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NIA - National Institute on Aging

Project Summary/Abstract Each year, more than three million adults aged 35 and older are admitted to intensive care units (ICUs) in the United States. Most require a surrogate decision-maker (SDM) to make timely, emotionally charged treatment decisions. Often unprepared for this responsibility, SDMs frequently experience significant psychological distress that can impair their ability to make informed, value-congruent decisions. Long-term psychological consequences, such as post-traumatic stress disorder (PTSD) and decision regret, often follow these acute effects. Despite decades of research, few evidence-based and scalable interventions effectively address the SDMs’ emotional needs during ICU stays. This project will evaluate the efficacy and mechanisms of REFRAME, a brief, self-directed, tablet-based intervention grounded in cognitive reappraisal theory. REFRAME is designed to help SDMs recognize, reinterpret, and regulate their emotional responses in real time as they navigate high-stakes decisions. The intervention includes interactive psychoeducation and emotional assessments, guided strategy selection, emotionally relevant ICU scenarios, and structured planning to apply reappraisal techniques to real-world decision-making. In a two-arm, parallel-group randomized controlled trial, 387 SDMs of critically ill patients will be enrolled and randomized to either the REFRAME intervention or an attention-matched informational support (IS) control condition. Participants will complete standardized outcome measures at baseline (T0), 24-48 hours post- intervention (T1), 24-48 hours post-T1 (T2), and 90 days post-baseline (T3). Aim 1 will evaluate the effects of REFRAME on depressive symptoms (primary outcome at T2) and PTSD symptoms and decision regret (secondary outcomes at T3). Aim 2 will examine differences between groups in state emotion regulation (cognitive reappraisal and expressive suppression) at T1. Aim 3 will test whether changes in state emotion regulation mediate the effect of the intervention condition on psychological outcomes. By targeting a core, modifiable mechanism—emotion regulation—this trial aims to enhance psychological resilience, decision-making quality, and overall family-centered outcomes. The study findings will guide the development of scalable, mechanism-focused interventions to alleviate mental health burdens and improve care experiences in critical care and other surrogate decision-making contexts.

NIDA - National Institute on Drug Abuse

Project Summary/Abstract In the current landscape of increasing access to adult-use cannabis via legalization and lower-than-ever cannabis-related risk perceptions, cannabis use and cannabis use disorder (CUD) are increasing in the United States. CUD, occurring in about 22% of people who use cannabis, is associated with serious consequences on health and wellbeing, including worsened mental health. Despite these outcomes, fewer than 10% of people living with CUD receive treatment or care for this chronic condition. To improve engagement and accessibility of CUD care, we urgently need to develop and study new care models with proactive outreach and provision of new, appealing interventions that meet the goals of the large population of patients with CUD who are not actively seeking traditional substance use disorder treatments. Virtually-delivered care (herein: synchronous videoconferencing between providers and patients across locations) can potentially improve accessibility and appeal of different intervention strategies while reducing stigma about engaging in treatment for substance use disorders. Our proposed strategy seeks to increase involvement in CUD care by delivering interventions in patient-preferred locations and reducing barriers to attending traditional treatments, including by supporting harm reduction and wellbeing outcomes. Behavioral economics-based interventions as applied to CUD bring novel approaches to substitute alternative, healthier behaviors for cannabis use. There is an untapped potential for virtually-delivered, behavioral economic approaches to engage the large majority of individuals who have CUD, who otherwise do not receive treatment, but could benefit from change. Building on our prior work engaging non-treatment-seeking adults in virtual substance use interventions, we piloted a novel behavioral economic intervention, infused with motivational interviewing principles (MI-BE). The MI-BE intervention engages adults with CUD into a virtual intervention focused on enhancing valued activities (with reinforcement for cannabis-free activity sampling) and reducing cannabis use. Using a Hybrid Type 1 efficacy-implementation design, we will evaluate the virtually-delivered behavioral economic-based intervention for CUD compared to an enhanced usual care (EUC) control condition. Patients with CUD will be recruited from a large health system and randomized to either MI-BE or an EUC and followed over 1 year. We will then evaluate the effect of MI-BE vs. EUC on cannabis and health outcomes (e.g., quality of life/functioning), and explore behavioral economic mechanisms of change (e.g., cannabis demand, cannabis-free reinforcement). With consideration for future translation, we will also collect and evaluate qualitative data from clinicians/administrators (N=10) and selected participants (N=20) on barriers and facilitators to future implementation in healthcare settings using a rapid analysis process. Impact: The findings from this study will have a significant public health impact and move the field forward as a novel, patient-centered, scalable approach to address the gap in care that is urgently needed in the context of rising CUD rates.

