Do You Really Expect Me to get MST Care in a VA Where Everyone is Male? Innovative Delivery of Evidence Based Psychotherapy to Women with Military Sexual Trauma
Sponsor/Type: US Army/USAMRAA
Project Period: 08/01/2014 – 07/31/2019
Ronald E. Acierno, PhD
Veterans who experience military sexual trauma (MST) are at heightened risk of developing psychiatric difficulties such as post-traumatic stress disorder (PTSD). Although the Veterans Health Administration (VHA) has identified MST positive Veterans as a high priority population, this group of Veterans may under-utilize evidence-based interventions for PTSD such as Prolonged Exposure (PE). Likely reasons for this under-utilization include unique barriers to care faced by MST survivors such as avoidance of VA medical facilities due to their potential to cue distressing memories and symptoms. The current study includes a randomized controlled study design comparing treatment engagement and clinical and quality of life outcomes between two groups: Veterans receiving PE for PTSD-related MST via home based telehealth (PE-HBT) and Veterans receiving PE for PTSD-related MST via standard service delivery (PE-SD). The intervention component of the study is complemented by a qualitative component (i.e., patient interviews) designed to better understand Veterans’ reactions, preferences, difficulties, and suggestions for the intervention, as well as to solicit feedback about this patient population’s service needs and preferences more broadly. All Veterans enrolled in the study (i.e. Veterans in both groups) will benefit from receiving a well supported intervention for PTSD, Prolonged Exposure (PE), to address their MST-related symptoms. As such, all Veterans have the potential to experience significant symptom reduction related to their military sexual trauma post-intervention (i.e., within 12 weeks). However, women assigned to receive PE via home-based telehealth will have the particular advantage of being able to receive services from their home, thereby circumventing some of the traditional access to care barriers faced by this clinical population. It is anticipated that this advantage will result in increased session attendance and compliance, which in turn will result in better clinical and quality of life outcomes due to increased ‘dosing’ of the intervention. Thus, it is predicted that Veterans in PE-HBT will evidence better treatment engagement and more significant symptom improvement relative to Veterans in PE-SD. Treatment gains include a reduction of PTSD and other psychiatric symptoms such depression, as well as more global improvements in quality of life and social/occupational functioning. If, as anticipated, women in PE-HBT evidence improved outcomes relative to women in PE-SD, the current study findings can be used to establish an innovative service delivery model that will circumvent traditional barriers to care in an underserved, yet high risk patient population. Regardless of study outcomes, the proposed project stands to fill significant gaps in the literature with regard to how to optimally engage and retain MST positive Veterans in VA mental healthcare. Additionally however, there is only one PTSD treatment outcome study focused exclusively on female Veterans and no extant studies testing home-based telehealth for sexual assault victims. Thus, the proposed project also stands to make a significant contribution to mental health service delivery models for female Veterans and sexual assault victims more broadly.
Peer Social Support During In Vivo Exposure for PTSD: A Program to Address Dropout from Prolonged Exposure
Sponsor/Type: US Army/USAMRAA
Project Period: 03/15/2018 – 03/14/2022
Ronald E. Acierno, PhD
*Background: Post-traumatic Stress Disorder (PTSD) is a significant problem for Veterans and Active Duty personnel. Although effective treatments for PTSD exist (e.g., Prolonged Exposure, PE; Cognitive Processing Therapy; CPT) and have, at great expense, been widely disseminated by VA and DoD, over of those 30% who start treatment subsequently drop out prior to completion.
In our first preliminary study we addressed published survey data from Veterans indicating that dropout was related to logistical barriers such as travel time, cost, and stigma associated with care from mental health settings, and so overcame these barriers by delivering treatment via home based telehealth. However, dropout remained virtually unchanged. Veterans in our study who dropped out of treatment, including that delivered via home based telehealth, were interviewed and a majority responded that they would (a) consider returning to treatment and (b) would be more likely to complete treatment if a peer who had themselves successfully completed treatment were available to help them with exposure homework.
In keeping with this feedback, our second preliminary study examined the feasibility of using peers to (a) encourage Veterans who had dropped out of PE to return to treatment and (b) offer support during in vivo (real world) exposure therapy homework assignments (e.g., as they would during ‘gym workouts’). Preliminary findings indicate that such an approach is feasible, and potentially effective, in that over 50% of dropouts from PE agreed to return to treatment and 30% of these actually did so immediately.
*Objective: We propose to evaluate whether the opportunity to receive social support during in vivo exposure therapy homework from Veterans who themselves have successfully competed PE (i.e., the therapeutic equivalent of an exposure therapy ‘workout buddy’) is effective in reversing dropout and improving PTSD outcomes; and, secondarily, to determine whether this program is particularly helpful for those receiving PE via telemedicine.
*Study Design: We will use a between group, randomized controlled repeated measures design comparing PE+Exposure Workout Buddy vs. Supportive Counseling (the standard treatment referral option for PE dropouts) to evaluate the ‘PE+Exposure Workout buddy’ adjunctive therapy component in terms of its ability to increase likelihood that veterans will (a) return to and complete treatment & (b) evince reduced PTSD Symptomatology at post, 3&6 month followup.
*Specific Aims: Aim 1: To determine relative differences in treatment dose obtained, measured in terms of the number of sessions completed upon return to treatment, in response to ‘PE+ Exposure Therapy Workout Buddy’ vs. ‘Supportive Counseling’ in individuals who have previously dropped out of evidence based treatment for PTSD. Aim 2: To determine differential effectiveness, measured in terms of therapeutic gains over time on measures of PTSD symptomatology, of ‘PE+ Exposure Workout Buddy’ with therapy dropouts in (i.e., ‘treatment outcome’). Exploratory Aim 3. To determine the presence of an initial signal of differential dose and effectiveness of ‘PE+ Exposure Therapy Workout Buddy’ when delivered in traditional in person (face to face) vs. telemedicine formats.
*Hypotheses: Hypothesis 1: Treatment ‘dose’, measured in terms of number of sessions completed post randomization, will be greater for participants in the PE+ Exposure Workout Buddy condition compared to the Supportive Counseling condition.
Hypothesis 2: Treatment ‘outcome’, measured in terms of PTSD symptom reduction scores, will be significantly more improved for participants in the PE+ Exposure Workout Buddy relative to Supportive Counseling condition at each assessment point (post treatment, 3 month and 6 month followup).
*Relevance: Military: If the present intervention, which builds upon the teamwork and leadership skills implicit in military training, is effective in retaining individuals in treatment who otherwise would drop out, then we may well be able to dramatically address the high dropout rate from our most effective class of interventions, and thus significantly enhance our ability to sustain force strength. Civilian: Findings from this study will potentially provide direction to reducing the high dropout rate from evidenced based treatment for PTSD among rape victims, accident victims, victims of natural disaster, and victims of terrorist acts. As such, the public impact of this project’s findings are potentially enormous.
The Efficacy of 90-Minute vs. 60-Minute Sessions of Prolonged Exposure for PTSD: A Randomized Controlled Trial in Active Duty Military Personnel
Sponsor/Type: Sub University of Pennsylvania/Dept. of the Army
Project Period: 10/01/2017-09/29/2019
Ronald E. Acierno, PhD
PTSD among active military personnel has devastating effects on multiple aspects of functioning, making it imperative to increase access to evidence-based treatments for military personnel. Prolonged Exposure (PE) is the most available evidence-based treatment, but the standard 90-minute PE session format constitutes a significant barrier to its implementation in military settings, which typically use 60-minute appointment sessions. Thus, reducing PE sessions from 90 minutes to 60 minutes would remove a major barrier to the adoption of PE in the military. The proposed study is a 2-group, prospective, randomized, controlled, non-inferiority trial, comparing 60 vs. 90-minute PE sessions. This trial will consent 200 active duty military personnel with PTSD with the intent to randomize 160 equally into one of the two treatment arms. The main aims of this study are: 1) To investigate the efficacy and efficiency (i.e., rate of improvement) of 60 vs. 90-minute PE sessions (including 20 vs. 40-minute imaginal exposures, respectively); 2) To compare pre-/post- psychophysiological markers of treatment response; and 3) To test mechanisms of PE by investigating the associations between objective (i.e., psychophysiological) and subjective (i.e., self-report ) measures of extinction-related arousal, changes in cognitions, and clinical outcomes. The results of this study will inform dissemination efforts of evidence-based treatment in the military as well as in the public sector. Identifying mechanisms of therapeutic change will answer important theoretical questions about how PE works, in order to refine and improve PE to better meet the needs of afflicted service members.
