study is to verify the clinical benefit of monthly doses of aducanumab in slowing cognitive and functional impairment as measured by changes in the Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) score as compared with placebo in participants with early Alzheimer’s disease.
Measuring the use of research evidence within organizations and systems is a rapidly growing area of study in the social sciences as researchers, policymakers, and practitioners in a variety of systems try to bridge the research-to-practice gap. With growing calls for justice systems, especially juvenile justice systems, to integrate developmental and behavioral health science within […]
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 […]
AIMS Center staff and faculty are working with primary care and behavioral health partners in each ACH to train staff and providers on whole person care strategies. This includes training primary care practices to adopt the Collaborative Care model and/or Bree Behavioral Health Integration Recommendations and training community behavioral health agencies to address the physical […]
Suicide is a leading cause of death among 10- to 24-year-olds in the US, and half of youth who die by suicide contact a primary care provider within one month prior to suicide. Suicide risk screening and access to brief and effective suicide prevention interventions remain an important step in reducing suicide, yet comprehensive suicide […]
This project will begin foundational work to inform the development of a family-focused lifespan clinic at UW serving adults and children with ADHD.
The proposed F32 aims to conduct a secondary analysis of time-intensive daily data (MPIs: Lee/Patrick; R01AA025037) to elucidate the roles of affect and affective dynamics on simultaneous alcohol and marijuana (SAM) use outcomes among a sample of high-risk adults (N = 409). We will test whether theoretically-relevant affective dynamic processes (affective instability, negative emotion differentiation): […]
This project will integrate and analyze datasets from multisite clinical trials of alcohol use disorder treatments to understand alcohol addiction research domain criteria (AARDoC) phenotypes and biopsychosocial predictors of alcohol use disorder recovery up to three and ten years following treatment.
This project will help families and friends learn how to help their loved ones access and stay on medications that treat opioid use disorder.
This project aims to deploy a mHealth assessment system in a national sample of individuals who experience persecutory ideation (PI). Specifically, we will (1) evaluate whether PI with need for clinical care is associated with differential phenomenology of PI – frequency, valence, conviction, appraisals, and behavioral responses, (2) examine relationships between baseline clinical, functional and […]
This is a multicenter longitudinal study that aims to identify, develop and validate a set of measures that can be used as stratification biomarkers and/or sensitive and reliable objective measures of social impairment in ASD that could serve as markers of long term clinical outcome.
The aims of the current project are to: 1) Engage stakeholders to identify targets for ACT SMART redesign to optimize its fit for middle and high school providers who serve autistic adolescents; 2) Conduct prototyping and usability field testing of the redesigned ACT SMART and iteratively refine to ensure usability, feasibility, acceptability, and appropriateness for […]
This research developed and tested a pre-implementation intervention, based on Motivational Interviewing, as means of facilitating greater adoption of useful school-based practices among preventionists working in high schools.
The goal of this study is to adapt and test the feasibility and potential efficacy of a theory-driven pre-implementation intervention to address individual-level barriers to evidence-based practice (EBP) implementation – Beliefs and Attitudes for Successful Implementation in Schools (BASIS) – designed to improve school-based mental health providers’ implementation of EBP. The BASIS-T project will develop a teacher-focused […]
This clinical trial is designed to pilot an electroretinogram (ERG) biomarker for predicting treatment response to SSRIs in PTSD. Serotonergic brain centers project to the retina, and ERG allows assessment of brain serotonergic signals via retinal signals. In this study we are characterizing the ERG waveform in veterans with PTSD before and after SSRI administration. […]
The goals of this project are to 1) determine which validated bipolar disorder patient-reported symptom measure is most acceptable and helpful to patients and clinicians in clinical care, 2) demonstrate that the preferred measure can be used to monitor outcomes with high fidelity in routine care, and 3) assess the feasibility of comparing effectiveness of […]
This project aims to develop and test a mobile health (mHealth) intervention designed for caregivers of young adults with early psychosis who are unengaged in services, and specifically to examine whether it can help aid caregiver treatment facilitation.
Moderate to severe traumatic brain injury (TBI) is a common cause of long-term disability. Persons with TBI receiving care in inpatient rehabilitation facilities (IRFs) are at risk for rehospitalization, poor community reintegration, family stress, and other unfavorable outcomes. In a six-center randomized pragmatic comparative effectiveness study, we compare the effectiveness of two methods for transition […]
This application seeks to address gaps in our understanding of fetal alcohol spectrum disorder in adults (FASD) by evaluating protracted effects of prenatal alcohol exposure (PAE) on the brain. Individuals aged 30 and 60, who were diagnosed with FASD in childhood, and matched controls, who had previous structural MRI scans in their teens and twenties […]
This study will expand and enhance training in evidence-based psychosocial interventions (EBPIs) by designing and testing a computerized training program that is based on adaptive training algorithms. We hypothesize that by simplifying training and supplementing classroom curriculum, we can enhance clinical ability to deliver treatment more competently, more quickly, and with a higher quality of […]
This project involves analyses of data from the Washington State Young Adult Health Study to examine the impact of cannabis legalization on cannabis-related risk factors, substance use, and related health risk behaviors such as driving while intoxicated, and to study developmental trajectories of substance use and the role of community level and other cannabis-specific risk […]
The CARR study explores trajectories of mental health and social-emotional wellbeing among youth, including those with autism, ADHD, and/or anxiety. Online assessments of social-emotional features from both youth and caregiver perspective take place every 6 months over a 2-year period, with the goal of understanding mental health in the context of the Covid pandemic.
To evaluate the efficacy of ZYN002 administered as a transdermal gel formulation, for up to 12 weeks, in patients ages 3 to <18 years, in the treatment of symptoms of Fragile X Syndrome (FXS).
