Funded Projects

Principal Investigator	Title (click each link for more info)	Sponsor / Type
Griggs, Kellie	Supporting Educational Excellence and Diversity (SEED) for SC Nursing	The Duke Endowment
Chinnis, Simone	Psychiatric Advanced Practice Registered Nurse TechNology Enhanced Residency (PARTNER) Program	The Duke Endowment
Chandler, Jessica	Patient Centered Health Technology Medication Adherence Program for African American Hypertensives	NIH/NHLBI
Cormack, Carrie	Palliative Care Certificate	The David R. Clare and Margaret C. Clare Foundation
Davidson, Tatiana M	Dissemination of a stepped care intervention to address emotional recovery among traumatic injury patients in the Carolinas	The Duke Endowment
	Elder Abuse Assessment Training and MentalHealth Services Program	S.C. Office of the Attorney General/Dept. of Crime Victim Assistance Grants
	Expanding the Reach of a Novel Mental Health Service for Traumatic Injury Patients	The Duke Endowment
	Evaluation of Trauma Center-Based, Technology Enhanced Stepped Care Intervention for Adolescent Traumatic Injury Survivors	NIH/NICHD
	Telehealth Solutions to Improve Access and Quality for Care for Firefighters	Dept. of Homeland Security/Federal Emergency Management Agency (FEMA)
Durham, Catherine (Cathy) O.	The Choose Well Initiative	The New Morning Foundation
Fowler, Terry	Leveraging an Interprofessional Diabetes Telehealth Service to Optimize Outcomes in High Risk Underserved Patients	The Duke Endowment
Kelechi, Teresa J	A Social Genomics Model to Explore Loneliness and Systemic Inflammation in an Older Adult Population with Chronic Venous Leg Ulcers	NIH/NINR
Kelechi, Teresa J. and Qanungo, Suparna	Mealtime Partnership for People with Dementia in Respite Centers & at Home	NIH/NINR
Kozachik, Sharon	Advanced Nursing Education Workforce (ANEW) Program	Health Resources and Services Administration (HRSA)
	Enhanced Screening, Brief Intervention, & Referral (SBIRT) Training through Multi-Modal Medication Assisted Treatment Instruction	Duke Endowment
Mueller, Martina	A Randomized Controlled Trial of Electroconvulsive Therapy versus Usual Care for the Acute Management of Severe Agitation in Alzheimer's Dementia (ECT-AD)	Sub. McClean Hospital/NIH/NIA
Newman, Susan	Nurse Faculty Loan Program	HRSA
	Preparing PHOENIX to Fly: Building Capacity for Research on Spinal Cord Injury Peer Mentoring	DHHS/NIDILRR
Qanungo, Suparna	Implementation of Home-Based Palliative Care in Limited Resource Settings	NIH/NCI
Riding, Leigh	A Scalable mHealth Resource to Facilitate Behavioral and Emotional Recovery after Pediatric Traumatic Injury	NIH/ Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Ruggiero, Kenneth J.	Improving Quality of Care in Child Mental Health Service Settings	NIH/NIMH
	Optimizing Efforts to Restore Psychiatric and Social Function After a Major Hurricane	NIH/NIMH
	Testing a Scalable Model of Care to Improve Patients’ Access to Mental Health Services after Traumatic Injury	AHRQ
Stecker, Tracy	CBT by Phone to Promote Use of Alcohol Related Care and Reduce Drinking: COVID-19 Administrative Supplement	Sub. University of Rochester/NIH/NIAAA
	CBT by Phone to Promote Use of Alcohol Related Care and Reduce Drinking	Sub. University of Rochester/NIH/NIAAA
	Investigations to Improve Treatment Seeking Among Those At-Risk for Suicide	Warren Alpert Foundation
Wagner, Janelle	Fostering Medication Adherence in Children with Epilepsy using mHealth Technology	Sub. Cincinnati Children’s Hospital Medical Center/NIH/NINR
Williams, Amy	Healthy Steps	First Steps South Carolina

Psychiatric Advanced Practice Registered Nurse TechNology Enhanced Residency (PARTNER) Program

Sponsor/Type: The Duke Endowment
Project Period: 01/01/2021 – 12/31/2023
Simone Chinnis, DNP, MBA, FNP-C, AE-C

Abstract:

Behavioral health (BH) disorders represent a significant burden in the United States (US) and South Carolina (SC) populations at 18.6% for adults and up to13%-20% of children. SC data in 2016, reports a higher prevalence of depression among lower-income residents

SC is a mostly rural, economically disadvantaged state, with 21% of its population living in rural communities. Access to BH services is limited due to capacity, equity, and cost. Rural patients often lack private or public transportation, but many travel over 100 miles for mental health consultations, crisis intervention/ stabilization, and follow-up care coordination appointments. Minimal childcare options and a lack of qualified BH providers lead to scarce appointment availability and delays in care; delayed care can lead to a BH crisis, resulting in costly treatment in the acute care setting. Further, the COVID-19 pandemic has pushed the healthcare system to reinvent care delivery models that accommodate social distancing. Meeting mental health needs for patients in rural communities will require cost-effective and innovative solutions, where mental health specialists and primary care providers partner to offer continuity of care services in the communities where patients live, work and play. Embedding BH clinicians into the primary care setting is a best practice strategy, but rurality and a shortage of mental health experts is a significant barrier for rural and at-risk communities. Seventeen of SC's 46 counties are without a practicing psychiatrist, and 22 of the 46 have fewer than ten psychiatrists.

The need for affordable mental health services in SC has never been greater and services provided by Psychiatric Mental Health Advanced Practice Registered Nurse Practitioners (PMH-NPs) are a valid, reliable, and clinically effective strategy for treating mental health. The proposed Psychiatric Advanced Practice Registered Nurse TechNology Enhanced Residency (PARTNER) Program will deploy psychiatric mental health nurse practitioners (PMH-NP) and train post-graduate PMH-NPs in an innovative telehealth residency for psychiatric mental health APRNs; the only such program in the country. The PARTNER program will support workforce readiness for PMH-NPs using a continuity of care tele-mental health model for rural primary care integration to increase accessibility while lowering cost. This formal post-graduate residency training program will offer high-quality and effective care to patients and a transition path for new, board-certified PMH-NPs to advance their proficiency.

PARTNER will leverage MUSC's current Telepsychiatry Outpatient Program (described program) to optimize outpatient psychiatry services for patients in SC's “Promise Zone” which includes Allendale, Barnwell, Bamberg, Colleton, Hampton, and Jasper counties. The Promise Zone is in SC’s southernmost tip of the state, located west of I-95, and suffers from severe poverty, economic, and health disparities disadvantages. Beaufort county, which is just outside the Promise Zone, also suffers the same challenges with high numbers of mental health referrals to the MUSC OT program (39%) and will be included in PARTNER.

For more information contact Simone Chinnis at chinniss@musc.edu

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Patient Centered Health Technology Medication Adherence Program for African American Hypertensives

Sponsor/Type: NIH/NHLBI
Project Period: 07/10/2017- 04/30/2023
Jessica Chandler, PhD.

