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.

National Program Office for the Alliance to Advance Patient-Centered Cancer Care

February 2017 - January 2022

The University of Michigan is pleased to submit a proposal to serve as the National Program Office (NPO) for the Merck Foundation Alliance to Advance Patient-Centered Cancer Care (Alliance). Michigan is well-positioned to serve as the Alliance’s NPO due to its extraordinary depth and breadth in patient-centered cancer care delivery research, outstanding accrual into complex clinical trials, national-level expertise on health disparities, cancer symptom management, and dissemination/implementation research. Unique assets include a robust Comprehensive Cancer Center, Survey Research Institute, and Institute for Healthcare Policy and Innovation, which serve to leverage existing resources to assure high impact of the Alliance’s grantees. Over the five-year award, we will monitor and assure that high-quality scientific research is conducted in a fiscally responsive manner. We will draw upon our local and national network to render technical assistance to grantees. We will partner with key groups at the local, regional, and national level to disseminate findings and identify opportunities to implement promising interventions. These activities coalesce with our vision to support the delivery of outstanding patient-centered cancer care in a manner that promotes optimal outcomes for all.

Behavioral Health Workforce Research Center

October 2018 - August 2019

The University of Michigan School of Public Health and its Consortium of partners request continued support of the Behavioral Health Workforce Research Center, which was established in 2015 with a mission to conduct research to produce a workforce to meet the Nation’s behavioral health needs. The Center services the workforce responsible for prevention and treatment of mental health conditions and substance use disorders. The Consortium represents a range of professions, health plans, and academic partners who work collaboratively to address the research needs of the field. The Center’s portfolio of research activities will collectively address three priority research areas: strengthening the behavioral health workforce to address the consequences and impact of substance use disorders and mental illness; addressing behavioral health shortage and maldistribution; and improving service delivery and reimbursement. Key objectives for the Center include: 1) completing eight studies per year, along with Rapid Response Requests; 2) expanding the number of Consortium members or partnerships each year; and 3) expanding reach to new audiences and stakeholders by disseminating study findings in multiple formats. Proposed Year 1 studies address a range of behavioral health workforce needs including: investigating the education requirements and telehealth restrictions that potentially inhibit delivery of medication-assisted treatment; developing a national workforce recruitment strategy for rural and frontier areas; examining service delivery in Certified Community Behavioral Health Clinics; developing a new measure of workforce capacity for the opioid crisis; investigating the financing of collaborative care models to enhance workforce capacity; examining the training and care delivery of peer providers in behavioral health; assessing reimbursement inequities and their impact on service delivery; and describing the roles of primary care providers in behavioral health service delivery. The strength of the research infrastructure and partnership network established over the past three years will ensure success of this interdisciplinary Center.

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).

CBPR: Extending the Use of Innovative Methodologies in the Behavioral & Social Sciences

May 2020 - January 2024

The need for the use of innovative methodologies in the behavioral and social sciences has been widely noted. Innovative and community-engaged approaches to research and interventions are essential to address social and physical environmental determinants of population health and more specifically racial and ethnic inequities in health, which aligns with NIH’s mission of uncovering new knowledge that will lead to better health for all. There is a need to enhance capacity in innovative methods for researchers conducting behavioral and social sciences research (BSSR) particularly in the context of community-engaged approaches. One such approach, community-based participatory research (CBPR), is innovative in and of itself for many researchers conducting BSSR, and there are also numerous specific innovations within the context of a CBPR approach that are particularly relevant to the mission of NIH. These include the integrated use of mixed methods (combining qualitative and quantitative data), innovative research designs that complement randomized controlled designs, methods to advance dissemination and implementation science, and methods for examining the combined influence of physical environmental and socioeconomic factors on behavioral and health outcomes. Further, there are few opportunities for both early-career and established researchers to engage in a co-learning process facilitated by experienced academic-community faculty teams. Finally, there is a need to promote the diversity of the BSSR workforce, including increasing participation of researchers from underrepresented racial, ethnic, and economically and educationally disadvantaged groups. Thus, the overarching goal of the proposed research education program renewal, Community-Based Participatory Research: Extending Capacity to Use Innovative Methodologies in the Behavioral and Social Sciences (the Extend Program), is to enhance knowledge and skills in the use of innovative methodologies in BSSR within the context of CBPR, in partnership with the communities involved, to examine and address health inequities. The Extend Program will be carried out by the Detroit Community- Academic Urban Research Center (Detroit URC), a CBPR partnership established in 1995 which aims to enhance capacity of community and academic entities to conduct and foster CBPR to promote health equity, in conjunction with Community-Campus Partnerships for Health (CCPH), a national non-profit membership organization that promotes health equity through community-academic partnerships. The program includes three components: integrated educational activities for academic-community research teams involving an intensive skill development short course and mentoring and career development activities; ongoing learning and capacity-building using a train-the-trainers model and the continuation of a Community-Academic Scholars Network; and widespread national dissemination activities.

Greater Than

December 2016 - September 2021

To focus on substance abuse and HIV prevention services is commendable and essential. The focus on at-risk racial and ethnic minority adolescents is also ideal as their rates of substance use and HIV is disproportionately high. The UM contribution to the larger grant will be in providing an evaluation of the project and disseminating evaluation findings to both the larger project team and to the local community in Detroit, Michigan.

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.

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 Rewards Card Study

February 2018 - April 2019

The Center on Assets, Education, and Inclusion (AEDI) proposes to conduct a rapid-cycle randomized control trial to test the impact of providing rewards cards (vs. no rewards cards) to families of students with Children’s Savings Accounts (CSAs). Reward cards provide a rebate up to 5% on all grocery store and pharmacy purchases. At the time of purchase the rebate is ear marked to be deposited into a child’s CSA. By transforming spending into saving, rewards card programs have the potential to allow even the poorest CSA participants to begin building assets to help pay for college, even when purchasing goods with food stamps.