Currently Funded Research Projects
Do You Really Expect Me to get MST Care in a VA Where Everyone is Male? Innovative Delivery of Evidence Based Psychotherapy to Women with Military Sexual Trauma
Veterans who experience military sexual trauma (MST) are at heightened risk of developing psychiatric difficulties such as post-traumatic stress disorder (PTSD). Although the Veterans Health Administration (VHA) has identified MST positive Veterans as a high priority population, this group of Veterans may under-utilize evidence-based interventions for PTSD such as Prolonged Exposure (PE). Likely reasons for this under-utilization include unique barriers to care faced by MST survivors such as avoidance of VA medical facilities due to their potential to cue distressing memories and symptoms. The current study includes a randomized controlled study design comparing treatment engagement and clinical and quality of life outcomes between two groups: Veterans receiving PE for PTSD-related MST via homebased telehealth (PE-HBT) and Veterans receiving PE for PTSD-related MST via standard service delivery (PE-SD). The intervention component of the study is complemented by a qualitative component (i.e., patient interviews) designed to better understand Veterans’ reactions, preferences, difficulties, and suggestions for the intervention, as well as to solicit feedback about this patient population’s service needs and preferences more broadly. All Veterans enrolled in the study (i.e. Veterans in both groups) will benefit from receiving a well supported intervention for PTSD, Prolonged Exposure (PE), to address their MST-related symptoms. As such, all Veterans have the potential to experience significant symptom reduction related to their military sexual trauma post-intervention (i.e., within 12 weeks). However, women assigned to receive PE via home-based telehealth will have the particular advantage of being able to receive services from their home, thereby circumventing some of the traditional access to care barriers faced by this clinical population. It is anticipated that this advantage will result in increased session attendance and compliance, which in turn will result in better clinical and quality of life outcomes due to increased ‘dosing’ of the intervention. Thus, it is predicted that Veterans in PE-HBT will evidence better treatment engagement and more significant symptom improvement relative to Veterans in PE-SD. Treatment gains include a reduction of PTSD and other psychiatric symptoms such depression, as well as more global improvements in quality of life and social/occupational functioning. If, as anticipated, women in PE-HBT evidence improved outcomes relative to women in PE-SD, the current study findings can be used to establish an innovative service delivery model that will circumvent traditional barriers to care in an underserved, yet high risk patient population. Regardless of study outcomes, the proposed project stands to fill significant gaps in the literature with regard to how to optimally engage and retain MST positive Veterans in VA mental healthcare. Additionally however, there is only one PTSD treatment outcome study focused exclusively on female Veterans and no extant studies testing home-based telehealth for sexual assault victims. Thus, the proposed project also stands to make a significant contribution to mental health service delivery models for female Veterans and sexual assault victims more broadly.
Sponsor/Type: Sub with Veterans Education and Research Association of Michigan (VERAM)
The current research study aims to compare the effectiveness of two proven treatments for posttraumatic stress disorder (PTSD): Prolonged Exposure (PE), sertraline, and their combination. In addition, the investigators are examining predictors of response to these two treatments and how PTSD symptoms, thoughts, and biological factors may be changed by such treatments. In addition, the investigators will examine acceptability of each treatment and reasons for ending treatment.
Official title: Randomized Trial of Sertraline, Prolonged Exposure, and Their Combination for Post-traumatic Stress Disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF).
Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
Primary outcome: Posttraumatic stress disorder (PTSD) symptoms as measured by the Clinician Administered Posttraumatic Stress Disorder Scale (CAPS)
Secondary outcome: Posttraumatic stress disorder (PTSD) related psychopathology, including depression, alcohol and substance abuse, and general anxiety
RWJF Future of Nursing
This proposal requests support for two RWJ Future of Nursing Scholars for the MUSC Online PhD in Nursing program. Our program strives to take nursing science to the highest level in a culture of innovation, collaboration and accountability. We define nurse scientists as nurses who plan to pursue a research interest with a program of externally funded research using rigorous, well-designed methods that address a gap in the care of vulnerable populations. We demonstrate the resources, experience, and innovation to successfully mentor a focused student through the 45 semester-hour online program in three years. This program is streamlined to focus on the essential competencies to the developing nurse scientist yet include diverse opportunities for mentored and elective work in policy, teaching, research, and leadership.
Our experience in mentoring students in a distance format is reflected in our ranking as #2 among online graduate programs in US News and World Report. Mentoring and academic support services delivered in an online format are time tested and ready. We will supply these RWJ scholars with a senior peer, a faculty advisor, comprehensive academic support course, a writing specialist and link them to our 2014 RWJ Scholar during the summer before classes even begin. The scholars will be mentored and taught by a faculty that reached 17th in NIH funding, with 75% (12/16) of the educator-research faculty funded as PI’s on federally funded grants. In the past five years, we have obtained 7 NIH R01 awards and additional NIH training and pilot awards. PhD students played a strong role in the research funding effort, with 5 of the 26 submitted proposals initiated by students. We have faculty with experience in mentoring post docs and participation in T-32s. About 80% of our PhD alumni are working as faculty and a majority are employed in research intensive environments. We benchmark our program success through the publications and funded grants of our current students and alumni.