Abstract:

Efforts to improve medication non-adherence (MNA) and blood pressure (BP) control in patients with essential hypertension (EH) have met with limited success. Innovative approaches are needed that are acceptable, sustainable, efficacious, and easily disseminated. There have been no randomized controlled trials (RCTs) evaluating the application of theory-driven, patient centered, mobile health (mHealth) technology programs among African Americans with MNA and uncontrolled EH. The proposed research will test and refine the Smart phone Medication Adherence Stops Hypertension (SMASH) program. SMASH includes multi-level components: 1) automated reminders from an electronic medication tray; 2) tailored text message/voice mail motivational feedback and reinforcement guided by self-determination theory and based upon adherence to daily medication and BP monitoring and 3) automated summary reports and direct alerts to providers. A 6-month, 2-arm (SMASH vs. enhanced Standard Care [SC]) efficacy RCT will be conducted in 192 African Americans (21-59 years old) with MNA and uncontrolled EH. Evaluations will occur at baseline, months 3 and 6, and post-trial follow-ups at months 12 and 18. Specific aims are to test the hypotheses that, compared to the enhanced SC cohort, the SMASH cohort will demonstrate significantly improved and sustained changes in:

1. Primary Outcome Variables: a)  Medication adherence: percent with electronic monitor-derived adherence scores greater than 0.90; b) BP control: percent meeting JNC8 guidelines for BP control (resting BP less than 140 / 90 mmHg.)
2. Secondary Outcome Variables: a) percent reaching and sustaining 24-hr ambulatory BP less than 130 / 80 mmHg and b) provider adherence to JNC8 guidelines as measured by timing of medication changes c) patient changes in Self-Determination Theory constructs (e.g., competence and autonomous regulation.)
3. Exploratory Outcome Variable of cost effectiveness. After final follow-up evaluations, focus groups with random sample of SMASH subjects (n = 30) and healthcare providers (n =~ 12) will assess key user reactions including acceptability, usability, salience and aids/barriers to sustainability. Data from RCT and focus groups will be triangulated to further refine and optimize SMASH and prepare for a multi-site effectiveness RCT. Our long-term objective is to reduce premature mortality among African Americans by developing effective and sustainable mHealth secondary prevention self-management programs for medication adherence and bio-function monitoring (e.g., BP) related to their chronic diseases.

 

For more information contact Dr. Chandler at chandlje@musc.edu

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Palliative Care Certificate

Sponsor/Type: The David R. Clare and Margaret C. Clare Foundation
Project Period: 09/09/2019 – 06/30/2023
Carrie Cormack, DNP, APRN, CPNP-PC, CHPPN

Abstract:

1) Purpose and goals. MUSC CON will develop a post-Master of Science in Nursing to Doctorate of Nursing Practice (DNP) palliative care track and post-graduate certificate. The National Hospice and Palliative Care Organization (NHPCO) defines palliative care as “patient and family-centered care that optimizes quality of life…and occurs throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs…to facilitate patient…choice” (NHPCO, 2018). Advanced practice registered nurses (APRN) trained in palliative care could fill an important gap in access to evidence-based, high quality care. Nurse Practitioners (NPs) provide holistic, person-centered care, advocate and seek patient goals for care (AACN, 2018a; AANP, 2019) and this correlates perfectly with palliative care (Fennimore, et al., 2018). NPs are licensed to diagnose and treat health conditions with an added emphasis on disease prevention and health management using a comprehensive approach (AANP, 2019).

Research has demonstrated that implementing palliative care early leads to a reduction in costly and preventable hospitalizations, readmission, and emergency department visits (Meier, 2011). It is important to note that hospice care is part of the palliative care continuum. Hospice care specifically addresses the end of life needs whereas palliative care stresses quality of life for the patient and family living with a serious and life-limiting disease from time of diagnosis throughout the trajectory (Meier, 2011). With the aging population living longer and the number of serious illnesses on the rise, the demand for health care services including lifespan palliative care, is expected to rise to an unprecedented high in South Carolina (see below). These changing demographics creates an important need for trained healthcare providers, such as APRNs trained specifically in palliative care with a post-graduate certificates or post-MSN DNP degree, who have the specialized knowledge and skills in providing palliative care, for both adults and children. Unfortunately, it is also well-recognized that there is not a sufficient cohort of trained palliative care healthcare providers to meet those diagnosed with life-limiting illnesses or conditions. The World Health Organization identifies a number of pediatric and adult diseases which benefit from palliative care:

Pediatric - cancer, cardiovascular diseases, cirrhosis of the liver, congenital anomalies, blood and immune disorders, HIV/AIDS, meningitis, kidney diseases, neurological diseases, and neonatal conditions.

Adult - Alzheimer’s and other dementias, cancer, cardiovascular diseases, cirrhosis of the liver, chronic obstructive pulmonary diseases, diabetes, HIV/AIDS, kidney failure, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, and drug-resistant tuberculosis.

The treatment and care a child or adult needs can affect a parent’s or family’s ability to continue working, care for other children and critical relationships (e.g. marriage). Palliative care interventions address these issues and lead to improved quality of life for the child and family.

For more information contact Dr. Cormack at cormackc@musc.edu

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Dissemination of a stepped care intervention to address emotional recovery among traumatic injury patients in the Carolinas

Sponsor/Type: The Duke Endowment
Project Period: 01/01/2021 – 12/31/2023
Tatiana M. Davidson, PhD

Abstract:

Annually, 140,000 Carolinians are hospitalized after traumatic injury (e.g., gunshot wounds, stabbings, serious car or motorcycle crashes, pedestrians struck by automobiles). More than 20% (~30,000 each year) develop posttraumatic stress disorder (PTSD) and/or depression, both major risk factors for poor quality of life, social and occupational impairment, and prolonged physical recovery. Moreover, only 28% of patients who develop PTSD or depression after traumatic injury return to work within one year vs. 61% of those who develop neither disorder. It is therefore critical that sustainable models of mental health care are embedded within trauma centers to ensure that patients receive the full range of services that they need. The American College of Surgeons Committee on Trauma now explicitly identifies this as a top national priority. Unfortunately, however, only ~10% of the >525 US trauma centers have taken initial steps to address mental health recovery, and almost all of them are doing it differently and have very basic programs that lack strong evidence. No program has been widely adopted, and there are no clear roadmaps. South Carolina has emerged as an exception and national leader as a result of our launch of the Trauma Resilience and Recovery Program (TRRP) at the Medical University of South Carolina in 2015, followed by our Duke Endowment grant awarded in 2017 that allowed us to implement TRRP in three additional Level I-II trauma centers: Prisma Health – Upstate, Prisma Health – Midlands, and Trident. Collectively, these programs already have reached more than 10,000 patients. If awarded, this grant will triple the number of trauma centers in the Carolinas with mental health programs to 12 by supporting our efforts to implement TRRP at: Carolinas Medical Center, Spartanburg Regional, UNC Medical Center, Duke University Hospital, Vidant Medical Center, Grand Strand Medical Center, WakeMed Health, and Wake Forest Baptist Health.

For more information contact Dr. Davidson at davidst@musc.edu

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Elder Abuse Assessment Training and Mental Health Services Program

Sponsor/Type: S.C. Office of the Attorney General/Dept. of Crime Victim Assistance Grants
Project Period: 10/01/2020 – 09/30/2023
Tatiana M. Davidson, PhD

Project Description:

Problem Summary:

1. Health care personnel and other professionals such as professional caregivers (CNAs, PCAs) etc., are in a pivotal position to help victims of elder mistreatment because they see virtually every adult over age 60 each year. However, they frequently fail to do so because they are not trained to consistently recognize, assess, and refer to services and
2. Evidence-based counseling services are not readily available, particularly to rural elder abuse victims. We still remain the only specialized evidence-based mental health services program for victims of elder abuse in South Carolina.

 

Training Component: We have implemented since October 2015 a low-cost, easily disseminated and highly sustainable elder abuse identification, intervention, and referral training program designed for

1. (a) health care professionals already in practice,
2. (b) healthcare professional students in training in academic settings.

