Pilot grant awardees from 2019 report final project outcomes

CocoBot - Tailored Self-Management Program for Caregivers of Children with Chronic Conditions

Investigators
Weichao Yuwen, Nursing & Healthcare Leadership, UW Tacoma
Dong Si, Computing and Software Systems, UW Bothell
Sunny Chieh Cheng, Nursing & Healthcare Leadership, UW Tacoma
Teresa Ward, Psychosocial & Community Health

Project summary
Chronic diseases such as diabetes and cancer are the leading causes of death and disability in the U.S., treatment and management which account for more than three-quarters of all U.S. health care spending, estimated at around 2.6 trillion dollars annually. The burden of management of chronic disease falls largely upon patients and family – there are over 50 million family caregivers providing an estimated $470 billion in unpaid care services in the U.S. every year.

In considering the multiple needs of these caregivers in marginalized communities, we established a transdisciplinary team consisting of faculty, undergraduate and graduate students from nursing, computer science, biomedical informatics, and human-centered design and engineering across all three campuses and created Caring for Caregivers Online (COCO).

COCO is a platform that delivers an AI-augmented application providing on-demand, empathetic and tailored caregiving support, skills building and access to live text chat with a nurse on their phone for family caregivers – particularly those with limited resources and high stress and burnout – to promote the health and well-being of families with chronically ill members.

We built a prototype based on design sessions with 12 caregivers with children with asthma. The data was collected and used for further refining dialog algorithms, and then testing with actual caregivers of children with chronic health conditions. We refined our Wizard of Oz platform and intervention materials accordingly and designed the mobile app through iterative user research and testing.

We are now finalizing the refinement of the mobile app, WoZ platform and Natural Language Processors models, and will test COCO with an additional 50 caregivers of children with chronic health conditions remotely in real-life situations in January 2021.

Community Pharmacist Integrated Population Health Management of People Living with Epilepsy

Investigators
Jennifer Bacci, Pharmacy
H. Steve White, Pharmacy
Sabra Zarâa, Pharmacy
John Miller, Neurology and Neurological Surgery
Edward Novotny, Pediatrics and Neurology
Bryan Weiner, Global Health and Health Services

Project summary
This project seeks to develop a community pharmacist integrated population health intervention for people living with epilepsy (PLE) by (1) identifying best practices to address the needs of persons living with epilepsy and their caregivers; (2) developing an intervention using a stakeholder driven and consensus building approach; and (3) evaluating the acceptability, appropriateness and feasibility of the intervention.

A scoping literature review was conducted to identify and describe best practices that address the needs of PLE, including population-based practices. Eleven articles were identified that describe how community pharmacists have been previously integrated into the care of PLE. Fifteen articles were identified that describe current best practices in epilepsy care. Thirty-one key informant interviews were conducted with five PLE, 10 caregivers, seven epileptologists, one neurologist, one epilepsy nurse and seven community pharmacists from September 2019 to February 2020 to identify the predisposing, enabling and reinforcing factors that influence integration of community pharmacists in a population health approach to epilepsy care.

A 15-person advisory panel was convened to inform the design of the community pharmacy-based population health intervention using the findings of the literature review and key informant interview. Ultimately, three potential interventions were designed and evaluated for acceptability, appropriateness and feasibility with five community pharmacists. One intervention was designed for individuals who recently experienced their first seizure and/or who were recently diagnosed with epilepsy; one for individuals whose epilepsy is well controlled; and one for individuals whose epilepsy is not well controlled.

Additional funding has been obtained to continue the work through August 2021 in collaboration with UCB, Inc. This additional funding will be used to (1) assess PLEs’ and caregivers’ perceptions of the acceptability, appropriateness and feasibility of the three interventions and (2) conduct a pilot of the intervention in a limited number of community pharmacies to test procedures, further refine the intervention and estimate recruitment and sample size for an effectiveness trial.

Creating Climate Resilient Agricultural Communities in the Tropics through Natural Climate Solutions

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
June Spector, Environmental and Occupational Health Sciences
David Battisti, Atmospheric Sciences

Project summary
This project seeks to examine how potential future climate and land use scenarios (i.e. deforestation patterns) affect heat exposure, mortality, and unsafe working conditions in agricultural communities in industrializing tropical countries.

During the May t0 November 2019 period, we established a multi-disciplinary team from the University of Washington (UW) and The Nature Conservancy (TNC) and conducted initial analyses focusing on Berau Regency, Indonesia. We found that:

1. Warming associated with deforestation and climate change is already affecting the health of populations in low-latitude, industrializing countries;
2. The most extreme warming is typically found in large patches of deforestation; and,
3. Populations across the tropics are already exposed to unsafe working conditions due to heat exposure from 21st century tree cover loss.

Specifically, local warming from deforestation is larger than that predicted from a century of climate change under a worst-case emissions scenario, and certain geographic areas are under particular threat from future global warming.

