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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

Research Plan. Asian American (AA) lesbian, gay, and bisexual (LGB) individuals represent an understudied LGB population with substantial mental health needs for whom there are documented disparities in access and engagement in mental health interventions. Lifetime prevalence estimates of depression among AA LGB are as high as 97%, approximately 20% have been diagnosed with depression compared to 7% of AA heterosexual individuals, and suicide remains the leading cause of death among AA young adults. Despite these needs, AA are the least likely racial/ethnic group in the United States to receive mental healthcare, with less than 9% receiving any type of mental health care compared to 18% of the general U.S. population. AA LGB experience multiple forms of stressors (including social- and mental health-related stigma) that contribute to depression and anxiety. Resilience, the process of coping with stressful life experiences, has been found to buffer the impact of stigma related to social experiences and mental health. HealthMpowerment, a CDC-designated evidence-based digital health intervention, has shown effectiveness in reducing stigma among Black and Latino LGB individuals by providing tailored content, decision tools, and skills to foster resilience. However, engagement of AA LGB in large scale iterations of HealthMpowerment has been limited, with only 0.9% of more than 3,000 enrolled participants identifying as AA LGB in the HMP LITE2 cohort study, highlighting the need to systematically adapt HealthMpowerment to improve its reach and engagement among AA LGB. Consistent with meta-analytic evidence demonstrating that culturally adapted interventions improve engagement and treatment outcomes among AA populations, this project will systematically adapt HealthMpowerment for AA LGB while generating a rigorous adaptation framework that can inform future adaptation of evidence-based digital mental health interventions for other populations. Specifically, leveraging the HealthMpowerment digital structure, this K01 proposes to conduct formative research to understand how multiple sources of stress experienced by AA LGB influence mental health outcomes (AIM 1) to inform the adaptation of intervention components designed to strengthen resilience and social connectedness that will follow an iterative community-engaged process guided by the ADAPT-ITT model, to reflect the cultural, social, environmental, and psychological factors influencing mental health in this population (AIM 2). The adapted intervention will be pilot tested to assess preliminary efficacy and implementation outcomes such as participant engagement, and to develop all procedures that will inform and lead the subsequent R01 trial as a fully powered RCT while generating a rigorous, reproducible adaptation framework to optimize the reach and engagement of evidence-based digital mental health interventions among populations less likely to seek or engage in mental health care (AIM 3). Career Development. As an emerging scholar, Dr. Lee will leverage USF’s training infrastructure to build her professional independence and expertise to develop a high-impact community-engaged research agenda focused on addressing mental health disparities through innovative and multidimensional digital health approaches. Specifically, Dr. Lee seeks to expand her repertoire of methodological skills in mental health research in the key areas of 1) the application of relevant frameworks to understand how stress attributed to multiple factors experienced by AA LGB contribute to mental health problems; 2) community-engaged research methods; 3) adaptation of digital mental health intervention components; and 4) integrating implementation considerations in digital mental health intervention research. Scientific results from this K01 will provide crucial data, training, and methodological expertise to make Dr. Lee competitive for a future R01 to test the efficacy and implementation of the adapted HealthMpowerment intervention. Mentorship. A multidisciplinary team of expert investigators in mental health, social determinants of mental health, community-engaged research, intervention adaptation, digital health interventions, and implementation science will support the research aims and training goals of this K01 proposal. Public Health Impact. This project addresses a critical gap in evidence-based mental health intervention research by systematically adapting an evidence-based intervention for AA LGB, a population that experiences substantial mental health disparities and for whom no tailored evidence-based mental health intervention currently exists. The project will also establish and evaluate a rigorous community-engaged adaptation process that may inform future adaptation of evidence-based digital mental health interventions for other populations and settings.

