Awardees of autumn 2024 Tier 1 pilot research grants report final project outcomes

Investigators
Gregory C. Valentine, Department of Pediatrics
Brent Collett, Department of Pediatrics
Sandra Juul, Institute on Human Development and Disability
Sara Neches, Department of Pediatrics
Kendell German, Department Pediatrics
Ulrike Mietzsch, Department of Pediatrics
Niranjana Natarajan, Department of Pediatrics
Krystle Perez, Department of Pediatrics
Cindy Trevino, Department of Psychiatry & Behavioral Sciences
John Feltner, Department of Pediatrics
Nicki Sherr, Seattle Children’s Research Institute

Project summary
We sought to clarify barriers and facilitators for parents bringing their high-risk children to neurodevelopmental follow-up care after neonatal intensive care unit discharge. This study was performed in collaboration with the Department of Health and the Washington State Perinatal Collaborative.

We aimed to identify and characterize barriers including beliefs, perceptions, knowledge, socioeconomic, transportation, financial or other factors to neurodevelopmental follow-up among families of children at high risk for neurodevelopmental delay, identify facilitators to follow-up and evaluate factors that predict follow-up or lack thereof to neurodevelopmental services. We conducted individualized interviews using the Consolidated Framework for Implementation Research to identify multilevel barriers and facilitators, and performed chart reviews of infants meeting criteria for high-risk infant follow-up to determine significant associations with follow-up.

A retrospective chart review was performed for infants meeting criteria for high-risk neurodevelopmental follow up from a level IV NICU discharged between 01/01/2022-07/31/2025. Attendance at neurodevelopmental follow-up was lower among families with markers of social vulnerability and higher among preterm neonates with greater severity of illness after birth. Increasing markers of lower socioeconomic status, including a higher social vulnerability index, were strongly associated with reduced rates of follow-up. For every 0.1 point increase in the social vulnerability index, there was a 16% reduced odds of attending neurodevelopmental follow-up within the first 12 months after birth.

These findings highlight that using indicators such as the social vulnerability index may help facilitate directed activities to increase follow-up for neurodevelopmental care among vulnerable high-risk children and improve access to high quality care.

Investigators
Lily Li, Department of Medicine
Julie Dombrowski, Public Health – Seattle & King County
Kelly Colas, Department of Medicine
Jimmy Ma, Department of Medicine

Project summary
Penicillin allergies are commonly reported, but more than 90% are found to be inaccurate after formal allergy testing. Unverified antibiotic allergies are associated with increased antimicrobial resistance and higher healthcare costs. Despite the effectiveness of medication allergy delabeling programs, allergy testing remains not widely available. Equitable access to drug allergy testing is critical to minimize adverse health outcomes, particularly within infectious disease care.

In this study, we quantified trends in antibiotic allergy labeling and access to allergy testing among patients receiving infectious disease specialty care across multiple academic and community-based settings within the University of Washington and affiliated Seattle & King County Public Health Centers. We found that penicillin allergy labels were present in 7.6–16.7% of patients receiving care in outpatient infectious disease clinics, and 8.8–15.5% of patients seen on inpatient infectious disease consultation services. Notably, over 40% of individuals with penicillin allergy labels reported isolated cutaneous symptoms, and approximately one-quarter of allergy entries were consistent with medication side effects, intolerances or unknown reactions. Current risk stratification algorithms suggest classification of such patients as low-risk and ideal candidates for drug challenge and potential delabeling, including by non-allergists. However, few individuals (<15%) were delabeled during the study time frame. The high prevalence of penicillin allergy labels underscores ongoing challenges in addressing unverified antibiotic allergies.

To qualitatively identify determinants that may influence future implementation of task sharing antibiotic allergy evaluations with non-allergy providers, we conducted 19 one-on-one semistructured interviews with participants in three cadres: 1) providers caring for individuals with antibiotic allergies, 2) non-provider healthcare worker stakeholders and 3) clients with antibiotic allergies. Participants described varying levels of awareness and knowledge related to antibiotic allergies and highlighted key barriers and facilitators that may shape engagement in allergy evaluation processes. Both provider and non-provider healthcare workers identified challenges in beta-lactam allergy management, including inadequate training, insufficient staffing and resources and time constraints in clinical patient care settings. Across client interviews, a key theme that emerged was doubt surrounding the removal of a prior allergy label in the absence of formal testing, accompanied by a desire to obtain additional information and guidance from a trusted healthcare provider.

