Autumn 2022 pilot grant awardees report out the final outcomes of their projects

Be REAL: A Task-sharing Approach to Implementing a Mental Health Prevention Program for College Students

Investigators
Liliana Lengua, Department of Psychology, Center for Child & Family Well-Being
Megan Kennedy, UW Resilience Lab
Paula Nurius, School of Social Work
Sasha Duttchoudhury, Resilience Lab
Sara McDermott, Center for Child & Family Well-Being
Tyneshia Valdez, Department of Astronomy

Project summary
The central goal of this project was to adapt and scale a task-sharing model for disseminating and implementing Be REAL (REsilient Attitudes and Living; Long et al., 2021a) by training staff on multiple college campuses to deliver the program. We proposed to adapt and evaluate an online Be REAL facilitator training with a cohort of staff from colleges across the country, enabling us to improve the online cross-campus facilitator training and evaluate the effectiveness of Be REAL when delivered to students by staff who receive this training.

AIM 1: Adapt the Be REAL Train-the-Trainer program with qualitative feedback from the first cohort of staff who have already received the training: In January 2023, we contacted staff who participated in our first multi-campus training that had been offered in the spring of 2022, inviting their feedback on the training via qualitative interviews and/or open-ended questions through a Google form. We received excellent suggestions for improving the training, including providing more support in delivering the yoga portions of the program, providing more opportunities to practice the content and receive feedback, and initiating an ongoing learning community that can provide continued support and consultation. To address the first suggestion, we created three instructional videos that provide training in leading yoga practices and demonstrate the practices. This will not only support facilitators who may not be comfortable delivering yoga, it can also support building the yoga into the sessions. To address the second suggestion, trainees were offered opportunities to practice mindfulness skills in optional small groups with their training cohort and facilitator. Five small group sessions took place with 2-4 people in each group. Each trainee led a mindfulness practice and were given feedback from the group and facilitator in a community space. To address the third suggestion, we initiated a learning community after the spring 2023 training concluded, inviting participants from both the 2022 and 2023 training programs to drop in as needed for support in program delivery. We offered an additional facilitator training in the spring of 2024 to 18 participants from eight college campuses, and those individuals were also invited to participate in the ongoing learning community.

AIM 2: Pilot the adapted training with a new cohort of staff, obtaining input for further revisions: The revisions described above along with other smaller changes were implemented in the spring 2023 pilot training program. The 2023 training was enrolled by 30 staff from 12 institutions and the 2024 training was enrolled by 18 participants from 8 institutions across the country. Participants were highly satisfied with the training and participation rates were strong.

AIM 3: Conduct a preliminary multi-site pre-/post-test evaluation of the effects of Be REAL on student mental health when delivered by staff at multiple higher-education institutions: All staff who participated in 2022, 2023 and 2024 trainings were contacted and asked to inform us whether they plan to deliver Be REAL at their institution in the coming year. Ten groups were offered to 105 students, and those students were invited to participate in the evaluation study. However, student participation rates have been low despite several efforts to enhance engagement.

Evaluate potential delays in access to abortion services in Washington State following the U.S. Supreme Court decision

Investigators
Jen Balkus, Department of Epidemiology
Lyndsey Benson, Department of Obstetrics & Gynecology
Anna Fiastro, Department of Family Medicine
Emily Godfrey, Department of Family Medicine
Anuj Khattar, Cedar River Clinic
Sarah Prager, Department of Obstetrics & Gynecology
Taylor Riley, Department of Epidemiology

Project summary
The goal of this project was to develop a system to efficiently extract and summarize electronic medical records data to evaluate potential changes in abortion provision and delays to care in Washington following the Supreme Court Dobbs decision. In partnership with Cedar River Clinics, we built a data extraction and management system to facilitate ongoing analyses of abortion access at Cedar River Clinics from January 1, 2017 through July 31, 2023. We also developed a process for extracting abortion data from the University of Washington Medicine health care system, which we currently have data from January 1, 2022 through October 31, 2023.