NIH

Significance to VA: Many Veterans who served on or after September 11, 2001 (post 9/11) experience impaired psychosocial functioning, due in part to high rates of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Less than half of post 9/11 Veterans with these conditions seek mental health (MH) treatment, with key barriers being a preference to self-manage and lack of time. Veterans also report difficulty navigating the overwhelming array of resources available. To address a gap for post 9/11 Veterans with unmet MH needs, we propose a self-help intervention to provide skills for healthy self-management as well as curated guidance on recovery support services that address MH and broader whole-person functional challenges. There is ample evidence that self-help interventions improve MH symptoms, possibly with greater impact if clinicians provide support, but their impact on psychosocial functioning is understudied. Resilience Training for Veterans (REST-V) is a self-help intervention tailored for post 9/11 Veterans with MDD and/or PTSD symptoms who are not in psychotherapy. REST-V comprises 2 handouts per week for 6 weeks delivering (a) instruction and cues to use evidence-based self-management coping skills (to promote use of adaptive coping) and (b) information to educate, normalize, and navigate recovery support services (to promote use of MH treatment, Other relevant VHA care such as Whole Health, and Informal resources such as MH apps). Veterans may elect to receive optional support via brief calls or text reminders. Using a stepped care approach with low-cost self-help as the first step, REST-V aims to increase access to evidence-based coping skills and easy-to-understand guidance on recovery support services for Veterans who choose not to access MH treatment. Given high rates of untreated MDD and PTSD among post 9/11 Veterans, this proposal addresses a known gap to support VHA priorities, suicide prevention efforts, and Brain, Behavioral and Mental Health (BBMH) Portfolio priorities for clinical studies to improve functioning and reintegration in Veterans with MH conditions. Innovation & Impact: REST-V is innovative for its dual focus on psychosocial functioning/MH and recovery support services, examining whether self-help improves functioning and resource utilization, and accommodating patient preferences for format of delivery (mail, secure message, text) and support (telephone, text). REST-V aims to increase Veterans’ tools for recovery to reduce functional impairment impacting family, social, work, and other life roles. REST-V is being delivered through Primary Care Mental Health Integration (PCMHI) in this study but could be used in a variety of VHA care settings. Specific Aims: The specific aims of this clinical trial are to: Evaluate the efficacy of REST-V (vs. Control) at improving 1) psychosocial functional impairment, 2) MH outcomes, and utilization of 3a1) cognitive-behavioral coping skills and 3a2) recovery support services, with use of skills and services being 3b) explored as potential mediators. We hypothesize that REST-V will be more efficacious than Control. Methodology: This randomized controlled trial (RCT) will take place at 2 VHA healthcare systems (Syracuse and Durham). VHA-enrolled post 9/11 Veterans (N=200) who screen positive for MDD and/or PTSD symptoms and functional impairment but are not in psychotherapy will be randomized to the intervention (REST-V) or control (standard printed resource/ treatment information) condition and assessed at baseline, 8, 16, 24, 32, and 40 weeks using validated self-report scales and electronic health record (EHR) data (for VHA care utilization). The primary outcome is psychosocial functional impairment. Secondary MH outcomes are psychological distress, MDD and PTSD symptom severity, and suicidal ideation. Aims 1, 2, and 3a will be tested using generalized linear mixed models with an intent-to-treat analysis. Aim 3b will use exploratory mediation models with non-parametric bootstrapping procedures. Path to Translation/Implementation: If efficacy is confirmed, we will work with our national operations partners and use data collected in this trial to plan a hybrid II or III trial to facilitate implementation into VHA clinical practice.

National Institutes of Health

This NOFO is a call to action in response to the mental health crisis in the United States. We seek applications that will study methods to increase access to evidence-based interventions and services for youth mental health, including those living in rural areas, inner cities, and other under-resourced areas, and youth experiencing housing and food insecurities and out-right homelessness. Applications should address research related to optimizing assessment, intervention and service strategies, overcoming challenges related to the workforce shortage, wait lists for treatment, integration of treatment and preventive interventions into settings where people are most likely to be best identified as needing care (eg: schools, social service, pediatric medicine and justice), and service interventions that address systemic barriers to access and quality of mental health care (structural, policy, organizational, value (cost/financing), management).

National Institutes of Health

This NOFO is a call to action in response to the mental health crisis in the United States. We seek applications that will study methods to increase access to evidence-based interventions and services for youth mental health, including those living in rural areas, inner cities, and other under-resourced areas, and youth experiencing housing and food insecurities and out-right homelessness. Applications should address research related to optimizing assessment, intervention and service strategies, overcoming challenges related to the workforce shortage, wait lists for treatment, integration of treatment and preventive interventions into settings where people are most likely to be best identified as needing care (eg: schools, social service, pediatric medicine and justice), and service interventions that address systemic barriers to access and quality of mental health care (structural, policy, organizational, value (cost/financing), management).

National Institutes of Health

Accelerating Solutions to Improve Access and Quality of Empirically-Supported Practices for Youth Mental Health (R01 Clinical Trial Optional)

NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development

SUMMARY Relevant to NICHD’s mission is prioritizing research to improve the health of American children and families. Similarly, reducing the prevalence of childhood chronic diseases by understanding and diminishing contributions to disease risk is a goal of the Make American Healthy Again initiative. The proposed conference is unique in that it focuses specifically on the relatively new field of prenatal pediatrics; that is, optimizing fetal well-being through maternal-fetal research and fetal interventions to improve outcomes in the neonatal period and beyond. Our MPI team at the Prenatal Pediatrics Institute (Adre duPlessis, MBChB) and the Developing Brain Institute (Catherine Limperopoulos, PhD, and Katherine L. Wisner, MD, MS) at Children’s National Hospital (CNH) has evolved a progressive model of in utero pediatric care to underscore the importance of pregnancy and the womb as the time and place where childhood chronic disease first takes hold. The fetal environmental milieu has a key role in defining the trajectory of life-long health. Our objective is to concentrate on the potential of prenatal pediatrics as a powerful conceptual framework to guide research to reduce the escalating rates of childhood chronic diseases. Examining the potential dietary, behavioral, medical, and socio- environmental factors associated with childhood chronic disease is crucial to encourage interdisciplinary, evidence-based research to inform interventions, societal change, and policy. This conference was developed with the goal of reducing institutional and research compartmentalization. We plan two days of presentations by speakers representing a broad array of prenatal pediatrics/neonatology and subspecialties, maternal-fetal medicine, perinatal mental health, translational scientists in non-invasive technologies to evaluate fetal health, genetics/epigenetics, nutrition, infectious disease and the microbiome, public health, artificial intelligence and data science. Conference meals include extended periods of time for lunch and a dinner to support delegate networking. A final panel including the MPIs and Dr. Yoel Sadovsky will synthesize the conference proceedings and generate recommendations to advance the field. Manuscripts will be developed from the lectures for publication in an issue of the journal Seminars in Perinatology focusing on the theme, Translational Research to Integrate Maternal, Fetal and Infant Health.