NIMH - National Institute of Mental Health

Project Summary Adolescents face significant structural, cultural, and economic barriers to accessing mental health care for depression. These discrepancies are deeply pronounced in rural communities, where adolescents report higher rates of internalizing problems compared to their urban peers, yet providers and treatment options are especially scarce. Rural adolescents that do access treatment are overwhelmingly likely to do so in school settings. However, even in schools, treatment options are limited due to a shortage of school mental health providers and funding making it difficult to implement resource-intensive interventions delivered by teachers or other school staff. Thus, when expanding the reach of evidence-based services in rural-area schools, school mental health professionals (SMHP) will be essential for sustainable implementation. Single-session interventions (SSIs) represent one promising approach to offering scalable, effective mental health support in school settings for youth with internalizing symptoms. SSIs offered within school settings can greatly improve rural youths’ access to mental health services – overcoming several of the system-level barriers often faced by their population. Due to difficulty accessing reliable internet services and youth preferences for self-guided treatment versus human-delivered, providing multiple modalities (e.g., digital self- guided treatment, human- delivered) for accessing mental health support can help to alleviate youth internalizing problems. Task sharing has the potential to accelerate the dissemination and implementation of mental health supports for rural youth as a Tier 2 support and provide alternative sources of mental health support for rural teens. In line with NIMH strategic plan goals 3 and 4, which focus on tailoring existing interventions to optimize outcomes and meet the needs of populations in resource constrained settings (e.g., rural adolescents), testing interventions for effectiveness in community settings, and improving the efficiency, effectiveness, and reach of interventions in different communities and populations. The goal of my proposal is to improve access to mental health care for rural youth through the development and evaluation of human-delivered SSIs as a Tier 2 support within school settings by SMHP. I will be in an ideal training environment at Northwestern University to conduct this study and learn how to develop a general research pipeline. Training and mentorship will be received from Dr. Jessica Schleider will provide training in the implementation of SSIs within rural school systems, Dr. Eric J. Bruns on community- engaged research with rural school systems, Dr. Sara Becker on user-centered design (UCD) and dissemination science, Dr. Miya Barnett on UCD and the development of the SMHP toolkit/human- delivered SSI, Dr. Andrew Berry on UCD methods and facilitation of asynchronous remote communities/semi- structured interviews, Dr. Ijeoma Opara on community-engaged research and design with resource- constrained communities. Lastly, Dr. Eric Arzubi will provide mentorship and on-the-ground support in rural communities through his expertise working in rural Montana school districts.

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.

NIMH - National Institute of Mental Health

PROJECT SUMMARY This ambitious research project will test the effectiveness and dissemination of a digital intervention to promote home HIV testing and linkage to PrEP (Pre-Exposure Prophylaxis) among Men who have Sex with Men (MSM) in Philadelphia. In alignment with the strategic priorities of the Office of HIV Health in the Philadelphia Department of Public Health (PDPH), the experimental arm will deliver tailored social-media and SMS messages and nudges generated by a local Community Advisory Board (CAB) and Al-driven algorithms. We will randomize MSM participants (N = 1,000) to one of two conditions. The standard of care arm will involve the PhillyKeepOnLoving social marketing campaign that the PDPH is currently implementing and future city campaigns. The primary effectiveness outcome is annual routine HIV testing and PrEP (2 HIV tests at least 4 months apart from one another for HIV-negative participants and PrEP), and secondary effectiveness outcomes are ART uptake and retention, as well as sexual risk behavior. Implementation outcomes include reach, adoption, implementation, and maintenance, and dissemination outcomes include the number of shares and likes of the messages from the campaign. We will also evaluate mediators, including the personal relevance and trustworthiness of the messages, as well as motivation, information, and behavioral skills to seek services. This trial, led by an outstanding team and involving institutions committed to successful HIV prevention, will help to advance the Respond pillar of the Ending the HIV Epidemic (EHE) initiative. Through a novel synergy, the proposed research may transform how future campaigns are conducted to engage participants in HIV prevention leveraging LLMs (Large Language Models) and community engagement.