We have two manuscripts under review/in progress. For the first manuscript under review, we conducted an interrupted time series analysis to assess changes in abortion provision and delays to care following the Dobbs decision in the Cedar River clinic network. We found that the Dobbs decision was associated with a weekly increase in the number of procedural abortions, number of out of state patients, and the average gestational duration in this clinic network. For the second manuscript which is under consideration for a special journal issue, we described abortion provision in the largest academic medical center in Washington state before and after the Dobbs decision. Academic medical centers which might play an increasingly important role post-Dobbs because abortion bans force people to travel long distances to receive care, leading to delays and obtaining abortions at later gestations, which have a greater risk of complications and may necessitate care in a hospital-based setting. This study is the first to document abortion care in an academic medical center that spans clinic-based and hospital-based settings.

Additionally, we are nearing the end of data abstraction for information on fetal anomalies and abnormal pregnancy among Cedar River patients from 2017 to 2023. After this extensive data collection process is complete, we will start analyzing the data and producing a manuscript related to access to care for fetal indications and any changes to care or access after the Dobbs decision.

Development of PCR-free, phage-mediated molecular diagnostic tools for bacterial infection detection at the point-of-care

Investigators
Alex Meeske, Department of Microbiology
Jeff Nivala, Allen School of Computer Science & Engineering
Nuttada Panpradist, Department of Bioengineering
Holly Rawizza, Department of Medicine, Harvard University
Georg Seelig, Department of Electrical & Computer Engineering

Project summary
Our ultimate goal is to develop a cost-effective and rapid diagnostic workflow that can simultaneously detect a panel of 10+ sepsis-causing bacteria. In this project, we aim to develop proof-of-concept novel chemistry to detect the most common sepsis-causing bacterium, E. coli. We envision our novel chemistry to trick the E. coli into “performing self-diagnostics.” This system has not yet been demonstrated and could revolutionize bacterial sepsis detection by overcoming complex, costly, and time-consuming workflow in traditional PCR or blood culture.

We proposed to demonstrate a three-part chemistry system that using a restriction endonuclease DNA strand displacement (resDSD) circuit and phage to target the organisms of interest. During the project period, We successfully demonstrated a functioning resDSD circuit. This is the first-of-its-kind DNA circuit, and we had anticipated this part of the project to be the most challenging. We successfully cloned the e.coli vector for expression of a restriction endonuclease which later will be integrated in the phage.

Additionally, it is worth noting that these successful experiments were designed and conducted by an undergraduate student, Megan van Meur (they). Throughout the duration of this project, they received a Mary Gates Undergraduate Research Award and applied for the Washington Research Foundation Fellowship. Lastly, the experimental results became an accepted abstract which will be presented by Megan at a national Biomedical Engineering Society Conference (BMES) conference in October of 2023. Megan went on the pursue a graduate degree, focusing on synthetic biology in Belgium. The finding and the concept of resDSD was filed for provisional patent in October of 2024 through the UW (ref 49955).

NEW Parents Connect: Nurturing Emotional Wellbeing in Perinatal Parents Living in a Low-income Context

Investigators
Liliana J. Lengua, Department of Psychology, Center for Child and Family Well-being (CCFW)
Stephanie Thompson, Department of Psychology
Ira Kantrowitz-Gordon, Department of Child, Family, and Population Health Nursing
Becca Calhoun, Department of Psychology
Krystle Perez, Department of Pediatrics
Keshet Ronen, Department of Global Health

Project summary
This research team previously developed programs to be delivered in pregnancy and the early postpartum to diverse families. Benefits observed in pregnancy did not last, and new parents struggled to attend. The current study was to conduct an online adaptation of the intervention, to partner with a community organization, and ultimately, to offer the program across pregnancy and early postpartum. The ultimate goal is to evaluate a scalable preventive intervention aimed at promoting maternal and infant mental health to address health inequities. The plan is to scale the program using a task-sharing model in which professionals already serving parents in low-income community settings would be trained to incorporate the NEW Parents Connect (NPC) intervention into their work. We proposed two phases of this project:

Phase 1 Aim. Improve postpartum intervention accessibility. To be responsive to attendance barriers, time-limited program effects, and participant feedback from our previous study, we adapted the previously in-person, postpartum intervention to instead be delivered online that spans both pregnancy and postpartum.