Seniors Creating Art

Access to Art Expansion- West Seattle is a free weekly art workshops for one-year for the residents living in four Seattle Housing Authority (SHA) Senior Living Buildings in the West Seattle/High Point Neighborhoods. As well as weekly art programming, there will be monthly Intergenerational Creative Nights held at a selected SHA building and a Summer Community-wide ArtWalk taking place in High Point. The purpose of this project is to improve the physical and mental health of participants and provide jobs for artists within the Seattle region.

FIC - John E. Fogarty International Center for Advanced Study in the Health Sciences

In Vietnam, adolescent and young men vulnerable to HIV through sexual behaviors are among those most affected by the infection, with an HIV prevalence that quadrupled from 3% in 2011 to 13% in 2020. More than 20% of Vietnamese young men living with HIV had moderate-to-severe depression and anxiety symptoms. These youths experienced extensive stigma related to their HIV status and sexual behaviors. There is a dearth of youth-friendly mental health services in Vietnam where there is less than one psychiatrist per 100,000 people. Project YES+ is an intervention integrating two evidence-based interventions, Project YES! and Self-Help+ to improve mental health, stigma, and HIV outcomes among youth living with HIV in Zambia (5R01TW012411). Youth Engaging for Success (Project YES!) is an HIV clinic-based peer mentoring CDC-designated intervention that successfully decreased HIV self-stigma and increased viral suppression. Self-Help+ is a group-based lay-delivered program endorsed by WHO that effectively prevents the onset of mental disorders and reduces mental health symptoms in different cultures. We propose to adapt Project YES+ for adolescent and young men living with HIV in Vietnam to create To Hieu (I Understand) and to pilot test the adapted intervention. The specific aims are to (1) Adapt Project YES+ to create To Hieu to improve mental health and reduce internalized HIV stigma for adolescent and young men living with HIV in Vietnam and (2) Examine acceptability and feasibility of To Hieu among adolescent and young men living with HIV through a pilot randomized controlled trial. In Aim 1, the adaption will follow the 8-step ADAPT-ITT framework.38 We will conduct in-depth interviews with adolescent and young men living with HIV (N=20) to explore preferences for the core components and formats of To Hieu. We will hold a human-centered design workshop to engage adolescent and young men living with HIV in co-design activities to refine To Hieu. In Aim 2, we will recruit 80 adolescent and young men living with HIV with depression or anxiety symptoms at two HIV clinics in Hanoi, Vietnam and randomize them 1:1 into two arms. The intervention arm will receive To Hieu in 4 months, while the control arm will receive standard of care at the clinics. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework will guide the measurement of the outcomes. We will calculate participation rates of participants (Reach) at baseline. We will assess acceptability through the Client Satisfaction Questionnaire and feasibility through intervention attendance (Adoption) at 4 months. Depression, anxiety symptoms, internalized HIV and sexual stigma, ART adherence and viral suppression of participants will be evaluated at baseline, 4 months and compared between groups (preliminary Effectiveness). We will conduct exit interviews with participants, youth peer mentors and HIV providers (N=30) to explore acceptability, feasibility (Implementation) and sustainability (Maintenance) of To Hieu. This research will build local capacity and develop networks for collaborative research on mental health and stigma among adolescent and young men living with HIV between Vietnam and the US.