NCCIH - National Center for Complementary and Integrative Health

Project Summary Problematic social media use (PSMU) is a generation-defining public health concern for emerging adults. PSMU is associated with anxious symptoms and may operate through mechanisms such as social media rumination and depersonalization. Mindfulness based interventions are efficacious for reducing anxious symptoms, experiences of rumination, and potentially depersonalization. Despite this, challenges persist in engaging and sustaining mindfulness practices among emerging adults. Digital mindfulness interventions (DMIs), such as the Healthy Minds Program (HMP), which trains mindfulness skills through educational and guided mindfulness practice modules, may be a viable solution to this problem. HMP has been shown to reduce anxious symptoms among adults and may be uniquely primed to address anxious symptoms and PSMU among emerging adults, as reductions in anxious symptoms in HMP were mediated by changes in rumination. The overall goal of this K01 is to develop the HMP for Emerging Adults (HMP-EA), based on the existing HMP, by tailoring it to the specific needs of emerging adults with PSMU and anxious symptoms and integrating just-in-time (JIT) technology to curb social media exposure directly. First, HMP-EA will tailor app content to relevant examples and preferences of emerging adults with PSMU. Previous work led by Dr. Vranceanu (Primary Mentor) has shown that tailoring led to high engagement and retention in a different study using HMP with dementia caregivers. Second, HMP-EA will use JIT intervention delivery to interrupt periods of social media binging, which are associated with anxious symptoms and key mechanisms, with nudges to engage with mindfulness practices, which have been shown in other contexts to interrupt maladaptive behaviors and improve mental well-being. The proposed research has three specific aims. Aim 1: Refine HMP-EA using a user-centered design framework and qualitative interviews with emerging adults with PSMU and have elevated anxious symptoms (N=12-20) to identify user needs, preferences, contextual factors influencing engagement, and inform the development of the JIT component designed to prompt mindfulness practice following during social media binges. Aim 2: Conduct a beta test and single-arm feasibility pilot of HMP-EA (N=10) to evaluate feasibility, acceptability, usability, and adherence, using mixed methods. Aim 3: Conduct a 12-week single-blind feasibility randomized controlled trial (n=50) comparing HMP-EA to a wellness podcast control matched on time and attention. Feasibility metrics (e.g., recruitment, retention, adherence, engagement), anxious symptoms, social media usage, and theory-driven mechanisms (e.g., rumination, depersonalization) will be assessed at baseline, post-intervention, and 3-month follow-up. The completion of the proposed research aims will be facilitated by the following 3 training aims: 1) User-centered design informed qualitative methods for JIT mindfulness DHI development, 2) Mixed methods approaches for mindfulness intervention refinement, and 3) Lead health-related clinical research teams and quantitatively analyze feasibility RCTs. I was also engage with several professional development activities to scaffold my transition from K awardee to independent investigator. This research follows NCCIH’s priorities for multicomponent, whole-person digital interventions and represents a critical step toward addressing mental health challenges faced by emerging adults.

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.