 

Specifically, we have trained since October 2015 more than 4000 healthcare providers in the tri-county area of Charleston. As an added incentive to engage providers into training we worked extensively in the curriculum and updated in the past year its contents, by working closely with our Continuing Education Office and Web-based educational system “MyQuest” to offer the program in both in person and online versions. In addition, we are offering CME/CE credits which are a tremendous incentive and validation to the training we are offering. Every two years a few must be paid to continue offering the CME/CE credits. We have added this component to our budget. The advantages offered by this our multiple: First, our comprehensive revision have created a version online that can be paced according to the providers available time and needs. The in person though still kept brief, goes a little bit further into addressing specific questions to the providers on site.
Whether in person or online, this training program has been designed in a way that its main components are easily integrated into (a) existing practice sites, particularly those serving low income and underserved populations, where risk of elder mistreatment is greatest. In addition, these training protocols are amenable to being delivered to (b) nursing, medical, and physician assistant students as part of their classroom instruction. Finally, for dissemination purposes and incorporation of these methods of evaluation and referral of older adults at risk into the culture of each practice, we propose to train nurse practitioners, residents and junior level healthcare providers to deliver these elder abuse training programs to other health care personnel in their clinical settings.

Components of the Training Program:

Components of the training program are tailored considering provider’s location and serving populations particularly if those are underserved or rural groups, and characteristics of the clinics in terms of budgetary and time constraints. In this way we determine feasibility and applicability of the screenings and referral systems. Overall, the components are established based on goals to achieve which are:

• Identification of the signs, symptoms, risk factors, perpetrator characteristics, and mental health outcomes of elder abuse.
• Assessing an older adult with evidence-based validated screening tools such as the Elder Abuse Suspicion Index (EASI).

 

For more information contact Dr. Davidson at davidst@musc.edu

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Evaluation of Trauma Center-Based, Technology Enhanced Stepped Care Intervention for Adolescent Traumatic Injury Survivors

Sponsor/Type: NIH/NICHD
Project Period: 09/01/2021 – 08/31/2025
Tatiana M. Davidson, PhD

Abstract:

Pediatric traumatic injury (i.e., injury of sudden onset and severity requiring immediate attention) is the leading cause of death and morbidity among US adolescents and are associated with mental health and health risk outcomes. Pediatric traumatic injuries are associated with medical and societal costs of $87 billion and elevates risk for a wide range of health risk consequences that affect quality of life, physical recovery, social functioning, and return to previous activities. The prevalence of PTSD and depression is high among pediatric traumatic injury patients; however, most  pediatric trauma centers don’t have the resources to implement models of care that address mental health following injury. Current guidelines by the American College of Surgeons (ACS) Committee on Trauma strongly recommend screening and addressing emotional recovery in traumatic injury patients. The ACS Committee on Trauma has identified this as a priority and likely will begin to mandate mental health programs in Level I and II pediatric trauma centers nationally. It is therefore critical that policy and practice is guided by the implementation and evaluation of scalable and sustainable models of care. In 2015 our team launched the Trauma Resilience and Recovery Program (TRRP), a scalable and sustainable, technology-enhanced, multidisciplinary stepped model of care – one of the few in the US - that provides early intervention and direct services to improve access to evidence-based mental health care after traumatic injury for children, adults and families. We have found this model of care to be feasible and acceptable to adolescent patients (ages 12-17) at each level of service. TRRP includes 3 major steps: (1) in-hospital education, brief risk reduction session, and tracking patients’ emotional recovery via an automated text-messaging system, (2) conducting a 30-day screen via telephone to identify patients who are good candidates for psychological treatment, and (3) providing referral to best-practice telehealth-based or in-person assessment and treatment. We have partnered with three accredited Level I and II pediatric trauma centers and propose a multi-site hybrid 1 effectiveness-implementation trial with 300 adolescent (ages 12-17) traumatic injury patients to: 1) assess the extent to which TRRP promotes improvement in quality of life and emotional recovery and 2) gather preliminary data on the potential for TRRP to be implemented in other Level I trauma centers. Directly in line with NICHD’s Pediatric Trauma and Critical Illness Research and Training (PTCIB) Strategic Research and Training agenda, this study will provide valuable data on the efficacy, preliminary effectiveness and potential for implementation of an innovative, cost-effective, sustainable technology-enhanced intervention designed to address the unique needs of adolescent injury patients and mitigate short- and long-term impact of injury on mental health, quality of life, and overall well-being.

For more information contact Dr. Davidson at davidst@musc.edu

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Telehealth Solutions to Improve Access and Quality of Care for Firefighters

Sponsor/Type: Dept. of Homeland Security/Federal emergency Management Agency (FEMA)
Project Period: 09/01/2021 – 08/31/2023
Tatiana M. Davidson, PhD

Abstract:

For more than a decade, our team has launched freely available online training resources to improve firefighter behavioral health and mitigate symptoms of PTSD and other related disorders affecting occupational functioning and well-being. However, mental health service delivery is highly variable in community practice settings which can negatively impact firefighter mental health. This project seeks to improve the quality of treatment delivery and increase firefighter engagement in treatment. We will accomplish this by creating a mobile resource to assist providers in real-time to deliver best practice mental health services that will 1) host interactive activities to be used in session to reinforce treatment, 2) allow providers to assign and track between-session practice activities, and 3) include provider assistance tools to guide treatment delivery, promote therapeutic alliance via telehealth platforms, and address trauma-related barriers when delivering treatment via telehealth.

For more information contact Dr. Davidson at davidst@musc.edu

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Leveraging an Interprofessional Diabetes Telehealth Service to Optimize Outcomes in High Risk Underserved Patients

Sponsor/Type: Duke Endowment
Project Period: 01/01/2020 – 12/31/2022
Terri Fowler DNP, APRN, FNP-C

Abstract:

Federally Qualified Health Centers (FQHCs) serve underserved communities with complex medical needs. Health disparities in this population demonstrate disproportionally high rates of diabetes-related morbidity and mortality, both of which are preventable with access to expert interprofessional (IP) teams. Unfortunately, the FQHCs that serve these patients often lack such teams. For example, at Fetter Healthcare Network (FHCN), 30% of patients are diagnosed with DM; 63% of these patients are uncontrolled and 32% are markedly uncontrolled (A1C less than 9%), but these patients have limited access to expert-led diabetes care teams such as those in academic health centers. The lack of access increases health disparities and poor health outcomes experienced by underserved populations. Health inequities, underserved groups, and persons with lower socioeconomic status have 2-4 times higher rates of diabetes related hospitalizations, amputations, renal disease and death. With Health Resources and Services Administration funding, a pilot telehealth pharmacotherapy program was established at FHCN with MUSC collaboration in 2016 and demonstrated success in integrating the infrastructure and processes for providing telehealth-based care in a FQHC. In 2018, the pharmacotherapy program completed 721 visits across seven FHCN sites with a median A1C decrease of 1.6% per patient. Pharmacotherapy management is one aspect of diabetes; however, diabetes is a complex disease with many issues such as concurrent comorbidities, primary and secondary disease prevention and life-style modifications. The American Diabetes Association and American Association of Clinical Endocrinologists support the use of diabetes management with an expert IP care team. This project will build on the success of the pharmacotherapy program and provide a comprehensive expert IP team approach to diabetes management by leveraging the telehealth model to reach multiple FQHC sites, rather than having to deploy separate teams at each site, thereby meeting patients and providers “where they are at” to improve health outcomes.