NIH

The proposed CDA-2 will support Dr. Giff’s pursuit of a VA research career focused on improving the psychosocial functioning of Veterans with co-occurring post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD). Significance to VA: PTSD and AUD are highly comorbid, which presents a unique set of challenges for Veterans and their loved ones. Experiencing PTSD-AUD exponentially increases Veterans’ risk for debilitating mental health sequelae, poor physical health, and deleterious social and occupational outcomes. COPE is a robustly evidence-based treatment for PTSD-AUD that is widely used in VA clinics. While COPE outcomes related to PTSD symptom reduction are consistently outstanding, there is room to improve both AUD outcomes and rates of retention. COPE shows moderate effects on Veterans’ drinking reductions, indicating a critical need for research examining novel ways to bolster drinking outcomes. Innovation and Impact: Results from separate literatures indicate that integrating a family member or significant other (SO) is a promising method to improve AUD recovery and AUD and PTSD treatment retention. Veterans with AUD and PTSD often report conflictual relationships, which can interfere with AUD recovery, and including SOs is likely to foster more effective dyadic support and communication. The brief inclusion of SOs in Veterans’ treatment of PTSD-AUD is yet to be studied, despite strong potential for this model to improve treatment effectiveness, retention, and dyadic functioning. Pairing COPE with Brief Family-Involved Treatment for Alcohol Use Disorder (B-FIT) is one promising method to bridge this persistent gap in treatment programming for Veterans. B-FIT is a 3-session dyadic intervention designed to be delivered alongside evidence-based individual AUD treatments. Distilled from the original 12-session Alcohol Behavioral Couple Therapy, B-FIT focuses on enhancing family support for alcohol behavior change efforts and improving communication skills. A recent pilot of B-FIT demonstrated large effects for reductions in risky drinking. The objective of the proposed study is to examine the preliminary feasibility and acceptability of combining B-FIT with COPE among Veterans with co-occurring PTSD and AUD. Specific Aims: 1. Adapt the B-FIT manual to be delivered as an adjunct intervention to COPE; 2. Examine the feasibility and acceptability of BFIT + COPE through a one-armed open-label pilot trial as assessed by (a) rates of enrollment and treatment completion; and (b) participants’ quantitative ratings and qualitative perceptions of the intervention; and 3) Explore the effects of BFIT + COPE from pre- to posttreatment and at 3-month follow-up on (a) AUD outcomes, (b) psychosocial and relationship functioning, and (c) PTSD outcomes. Methodology: Aim 1 will include qualitative interviews with 10 Veteran-SO dyads and 10 VHA mental health clinicians to inform an adaptation of the B-FIT manual to be relevant for Veterans with PTSD-AUD. Once completed, the adapted manual will be piloted through a single-arm, open feasibility trial of 40 Veteran-SO dyads with primary outcomes of feasibility and acceptability. Secondary outcomes of AUD (AUDIT & TLFB); psychosocial functioning (B-IPF, Q-LES-Q-SF, DAS-7); and PTSD (PCL-5 & CAPS) will be explored. Path to Translation/Implementation: This project will provide critical pilot data on feasibility and implementation to support a subsequent Merit award testing the effectiveness and implementation of this intervention in VA clinics. The following training aims will ensure that the candidate is poised to continue this work: (1) Veteran-centered intervention development/adaptation and clinical trials management; (2) Knowledge of AUD; (3) Advanced statistical analysis; (4) Preliminary education in dissemination and implementation; and (5) Scholarly productivity and professional development. The candidate will accomplish these aims through devoted mentorship, didactic opportunities, and by leading the proposed project. She will conduct this work with support from the scientific community at the Ralph H. Johnson VAHCS and MUSC. The research and training proposed can address urgent needs within VHA and will prepare the candidate to be an expert in family-supported interventions to improve the lives of Veterans.

NIMH - National Institute of Mental Health

Globally, alcohol use disorders (AUD) cause 3.3 million deaths each year and account for nearly 100 million disability-adjusted life years (DALYs). Alcohol use is also one of the most prominent risk factors for death by suicide, as people with AUD have a lifetime risk of suicide more than 7 times higher than the general population. Efforts to prevent suicide can reduce disruptions and fragility of the U.S. health system and serve as a public health good to benefit Americans. We are developing innovative approaches to bridge mental health and substance use treatment gaps, including telehealth and nurse-led counseling interventions with clear potential to reduce suicide in the United States and other settings. In our preliminary study, 7% of patients with AUD were experiencing suicidal thoughts or behavior. Despite this high comorbidity, routine screening and treatment for both suicide risk and alcohol use disorder are extremely rare in emergency care settings. Thus, there is a critical need for innovative, resource-efficient treatments for suicide prevention among people with AUD. In an earlier NIMH-funded study, our team adapted an evidence-based Motivational Interviewing intervention, MI-SafeCope, to develop IDEAS for Hope, a telehealth intervention for suicide prevention in HIV care. In the current grant, we will revisit this process by adapting MI-SafeCope to reduce suicide risk among people with AUD who are presenting for care in a Tanzanian Emergency Department. The resulting intervention, IDEAS-AUD, will address suicide risk with a four-pillared approach: reducing alcohol-related harm, building social support, enhancing emotional health, and meeting basic needs. The pillars are integrated with Motivational Interviewing-enhanced safety planning and referral for psychiatric care as appropriate. Intervention refinement in a low-cost, high-burden global setting has great potential for adaptation and implementation in the rural U.S., where mental health needs are high. The aims of this grant are to: 1) adapt IDEAS-AUD for the AUD population; 2) rigorously evaluate the acceptability and feasibility of IDEAS-AUD; and 3) develop our intervention package for a future implementation evaluation and a clinical trial in the rural U.S. In Aim 1 of the current study, we will identify drivers of suicide risk and desired intervention characteristics to prevent suicide in the AUD population. In Aim 2, we will adapt an evidence-based suicide prevention intervention to existing AUD care, guided by a community coalition. In Aim 3, we will pilot test the telehealth intervention to assess its feasibility and acceptability for reducing suicide risk in the AUD population. By the end of this proposed project, we will have a framework-guided, resource-adapted, piloted protocol for IDEAS-AUD, including screening tools, programmatic, and implementation components. The research is innovative, yet fundamentally essential, and supports NIH Strategic Objectives to prevent suicide across the lifespan, address mental health comorbidities such as AUD, and develop interventions that can be rapidly implemented to strengthen mental health outcomes in the U.S. and improve the health of Americans.