The CON faculty is known for a range of funded work and populations that extends from population-based interventions to the physiological investigation of caring for chronic and acute illness. Our Office of Research highlights four stepwise mechanisms to help students with proposal development and implementation, and is supported by pre- and post-award support personnel and systems.
Our approach to diversity and inclusiveness is evidenced in our diverse student profile and high retention. We have 25 - 50% minority students any given year and an 89% rate of graduation. Our commitment to health equity, vulnerable populations, and diversity is reflected in every course. This same content is integrated into rich community based research opportunities with minority and vulnerable populations. CON faculty play key leadership roles in the NIH funded MUSC South Carolina Clinical and Translational Institute (SCTR). The South Carolina Clinical & Translation Research Center for Community Health Partnerships (SCTR/CCHP),dedicated to engaging community members and academic partners in all aspects of the research process to promote health, reduce the risk of illness and disease, and build community resilience to help transform health care and eliminate health disparities. Other intra-institutional research collaborations include the Center for Health Disparities Research, Hollings Cancer Center, College of Medicine, College of Dental Medicine, and College of Health Professions, and the VA. The RWJ scholar will participate and observe the working mechanism of these interdisciplinary SCTR cores, as well as assist in the academic products that result from them.
We are able to comply with all program requests and will meet the matching contribution required by the grant as detailed in the narrative.
Sponsor/Type: NIH/NIMH F32
Most evidence-based interventions in traditional mental health care require that patients participate in activities outside of the treatment setting (e.g., at home or in other relevant settings). These homework (HW) assignments increase generalization of skills learned in the treatment setting and play a crucial role in positive outcomes (i.e., decreased symptom severity, increased recovery and treatment retention) and ultimately the quality of child mental health services. Despite being an integral component of treatment, systematic use of and adherence to HW assignments generally is low to moderate, and thus results in poorer clinical outcomes and increased dropout. Solutions that effectively improve HW utilization and adherence may have potential to improve the efficiency of treatment, completion of treatment, and benefit from treatment. The candidate has proposed a wide range of training opportunities to prepare him to lead multi-disciplinary, innovative research that identifies, evaluates, and disseminates technology-based solutions designed to improve quality of care in child mental health treatment. His proposed pilot under this F32 will make use of qualitative interviewing methodology to take initial steps toward addressing provider- and patient-level barriers to HW use/adherence via mobile technology. The treatment model chosen for this project will ensure strong translatability of this work to a wide range of behavioral health treatments. Data collected during this project will be used to develop and preliminarily evaluate a “functional mockup” of a mobile application. The functional mockup will not itself be a mobile application but will allow the candidate to create a resource that has the full look and feel of a mobile application to solicit feedback from providers and families without the expense associated with development of a fully programmed web intervention or native application. Data obtained via this pilot work will guide the development of a mobile/web-based application that the candidate intends to develop and test in a subsequent exploratory study (e.g., NIH R21/R34). The proposed investigation and training program will leverage ongoing research and dissemination initiatives allowing for an ideal training environment for the candidate. The proposed F32 award will allow the candidate to continue ongoing programmatic research focusing on the integration of technology into evidence-based practice. It will also support training of the candidate toward his career goals of becoming an independent clinical researcher in this area.
Reducing Hospital Readmission Rates by Implementing an Inpatient Tobacco Cessation Service Driven by Interactive-Voice Recognition Technology
There is good reason to believe that providing tobacco cessation services to patients while hospitalized can improve clinical outcomes for patients. Smoking increases a patient’s risk for a host of negative clinical outcomes, including treatment-related toxicities and complications, medication side effects, and reduced performance status. Intervening with patients while hospitalized offers several advantages. First, patients are not permitted to smoke while in the hospital and temporary smoking abstinence may serve as a catalyst to help them remain tobacco free after discharge. Second, the illness that brought patients to the hospital may serve to motivate them to refrain from smoking. Third, hospitalized smokers have access to medical professionals and medications to assist in refraining from smoking. Thus, the Joint Commission (JC) has recommended that hospitals screen all patients for tobacco use and offer cessation services and follow up support within 1 month of discharge. Unfortunately, few hospitals implement the JC tobacco treatment standards in part because the services require extra costs, the standards are voluntary, and the financial benefits to hospitals and insurers have yet to be documented. In the future, national health policy changes may incentivize hospitals and insurers to explore how smoking cessation services may help to control healthcare costs. For example, the Centers for Medicare and Medicaid will penalize hospitals whose 30-day readmission rates exceed allowable limits for 5 conditions: 1) acute MI, 2) heart failure, 3) pneumonia, 4) COPD and 5) hip/knee replacement). The Medical University of South Carolina recently implemented an automated in-hospital smoking cessation program using IVR technology to follow-up with patients post-discharge in accordance with JC standards. This study takes advantage of in-place data capture mechanisms that allow efficient linkage between hospital clinical system, cessation program and statewide healthcare utilization datasets to examine hospital readmission and cost outcomes. The proposed study will use an interrupted time series design to examine monthly trends in readmission rates before (01/01/13-12/31/13) and after (02/01/14-01/31/15) program implementation, allowing us to test the hypothesis that an automated inpatient smoking cessation program will reduce unplanned readmissions and healthcare costs. This study provides an efficient way to examine whether investing in tobacco cessation services can help hospitals to avoid readmission penalties and reduce healthcare costs via secondary data analyses.
