Initiative announces award of 2018 pilot research grants

Addressing Health Disparities Faced by Rural Underserved Agricultural Communities

Investigators
Vanessa E. Galavíz, Environmental and Occupational Health Sciences
June Spector, Medicine (General Internal Medicine)
Gino Aisenberg, Social Work

Project abstract
This collaborative community-academic project proposes to incorporate interdisciplinary approaches to assess and, ultimately, address health disparities related to occupational, environmental, socioeconomic, and biological stressors faced by rural underserved agricultural communities. Based on the specific request of a community partner, Community to Community Development, we will support the launch of a pilot-scale rural agricultural community survey and promotorx (community health educator) program in Skagit and Whatcom County, Washington. Paired with environmental data collection, this approach will ensure community-driven solutions and increase capacity and resilience by utilizing elements of community-based participatory research, citizen science, and civic engagement to achieve health equity.

Based on recent conversations with community leaders and Promotoras, integration of an adapted Rural Agricultural Promotorx Certification Program focusing on environmental and occupational health is critical for addressing and reducing community-prioritized disparities. The purpose is to improve educational transparency, literacy, capacity, and resilience at a community level. This project will leverage a unique interdisciplinary collaboration across distinct academic units at the University of Washington between leading experts in the fields of policy, advocacy, environmental health, and medicine to address all three pillars of population health (human health, environmental resilience, and social equity).

It is imperative to ensure sustainability of community-driven solutions, thus opportunities to apply for larger funding to expand this approach to more communities in Washington State will be pursued. When academic institutions follow the lead of advocates and parallel their efforts for health, environmental, and social equity, we strengthen the fight to achieve justice for rural underserved communities.

Health for Homeless Youth and Companion Animals in Seattle: Pilot Research into Healthcare, Social Services, and Rights for the Human-Animal Unit

Investigators
Peter Rabinowitz, Environmental and Occupational Health Sciences, Family Medicine, Global Health
Josephine Ensign, Psychosocial & Community Health
Lisa Kelly, School of Law
Charlotte Sanders, Social Work

Project abstract
We propose a community-based participatory research pilot study focusing on the remarkable human-animal bond between homeless youth and their companion animals, and the creation of an innovative “One Health” clinic that treats the human-animal unit. The research will focus on the interdependent health and social needs of teens/young adults experiencing homelessness and their animals including mental health, food security, substance dependence, and risk of infection and injury, as well as the legal and ethical issues related to housing, education and access to medical care.

The study will identify and help close service delivery gaps, include homeless youth in the development of a plan for the “One Health” clinic, and help create policy and legal reform solutions. The study will pilot this concept through a number of health screenings for young people and their companion animals at the “Pop Up Community Cafes” of the UW Doorway Project. It will use client centered data collection methodologies at these screenings and other settings including 1) in-depth semi-structured interviewing 2) participatory community mapping, 3) PhotoVoice documentation, and 4) student empathy and social justice evaluations.

This project will facilitate the initiation of an ongoing “One Health” clinic for homeless young people and their animals in the University District, and serve as a national and international model for interprofessional team care for this vulnerable population.

Lethal Means Assessment in Psychiatric Emergency Services for Suicide Prevention

Investigators
Ali Rowhani-Rahbar, Epidemiology
Paul Borghesani, Psychiatry and Behavioral Sciences
Jennifer Stuber, Social Work
Anna Ratzliff, Psychiatry and Behavioral Sciences
Frederick Rivara, Pediatrics

Project abstract
Washington has a 15% greater rate of suicide than the national average. In this state, 1 person dies by suicide every 8 hours with a combined lifetime medical and work loss cost of about 1 million dollars for each suicide death. Suicide is respectively the 1st, 2nd, and 3rd leading cause of death among individuals aged 10-14, 15-34, and 35-44 years in Washington.

Counseling on access to lethal means such as medications and firearms is an emerging approach to suicide prevention; however, currently little is known about its uptake and effectiveness in clinical settings. In 2017, Washington became the first state in the nation to require suicide prevention training for all healthcare providers. Leading experts have collaborated to develop All Patients Safe which is an interactive online training offering an engaging option for providers to become better skilled at suicide prevention. Future evaluations of All Patients Safe’s effectiveness will depend on a rigorous understanding of several indicators before the training went into effect. These indicators include the prevalence of access to lethal means, scope of practices to reduce access to them, and risk of subsequent suicide attempt and death among patients at high risk of suicide.

We propose to conduct an investigation among patients presenting to Psychiatric Emergency Services at Harborview Medical Center over the last decade to provide this much needed information as the first step toward our overarching goal of promoting the uptake of lethal means counseling and reducing the rate of suicide attempt and death in Washington.