For more information contact Dr. Fowler at fowlerte@musc.edu

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A Social Genomics Model to Explore Loneliness and Systemic Inflammation in an Older Adult Population with Chronic Venous Leg Ulcers

Sponsor/Type: NIH/NINR
Project Period: 09/09/2020 – 07/31/2023
Teresa J. Kelechi RN, PhD, FAAN

Abstract:

This application seeks to advance social genomics research by exploring psychosocial stressors, symptoms and biomarkers in a chronic wound population. The most common type of chronic wound is a venous leg ulcer (CVLU), which accounts for 70-80% of the 6.5 million wounds currently being treated in the U.S. at health care costs approaching $25 billion. One of the most common psychosocial stressors is loneliness, which affects 68% of individuals with CVLUs, negatively influencing social relationships and reducing quality of life. Unfortunately, psychosocial stressors are rarely assessed or managed during clinical encounters, and may play a predominant role in the chronic, non-healing state. Loneliness has been linked to systemic inflammation through various molecular pathways such as the upregulation of inflammatory genes. Inflammation is also a well-established biological pathway associated with poor healing suggesting inflammation is a common molecular mechanism that underlies both loneliness and poor wound healing. However, the confluence of loneliness and inflammation in a wound population has not been elucidated. Thus, we hypothesize that substantially heightened inflammation is a common molecular mechanism with a distinct profile that underlies both loneliness and poor wound healing in a chronic wound population compared to a wound population without loneliness. In this application, using a social genomics framework guided by the psychoneuroimmunology (PNI) paradigm and the conserved transcriptional response to adversity (CTRA) model, the aims of our prospective observational longitudinal study are to: examine whether psychosocial stressors (i.e., social isolation, social support) and symptoms (i.e., fatigue, pain, depression, anxiety, sleep disturbance, reduced QOL) differ between lonely (L+) and non-lonely (L-) patients with CVLUs using well-validated questionnaires; characterize a biomarker (chemotaxic factors, growth factors, vascular damage and immune regulators) profile common to L+ and CLVU using well-established RNA sequencing and PCR methods for whole blood samples; and, explore whether age and sex/psychological stressors and symptoms indicate potential moderation/mediation of the effect of loneliness on the biomarker profile, over a 3-month study period, collecting data at 3 time points during wound care. We will also explore demographic and other variables such as age (60 – 74, ≥75 years), sex, chronic illnesses, cognition, health status, functional activity, stigma, nutritional status, length of time to heal (healing trajectory), and wound treatment type across the 3 time points. The long-term objective of this research to better understand molecular mechanisms common to loneliness and inflammation towards development of a biopsychosocial prognostic indicator of healing potential in persons with chronic wounds.

For more information contact Dr. Kelechi at kelechtj@musc.edu

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Mealtime Partnerships for People with Dementia in Respite Centers & at Home

Sponsor/Type: NIH/NINR
Project Period: 09/01/2017 – 06/30/2023
Teresa J. Kelechi, PhD, RN, GCNS-BC, CWCN and Suparna Qanungo, PhD

Abstract:

The goal of this study is to test the efficacy of a mealtime intervention (Partners at Meals) in respite care centers (RCCs) that provide a social model of care for people with dementia living in the community and support for their caregivers. Largely staffed by long-time volunteers, these centers support caregivers’ ability to maintain their loved one in the home. Outcomes include improvements in: a) quality of life (QOL) and nutritional outcomes for people with dementia (PWD) and QOL outcomes for family caregivers (CGs); b) self-efficacy training outcomes for assessing and managing meals for the CGs and the RCC volunteers; and c) sustainability outcomes as determined by directors of the RCCs. Two large RCCs with a total of 5 sites of care in suburban and rural areas of SC will be the sites of this project; and 60 PWDs and 60 CGs will be recruited for this cluster-randomized trial, as well as potentially 60 staff and volunteers. Caregiving for PWDs is increasingly occurring in the community by persons who are often not prepared to assume this responsibility. Fortunately, RCCs evolved as a vital community-based resource that provide socialization, meaningful activities, respite for caregivers and at least one meal daily. Mealtime is a particular problem for PWDs because as this life-limiting disease progresses, they lose the functional ability to manage meals and display a variety of challenging behaviors all of which will eventually affect their ability to consume adequate calories and continue the social aspects of meals that connect them to others. A HIPAA-compliant telehealth system using simple ‘tablets’ will allow CGs to capture behaviors and environmental aspects of meals in the home at the time behaviors occur so that plans of care can be tailored to PWD needs. Using a train-the-trainer model, volunteers will be taught to assess the environment (Place), the interactions between the PWD and others (People), and the actions of the PWD (Person). They will then train the CGs to make those observations so they can tailor and change mealtimes in the home – the telehealth component supports this. Thus this project could be used in the community as a model for behavior modification for other dysfunctional behaviors in the home. This study proposes to examine the following aims: (Primary) Compared to participants in ‘enhanced usual care’ sites, PWD participants in the intervention sites will demonstrate improvement in nutritional status and dysfunctional behaviors, and QOL; (Secondary) a) CGs will report improve QOL and self-efficacy for managing meals, and decreased depression and burden; c) RCC volunteers will report improved self-efficacy for training and management of feeding issues; and d) Directors will report satisfaction with the program and willingness to continue the program post-funding. Additionally, hospitalizations and discharges related to nutrition-related issues among PWDs will be collected for future work.

For more information contact Dr. Kelechi kelechtj@musc.edu or Dr. Qanungo at qanungo@musc.edu

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Supporting Educational Excellence and Diversity (SEED) for SC Nursing

Sponsor/Type: The Duke Endowment
Project Period: 01/01/2021 – 12/31/2023
Griggs, Kellie, DNP, MSN-Ed, RNC-OB

Abstract:

The State of South Carolina (SC) leads the nation in poor health outcomes (ranked 42 of 50) as evidenced by 26,248 deaths and 91,364 years per lives lost in 2016 due to chronic diseases. Health disparities abound, as African Americans are 30% more likely to die from heart disease and 43% more likely to die from stroke than non-Hispanic White South Carolinians. Chronic diseases are the leading causes of morbidity, hospitalizations and mortality among African Americans in SC. Nationally, minorities are more likely to be infected with COVID-19. When minorities are infected, they have more severe disease and higher rates of mortality when compared to White Americans. Other factors associated with COVID-19 morbidity and mortality include urban living and poor socioeconomic status. These statistics hold true for SC; according to the SC Department of Health and Environmental Control, the largest number of confirmed and estimated COVID-19 cases are in SC’s urban (Lexington, Richland, Sumter) and impoverished rural counties (Beaufort, Horry, Greenville), with Horry county leading in infections with an estimated 24,000 COVID-19 cases. These facts further elucidate the urgent need skilled nurses in SC’s rural and underserved communities. At MUSC College of Nursing (CON), 87% of our graduates obtain positions in SC. Rural clinical rotations can lead to graduates choosing to work and live in underserved areas.

Chronic disease management includes teaching the skills and behaviors patients and families need to improve health outcomes, increase quality of life, and decrease morbidity and mortality rates. Self-management is affected by, and highly correlated with cultural behaviors, health beliefs, and morays that have been passed down through generations. In acknowledgement of this, the American Nurses Association created Standard 8 which mandates culturally congruent nursing practice. Culturally congruent practice empowers the nurse to deliver evidence based care that considers the values, beliefs and worldviews of the patient.10 This is best done when providers representative of their communities work to improve access, health outcomes and reduce disparities.

There is an urgent need to increase the number of culturally congruent nurses in SC. South Carolina’s nursing workforce (82.6% White; 11% Black; 1% Hispanic) does not reflect its citizens (68.5% White; 27% Black; 5.7% Hispanic), which supports the need to increase diverse nursing student enrollment. South Carolina’s educational disparities also create challenges for a diverse group students, especially those attending primarily white institutions (PWI) of higher learning. The MUSC College of Nursing (CON) supports culturally congruent care and has developed a plan to facilitate student success improving SC’s nursing diversity and patient health outcomes that will be sustainable.

The purpose of SEED is two-fold: 1) promote diversity in the SC health care workforce by training diverse group of students in nursing with the knowledge, skills and behaviors to provide culturally and linguistically competent care in rural and other medically underserved communities 2) develop rural clinical training rotations with MUSC affiliate hospitals to improve the distribution of baccalaureate prepared nurses.