There is a clear need for innovative and accessible strategies to assess antibiotic drug allergies among diverse populations with complex antimicrobial needs and limited access to allergy specialists. Results from this study help to clarify the practical barriers and opportunities involved in identifying patients who could safely undergo delabeling by allergists or non-allergists. This work and future efforts will support broader outpatient antimicrobial stewardship initiatives and promote the safe use of first-line beta-lactam antibiotics when clinically appropriate.

Investigators
Erin Blakeney, Department of Biobehavioral Nursing and Health Informatics
Jill Steiner, Department of Medicine
Salpy Pamboukian, Department of Medicine
Jason Deen, Departments of Medicine and Pediatrics
Maggie Ramirez, Department of Health Systems and Population Health

Project summary
The aim of this pilot project was to engage members of the Serious Cardiac Illness (SCI) community to identify 1) priority research topics and 2) participants’ interests, barriers and facilitators to participate in a CAB, with the goal of improving SCI care for the WWAMI region.

We convened a group of individuals (n=21) including adults (≥18 years old) with SCI (n=9), their family members/caregivers (n=5) and clinicians (n=7; including nurses, physicians, advance practice providers) to participate in a series of workshops focused on improving SCI care. Types of SCI included ischemic and non-ischemic cardiomyopathy and adult congenital heart disease. Family members and caregivers were recommended by patients. Clinicians were eligible if they provided SCI care either as regional referring clinicians or as SCI clinicians at our institution. Participants were from Washington, Alaska and Montana; n=11 (52%) were women.

Based on the Assessing Community Engagement Conceptual Model, we designed a series of five workshops (four virtual meetings 60-90 mins in length, one in-person 1.5 day-long meeting) focused on discovery, design and prioritization. Workshops were held February – August 2025 and leveraged large and small group discussions and interactive polls to identify discussion topics and iteratively inform subsequent workshop content. During the final workshops, we used a modified Delphi format to create a ranked list of research priorities over 3 rounds of discussion and voting.

This project yielded key information to guide the development of a sustainable SCI CAB and a co-produced, ranked list of priority research topics. Importantly, all participants supported the formation of an ongoing, sustainable CAB. In terms of research priorities, the top priority was Support for Families During Hospitalization, ranked as “very important” by 19/21 (91%) participants. The next 3 priorities were tied, ranked as “very important” by 18/21 (86%) participants: Considering Differences in Geography/Location (e.g. coordinating care to minimize travel); Communication with UW Providers When Not at UW; and How to Access Medical Information in an Emergency.

Investigators
Kelsey Conrick, Department of Epidemiology
Stacey De Fries, School of Social Work
Ali Rowhani-Rahbar, Department of Epidemiology
Adam Davis, School of Social Work
Sarah F Porter, School of Social Work
Megan Moore, School of Social Work
Michelle Sperlich, University of Buffalo
Patricia Logan-Greene, University of Buffalo

Project summary
The goal of this project was to adapt, refine and preliminarily test a pilot training program for social workers in Washington State on secure firearm storage. We created Pathways to Safety, a culturally resonant training designed to prepare social workers to routinely discuss firearm access and safety with clients. The training and its PATHS counseling framework—Position the approach, Ask about access, Tend to context, Highlight options and Solidify a plan—were developed from seven existing physician-focused firearm safety trainings and informed by interviews with 20 licensed social workers across racially, geographically and socioeconomically diverse settings across the state. The resulting two-hour, five-module curriculum included content on firearm terminology, strategies for temporarily reducing firearm access, case examples derived from social-work practice and modeled counseling sessions.

In May 2025, we delivered seven sessions of the pilot training to 82 Master of Social Work students at UW and Eastern Washington University, marking a significant milestone in testing and refining our training model. Participants completed pre- and post-training surveys assessing knowledge, attitudes and confidence, and a subset completed standardized-client interviews to assess observed counseling skills. Most participants (59.8%) reported no prior training in lethal-means counseling. Following the training, mean knowledge scores increased from 3.1 to 4.7 of 6 items (p < .001), and confidence improved across all domains (p < .001). Participants also expressed stronger agreement that firearm safety counseling should be a routine part of social-work practice. Counseling scores with a standardized client improved from 47% to 70% (p < .01).

Pathways to Safety produced measurable gains in knowledge, attitudes, confidence and applied counseling skills, demonstrating the feasibility and promise of training social workers to engage clients in firearm-safety conversations as part of routine behavioral-health care.