Mama Ammaan (Safe Mother) Project: African Mother-to-Mother Antenatal Assistance Network (AMMAAN)

Investigators
James Pfeiffer, Global Health
Rachel Chapman, Anthropology
Bonnie Duran, Social Work
Myra Parker, Psychiatry and Behavioral Sciences
Melissa Mugambi, Global Health
Michelle Terry, Pediatrics

Project abstract
Southeast Seattle reports the highest rates of preterm/low birthweight babies, cesarean births, women receiving inadequate perinatal care and unmet mental health needs in Washington. These communities are located in a federally designated Medically Underserved Area, indicating primary care service shortages. Factors proposed to explain perinatal disparities include: gaps in resettlement services for immigrants/refugees; lack of patient navigation support to access existing information, resources, institutions; social isolation; discrimination; linguistic/racial barriers to support seeking; social-cultural distrust of dominant authorities, institutions and care-givers; scarcity of linguistically and culturally-appropriate care-providers, services and facility locations.

Adequate perinatal care begins early in pregnancy and includes minimally 4 prenatal visits through services that are culturally accepted, seamless, and attend to biological and psychosocial well-being. The Group Prenatal Care (GPC) model promotes cultural congruence and social support. Efficacy derives from additional education time, skill-building, patient navigation support, and opportunities to learn from the experience of peers, as well as more face-time with community-based caregivers.

The proposed pilot is a collaboration between Somali Health Board (SHB), Health Alliance International (HAI), Parent Trust (PT), and UW to test the feasibility of a community-based doulas and nurses-led culturally-adapted GPC and home-visitation service model. If feasible, researchers will use findings to seek larger controlled trial funding to test a culturally-adapted GPC and doula model to improve perinatal outcomes in Southeast Seattle. Using a multidirectional learning approach, we seek to cross-fertilize by capacity-building for future implementation in other underserved, perinatally-vulnerable communities (including AIAN and African American), and strengthening community researcher capacity to meet community needs.

Building Back Better: Innovative Methods to Measure Resilience

Investigators
Nicole Errett, Environmental and Occupational Health Sciences
Scott Miles, Human Centered Design and Engineering

Project abstract
The disaster recovery period often brings an influx of resources that, if used strategically, can respond to health and well-being hazard impacts, while concurrently strengthening community resilience and capacity. However, there is little evidence on how to maximize the disaster recovery process to build back healthier and more resilient communities. This is, in part, due to challenges in monitoring health and well-being during disaster recovery.

In response, we propose to assess the use of data from personal health monitoring devices (e.g., Fitbit) and applications (e.g., Strava) to inform, monitor and assess disaster recovery strategies. We will conduct focus groups with personal health monitoring device and application users to understand their experiences with their personal health tracking devices and/or applications before and after Hurricane Harvey and the Santa Rosa Wildfires, as well as their perceptions about the use of personal health tracking data to inform and assess recovery. We will investigate trends in available personal health monitoring data during the recovery periods compared to data from an equal time period before each case study event, the same period for past years, and other data typically used to understand recovery trends (e.g., building permits, those receiving mail, etc.).

This innovative work will lead to the development of a publishable manuscript and two conference presentations. Importantly, it will serve as pilot data for a larger, interdisciplinary project on the use of personal health monitoring device and application data to inform, monitor, assess, and promote health and well-being following an extreme event.

The UW MetaCenter for Global Disease Preparedness: Proof of Concept Research in Peru

Half of the funding for this award came via a partnership with the UW Office of Global Affairs, which seeks to enhance the UW’s global engagement and reach.

Investigators
Peter Rabinowitz, Global Health, DEOHS, Epidemiology, Family Medicine
David Pigott, Global Health
Cory Morin, Global Health
Beth Bell, Global Health
Ursula Valdez, UW Bothell
Adam Warren, History
Michael Gale, Immunology, Global Health, Microbiology
Paul Yager, Bioengineering, Oral Health Sciences, Global Health, Chemistry
Stefan Wiktor, Global Health
Lance Stewart, Biochemistry
Wesley Van Voorhis, Global Health, Microbiology
Janet Baseman, Epidemiology, Health Services
Jeffrey Heer, Computer Science and Engineering
Patricia Garcia, Global Health

Project abstract
As the ongoing Zika virus epidemic demonstrates, emerging infectious diseases represent an ongoing threat to global population health. The proposed study represents a proof of principle pilot project to help create a UW MetaCenter for Global Pandemic Disease Preparedness and Global Health Security. The MetaCenter will be a highly interdisciplinary UW initiative to improve global readiness to address emerging infectious disease epidemics using a proactive, integrated, systems-based approach.

