Awardees of 2019 pilot research grants report on progress

CocoBot - Tailored Self-Management Program for Caregivers of Children with Chronic Conditions

Investigators
Weichao Yuwen, Nursing & Healthcare Leadership, UW Tacoma
Dong Si, Computing and Software Systems, UW Bothell
Sunny Chieh Cheng, Nursing & Healthcare Leadership, UW Tacoma
Teresa Ward, Psychosocial & Community Health

Project update
In the United States, 10 million family caregivers care for children with chronic health conditions. The stress of caregiving, particularly for the underserved is so significant that it negatively impacts caregivers’ physical and mental health and well-being. These caregivers are often isolated and reside in high-poverty communities with limited access to healthcare.

In considering the multiple needs of these caregivers, we are developing a health dialog system – CocoBot – that delivers a theory-based self-management intervention that uses artificial intelligence (AI) “chatbot” technology to provide family caregivers of children with chronic asthma and arthritis with on-demand and interactive self-management skill development to reduce physical and mental health symptoms.

We have established an interdisciplinary research team consisting of faculty, undergraduate and graduate students from nursing, computer science, biomedical informatics and human-centered design and engineering across all three campuses. We have obtained approval from the IRB and conducted in-person and remote participatory design (PD) sessions with 12 caregivers of children with asthma, as well as three content experts from the Puget Sound Asthma Coalition.

With the knowledge learned from the PD sessions and our previous research, we have built the initial prototype of CocoBot. We have developed the testing protocol and are getting ready for the first round of testing and dialog data collection in January 2020 with standardized patients. The data collected will be used for further refining dialog algorithms, and then testing CocoBot with actual caregivers of children with chronic health conditions. Visit the project website to learn more.

Community Pharmacist Integrated Population Health Management of People Living with Epilepsy

Investigators
Jennifer Bacci, Pharmacy
H. Steve White, Pharmacy
Sabra Zarâa, Pharmacy
John Miller, Neurology and Neurological Surgery
Edward Novotny, Pediatrics and Neurology
Bryan Weiner, Global Health and Health Services

Project update
This project seeks to develop a community pharmacist integrated population health intervention for people living with epilepsy by (1) identifying best practices to address the needs of persons living with epilepsy and their caregivers; (2) developing an intervention using a stakeholder driven and consensus building approach; and (3) evaluating the acceptability, appropriateness and feasibility of the intervention.

As of this mid-point report, the research team has either completed or is working on the following phases of the project:

1. Conducted a scoping review of the primary and “gray” literature to comprehensively and rapidly identify and describe best practices that address the needs of persons living with epilepsy, including population-based practices. A total of 2,263 articles were identified by the search strategy; 1,610 articles were excluded during title review; and, in-depth abstract screening of remaining 653 articles occurred, resulting in identifying 11 articles that describe how community pharmacists have been previously integrated into the care of people living with epilepsy. Thirty-three articles were identified that describe current best practices in epilepsy care, including population health approaches.
2. Conducted structured interviews with key stakeholders in the epilepsy community in Washington State, including epileptologists, neurologists, community pharmacists, patients and caregivers. Data saturation has been achieved in the epileptologist and neurologist groups and their enrollment has been suspended. Enrollment is ongoing in the community pharmacist, patient and caregiver groups and thematic analysis of completed interviews is ongoing.
3. Convened an advisory panel of regional and national experts to inform the design the community pharmacy-based population health intervention using the findings of the literature review and key informant interview. The 15-person advisory panel includes a person living with epilepsy and their caregiver, two epileptologists, two pharmacists, an implementation scientist and a health care payer representative. The advisory panel met for the first time on October 24, 2019.

Based on the preliminary findings from the literature review, data collected and recommendations of the advisory panel, three potential interventions are being explored and further defined. These initial explorations will be presented back to the next advisory panel meeting to be held in February 2020 for refinement. Subsequently, the intervention(s) developed from this project will be piloted and evaluated for effectiveness in future research.