Expanding the Reach of a Novel Mental Health Service for Traumatic Injury Patients
To expand the trauma/telehealth resilience and recovery program in South Carolina. The purpose of this proposal is to seek support to expand our services to three additional trauma centers in South Carolina.
The Choose Well Initiative
Choose Well is a statewide initiative of the New Morning Foundation, whose goal is to substantially and measurably reduce unintended pregnancy among women and teens in South Carolina over a 4-year period (2017-2020). This collective impact initiative will involve a wide range of partners, including state agencies and coalitions, health care services, schools and colleges of nursing and medicine, and community-based and community-serving organizations, whose individual and collaborative work will result in better access to highly effective contraceptive methods and a decrease in unintended pregnancy.
Building the Healthcare Workforce to Serve the Underserved
The goal of this proposal is to develop a model of integrated clinical experiences for interprofessional teams of students within the safety net delivery systems to establish a network of teaching community health centers. This proposal builds on the momentum established by the AHEC Institute for Primary Care, a collaboration between the Medical University of South Carolina (MUSC) and East Cooper Community Outreach (ECCO) to provide care to the uninsured, and an interest by Fetter Health Care Network (FHCN), a Federally Qualified Health Center, to build a pipeline of primary care providers to serve the underserved.
Identifying and Intervening in Elder Abuse
SC community (not nursing home) elder abuse prevalence is 10%, but detection by healthcare providers is less than 1%. There is a lack of training in elder abuse during nursing/medical education; and there is a lack of skills & knowledge to screen & intervene in primary care settings. We address this need by training1. primary care providers (nurse, MD, PA) & 2.
students (nursing, medical, & PA) to assess & intervene in elder abuse.
1. Training health care providers in clinics across the tri-county area to screen, intervene and refer victims of elder abuse, with an emphasis on clinics and providers that serve minority populations, for which elder abuse rates are higher.
2. Training students of the health care professions in the Medical University of South Carolina (medical students, nursing students, physician assistant students) about elder mistreatment prevalence, risk factors, and how to screen, intervene, and refer for services for elder abuse, particularly in minority populations.
3. Training Trainers to teach others how to screen and identify, intervene, and refer elder abuse victims for services in healthcare settings so that the program is grown and sustained far beyond initial VOCA funding.
Sponsor/Type: NIH/NINR - R21
Monitoring and managing newly healed chronic leg and foot ulcer skin temperature: a cooling intervention (MUSTCOOL) to prevent ulcer recurrence
The goal of this randomized control trial is to test a patient directed self-monitoring and self-management intervention aimed at preventing the recurrence of chronic venous leg and diabetic foot ulcers using skin temperature and cryotherapy (cooling). We propose MUSTCOOL, a novel ulcer prevention strategy for patients at highest risk for developing chronic ulcers; those with a previous history. We aim to compare a cooling treatment to a placebo to determine the outcomes on ulcer recurrence, pain, physical activity and quality of life.
Individuals with newly healed chronic ulcers will be invited to participate in MUSTCOOL’s two component intervention: 1) self monitoring skin temperature over targeted “hot spots” daily with an infrared thermometer; and 2) maintenance cooling with a cooling pack (or placebo pack) placed over the “hot spot” three times each week for 30 minutes. If the temperature of the “hot spot” becomes elevated 2°F above baseline (average of 30 days of daily temperature readings) for 2 days in a row, a bolus regimen of 5 consecutive daily, 30 minute applications of the cooling or placebo pack will be implemented. We will monitor safety and side effects, however, there have been no reported adverse events reported in our previous cryotherapy studies.
We designed this chronic ulcer prevention intervention that targets the remodeling phase, the final repair process of healing after chronic ulcer closure. The skin environment is particularly vulnerable to ulcer recurrence due to a persistent aberrant inflammatory state. Our previous research has demonstrated that cooling this skin reduces the abnormal metabolic activity, protecting it against ulcer recurrence. Recent advancements in infrared technology allow us to take images of the affect skin to identify the area that has the highest temperature or vulnerable “hot spot”. These “hot spots” will be self monitored by patients with newly healed ulcers in the home with an infrared thermometer that date and time stamps each reading. The study’s outcomes on physical activity will be evaluated with an accelerometer. We hypothesize that by improving the skin environment and reducing pain, patients will more likely be physically active and have better quality of life, all measurable goals for this study.
We will evaluate this prevention strategy over six months in 180 patients, 90 of whom will be randomized to receive the cooling pack and 90 the placebo. Our goal is to test this non-pharmacological, non-invasive clinical intervention as a tailored self-management strategy to prevent chronic ulcer recurrence. It will also determine alleviation of symptoms such as pain, and the debilitating effects on physical activity and quality of life.