Mealtime Partnerships for People with Dementia in Respite Centers & at Home
Project Period: 09/01/2017 – 06/30/2021
Elaine J. Amella, PhD, RN, FGSA, FAAN and Suparna Qanungo, PhD
The goal of this study is to test the efficacy of a mealtime intervention (Partners at Meals) in respite care centers (RCCs) that provide a social model of care for people with dementia living in the community and support for their caregivers. Largely staffed by long-time volunteers, these centers support caregivers’ ability to maintain their loved one in the home. Outcomes include improvements in: a) quality of life (QOL) and nutritional outcomes for people with dementia (PWD) and QOL outcomes for family caregivers (CGs); b) self-efficacy training outcomes for assessing and managing meals for the CGs and the RCC volunteers; and c) sustainability outcomes as determined by directors of the RCCs. Two large RCCs with a total of 5 sites of care in suburban and rural areas of SC will be the sites of this project; and 60 PWDs and 60 CGs will be recruited for this cluster-randomized trial, as well as potentially 60 staff and volunteers. Caregiving for PWDs is increasingly occurring in the community by persons who are often not prepared to assume this responsibility. Fortunately, RCCs evolved as a vital community-based resource that provide socialization, meaningful activities, respite for caregivers and at least one meal daily. Mealtime is a particular problem for PWDs because as this life-limiting disease progresses, they lose the functional ability to manage meals and display a variety of challenging behaviors all of which will eventually affect their ability to consume adequate calories and continue the social aspects of meals that connect them to others. A HIPAA-compliant telehealth system using simple ‘tablets’ will allow CGs to capture behaviors and environmental aspects of meals in the home at the time behaviors occur so that plans of care can be tailored to PWD needs. Using a train-the-trainer model, volunteers will be taught to assess the environment (Place), the interactions between the PWD and others (People), and the actions of the PWD (Person). They will then train the CGs to make those observations so they can tailor and change mealtimes in the home – the telehealth component supports this. Thus this project could be used in the community as a model for behavior modification for other dysfunctional behaviors in the home. This study proposes to examine the following aims: (Primary) Compared to participants in ‘enhanced usual care’ sites, PWD participants in the intervention sites will demonstrate improvement in nutritional status and dysfunctional behaviors, and QOL; (Secondary) a) CGs will report improve QOL and self-efficacy for managing meals, and decreased depression and burden; c) RCC volunteers will report improved self-efficacy for training and management of feeding issues; and d) Directors will report satisfaction with the program and willingness to continue the program post-funding. Additionally, hospitalizations and discharges related to nutrition-related issues among PWDs will be collected for future work.
Understanding the Effects of Substance Use on Male Couples' Risk for HIV
Sponsor/Type: Sub University of Hawaii/NIH/NIDA
Project Period: 04/01/2017-03/31/2020
Julie V. Barroso, PhD
The aims of this mixed methods project are to: (1) examine the intrapersonal, interpersonal, and contextual factors associated with event-level substance use and condomless anal sex among male couples by using a 6- month longitudinal study to collect and synthesize three types of dyadic data: ecological momentary assessments, quantitative assessments and qualitative interviews; (2) identify which intrapersonal, interpersonal, and contextual factors are associated with event-level substance use that did not involve CAS among male couples, and how these factors and substance use events differed from usage that occurred with CAS. The proposal is innovative as it applies mixed methods, uses technology to capture event-level substance use and other risky behavioral data, and applies theory and methods that are couples-based. The public health significance of the proposed study is to further our understanding and elucidate how substance use affects male couples' risk for HIV. Findings obtained from this novel project will help inform future development of HIV and substance use preventive interventions for this population.
Components of Team Science Implementation-What Contributes to Success?
Sponsor/Type: MUSC SCTR Pilot Grant
Project Period: 10/02/2017 – 06/30/2019
Melanie L. Cason, PhD RN, CNE
This project will generate pilot data through a qualitative inquiry with front line caregivers and administrators to contribute to the knowledge base of team science in order to close the gap of a lack of rich information and perspectives from essential stakeholders in team training. The study team will interview approximately 40 participants including all types of caregivers and relevant administrators with open ended questions regarding past and/or current experiences with team training to determine multidisciplinary perspectives. By analyzing the data qualitatively using an implementation science framework, the Consolidated Framework for Implementation Research, themes will be identified that can impact team science knowledge relating to team training that may contribute to practical clinical outcomes. In this way, the team will contribute towards progress with integrative and cumulative changes in collaborative behaviors by examining the “why” and “how” perspectives from stakeholders on the front lines of patient care and organizational decision making regarding team training. An Engaging Teams for Improved Outcomes Framework will be developed for future use in developing team training at MUSC and beyond.
Taking Student Learning Higher with Simulation Collaboration
Sponsor/Type: The Foundation of the National Student Nurses’ Association, Inc. (FNSNA)
Project Period: 10/01/2017 – 06/30/2019
Melanie L. Cason, PhD RN, CNE
This project seeks to advance the science of simulation in nursing education by (a) developing a unique statewide alliance with student involvement to promote collaboration; (b) developing evidence-based simulation pedagogy and simulation regulation recommendations; and (c) implementing a reliable and valid outcomes based measurement system for simulation users. At the present time, there is a lack of opportunity for student involvement in advancing simulation science in nursing education, a lack of clear, consistent and evidence based pedagogy guidelines for simulation, and inconsistency in outcomes measurement quality and implementation. The present project is designed to address each of these deficits.
This project will accomplish several important objectives for improving nursing education in South Carolina and beyond. Collaboration across the state with faculty and student involvement will occur through the formation of the South Carolina Simulation Alliance. A steering committee with members from each region of the state-- Low country, Midlands, and the Upstate will guide the development process. Through collaboration with the Medical University of South Carolina Medical Center, there is access to experts in all specialties available for providing input into the latest evidence-based practices for simulation scenario development.
Sharing will occur via teleconference, in-person meetings, conference calls, and culminate in a simulation conference created by alliance members with rewards for excellence in simulation presented at the student and faculty level. The implications for healthcare and practice are far-reaching as a team of nurse educator simulation experts will be developed allowing for input into regulatory processes for simulation in nursing education, collaboration, and multi-site research opportunities. The South Carolina Simulation Alliance will also provide opportunities for student involvement in the areas of simulation participation and scenario development. Additionally, with the support of the Promise of Nursing School Grant, there is an opportunity for enhanced student learning with the sharing of resources and content experts via three mobile video conferencing robots.
1) Develop and maintain a South Carolina Simulation Alliance to improve, coordinate, and expand the use of simulation in nursing education.
2) Collaborate with students to adopt advanced technology that enables access to resources and experiences not otherwise available (video-conferencing robots).
3) Develop a set of evidence-based practices that expand the science of simulation in nursing education as measured by increased measurement of outcomes with valid and reliable instruments.
Expanding the Reach of a Novel Mental Health Service for Traumatic Injury Patients
Sponsor/Type: Duke Endowment
Project Period: 06/01/2017 – 05/31/2020
Tatiana M. Davidson, Ph.D.
Our primary aim is to implement Trauma/Telehealth Resilience and Recovery Program (TRRP) in three partnering Level I-II trauma centers in South Carolina. TRRP activities include provision of in-hospital education after traumatic injury (Step 1), enrollment in our text-message service to monitor emotional recovery (Step 2), 30-day telephone mental health screen (Step 3), and provision of mental health treatment or referral (Step 4). We will initiate this process with each center by working closely with hospital leadership (i.e., trauma medical director, trauma program manager) and key personnel (e.g., social workers) to determine the optimal approach toward implementing TRRP and identify, record, and address barriers to integration. Most of this planning will focus on optimal procedures supporting the initial brief (i.e., 10 min) educational encounter because all other levels of our service will be provided via various forms of technology. We will document barriers and solutions to implementation at each site to inform future dissemination initiatives.
One full-time coordinator will be hired at each Center to provide TRRP services using funds from The Duke Endowment and MUSC Health Center for Telehealth. Coordinators will complete a 2-week intensive training in TRRP operations at MUSC. Training will include orientation to program goals and procedures, guided reading and discussion, and hands-on supervised experience in the first (in-hospital education) and third (telephone mental health screen) step of TRRP. MUSC staff will provide all support for the second (text messaging) and fourth (mental health treatment) steps of TRRP. Best practice treatment will be offered directly or by referral based, in part, on our capacity and patient preference. We will continue to provide oversight to coordinators throughout the award period and will travel to each site on a quarterly basis to work with hospital leadership and provide booster training. Site coordinators will maintain daily contact with the MUSC team to support program operations.
Mobile web resources to improve firefighters' use and benefit from behavioral health services
Sponsor/Type: Dept. of Homeland Security/Federal emergency Management Agency (FEMA)
Project Period: 08/22/2018 – 08/21/2020
Tatiana M. Davidson, Ph.D.