The gold-standard intervention for Opioid Use Disorder (OUD) is Medication for Opioid Use Disorder (MOUD). Because more patients with OUD need access to MOUD in primary care, the AIMS Center at the University of Washington is testing a Collaborative Care model to treat mental health disorders and OUD concurrently in primary care settings. The CHAMP study addresses […]
This study aims to refine and test a brief intervention (CARE) that aims to promote recovery in recent sexual assault survivors. CARE is delivered to supporters of sexual assault survivors (e.g., friends, family members, romantic partners), with or without the survivor present. It aims to encourage conversations about the assault and decrease negative reactions by […]
Curriculum codesign is a capacity building initiative to cocreate therapeutic interventions alongside community partners using research translation and design-oriented activities.
Asian Indians, are one of the fastest growing ethnic groups in the country, growing from 1.9 million (2000) to 4.6 million (2020). With a median household income of $119,000, Asian Indians are highly educated (43% have a postgraduate degree), are proficient English speakers (82%) and are often touted as a “model minority”. While these data […]
The major goals of this project are to conduct a needs assessment for suicide safety planning training among Department of Defense (DoD) healthcare providers and design paper documentation to support the future development of a virtual standardized patient specific to the needs of DoD providers.
The COBRA study seeks to identify the specific neural circuits that are altered in autism spectrum disorder (ASD). Our experiments test the strength of “divisive normalization”, a measure that describes how neurons in the brain suppress each other. Our hypothesis is that suppressive interactions are reduced in individuals with ASD. Because suppressive neural interactions are […]
This study will explore which interventions people with lived experience of suicide find acceptable (e.g., different types of in-person and telehealth care, web-based, text message, app, etc.), who should be the agent to deliver the intervention, and what concerns would they have in having social media and search data used for risk identification and then […]
This project involved an anonymous needs assessment for 6th through 12th graders in Washington to collect data on what students thought was going well, what challenges they had encountered, and what their needs were as schools replied to largely in-person instruction following a largely virtually year because of the COVID-19 pandemic.
This project will evaluate the effect of a debriefing workshop on the knowledge, attitudes, and practice of giving debriefs after adverse events among physicians and their trainees.
This multiphase project aims to 1) understand more about cues that young adults experience that influence their decisions while drinking that may lead to unwanted outcomes or experiences; and 2) use human center design and young adult feedback to develop and assess the feasibility of an electronic program or resources to focused on reducing these […]
In the US, approximately one in five adolescent and young adults have seriously thought about suicide and one in 11 have made a suicide attempt. Unfortunately, a third to half of adolescent and young adults who are experiencing suicidal and self-injurious thoughts do not seek professional help and when they do, there is a nationwide […]
The vast majority of young adults with early psychosis own mobile phones, identify texting as their preferred communication modality, and report an interest in messaging-based treatments. We developed a texting intervention for people with psychosis called the Mobile Interventionist. Treatment is conducted via daily recovery-oriented text conversations between patients and a trained messaging practitioner. This […]
The main goals of this proposal are twofold: 1) to develop and optimize a general behavioral and technical platform for studying the functional neurocircuitry underlying opioid use disorder, and 2) to determine if activity in LHb projections to the RMTg promotes cued reinstatement to fentanyl seeking through indirect inhibition of VTA dopamine neurons.
Opioid abuse has reached epidemic proportions in the United States and is responsible for more than 40,000 overdose deaths each year. Avoidance of withdrawal and drug-associated cues are key deterrents to voluntary abstinence in humans. By studying the neural circuits responsible for motivating avoidance of physical and emotional pain, as well as those that process […]
The World Health Organization ranks psychotic disorders as the third most disabling health condition worldwide. Eleven million Americans will experience psychosis during their lifetime, and roughly 60 million Americans have a loved one affected by psychosis. Research affirms that psychotherapeutic interventions can help family caregivers develop skills to better connect and communicate with their loved […]
As rates of pediatric mental health emergencies have skyrocketed over the last decade – and even more so since the Covid-19 pandemic – the number of youth staying in emergency departments (EDs) and medical units while awaiting inpatient psychiatric care or stabilization (i.e., “boarding”) has reached unprecedented levels. The massive surges in patient volume, coupled […]
This project will develop a resource toolkit for clinician survivors of suicide loss. For clinicians, the death of a patient by suicide is a dreaded event and can be more distressing than death and dying encountered in other clinical situations. In response to patient suicide, some clinician survivors experience emotional and psychological distress that may […]
Perinatal depression is a common and serious disorder, with suicide representing a major cause of maternal mortality, but few women from low and middle income countries (LMICs) receive effective treatment. Effective models of care that improve perinatal depression and support suicide prevention exist but have not yet been widely implemented in routine maternal-child care services […]
This multi-component project aims to (1) gather information about the digital-health related needs, interests, and preferences of young adults with early psychosis and their families, and (2) develop digital health resources that meet those needs. We have collaborated with colleagues to identify interests and needs of family caregivers, and are currently surveying affected young adults. […]
This research develops and tests digital technology to help clinicians and patients systematically measure and monitor clinical progress during addiction treatment. The technology is being developed based on end-user input and user-centered design methods and will be pilot tested as an add-on to real-world care in an addiction treatment clinic.
This project is developing and implementing a county-level plan to institute a recovery-oriented system of care.
The widespread availability of fentanyl and other potent synthetic opioids has dramatically increased opioid-related fatal overdoses. This project will develop and manufacture immune molecules (monoclonal antibodies) to reverse and treat overdose from fentanyl by keeping it out of the brain. This research will advance promising results in animal studies (preventing and reversing fentanyl- and carfentanil-induced […]
This project will develop and test an interactive web-based intervention with text-message reminders for young adults who drink to cope with negative affect. The intervention will include interactive modules on CBT coping skills, assignments to practice the skills, text-message reminders, and weekly assessments on coping skill utilization and barriers to use. A total of 120 […]
This project will develop and pilot an emerging clinical role – the mHealth support specialist (mHSS) – equipped specifically to support caregivers to youth with early psychosis.