For more information contact Dr. Kozachik at kozachik@musc.edu

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Advanced Nursing Education Workforce (ANEW) Program

Sponsor/Type: Health Resources and Services Administration (HRSA)
Project Period: 07/01/2017 – 06/30/2023
Sharon L. Kozachik, MSN, PhD, RN, FAAN

Abstract:

This application requests $2.5 million to support innovative academic-practice partnerships to prepare primary care APRN students in the MUSC CON DNP program. The purpose is to increase the longitudinal clinical immersive training experiences with rural and/or underserved populations for selected primary care (PC) APRN students, implement a clinical preceptor orientation and support program, and facilitate post-graduate employment and follow-up in rural and HPSA and/or MUA in four nurse practitioner roles: AGNP, FNP, PMHNP, and PNP. The ANEW project will provide traineeships to 16-18 students who commit to at least two years of primary care work in a rural and HPSA and/or MUA. CON graduated 55 APRN students during 07/01/17-06/30/18; 100% are employed in rural, underserved and public health settings, and 84% are employed in HPSAs and 53% in MUAs (Table 1). Since 2010, CON has funded a total of 136 students who received AENT (n=81), ANEE (n=30) and ANEW (n=25) HRSA grants. Currently, 100% of their practice sites are in underserved and public health settings of which 76% are in HPSAs, 82% in MUAs and 24% in rural areas. We are requesting special funding consideration based upon the CON’s significant contribution to meeting the needs of the rural and underserved in SC.

The objectives for the ANEW grant include:

• Establish or enhance at least 1 innovative academic/clinical partnership between 1 or more schools of nursing and 1 or more clinical practice partners;
• Provide longitudinal immersive clinical training experiences for APRN students in community-based settings, including providing support through traineeships;
• Recruit, train, develop, support, and evaluate preceptors as program partners to enhance community-based clinical and didactic nursing education;
• Connect APRN graduates with resources to assist employment in rural and underserved areas;
• Follow up on graduates’ careers to determine retention in nursing practice and in rural/underserved communities for at least 1-year after graduation.

Processes and evaluation for the ANEW program will occur as follows:

Objective 1: CON will continue to partner with SC AHEC for clinical placements for APRN students and support students’ participation in AHEC’s Institute for Primary Care, promoting interprofessional development and AHEC’s Scholars program. We are establishing a new partnership with MUSC Family Medicine Clinic and an innovative partnership with Francis Marion University Graduate Nursing Program to disseminate our online APRN telehealth curriculum.

Objective 2: Full-time APRN students at any program point and part-time students in the last year will be eligible to apply. A rubric will rank the top students. Priority points will be awarded to disadvantaged and/or diverse students, and students who live in or have clinical rotations in rural areas, MUAs or HPSAs. Students will be tracked and registered each semester. Support during training includes enhanced curriculum experiences in palliative care, substance abuse, and telehealth. Students will sign a commitment letter (see Workplan & Budget Justification) each funded semester. Longitudinal data to be collected includes post-graduation position placement. An annual performance report and final report will be submitted as required.

Objective 3: The online clinical preceptor orientation will be implemented in fall 2019 after pilot testing in spring 2019. The program will be housed on the AHEC website. Preceptors will earn a certificate upon completion; they are also invited to events for faculty at CON, the annual faculty telehealth conference, and CON’s online SBIRT/Opioid training modules at no cost.

Objective 4: We will disseminate a recruitment program we developed with AHEC for NP/PA/medical students to encourage post-graduation primary care employment in rural, MUA and HPSA areas. Students will also be oriented to the HRSA Healthcare Workforce Connector to assist with finding employment.

Objective 5: Student Services maintains communication with CON graduates and distributes the annual Alumni Survey to ascertain employment location and measures such as committee work, presentations/publications, and evaluation of skills used and/or needed in practice. CON will obtain graduates’ NPI numbers to track employment.

For more information contact Dr. Kozachik at kozachik@musc.edu

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A Randomized Controlled Trial of Electroconvulsive Therapy versus Usual Care for the Acute Management of Severe Agitation in Alzheimer's Dementia (ECT-AD)

Sponsor/Type: Sub. McClean Hospital/NIH/NIA
Project Period: 09/30/2018 – 05/31/2023
Martina Mueller, PhD

Abstract:

Alzheimer's dementia (AD), the most prevalent neurodegenerative disease of aging, affects cognition, emotion, and behavior. Agitation is a common behavioral syndrome that frequently emerges during middle to late stage AD and is characterized by psychomotor hyperactivity, aggression, irritability, yelling, resistance to care, and insomnia. The untoward consequences of agitation and related behavioral disturbances are considerable and include impaired quality of life, accelerated cognitive decline, heightened risk of institutionalization, and increased morbidity and mortality. Agitation also increases caregiver burden, including stress and deleterious health consequences. However, despite the damaging impact of agitation on the patient and caregiver, current treatments have only modest efficacy. Behavior management strategies are widely employed, but effective only in mild cases. Antipsychotics, the most commonly used class of medication for agitation and psychosis in dementia, have demonstrated mixed results in controlled studies and are associated with elevated morbidity and mortality. Thus, there is a clear need for improved interventions, particularly for severe agitation in AD. Electroconvulsive Therapy (ECT) is a safe and effective intervention for severe mood disorders in later life, including depression complicated by psychosis, mania or catatonia. Concerns regarding adverse cognitive effects of ECT, however, have limited ECT's clinical use in treating dementia with agitation. Both retrospective and prospective studies conducted by our group support the safety and efficacy of ECT in patients with AD and severe agitation. ECT, therefore, may represent an effective treatment of severe agitation in AD. We propose a five-site, randomized, single-blind, controlled clinical trial to determine the safety and efficacy of ECT plus usual care compared with Simulated ECT (S-ECT) plus usual care in 200 hospitalized individuals with moderate to severe stage AD, probable Alzheimer's type (based on NIA-AA criteria), complicated by severe agitation.

Subjects will be randomized to either (1) ECT for three weeks (up to 9 ECT treatments) plus usual care (UC), defined as standard behavioral therapy and pharmacotherapy or (2) Simulated ECT (S-ECT) plus UC. Primary efficacy will be measured with the Cohen-Mansfield Agitation Inventory (CMAI). Safety parameters include daily assessment of delirium (Confusion Assessment Method, CAM), cognition (Severe Impairment Battery, SIB-8) and serious adverse events. A 12-week follow-up includes monthly assessments to explore stability of agitation reduction.

For more information contact Mrs. Mueller at muellerm@musc.edu

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Nurse Faculty Loan Program

Sponsor/Type: HRSA
Project Period: 07/01/2013 – 06/30/2023
Susan D Newman RN, PhD, CRRN

Abstract:

This application is a funding priority request for financial loan support for students enrolled in a Doctor of Philosophy in Nursing (PhD) degree program and the post-Master’s Doctorate of Nursing Practice Program (DNP) at the College of Nursing (CON), Medical University of South Carolina (MUSC) with a career goal to serve as nurse faculty upon graduation. The CON DNP program is fully accredited by the Commission of Collegiate Nursing Education (CCNE) through June 30, 2026, and all MUSC programs were reaccredited by the Southern Association of Colleges and Schools Commission on Colleges (SACs) through 2027 (Attachment 1).

The objectives for this program are as follows:

• Increase the number of graduate doctoral students in the post MSN-DNP, BSN-PhD and MSN-PhD programs who are prepared to become qualified nurse faculty upon program completion by ensuring:
  • All students who received NFLP funding complete the three educational courses needed for national certification as a nurse educator.
  • Students who previously completed the three educational courses and are not certified as nurse educators with at least one year of teaching experience are offered the mentored teaching course to gain doctoral level teaching experience.