Behavioral Health Workforce Education and Training (BHWET) Program
Sponsor/Type: Health Resources and Services Administration (HRSA)
Project Period: 09/30/2017 – 08/31/2021
Catherine (Cathy) O. Durham, DNP, APRN, FNP-C
This application requests funds to support innovative interdisciplinary academic-practice partnerships to prepare psychiatric mental health nurse practitioner (PMHNP) students in the MSN and DNP at MUSC CON for the professional track. The purpose of this project is to expand lifespan behavioral health workforce through increased longitudinal placements and provide interprofessional training in collaborative practice for students, faculty, and preceptors (field placement supervisors). The BHWET project will provide stipends to PMHNP students who commit to completing their field placement and plan to pursue employment in rural, vulnerable, and/or medically underserved areas (MUA). MUSC CON opened a PMHNP BSN to MSN/DNP program in Fall 2016 and enrolled 11 PMHNP students and 10 new students will be matriculating for Fall 2017. The CON graduated 68 primary care nurse practitioner students during 07/01/16-06/30/17. 100% of graduates from the previous year (07/01/2015 – 06/30/2016) are employed in rural, underserved and public health practice settings with 51% being classified as a HPSAs and 91% as a MUAs. Thus, demonstrating our historical support of these populations. We are requesting special funding consideration based upon the CON’s significant contribution to meeting the needs of the rural and underserved in SC.
The Goals/Objectives for the BHWET grant include:
1. Provide stipend support to eligible PMHNP students completing final field placement.
2. Expand community partnerships to increase longitudinal field placements while developing recruitment strategies with AHEC to increase employment for PMHNP students post-graduation in rural, vulnerable, and /or medically underserved areas.
3. Implement and provide interprofessional collaborative practice training to CON students, faculty and preceptors using enhanced didactic and experiential activities integrating behavioral health and team-based care to increase competencies.
4. Communicate with other BHWET Program grant recipients to share successes and problem solve any challenges or barriers to ensure optimal program outcomes as part of ongoing quality improvement and evaluation.
Processes and evaluation for the BHWET program will occur as follows:
Objective 1: PMHNP students will be eligible to apply in the final year of full-time or final two years for part-time study. A rubric will be used to rank and fund the top students. Priority points will be awarded to disadvantaged and/or diverse students, and students who live or have clinical rotations in rural areas, MUAs or HPSAs. Students must remain in good standing each semester. All BHWET students will sign a commitment letter (Attachment 8) each funded year. Longitudinal data collected includes post-graduation position placement.
Objective 2: Innovative community partnerships will be expanded.
Objective 3: Didactic and experiential training using the Interprofessional Core Competencies will occur with students, faculty and preceptors.
Objective 4: As part of ongoing project quality improvement, we commit to participating in email, blog and/or HRSA interactive phone conferences to ensure best program outcomes. An annual performance report and final report will be submitted as required.
The Choose Well Initiative
Sponsor/Type:The New Morning Foundation
Project Period: 01/01/2017 – 12/31/2020
Catherine (Cathy) O. Durham, DNP, APRN, FNP-C
Choose Well is a statewide initiative of the New Morning Foundation, whose goal is to substantially and measurablyreduce unintended pregnancy among women and teens in South Carolina over a 4-year period (2017-2020). This collective impact initiative will involve a wide range of partners, including state agencies and coalitions, health care services, schools and colleges of nursing and medicine, and community-based and community-serving organizations, whose individual and collaborative work will result in better access to highly effective contraceptive methods and a decrease in unintended pregnancy.
Building the Healthcare Workforce to Serve the Underserved
Sponsor/Type: Duke Endowment
Project Period: 12/01/2016 – 06/30/2019
Terri O. Fowler, DNP, APRN, FNP-C
The goal of this proposal is to develop a model of integrated clinical experiences for interprofessional teams of students within the safety net delivery systems to establish a network of teaching community health centers. This proposal builds on the momentum established by the AHEC Institute for Primary Care, a collaboration between the Medical University of South Carolina (MUSC) and East Cooper Community Outreach (ECCO) to provide care to the uninsured, and an interest by Fetter Health Care Network (FHCN), a Federally Qualified Health Center, to build a pipeline of primary care providers to serve the underserved.
Alcohol and Violence Prevention for College Students
Project Period: 03/15/2018 – 02/28/2021
Amanda K. Gilmore, PHD
The overarching goal of this Planning Grant (R34) is to conduct a Stage IA and IB pilot of a behavioral intervention for heavy episodic drinking (HED) and violence among college students. In response to high rates of violence on college campuses, federal guidelines recommend universal violence prevention. However, violence prevention is less effective for individuals who engage in HED. It is imperative to develop and test interventions aligned with theoretically-based and evidence-based models, to target the role of alcohol in sexual assault, provide personalized information relevant to risk and protective factors for HED and violence, and to do so using a mode of delivery that is highly scalable (i.e., mHealth) to address the research-practice gap in college violence prevention. The current project includes the following aims: 1) to modify alcohol and violence prevention content to a personalized mHealth format that addresses risk factors; 2) to obtain usability of the intervention among college students who engage in HED to incorporate user feedback into the intervention content; and 3) to randomize students who engage in HED to an integrated personalized mHealth alcohol and violence prevention program or to a control condition to observe effect sizes and estimate the variability using a 3-month follow-up for designing a larger randomized controlled trial grant application. By accomplishing these aims, we will have established the research team, programming, and feasibility of the research protocol for a large scale, grant application to test the efficacy of this personalized integrated mHealth intervention. This research has the potential to reduce alcohol use among young adults as well as reduce violence among high-risk groups, thereby meeting both NIAAA and national priorities.
Technology-Based Prevention for Adolescent Substance Use, Sexual Assault, and Sexual Risk in Primary Care
Project Period: 07/01/2017 – 06/30/2022
Amanda K. Gilmore, PHD
The overarching goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to provide Dr. Amanda Gilmore with the training and research activities needed to become an independent investigator. Her program of research will focus on the development, testing, and dissemination of innovative, technology-based prevention focused on adolescent substance use, sexual assault (SA), and sexual risk behaviors (SRBs) in primary care settings. Substance use, sexual assault, and sexual risk behaviors are common among adolescents. They occur concurrently and are interrelated, making integrated prevention concerning these health risk behaviors imperative. Preventative visits in pediatric primary care settings are an ideal location to implement brief, integrated prevention due to their potential for wide reach. This proposal includes training activities to ensure that Dr. Gilmore achieves the following five new career goals: 1) Receive training in integrated prevention for adolescents to become a prevention researcher focused on preventing substance use, SA, and SRBs; 2) Receive training in implementing prevention-based clinical trials in primary care settings using screening, brief intervention, and referral to treatment (SBIRT) models; 3) Enhance statistical training in clinical trials and longitudinal analyses; 4) Enhance training in the use of innovative technologies as a mode of delivering prevention programs; 5) Increase manuscript writing, grant writing, and grant management skills; and 6) Enhance understanding of research ethics. The mentorship team includes expert psychologists and pediatricians in the following areas of research: integrated prevention of adolescent risk behavior (Danielson), substance use SBIRT in pediatrics (Levy), substance use prevention among sexual assault victims (Resnick), technology-based prevention programs for adolescents (Ruggiero), research within community pediatric practice research networks (Wallis), longitudinal data analyses from clinical trials (Ramakrishnan) and interventions for sexual minorities (Kaysen). Dr. Gilmore will apply the skills acquired during the training activities to a research project focused on the adaptation and integration of evidence-based prevention programs targeting adolescent substance use, sexual assault, and sexual risk behaviors to a tablet-based prevention program for primary care. The research project includes focus groups and expert input in the adaptation/integration phase, usability tests with both adolescents and physicians within community pediatric clinics, and a feasibility study within community pediatric clinics. The feasibility study will establish feasibility of conducting a larger randomized controlled trial testing the efficacy of the newly integrated and adapted prevention program. Preliminary efficacy of the prevention program will be examined. However, determining feasibility is the primary goal. The proposed training and research activities will prepare Dr. Gilmore for an independent research career focused on the development, testing, and dissemination of prevention focused on substance use, sexual assault, and sexual risk among adolescents in primary care settings.
Elder Abuse Assessment Training and Mental Health Services Program
Sponsor: Dept. of Public Safety/Victims of Crime Act (VOCA)
Project Period: 10/01/2017 – 09/30/2019
Melba A. Hernandez-Tejada, DHA
(1) Health care personnel and other professionals such as professional caregivers (CNAs, PCAs) etc., are in a pivotal position to help victims of elder mistreatment because they see virtually every adult over age 60 each year. However, they frequently fail to do so because 1) they are not trained to consistently recognize, assess, and refer to services and (2) evidence based counseling services are not readily available, particularly to rural elder abuse victims.
Solution: We have already designed and now propose to implement a low-cost, easily disseminated and highly sustainable elder abuse identification, intervention, and referral training program designed for (a) health care professionals already in practice, and (b) healthcare professional students in training in academic settings. In conducting this (a) training and (b) services program, we will not only reach victims currently under the care of providers, but will reach future victims treated by future healthcare providers, thereby assuring the program’s reach and sustainability. In addition, we propose to greatly expand the number of medical and health care personnel this program reaches by incorporating a "train the trainer" component, during which health care providers with interests in addressing the issue of elder abuse will be trained to provide these screening, intervention, and referral trainings to other health care personnel.