Technology Enhanced Self-Management Interventions for Fatigue and Pain: The Symptoms Self-Management Center
The overall goal of the Symptoms Self Management Center is to build a critical mass of research thematically focused on targeting symptoms of fatigue and pain through complementary, synergistic research activities. Toward this end, the National Institute on Nursing Research-funded (NINR-P20) Symptom Self Management Center (SSMC) at the College of Nursing, Medical University of South Carolina, provides the infrastructure and context for nurse scientists who will:
Community-based Intervention under Nurse Guidance after Stroke (CINGS)
Stroke is the leading cause of severe disability in Americans, and African Americans (AA) are at the highest risk for stroke with rates approximately twice those of Whites. Also concerning, stroke in AA occur at younger age, and with higher severity than whites. Despite being affected at younger ages, AAs are less likely than whites to return to equivalent functional status and are more likely to die following stroke. This disparity cannot be explained by access to acute care or rehabilitation, but may relate to other personal, familial, and community factors that remain understudied. Because diabetes and hypertension are more prevalent among AA relative to Whites, and because both are significant risk factors for stroke, complex factors underlying these chronic diseases very likely also contribute to increased rate and relatively poor outcome of stroke found in AA. To address these complex issues, an innovative, coordinated approach is required that considers patient, family, and community level factors, both to explain disparate stroke recovery rates and to design and implement efficacious interventions for post stroke recovery in community residing AA patients. We have designed and successfully implemented precisely such an approach with Diabetes Belt communities and propose to do so for Stroke Belt communities as well through the Community-based Intervention under Nurse Guidance after Stroke (CINGS), a 12 week, nurse-coordinated, community health worker-delivered home-based intervention. Therefore, we propose to (1) Identify primary barriers and facilitators of post-stroke recovery for AA in the US Stroke Belt Buckle of SC through formative qualitative research (i.e., interviews, focus groups) with AA patients with stroke, their families, community leaders, and public health practitioners. (2) Develop CINGS intervention components to improve AA stroke recovery and community participation in stroke recovery activities by integrating evidence-based guidelines and AA community generated evidence to address factors that perpetuate disparity in stroke recovery. And (3) Subject CINGS to a pilot RCT with approximately 60 patients obtain variability estimates, measure preliminary effects, and explore potential relationships with mediators/moderators. We hypothesize that the intervention group will significantly improve along impact and outcome measures of interest as compared with the usual care group.
Novel Intervention Linking Public Housing with Primary Care to Prevent Diabetes
African American (AA) women are 80% more likely to be obese than their non-Hispanic, white counterparts. AA women are also at disproportionate risk for negative obesity-related health outcomes, including type 2 diabetes, hypertension, dyslipidemia, heart disease, and cancer. Further, AA women living in racially segregated, impoverished inner city neighborhoods are at even higher risk for obesity and associated sequalae, a set of problems exacerbated by the fact that they lack access to primary care and community related resources. To address barriers to primary care among these high-risk groups, Federally Qualified Health Center (FQHC) Primary Care Networks were formed, and now offer services to low SES patients who would otherwise go without care. However, DPP adaptation to this type of setting (that is, exporting DPP interventions to public housing) has not been thoroughly evaluated. Thus, there is a prime opportunity to examine whether novel partnerships linking FQHC networks with Public Housing infrastructure to deliver modified DPP programs directly into high risk communities are effective in reducing obesity and diabetes risk.
The goal of this R34 two-year planning project is to develop, implement, and evaluate a pilot multi-level DPP intervention. In this pilot study, we will use a randomized wait list control design to allocate 60 participants to pilot test a translational community based DPP intervention or FHCN/FQHC usual care. The specific aims are to: 1) Evaluate the feasibility, acceptability and implementation of the SHAPE UP intervention in Public Housing settings in the context of FHCN/FQHC infrastructure, using RE-AIM process and outcome indicators. 2) Conduct a preliminary evaluation of this intervention's effectiveness including weight loss at 24 weeks (primary outcome), secondary impact physiological measures (e.g., glucose, A1C, BP, lipids) and behavioral measures (e.g., physical activity (PA), nutrition) in intervention vs. control arms to estimate variability of measures for subsequent sample size calculation.
This highly significant and novel study by an experienced team with an extensive partnership history will provide preliminary data to inform an adequately powered, larger randomized controlled trial
Innovative Treatment for Female Victims of Military Sexual Trauma
Female Veterans report experiencing sexual assault while in the military at rates 400% that of their civilian counterparts. However, the overwhelming majority (over 95%) choose not to obtain services from the VA hospitals for emotional problems resulting from these sexual assaults. This may be because VA services and providers are usually male oriented. This project offers evidence-based counseling services tailored to these female victims of Military Sexual Trauma in an innovative context.
1. Formal agreements for sail training and counseling of Military Sexual Trauma Victims will be made between the non-profit Veterans on Deck and MUSC.
2. Formal volunteer rosters of counselors trained to treat sexual trauma and Military Sexual Trauma will be finalized (6 counselors at the Charleston VA PTSD Clinical Team have already indicated they are willing to volunteer during non-duty hours).