NIDA - National Institute on Drug Abuse

ABSTRACT People with HIV (PWH) with substance use disorders (SUDs) are at high risk of worse HIV-related health outcomes. Further, SU forms a complex syndemic with intimate partner violence (IPV), wherein SUD and IPV commonly co-occur and additively, negatively impact HIV care engagement by increasing risk of mental health disorders, housing, financial, and food insecurity, and weakening social support and executive function. Thus, integrated screening, treatment, and support for IPV and SU alongside HIV care linkage/re-linkage and retention efforts is critical. Emergency departments (EDs) are ideal venues for linking newly-diagnosed PWH, re-linking PWH who have been out-of-care, and initiating comprehensive, needs-driven support for PWH to be retained in HIV care long-term. Unfortunately, sustained retention in HIV care after initial linkage/re-linkage to HIV care from EDs is poor and particularly challenging for PWH with SUDs and mental health disorders. We hypothesize that the low rates of retention after initial linkage/re-linkage of PWH from the EDs is due to missed early opportunities in addressing barriers to retention like SUDs, IPV, and comorbid mental health disorders, housing insecurity, and fractured social support. Building on the evidence-base demonstrating the impact of Screening, Brief Intervention, and Referral to Treatment (SBIRT) and peer-driven processes in EDs to link patients to subsequent services for SUDs and existing support services in Ryan White HIV Clinics (RWCs) and community, we propose to develop and pilot comprehensive implementation strategies to support delivery of an ED-based “Peer Bridge Model (PBM)” targeting PWH that utilizes multiple evidence-based practices: (1) peer linkage specialists (due to their capacity to understand and build trust with patients, fewer time constraints, and cost-efficiency) to (2) screen for IPV, SUD, and co-occurring mental health and support needs, (3) deliver Psychological First Aid (PFA), a brief, trauma-informed intervention widely employed to help individuals in the aftermath of experiencing a trauma, with (4) warm linkage to comprehensive, existing services (i.e., mental health, substance use, and peer counseling, case management, and housing assistance) in local community-based organizations and RWCs. Specifically, we aim to: 1) Identify and develop patient-centered and contextually responsive implementation strategies to facilitate delivery of the PBM using a Modified Delphi process with multiple stakeholders, 2) Refine the implementation strategies developed in Aim 1 to a specific delivery context through theater testing with PBM implementing stakeholders; and 3) Pilot and perform a mixed-methods evaluation of the preliminary effectiveness of the implementation strategies on PBM implementation outcomes at a high-volume ED in Atlanta capturing multistakeholder perspectives at 0, 3 and 6 months post implementation onset to examine acceptability, feasibility, fidelity, reach, patient satisfaction, adaptations, and barriers/facilitators to intervention implementation and efficacy. Findings will inform a future Hybrid Type 2 effectiveness-implementation trial examining the impact of the PBM in enhancing linkage and retention on HIV care, SUD and IPV outcomes.

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.

NIMH - National Institute of Mental Health

ABSTRACT The purpose of this Mentored Patient-Oriented Research Career Development Award is to prepare Ashley Foster, MD, a general and pediatric emergency medicine physician, for a career as an independent clinician investigator. Her work will focus on designing and implementing sustainable, scalable suicide prevention interventions for adolescents who receive care in the emergency department (ED) setting. This proposal integrates targeted training, career development, and research initiatives to enhance Dr. Foster’s experience in health services research, equipping her to: (1) gain specialized skills in human-centered design for adapting a proactive crisis line intervention for adolescents, (2) deepen her knowledge of implementation science frameworks, and (3) advance her capabilities in conducting adolescent suicide prevention research, positioning her for future contributions as a leader in the field. Suicide remains a major cause of death among adolescents in the United States (US), with ED visits for suicidal ideation and behaviors rising significantly over the past decade. The ED is a critical point for identifying adolescents at risk of suicide, but the post-discharge period remains high-risk as many adolescents continue to experience suicidal thoughts and behaviors. Timely mental health follow-up is vital, yet systemic issues like workforce shortages often cause delays and low follow-up rates, highlighting the need for effective interventions. Proactive interventions in adults have proven to increase mental health visit attendance, reduce suicidal behaviors, and lower suicide deaths, with crisis line centers well-suited for this role due to their resources, specialized training, and national infrastructure. Numerous crisis line centers currently provide proactive interventions after ED discharge. However, these interventions often exclude adolescents, highlighting the need for tailored approaches to their unique needs. Therefore, the objective of this proposal is to adapt and pilot a proactive crisis line intervention for adolescents with increased suicide risk discharged from the ED. To do so, Dr. Foster will pursue the following specific aims: 1) Identify specific needs for an adolescent-adapted proactive crisis line intervention 2) Adapt a proactive crisis line intervention for adolescents, 3) Conduct a pilot randomized controlled trial of the adolescent-adapted proactive crisis line intervention. Results will provide the data necessary for a planned R01, which is a full-scale hybrid effectiveness- implementation type I study of the adolescent-adapted proactive crisis line intervention. This proposal aligns with one of the National Institute of Mental Health’s cross-cutting themes of prevention in a research priority area of suicide prevention within a population of concern of children and youth. If successful, an adolescent-adapted proactive crisis line intervention could harness the national crisis line center infrastructure to deliver a transformative solution for at-risk adolescents following discharge from US EDs.

