Integrating Evidence-Based Behavioral Health Technologies into Primary Care

Funding Source: Dartmouth SYNERGY Translational Program (Community-Based Research Core)

Project Period: July 2014-June 2016

Principal Investigator(s): Lisa Marsch, PhD; Sarah Lord, PhD; Bob Drake, MD, PhD

Other Project Staff:  Erin Corriveau, MD; Elliott Fisher, MD; Mark McGovern, PhD; Haiyi Xie, PhD; Ardis Olson, MD; Ben Crosier, PhD

Project Summary:

This project engages community and academic partners in understanding needs and priorities among rural community health care systems around shifting health care systems (e.g., in light of ACA) – with a particular focus on integrating behavioral health and medical care in rural settings.

Behavioral health problems (addictions and mental health disorders, such as depression) are highly prevalent, especially in poor and disenfranchised populations. The great majority of these people (over 90%) receive no treatment. Behavioral health problems also complicate diagnosis, treatment, and outcomes for many chronic conditions, such as diabetes, obesity, heart failure, and cancer.  A sufficient workforce to address these problems does not exist - especially in rural communities.

Incorporating new health technologies could be a cost-effective solution.  New technology tools could be used in primary care to improve access, self-care, and outcomes, and to reduce costs and health disparities.  Yet, successful implementation and sustainability of any new intervention process, including a technology-based care approach, is strengthened by attention to pre-implementation readiness of the primary care community agencies and constituent stakeholders to adopt a technology treatment innovation in their system of care. 

This two-year, 2-phased project includes mixed-methods formative research in year 1 to assess community priorities and readiness for technology-based behavioral health tools in primary care settings, followed by a demonstration implementation project of a technology-based behavioral health intervention within rural primary care settings in year 2. 

Public Health Relevance:

This work will inform strategies for optimizing implementation outcomes when embedding technology-based behavioral health tools in rural primary care settings, supported by appropriate training/technical assistance.    

May 9, 2014

Emerging Communications Technologies to Advance Prevention and Recovery

10th Annual Dartmouth Symposium on Substance Use 

Mary Brunette, MD – Associate Professor of Psychiatry, Geisel School of Medicine, Hanover, NH; Medical Director, Bureau of Behavioral Health, Department of Health and Human Services, Concord, NH

Andrew Campbell, PhD – Professor of Computer Science, Dartmouth College, Hanover, NH

Lynn Fiellin, MD – Associate Professor of Medicine, Yale University, New Haven, CT

Sarah Lord, PhD – Assistant Professor of Psychiatry and Pediatrics, Geisel School of Medicine, Hanover, NH; Director, Dissemination and Implementation Core, Center for Technology and Behavioral Health, Lebanon, NH

Lisa Marsch, PhD – Associate Professor of Psychiatry Geisel School of Medicine, Hanover, NH; Director, Center for Technology and Behavioral Health, Lebanon, NH; Director, Dartmouth Psychiatric Research Center, Lebanon, NH

Rachel Brian, MPH – Project Coordinator, Geisel School of Medicine, Hanover, NH

About the Conference:

Only a small percentage of persons with substance use disorders- or at risk for developing them- get the care they need. Communications technologies such as internet, smart phones, and interactive video games offer huge opportunities to expand prevention and treatment of substance use disorders and other mental health challenges. This symposium presents innovative initiatives that usetechnology to engage patients in addressing diverse substances challenges and phases of use - from tobacco to opioids to alcohol and across the spectrum of use from prevention to treatment to support of recovery. Speakers emphasize practical strategies for implementing use of technologies in clinical practice and attendees are given opportunities to try out many of the technology programs presented.

April 4, 2014

Implementation strategies and outcomes: advancing the science

Enola K. Proctor, PhD
Shanti K. Khinduka Distinguished Professor of Social Work
Associate Dean for Faculty
George Warren Brown School of Social Work
Washington University, in St. Louis, MO

About the Presentation:

How do we move evidence-based practices into real-world care, and how do we sustain them once they are adopted?  How do we capture the challenges and successes in implementation?  What are some of the cutting edge research questions in implementation science? What are the methodological advances and challenges in implementation science? These issues will be the focus of Dr. Proctor’s talk.

About the Presenter:

Dr. Enola Proctor is the Shanti K. Khinduka Distinguished Professor of Social Work and Associate Dean for Faculty at the George Warren Brown School of Social Work, Washington University, in St. Louis, MO.

Her teaching and research are motivated by the question, how do we ensure that people receive the very best possible care?  She has studied this question in a variety of social work, public health, and health care settings, ranging from hospitals to community agencies.  Her most current work focuses on how organizations and individual providers can adopt and deliver evidence based programs and interventions. Her research has been funded by the NIMH, the NIA, and AHRQ.  She directs the Implementation Research Institute, an NIMH supported training program in implementation science. She also leads the Center for Dissemination and Implementation for the Washington University Institute for Public Health, the Dissemination and Implementation Research Core for Washington University’s CTSA program, and dissemination and implementation research cores for research centers in the areas of cancer and diabetes.   She also directs the Center for Mental Health Services Research at Washington University, launched and supported for 20 years with NIMH support. 