Specifically, this is a training and services project. With respect to training: we propose to offer a brief training program to identify and intervene in cases of elder mistreatment. This program is specifically designed to be easily integrated into (a) existing practice sites, particularly those serving low income and minority populations, where risk of elder mistreatment is greatest such as our partners represented by ECCO, Harvest Free Clinic, and State wide as represented by the SC Office for Rural Health (see letters of support). In addition, these training protocols are amenable to being delivered to (b) nursing, medical, and physician assistant students as part of their classroom instruction. Finally, we propose to train nurse practitioners, residents and junior level healthcare providers to deliver these elder abuse training programs to other health care personnel in their clinical settings.
Components of the training program include: (1) a complete, practice-ready elder abuse screening and intervention protocol designed for active clinics, particularly those healthcare settings serving minority populations as well as clinics facing budgetary and time constraints; (2) a brief, pragmatic, and integrated training program in how to use the elder abuse screening and intervention protocol in real practice settings, (3) a complementary training program for nursing, medical, and physician assistant students to conduct sensitive and comprehensive assessments for elder abuse, including elder DV, (4) a train the trainer component where program components are reviewed in depth, and training parameters conveyed to new cadres of providers with interests in addressing elder abuse.
1. Training health care providers in clinics across the tri-county area to screen, intervene and refer victims of elder abuse, with an emphasis on clinics and providers that serve minority populations, for which elder abuse rates are higher.
2. Training other community based agency personnel about elder mistreatment prevalence, risk factors, and how to screen, intervene, and refer for services for elder abuse, particularly in minority populations.
3. Provide group and individual counseling services in the community and via telehealth to both rural and urban older adult victims of abuse (psychological, physical, sexual, neglectful and financial).
To recruit a team of highly motivated volunteers.
Monitoring and managing newly healed chronic leg and foot ulcer skin temperature: a cooling intervention (MUSTCOOL) to prevent ulcer recurrence
Sponsor/Type: NIH/NINR - R01
Project Period: 06/15/2015 – 03/31/2019
Teresa J. Kelechi, PhD, RN, GCNS-BC, CWCN
The goal of this randomized control trial is to test a patient directed self-monitoring and self-management intervention aimed at preventing the recurrence of chronic venous leg and diabetic foot ulcers using skin temperature and cryotherapy (cooling). We propose MUSTCOOL, a novel ulcer prevention strategy for patients at highest risk for developing chronic ulcers; those with a previous history. We aim to compare a cooling treatment to a placebo to determine the outcomes on ulcer recurrence, pain, physical activity and quality of life.
Individuals with newly healed chronic ulcers will be invited to participate in MUSTCOOL’s two component intervention: 1) self monitoring skin temperature over targeted “hot spots” daily with an infrared thermometer; and 2) maintenance cooling with a cooling pack (or placebo pack) placed over the “hot spot” three times each week for 30 minutes. If the temperature of the “hot spot” becomes elevated 2°F above baseline (average of 30 days of daily temperature readings) for 2 days in a row, a bolus regimen of 5 consecutive daily, 30 minute applications of the cooling or placebo pack will be implemented. We will monitor safety and side effects, however, there have been no reported adverse events reported in our previous cryotherapy studies.
We designed this chronic ulcer prevention intervention that targets the remodeling phase, the final repair process of healing after chronic ulcer closure. The skin environment is particularly vulnerable to ulcer recurrence due to a persistent aberrant inflammatory state. Our previous research has demonstrated that cooling this skin reduces the abnormal metabolic activity, protecting it against ulcer recurrence. Recent advancements in infrared technology allow us to take images of the affect skin to identify the area that has the highest temperature or vulnerable “hot spot”. These “hot spots” will be self monitored by patients with newly healed ulcers in the home with an infrared thermometer that date and time stamps each reading. The study’s outcomes on physical activity will be evaluated with an accelerometer. We hypothesize that by improving the skin environment and reducing pain, patients will more likely be physically active and have better quality of life, all measurable goals for this study.
We will evaluate this prevention strategy over six months in 180 patients, 90 of whom will be randomized to receive the cooling pack and 90 the placebo. Our goal is to test this non-pharmacological, non-invasive clinical intervention as a tailored self-management strategy to prevent chronic ulcer recurrence. It will also determine alleviation of symptoms such as pain, and the debilitating effects on physical activity and quality of life.
Technology Enhanced Self-Management Interventions for Fatigue and Pain: The Symptoms Self-Management Center
Project Period: 08/01/2016 – 07/31/2021
Teresa J. Kelechi, PhD, RN, GCNS-BC, CWCN
The overall goal of the Symptoms Self Management Center is to build a critical mass of research thematically focused on targeting symptoms of fatigue and pain through complementary, synergistic research activities. Toward this end, the National Institute on Nursing Research-funded (NINR-P20) Symptom Self Management Center (SSMC) at the College of Nursing, Medical University of South Carolina, provides the infrastructure and context for nurse scientists who will:
IDENTIFY groups of patients, who are at risk for chronic disease symptom exacerbation in the areas of fatigue and pain through cutting edge biomedical informatics
DEVELOP effective, scalable and sustainable technology enhanced self management interventions that are accessible to these patients through iterative, patient-centered design approaches; and
EVALUATE these in real world community settings through established community partnerships interventions.
In other words, the SSMC will deliver novel self management interventions where they are needed, to whom they are needed, when they are needed.
Thus, the SSMC Specific Goals are:
Strengthen the infrastructure within which emerging investigators in self management interventions can collaborate with biomedical informaticists to use predictive analytic strategies to identify patients suffering from symptoms of fatigue and pain, across a variety of disorders in the early stages of symptom development.
Provide instrumental support for junior and experienced investigators to collaborate with ehealth, mhealth, and web health design experts from the MUSC Technology Applications for Health Lifestyles (TACHL) health-technology center to iteratively design patient centered, technology enhanced self and self/family management interventions.
Build upon the existing community based infrastructure that facilitates enhanced access to and relationships with community partners to develop ecologically valid, natural community laboratories that would otherwise not be feasible to create in the short time frame of pilot projects.
Community-based Intervention under Nurse Guidance after Stroke (CINGS)
Sponsor/Type: American Heart Association (AHA)
Project period 07/01/2015-06/30/2019
Gayenell S. Magwood, PhD, RN, Alumnus CCRN
Stroke is the leading cause of severe disability in Americans, and African Americans (AA) are at the highest risk for stroke with rates approximately twice those of Whites. Also concerning, stroke in AA occur at younger age, and with higher severity than whites. Despite being affected at younger ages, AAs are less likely than whites to return to equivalent functional status and are more likely to die following stroke. This disparity cannot be explained by access to acute care or rehabilitation, but may relate to other personal, familial, and community factors that remain understudied. Because diabetes and hypertension are more prevalent among AA relative to Whites, and because both are significant risk factors for stroke, complex factors underlying these chronic diseases very likely also contribute to increased rate and relatively poor outcome of stroke found in AA. To address these complex issues, an innovative, coordinated approach is required that considers patient, family, and community level factors, both to explain disparate stroke recovery rates and to design and implement efficacious interventions for post stroke recovery in community residing AA patients. We have designed and successfully implemented precisely such an approach with Diabetes Belt communities and propose to do so for Stroke Belt communities as well through the Community-based Intervention under Nurse Guidance after Stroke (CINGS), a 12 week, nurse-coordinated, community health worker-delivered home-based intervention. Therefore, we propose to (1) Identify primary barriers and facilitators of post-stroke recovery for AA in the US Stroke Belt Buckle of SC through formative qualitative research (i.e., interviews, focus groups) with AA patients with stroke, their families, community leaders, and public health practitioners. (2) Develop CINGS intervention components to improve AA stroke recovery and community participation in stroke recovery activities by integrating evidence-based guidelines and AA community generated evidence to address factors that perpetuate disparity in stroke recovery. And (3) Subject CINGS to a pilot RCT with approximately 60 patients obtain variability estimates, measure preliminary effects, and explore potential relationships with mediators/moderators. We hypothesize that the intervention group will significantly improve along impact and outcome measures of interest as compared with the usual care group.