NIMH - National Institute of Mental Health

More than half of people living with HIV (PWH) in the United States (US) are 50 years of age or older. Compared with those without HIV, older PWH have 2.3-fold increased risk of depression. The impact of unmitigated mental health symptoms and related conditions among this growing population is significant and includes social isolation, loss of independence, and poor engagement with healthcare, undermining progress towards ending the HIV epidemic. Due to a shortage behavioral health providers, there is growing interest in innovative interventions using community-based, peer-led approaches to improve access to effective mental health services. Behavioral activation is an evidence-based intervention that has shown promise for reducing depressive symptoms among older adults. Our team has developed a streamlined lay-delivered behavioral activation intervention called “Do More, Feel Better” (DMFB) that has been shown to decrease depressive symptoms among depressed (PHQ-9 ≥10) older adults obtaining services in community senior centers. Delivery of an adapted version of the DMFB intervention for older PWH with poor access to professional counseling could be relatively straightforward within the existing Ryan White HIV/AIDS program, supported by organizations that provide essential services such as non-medical case management to low-income PWH. Because the intervention is tailored to individual preferences and needs, it promises to be acceptable, especially after careful adaptation using input from community members and stakeholders. Our aims for the proposed work are therefore: (1) to understand the impact of mental health issues on HIV care, functioning, and quality of life and identify multi-level barriers and facilitators that could influence participation in and delivery of an adapted DMFB intervention; (2) to adapt and enhance the DMFB intervention for delivery by case management program staff or volunteers to older PWH, following the ADAPT-ITT model in collaboration with community partners; and (3) to determine the acceptability, feasibility, and appropriateness of the adapted DMFB intervention compared to clinician-delivered Behavioral Activation therapy over 3 months in a pilot randomized controlled trial. Results of this research will have high impact by adapting an effective lay-delivered behavioral activation intervention for older PWH that is low-cost, scalable, and easily tailored to individual preferences and needs. Our ongoing work on the DMFB intervention indicates that this lay-delivered intervention has great potential to produce concrete improvements in mental health and quality of life. Our multidisciplinary team has a strong record of research on HIV care, geriatric mental health, HIV and aging, behavioral health and implementation science, and the experience with mixed methods approaches, intervention adaptation, and clinical trials necessary to successfully carry out this work. Adaptation of the DMFB intervention has the potential to be acceptable, feasible, effective and scalable when delivered within case management organizations, improving the lives and HIV outcomes of older PWH.

NIMH - National Institute of Mental Health

The objective of the proposed K23 research and training plan is to support Dr. Emily Tilstra-Ferrell in obtaining training needed to become an independent clinical scientist with a program of research focused on developing highly scalable, efficient evidence-based treatments (EBTs) for adolescents with posttraumatic stress disorder (PTSD) that can be delivered in accessible, real-world, multidisciplinary settings. Over four million adolescents in the United States (US) have PTSD. Although PTSD EBTs are available, only one third (37%) of adolescents access these treatments. Among the few who access PTSD EBTs, over one-third (34%) prematurely drop out due to barriers including lengthy protocols (the majority of dropout occurs before session seven). The proposed study directly addresses this clinical gap by adapting Written Exposure Therapy (WET), an EBT for adult PTSD, for adolescents. WET is an efficient, five-session PTSD treatment that is non-inferior to lengthier gold-standard PTSD EBTs for adults. WET addresses many barriers faced by adolescents who seek EBTs for PTSD due its brevity and related cost-effectiveness. However, WET has not been formally adapted or rigorously tested with adolescents. In Aim 1, WET will be adapted following a systematic model: Assessment, Decisions, Administration, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT). In Aim 2, a proof- of-concept randomized controlled trial (RCT) will be employed to compare WET to Trauma-Focused Cognitive Behavior Therapy (the gold-standard PTSD EBT for youth) delivered in a pediatric primary care setting to adolescents with PTSD. The final exploratory aim will examine the potential emotional (fear extinction) and cognitive (changes in ruminative cognition) mechanisms of action in WET. The mentorship team is comprised of numerous highly experienced mentors with NIH-funded research related to the proposed project including RCTs for adolescents with PTSD (Primary Mentor: Dr. Carla Kmett Danielson), ADAPT-ITT (Dr. Cristina López), advanced qualitative and mixed methods (Dr. Byron Powell), WET (Dr. Christine Hahn), dissemination and implementation science and EBTs for trauma-exposed youth in primary care settings (Dr. Rochelle Hanson), and longitudinal data analysis (Dr. Naomi Brownstein). The research opportunities, mentorship, and formal coursework afforded by the proposed K23 will ensure Dr. Tilstra-Ferrell gains the following skills needed to achieve her career goals: (1) conducting clinical trials with trauma-exposed adolescents, (2) using qualitative and mixed methods design to adapt and implement EBTs, (3) longitudinal data analysis, (4) dissemination and implementation science methods, and (5) improved scientific communication. The candidate will complete all proposed activities at the Medical University of South Carolina in the National Crime Victims Research and Treatment Center, which is internationally renowned for research on adolescent PTSD EBTs with a strong history of catapulting early career scientists to independence. The proposed K23 will ultimately prepare Dr. Tilstra-Ferrell to launch a program of research developing efficient and scalable PTSD EBTs for adolescents.