NIMH - National Institute of Mental Health

PROJECT ABSTRACT/SUMMARY HIV-associated hospitalizations remain high and Advanced HIV Disease (AHD) remain a persistent global problem despite widespread availability of antiretroviral therapy (ART). People with HIV (PWH) are more likely to be hospitalized, in the U.S. and globally, and at the time of hospitalization, gaps in the HIV care continuum (retention, adherence to ART, and viral suppression) are more widespread than seen in clinic or population-level data. After the end of a hospitalization (i.e., after discharge), PWH, particularly those with AHD, continue to face adverse events, including mortality and readmission. Unfortunately, poor outcomes during the hospital to home transition of care can occur in a blind spot in the health system as most HIV programs are anchored in outpatient/community settings and are unable to ascertain or intervene on inpatient and post-discharge deaths/disengagement in care among their clients. In this project, we will conduct a randomized clinical trial in Zambia to evaluate a novel intervention package called Advanced HIV Re-engagement in Care (ARC) to improve post-discharge outcomes of AHD. ARC entails a package of evidence-based and theory-informed elements that are delivered by supervised community health workers (CHWs) during hospitalization and in the post-discharge period. In Aim 1, we will evaluate the effect of ARC, compared to standard of care, on post-discharge mortality and other HIV and comorbidity outcomes. In Aim 2, effect mechanisms will be identified to inform future refinements to the intervention package. In Aim 3, we will investigate early implementation factors, and cost and cost effectiveness, that are expected to influence future uptake and sustainability of ARC and other interventions to improve HIV outcomes after discharge. Having U.S. researchers and U.S. universities conduct this project in Zambia provides multiple advantages to the U.S. First, because HIV is 20-50 times more common in Zambia than in the U.S., and outcomes of AHD are often suboptimal, conducting the study in Zambia allows researchers to have statistical power to evaluate effects of ARC on mortality, not just the HIV care cascade. In addition, while being evaluated in Zambia, ARC has potential application in the U.S., where CHW delivered interventions have become increasingly common as they provide cost and implementation advantages. Finally, the study aligns with NIH-supported ‘global health reciprocal innovation’ where partnerships between U.S. and low and middle-income country research teams ensure that the U.S. also benefits from international research. Study leaders are practicing HIV clinicians in the U.S., which positions then to introduce the ARC intervention package in U.S. healthcare settings should it be found effective.

NIMH - National Institute of Mental Health

PROJECT ABSTRACT/SUMMARY HIV-associated hospitalizations remain high and Advanced HIV Disease (AHD) remain a persistent global problem despite widespread availability of antiretroviral therapy (ART). People with HIV (PWH) are more likely to be hospitalized, in the U.S. and globally, and at the time of hospitalization, gaps in the HIV care continuum (retention, adherence to ART, and viral suppression) are more widespread than seen in clinic or population-level data. After the end of a hospitalization (i.e., after discharge), PWH, particularly those with AHD, continue to face adverse events, including mortality and readmission. Unfortunately, poor outcomes during the hospital to home transition of care can occur in a blind spot in the health system as most HIV programs are anchored in outpatient/community settings and are unable to ascertain or intervene on inpatient and post-discharge deaths/disengagement in care among their clients. In this project, we will conduct a randomized clinical trial in Zambia to evaluate a novel intervention package called Advanced HIV Re-engagement in Care (ARC) to improve post-discharge outcomes of AHD. ARC entails a package of evidence-based and theory-informed elements that are delivered by supervised community health workers (CHWs) during hospitalization and in the post-discharge period. In Aim 1, we will evaluate the effect of ARC, compared to standard of care, on post-discharge mortality and other HIV and comorbidity outcomes. In Aim 2, effect mechanisms will be identified to inform future refinements to the intervention package. In Aim 3, we will investigate early implementation factors, and cost and cost effectiveness, that are expected to influence future uptake and sustainability of ARC and other interventions to improve HIV outcomes after discharge. Having U.S. researchers and U.S. universities conduct this project in Zambia provides multiple advantages to the U.S. First, because HIV is 20-50 times more common in Zambia than in the U.S., and outcomes of AHD are often suboptimal, conducting the study in Zambia allows researchers to have statistical power to evaluate effects of ARC on mortality, not just the HIV care cascade. In addition, while being evaluated in Zambia, ARC has potential application in the U.S., where CHW delivered interventions have become increasingly common as they provide cost and implementation advantages. Finally, the study aligns with NIH-supported ‘global health reciprocal innovation’ where partnerships between U.S. and low and middle-income country research teams ensure that the U.S. also benefits from international research. Study leaders are practicing HIV clinicians in the U.S., which positions then to introduce the ARC intervention package in U.S. healthcare settings should it be found effective.

