Active Projects/Grants Managed in the SSW

Interprofessional Health Education and Collaborative Care: A Transformative Model for the Health Sciences

January 2015 - June 2020

The seven health science schools at the University of Mich igan have cooperated in this submission to outline a program to transform how we teach our health professions students. Currently, the >4,000 students from our schools are taught almost exclusively by faculty from their own units; very rarely do they learn alongside their peers from the other health science schools. Dental, Medical, Pharmacy, Nursing, Social Work, Kinesiology, and Public Health students learning in these educational silos are expected to work in collaborative teams after graduation to provide quality patient care. Not surprisingly, this suboptimal educational approach has been criticized by the major health organizations (World Health Organization, Institute of Medicine,Institute of Healthcare Improvement, etc.) as an ineffective model for positively influencing the “Triple Aims” of health care: improving 1) patient experience of care; 2) population health; 3) cost of health care. The accreditation bodies for our health schools have responded to these criticisms by requiring increased implementation of interprofessional education (IPE) methods as a means to improve the development of more effective collaborative care models. Implementing more IPE experiences seems to be an obvious strategy, but thus far, the barriers to coordinating IPE between seven units have limited Michigan’s IPE offerings to small pilot projects led by individual faculty champions.

Healthy Michigan Plan CMS Evaluation FY20

October 2019 - September 2020

An interdisciplinary team of researchers from the Institute for Healthcare Policy and Innovation has partnered with MDHHS to conduct the evaluation of Michigan's Medicaid expansion, known as the Healthy Michigan Plan (HMP). Per the Centers for Medicare and Medicaid Services, IHPI will carry out evaluation in seven domains: 1) an analysis of the impact of Medicaid expansion on uncompensated care costs borne by Michigan hospitals; 2) an analysis of the effect of HMP on the number of uninsured in Michigan; 3) the impact of HMP on increasing healthy behaviors and improving health outcomes; 4) the viewpoints of beneficiaries and providers of the impact of HMP; 5/6) the impact of HMP's contribution requirements and MI Health Accounts on beneficiary healthcare utilization; 7) the cost effectiveness of the Marketplace Option.

NIMH Data Use Certification

The objective of this research project is to examine the social and contextual influences on the intentions to use electronic cigarettes among youth.

OCCUPATIONAL SAFETY AND HEALTH EDUCATION AND RESEARCH CENTERS (T42)

October 2018 - June 2023

The University of Michigan Center for Occupational Health and Safety Engineering (COHSE), a NIOSH Education and Research Center (ERC), has been continuously funded by NIOSH since its establishment in 1982. Our Center has a distinguished legacy, building on NIOSH Trainee Program grants in the early 1970s, the Institute of Industrial Health founded in 1951, and may other milestones dating back to the establishment of the Laboratory of Hygiene in 1888. The mission of the Center is to serve the region, nation and world as a center of excellence for graduate education and research in occupational health and safety. We maintain outstanding Master’s, doctoral and research programs in Industrial Hygiene, Occupational Health Nursing, Occupational Safety Engineering and Ergonomics, and Occupational Epidemiology. Our academic and research programs provide broad-based interdisciplinary academic training to ensure that graduates are qualified to pursue careers and assume leadership roles in the practice of occupational health and safety, and to help ensure an adequate supply of well-trained researchers. Complementing the academic programs, our suite of Research-to-Practice projects, Continuing Education programs, and Outreach activities are aimed at transferring state-of-the-art knowledge to professionals and practitioners in occupational health and safety and allied disciplines. As a NIOSH Education and Research Center, we serve a number of constituencies, including: (1) NIOSH; (2) industry, labor and professional interests in our region and beyond; (3) academic units within the University of Michigan that provide critical teaching and research resources necessary for Center success; and (4) our students. The broad goals of the Center are to: • Promote excellence in our professional training and research training programs in each core program; • Increase the financial resources needed to improve the number, quality and diversity of graduate students in each core area; • Enhance the quality of our continuing education courses and other service and outreach activities; • Increase external research funding to improve our research infrastructure, expand opportunities for research training, and promote interdisciplinary research related to occupational health and safety; • Provide an organizational structure to coordinate and promote interdisciplinary educational activities for all core programs; • Promote awareness and education of occupational health and safety in undergraduate and graduate courses in other departments and schools; • Utilize a variety of research-to-practice (R2P) mechanisms, including our Visiting Partners Program, to develop skills and capabilities of mid-career occupational health and safety professionals; and • Assist Center programs and affiliated academic units in recruiting, promoting and retaining faculty

Comprehensive Community Assessment of Detroit's Older Adults

April 2018 - May 2019

The proposed Detroit Area Older Adult Comprehensive Community Assessment will update the 2002 assessment data on older Detroiters in the context of a post-bankrupt Detroit along with rapidly gentrifying pockets of the city where displacement of seniors continues. Thus, this is a crucial time to collect data on the contributions and needs of seniors in Detroit’s changing environment and make recommendations to stakeholders and community-based agencies. Given the city’s leadership (Councilpersons’ Mary Sheffield and Casteneda-Lopez), and collaborating city departments (Health Department, Department of Transportation, Parks and Recreation, Disability Department) in this project, key stakeholders have expressed the benefit of this project for the future of the city, given the absence of a Senior Citizens Department at this time.