3. Female victims of Military Sexual Trauma will receive counseling services via on the water training.
A Virtual Learning Collaborative for Alcohol Screening, Brief Intervention and Treatment in Primary Care
This R25 application represents an innovative, virtual learning collaborative (VLC) in which primary care practice clinicians and staff will engage in web-based learning, quality improvement planning and review of performance on alcohol screening, brief intervention and medication management measures over a 12-18 month timeframe. This VLC will promote the dissemination and implementation of alcohol guidelines developed by the National Institutes of Alcohol Abuse and Alcoholism, and use sound implementation science concepts to foster effective adoption of strategies to improve practice outcomes.
For more information contact Dr. Nemeth at email@example.com
Bounce Back Now: A Low-Cost Intervention to Facilitate Post-Disaster Recovery
Fire Prevention & Safety: Web-Based Training in Behavioral Health Screening for Firefighters
The purpose of this study is to examine a novel, scalable, and sustainable intervention - Firefighters Helping Firefighters - that is designed to increase use of high-quality behavioral health care among firefighters who need it.
One in four firefighters will need behavioral health care at some point in their careers in regard to occupational impacts such as posttraumatic stress disorder (PTSD), depression, substance abuse, or marital discord. Effective behavioral health programs are widely available to address these needs, but firefighters are often resistant to reaching out and getting the help they need when needed most. Effective, cost-efficient solutions are needed to address stigma and increase readiness to seek help. Our team addressed this challenge in partnership with the National Fallen Firefighters Foundation (NFFF) by developing a novel intervention for firefighters that relies heavily on peer education. Firefighters Helping Firefighters (FHF), developed under a current Fire Prevention and Safety award, features personal stories and recommendations of firefighters and fire service chiefs regarding behavioral health and help-seeking experiences. The intervention is highly scalable (i.e., accessible via any internet-connected device) but has not yet been evaluated. If it is found to effectively reduce stigma and increase readiness to seek help among firefighters, it may have tremendous impact in the population and could serve as a national model for other high-risk populations that routinely experience occupational stressors.
The three main objectives are as follows:
Objective 1: Conduct a usability test of FHF with fire service professionals to assess thoughts, behavior, and other reactions to FHF. This will assist us in gathering critical feedback from firefighters to improve the resource and prepare it for large scale evaluation.
Objective 2: Conduct a small feasibility trial to pilot the study methodology that we propose to use in large-scale evaluation of FHF. This will include tracking of recruitment, assessment of stigma and behavioral health needs, use of the FHF resource, and retention of firefighters in the study protocol.
Objective 3: Conduct qualitative interviews to identify effective strategies to maximize uptake and dissemination of FHF. This includes assessment of barriers to dissemination. This aim will be achieved in partnership with fire service leaders across the nation.
Improving Quality of Care in Child Mental Health Service Settings
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.
Integrated Web-Based Resource to Address Risk for Substance Use Problems in the Fire Service
Firefighter substance use problems are an urgent issue, and efforts to reduce its impact on job functioning, situational awareness, and firefighter safety hold high priority. Our team has developed resources to improve the quality of education and treatment for firefighters. However, there is great need to improve substance use screening and assessment as well as ensure that firefighters receive appropriate care for these issues that are tailored to their needs. Screening, Brief Intervention and Referral to Treatment (SBRIT) is an evidence-based practice used to identify, reduce and prevent problematic use, abuse and dependence on alcohol and illicit drugs. This model has been widely used in community settings and has high applicability to the fire service. Based on our history of success of bringing accessible, no-cost behavioral health programs to the fire service, we were asked by the National Fallen Firefighters Foundation to create an integrated, web-based resource that heightens access and usage of substance use screening and brief intervention tools among firefighters, Employee Assistance Program (EAP) providers, and behavioral health professionals working with firefighters.
The goal of this application is to advance the development and evaluation of freely accessible, integrated learning resources for behavioral health providers and firefighters to facilitate screening, assessment and access to education to support behavioral health and well-being and encourage help seeking specifically related to substance use problems.
Addressing Mental Health Needs in SC by Primary Care Nurse Practitioners
The MUSC College of Nursing (CON) outcomes obtained because of BSBSSCF's 2012 grant funding are powerful, however, there is much more work to be done! Additional advanced competencies are needed by CON DNP graduates in the fluctuating health care environment in order to best serve South Carolina's (SC) future health needs. SC has significant challenges with chronic illnesses such as asthma, cancer, diabetes, and heart disease, as well as comorbid mental health conditions. There are no SC DNP programs preparing nurses for certification in mental health care in the primary care setting at this time. This proposed project would provide outcomes that meet the BCBSSCF focus areas through increasing the number of frontline health care professionals and supporting innovative approaches to knowledge and skills development. The project activities, timetable and outcomes will include:
Further growth in information technology and technology support to ensure relevancy in online programming, teaching and clinical supervision for students in collaboration in monthly meetings with CON IT staff. Outcome: curriculum map, program evaluation. Grant funding will enable the development and implementation of an innovative program that will educate critically needed primary care nurse practitioners in psychiatric-mental health care to meet the complex health care needs of South Carolina.