Prazosin, a drug that prevents the neurotransmitter norepinephrine from binding to its alpha1 receptor (alpha1-AR) subtype has shown efficacy in reducing PTSD symptoms in most, but not all, studies of trauma-exposed Service Members, Veterans, and civilians. However, it is not effective in all patients and its use is complicated by variability in effective doses, a […]
This study will explore the feasibility of implementation of a technology-enhanced Evidence-Based Psychosocial Behavioral Intervention entitled Mobile Motivational Physical Activity Targeted Intervention (MobMPATI) by frontline primary care staff (e.g., nurses, medical assistants) to expand workforce capacity to deliver acceptable, sustainable, and effective treatment for depression in older adults.
Millions of people lack access to mental health treatment due to barriers such as limited therapist availability, long wait times, high cost, and stigma. The COVID-19 pandemic has problematically increased demand for treatment while decreasing access. Because the internet is widely available, many people first turn to the internet for mental health support, giving rise […]
The proposed research will be a preliminary investigation into the potential association between microbiota abundance, hormone levels, peripheral inflammation and current symptoms (psychiatric and cognitive) in Veterans with and without a history of mild traumatic brain injury (mTBI). This work has the potential to form a new line of research that could ultimately provide new […]
This pragmatic trial will study a DVD- and coaching-based weight loss intervention among Veterans, relative to VA usual care.
An estimated 10-20% of children globally are affected by a mental health problem. Child mental health has been identified as a priority within the WHO’s Eastern Mediterranean Region (WHO EMRO). Following consultations with international and regional experts and stakeholders, WHO EMRO developed an evidence-based manualised School Mental Health Intervention (EMRO SMHI), endorsed by all member […]
Lewy body dementias (LBD), a term referring to both dementia with Lewy bodies and Parkinson’s disease dementia, are the second most common type of degenerative dementia in older adults. These are complex disorders in which patients may exhibit disruptive behaviors that make caregiving challenging. Compared to other types of dementias, caregivers of people with LBD […]
The goal of this project is to engage more families of children with CHD8 mutations with a novel online platform (GroopIt) and to empower families to be partners in research. We are utilizing a community-based participatory research (CBPR) approach to enable families to identify research priorities. Through an established Facebook group for CHD8, families will […]
Although several randomized clinical trials have demonstrated that digital mental health (DMH) tools are highly effective, most consumers do not sustain their use of these tools. The field currently lacks an understanding of DMH tool engagement, how engagement is associated with well-being, and what practices are effective at sustaining engagement. In this partnership between Mental […]
This project is initiating a collaboration between clinicians and law enforcement for dementia crisis intervention in order to establish appropriate safety measures to be enacted in WA communities.
Project: EVO (or “EVO”) is a mobile 3D video game that has been shown to reduce older adults’ susceptibility to interference by augmenting sustained attention and working memory abilities (e.g. cognitive control) through targeted adaptive algorithms. The combination of peer-reviewed validity, adaptivity, and fun video game mechanics elevates the EVO platform beyond other at-home training […]
Perinatal depression affects 10-15% of pregnant and postpartum individuals, with detrimental impacts on both parent and infant. In response to this, our department developed a perinatal consultation line for providers, PAL for Moms, to increase access to specialty perinatal psychiatric expertise and care. The purpose of the Evaluating Lifeline4Moms (ELM) is to assess comparative effectiveness […]
Chronic pain is one of the most prevalent and disabling conditions affecting Veterans. One of the Veterans Health Administration’s (VHA’s) most pressing national clinical priorities is to increase access to non- pharmacological pain management and improve the safety of opioid prescribing. The National Pain Management and Opioid Safety Program (PMOP) is implementing virtual interdisciplinary pain […]
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 […]
This project will conduct a formal evaluation of a group intervention program for caregivers of transgender and gender diverse adolescents which will inform future implementation and evaluation of this program in pediatric gender clinics across the United States.
The study will evaluate a novel program developed by our team to improve the effective outpatient management of youth with acute suicide risk. This program evaluation examines just-in time intervention to assess suicide risk level, address imminent risk, and begin treatment to address ideographic suicidal drivers over time. The clinic has served over 200 youth […]
The Evidence-Based Practice Institute (EBPI) is a partnership between the University of Washington and the Washington State Healthcare Authority (HCA), housed at CoLab. We promote the use of evidence-based practices in Washington State through training, research, workforce development, and data sharing. EBPI was initially established as an independent institute in 2007 by the Washington State […]
Using a scoping review approach, CoLab is systematically looking for reviews and authoritative sources to guide a model for value-based care for pediatric behavioral health. Our review approach was informed by guidelines for scoping reviews and rapid evidence reviews. The initial goal of this project was systematically looking for reviews and authoritative sources to guide […]
The purpose of this project is to enhance the usefulness and cultural relevance of the Spanish version of the PMQ-9, a questionnaire that assesses manic symptoms in individuals with bipolar disorder.
Adolescent depression is one of the most common mental health concerns during adolescence and can be a cause of significant impairment across the lifespan, particularly if untreated. Access to evidence-based psychotherapy is poor and pandemic-related increased demand for services has greatly worsened access issues, leaving many adolescents without effective and critically needed treatment. Adolescent depression […]
The purpose of this study is to: 1) compare schools randomized to the RUBIES intervention or a usual-care in-service training on teacher burnout and disruptive behavior in children with autism spectrum disorder; and 2) test RUBIES’ mechanisms of change (knowledge and skills) on teacher (burnout), child (disruptive behavior), and implementation outcomes (fidelity).