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

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

Schizophrenia (scz) affects 0.5-1% of the American population with devastating consequence. The fate of older individuals with scz is of particular concern: this population is rapidly increasing, estimated to reach 1.1 million in the US by 2025, complicated by advanced medical age and early mortality (> 20 years shorter life span). Further, there is accumulating evidence that, in at least a subset of older patients, scz is a progressive disorder, resulting in remarkably high rates of dementia (greater than 10x that of the general population), reduced response to pharmacological and nonpharmacological treatments, and severe impairments in social function and community integration. We hypothesize that dysfunction of the cerebral microvasculature and the CSF circulation and clearance system are critical pathophysiological factors contributing to this deterioration. We propose to use advanced multimodal MR imaging at high magnetic field (7T) to test the hypothesis that microvasculature and CSF circulation and clearance deteriorate with aging in scz, resulting in impaired cognition, functional capacity, brain aging, and treatment response. 90 individuals with scz (to include schizoaffective disorder), ranging in age from 18 to >70, and 60 matched controls, will be recruited from our ongoing Schizophrenia Phenotype Study (SPS). Each individual will receive a comprehensive diagnostic, clinical and neuropsychological assessment and then an MRI scan. In Aim 1, Quantitative MRI of microvasculature, we will use a novel imaging method developed by our group, iVASO, for mapping arteriolar cerebral blood volume (CBVa), a key measure of the microvasculature. We hypothesize, based on our preliminary work, that CBVa decreases in scz with age and disease duration relative to matched controls. In Aim 2, Quantitative MRI of CSF circulation and clearance, we will use a novel imaging method, “Dynamic Susceptibility Contrast in the CSF” (cDSC), also developed by our group, to assess CSF volume in the choroid plexus, lateral ventricle, and perivascular space, and CSF flow in the meningeal lymphatic vessels. We hypothesize that CSF circulation/clearance will also decline with age in scz, and that measures of the components of the system will be correlated. In Aim 3, Exploratory Measures, we will determine the relationship of microvascular and CSF flow measures to each other, develop a composite index that integrates all useful measurements, and model the extent to which microvascular and CSF flow in scz mediates the relationship between age and cognition, treatment response, function, and brain age, a biomarker based on structural MRI. Overall, establishing the relationship among aging, microvasculature, CSF flow, clinical outcomes, and biomarkers of age in scz has the potential to provide important insights into scz pathogenic mechanisms associated with aging, biomarkers of disease state, latent subtypes of scz, and new therapeutic targets.

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 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.