Using Portable Telemedicine to Connect Home Bound Patients to Medical and Social Resources (Connected Home)
Sponsor/Type: South Carolina Research Authority (SCRA)
Project period 05/01/2018 – 04/30/2019
Gayenell S. Magwood, PhD, RN, Alumnus CCRN
A Randomized Controlled Trial of Electroconvulsive Therapy versus Usual Care for the Acute Management of Severe Agitation in Alzheimer's Dementia (ECT-AD)
Sponsor/Type: Sub. McClean Hospital/NIH/NIA
Project Period: 09/30/2018 – 05/31/2023
Martina Mueller, PhD
Alzheimer's dementia (AD), the most prevalent neurodegenerative disease of aging, affects cognition, emotion, and behavior. Agitation is a common behavioral syndrome that frequently emerges during middle to late stage AD and is characterized by psychomotor hyperactivity, aggression, irritability, yelling, resistance to care, and insomnia. The untoward consequences of agitation and related behavioral disturbances are considerable and include impaired quality of life, accelerated cognitive decline, heightened risk of institutionalization, and increased morbidity and mortality. Agitation also increases caregiver burden, including stress and deleterious health consequences. However, despite the damaging impact of agitation on the patient and caregiver, current treatments have only modest efficacy. Behavior management strategies are widely employed, but effective only in mild cases. Antipsychotics, the most commonly used class of medication for agitation and psychosis in dementia, have demonstrated mixed results in controlled studies and are associated with elevated morbidity and mortality. Thus, there is a clear need for improved interventions, particularly for severe agitation in AD. Electroconvulsive Therapy (ECT) is a safe and effective intervention for severe mood disorders in later life, including depression complicated by psychosis, mania or catatonia. Concerns regarding adverse cognitive effects of ECT, however, have limited ECT's clinical use in treating dementia with agitation. Both retrospective and prospective studies conducted by our group support the safety and efficacy of ECT in patients with AD and severe agitation. ECT, therefore, may represent an effective treatment of severe agitation in AD. We propose a five-site, randomized, single-blind, controlled clinical trial to determine the safety and efficacy of ECT plus usual care compared with Simulated ECT (S-ECT) plus usual care in 200 hospitalized individuals with moderate to severe stage AD, probable Alzheimer's type (based on NIA-AA criteria), complicated by severe agitation. Subjects will be randomized to either (1) ECT for three weeks (up to 9 ECT treatments) plus usual care (UC), defined as standard behavioral therapy and pharmacotherapy or (2) Simulated ECT (S-ECT) plus UC. Primary efficacy will be measured with the Cohen-Mansfield Agitation Inventory (CMAI). Safety parameters include daily assessment of delirium (Confusion Assessment Method, CAM), cognition (Severe Impairment Battery, SIB-8) and serious adverse events. A 12-week follow-up includes monthly assessments to explore stability of agitation reduction.
Innovative Treatment for Female Victims of Military Sexual Trauma (MST) and PTSD
Sponsor/Type: Dept. of Public Safety/Violence Against Women Act (VAWA)
Project Period: 10/01/2017 – 09/30/2019
Female members of our Armed Forces experience sexual trauma (MST-Military Sexual Trauma) at a rate 400% that of female civilians. Social Withdrawal leading to depression and other psychological problems is a major problem following MST. Treatment programs for these women are housed in VA Medical Centers, where patients and counselors are predominantly male and services are thus predominantly male oriented. As such, greater than 95% of all identified female victims of Military Sexual Trauma Veterans DO NOT receive any services from the VA for the psychological effects of their MST experience.
1. The MUSC College of Nursing will collaborate with the non-profit 501c3, Veterans on Deck, to provide evidence based counseling services for Military Sexual Trauma and combine these with mastery and empowerment experiences specifically designed to the counter-act Social Withdrawal common in Military Sexual Trauma victims. These experiences will make use of the Veterans On Deck sailing vessels and Veterans on Deck volunteer psychologists and social work counselors, and will include team building, mastery, and empowerment training during sometimes challenging conditions found on sailing vessels.
2. The Project will include Spanish speaking and African American counselors and trainers during empowerment and mastery sailing sessions.
3. The College of Nursing will collaborate with the Veterans on Deck non-profit and with the Charleston VA Medical Center, PTSD Clinical Team (PCT). The PCT will refer women identified as victims of Military Sexual Trauma to this program. Note, the Director of the current project is a collaborates with the VA PCT team on multiple projects, thereby assuring referral flow and inter-agency cooperation.
1. Formal agreements for sail training and counseling of Military Sexual Trauma Victims will be made between the non-profit Veterans on Deck and MUSC.
2. Formal volunteer rosters of counselors trained to treat sexual trauma and Military Sexual Trauma will be finalized.
Female victims of Military Sexual Trauma will receive counseling services via on the water training.
A Virtual Learning Collaborative for Alcohol Screening, Brief Intervention and Treatment in Primary Care
Project Period: 06/20/2016 – 05/31/2019
Lynne S. Nemeth, PhD, RN, FAAN
This application builds upon previous studies by investigators at Medical University of South Carolina (MUSC) that resulted in significant improvements in alcohol screening and brief interventions, and modest improvements in adoption of pharmacotherapy for alcohol disorders in primary care practices across the United States. While PPRNet accomplished these improvements in a crossover randomized trial, effective strategies are still needed to more widely disseminate findings and approaches practices used, and develop mechanisms to make a larger national impact in the adoption of and effective implementation of the NIAAA recommended clinical guidelines. The proposed R25 education program implements an innovative virtual learning collaborative (VLC) approach to disseminating evidence, guidelines and strategies for implementation of screening, brief intervention, and referral to treatment (SBIRT) to primary care clinicians, nurses and other clinical staff nationwide that participate in PPRNet, a practice based research network with 15 years of experience in translating research into practice (TRIP). The proposed project tests the comparative effectiveness of participating in ALC-TRIP (Alcohol Learning Collaborative–Translating Research into Practice) compared to practices that have not participated in this VLC. This study will be the first use of an innovative VLC that involves learner participation in web-based discussions/planning to improve alcohol screening and intervention in primary care, with the potential to reach a large number of primary care practices throughout the US. The primary aims of this alcohol education project proposal are to: 1) Develop and implement ALC-TRIP, a multi-component VLC designed to educate primary care staff and clinicians to develop practice approaches to improve alcohol screening, brief intervention and alcohol pharmacotherapy for alcohol use disorders; 2) Compare the effectiveness of practice participation in ALC-TRIP on alcohol screening, brief intervention and use of alcohol pharmacotherapy to non-participation in this learning collaborative, in a nationwide sample of 10 practices in each group; and 3) Conduct a process evaluation of this learning collaborative to examine the strengths, weaknesses, opportunities and threats related to this approach from the perspective of the stakeholders. Findings from this project will advance the educational mission of the NIAAA and inform future dissemination and implementation programs for alcohol SBIRT. If ALC-TRIP is more effective than passive dissemination of guidelines through an educational webinar and quarterly practice reports, VLCs might play a critical role in primary care-focused alcohol and illicit drug use initiatives.
For more information contact Dr. Nemeth at firstname.lastname@example.org
A Qualitative Exploration of Peer Mentoring after Spinal Cord Injury in Delhi, India
Sponsor/Type: Sigma Theta Tau
Project Period: 11/01/2018 – 05/01/2020
Susan D. Newman, PhD, RN, CRRN
For more information contact Dr. Newman at email@example.com
PHOENIX: Development of a Spinal Cord Injury Peer-Supported Self-Management Intervention
Sponsor/Type: Dept. of Health and Human Services (DHHS)/Administration for Community Living
Project Period: 09/30/2017 – 09/29/2020
Susan D. Newman, PhD, RN, CRRN
The goal of this 2-phase, 3-year proposal is to develop and pilot test, in partnership with the South Carolina Spinal Cord Injury (SCI) Association, a SCI Peer Navigator intervention for implementation across South Carolina, integrating online and telehealth platforms. Our Peer-supported Health Outreach, Education, aNd Information eXchange (PHOENIX) intervention, which builds on our pilot Peer Navigator study, is specifically designed to promote self-management after SCI. The broad goals of PHOENIX are to improve participants’ community participation and quality of life (QOL) and decrease subjective impact and occurrence of secondary conditions and rehospitalization after SCI. During Phase 1, we will complete translation of our existing in-person SCI Peer Navigation program for online and telehealth delivery. Key objectives of Phase 1 include: 1) integration of mobile technology to improve access and reach of PHOENIX, and 2) development of additional multimedia online educational content. During Phase 2, we will conduct a randomized waitlisted pilot trial to identify potential logistical and methodological issues of both intervention implementation and study procedures in preparation for conducting a future full scale, randomized controlled trial. Key objectives of Phase 2 include: 1) evaluation of feasibility, acceptability, and fidelity of intervention implementation and study design and procedures, and 2) obtaining estimates of variability of relevant outcome measures. The expected outcomes are that PHOENIX will be feasible and acceptable to participants and stakeholders, and we will observe increased levels of community participation and QOL, and decreased subjective impact and incidence of medically serious secondary conditions and rehospitalizations. The expected products are Peer Navigator training and PHOENIX curriculum housed in the online iTunes U platform.
For more information contact Dr. Newman at firstname.lastname@example.org
RWJF Future of Nursing Scholars Program (2016-2019)
Sponsor/Type: Robert Wood Johnson Foundation (RWJF) and Northwell Health, Inc.