 

Processes and evaluation for the program will occur as follows:
Recruitment and student orientation. Following receipt of funds from HRSA, an e-mail and CON electronic newsletter outlining the purpose, criteria and eligibility of the NFLP program is sent out to all PhD and post-MSN DNP students (July). Students are informed how the loan works, and required completion of the service agreement as full-time nursing faculty at an accredited school of nursing. Students then apply by completing a three-page application that includes a statement of commitment to complete the three required nurse educator courses prior to graduation. Students understand a new plan of study will be developed to reflect the change. Previous students will be given priority for funding. New applicants meeting criteria for the loan and completing an entrance interview will be considered on a first come first serve basis, with priority given to those from diverse or disadvantaged backgrounds. Students will be notified (August) and receive information about cancellation provisions, loan default and complete paperwork.

Program requirements and monitoring. Once awarded NFLP loan funding, students’ plans of study will be rewritten with specific educator courses required and signed (August). The Office of Academics will track and register the students each semester with loan funding provided at that time (Fall 2019; Spring and Summer 2020). Students in the program will be asked to re-sign their commitment letters each funded academic year.

Program completion, reports and post-graduation follow-up. Students will be followed at the end of each semester to ensure successful completion of the courses. Five students are scheduled to graduate from the 2018-19 NFLP funding period, and 5 from the 2019-20 funding period. Longitudinal data will include collection of teaching program level for each NFLP graduate completed by the coordinators of the DNP and PhD programs at 4-months post-graduation followed by annually for four years. Bi-annual reports for HRSA will be completed and submitted, (January and July) as required, by the Executive Associate Dean of Academics.

For more information contact Dr. Newman at newmansu@musc.edu

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Preparing PHOENIX to Fly: Building Capacity for Research on Spinal Cord Injury Peer Mentoring

Sponsor/Type: DHHS/NIDILRR
Project Period: 09/01/2022 – 08/31/2025
Susan D Newman RN, PhD, CRRN

Abstract:

This 3 year field initiated project will drive the next steps in the development and testing of our community-based, peer-led, spinal cord injury (SCI) self-management intervention known as “PHOENIX” (Peer Health Outreach, Education, aNd Information eXchange). The aims and objectives of this project support further development and refinements of our original PHOENIX intervention in preparation for future efficacy testing on a national scale. The activities of this project are designed to achieve the goal of building expanded capacity of our academic-community partnership for research on community-based SCI peer mentoring. To accomplish this goal, the Medical University of South Carolina College of Nursing is engaging with key community stakeholders (the South Carolina Spinal Cord Injury Association, United Spinal Association, More Than Walking, and the Christopher & Dana Reeve Foundation). The study aims are to 1) describe the structure, processes, and outcomes of peer mentoring valued by the SCI community using a sequential explanatory mixed methods design; and 2) evaluate the implementation of an adaptation of PHOENIX by a community-based nonprofit organization using a program evaluation approach. Results of this study will generate evidence from community-engaged research, guided by people with SCI, to inform future development, testing, and dissemination of effective, scalable peer mentoring interventions, such as PHOENIX, for this population. Our long range goal is the development of evidence-based standards that will facilitate future design and rigorous study of community-based peer mentoring programs that promote improved community living and participation outcomes for people with SCI.

For more information contact Dr. Newman at newmansu@musc.edu

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Implementation of Home-Based Palliative Care in Limited Resource Settings

Sponsor/Type: NIH/NCI
Project Period: 08/01/2020 – 07/31/2023
Suparna Qanungo, PhD

Product Summary/Abstract:

The extremely limited use of palliative care in low resource settings exacerbates suffering in patients with life-limiting illnesses such as cancer. This is particularly a problem for patients living in rural areas where barriers to care are even more pronounced. These barriers include factors such as distance from a cancer center, lack of healthcare providers in rural communities, restrictive morphine access policies, lack of transportation and treatment costs. For these reasons, most patients living in rural communities never receive palliative care or even basic pain management. In recognition of the urgent need for palliative care in limited resource settings, the World Health Organization released the Palliative Care Toolkit as a resource that community members can use to deliver palliative care in their own communities. The toolkit provides evidence-based educational materials to manage the physical, emotional and practical challenges of life-threatening illnesses, along with data collection instruments to assess and manage patient needs. We will carry out a pragmatic clinical trial to evaluate implementation of a novel Pal-Care intervention that will leverage community health workers to facilitate the delivery of basic palliative care using the Palliative Care Toolkit. The study will be conducted at the Tata Medical Center in Kolkata India, among their patients who reside in the 24 Parganas region outside of Kolkata, India. With randomization at the patient level, there will be an intervention group which will receive home-based palliative care services from a community health worker trained in palliative care and a control group which will receive standard cancer-center based palliative care services. Two specific aims will be evaluated within the study. Aim 1 will be to evaluate implementation of the home-based palliative care intervention within the context of the RE-AIM Framework domains (e.g. Reach, Effectiveness, Adoption, Implementation and Maintenance). To evaluate this aim, we will triangulate data from multiple data sources, including pre-post surveys to evaluate the community health worker training, palliative care logs completed by navigators while delivering care, meeting minutes and post-intervention interviews with cancer center stakeholders (clinical team, health workers and patients/caregivers). Aim 2 will be to evaluate outcomes of this intervention to determine its relative effects compared to a standard control group on diverse patient endpoints, including palliative care needs, symptom burden, quality of life and experience with care.

For more information contact Dr. Qanungo at qanungo@musc.edu

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A Scalable mHealth Resource to Facilitate Behavioral and Emotional Recovery after Pediatric Traumatic Injury

Sponsor/Type: NIH/ Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Project Period: 07/15/2020 – 06/03/2025
Leigh Ridings, PhD

Abstract:

Pediatric traumatic injury (PTI) is a public health priority, with nearly 300,000 children incurring injuries so severe that they require hospitalization each year. PTI is associated with annual individual and societal costs of $87 billion and elevates risk for posttraumatic stress, depression, and other health risk consequences that affect quality of life, physical recovery, emotional and behavioral outcomes, family roles and routines, and academic functioning. Follow-up care for affected children and caregivers is critical to support behavioral and emotional recovery, but few trauma centers provide these services and established, scalable models of care are lacking. Cost-effective, sustainable interventions are needed to reduce barriers to care and reach families that need it most. Pilot data collected by the candidate suggest that a technology-enhanced model of care is appealing to caregivers and has high potential to address service barriers by providing real-time assistance to help caregivers manage their own distress and their children’s behavioral and emotional recovery. The candidate proposes to develop and systematically evaluate CAARE (Caregivers’ Aid to Accelerate Recovery after pediatric Emergencies), an intervention informed by our ongoing clinical initiatives together with results of qualitative semi-structured interviews with caregivers of young children after PTI. CAARE will consist of education, self-monitoring, and coping resources.

Specific aims include:

1. Finalize the CAARE model and research protocol with ~15 caregivers after PTI;
2. Pilot test CAARE via an open trial (n=60)
3. Assess CAARE implementation feasibility with families (n~20), trauma center directors (n~15), and program managers (n~15)

The research environment, facilities, and resources at MUSC are ideally suited for mentored career development in child traumatic stress research.

Dovetailing with the research aims, K23 training objectives are to:

1. Develop proficiency in clinical trial design, implementation, and evaluation
2. Eenhance proficiency in the use of iterative-design technology-based solutions
3. Develop expertise in implementation science
4. Enhance statistical training in clinical trials, longitudinal analyses, and qualitative data analysis
5. Expand skills in scientific communication, including grant writing, presentations, and publications

Mentorship and consultation from experts in pediatric trauma, health technology solutions, implementation science, and advanced statistics will ensure training goals are met. The candidate’s long-term career goal is to establish a research portfolio that develops, rigorously tests, and scales innovative, cost-efficient, evidence-based health technology resources to improve access and quality of care for trauma-impacted families in real-world settings. These research and training goals directly correspond with priorities detailed in NICHD’s Pediatric Trauma and Critical Illness Branch, and will allow the candidate to become an internationally recognized leader in child and family trauma prevention and treatment research. The training proposed herein is designed to develop expertise in this area, represents a clear progression from prior training, and would not be possible without this K23.