By developing mapping tools to characterize the epidemic potential of viruses transmitted by the Aedes aegypti mosquito (e.g., dengue and Zika virus) at a subnational level in Peru, we aim to test the hypothesis that vulnerability mapping, a foundational component of the MetaCenter, is feasible and yields valid results that are useful to improve community resiliency and preparedness. We will build on University-wide expertise about Peru and existing collaboration with the Universidad Peruana Cayetano Heredia (UPCH), to incorporate environmental, demographic, climate, health services, and surveillance data into analyses to produce maps that highlight where and when people are most vulnerable to outbreaks as a function not only of pathogen exposure, but also seasonal climate, healthcare capacity, and general infrastructure. We will assess the utility of these tools to improve Peru’s capacity to respond to these threats by helping focus and prioritize resources in the areas with greatest vulnerability.

This initial project of the MetaCenter will be followed by future projects on a global scale to characterize vulnerabilities and develop vaccines, diagnostics, and local capacity to address disease threats to population health.

Using Digital Learning Tools to Enhance Emotional Regulation for Youth Hospitalized for Aggressive Crises

Investigators
Carol Rockhill, Psychiatry and Behavioral Sciences
Annie Chen, Biomedical Informatics and Medical Education

Project abstract
Violence and aggressive behaviors are an urgent public health issue, with great costs including injury and death, fear and trauma, incarceration, unemployment, reduced mental and physical health, and loss of human potential. Reducing violence has local, national and international implications.

This project utilizes digital tools to teach disruptive youth skills to manage aggression. Technology based/computer assisted learning tools increase the depth and intensity of skill training and practice, and include extended support tools to reinforce the practice of new skills in community, school and home situations.

Inpatient hospitalization often occurs for aggressive youth after a crisis event. Inpatient treatment includes psychiatric evaluation, medication management, safety planning, and therapy meetings with the patient and parents. We are proposing an additional intervention, delivered on our inpatient psychiatry unit, for aggression and disruptive behavior. Despite how commonly aggression is the primary reason for admission, we lack effective behavioral treatments. A recent meta-analysis of randomized clinical trials for youth with conduct disorder (CD) problems concluded that “psychological treatments have a small effect in reducing parent, teacher- and observer-rated CD problems in children and adolescents with clinical CD problems/diagnosis” (Bakker et al., 2017).

We propose to use a technology-based set of personalizable Social Emotional Learning Tools developed and tested in education, juvenile justice, and partial psychiatric hospitalization environments with youth with behavior problems, with significant evidence of effectiveness (e.g., Taylor et al, 2017; theoretical underpinnings and research evidence reviewed at https://rippleeffects.com/impacts/).

Addressing Health Disparities in Washington State: The Role of Social and Economic Inequities in Intersectional Marginalized Populations

Investigators
Karen I. Fredriksen Goldsen, Social Work
Barbara Cochrane, Family and Child Nursing
Corinne S. Heinen, Family Medicine
Marieka Klawitter, Evans School of Public Policy & Governance
Charles A. Emlet, UW Tacoma
Hyun-Jun Kim, Social Work

Project abstract
The Institute of Medicine and Healthy People 2020 have identified racial/ethnic minorities and sexual and gender minorities as health disparate populations. The state of Washington has significant racial and ethnic diversity and one of the highest concentrations of sexual and gender minority people in the country, providing a unique opportunity to investigate intersectional social and economic inequities and within-group heterogeneity in health outcomes.

This newly-assembled research team cuts across four UW departments (Medicine, Nursing, Social Work, Public Policy/Governance) and two campuses (Seattle and Tacoma) as the first to comprehensively investigate population health in Washington State across two intersecting vulnerable populations. Based on the Health Equity Promotion Model, the pilot research will investigate innovative, feasible study aims by utilizing data from the Washington State BRFSS to examine 14-year time trends of disability, multiple chronic health conditions, and mental health by race/ethnicity and sexual orientation and gender identity to identify high-risk health disparate groups. In conjunction, we will pilot-test an online population-based survey designed to identify key modifiable mechanisms, including social and community level risks (e.g., stigma, lack of community connection, and barriers to health care) and economic inequities (e.g., resource instability, food insecurity, and lack of housing and mobility) and to improve health outcomes.

Based on this foundation, we will develop a full-scale research program to develop and test interventions to reduce health disparities at the state level, ensure sustainability, and extend our educational training mission for students to better serve underrepresented communities.