This project will develop 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.
This small business technology transfer grant will test the feasibility and usability of a smartphone mHealth tool that allows for video directly observed therapy of methadone and remote screening for COVID-19 symptoms.
This study is looking at individuals who carry a rare gene event and their biological family members, with the the goal of exploring the differences between individuals with one of these gene events and their biological family members.
The GENDAAR 2.0 study is part of the Autism Center of Excellence (ACE Network), which includes researchers from across the country. The main goal of this follow up study is to investigate the transition through adolescence and into young adulthood. We aim to identify sex differences in individuals with autism spectrum disorders (ASD) and look […]
The goal of this study is to learn how best to design a databank – a pool of data – about emotional health experiences from youth from around the world. The University of Washington is partnering with Sage Bionetworks to develop a user-friendly data platform for mental health interventions for youth. The overall scope of […]
Patients on long-term opioid therapy are aging and now face magnified risk of harm with continued high-dose opioid use. These increased risks are due to age-related changes in drug metabolism, multi-morbidity, and polypharmacy. The dominant approach to mitigate these risks is to screen for aberrant patient opioid behaviors, with assessments like the Current Opioid Misuse […]
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 […]
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.
This project will adapt and test a leadership-focused implementation strategy targeting elementary school principals in buildings where universal social, emotional, and behavioral programs are being implemented.
This center grant supports diverse workforce development efforts for those who provide behavioral health and addiction care services to persons with substance use disorders in HHS Region 10 states of AK, ID, OR, and WA.
The overall goal of this project is to develop a cell phone app that provides continuous assessment of Warfighter health readiness in real time. We are a subcontractor to Warfighter Analytics using Smart Phones for Health (WASH) program and Charles Rivers Analytics for the subject recruitment portion of the overall project. The UW objective is […]
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 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 […]
Though the focus of most research on dementia is the pathogenesis of cognitive deficits, neuropsychiatric symptoms (NPS) are identified in >90% of those afflicted, resulting in hastened cognitive decline, worsened general health, reduced patient and caregiver quality of life, sooner institutionalization, and increased mortality. Affective symptoms, including depression, are the most common NPS in Alzheimer’s […]
We will analyze Veterans Health Administration electronic medical record data to determine the effects of medical marijuana laws (MML) and recreational marijuana laws (RML) on cannabis (use and cannabis use disorder); opioids (prescriptions, fatal and non-fatal overdoses, opioid use disorders); and psychotropic medication prescriptions, providing important information on MML and RML effects in VA patients […]
This research is testing the utility of external facilitation and pay-for-performance incentives as implementation strategies to facilitate adoption and implementation of contingency management in a cluster-randomized trial of 30 opioid treatment programs in New England.
More than a million people in the US sustain a mild traumatic brain injury (mTBI) every year, and many report difficulties with attention, memory and other thinking abilities months and even years following their injury. A promising treatment option is cognitive rehabilitation, but the full-length (20 hours), in-person intervention is not feasible for many people […]
Infection by West Nile Virus can lead to encephalitis, or harmful inflammation of the brain. The immune system is critical for controlling viral replication and spread early in West Nile Virus infection, but persistent immune activation causes encephalitis that can result in brain damage even after the virus has been cleared. Recent pharmacologic advances have […]
Long Covid includes symptoms of fatigue, sleep changes, anxiety and depression lasting at least three months following infection with COVID-19 and occurs in 10-20% of individuals following infection. Approximately 16% of children experience persistent mood symptoms as part of their Long Covid symptoms. This amounts to over two million children with new symptoms of anxiety […]
Deaths related to the opioid overdose epidemic remain at an all-time high across the country despite significant efforts to reduce them. There is a pressing need to support medication treatment for opioid use disorder (OUD) to help people stay in treatment and reduce the risk of overdose death and other serious health consequences of untreated […]
UW Medicine has amassed detailed patient treatment and business data in its electronic medical record (EMR). This information is a treasure trove that is not used to its full potential for two reasons: 1) For each clinical encounter, only a fraction of the information in the EMR is relevant, and virtually all of the information […]
Most adults in the US experience a traumatic event at some point in their lives. Trauma is linked to the development of mental health disorders, increased suicidality, work and relationship impairment and increased physical health conditions. Effective treatments exist, but many people don’t receive these treatments because of a lack of providers who are trained […]
While evidence-based psychosocial interventions (EBPIs) are important, their design is cumbersome, complex, overwhelming, inflexible, and minimizes factors that are crucial for quality delivery of care. This study will work with six FQHCs across MT that were recently reorganized under Bighorn Valley Health Center’s umbrella to involve their Therapists and Care Managers in the redesign of […]
This A-START award included the conduct of secondary analyses of the national CNICS HIV care database to examine the prevalence and impact of substance use disorders on HIV care indices, and a mixed-method study of the contextual readiness of regional HIV care settings for empirically-supported behavior therapies.
Although suicide is one of the leading causes of death for people with substance use disorders (SUDs), no widespread suicide prevention intervention exists for delivery in community addiction treatment settings. The effectiveness and feasibility of delivering Preventing Addiction Related Suicide (PARS), a group-based psychoeducational program that provides evidence-based suicide prevention and safety strategies, was recently […]
This mentored career development award funded the conduct of two studies to inform efforts to disseminate and implement contingency management (CM): 1) a mixed-method study of CM attitudes and practices among personnel at a nationwide sampling of 16 community-based opioid treatment programs; and 2) a pilot type III hybrid effectiveness/implementation trial examining strategies for implementing […]
This multi-site study will test the efficacy of an intervention to train and equip pharmacists to provide naloxone, an overdose antidote, to patients using prescribed and illicit opioids, to improve opioid safety and prevent opioid-involved adverse events. The study will carry out a stepped-wedge, cluster randomized trial implemented over five waves, within two chain community pharmacies across four states with varying pharmacy-based naloxone distribution laws: Oregon, Washington, Massachusetts […]
This project aims to examine health disparities in substance use and factors influencing the health and well-being of Latinx youth residing in rural and small-town communities of the United States, a growing but understudied and underserved population.