Project Period: 04/01/2016 – 04/14/2019
Susan D. Newman, PhD, RN, CRRN
Study Goals: The overall objective of the Nurse-led Education and Engagement in Diabetes care in Sub-Saharan African (NEEDS) study is to characterize the burden of Type 2 Diabetes (T2DM) patients in SSA, and explore and prioritize preferences of patients with T2DM, caregivers, and health providers in the development of a theoretical, multi-level, culturally tailored nurse-led diabetes management intervention that incorporates mobile health (mHealth) technology to increase adherence, improve outcomes, and reduce the burden of diabetes in SSA, that will be subsequently tested in a future trial. Our hypothesis is that a multi-level, culturally situated assessment of diabetes can lead to the development of a nurse-led intervention enhanced by the use of mHealth to address diabetes education and care management.
Specific Aims: Guided by a social ecological model (SEM)22, community based participatory research23, and NIH best practices for mixed methods research24, the Medical University of South Carolina (MUSC) and Ghanaian partner will conduct a mixed methods study with the following aims:
Aim #1: Assess the characteristics, including contextual factors, beliefs, practices, and self-management behaviors, of patients with T2DM in SSA.
Aim #2: Assess the characteristics, beliefs, knowledge levels, access and familiarity to technology of patients with T2DM in SSA, as well as the barriers and facilitators influencing diabetes care and its potential influence on outcomes, at the various levels of the SEM: a) individual, b) family/significant other/caregiver, c) healthcare organizations, and d) community. Using focused ethnography25, 26, the following research questions will be addressed:
a) What are the individual, interpersonal, health system, and community factors that act as barriers and facilitators influencing diabetes care, adherence behaviors and outcomes among Ghanaian patients, and their communities?
b) What are the preferences, needs, and recommended intervening strategies to develop a successful nurse led education and intervention and study within the Ghanaian medical system and the community to address diabetes?
c) What is the familiarity with, access to, and preferences towards the use of technology to facilitate care management among Ghanaian patients with T2DM?
Aim #3: Triangulate quantitative data (Aim 1) with qualitative data (Aim 2) to guide the design of a theory, driven, multimodal nurse-led intervention incorporating technology for diabetes management for testing in a future trial.
Long-term Goal: To develop a practical, collaborative, effective, and sustainable diabetes prevention and management program for patients with T2DM in SSA and improve access to care through task shifting and use of technology.
For more information contact Dr. Newman at email@example.com
Bounce Back Now: A Low-Cost Intervention to Facilitate Post-Disaster Recovery
Sponsor/Type: NIH/NIMH - R01
Project Period: 08/01/2015 – 07/31/2019
Ken Ruggiero, PhD
Disasters confront individuals with a wide range of stressors, including threat of death or injury, loss of loved ones, limited access to basic needs, and financial strain due to property damage or disruptions in employment. Many survivors are resilient or recover rapidly, but a significant minority develops behavioral health problems such as posttraumatic stress disorder and depression. Some efficacious treatments exist for these mental health problems, but many disaster survivors encounter barriers to receipt of services (e.g., stigma, time commitment, cost, scheduling, transportation). The availability of brief, effective, free, and highly accessible interventions to facilitate personal and community resilience and rapid and sustained recovery is potentially of tremendous value to disaster-affected communities and disaster response agencies. We propose to evaluate Bounce Back Now (BBN),a novel, scalable, and highly sustainable technology-based intervention. BBN will be accessible via any device that is connected to the internet, such as a computer, smartphone, or tablet; it will be optimized for mobile devices to ensure that it is highly accessible and user friendly. The intervention consists of three major components: (1) a symptom/activity tracking component designed to facilitate self-monitoring in the acute post-disaster phase; (2) a brief self-help intervention component that aims to accelerate mental health recovery relative to PTSD and mood symptoms; and (3) a provider assistance component that will connect survivors to a national Disaster Distress Helpline. Our research has supported the feasibility of the first two components of BBN, and the initial efficacy of the brief intervention component of BBN. The Disaster Distress Helpline is a national service administered by the Substance Abuse and Mental Health Services Administration that provides crisis counseling and local referrals to mental health providers. We will recruit 5,000 disaster survivors to test the intervention: 2,500 will be randomly assigned to the BBN condition, the other 2,500 to an enhanced usual care comparison condition. We will also examine the cost effectiveness of the BBN intervention relative to enhanced usual care. A secondary research aim centers on the exploration of triage-level risk factors that are associated with mental health recovery, use of BBN, and service utilization. The American Red Cross and the Office of the Assistant Secretary for Preparedness and Response have partnered with us on this proposal and will assist us with participant recruitment and collection of data relating to triage-level risk factors. We will conduct this research using an innovative phased-funding approach that will ensure that we are prepared to initiate research in the immediate aftermath of a triggering disaster incident. This study will significantly improve the evidence base around technology-based disaster mental health intervention.
For more information contact Dr. Ruggiero at firstname.lastname@example.org
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Improving Quality of Care in Child Mental Health Service Settings
Project Period: 08/01/2017 – 05/31/2021
Ken Ruggiero, PhD
Assuring children access to the highest quality mental health care is a top national priority. Yet, quality of care continues to be highly variable in traditional service settings. Novel, scalable solutions are needed to address modifiable quality-of-care indicators in sustainable ways. To this end, provider fidelity and children’s engagement are key correlates of clinical outcome and practical targets for intervention. There is tremendous opportunity to address both through technology. Studies in child education show that interactive games, touch-screen learning, and demonstration videos enhance engagement, knowledge, motivation, and learning. These benefits also may extend to the therapeutic context, where strategic integration of technology-based activities may enhance children’s learning, strengthen the therapeutic alliance, and keep providers on protocol. We are in the final stages of an NIMH R34 in which we piloted a patient- and provider-informed tablet-based toolkit designed to facilitate delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – a treatment that was selected because it addresses a wide range of symptoms using techniques shared by other treatments for emotional and behavioral disorders. The tablet-based toolkit consists of numerous components (e.g., videos, interactive games, drawing applications) that are designed to facilitate provider-patient interactions in a way that enhances children’s engagement and supports adherence to the treatment model. The tablet-based toolkit was very well received by children, caregivers, and providers in our pilot work. Moreover, all benchmarks for feasibility outlined in our NIMH R34 application were met or exceeded. We now propose to conduct a hybrid effectiveness-implementation trial to examine the extent to which the tablet intervention may improve fidelity, engagement, and children’s mental health outcomes. We will conduct a randomized controlled trial with 120 mental health providers and 360 families in partnership with dozens of clinics in the Carolinas and Florida. Providers will be assigned randomly to tablet-facilitated vs. standard TF-CBT. Youth aged 8-16 years with clinically elevated symptoms of PTSD will be recruited. Baseline and 3-, 6-, 9-, and 12-month post-baseline assessments will be conducted by independent, blind evaluators. Sessions will be video recorded for observational coding of engagement and fidelity by independent raters blind to study hypotheses. We will also examine costs and conduct semi-structured interviews with families, providers, supervisors, and agency leaders to inform future dissemination and implementation initiatives. Technology-based resources that are scalable, easy to use, and designed for efficient integration into everyday practice may have sustained national impact. The return on investment of these initiatives will ultimately rest on their potential to improve the spread of best-practice treatments and the quality with which they are delivered to the children who need them.
Mobile Web Resources to Support Spouses and Family Members of Fire Service Personnel
Sponsor/Type: Department of Homeland Security/FEMA (Federal Emergency Management Agency)
Project Period: 08/01/2017 – 03/01/2019
Ken Ruggiero, PhD
Earlier studies showed that, after critical incidents and occupational stressors, 19% of firefighters looked to peers for support but four times as many (74%) turned to spouses and family members. Later studies have emphasized even further that family members are often the first to recognize the need for help. This shows a critical need for resources that can help firefighter families to: (1) understand and identify common firefighter stressors and behavioral reactions; (2) identify their own stressors and behaviors (e.g., worry, anxiety, distress, marital discord) when they occur; (3) learn about evidence-based self-care, peer/social support, and communication strategies; (4) build skills to recognize warning signs and take action; and (5) know how to seek help through local and online resources. We were asked by the National Fallen Firefighters Foundation to create such a resource to add into our fire service portfolio. This project will develop and evaluate these resources.
The National Fallen Firefighters Foundation (NFFF) solicited our participation in the consensus groups that originally identified and designed comprehensive behavioral health projects for Firefighter Life Safety Initiative 13, and we have been partners ever since. Our team is internationally recognized for expertise in developing web- and smartphone-based screening, assessment, self-help, and provider training resources in behavioral health. The projects we have been asked to develop for this initiative, including the spouse and family resources proposed here, have been identified in consensus sessions as high priority needs with designs based on the best evidence-supported approaches.
Our work on behalf of America's firefighters has become a passion and a commitment for our staff and our program. Our first FPS supported project involved the launch of our Helping Heroes training course to teach providers how to effectively deliver the best treatments to firefighters for posttraumatic stress and depression. More than 5,000 health care providers successfully acquired these critical skills to date, and their endorsement of its utility and contribution has been extraordinary.