Advanced Nursing Education Workforce (ANEW) Program
This application requests $1.4 million in funds to support innovative academic-practice partnerships to prepare primary care APRN students in the MSN and DNP at MUSC CON. The purpose of this project is to increase the longitudinal clinical immersive training experiences with rural and/or underserved population for selected primary care APRN students, develop a clinical preceptor education and support program, and facilitate post-graduate employment in rural and HPSA and/or MUA in three nurse practitioner roles: AGNP, FNP, and PNP. The ANEW project will provide traineeships to 14-16 students who commit to at least two years of primary care work in a rural and HPSA and/or MUA after graduation. MUSC CON graduated 55 primary care nurse practitioner students during 07/01/15-06/30/16, and 100% are employed in rural, underserved and public health practice settings of which 51% are employed in HPSAs and 49% in MUAs (Data Form Table 1 Part A & B). Since 2012, a total of 110 students have received AENT (n=80) and ANEE (n=30) HRSA funding; currently 74% of their practice sites can be classified a HPSA, 77% as a MUA, and 25% as a rural, underserved area. 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:
Processes and evaluation for the ANEW program will occur as follows:
Objective 1. Full-time APRN students at any program point and part-time students in the last year will be eligible to apply. A rubric will be used to rank and fund the top students. Priority points will be awarded to disadvantaged and/or diverse students, and students who live or have clinical rotations in rural areas, MUAs or HPSAs. Students will be tracked for success and registered each semester. Students will sign a commitment letter (see Work Plan & Budget Narrative) each funded semester. Longitudinal data collected includes post-graduation position placement. An annual performance report and final report will be submitted as required.
Nurse Faculty Loan Program
This application is a 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, 2016, and MUSC is an accredited university by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC).
The objectives for this program are as follows:
Increase the number of graduate doctoral students in the BSN-DNP, post MSN-DNP, BSN-PhD and MSN-PHD programs who are prepared to become qualified nurse faculty upon program completion by:
Processes and evaluation for the program will occur as follows:
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. Longitudinal data will include collection of teaching program level for each NFLP graduate completed by the coordinators for the DNP and PhD program at 6 months post-graduation and every year for four years. Bi-annual reports for HRSA will be completed and submitted, (January & July) as required, by the Associate Dean of Academics.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Health Professions Student Training (SBIRT- Student Training)
Substance abuse ruins lives, destroys families, and increases health care costs. South Carolina is a state with significant chronic illness, including substance use paired with a large medically disenfranchised population (NACHC, 2007). The goal of this project is to improve and enhance the training of health professions students (undergraduate and graduate nursing students, and medical students) to provide competent screening, brief intervention and referral to treatment for persons who have or are at-risk for substance use disorder (SUD). With Screening, Brief Intervention and Referral to Treatment (SBIRT) training, the pool of nursing and medical professionals at every level of education and in every clinical setting will have the knowledge and skill to improve the assessment and intervention provided to active or at-risk individuals of SUD and negative sequelae. A proactive approach identifying those active or at-risk of SUD will lead to improved health, decreased health costs and poor outcomes. The basics of SBIRT are the same regardless of setting. All patients in hospitals, emergency rooms, primary health clinics, community health centers, schools, or other health care venues undergo a quick screening to assess alcohol and drug use. If they have or are at risk of developing a serious problem, they receive a brief intervention that focuses on raising their awareness of substance abuse with motivation to change their behavior. Patients who need more extensive treatment receive referrals to specialty care. SBIRT is a simple, evidence-based approach to incorporate screening for and intervention in one of our largest public health problems – substance abuse.
This project at the Medical University of South Carolina (MUSC) will implement a unique strategy to address the unmet detection and treatment needs of the underserved and active or at-risk population for SUD by: 1) educating all educator/clinical faculty at the College of Nursing (CON) and College of Medicine (COM) in the use of SBIRT (approximately 90 faculty in the first year); 2) integrating SBIRT training into existing courses in the undergraduate and graduate nursing and medicine curricula to promote competency of all nursing and medical graduates in using SBIRT (training 440 new students each year); 3) creating simulations, videos and online teaching modules, online resource library, and competency evaluations to facilitate the mastery of SBIRT for use by students; 4) enhancing the cultural and linguistic competencies of students in utilizing SBIRT; and 5) providing local and state-wide trainings through MUSC initiatives, AHEC, and health professional organizations. Health care providers have highlighted the need for specific knowledge and skills training to provide interventions for those active or at-risk of SUD. Embedding this training into the core curricula assures its implementation and sustainability. More importantly, this training program represents educating nurses, advanced practice nurses and physicians for the future of health care, in which physical and mental health systems of care will be integrated allowing intervention for patients experiencing both medical and behavioral health problems.
Increasing Treatment Seeking Among At-Risk Service Members Returning from Warzones
Dr. Stecker was awarded a five year trial (W81XWH-13-2-0032) entitled Increasing Treatment Seeking Among At-Risk Service Members Returning from Warzones by the Department of Defense. The goal of this research is to evaluate the effectiveness of the cognitive-behavioral intervention to increase behavioral health treatment seeking among military personnel at-risk for suicide. Reducing suicide is a national priority and an urgent concern within the Department of Defense and the Department of Veterans Affairs. Indeed, rates of suicide among active duty service members and Veterans have increased dramatically since 2005, with an average of 20 Veterans completing suicide per day. The vast majority of service members and Veterans at-risk for suicide do not seek help.