NIH

Background: There have been sharp increases in stimulant use disorder among Veterans nationally over the past twenty years, including co-occurring opioid and methamphetamine use disorder. Our previous research shows a high prevalence of multimorbidity among people who use stimulants, which has important implications for delivering healthcare for this high-risk population. Since 2011, the Veterans Health Administration (VHA) has prioritized the availability of contingency management (CM) programs for all Veterans with a stimulant use disorder as a standard of care. Meanwhile, several recent studies have been conducted or are being done to examine how CM may improve other health outcomes. However, limited work has been done to consider CM as a method for delivering integrated care for patients with multimorbidity. This study will fill this knowledge gap by examining patterns of multimorbidity and healthcare utilization among Veterans with stimulant use disorders to develop an integrated intervention to improve health outcomes for this population. Significance: Given the elevated risks of poor health outcomes among Veterans with stimulant use disorders, VHA must provide integrated interventions to address the complex needs of this population. This study directly responds to multiple priorities of the VHA, Health Systems Research, Office of Mental Health and Suicide Prevention, and Veterans Justice Programs (VJP) to improve the health delivery of this high-risk population. Innovation & Impact: Addressing multimorbidity among high-risk patient populations necessitates an integrated approach to care rather than disease-specific treatment. Veterans with stimulant use disorders have unique health needs, given the complex interplay between substance use disorders, mental illness, and medical multimorbidity. Improving health outcomes for this population involves innovative approaches that must be patient-centered and recognize the stigma related to SUDs. This study will utilize multidisciplinary expertise in geriatric and addiction medicine to develop innovative interventions to improve a vulnerable population's health and healthcare delivery. Specific Aims: The three aims are scientifically important and reflect input from Veterans and VHA staff: (1) To describe the prevalence and predictors of multiple chronic conditions, outpatient care fragmentation, and high acute healthcare utilization among Veterans with stimulant use disorders; (2) Adapt VA contingency management (CM) programs to integrate team-based intensive chronic disease management to improve health outcomes and reduce acute healthcare utilization among Veterans with stimulant use disorders; (3) Pilot test an intervention that integrates CM with intensive chronic disease management. Methodology: In Aim 1, we will conduct a retrospective longitudinal cohort study using VHA national data to describe comorbidities and identify predictors for high acute healthcare utilization among Veterans with stimulant use disorders (n=~177,714). For Aim 2, we will conduct qualitative interviews with 35 Veterans with stimulant use disorders and 45 VHA staff and providers and elicit expert feedback from our VHA operational partners to develop an intervention. Finally, Aim 3 will involve pilot testing an intervention coupled with CM programs for the treatment of stimulant use disorders. Next Steps/Implementation: The goal is to have a fully developed protocol for use in a multi-site randomized trial of an integrated model of care intervention to improve health outcomes among Veterans with stimulant use disorders within the VHA that will be evaluated in a subsequent IIR. An evidence-based integrated intervention to address multimorbidity among a high-risk Veteran patient population will have important implications for sustained care delivery for a high-risk patient population.

NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development

PROJECT ABSTRACT The proposed research will assess the impact adolescent friendship networks have on the psychosocial health of immigrant youth (i.e., the 1st and 2nd generation). Immigrant youth are a vulnerable population, with disproportionately high prevalence of adverse psychosocial health outcomes, including higher rates of mental health disorders, and lower sense of belonging, self-esteem, and wellbeing. Adolescence is a critical developmental stage, marked by the ascension in the complexity and importance of peer friendships. Although immigrant youth’s friendship networks look different from non-immigrant youth’s networks in a variety of ways, very little research have examined whether and how these friendship patterns and processes may explain the immigrant-based disparities in psychosocial health. This proposed research will bring more contemporary data to the forefront of research on immigrant youth’s school friendships, generate new and rare data on immigrant youth’s non-school friendships, and use advanced social network analytical methods to provide a more comprehensive examination of the impacts adolescent friendship networks have on the psychosocial health of immigrant youth. During the K99 phase, Dr. Khuu will focus on friendships developed in school, a major peer context shared by both immigrant and nonimmigrant youth. AIM 1 is to identify and understand differences in friendship patterns and processes between immigrant and nonimmigrant youth. AIM 2 is to compare measures of psychosocial health between these two groups and test whether differential friendship patterns and processes explain differences in psychosocial health. During the R00 phase, Dr. Khuu will leverage her training in survey design and network sampling methods as well as in adolescent development and psychosocial health to lead a new data collection effort on immigrant youth’s friendship networks extending beyond school. AIM 3 is to understand how the social contexts of friendships shape friendship patterns and composition. AIM 4 is to test the relationship between immigrant youth’s psychosocial health and these friendship measures. As a sub aim, Dr. Khuu will also take the opportunity to examine heterogeneity among immigrant youth, focusing particularly on the distinctions between refugee and non-refugee youth. Dr. Khuu’s career goal is to become a leading research authority on the friendships, health, and critical life outcomes of immigrant youth. The training and findings of the proposed research will position her favorably to pursue an R01 grant, enabling her to propose a more expansive, longitudinal study that explores the social integration and health of immigrant youth, with a specific focus on refugee youth, who have resettled in a diversity of new immigrant destinations in the United States.