Our second FPS grant supported development and launch of a smartphone app, RIT Tools for Firefighter Suicide Prevention. The app develops fire service peers' ability to recognize suicide risk and use effective motivational techniques to get at-risk firefighters to sources of effective help. We have worked with NFFF to disseminate and maximize uptake of the app. Our third FPS grant supported development of Firefighters Helping Firefighters, a video peer education intervention that features the personal stories of over 20 firefighters to address mental health stigma and improve readiness to seek behavioral health care among firefighters who need it. Our fourth grant was a web-based screening, assessment, and educational resource for firefighters and behavioral health professionals working with firefighters after a critical incident. Our fifth, and current, grant is a smartphone screening, brief intervention, and referral resource for firefighters and behavioral health professionals to address alcohol abuse in the fire service. We have fully developed this content and are on schedule for successful launch.
For all resources launched by our team, all major tasks were completed according to timelines proposed, including focus groups, content development, production and editing of videos, and input from fire service groups at NFFF-sponsored meetings. We have successfully completed a number of other projects very similar in scope to the one here proposed, including development, testing, launch, extensive evaluation, and ongoing maintenance of numerous web- and smartphone-based resources. Each was completed on time and within budget, and each has met and exceeded its development and dissemination objectives as demonstrated through detailed evaluation and study.
Addressing Mental Health Needs in SC by Primary Care Nurse Practitioners
Sponsor/Type: BlueCross BlueShield of South Carolina
Project Period: 07/01/2015-06/30/2019
Gigi Smith, PhD, APRN, CPNP-PC
The MUSC College of Nursing (CON) outcomes obtained because of BSBSSCF's 2012 grant funding are powerful, however, there is much more work to be done! Additional advanced competencies are needed by CON DNP graduates in the fluctuating health care environment in order to best serve South Carolina's (SC) future health needs. SC has significant challenges with chronic illnesses such as asthma, cancer, diabetes, and heart disease, as well as comorbid mental health conditions. There are no SC DNP programs preparing nurses for certification in mental health care in the primary care setting at this time. This proposed project would provide outcomes that meet the BCBSSCF focus areas through increasing the number of frontline health care professionals and supporting innovative approaches to knowledge and skills development. The project activities, timetable and outcomes will include:
Further the integration of mental health services in primary care by providing increased access and first line intervention in the primary care setting to those identified with psychiatric disorders, thereby preventing the worsening of chronic medical conditions, improving quality of life and decreasing health care costs. This will include development of a DNP certificate and degree program in psychiatric-mental health nursing to meet the growing demand for mental health care in SC. This program could open in fall 2016. Outcome: curriculum map, 2016 opening of innovative program focused on mental health in the primary care setting.
Expanding annual enrollment to 85 students per year with continued growth and development of the asynchronous online program. Outcome: increased enrollment numbers.
Further growth in information technology and technology support to ensure relevancy in online programming, teaching and clinical supervision for students in collaboration in monthly meetings with CON IT staff. Outcome: curriculum map, program evaluation. Grant funding will enable the development and implementation of an innovative program that will educate critically needed primary care nurse practitioners in psychiatric-mental health care to meet the complex health care needs of South Carolina.
Advanced Nursing Education Workforce (ANEW) Program
Sponsor/Type: Health Resources and Services Administration (HRSA)
Project Period: 07/01/2017 – 06/30/2019
Gigi Smith, PhD, APRN, CPNP-PC
This application requests $1.4 million in funds to support innovative academic-practice partnerships to prepare primary care APRN students in the MSN and DNP at MUSC CON. The purpose of this project is to increase the longitudinal clinical immersive training experiences with rural and/or underserved population for selected primary care APRN students, develop a clinical preceptor education and support program, and facilitate post-graduate employment in rural and HPSA and/or MUA in three nurse practitioner roles: AGNP, FNP, and PNP. The ANEW project will provide traineeships to 14-16 students who commit to at least two years of primary care work in a rural and HPSA and/or MUA after graduation. MUSC CON graduated 55 primary care nurse practitioner students during 07/01/15-06/30/16, and 100% are employed in rural, underserved and public health practice settings of which 51% are employed in HPSAs and 49% in MUAs (Data Form Table 1 Part A & B). Since 2012, a total of 110 students have received AENT (n=80) and ANEE (n=30) HRSA funding; currently 74% of their practice sites can be classified a HPSA, 77% as a MUA, and 25% as a rural, underserved area. We are requesting special funding consideration based upon the CON’s significant contribution to meeting the needs of the rural and underserved in SC.
The objectives for the ANEW grant include:
Provide traineeships with primary care longitudinal clinical placements to eligible CON students, including those who currently live in rural or underserved areas.
Develop an online clinical preceptor education and support program with academic-practice partner AHEC, that will be pilot tested, and later disseminated via AHEC for statewide use.
Develop recruitment strategies and a formal program with AHEC to increase employment in rural and/or underserved areas.
Provide telehealth training and simulation in the APRN curriculum to increase access to care and improve health outcomes in rural and underserved areas.
Communicate with other ANEW Program grant recipients to share successes and problem solve any challenges or barriers to ensure optimal program outcomes.
Processes and evaluation for the ANEW program will occur as follows:
Objective 1. Full-time APRN students at any program point and part-time students in the last year will be eligible to apply. A rubric will be used to rank and fund the top students. Priority points will be awarded to disadvantaged and/or diverse students, and students who live or have clinical rotations in rural areas, MUAs or HPSAs. Students will be tracked for success and registered each semester. Students will sign a commitment letter (see Work Plan & Budget Narrative) each funded semester. Longitudinal data collected includes post-graduation position placement. An annual performance report and final report will be submitted as required.
Objective 2: The current clinical preceptor orientation will be increased and modified into online modules, in Fall 2017 and Spring 2018. This program will be pilot tested Summer 2018 with MUSC CON clinical preceptors. Pre- and post-surveys to evaluate the program and preceptor outcomes will assist in refining the program in early year 2. The program can then be disseminated during year 2 via AHEC to all clinical preceptors.
Objective 3: We will develop and pilot test a recruitment program for AHEC students by the end of the first year to provide information and encourage clinical placements as well as promote post-graduation employment opportunities in rural and/or underserved areas. Surveys will be used to evaluate the program impact and number of hires tracked and dissemination year 2.
Objective 4: Thread telehealth training in the advanced care management courses and learning intensives. Students, via course evaluations, will evaluate the impact of this curriculum change.
Objective 5: As part of ongoing project quality improvement, we commit to participating in email, blog and/or HRSA interactive phone conferences to ensure best program outcomes.
Nurse Faculty Loan Program
Project Period: 07/01/2013 – 06/30/2019
Gigi Smith, PhD, APRN, CPNP-PC
This application is a request for financial loan support for students enrolled in a Doctor of Philosophy in Nursing (PhD) degree program and the post-Master’s Doctorate of Nursing Practice Program (DNP) at the College of Nursing (CON), Medical University of South Carolina (MUSC) with a career goal to serve as nurse faculty upon graduation. The CON DNP program is fully accredited by the Commission of Collegiate Nursing Education (CCNE) through June 30, 2016, and MUSC is an accredited university by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC).
The objectives for this program are as follows:
Increase the number of graduate doctoral students in the BSN-DNP, post MSN-DNP, BSN-PhD and MSN-PHD programs who are prepared to become qualified nurse faculty upon program completion by:
Ensuring all students who received NFLP funding complete the three educational courses needed for national certification as a nurse educator.
Ensuring students who previously completed the three educational courses will complete the mentored teaching course to gain doctoral level teaching experience.
Processes and evaluation for the program will occur as follows:
Recruitment and student orientation. Following receipt of funds from HRSA, an e-mail and CON electronic newsletter notice outlining the purpose, criteria and eligibility of the NFLP program will go out all PhD and DNP students (July). Students will be informed how the loan works, and the required completion of the service agreement as full time nursing faculty at an accredited school of nursing. Students will then apply by completing a one-page application including their commitment to complete the three required educational courses prior to graduation. Students will understand a new plan of study will be developed to reflect the change. Previous students will be given priority for funding. New applicants meeting criteria for the loan and completing an entrance interview will be considered on a first come first serve basis, with priority given to those from diverse or disadvantaged backgrounds. Students will be notified (August) and receive information about cancellation provisions, loan default and complete all paperwork.
Program requirements and monitoring. Once awarded the NFLP loan funding, students’ plans of study will be rewritten with specific educator courses required and signed (August). The Office of Academics will track and register the students each semester with loan funding provided at that time (Fall, 2015; Spring and Summer 2016). Students in the program will be asked to re-sign their commitment letters each funded semester.