Feasibility, acceptability, and preliminary effectiveness of a cognitive-behavioral suicide prevention-focused intervention tailored to adults diagnosed with schizophrenia spectrum disorders

August 2020 - August 2023

Suicide is among the leading causes of death for adults with schizophrenia, with risk estimates being over eight times greater than among the general population. While research has largely focused on depression and hopelessness, there is growing support for the role that symptoms of psychosis (e.g. hallucinations) play in suicide risk. Further, this high suicide rate continues to be a major public health concern given the paucity of evidence-based interventions to reduce suicidality in this population. We propose to modify and evaluate the acceptability and preliminary effectiveness of Cognitive Behavioral Suicide Prevention for psychosis (CBSPp), a promising intervention requiring protocol and implementation modifications to increase its utility in community mental health (CMH). The following modifications will be pursued given feedback from clients and providers: 1) modify and shorten treatment; 2) develop a hybrid technology-assisted provider training; and, 3) develop a between-session client text booster. Further innovations will be informed by engagement with stakeholders (clients, staff, providers, directors, and leaders) in CMH to review and gain feedback on the protocol. We will then test acceptability, feasibility, fidelity, and preliminary effectiveness of the modified CBSPp. Accordingly, the study aims to: 1) modify CBSPp for clients with schizophrenia spectrum and other psychotic disorders (SSPD) receiving CMH services, and 2) evaluate the feasibility and preliminary effectiveness of modified CBSPp in a randomized trial in comparison to services-as-usual (SAU). Aim 1 will involve: 1) the development of a hybrid technology-assisted CBSPp provider training, text boosters; 2) in-depth qualitative interviews to evaluate all CBSPp materials and delivery protocol with stakeholders, including 15 adults with SSPD and suicidal ideation and/or attempt (SI/A) within 3 months of screening and 10 CMH staff, providers, directors, and leaders); 3) CBSPp protocol and delivery, hybrid provider training, and text booster modifications with input from an expert panel of scholars; 4) an open pilot trial with 8 clients and 2 providers using modified CBSPp; 5) qualitative interviews with CBSPp delivery providers (n=2) and 5 staff, leaders, and directors in CMH to explore provider experiences and organizational impact of CBSPp implementation at the research site (Washtenaw County Community Mental Health; WCCMH); and, 6) final modifications prior to the Aim 2 trial. Aim 2 will involve a trial to test preliminary effectiveness and implementation of modified CBSPp (versus services as usual; SAU) among adults with SSPD and SI/SA within 3 months of screening (n=60). A 4-wave design will include quantitative assessments at baseline (T1), mid-test (T2), post-test (T3), and follow-up (T4) with in-depth qualitative interviews at T4 for a random sample of adults in the CBSPp group (n=10). Providers (n=8) will be trained to deliver CBSPp and be assessed T1-T4 to evaluate the implementation process, including in-depth qualitative interviews at T4. We will monitor fidelity, acceptability, usability, and feasibility of the modified CBSPp. This proposal is in response to RFA-MH-18-706, Pilot Effectiveness Trials for Treatment, Preventative and Services Interventions, and follows NIMH’s strategic plan to develop ways to tailor existing and new interventions to optimize outcomes (3.2) and test interventions for effectiveness in community practice (3.3).

Youth Civil Rights as Pathways to Higher Education

The purpose of project is to prepare a new generation of civil rights leaders in ways that provide pathways into higher education for everyone, with special emphasis on first generation, low income, and students of color.