For more information contact Dr. Ridings at ridingle@musc.edu

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Improving Quality of Care in Child Mental Health Service Settings

Sponsor/Type: NIH/NIMH
Project Period: 08/01/2017 – 05/31/2023
Ken Ruggiero, PhD

Abstract:

Assuring children access to the highest quality mental health care is a top national priority. Yet, quality of care continues to be highly variable in traditional service settings. Novel, scalable solutions are needed to address modifiable quality-of-care indicators in sustainable ways. To this end, provider fidelity and children’s engagement are key correlates of clinical outcome and practical targets for intervention. There is tremendous opportunity to address both through technology. Studies in child education show that interactive games, touch-screen learning, and demonstration videos enhance engagement, knowledge, motivation, and learning. These benefits also may extend to the therapeutic context, where strategic integration of technology-based activities may enhance children’s learning, strengthen the therapeutic alliance, and keep providers on protocol. We are in the final stages of an NIMH R34 in which we piloted a patient- and provider-informed tablet-based toolkit designed to facilitate delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – a treatment that was selected because it addresses a wide range of symptoms using techniques shared by other treatments for emotional and behavioral disorders. The tablet-based toolkit consists of numerous components (e.g., videos, interactive games, drawing applications) that are designed to facilitate provider-patient interactions in a way that enhances children’s engagement and supports adherence to the treatment model. The tablet-based toolkit was very well received by children, caregivers, and providers in our pilot work. Moreover, all benchmarks for feasibility outlined in our NIMH R34 application were met or exceeded. We now propose to conduct a hybrid effectiveness-implementation trial to examine the extent to which the tablet intervention may improve fidelity, engagement, and children’s mental health outcomes. We will conduct a randomized controlled trial with 120 mental health providers and 360 families in partnership with dozens of clinics in the Carolinas and Florida. Providers will be assigned randomly to tablet-facilitated vs. standard TF-CBT. Youth aged 8-16 years with clinically elevated symptoms of PTSD will be recruited. Baseline and 3-, 6-, 9-, and 12-month post-baseline assessments will be conducted by independent, blind evaluators. Sessions will be video recorded for observational coding of engagement and fidelity by independent raters blind to study hypotheses. We will also examine costs and conduct semi-structured interviews with families, providers, supervisors, and agency leaders to inform future dissemination and implementation initiatives. Technology-based resources that are scalable, easy to use, and designed for efficient integration into everyday practice may have sustained national impact. The return on investment of these initiatives will ultimately rest on their potential to improve the spread of best-practice treatments and the quality with which they are delivered to the children who need them.

For more information contact Dr. Ruggiero at ruggierk@musc.edu

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Optimizing Efforts to Restore Psychiatric and Social Function After a Major Hurricane

Sponsor/Type: NIH/NIMH
Project Period: 04/01/2020 – 02/29/2024
Kenneth J. Ruggiero, PhD

Abstract:

The 2017 fall Atlantic hurricane season, including Hurricane Harvey, was the most extreme in recorded history, and, in light of global climate change, a possible harbinger of future seasons to come. It is increasingly critical to understand how potentially modifiable pre-, peri-, and post-hurricane factors shape the long-term mental health of affected populations, so that we may optimize interventions to limit the ultimate impact of such storms. Individual-level experiences during and after hurricanes – such as displacement and job loss – shape post-hurricane mental health, but a better understanding of how these individual-level events interact with community-level factors to produce outcomes could help us to further tailor treatment approaches for individuals and communities in disaster settings. Critically, very little is known about the effects of hurricane relief efforts – including housing and income assistance – on longer-term outcomes. We will address these gaps using a pre-, peri-, and post-hurricane framework to organize the influences of exposure characteristics and sequencing on mental health outcomes. In our first aim, we will characterize how interactions among pre- hurricane capacities (e.g., social capital) and vulnerabilities (e.g., poor housing quality) as well as peri- hurricane stressors (e.g., power outages) and protectors (e.g., efficient government responses) – at both individual and community levels – shape post-hurricane depression and post traumatic stress disorder. In our second aim, we will identify and test the effects of hypothetical interventions on post-hurricane mental health through discrete stochastic simulations, under varying profiles of pre-, peri-, and post-hurricane capacities, vulnerabilities, stressors, and protectors derived from aim 1. The primary goal of this proposed project is to build on and validate prior simulation analyses to create a set of first-in-class simulation models to identify optimal approaches to mental health services following natural disasters, and to project their public health impact. To achieve these aims, we will geographically sample and survey individuals who lived in Hurricane Harvey-affected areas of Texas about their experiences, incorporating a recall validation subsample with previously collected pre-hurricane data. We will also capitalize on archival data by collecting variables at the community level such as income inequality measures, quality of built environment, and hurricane exposure indicators, to perform multilevel analyses across varying geographic levels. Finally, we will leverage data from our de-novo survey to create synthetic populations with varying combinations of pre-, peri-, and post-event factors, and use data from an ongoing post-hurricane randomized control trial to calibrate and validate simulation models. Such in-silico experiments will shed light on the effectiveness of candidate interventions and help us to understand their potential benefits, including comparative treatment- and cost-effectiveness. This project will bring together an experienced team using novel methods to tackle an essential and timely public health problem, the implications of which may also be extended to other types of disasters and contexts.

For more information contact Dr. Ruggiero at ruggierk@musc.edu

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Testing a Scalable Model of Care to Improve Patients’ Access to Mental Health Services after Traumatic Injury

Sponsor/Type: AHRQ
Project Period: 05/01/2022 – 02/28/2026
Kenneth J. Ruggiero, PhD

Abstract:

Annually, traumatic injuries affect roughly 3 million people in the US and account for over $650B in costs. Many patients are resilient and recover well emotionally, but over 20% (~600,000 people per year) develop mental health problems such as posttraumatic stress disorder and depression, both major risk factors for social and occupational impairment; poor physical health and quality of life; and lost productivity, work, and financial resources. Most trauma centers do not address the mental health recovery of patients after a traumatic injury. This gap in the quality of patient care, combined with unique barriers to mental health services that traumatic injury patients face, necessitates a cost-effective intervention that meets the needs of these patients at each stage of the recovery process. We will test the Trauma Resilience and Recovery Program (TRRP), a scalable, sustainable technology-enhanced intervention to support the mental health recovery of patients who have experienced a traumatic injury. The model includes education, risk screening, and brief intervention at the bedside (Step 1); symptom self-monitoring and continued education via a daily text messaging system (Step 2); mental health screening at 30 days via chatbot or telephone (Step 3); and, when appropriate, mental health treatment referrals (Step 4). Our previous work has provided strong support for the acceptability and feasibility of TRRP: (1) 98% of patients approached at Step 1 by TRRP staff at the bedside enroll in mental health follow-up, (2) more than 2 in 3 patients enroll in the symptom self-monitoring system (Step 2), and (3) 75% of patients who screen positive for PTSD or depression at the 30-day call (Step 3) accept treatment referrals (Step 4). TRRP staff has provided mental health follow-up to over 8,000 patients to date, only about 400 of whom would have received mental health follow-up services under usual-care conditions based on the results of our needs assessment. We are implementing TRRP in 12 trauma centers in the Carolinas, 4 of which already have fully implemented it. This experience has informed the approach we propose to use in partnership with George Washington University (GWU) hospital. We will conduct a randomized controlled trial with 1-year follow up of TRRP vs. enhanced usual care with 350 patients at GWU, which serves a diverse population of ~2000 traumatic injury patients per year (15% penetrating mechanism). Engagement in mental health services and clinical and functional outcomes will be assessed 3, 6, and 12 months post-baseline by trained interviewers blind to study condition. Qualitative interviews will be conducted with 20 TRRP patients who have experienced violent trauma as well as 15 African American and 15 Latinx patients who have experienced non-violent trauma. These data will inform improvements to the TRRP model as well as the implementation process in preparation for a future hybrid implementation-effectiveness trial with 8 trauma centers. This body of work is critical to informing the field as it continues to move toward national standards and recommendations.