NIMH - National Institute of Mental Health

Bioamplifiers have revolutionized healthcare over the past century by enabling transformative diagnostic and therapeutic tools. Among these, EEG has emerged as the most widely utilized neuroimaging modality, critical for researching, diagnosing, and treating a wide range of mental health and neurological disorders. Recent advancements in wearable electronics have expanded the potential of EEG devices, shifting from cumbersome desktop machines and wet electrodes to user-friendly, wearable devices with comfortable dry electrodes suitable for long-term, ambulatory use. Despite these technological advancements, the widespread deployment of clinical-grade EEG systems remains limited by high costs, proprietary technologies, and non-adaptable hardware. Similarly, med-tech and neuro-tech startups often struggle to access affordable, regulatory-compliant tools for product validation and market entry, frequently failing during the “valley of death” - the critical stage in development where funding is required to meet both regulatory and market demands. OpenBCI aims to address these challenges with Cyton V2, the first affordable, FDA-cleared bioamplifier featuring open-source hardware and software. Building on OpenBCI’s legacy of pioneering open-source physiological monitoring, Cyton V2 will be a medical-grade, adaptable, and repairable bioamplifier system. It is designed to meet the needs of cost-conscious researchers and clinicians, while also providing regulatory-compliant tools to support medical technology innovators developing new healthcare solutions through physiological monitoring. The outcome of this project will be a finished bioamplifier system that has been tested and cleared by the FDA for initial indication. The specific aims of this Direct to Phase II (D2P2) project are: 1. Refine bioamplifier design and technical specifications; 2. Design for Manufacturability (DFM) and scale-up manufacturing processes; 3. Validate bioamplifier system quality, safety and performance to standards; and 4. Prepare and submit the final bioamplifier product for regulatory approval. By achieving these aims, this project will maximize the practical availability of medical-grade EEG and other biosensing technologies. These outcomes will address critical gaps in neurological and mental health diagnostics.

NIA - National Institute on Aging

Project Summary/Abstract As the frequency, prevalence, and severity of extreme weather events and disasters increase, the long- term and life course consequences on the older population in the US of experiencing cyclones, heat waves, droughts, floods, and wildfires grows in terms of its significance for research, policy, and population well-being. Of particular urgency is developing a better understanding of the effects of disasters exposures and post-disas- ter experiences on disparities in well-being over the older life course years, on levels and differentials in health and mortality, and for policies aimed at mitigating long-term consequences of disasters. A predominant focus of the literature addressing disaster effects on health and well-being is the period in the immediate aftermath of the event. Much is known about short-term effects on mortality, mental health, displacement, living arrange- ments, and recovery. For subsequent post-disaster years, however, there is a dearth of data sources, and hence of population-level empirical research, on individual outcomes, especially among the elderly population. Key issues that remain uninvestigated include whether disaster effects are fleeting, whether they have long- term negative consequences, or whether individuals may actually be better off. This project will build on a ma- jor investment we have made to create a linked data source for addressing the medium- and long-run effects of Hurricane Katrina on the pre-disaster population of New Orleans. We will use these new linked data to exam- ine living arrangements, well-being, and mortality among the older population of New Orleans aged 60-plus years in the period following Hurricane Katrina. Using within-New Orleans comparisons along with an external counterfactual comparison group, we will address two aims. First, we will examine how exposure to Hurricane Katrina for the older New Orleans population affected long-term trajectories of living arrangements and resi- dential neighborhood attainment compared to the counterfactual comparison group. Second, we will examine post-Katrina mortality and disability disparities within the older New Orleans population by race, pre-Katrina social and economic characteristics, hurricane impact, and post-disaster experiences. This is a novel and ex- ploratory project to establish a general and broadly-applicable approach to studying the effects of disasters on the older population using linked census and administrative data. It will also make significant substantive con- tributions by combining stress and social vulnerability theories to generate and evaluate testable hypotheses about the effects of pre-disaster socioeconomic resources and disaster exposure on key health and well-being outcomes among the older New Orleans population. The project will set the stage for future replications for other disasters as well as for a variety of enhancements and extensions in order to answer pressing questions on the consequences of disasters on the health and well-being of the older US population.