Cognitive therapies help patients by providing ways to modify habitual but unproductive thought patterns, known as maladaptive thinking styles. Cognitive therapies are effective in treating depression, amongst other conditions, and are increasingly delivered remotely as text-based interventions. This trend toward digital delivery has accelerated on account of physical isolation and psychological stressors during the global […]
Perinatal mood and anxiety disorders affect one in seven pregnant and postpartum women nationwide, making them the most common complication of pregnancy. Unfortunately, only one in 20 women who need treatment for these conditions actually receives it. This translates to a multigenerational issue, which can negatively affect the mother and child’s long-term physical, emotional and […]
The goals of the proposed research are to 1) distinguish sexual and gender minoritized (SGM) subgroups and intersections at heightened risk for alcohol use (AU; e.g., bisexuals and trans persons, SGM young women of color), 2) assess the role of state policies in moderating AU risk, and 3) delineate moderators and mechanisms of heightened AU […]
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 […]
The MInD-I study targets improving dissemination of the evidence based Collaborative Care treatment model for pregnant and postpartum women with depression. Longitudinal remote consultation (LRC) is an implementation strategy that has been have shown to improve fidelity to evidence-based practices and patient outcomes for mental health innovations. The investigators believe LRC can be used with […]
The application was built on our prior intervention trials to further explore conditions under which normative feedback may reduce college drinking. Specifically, we proposed to contrast efficacy of personalized normative feedback (PNF) regarding specific reference groups (i.e., gender-, ethnicity-, and residence-specific feedback) versus a generic (typical college student) reference group, evaluate identification with the normative […]
The mHealth Washington team is partnering with 20 community agencies to implement FOCUS in multiple counties throughout Washington State. This implementation effectiveness trial aims to evaluate strategies to integrate mHealth into real-world clinical practice. The team is comprised of multi-discipline experts including academic researchers, policy makers, mental health advocates, Medicaid leaders and individuals with lived experience.
Extensive opioid use and repeated abstinence increases the likelihood of severe withdrawal and contributes to the risk of relapse. Previously we found that microglia, the innate immune cells in the brain, have dramatic changes in gene expression and signaling during opioid tolerance and withdrawal. We propose to use fentanyl and a recently developed transgenic mice to […]
Using a mobile data collection system that leverages smartphone technology to capture an abundance of time-varying information both passively (i.e., behavioral sensing) and actively (e.g., Ecological Momentary Assessment or EMA) we aim to: 1) Evaluate whether need for care is associated with real-time/real-place AVH experience; 2) Examine relationships between baseline demographic and functional variables, time-varying […]
This project developed and delivered training and technical assistance concerning medications for opioid use disorder to preservice workforce populations enrolled in health service programs at UW and WA state community colleges.
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 […]
The ages of 18-25 years are ‘peak onset’ times of major depression and bipolar disorder. These disorders have different courses and treatments, but diagnosing bipolar disorder is difficult because manic symptoms occur less often than depressive symptoms and many individuals do not recall manic symptoms. A ‘misdiagnosis lag’ of 8-10 years can contribute to prolonged […]
This Hybrid Type 1 Trial will test the effectiveness of MOVE!+UP, a behavioral weight management intervention tailored to address PTSD-based weight loss barriers. The trial will compare MOVE!+UP to VA’s standard weight loss program on weight and PTSD symptom changes. The study also will identify implementation barriers and facilitators to help understand effectiveness findings and […]
This multi-method, participatory study centers Black Veterans and seeks to understand barriers and facilitators to weight loss among Black Veterans. The overall goal of this project is to reduce disparities between Black Veterans and White Veterans in the effectiveness of weight loss treatments.
This project focused on assessing college students’ understanding of commonly used terms related to alcohol use and related consequences. Further, our team worked to update NIAAA statistics related to college student drinking and propose additional options for ongoing updates to their findings.
Through partnership with New York-based practice coaches as well as its own expert clinician trainers, the AIMS Center supports effective practice change for behavioral health integration, planning for implementation of the Collaborative Care Model (CoCM), and providing behavioral health clinician training and technical support for New York Medicaid primary care providers.
The NIDA Clinical Trials Network (CTN) is a means by which medical and specialty treatment providers, treatment researchers, participating patients, and the National Institute on Drug Abuse cooperatively develop, validate, refine, and deliver new treatment options to patients. The Network consists of 16 regional Nodes, including the Pacific Northwest Node located at the UW Addictions, […]
Following severe cases of traumatic brain injury (TBI), the brain can swell, leading to elevations in intracranial pressure (ICP). Patients who develop high ICP following severe TBI are more likely to have poor neurologic recovery from their injury, and control of ICP likely contributes to improved outcomes. ICP detection and management is typically guided by […]
The proposed research project proposes to develop and test a mobile intervention, Normalizing Orientation to Treatment and Help-Seeking (NORTH) designed to impact knowledge and attitudes to encourage help-seeking among young adults at risk for psychosis. This project involves (1) a needs assessment to understand barriers, interests and preferences related to mHealth and in-person treatment, (2) […]
Traumatic brain injury (TBI) is common in the United States with 2.87 million emergency department visits related to TBI per year. Chronic pain is a frequent complaint following TBI, with more than half of patients reporting pain. Individuals with TBI are often prescribed opioids for pain following their injury, but unfortunately may be especially vulnerable […]
This project contributed to the initial offering of the Opioid Response Network (ORN), a national partnership of the American Academy of Addiction Psychiatry and the Addiction Technology Transfer Center (ATTC) network, to provide on-demand technical assistance in areas of prevention, treatment, and recovery for care related to opioid use disorders.