National Institutes of Health

<p>The National Institute of Mental Health (NIMH) intends to publish a notice of funding opportunity (NOFO) to solicit research applications for practice-based research centers to support interdisciplinary teams of mental health researchers to engage in high-impact studies that will significantly advance clinical practice and generate knowledge to fuel the transformation of mental health care in the United States. Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness (ALACRITY) Research Centers support research projects aimed at the rapid development, testing, and refinement of novel and integrative approaches for (1) optimizing the effectiveness of therapeutic or preventive interventions for mental disorders; (2) developing and testing empirically informed patient-, provider- and system-level interventions to improve mental health care access, engagement, continuity, efficiency, and quality; and (3) continuously improving the quality, impact, and durability of optimized interventions and health for individuals with or at risk for mental health problems, including those with serious mental illness. Notice is being provided to allow potential applicants sufficient time to develop meaningful collaborations and responsive research projects.&nbsp; This NOFO will utilize the P50 activity code.</p><p>Applications must propose research that maximizes synergies across various components of the mental health research ecosystem, including new discoveries in clinical research, transformative health care technologies, advances in information science, and new federal and state mechanisms for organizing mental health care. Applicants with interdisciplinary expertise, such as behavioral science, health information and data science, health systems engineering, decision science, implementation science, and related fields, whose practice-based research needs cannot be met through standard research project grant mechanisms, should consider applying to this NOFO. Applications are also expected to include research activities that facilitate the widespread sharing of data, methods, and resources to accelerate clinical research and to provide opportunities for graduate students, postdoctoral researchers, and early-career investigators to participate in interdisciplinary research-to-practice translational mental health research.</p>

National Institutes of Health

Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness (ALACRITY) Research Centers

National Institutes of Health

The National Institute of Mental Health (NIMH) intends to publish a notice of funding opportunity (NOFO) to solicit research applications for practice-based research centers to support interdisciplinary teams of mental health researchers to engage in high-impact studies that will significantly advance clinical practice and generate knowledge to fuel the transformation of mental health care in the United States. Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness (ALACRITY) Research Centers support research projects aimed at the rapid development, testing, and refinement of novel and integrative approaches for (1) optimizing the effectiveness of therapeutic or preventive interventions for mental disorders; (2) developing and testing empirically informed patient-, provider- and system-level interventions to improve mental health care access, engagement, continuity, efficiency, and quality; and (3) continuously improving the quality, impact, and durability of optimized interventions and health for individuals with or at risk for mental health problems, including those with serious mental illness. Notice is being provided to allow potential applicants sufficient time to develop meaningful collaborations and responsive research projects. This NOFO will utilize the P50 activity code.Applications must propose research that maximizes synergies across various components of the mental health research ecosystem, including new discoveries in clinical research, transformative health care technologies, advances in information science, and new federal and state mechanisms for organizing mental health care. Applicants with interdisciplinary expertise, such as behavioral science, health information and data science, health systems engineering, decision science, implementation science, and related fields, whose practice-based research needs cannot be met through standard research project grant mechanisms, should consider applying to this NOFO. Applications are also expected to include research activities that facilitate the widespread sharing of data, methods, and resources to accelerate clinical research and to provide opportunities for graduate students, postdoctoral researchers, and early-career investigators to participate in interdisciplinary research-to-practice translational mental health research.

NIMH - National Institute of Mental Health

PROJECT SUMMARY Cell-type specific recording and manipulations are powerful methods for targeting categories of neurons that have a particular behavior or disease relevance. Cutting-edge genetic engineering approaches, such as optogenetics, enable interactions with neurons in a cell type-specific manner. However, these approaches have by and large been relegated to smaller animal models, with limited success in larger animals such as nonhuman primates. This proposal seeks to address this major gap in methodology by establishing tools for interfacing with dopamine circuitry in the macaque animal model. Dopamine is a critical neurotransmitter for a suite of cognitive processes and is implicated in many neurological and neuropsychiatric conditions, making it of clear interest for neuroscientific studies and the development of neurotherapeutics. Nonhuman primates are important preclinical animal models and it is essential to develop tools and technologies that continue to advance our capabilities to interface with the nervous system in this model system. In this work we will establish and characterize the dLight sensor, a genetically encoded fluorescent dopamine indicator, in the macaque model system. We will also develop a sono-chemogenetic approach to selectively modulate signaling in this neural population. Chemogenetics has emerged as a less invasive alternative to achieve similar manipulation of neural signaling to optogenetics. However, current chemogenetic approaches typically rely on systemic drug administration, which limits the temporal and tunable control of the manipulation. Sono-chemogenetics is an innovative new area that leverages ultrasound-programmable nanoparticles for drug delivery. This approach is non-invasive and facilitates precise manipulation of specific cells and overcomes barriers of previous optogenetic and chemogenetic methods. In Aim 1, we will characterize the in vivo sensitivity of the dLight sensor to targeted interventions and behavior. We will use pharmacological techniques and electrical stimulation to mediate dopamine release to validate functional changes in the recorded fluorescent signal. Additionally, we will establish the sensitivity of the sensor to natural variations in dopamine levels during behavior. In Aim 2, we will determine the timescale over which dopamine signals are stable. These longitudinal studies are critical to verify the longevity of this methodology, which is relevant to chronic studies. In Aim 3, we establish the sono-chemogenetic approach to mediate signaling in dopamine neurons and verify the functional effects in a relevant behavioral paradigm. Together these aims will take critical steps toward refining and optimizing these tools for use in a large animal model which is a valuable platform for developing therapies and treatments for human conditions.