Creating Climate Resilient Agricultural Communities in the Tropics through Natural Climate Solutions

Half of the funding for this award came via a partnership with the UW Office of Global Affairs, which seeks to enhance the UW’s global engagement and reach.

Investigators
June Spector, Environmental and Occupational Health Sciences
David Battisti, Atmospheric Sciences

Project update
This project seeks to examine how potential future climate and land use scenarios (i.e. deforestation patterns) affect heat exposure, mortality, and unsafe working conditions in agricultural communities in industrializing tropical countries. During the May-November 2019 period, we established a multi-disciplinary team from the University of Washington (UW) and The Nature Conservancy (TNC) and conducted initial analyses focusing on Berau Regency, Indonesia.

These analyses combined satellite observations of temperature and forest cover, published heat-mortality relationships, established occupational health guidance and spatially explicit population density data to estimate the effect of deforestation on temperature and heat index changes, morality and work hour adjustments necessary to avoid unsustainable elevations in core body temperature.

We extended this analysis by using an ensemble of global climate model simulations to estimate mortality and unsafe working conditions due to various degrees of global warming, assuming no further deforestation. We have also conducted preliminary pan-tropical analyses and have begun to establish the groundwork for translating results into practice.

Does access to federally qualified health centers with high levels of behavioral health integration impact ED and hospital use among Medicaid beneficiaries?

Investigators
Amber Sabbatini, Emergency Medicine
Theresa Hoeft, Psychiatry & Behavioral Sciences
Herbert Duber, Emergency Medicine

Project update
The goal of the project is to evaluate the effects of behavioral health integration on outcomes for Medicaid beneficiaries. We will determine whether highly integrated care results in reduced emergency department (ED) and hospital use.

We have worked closely with collaborators at Public Health – Seattle King County (PHSKC) and Healthier Here, the King County Accountable Community of Health, since May to gather and clean data for analysis. In June, HealthierHere collected MeHAF Site Self Assessments on bi-directional care integration of primary care and behavioral health. Our team provided some feedback on the instrument, and we added some questions that will allow us to describe the characteristics associated with higher levels of integration in practices.

The UW team is also working closely with PHSKC and HealthierHere to develop the algorithms for our cohort derivation and outcomes assessment using Medicaid claims, including attributing beneficiaries to clinics for outcomes assessment. This is a very detailed process. Thus far, our team has developed our algorithm for the identification of ED visits and the linking of ED visits with inpatient data to identify those visits that resulted in an unplanned hospitalization.

We conducted a more in-depth review of grey literature from states who have implemented delivery system reforms in primary care settings (such as primary care medical homes or other demonstrations) to better understand what attribution methods have been used. We have now agreed upon an attribution method for our data, and our partners at PHSKC are in the process of identifying primary care providers using specified E&M codes and provider taxonomies, and associating providers with FQHCs using practice addresses. Once complete, we will associate individual Medicaid beneficiaries with a practice site based on where they receive a plurality of their care.

We are also coding Elixhauser comorbidities from claims for risk-adjustment. We anticipate having beneficiaries attributed to practice sites, and our outcomes and risk-adjustment variables completely coded by January 2020. Once beneficiaries have been attributed to clinics, we can link the MeHAF data for that clinic, which will comprise our main exposure variable. We anticipate beginning our main analyses in the winter.

In the meantime, we are working with two IRBs for the two types of data in our study. The use of Medicaid claims data will fall under the data use agreement between PHSKC and HealthierHere, which is written broadly to allow for evaluation and research to further public health. However, we will submit an exempt determination application to the Washington State IRB and have the specific study aims reviewed in early December by the HCA Data Use Committee, as is required under the HCA-PHSKC DSA. For our work with the MeHAF data (Aim 1) at UW we contacted the UW IRB and with their guidance have self-determined this work is not considered human subjects research, and thus does not require IRB approval.