Her books include Dissemination and Implementation Research in Health: Translating Science to Practice, published in 2012 with Oxford University Press.  She was a member of the National Advisory Council for the National Institute of Mental Health, and served as Editor in Chief for Social Work Research.  She has received a number of awards, including the Lifetime Achievement Award from the Society for Social Work and Research (2002); the Knee-Wittman Award for lifetime Achievement in Health and Mental Health Practice (2011) from the National Association of Social Workers; and the Mental Health Professional of the Year award from the St. Louis Alliance for the Mentally Ill (1997).  She has received several teaching and mentoring awards and Washington University’s highest faculty honor, the Compton Award (2009).  In 2010, she was elected to the inaugural class of the American Academy of Social Work and Social Welfare and its Board of Directors (2010-11). 

Increasing HIV Testing in Urban Emergency Departments via Mobile Technology

Funding Source: National Institute on Drug Abuse (NIDA)

Project Period: 07/01/2014 – 06/30/2017

Principal Investigator: Ian David Aronson, PHD

Project Summary:

Our proposed intervention builds upon initial findings from a trial our research team conducted with patients who declined HIV testing. The brief intervention had a potent effect: a third accepted HIV testing post-intervention. While this preliminary study is highly encouraging, it revealed a number of other critical research questions. First, it remains unclear what intervention component most strongly contributed to patients’ decisions to test. Second, consistent with the literature, participants indicated that depicting a community member onscreen would increase the proportion of patients who test. Third, results suggest there is individual variation in the extent to which behavior is more strongly influenced by onscreen community members or experts (e.g. physicians). Therefore, the goal of the present study is to determine how we can refine mobile computer-based interventions to maximize HIV testing rates among patients who initially decline to test in the ED. The present study will use a pilot four-arm randomized controlled design. All participants will use mobile computers to complete a pre-test assessment. One arm will see video of a physician explaining the importance of HIV testing and modeling rapid testing (similar to the original video). The second arm will view video of a community member who explains testing importance and models testing. A third will have a choice of which of the two videos to watch. A fourth group (control) will not see any video. At the end of the computerized intervention (pre-test/video or pre-test only), onscreen text will ask patients if they would agree to an HIV test. Those who agree will be tested by ED staff. The trial will recruit patients (N=300) aged 18-64 in a high volume, urban hospital center. The study’s endpoint will be post-intervention HIV test rates. Our study will inform scalable interventions for underserved populations nationwide.

Public Health Relevance:

When hospital emergency departments (EDs) offer routine HIV testing to reach substance users and other high-risk patients, those who could benefit most frequently decline. Thus, an important health priority remains not only offering HIV testing to more patients, but developing strategies to increase test rates by working with patients who are reluctant to learn their HIV status. The proposed research will develop and evaluate the acceptability, feasibility, and preliminary efficacy of a mobile computer-based video intervention designed to increase HIV test rates among vulnerable patients in EDs and other high volume clinical settings nationwide.

Justin Tauscher, MS, LADC, LCMHC

Research Associate and Project Director, Center for Technology and Behavioral Health and the Center for Supported Employment Technology

Prevention and Treatment for Co-occurring Disorders; Technology-based Interventions; Implementation Science; Adolescent Care

tauscherJustin Tauscher is a Research Associate and Project Director at the Center for Technology and Behavioral Health and the Center for Supported Employment Technology. He earned a Bachelor’s Degree in Psychology and Sociology from Western Washington University and a Master’s Degree in Mental Health Counseling from the University of Vermont. He is currently the Project Director for the Center for Supported Employment Technology at Dartmouth College and is working to develop new and innovative technology based strategies for enhancing the delivery of IPS supported employment services in community settings. In addition to his role as a Project Director, Justin provides cognitive behavioral interventions to OEF/OIF veterans as part of a research project aimed at enhancing treatment seeking behavior in veteran populations and is aiding in the adaptation of this intervention to a technology based platform. Along with other members of the CTBH research team, Justin is also involved with exploring ways to adapt technology based tools to enhance the process of screening, brief intervention, and referral to treatment (SBIRT) in a variety of settings.

Justin has an extensive clinical background as a dually licensed mental health and addiction counselor. He has developed a range of experiences while serving as a clinical supervisor and clinician specializing in providing co-occurring treatment with adolescents, adults, and families. Justin currently serves as an adjunct faculty member within the graduate counseling program at the University of Vermont with a focus on teaching about addiction issues and co-occurring treatment. Additionally, Justin provides consultation to state and community based agencies in the areas of program development; screening, assessing, and treating co-occurring mental health and substance use issues; and developing treatment approaches for reducing criminality and recidivism in the community.  Research interests include dissemination and implementation of evidence based practice in community settings, technology-based behavioral health care, criminality, PTSD, and supported employment. In his spare time, he enjoys reading, riding his bike, playing soccer, going hiking, and spending time with his friends and family.