NIMH - National Institute of Mental Health

ABSTRACT Despite advancements in antiretroviral therapy (ART), only 65% of people with HIV (PWH) in the United States (US) achieve viral suppression, with significant differences observed across sociodemographic groups. Long- acting injectable ART (LA ART) has the potential to address challenges associated with daily oral ART, but its adoption has been slow, with only 1.44% of PWH—approximately 15,000 individuals—on LA ART after two years of availability. This low uptake highlights persistent barriers and mirrors challenges seen with pre-exposure prophylaxis (PrEP), including slow adoption and differences in awareness, interest, and use. Further research is needed to understand factors shaping PWH decisions regarding innovative ART therapies. PWH face complex considerations when selecting treatment regimens, including regimen characteristics, psychosocial factors, and logistical barriers. While these factors are well-studied for oral ART, less is known about how PWH weigh these considerations for LA ART. This study will use advanced quantitative methods, including latent class analysis (LCA) and structural equation modeling (SEM), to identify treatment preference typologies and examine how individual, provider, and clinic-level factors shape ART preferences, addressing critical gaps in knowledge. Guided by the Consolidated Framework for Implementation Science 2.0, this project has two aims: 1) Identify HIV treatment regimen consideration patterns (classes) and assess the association between class membership and sociodemographic characteristics among PWH; and 2) Examine how patient (treatment regimen preference patterns), provider (trust, shared decision-making) and clinic-level factors (quality of clinical care) influence ART preferences among PWH. Findings will inform multilevel interventions to improve outcomes. Moreover, the identification of patient treatment typologies will enable providers to align discussions and interventions with the unique preferences of PWH. To achieve these aims, the proposed training plan focuses on developing advanced skills in LCA and SEM, deepening expertise in implementation science frameworks, and applying these findings to design multilevel interventions. Through mentorship, coursework, workshops, and applied research, the applicant will gain the knowledge and experience necessary to become an independent behavioral and implementation scientist, equipped to address access challenges in the evolving landscape of HIV treatment. This NRSA award will provide the necessary mentorship and resources to achieve these goals.

National Institute of Corrections

The National Institute of Corrections (NIC) acknowledges the pressing challenges facing behavioral health care within correctional settings nationwide. Correctional facilities increasingly contend with complex mental health and substance use issues among incarcerated individuals, yet existing behavioral health services are consistently limited by service gaps, inconsistent institutional policies, and insufficient staff training, as revealed through research and dialogue with NIC s Mental Health Network. These shortcomings jeopardize the rehabilitation and well-being of those in custody, while also causing elevated staff stress, burnout, and organizational instability.Through this cooperative agreement, NIC will launch a comprehensive initiative to address these systemic concerns. The project will encompass an in-depth gap analysis of behavioral health services, a rigorous review of institutional policies to ensure alignment with national standards, and robust stakeholder engagement to inform program development. Input from corrections professionals and behavioral health experts will play a pivotal role in shaping project strategies and solutions.A primary outcome of these efforts will be the creation of a dynamic behavioral health training e-course designed for correctional staff. This curriculum will draw on evidence-based best practices including trauma-informed care, cognitive-behavioral techniques, medication-assisted treatment for substance use disorders, and crisis intervention strategies. By equipping staff with practical, accessible tools rooted in the realities of correctional work, the initiative will enhance staff skills, foster professional development and wellness, and ultimately contribute to a safer and more stable correctional environment.

National Institutes of Health

The purpose of this notice of funding opportunity (NOFO) is to foster research that will inform and support the optimization, delivery, sustainability, and effectiveness of empirically-supported practices for addressing the mental health needs of older adults with serious mental illness (SMI). To this end, NIMH seeks applications that propose work that is focused on practice-relevant questions and conducted within and/or across settings where older adults with SMI are likely to be identified as needing care (e.g., primary care and geriatric specialty clinics, assisted living and long-term care facilities, and community centers). Applications may propose research related to adapting, optimizing, and implementing efficacious treatment and services interventions and strategies to improve clinical and functional outcomes among aging populations; examining mutable factors that impact fair and impartial mental health care access, utilization, quality, and outcomes and may serve as targets for intervention development for older adults with SMI; and developing and testing innovative treatment and service interventions that address barriers to accessing quality mental health care. Projects may also focus on systems-level factors and approaches for addressing SMI and improving access to evidence-based interventions in later life, such as evaluation of health system policies and practices, interventions that facilitate care transitions and continuity across settings, and strategies to improve care linkages and coordination across systems.

National Institutes of Health

The purpose of this notice of funding opportunity (NOFO) is to foster research that will inform and support the optimization, delivery, sustainability, and effectiveness of empirically-supported practices for addressing the mental health needs of older adults with serious mental illness (SMI). To this end, NIMH seeks applications that propose work that is focused on practice-relevant questions and conducted within and/or across settings where older adults with SMI are likely to be identified as needing care (e.g., primary care and geriatric specialty clinics, assisted living and long-term care facilities, and community centers). Applications may propose research related to adapting, optimizing, and implementing efficacious treatment and services interventions and strategies to improve clinical and functional outcomes among aging populations; examining mutable factors that impact fair and impartial mental health care access, utilization, quality, and outcomes and may serve as targets for intervention development for older adults with SMI; and developing and testing innovative treatment and service interventions that address barriers to accessing quality mental health care. Projects may also focus on systems-level factors and approaches for addressing SMI and improving access to evidence-based interventions in later life, such as evaluation of health system policies and practices, interventions that facilitate care transitions and continuity across settings, and strategies to improve care linkages and coordination across systems.

National Institutes of Health

Advancing Research on Empirically-Supported Interventions for Older Adults Living with Serious Mental Illness (SMI) (R01 Clinical Trial Optional)