This work has led to follow-on funding to advance understanding of the co-benefits of agroforestry, an action-oriented activity rather than loss prevention (i.e., preventing deforestation), with a goal of identifying where and to what extent agroforestry, forest protection and other strategies can provide cooling and health benefits and carbon sequestration to inform programmatic and policy processes.

Project team members have contributed to and delivered around a dozen presentations, abstracts, and blogs about research findings in the community. Further, the work will go towards accelerating countries who have committed to meeting their Nationally Determined Commitments for the Paris Agreement via natural climate solutions and will inform the programmatic and policy processes that identify where and to what extent agroforestry, forest protection and other strategies can provide cooling benefits and carbon sequestration.

Does access to federally qualified health centers with high levels of behavioral health integration impact ED and hospital use among Medicaid beneficiaries?

Investigators
Amber Sabbatini, Emergency Medicine
Theresa Hoeft, Psychiatry & Behavioral Sciences
Herbert Duber, Emergency Medicine

Project summary
The goal of the project is to evaluate the effects of behavioral health integration on outcomes for Medicaid beneficiaries, and specifically to determine whether highly integrated care results in reduced emergency department (ED) and hospital use. We have worked closely with collaborators at Public Health – Seattle & King County and Healthier Here, the King County Accountable Community of Health, since May 2019 to gather and clean data for analysis.

The instrument used to collect data on behavioral health integration was the Maine Health Foundation Site Self-Assessment (plus version, 21 questions; MeHAF). We found that the MeHAF showed good internal consistency, and that different factors appeared to be important for integration efforts than those of primary care. These were: data and systems infrastructure, social/community engagement, and patient/family engagement.

When analyzing MeHAF scores, it was found that persons of color were less likely to be seen at more highly integrated clinics. In addition, we did link community level socioeconomic characteristics from Area Resource Files using clinic zip code, but ultimately did not find any association between any of the clinic characteristics or community characteristics and the level of integration. We also developed an attribution algorithm that would allow us to assign specific Medicaid beneficiaries to clinics participating in the bidirectional integration demonstration and for which we had MeHAF data.

The proposed project developed a new academic-public partnership to evaluate the effects of behavioral health integration with primary care on outcomes for Medicaid beneficiaries in Washington state. Behavioral health integration is an expanding strategy under Washington state’s Medicaid Transformation Program (MTP).

Ethnoforestry: Applying Traditional Ecological Knowledge for Ecosystem Sustainability on the Olympic Peninsula

Half of the funding for this award came via a partnership with UW’s EarthLab, which works in partnership with others to co-produce and catalyze actionable science.

Investigators
Bernard Bormann, Environmental and Forest Sciences
Marc Miller, Marine and Environmental Affairs
Courtney Bobsin, Environmental and Forest Sciences

Project summary
This project uses a new model for ecosystem wellbeing that gives equal weight to both
environmental and community well-being, knowing that there are inherent interactions
between these two components where learning occurs. In order to fully meet ecosystem wellbeing needs, our project focused on two key components: 1) semi-structured interviews and 2) an ethnoforestry field study.

The UW’s Olympic Natural Resources Center (ONRC) has been building relationships with the coastal tribes for the last two decades. We conducted interviews with community members from Forks, the Quileute Tribe and the Hoh Tribe. Interviews centered around several key components: relationship to plants and animals in nearby forests, use of public lands throughout their lifetime (i.e., hunt, fish, or gather), perception of local lands management and if/how their well-being and livelihood is tied to public lands management. These interviews allowed us to understand how lands management can better meet the needs of local people who have historically used these areas for personal, cultural, or commercial harvesting and hunting.

Information provided in these interviews will be directly applied to a much larger watershed study conducted by ONRC and WA Department of Natural Resources in the coming years. We will continue to conduct interviews with community members throughout the next several months to ensure that any person interested in speaking with us as the opportunity to do so.

In the next several months, we will be installing wildlife fencing on site in order to measure the quantity of plant material browsed by wildlife and its impact on plant health and growth. Once this is installed, approximately 7,500 tree and understory plant species will be planted. Measurements on this site will start Summer 2021.

Supporting Latinx Parents of Young Children with Tools for Parenting, Stress-Management and Legal Education

Investigators
Elizabeth Dawson-Hahn, Pediatrics
Liliana Lengua, Psychology
Nora Coronado, Center for Health Equity, Diversity and Inclusion
Brian Johnston, Pediatrics
Gino Aisenberg, Social Work

Project summary
This study seeks to offer Latinx families with vulnerable immigration status a parenting program enhanced with stress-management and legal education components. The existing parenting program was developed to be a brief behavioral parenting skills program for parents experiencing low-income and related adversity.

The program offers tools for mindfulness-based stress management to support parent well-being and effective parenting behaviors that promote child self-regulation and school readiness. Latinx parents with vulnerable immigration status face additional stress above and beyond the experiences of those that are low income.

The COVID-19 pandemic has significantly altered the course of this project, and the team is now working to adapt the intervention to be delivered online rather than in person.