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.

Genetic Contributions to Smoking and Internalizing Problems in Adolescence

August 2015 - August 2019

This Career Development Award (K01) will provide the candidate with the necessary skills to develop an independent research program focused on integrating genetic methodologies to the candidate's already strong longitudinal modeling skills to explore and clarify the etiology of the interplay between cigarette use and internalizing problems during adolescence. Despite decreases in prevalence of smoking during adolescence in the past two decades, adolescence continues to be the developmental period of greatest risk for cigarette use onset and increase in internalizing problems. Clarifying the complex etiological pathways involved in the co-occurrence between cigarette use and internalizing problems during this vulnerable time requires using multiple methodologies. The overall aim of the current proposal is to test increasingly complex longitudinal models that explore the degree to which the co-occurrence between adolescent cigarette use and internalizing problems are influenced by genetic and environmental factors and to include measured genetic variants. The training plan will be completed at the Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University and is designed to provide the candidate with skills in genetic epidemiology, quantitative genetics, and molecular genetics. The candidate will acquire the knowledge and skills to a) conduct univariate, bivariate, and multivariate genetically informed studies to identify the genetic and environmental risk factors in smoking initiation, progression t heavier smoking, nicotine dependence, and internalizing problems; b) conduct longitudinal genetically informed studies to clarify the causal pathways involved in cigarette use and internalizing problems by exploring the degree to which genetic and environmental factors explain the covariance between the behaviors; and c) conduct genetically informed ecological momentary assessment studies of adolescent twin pairs to explore the causal pathway between these problems behaviors. These skills will be developed through a combination of formal coursework, mentored research projects, and didactic training. The proposed research program involves a combination of analysis of existing longitudinal studies of adolescent twins and an original data collection pilot project. The existing longitudinal studies of adolescent twins inclue the Swedish Twin Study of Child and Adolescent Development, the Minnesota Twin and Family Study, the Virginia Twin Study of Adolescent Behavioral Development, the National Longitudinal Study of Adolescent Health, the GEDI (Genes, Environment, Development Initiative part of NIDA's Genetics Consortium). In the pilot project, the candidate will collect momentary cigarette use and mood data of 16- and 17-year-old adolescent twin pairs recruited from a population-based twin registry comprised of over 50,000 twins. Training activities and results will be used to develop a R01 proposal for a prospective momentary assessment and genotyping study of 14 to 17 year old adolescent twins.

COHSE Evaluation

March 2016 - June 2018

Our evaluation of COHSE’s programming will be comprised of two phases. During the first phase of project discovery and planning, CC-PEG will work with COHSE stakeholders to create an evaluation plan and develop any information tracking systems needed for evaluation implementation. In the second phase, CC-PEG will pilot test the evaluation. Quantitative approaches (e.g. analysis of exit surveys, needs assessments and program performance data) will be utilized to assess the need for, quality and effectiveness of COHSE programming, whereas qualitative approaches (e.g. media content analysis, focus groups/key informant interviews) will be utilized to capture the impacts of COHSE programming, as well as facilitators and barriers to COHSE program effectiveness.

Civil Rights Leadership as a Pathway to Higher Education initiative

November 2015 - October 2017

This new initiative builds upon Youth Dialogues on Race and Ethnicity in Metropolitan Detroit involves high school students – of African, Asian, White European, Middle Eastern, and Latin American descent. They meet in intensive dialogues and learn how to communicate with others who are different from themselves. The dialogues program has long-term relationships with schools in highly segregated metropolitan Detroit.

Arts of Citizenship - Engaged Scholarship

November 2013 - October 2023

This program will examine concepts and techniques for strengthening the scholarship of engagement in the public research university, with special emphasis on the University of Michigan

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

February 2017 - January 2019

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.

Carding Communities: A Multi-Site Mixed Methods Longitudinal Study of Community ID Card Policies for Social and Mental Wellbeing

August 2015 - August 2017

Following a 2005 federal legislation intending to establish a national form of identification, many US states created restrictive policies for residents seeking to apply for or renew a state-issued driver’s license or identification card (ID). This policy not only limited the driving decisions and mobility of individuals but also created challenges to having an identity be recognized by multiple institutions. For example, not having a driver’s license restricts access to health-relevant social and economic resources and services that often require a US-government issued ID to prove their identities. These include opening or using a bank account, using check-cashing services, identifying as caregivers, accessing safety net programs, paying for goods and services, and safely identifying themselves to law enforcement to prevent an escalation of encounters. The stress of navigating interactions and access to resources and services without an ID also affected mental wellbeing of participants who lacked a current state-issued ID and/or those who had close network members who lacked a state-issued ID. Individuals affected by these laws are many and reflect many disadvantaged populations such as undocumented immigrants, minority elderly, and formerly incarcerated individuals, among others. Recognizing this societal problem, communities across the country are slowly beginning to issue IDs that are recognized by the communities for day-to-day businesses. We seek to conduct a multi-site, mixed methods, longitudinal pilot study to examine the effect municipal IDs may have on recipients’ access to services and well-being in three communities, Washtenaw County and City of Detroit in Michigan, and Johnson County in Iowa. This research will contribute to our understanding of the potential positive effects on ID recipients’ health and mental health.

Employer-Based Financial Wellness Programs Project

October 2015 - June 2017

Dr. Despard will help design and take on primary responsibility for overseeing implementation of the project research plan, as detailed in the revised proposal to the Ford Foundation (CSD Concept Note, Revised, 5/27/2015). Dr. Despard will also lead efforts to analyze data from the financial wellness program (FWP) employer survey and Household Financial Survey (HFS) FWP module, and disseminate findings.