Program completion, reports and post-graduation follow-up. Students will be followed at the end of each semester to ensure successful completion of the courses. Longitudinal data will include collection of teaching program level for each NFLP graduate completed by the coordinators for the DNP and PhD program at 6 months post-graduation and every year for four years. Bi-annual reports for HRSA will be completed and submitted, (January & July) as required, by the Associate Dean of Academics.
CBT by Phone to Promote Use of Alcohol Related Care and Reduce Drinking
Sponsor: Sub. University of Rochester/NIH/NIAAA
Project Period: 09/01/2018 – 08/31/2022
Tracy Stecker, PhD
Numerous evidence-based treatments for alcohol use disorder (AUD) have been developed, and research shows that individuals who obtain alcohol specialty care have improved drinking outcomes and are more likely to recover, yet a small percentage of individuals with AUD obtain treatment. Use of Screening, Brief Intervention, and Referral to Treatment (SBIRT) interventions is a potential strategy to increase treatment seeking, yet there is little evidence that these interventions increase participation in alcohol-related care and a lack of evidence that such care serves as a mechanism for improved drinking outcomes. The current randomized controlled trial (RCT) of a one session intervention delivered by telephone seeks to address these gaps in evidence. The specific aims are to show that research volunteers ages 18 and older with AUD who are assigned to the intervention compared to an information control condition are more likely to initiate alcohol specialty care (aim 1), have decreased frequency of alcohol use (as measured by percent days abstinent) and intensity of alcohol use (as measured by drinks per drinking day) (aim 2), and that treatment engagement serves as a mediator of the improved drinking outcomes (aim 3). Innovations include the use of an SBIRT intervention based on the theory of planned behavior and cognitive behavioral treatment principles and that the intervention was developed for phone administration from the onset and was explicitly designed to promote treatment engagement. The project is in response to PA-15-299, Alcohol Use Disorders: Behavioral Treatment, Services, and Recovery Research. It builds on a smaller efficacy trial that showed that the intervention leads to increased engagement in alcohol-related care (Stecker et al., 2012) and extends that study in several ways including through the use of a priori tests to determine efficacy of the intervention to improve drinking outcomes and that treatment engagement serves as a mediator of the improved outcomes.
Increasing Treatment Seeking Among At-Risk Service Members Returning from Warzones
Sponsor: US Army/MOMRP
Project Period: 02/28/2013 – 07/31/2019
Tracy Stecker, PhD
Dr. Stecker was awarded a five year trial (W81XWH-13-2-0032) entitled Increasing Treatment Seeking Among At-Risk Service Members Returning from Warzones by the Department of Defense. The goal of this research is to evaluate the effectiveness of the cognitive-behavioral intervention to increase behavioral health treatment seeking among military personnel at-risk for suicide. Reducing suicide is a national priority and an urgent concern within the Department of Defense and the Department of Veterans Affairs. Indeed, rates of suicide among active duty service members and Veterans have increased dramatically since 2005, with an average of 20 Veterans completing suicide per day. The vast majority of service members and Veterans at-risk for suicide do not seek help.
This is a randomized controlled clinical trial of 1,200 military service members who are at increased risk for suicide but not currently in behavioral health treatment for the purpose of determining if a brief intervention improves the initiation of treatment. Participants assigned to the treatment condition receive an individualized cognitive-behavioral intervention administered by phone. The intervention has been shown to promote treatment-seeking in preliminary studies of OEF/OIF Veterans with elevated posttraumatic stress disorder (PTSD) symptoms. Participants are assessed at baseline and at 1-month, 3-month, 6-month, and 12-month follow-up.
Patient Centered Health Technology Medication Adherence Program for African American Hypertensives
Project Period: 07/10/2017-04/30/2021
Frank A. Treiber, PhD
Efforts to improve medication non-adherence (MNA) and blood pressure (BP) control in patients with hypertension (HTN) have met with limited success. Innovative approaches are needed that are acceptable, sustainable, efficacious, and easily disseminated. There have been no randomized controlled trials (RCTs) evaluating the application of theory-driven, patient centered, mobile health (mHealth) technology programs among African Americans (AAs) with MNA and uncontrolled HTN. The proposed research will test and refine the Smart phone Medication Adherence Stops Hypertension (SMASH) program. SMASH includes multi-level components: 1) automated reminders from an electronic medication tray; 2) tailored text message/voice mail motivational feedback and reinforcement guided by self-determination theory and based upon adherence to daily medication and BP monitoring and 3) automated summary reports and direct alerts to providers. A 6-month, 2-arm (SMASH vs. enhanced Standard Care [SC]) efficacy RCT will be conducted in 192 AAs (21-59 years old) with electronic monitor derived MNA and repeated clinic and 24hr BP verified uncontrolled HTN. Evaluations will occur at baseline, months 3 and 6, and post-trial follow-ups at months 12 and 18. Specific aims are to test the hypotheses that, compared to the enhanced SC cohort, the SMASH cohort will demonstrate significantly improved and sustained changes in: 1) Primary Outcome Variables: a) Medication adherence: % with electronic monitor-derived adherence scores >0.90; b) BP control: % meeting JNC8 guidelines for BP control (resting BP <140/90 mmHg). 2) Secondary Outcome Variables: a) % reaching and sustaining 24-hr ambulatory BP<130/80 mmHg; b) % of provider adherence to JNC8 guidelines as measured by timing of medication changes and c) patient changes in Self-Determination Theory constructs (e.g., competence and autonomous motivation). 3) Exploratory Outcomes: a) moderators (e.g., gender, age, income) and mediators (e.g., perceived severity of disease, med side effects, depression symptoms, etc.) of medication adherence and BP control; b) cost effectiveness and c) physical risk factor changes (cholesterol, LDL, HgA1c, blood glucose). After final follow-up evaluations, focus groups with random sample of SMASH subjects (total n=32) and healthcare providers (total n=~12) will assess key user reactions including acceptability, usability, salience and aids/barriers to sustainability. Data from RCT and focus groups will be triangulated to further refine and optimize SMASH and prepare for a multi-site effectiveness RCT. Our long-term objective is to reduce premature mortality among AAs by developing effective and sustainable mHealth chronic disease medical regimen self-management programs including medication adherence, bio-function monitoring (e.g., BP) and timely bidirectional contact with healthcare providers.
Smartphone Delivered Meditation for BP Control among Prehypertensives
Sponsor/Type: NIH/NHLBI - R01
Project Period: 06/01/2013 – 05/31/2019
Frank A. Treiber, PhD
Stage 2 pre essential hypertension (preEH; 130-139/<90 mmHg) entails a 3-fold risk of developing EH and 2-fold risk of cardiovascular disease (CVD) events compared to those with optimal blood pressure (<120/80 mmHg). Prevention programs are needed which can be sustained by preEHs and readily disseminated by healthcare providers. Psychological stress is a risk factor for future EH and CVD. Stress reduction via meditation has shown promise in reducing blood pressure (BP) but adult studies have not determined optimal dosage level nor evaluated dosage adherence objectively. Multiple underlying biobehavioral mechanisms linking meditation with BP reduction also require additional scrutiny. The proposed research will address these issues by further developing and optimizing a smart phone breathing awareness meditation program (Tension Tamer:TT). Stage 2 preEH 21-50 year old African Americans and Whites balanced by geographical locale (urban vs. rural) and healthcare providers from 12 practice sites (6 urban/6 rural with 12,843 stage 2 preEHs) within the OQUIN practice based research network will be enrolled.
The 3 stage process of intervention development specified in PA-11-063 will involve:
1) Optimization of TT content and delivery formats guided by behavioral and technological theories using 6 focus groups of OQUIN healthcare providers and 6 focus groups with preEHs (8 preEHs per group);
2) 6 month TT proof of concept study (n=60 stage 2 preEHs) to establish dosage tolerability and impact upon resting and 24 hour SBP and biobehavioral mechanisms: worry, rumination, anxiety, hostility, mindfulness, sleep, physical activity, sympathetic nervous system (SNS) and hypothalamic pituitary adrenal axis (HPA) activity;
12 month 2-arm randomized control trial (RCT; TT vs enhanced standard of care smart phone health education program; total n=80) to generate estimates needed for design of a large scale RCT. This series of iterative studies, implemented and guided by healthcare providers and their preEH patients, will result in an intervention acceptable to multiple racial/ethnic groups in both urban and rural settings, feasible to conduct in clinical practice settings, effective in reducing SBP in a pilot RCT and ready for a large scale RCT.
Boosting Our Barrio: A Community Based Intervention to Improve School Preparedness for At-Risk ChildrenSponsor/Type: Duke Endowment
Project Period: 06/01/2016 – 05/30/2019
Amy A. Williams, PhD
Boosting Our Barrio is a care model focused on early childhood development, early intervention when necessary and access to culturally appropriate care that can decrease health care and school costs in the long term. This project will narrow the gap of health disparities within the Latino community by increased community engagement via use of the extant promotores model with PASOs, thus increasing sustainability and maximizing use of current supports and trusted agencies.