NINR - National Institute of Nursing Research

PROJECT SUMMARY There are over 177,000 women detained in U.S. jails and prisons on any day and another 800,000 serving sentences in the community under custodial supervision. About 20% of women with criminal legal system involvement (CLSI) are age 50 or older. Rates of women and older adults have both risen dramatically in recent decades, 700% and 280%, respectively. For many women, incarceration and probation are profoundly stressful experiences, often overlapping with other life circumstances—trauma and abuse, homelessness, substance use, mental illness—that disrupt women's support systems and health services access. Many women who experience CLSI also do so repeatedly, cycling in and out of incarceration and probation over many years. The toll on health can be profound. CLSI is associated with disproportionately high rates of many chronic and infectious diseases and early mortality in women of all ages and is hypothesized to lead to acceleration of aging-related conditions. Most of what we know about the health of older women (age 50 and older) with CLSI is extrapolated from the groups of older men and younger women. We lack an understanding of how CLSI functions as a social determinant for aging-related health in the group, including how much, when, and in conjunction with what other factors over the life course experiences of incarceration and probation contribute. We also know almost nothing about the health in aging attitudes, goals, self-efficacy, and experiences of community-dwelling older women with CLSI. The objective of the Aging-Related Health and Aging Acceleration in Older Women with Criminal Legal System Involvement Study (AGELIS) is to fill critical gaps in our knowledge about how CLSI functions as a life course social determinant and what women with CLSI mean by and want from health in aging. Closing such gaps is crucial in moving the field toward intervention readiness and ultimately improved health outcomes. The specific aims of AGELIS are to (a) establish relationships between the health in aging construct, functional ability, life course factors, and CLSI in older women with CLSI, compared with a matched comparison group in the Health and Retirement Study and (b) characterize attitudes, goals, self-efficacy and experiences of health in aging in older women with CLSI using semi-structured interviews and ethnographic case study. In partnership with a community research team, we will bring results from the two aims together in an integrated model of health in aging with CLSI. AGELIS will provide an empirical and experiential basis for subsequent intervention design and point the way forward for investigation in aging with other groups that experience significant life course stress.

NIMH - National Institute of Mental Health

AI-based decision support system for Addressing Emergency Department return Among Mental Health Patients Project Summary In 2022, more than 1 in 5 U.S. adults (59.3 million, 23.1% of the adult population) live with mental health (MH) illness. About 1 in 8 Emergency Department (ED) visits involve MH and/or substance use diagnoses. A study indicated MH patients are 4.7 times more likely to be frequent ED users, defined as those with three or more in the previous 3 months, compared to non-MH patients. Each preventable ED return visit contributes to the $32 billion preventable ED costs to the healthcare system annually. While prediction models exist for ED returns among general patient populations or specific groups such as elderly patients, there is a lack of validated models developed to predict ED returns among MH patients. The challenge stems from the complex and unique factors affecting the ED return of MH patients, including clinical, operational, and social determinants of health (SDoH) factors. This complexity makes it challenging for clinicians to anticipate ED return for MH patients using their clinical judgment. Therefore, there is a need for advanced analytical approaches that can process complex patient data and integrate it through real-time clinical decision support (CDS). This project will: 1) Develop a Large Language Model (LLM)-based system for to automatically extract MH ED return risk factors (MERRF) from clinical notes. We will develop a system using state-of-the-art LLM techniques, including Retrieval-Augmented Generation, to accurately extract key risk factors (e.g., SDoH, medication adherence, and poor outpatient follow-up) from unstructured clinical notes. The system’s accuracy will be validated through manual chart reviews by clinical experts and multisite validation. 2) Develop explainable Machine Learning (ML) models to predict ED returns for MH patients. We will develop and validate multisite explainable ML models that integrate structured clinical data with extracted MERRF to identify high risk of ED return among MH patients. We will create an explainability framework that translates ED return risk factors into natural language, making it easy for social workers and providers to understand both the ML-generated ED return risk scores and their contributing factors for each MH patient. 3) Develop and Integrate Artificial Intelligence (AI)- MH ED Return Risk Assessment (MERRA) CDS Tool in the EHR. Using human-centered design (HCD) design principles, we will engage ED stakeholders (e.g., social workers) to develop the proposed AI-MERRA CDS and investigate its integration into ED workflow. Through iterative design and testing, we will optimize the CDS usability and clinical relevance. 4) Evaluate the AI-MERRA CDS Implementation and Feasibility. We will implement a quasi-experimental pilot study at UABHS to evaluate AI-MERRA CDS. We will assess implementation outcomes (e.g., adoption) through quantitative metrics and semi-structured interviews with ED clinicians. Findings will inform a future large scale, multisite implementation of AI-MERRA through a randomized clinical trial. This project is highly feasible and will advance mental health ED care through innovative AI solutions.