Recruitment for this study was initially challenging, and we were unable to recruit a sample of pregnant women within the timeframe required to complete the “Cohort 2” of the proposed study. In conversations with several community partners, we learned that enrolling families in services/programs has been a common challenge since the pandemic. For Cohort 1, the anticipated n was to be 10-12 families, however, we were only able to recruit five parents. Although disappointing, we noted that 4/5 of the parents attended almost all of the sessions, suggesting that the online format was more accessible for them than the in-person format in the previous study. We subsequently recruited participants into additional groups in the fall and winter to increase the sample size. Rates of attendance and satisfaction ratings were high. We have not yet analyzed the quantitative data on maternal mental health and parenting.

Phase 2 Aim. Assess intervention effectiveness and scalability. Participation in the Phase 1 group was strong despite the low number of participants, and qualitative interviews with participants indicated that they found the program to be supportive and valuable. In partnership with our community partner organization, Open Arms Perinatal Services, we trained two doulas to deliver the NPC postpartum intervention and evaluate program effectiveness. Feedback from the doulas was that the content of the program was consistent with addressing the needs of their clients.

The two providers delivered the NPC postpartum program in the fall and winter. With a revised recruitment strategy of direct emails to potential participants, the two groups included 31 parents. The parents reported very high satisfaction with the program and rates of attendance were strong. This study provided proof-of-concept for a task-sharing approach for delivering perinatal prevention programs.

Early Hearing Detection and Intervention in Kenya (EHDI-K): Opportunities and challenges to improve access and decrease loss to follow up

Investigators
Sarah Benki-Nugent, Department of Global Health
Emily Gallagher, Department of Pediatrics
Nada Ali, Department of Otolaryngology-Head and Neck Surgery
Serah Ndegwa, University of Nairobi Department of Surgery and Kenyatta National Hospital
Manaseh Bocha, Kenya Ministry of Health
Chimmy Omamo-Olende, Operation Ear Drop Kenya
Dalton Wamalwa, University of Nairobi Department of Pediatrics
Irene Njuguna, Kenyatta National Hospital
Maureen Kinge, University of Nairobi Department of Pediatrics and Kenyatta National Hospital
Caren Mburu, Kenyatta National Hospital

Project summary
The objective of our project, Early Hearing Detection and Intervention in Kenya, was to understand key drivers of lack of access and loss to follow up to ear and hearing care (EHC) services for infants and children under six in Kenya from the caregiver and the clinician perspectives. This was a multidisciplinary collaboration among faculty, trainees, policymakers, and community leaders at the University of Washington, University of Nairobi, Kenya Ministry of Health Ear and Hearing Care Technical Working Group, and Operation Ear Drop Kenya (OEDK).

Through over 50 qualitative interviews and focus group discussions, we conducted formative work generating preliminary evidence to support policy development and future community-identified interventions for early childhood hearing loss in Kenya. Key findings of this project revealed that lack of knowledge about hearing loss, its management options, and sequelae if left unaddressed were the most significant barriers to access to EHC services among both caregivers and clinicians. These and other findings from this work have been presented at national and international meetings.

Through support from the Population Health Initiative, we strengthened a pre-existing partnership with policymakers in Kenya by organizing a working meeting in September 2023 with the Ministry of Health Ear and Hearing Care Technical Working Group. We also established a new partnership with Operation Ear Drop Kenya, a local non-governmental organization of Kenyan healthcare professionals engaged in hearing loss-related advocacy and education. Through this partnership, we were able to build a nine-item communication toolkit to support the organization’s community engagement activities.