This project contributed to the sustained offering of the Opioid Response Network (ORN), a national partnership of the American Academy of Addiction Psychiatry and the Addiction Technology Transfer Center (ATTC) network, to provide on-demand technical assistance in areas of prevention, treatment, and recovery for care related to opioid use disorders.
Opportunity-Based Probation (OBP) is a new juvenile probation model that expands on adolescent development research by leveraging adolescents’ drive towards independence as well as their heightened receptivity to rewards. In collaboration with their probation officers, youth create meaningful goals and incentives that reward the development of prosocial behavior. Probation officers scaffold prosocial behavior by reinforcing […]
This project is providing intensive technical assistance as support for implementation of contingency management by health settings in OR state.
The proposed research addresses three important objectives (1) complete a scoping review to map determinants of teacher implementation of evidence-based practices for child behavior in preschool , (2) identify strategies to improve teacher implementation through a series of casual pathway diagrams, and (3) conceptualize and operationalize strategies with stakeholders to increase feasibility.
Through a community-partnered approach we will develop and deliver a parent-teacher relationship intervention at local preschools that serve under-represented minority families.
This project provides direction, training, technical assistance, and evaluation of the Parent-Child Assistance Program (PCAP) being implemented by 13 community agencies and 15 sites serving 20 counties and up to 1490 mothers/families in Washington State.
CoLab partnered with the Tacoma-Pierce County Health Department to develop a health equity policy recommendation using a codesign process that combines research evidence and community and stakeholder voice. The first phase consists of an overarching review to identify existing public health policies that have a strong positive impact on health equity while also synthesizing community-identified […]
This project will survey community pharmacy staff and behavioral healthcare providers in Washington State to assess the acceptability, appropriateness and feasibility of long-acting injectable antipsychotics administration in community pharmacies.
This observational study will examine mobility challenges and opportunities among people living and working in South Beacon Hill using participatory research methods: 1) community member photography-enhanced storytelling (photovoice), 2) interviews with Beacon Hill stakeholders and community members, and 3) mobility audits.
The proposed research addresses three important objectives including: 1) Can OUD screening be effectively incorporated into primary care mental health screening protocols?; 2) Does implementing Collaborative Care for OUD and mental health disorders improve outcomes?; 3) What implementation strategies are effective at sustaining Collaborative Care programs that concurrently manage mental health disorders and OUD?
This project will develop a telephonic collaborative care model for opioid use disorder and depression and then conduct a pragmatic trial to test the model of care management primary care clinics in Washington state and Indiana.
The Perinatal Psychiatry Consultation Line (PCL) is a free telephone consultation service for health care providers caring for patients with mental health problems who are pregnant, postpartum, or planning pregnancy. Any health care provider in Washington State can receive consultation, recommendations, and referrals to community resources from a UW psychiatrist with expertise in perinatal mental […]
This project will adapt the Family Bridger Program for an inpatient setting.
This project aims to examine the feasibility and acceptability of FOCUS, a mobile self-management intervention for individuals with serious mental illnesses. We will recruit 30 veterans receiving services at VA Puget Sound and provide FOCUS for one month, examining feasibility of integrating this intervention into outpatient VA services, acceptability to veterans, and preliminary outcomes including […]
This pilot study will leverage Veteran expertise to inform user-centered design improvements and will pilot the effectiveness of a computerized intervention targeting anxiety sensitivity among this patient population.
This project examines the acceptability and feasibility of policy codesign process to help three regions in Washington develop their own local strategy to improve crisis response for people who use drugs, focusing on calls with law enforcement. Policy codesign is an evidence-based approach that aims to develop policies from “the ground up” that are tailored to community needs and promote region ownership. […]
The AIMS Center is partnering with Premera to support up to 30 clinics in rural Washington and Alaska to expand access to evidence-based mental health treatment.
The purpose of this IES study is to identify what EBPs teachers and paraeducators use to more meaningfully include and retain autistic in general education settings; and the malleable individual and organizational characteristics that increase EBP use.
To evaluate the use of an existing selective suicide prevention intervention, Preventing Addiction Related Suicide (PARS), for use with Veterans by: 1) adapting and tailoring content to Veteran populations and 2) conducting an open trial within a VA substance use disorder intensive outpatient program.
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.
The goal of this project is to develop and test a 3-week mobile-app that tracks mood, alcohol use, alcohol expectancies, and alcohol-related consequences 2x a day and provides real-time personalized feedback using individuals’ daily experiences and intentions. The app is designed for students attending 2-year/community colleges and 4-year colleges. This work is significant because there […]
This is a subaward to an R34 awarded to Dr. Melissa Lewis at University of North Texas Health Science Center (UNTHSC). This project develops and tests an intervention for young adults that focuses on motivations for and quality of alcohol and marijuana protective behavior strategy use, including a daily-level examination of these processes.
This project examines marijuana-specific self-regulation processes in relation to marijuana use and consequences both across days and throughout the day to identify how psychological states and contextual factors influence these self-regulation processes using an EMA design with surveys four times a day for two weeks.