Poor, Invisible, and Left Behind: Understanding Financial Instability, Material Hardship, and the Availability and Use of Community Resources among Low-Income Rural Households

January 2017 - January 2018

Rural poverty is a prevalent and persistent social problem in the United States. Despite the fact that rural and urban poverty rates are comparably high (Proctor, Semega, & Kollar, 2016), researchers and policymakers overwhelmingly focus on urban poverty (Porter, 2005; Slack & Jensen, 2002). This is of particular concern given rural counties comprise 301 of 353 persistently poor counties (88%) in the United States (USDA Economic Research Service, 2016) and rural female-headed households experience the highest poverty rate of any group in the United States, at 45% (American Community Survey, 2010). Additionally, rural Americans have experienced a decline in life expectancy over the last century (Ezzati et al., 2008), as well as increased rates of suicide, substance abuse, and chronic illness. Given consistently demonstrated associations between material hardship and mental health problems (Sullivan et al., 2008), including increased risk for depression (Heflin & Iceland, 2009), health problems (Wickrama et al., 2010) as well as poor developmental outcomes among children (Gershoff et al., 2007), and child maltreatment (Kang, 2013), there is a clear need to better understand the economic experiences of low-income rural residents. This study takes a step toward addressing this gap by exploring determinants of financial instability and material hardship among low-income rural households, as well as the variation in and contextual determinants of nonprofit resources to alleviate hardship and promote economic mobility in these households. Regression analysis and structural equation modeling will be used to examine the relationship between financial shocks and material hardship, while controlling for other factors and modeling liquid assets as a mediator among low-income tax filers who responded to a household financial survey (HFS) administered in two waves (upon tax filing and six months later). Also, we will investigate whether savings outcomes from a randomized control trial of an online tax-time savings intervention are similar or different for rural compared to non-rural tax filers. Using Internal Revenue Service Form 990, US Census Bureau, and Bureau of Labor Statistics data, community-level variation in charitable resources available to low-income households will be examined using mixed-effects, multi-level analysis and latent growth curve modeling. Understanding low-income rural households’ financial characteristics and circumstances will help inform community-level intervention strategies that target risk factors for material hardship. Understanding contextual variation in the availability and use of nonprofit sector resources will help inform public and private funding policies targeting a particularly vulnerable population that has faced persistent poverty and sustained economic hardship since the 2008 recession.

Driving Hope

‘Driving Hope’ is an innovative and collaborative program that empowers vulnerable families and individuals in Washtenaw County by providing low cost automotive services and advice.

Michigan Institute for Clinical and Health Research (MICHR) - KL2 Award

June 2017 - February 2022

The University of Michigan (U-M) and the Michigan Institute for Clinical and Health Research (MICHR) are strongly dedicated to the education of a competent clinical and translational research workforce. To this end, MICHR’s educational programs cater to members of the clinical and translational research workforce within four broad roles: 1) pre-doctoral students, 2) post-doctoral fellows, 3) faculty, and 4) staff. The “crown jewel” of our educational offerings is the KL2 program, which has attracted and developed exceptional scholars. Collectively, over the last 10 years, the MICHR KL2 Scholars have published more than 1000 peer-reviewed publications and received over $155,385,534 in grant support as principal investigators (more than $4 million per scholar). Importantly, 100% of the KL2 Scholars have remained in clinical and translational research and 68% have been successfully promoted since program completion. One of our main priorities going forward is to expand the program, use creative methods to increase the number of KL2-like trainees that we influence, and create pathways of access to our KL2 offerings for the many other categorical K-12 scholars at U-M. Additionally, we aim to focus on mentor training for both the mentee and the mentor, using the curriculum developed by the National Research Mentoring Network (NRMN). Creation of the MICHR Career Development Academy will provide education on critical skills for professional development that are often not taught. Through purposeful integration of our KL2 Scholars, along with our TL1 students, other MICHR Scholars, and community partners, we will provide the opportunity for our KL2 Scholars to gain “hands on” experience in mentoring and patient engaged research. Through development of an individualized learning plan, each Scholar will work with their mentoring team to successfully complete their research project and training plan. Monitoring of KL2 Scholar progress will take place through instruction and creation of eportfolios which will allow mentors ready access to each scholar’s work and formative reflective thoughts. Lastly, creation of a greater network or supportive research community surrounding our KL2 Scholars will be accomplished though purposeful integration with a diverse group of clinical and translational scientists as well as other Scholars within institutional training programs.

Promise Indiana Scholarship

April 2017 - June 2018

The purpose of this study is to examine the impact of providing financial awards based on learning, college planning, and savings behaviors on academic achievement and school attendance. This study will use multiple regression models and path analysis to isolate the effects CSAs as well as the added incentive of financial awards.

Legacy Corps Evaluation 2016-2017-nonfederal

Evaluation activities will consist of the following tasks: 1. Participation in conference calls and ongoing communication with senior project staff and site directors to determine data collection strategies. 2. Continuing development of longitudinal data collection instruments and strategies for long-term observations to measure impact at sites. 3. Review of ongoing administrative protocols for project and at each site to determine successful process variables. 4. Develop and monitor impact/outcome measures that directly relate to stated goals and objectives and reflect the underlying theory of action and project assumptions. 5. Prepare yearly summative reports from de-identified data for AmeriCorps that track the program objectives and accomplishments. 6. Maintain site specific tracking systems for compliance with data collection requirements. 7. Present yearly summary at national training sites for total program accomplishment and prepare once yearly a site specific summary of achievements for each subawardee. 8. Assist senior project staff in preparation of continuation funding applications. 9. Participate in dissemination activities including publication and presentation at professional conferences as well as program marketing as needed.