This is a randomized controlled clinical trial of 1,200 military service members who are at increased risk for suicide but not currently in behavioral health treatment for the purpose of determining if a brief intervention improves the initiation of treatment. Participants assigned to the treatment condition receive an individualized cognitive-behavioral intervention administered by phone. The intervention has been shown to promote treatment-seeking in preliminary studies of OEF/OIF Veterans with elevated posttraumatic stress disorder (PTSD) symptoms. Participants are assessed at baseline and at 1-month, 3-month, 6-month, and 12-month follow-up.
Jonas Nurse Leaders Scholar Program
The goal of the program is to increase the number of doctorally-prepared faculty available to teach in nursing schools nationwide, as advocated by the Institute of Medicine’s recent report, The Future of Nursing: Leading Change, Advancing Health. Supported by the Jonas Family Fund at the Jewish Communal Fund, the program will provide financial assistance, leadership development, and mentoring support to expand the pipeline of future nurse faculty into research-focused and practice-focused doctoral nursing programs.
Enhancing Kidney Donation Through Live Organ Video Educated Donors (LOVED)
Chronic Kidney Disease is diagnosed in four times as many African Americans (AAs) as Whites and nearly twice as many AAs perish from the condition. Kidney transplantation offers the best outcomes for patients with End Stage Renal Disease (ESRD) but rates of procurement far outnumber cadaver organ availability, especially among AAs. A superior option is living donor kidney transplantation (LDKT). Since AAs comprise only 18.5% of LDKT recipients, innovative and culturally preferred strategies are needed to increase LDKT within the AA community. We hypothesize that a patient-centered, two tiered culturally sensitive education/motivation intervention targeting AA ESRD patients and potential donors (PDs) using mobile health (mHealth) technology will result in: 1) increased ESRD patients’ willingness to ask for donation; 2) increased number of PDs who complete medical evaluation; and, 3) increased number of LDKTs. We will leverage mHealth technology as the delivery mechanism to maximize large scale dissemination potential. Guided by behavioral change and technology acceptability theories, the Live Organ Video Educated Donor [LOVED] program will be developed to address two domains. LOVED I will be tailored for AA ESRD patients and navigated by an AA LDKT recipient. LOVED II will be tailored for potential LDKT donors and navigated by an AA LDKT donor. iPad program delivery will include testimonial audio/video clips, home-work assignments, videoconferencing, chat room sessions, and text/emails. The proposed mixed methods research utilizes qualitative and quantitative studies in a 3 phase process of development that will involve:
1) Development of LOVED I and II technical content and delivery formats guided by behavioral and technological theories using 9 focus groups (8 per group) of AA LDKT recipients/donors, ESRD LDKT eligible patients, PDs who failed to complete screening and transplant healthcare provider team.
2) Conduct 3 month LOVED I and II proof of concept studies (LOVED I = 24 LDKT eligible patients; LOVED II = 24 PDs who did not complete screening) to assess program acceptability, feasibility, changes in self efficacy and attitudes. Also assessed will be % ESRD patients who identify PDs, % PDs who complete screening, % LDKTs and participants’ perceptions of cultural competence of intervention including levels of trust, discrimination, shared decision making and literacy.
3) Conduct two 6 month 2-arm randomized control trials (LOVED I vs. standard of care, N=60; LOVED II vs. standard of care, N=80) to generate estimates needed for design of a large scale RCT.
Patient Centered Health Technology Medication Adherence Program for African American Hypertensives
Efforts to improve medication non-adherence (MNA) and blood pressure (BP) control in patients with hypertension (HTN) 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 (AAs) with MNA and uncontrolled HTN. 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 AAs (21-59 years old) with electronic monitor derived MNA and repeated clinic and 24hr BP verified uncontrolled HTN. 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: % with electronic monitor-derived adherence scores >0.90; b) BP control: % meeting JNC8 guidelines for BP control (resting BP <140/90 mmHg). 2) Secondary Outcome Variables: a) % reaching and sustaining 24-hr ambulatory BP<130/80 mmHg; b) % of provider adherence to JNC8 guidelines as measured by timing of medication changes and c) patient changes in Self-Determination Theory constructs (e.g., competence and autonomous motivation). 3) Exploratory Outcomes: a) moderators (e.g., gender, age, income) and mediators (e.g., perceived severity of disease, med side effects, depression symptoms, etc.) of medication adherence and BP control; b) cost effectiveness and c) physical risk factor changes (cholesterol, LDL, HgA1c, blood glucose). After final follow-up evaluations, focus groups with random sample of SMASH subjects (total n=32) and healthcare providers (total 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 AAs by developing effective and sustainable mHealth chronic disease medical regimen self-management programs including medication adherence, bio-function monitoring (e.g., BP) and timely bidirectional contact with healthcare providers.