Ethnoforestry: Applying Traditional Ecological Knowledge for Ecosystem Sustainability on the Olympic Peninsula

Half of the funding for this award came via a partnership with UW’s EarthLab, which works in partnership with others to co-produce and catalyze actionable science.

Investigators
Bernard Bormann, Environmental and Forest Sciences
Marc Miller, Marine and Environmental Affairs
Courtney Bobsin, Environmental and Forest Sciences

Project update
Across the Olympic Peninsula, widespread changes in forest management policy have altered rural communities over the last several decades. We believe a key way to build community resilience and health is through ethnoforestry: using traditional ecological knowledge of local people and applying it to forest management on public lands.

Through this grant, we will work with tribal and non-tribal communities on the Washington coast to determine what plant species they would like to see us bring back in nearby ecosystems. We will develop a research proposal to test the growth and success of these species in permanent plots.

We have currently been working on obtaining interviews with members of the Quinault, Hoh, Quileute and Makah tribes. To ensure the interview process can move forward, we have been finalizing our IRB and consent forms. Throughout the summer, we have been developing interview questions by pulling from several methodologies including semi-structured interviewing, elite interviewing and participant observations. We have now finalized a version we believe will help to address our main research questions.

We have spoken to the WA Department of Natural Resources and they have agreed to provide space for our ethnoforestry field plots to be installed near Forks, WA in several of their recently harvested units.

We have been working on a literature review to better understand wildlife exclosure studies and the current market for non-timber forest products in the region. This information will be used to better inform our ethnoforestry field study. In addition, we have been working on a study design plan for the ethnoforestry field sites using knowledge gained from the literature review.

Over the last several years, tribal members have indicated that the bear grass population has been declining. This is a key ethnoforestry species we are hoping to install on our field sites this winter. In order to better understand its habitat, we toured bear grass prairies on the southeast side of the Olympic Peninsula with an ecologist from the U.S. Forest Service’s PNW Research Station who studies bear grass habitat. We also received wild seeds from the region to study. We are currently working on a plant propagation project with this seed lot to better understand its germination and growth. We will continue to monitor them over the next several months. In addition, we have started planning out propagation experiments on other native plant species that will be spearheaded by an ethnoforestry intern this fall.

Supporting Latinx Parents of Young Children with Tools for Parenting, Stress-Management and Legal Education

Investigators
Elizabeth Dawson-Hahn, Pediatrics
Liliana Lengua, Psychology
Nora Coronado, Center for Health Equity, Diversity and Inclusion
Brian Johnston, Pediatrics
Gino Aisenberg, Social Work

Project update
Our study seeks to address the grand challenge of 1) bolstering healthy starts for children, adolescents and families, in the area of: ensuring all families have access to the needed support to reduce childhood adversity; and 2) strengthening community resilience and capacity, in the area of: increased support for rule of law and community knowledge of rights.

We will offer Latinx families with vulnerable immigration status a parenting program enhanced with stress-management and legal education components. The existing parenting program was developed to be a brief behavioral parenting skills program for parents experiencing low-income and related adversity.

The program offers tools for mindfulness-based stress management to support parent well-being and effective parenting behaviors that promote child self-regulation and school readiness. Latinx parents with vulnerable immigration status face additional stress above and beyond the experiences of those that are low income.

This proposal seeks to support parenting skills and provide tools and resources to support parents experiencing stress related to immigration policy. We will do this with this following goals:

• Finalize project team leadership and confirm community partnerships
• Conduct qualitative interviews to identify strengths and stressors, and immigration law needs among Latinx parents
• Utilize the themes from the qualitative interviews to adapt the existing parenting program
• Pilot test the newly adapted parenting program

To date we have finalized our project team leadership. We developed a number of community contacts who have expressed enthusiasm in collaborating. We developed memorandums of understanding confirming our partnerships with two organizations serving Latinx families with vulnerable immigration status. We recently had our IRB application approved and we will shortly begin the qualitative interviews.