The present study seeks to significantly expand our understanding of alcohol and cannabis co-use behaviors in the context of young adult romantic relationships through collecting daily dyadic quantitative data and qualitative interviews, and using this information to develop and pilot an integrated brief intervention to decrease alcohol and cannabis misuse and increase healthy relationships skills […]
This study is conducting secondary analyses on data collected from an unprecedented, recent longitudinal study of young adult drinkers recruited from the community in WA State after adult marijuana use was legalized for recreational purposes, Project Transitions. Analyses will increase our knowledge of concurrent and simultaneous use of alcohol and marijuana across months, specifically examining substitution […]
The objective of this research project is to evaluate whether changes in cognitive factors can reduce hazardous drinking among current and graduating college students. These studies seek to evaluate naturalistic (Study 1) and experimentally-induced (Study 2) changes. The naturalistic study is currently following a sample of recent college graduates, with assessments every 4 months, beginning […]
This project is designed to integrate basic and clinical science to translate mechanisms of recovery from PTSD to testing an intervention in individuals with PTSD and marijuana use. We will recruit 72 individuals with PTSD and varying levels of marijuana use, 36 with current heavy marijuana use and 36 without current marijuana use, to complete […]
This study involved developing and preliminarily testing a new app to prevent PTSD and alcohol misuse following recent sexual assault.
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 […]
Project VERO will develop and test a personalized normative feedback intervention to reduce vaccine hesitancy among young adults. Phase one entails rapid prototyping – utilizing concepts from user experience research – to refine the content and design of the brief intervention. The second phase entails an RCT enrolling unvaccinated young adults from around the US […]
The overarching purpose of the research is to adapt and pilot test a technology-enhanced training for hospital nurses in the delivery of a suicide prevention intervention with patients hospitalized for medical reasons.
Schizophrenia is a debilitating mental health condition with high societal and personal costs, due largely to chronic difficulties with social and occupational functioning. While classical symptoms of schizophrenia – such as hearing voices – are often responsive to medication, people with schizophrenia also experience difficulties in social cognition, or understanding and interpreting the intentions and […]
This project will 1) identify the unique barriers autistic young adults experience in accessing full-model Dialectical Behavior Therapy (DBT) for suicidal thoughts and behaviors and non-suicidal self-injury in community settings, 2) determine needed adaptations to DBT from the perspectives of service providers and recipients, and 3) user-test elements of a redesigned DBT protocol.
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 […]
Alzheimer’s disease and related dementias (ADRD) affect more than 10% of adults who are age 65 and older, but the toll of ADRD is most devastating among older African Americans. COVID-19 widened these disparities; in addition to being more susceptible to COVID-19 infection and fatalities, older African Americans are more likely to experience digital and […]
This study will explore the role that criminal defense attorneys could play in reducing risk of suicide amongst recently arrested criminal defendants. Suicide is the leading cause of death in jails and the period after recent arrest may be a particularly vulnerable time for suicide. For many persons with recent arrest, their attorney is one […]
The RMHII is a partnership between the AIMS Center and Premera Blue Cross to expand access to evidence-based mental health treatment in rural areas. The AIMS Center will lead clinic selection, training, technical assistance, and practice coaching for up to 30 primary care clinics in rural Washington and Alaska.
S-MhINT is a research and capacity building consortium in Southern Africa that aims to strengthen regional mental health integration into primary health, antenatal, and chronic care platforms using implementation science in under-resourced areas of eastern South Africa, central Mozambique, and southern Tanzania. S-MhINT has the following overall aims: 1) To establish and engage a trans- […]
SPARK is an autism research study and a growing community of autistic individuals, their families, and researchers with a goal to advance the understanding of autism. This study aims to improve the lives of people with autism by identifying the causes of autism and informing more effective therapies, treatments, services, and supports.
This project is contributing to the expanded offering of the Opioid Response Network (ORN), a national partnership of the American Academy of Addiction Psychiatry and the Addiction Technology Transfer Center (ATTC) network, to provide on-demand technical assistance in areas of prevention, treatment, and recovery for care related to opioid and stimulant use disorders.
The primary goal of this project is to quantitatively compare the treatment experience, engagement, self-reported clinical outcomes, and recovery-oriented outcomes of patients initially randomized to telepsychiatry collaborative care and telepsychiatry enhanced referral. In addition, for the subset of patients randomized to telepsychiatry enhanced referral who do not engage in treatment and are still symptomatic at […]
Patients hospitalized for medical, surgical, or traumatic injury reasons at Harborview Medical Center are universally screened for suicide risk. The present research will advance knowledge about the practices occurring at this large healthcare institution serving the public and social safety net population and set the groundwork necessary for conducting future research designed to improve services […]
Several recent studies have found that for evidence-based psychosocial interventions (EBPIs) to be delivered more effectively, sustained quality, ongoing supervision, and guidance is critical. This study will develop an electronic support tool to support quality delivery of PST that is based on clinician feedback. We hypothesize that supporting clinician delivery of EBPIs will result in […]
Positron emission tomography (PET) is an imaging technique that uses radioactive substances to visualize and assess the brain function. Apart from its heavy use in clinical oncology, PET is widely used in a variety of other conditions such as various neurological, psychiatric, neuropsychological, and cognitive disorders and is the gold standard for assessing neurodegeneration. In […]
The aims of the current project are to: 1) Engage stakeholders to identify targets for ACT SMART redesign to optimize its fit for middle and high school providers who serve autistic adolescents; 2) Conduct prototyping and usability field testing of the redesigned ACT SMART and iteratively refine to ensure usability, feasibility, acceptability, and appropriateness for […]
Prazosin, like many of our most effective treatments for PTSD, seems to be significantly more effective for some individuals than others. We have hypothesized that this is because prazosin works to compensate for increased noradrenergic signaling, which is a primary driver of symptoms in some, but not all, individuals with PTSD. If we could identify […]
After COVID infection, 10-50% of people experience persistent symptoms such as fatigue, palpitations, insomnia, cognitive problems, and headache – often with significant associated distress and functional impairment. The exact combination of symptoms varies from person to person, and it is expected that the specific causes vary from person to person as well. Because of this […]
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 […]
This project will create a mentored research training program for University of Washington medical students to engage in substance use disorder-focused research and clinical practice during their medical school training.