Smartphone Delivered Meditation for BP Control among Prehypertensives
Stage 2 pre essential hypertension (preEH; 130-139/<90 mmHg) entails a 3-fold risk of developing EH and 2-fold risk of cardiovascular disease (CVD) events compared to those with optimal blood pressure (<120/80 mmHg). Prevention programs are needed which can be sustained by preEHs and readily disseminated by healthcare providers. Psychological stress is a risk factor for future EH and CVD. Stress reduction via meditation has shown promise in reducing blood pressure (BP) but adult studies have not determined optimal dosage level nor evaluated dosage adherence objectively. Multiple underlying biobehavioral mechanisms linking meditation with BP reduction also require additional scrutiny. The proposed research will address these issues by further developing and optimizing a smart phone breathing awareness meditation program (Tension Tamer:TT). Stage 2 preEH 21-50 year old African Americans and Whites balanced by geographical locale (urban vs. rural) and healthcare providers from 12 practice sites (6 urban/6 rural with 12,843 stage 2 preEHs) within the OQUIN practice based research network will be enrolled.
The 3 stage process of intervention development specified in PA-11-063 will involve:
1) Optimization of TT content and delivery formats guided by behavioral and technological theories using 6 focus groups of OQUIN healthcare providers and 6 focus groups with preEHs (8 preEHs per group);
2) 6 month TT proof of concept study (n=60 stage 2 preEHs) to establish dosage tolerability and impact upon resting and 24 hour SBP and biobehavioral mechanisms: worry, rumination, anxiety, hostility, mindfulness, sleep, physical activity, sympathetic nervous system (SNS) and hypothalamic pituitary adrenal axis (HPA) activity;
12 month 2-arm randomized control trial (RCT; TT vs enhanced standard of care smart phone health education program; total n=80) to generate estimates needed for design of a large scale RCT. This series of iterative studies, implemented and guided by healthcare providers and their preEH patients, will result in an intervention acceptable to multiple racial/ethnic groups in both urban and rural settings, feasible to conduct in clinical practice settings, effective in reducing SBP in a pilot RCT and ready for a large scale RCT.
Increasing Aging in Place Through Increased Physical Activity
This project will utilize (1) the existing telemedicine equipment to obtain baseline and weekly BP, HR, and weights on participants by interprofessional teams of nursing and physical therapy (PT) students, under supervision of MUSC faculty and the primary investigator; (2) this project would support tailored software (app) implementation that would allow us to leverage our existing telemedicine investment by (a) incorporating wearable activity monitors that allow participants and providers to monitor PA, in real time as part of integrated programs to increase daily PA levels. In addition, this project will allow us to leverage telemedicine technology to (b) enhance interprofessional training so PT students could provide televideo instruction and lead PA programs to participating residents in the complex.
A Community Based Intervention to Improve School Preparedness for At-Risk Children
Boosting Our Barrio is a care model focused on early childhood development, early intervention when necessary and access to culturally appropriate care that can decrease health care and school costs in the long term. This project will narrow the gap of health disparities within the Latino community by increased community engagement via use of the extant promotores model with PASOs, thus increasing sustainability and maximizing use of current supports and trusted agencies.
EQUIP: Excellence and Quality Using Interprofessional Practice
The goal of EQUIP (Excellence and Quality Using Interprofessional Practice) is to create an innovative and sustainable interprofessional collaborative practice (IPCP) to improve patient and population health outcomes within a network of Federally Qualified Health Centers (FQHCs) in South Carolina. Objective 1: Modify and tailor the infrastructure (personnel/IT) within a network of FQHCs to implement a model in which nurses and other health care professionals are competent in IPCP and systems level QI processes. Objective 2: Incorporate an innovative coaching model leveraging collaboration between an FQHC and academic partners to create an IPCP environment where high-functioning diverse professionals collaborate and communicate effectively to improve patient outcomes within the FQHC network. Objective 3: Institute a team-based quality improvement (QI) training program within the FQHC’s network followed by the identification and implementation of quality improvement initiatives based on practice metrics. Objective 4: Implement a model academic/FQHC partnership for student training that helps the student develop competencies in IPCP.
The Fetter Health Care Network (FHCN) and the Medical University of South Carolina (MUSC) will work together to leverage and expand nursing leadership within the FHCN to direct quality improvement (QI) processes utilizing an interprofessional (IP) collaborative team approach. These teams will include existing FHCN health care professionals (physicians, nurse practitioners, physician assistants, pharmacists, nurses, and front desk clerks), the addition of nurse case managers and community health workers to the FHCN, as well as new partners in nutrition and biomedical informatics. Quality improvement priorities will be based on team-identified assessment and practice metrics, and evidence-based strategies will be identified and implemented to address them. The project will begin July 2014, with IPCP team training and pre-implementation QI coaching, followed by clinical implementation December 1, 2014. Innovations of EQUIP include: 1) implementation of systems based QI initiative in a IPCP framework 2) the creation of a data dashboard tracking patient, practice and network improvements; 3) the development of an Academic/ Community Health Center interprofessional student training partnership, and 4) the use of telehealth for service delivery in remote locations. FHCN has 7 sites in 5 rural and 2 urban communities serving over18,500 patients of which 80% are African American and 8% are Hispanic. This diverse patient population is characterized by high rates of poverty, low educational attainment, and significant disparities in health outcomes. In addition, a funding preference is requested as this project will substantially benefit both rural and underserved populations, as the project will be implemented throughout a network of Federally Qualified Community Health Centers.