For more information contact Dr. Ruggiero at ruggierk@musc.edu

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CBT by Phone to Promote Use of Alcohol Related Care and Reduce Drinking

Sponsor: Sub. University of Rochester/NIH/NIAAA
Project Period: 09/01/2018 – 08/31/2023
Tracy Stecker, PhD

Abstract:

Numerous evidence-based treatments for alcohol use disorder (AUD) have been developed, and research shows that individuals who obtain alcohol specialty care have improved drinking outcomes and are more likely to recover, yet a small percentage of individuals with AUD obtain treatment. Use of Screening, Brief Intervention, and Referral to Treatment (SBIRT) interventions is a potential strategy to increase treatment seeking, yet there is little evidence that these interventions increase participation in alcohol-related care and a lack of evidence that such care serves as a mechanism for improved drinking outcomes. The current randomized controlled trial (RCT) of a one session intervention delivered by telephone seeks to address these gaps in evidence. The specific aims are to show that research volunteers ages 18 and older with AUD who are assigned to the intervention compared to an information control condition are more likely to initiate alcohol specialty care (aim 1), have decreased frequency of alcohol use (as measured by percent days abstinent) and intensity of alcohol use (as measured by drinks per drinking day) (aim 2), and that treatment engagement serves as a mediator of the improved drinking outcomes (aim 3). Innovations include the use of an SBIRT intervention based on the theory of planned behavior and cognitive behavioral treatment principles and that the intervention was developed for phone administration from the onset and was explicitly designed to promote treatment engagement. The project is in response to PA-15-299, Alcohol Use Disorders: Behavioral Treatment, Services, and Recovery Research. It builds on a smaller efficacy trial that showed that the intervention leads to increased engagement in alcohol-related care (Stecker et al., 2012) and extends that study in several ways including through the use of a priori tests to determine efficacy of the intervention to improve drinking outcomes and that treatment engagement serves as a mediator of the improved outcomes.

For more information about this trial contact Dr. Stecker at stecker@musc.edu.

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Investigations to Improve Treatment Seeking Among Those At-Risk for Suicide

Sponsor: Warren Alpert Foundation
Project Period: 01/01/2021 – 12/31/2022
Tracy Stecker, PhD

Abstract:

Dr. Stecker will develop grant applications and strategies to improve treatment uptake among those at risk for suicide. Strategies may include brief cognitive-behavioral interventions such as CBT-Treatment Seeking or more lengthy CBT interventions such as CBT-Loneliness.

For more information about this trial contact Dr. Stecker at stecker@musc.edu

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Fostering Medication Adherence in Children with Epilepsy using mHealth Technology

Sponsor/Type: Sub. Cincinnati Children’s Hospital Medical Center/NIH/NINR
Project Period: 08/01/2018 – 05/31/2023
Janelle L. Wagner, PhD

Abstract:

Non-adherence to antiepileptic drugs (AEDs) is a common problem (i.e., 58% of patients have some level of non-adherence) for young children with newly diagnosed epilepsy, with potentially devastating consequences. AED non-adherence is associated with a 3-fold increased risk of seizures, poor quality of life, inaccurate clinical decision-making, and higher health care utilization and costs. One of the primary barriers to adherence is forgetting, which may be particularly amenable to mHealth (mobile technology in healthcare) interventions. Despite the critical need to develop and implement interventions to improve adherence, there are few family- based interventions for young children with epilepsy and their families, with the exception of the PI's pilot and existing R01 trial. Although highly promising, this intervention requires six in-person sessions, which can be impossible for families who lack routine access to tertiary specialty care due to time, financial, or transportation constraints. Thus, unmet medical and psychosocial needs of the underserved pediatric epilepsy population are perpetuated and compounded by limited access to this state of the art care. Our overall goal is to test a mHealth adherence intervention that is easily accessible using a stepped up care model based on individual needs. This stepped up care model will conserve patient, family, and provider time, costs and resources. The aim of this multi-site R01 is to conduct a two-stage, sequential, multiple assignment, randomized trial (SMART) to evaluate the effectiveness of mHealth intervention strategies for improving AED adherence in caregivers of young children with epilepsy. A two-month baseline period will be followed by two stages. In Stage 1 (3-months long), non-adherent caregivers (less than 95%) will be randomized to a mHealth education module and automated digital reminders (control) or the mHealth education module, automated digital reminders, and individualized adherence feedback based on real-time adherence monitoring (treatment) to address the primary barrier of forgetting. At the beginning of Stage 2 (two months long), caregivers randomized to treatment who do not achieve adherence greater than 95% (response) by the end of Stage 1 will be re-randomized to either continued individualized adherence feedback or individualized adherence feedback augmented with two mHealth problem-solving modules (translated from the PIs existing RCTs) with a therapist. Thus, there are three intervention strategies embedded in this SMART: #1 control, #2 treatment, and #3 problem-solving augmented treatment if nonresponsive at three months. The primary outcome is electronically-monitored adherence and secondary outcomes include seizure severity/frequency, quality of life, and healthcare utilization. If the aims of the project are achieved, this study would have a large impact on pediatric epilepsy, with the potential to change clinical practice for treating non-adherence. The SMART design would allow us to identify patients who are most likely to respond to interventions and step up care with more time- and resource-intensive interventions (i.e., problem-solving with a therapist via the web), when necessary.

For more information contact Dr. Wagner at wagnerjl@musc.edu

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Healthy Steps

Sponsor/Type: First Steps South Carolina

Project Period: 04/01/2022 – 09/30/2024

Amy Williams, DNP, APRN, CPNP-PC

Task Overview and Description

HealthySteps, is an evidence-based, team-based pediatric primary care program that promotes the health, well-being and school readiness of babies and toddlers, with an emphasis on families living in low-income communities. The program is led by a HealthySteps Specialist, who joins the pediatric primary care team to ensure universal screening(s), provide successful intervention, referrals, and follow-up care to the whole family. All families will receive HealthySteps universal services. Families with additional needs will receive tier 2 (short-term support for mild concerns) or tier 3 (comprehensive serves for families most at risk).

The HealthySteps model consists of the following 8 Core Components: 1) child development, socio-emotional, and behavioral screening; 2) screening for family needs (i.e., maternal depression, other risk factors, social determinants of health); 3) child development support line (i.e., phone, text, email, online portal); 4) child development and behavior consults; 5) care coordination and systems navigation; 6) positive parenting guidance and information; 7) early learning resources; and 8) ongoing preventive team based well-child visits. 

The HealthySteps model seeks to serve all children and families birth to 3 years of age and is designed to be integrated into pediatric primary care or family medicine clinics throughout the nation. However, partnerships are encouraged to target clinics that serve the most at-risk families. School readiness risk factors targeted by HealthySteps include those associated with family need (poverty, maternal/caregiver risk factors) and child development risk factors (developmental delay, behavioral concerns).

Although there is no minimum length of time for the program, research has shown that the longer families are involved with the program, the more positive effects are seen. In order to ensure the delivery of high-quality services and the validity of agency-wide evaluation efforts, MUSC and Local Partnerships shall ensure that each SC First Steps-funded strategy is implemented with fidelity to its published, research-based model.

For more information contact Dr. Williams at williamy@musc.edu

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