This project offered training and intensive technical assistance in Motivational Interviewing for clinician members of a three-county provider association in OR state.
This project offered training and intensive technical assistance in Motivational Interviewing for behavioral health and medical clinicians throughout a county in OR state.
Our team provides training and technical assistance to 19 jails across Washington State who received legislative funding to implement and expand a medication for opioid use disorder program at their facility.
This project developed and delivered novel trainings in useful treatment and recovery practices for behavioral health providers in WA state.
This project offered a training of trainers process in SBIRT for personnel of a healthcare organization in King County.
This project developed and delivered training and technical assistance in Motivational Interviewing for primary care professionals in OR state.
This educational initiative seeks to craft an innovative curriculum for psychiatry residents focused on person-centered communication skills.
This project developed and delivered training and technical assistance in a range of useful treatment and recovery practices to the addiction workforce in WA state.
ADHD often runs in families. The TPAC study focuses on parents with ADHD who also have a child with the disorder, aiming to open the door to new ADHD treatments for adults and children. All parents in the study receive training that uses behavior modification techniques and reward-based interventions to improve communication, increase compliance and […]
LGBT Veterans have faced a long history of stigma, discrimination, and exclusionary policies that were intended to exclude them from military service. Despite recent shifts in policy and increased staff trainings, existing evidence suggests that this group is at high risk for health disparities, particularly with respect to mental health and health risk behaviors. While […]
Standardized measurements of unhealthy drinking and alcohol use disorder symptoms are integral to addressing alcohol problems. However, surprisingly little is known about how measures of alcohol consumption and alcohol use disorder symptoms function when they are used in real-world routine care settings and documented in electronic health records (EHRs). We propose to leverage EHRs to […]
Approximately 35% of youth who identified as transgender report having attempted suicide in the past 12 months. Despite this high risk, few preventive interventions have been developed specifically to address the unique needs of this group who experience high rates of marginalization, victimization and social isolation based on their gender identities. This study will use […]
The major goals of this project are to develop an interactive, virtual standardized patient to allow VA providers to practice implementing suicide safety planning with training feedback. The project includes a formative evaluation, usability testing, and a randomized pilot trial focused on evaluation of skill acquisition and transfer.
Alzheimer’s Disease (AD) is a degenerative condition that affected 5.8 million seniors in 2020 and is the sixth leading cause of death in the United States. Detecting mild cognitive impairment, often a precursor to AD, and predicting its advance to AD dementia are key clinical diagnostic problems. Early diagnosis can motivate early intervention with lifestyle […]
The most salient and debilitating aspect of dementia is memory loss. Unfortunately, memory loss is also the most difficult to quantify because it relies on doctor-administered tests that cannot be repeated very often. Without frequent and accurate measurements, it is difficult for clinicians to make reliable diagnoses, for patients and their caretakers to prepare in […]
This study will use a large population-based primary care sample in Washington state to understand how heavy alcohol use and alcohol use disorder symptoms contribute to suicidal thoughts. This study will allow examination of how different levels of alcohol use can predict short term risk of suicidality and allow us to better identify and support […]
On top of climate change, political divisiveness and cultural turbulence, we have faced the most devastating pandemic since global influenza 100 years ago. The resulting social and economic stresses have manifested as widespread anxiety, a worsening opioid epidemic and the highest suicide rates in decades. Proven behavioral health strategies like Caring Contacts offer hope. Caring […]
Over 2.5 million US adolescents struggle with mental health challenges, and multiracial adolescents are at greatest risk due to limited access to mental health programs. As roughly half of lifetime mental disorders have their first onset by mid-adolescence, it is vital to promote help-seeking for prevention and early intervention during this important developmental stage. This […]
This research will test the psychometric performance of a patient-report questionnaire that assesses DSM-5 substance use disorder symptoms as part of routine primary care.
We aim to determine the accuracy and specificity of Arterial spin labeling (ASL) — a non‐invasive perfusion technique used in MRI to track cerebral blood flow — in measuring vascular and glial‐dependent water transfer to establish whether it is a valuable clinical tool in Alzheimer’s disease. This simple and safe technique, already approved for use […]
Rates of suicide and mental health challenges among youth have never been higher. An essential part of youth well-being, mental health and suicide prevention is that parents and other caregivers of youth are prepared to support their children in these challenging times. Asking IS Caring is a parent-caregiver network started in Eastern Washington to provide […]
The objective of this proposal was to investigate the effects of a highly communicable infectious disease leading to severe pneumonia and death (COVID-19) in pregnant women in Washington State. Pregnant women are typically a highly vulnerable group to pathogenic respiratory viruses and have the highest WHO priority for influenza vaccination in a pandemic. The team’s […]
The WHO Director-General has identified mental health for accelerated implementation as part of WHOs 13th General Programme of Work (GPW13), covering 2019-2023. In response, WHO MSD established the WHO Special Initiation for Mental Health (2019-2023): Universal Health Coverage (UHC) for Mental Health; an ambitious plan to support 12 countries to include mental health in UHC, […]
Text messaging holds promise as a strategy for engaging older adults in depression treatment. The purpose of this project will be to develop and pilot test a text messaging intervention delivered in primary care settings practicing integrated care. Recent data shows that the vast majority of older adults have a cell phone and that about […]
The Center for Mental Health, Policy, and the Law (CMHPL), through an operations grant, is developing programming in Workforce Innovation and Leadership in Forensic Mental Health to address the forensic mental health workforce shortage. The CMHPL anticipates the programming will have a direct impact on recruitment and retention of mental health professionals who work in […]
This study aims to examine daily-level associations of health and transportation behaviors within young adults in Washington State.
This project offered training workshops in a range of useful youth treatment and recovery practices for members of the addiction workforce in WA state.