Preventing HIV/STI in Urban Adolescents via an mHealth Primary Care Intervention

February 2017 - January 2021

HIV/STI remain significant public health concerns in the United States and adolescents are disproportionately affected. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increases risk for HIV/STI infection. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Despite the facts that: (a) At-risk adolescents are disproportionately affected by HIV/STI risk behaviors, and infections, and (b) while CDC recommends routine HIV/STI testing in adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act, combined with technological advances, health clinics and mobile-health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, a dearth of efficacious mHealth interventions delivered in health clinics to prevent/reduce both condomless sex and drug use and increase HIV/STI testing in at-risk adolescents exists. To address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E) that has demonstrated feasibility and acceptability in a clinic setting. A next important step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by two aims: AIM 1 is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both IOS and Android operating systems, and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and AIM 2 is to evaluate the preliminary efficacy of S4E, relative to Usual Care control condition, in preventing/reducing drug use and condomless sex, and increasing HIV/STI testing in a clinic sample of at-risk adolescents aged 14 – 21 living in Southeast Michigan. One-hundred adolescents recruited from a youth-centered community health clinic will be randomized via a blocked randomization with random sequence of block sizes to one of two conditions: S4E mHealth intervention or Usual Care. Theory-driven and culturally-congruent, S4E is a mHealth adaptation of the face-to-face Storytelling for Empowerment, which is registered with the Substance Abuse and Mental Health Services Administration National Registry of Evidence Based Programs and Practices.

A Community-University Approach to Preventing HIV

March 2018 - March 2019

HIV remains a significant public health concern in the US, and African American youth residing in Flint, Michigan, are disproportionately affected. Few HIV prevention programs have been developed and tested with this vulnerable population. To address these HIV prevention concerns, we collaborated with community-based organizations via NIDA funding to develop and pilot test, Storytelling 4 Empowerment (S4E), a theory-driven, mobile-health (mHealth) HIV prevention program that delivers targeted and tailored prevention messaging to youth. Our pilot study demonstrated the feasibility, acceptability, and preliminary efficacy of S4E in a clinic setting with at-risk youth. The overarching goal of the proposed community-university research is to advance scientific knowledge of technology-based, HIV prevention, and improve public health by establishing the feasibility and acceptability of an innovative mHealth prevention program for at-risk African American youth. We will accomplish these goals with two specific aims. Employing the principles of CBPR, we will establish and mobilize a community steering committee to inform all aspects of the research process. We will test the feasibility and acceptability of S4E by: a) enrolling at-risk African American youth (N = 20) at water distribution sites in Flint, Michigan; b) delivering the S4E intervention by peer health educators (N=2); and c) measuring uptake of HIV testing. The primary outcome will be feasibility and acceptability of S4E (e.g., enrollment rates). The secondary outcome will be uptake of HIV testing immediately post-intervention. Our S4E approach is innovative in linking at-risk youth at water distribution sites to an mHealth intervention to improve HIV testing.

Ethnic-racial Socialization and Socio-political Stressors of Mixed-Status Latinx Families and their Impact on Adolescent Mental Health

April 2020 - June 2021

Ethnic-racial Socialization (ERS) serves a protective role in the development of minority children. However, few studies have addressed the socialization practices of mixed status Latinx families. These parents adapt their ERS in accordance with their experiences of stress, fear, and discrimination. In this project, qualitative data will be collected from both parents and adolescents to examine undocumented parents’ ERS as well their adolescents’ understanding of these practices. Furthermore, we will explore how such socialization impacts the adolescents’ mental health. Considering the increasing number of children raised by undocumented parents, this research has important implications for improving children’s mental health.

Mood-Lifters: a novel approach to mental wellness

Approximately 57% of adults in the United States will develop a mental illness during their lifetime and 32% of adults live with a mental health condition at any given time. This has significant costs to society, government and industry with lost wages and disability payments estimated at $217 billion. There are over 55 million adults in the USA with a mental illness not receiving any treatment and millions of others receive substandard care. We created a program that shifts the paradigm in how wellness care in delivered from a clinic-based, clinician-run structure, to a scalable paraprofessionally administered, community-based, educational, wellbeing program called Mood Lifters. Mood Lifters is a 15-week self-referral program, where facilitators, who are not trained clinicians but rather professionals in a number of fields, are certified specifically in the psychoeducation provided by Mood Lifters to be inexpensive to deliver, scalable and evidence-based mental health care. Up to 15 participants per group will participate in weekly meetings that cover the teaching of evidence-based techniques that fall within five domains known to influence mental health - biology, cognitive, emotion, social processes, and behavior including evidence based treatments such as Cognitive Behavior Therapy for Insomnia (CBTi), Dialectical Behavior Therapy (DBT), Cognitive Behavior Therapy (CBT) and character Strengths (positive psychology). Clients are given a targeted set of goals (homework) for incorporating new wellness activities associated with the covered material into their lives and receive “points” for self-reported wellness behaviors during the intervening week. Mood Lifters has the potential to be used by multiple groups that work on wellness such as employers, social service providers, local Ys, community centers, schools or prisons. Unlike online programs, such as Mood Gym, Mood Lifters has social interaction and peer support, two essential components to successful self-referral programs. In addition the points manual that is used by participants has the essential component of using self-management to track their own behavior and outcomes while at home and at work. This grant will help us to take the the model program from the lab in the community as well plan to run 24 adult groups and 4 child groups next year testing the efficacy of the program.