Investigators
Zahid Lalani, Department of Oral & Maxillofacial Surgery
Laurie Gold, CLEAR Center for Musculoskeletal Disorders
Karima Lalani, Department of Health Systems and Population Health

Project summary
The purpose of this study was to evaluate retrospective claims-based data from the Center for Medicare and Medicaid Services (CMS) for individuals over the age of 65 enrolled in Medicare and Marketscan® for commercial health insurance carriers for individuals from age 50 to 65 to evaluate the prescribing practices of physicians for use of antiresorptive medications and filling of these medications by patients diagnosed with osteoporosis and those who have sustained fragility fractures (initial and re-fracture) over 5 years (1, 3 and 5-year mark).

This data will lay the groundwork for a prospective study that we will design to look at patient adherence to taking antiresorptive medication and the barriers to it. That prospective study and its findings could have a significant impact on an often-forgotten population – seniors living alone at home, in nursing homes or in assisted living facilities who cannot advocate for themselves and their health needs. The physical and financial effects on seniors and their families of osteoporosis and the sequelae of non-treatment like fragility fractures are significant.

Our PIO question was – P – Patients with a diagnosis of osteoporosis or fragility fractures in two age groups – 50-65 years and > 65 years I – Use of an antiresorptive medication within 6 months of diagnosis of osteoporosis or fracture event O – How many patients with a diagnosis of osteoporosis or fragility fracture filled antiresorptive medication within 6 months and continued filling them at 1,3- and 5-year mark.

The number of men and women taking antiresorptive medication or not after the initial diagnosis of osteoporosis or fragility fracture secondary to osteoporosis was fairly constant over the followup period except there appeared to be a drop after the initial 6 months in women and after 54 months in both men and women, though the drop was more pronounced in women. Individuals who were prescribed and filled antiresorptive medications were at increased risk of subsequent fragility fracture compared to those who did not fill those medications, with hazard ratios remaining elevated even after adjustment for age, sex, prior fractures and comorbidities. These findings likely reflect that individuals at highest baseline risk were more likely to receive and take medications.

We also found that a large proportion of patients never filled or received antiresorptive medications, with approximately 79% of the cohort not initiating therapy. Among those who did initiate medications, exposure to antiresorptive therapy was highest near the time of diagnosis and declined steadily over time, indicating reduced persistence with treatment. These findings highlight important gaps in medication initiation and long-term adherence and underscore the need to better understand barriers to treatment uptake and continuation.

Investigators
Kenisha Campbell, Department of Pediatrics
Chris Buresh, Department of Emergency Medicine
Jerry Neufeld-Kaiser, Garfield High School History Teacher
Melanie Cope, Odessa Brown Community Clinic
Michelle Reese, Odessa Brown Community Clinic
Thomas Agostini, Department of Pediatrics
Adriana Herrera, Department of Pediatrics

Project summary
Our goal was to create a student-led opioid overdose prevention group within Garfield High School to develop and implement effective overdose education and naloxone distribution (OEND) initiatives. Initially, we aimed to create an intraorganizational relationship with peer-health-educators at Seattle University and high school students to develop a near-peer train-the-trainer model. Limitations within the college partnership, including shifts in their funding leadership, led to the work at the college and high school being largely independent initiatives.

The college peer-health educators participated in a 60-minute training session reviewing opioid overdose death epidemiology, overdose recognition, naloxone administration and how to provide overdose prevention counseling. College students completed pre- and post-session surveys assessing accuracy of responses in content-related multiple-choice questions, and questions to evaluate self-reported comfort with the presented topics. The number of correct responses to the content questions was totaled for each participant before and after the didactics. Paired two-sided t-tests were performed to compare changes before and after the training. Responses related to comfort questions were converted to numeric values on a scale of 1 to 5, averaged across the cohort and reported as mean values.

Fourteen college peer-health educators participated in the intervention, and 11 completed both pre- and post-surveys (79%), with results showing significant increases in the college students’ comfort administering naloxone as a first responder, teaching others how to recognize signs of overdose and how to administer naloxone, and a significant increase in the average number of correct responses to content-based questions.

We partnered with a history teacher and two staff at the Odessa Brown Children’s Clinic’s Garfield Teen Health Center throughout the 2024-2025 school year. The OEND efforts in the fall semester consisted of pediatric resident-led education in classrooms. From September to November 2024, residents presented in 22 classrooms and provided 30-minute presentations on the basics of opioid overdose prevention and overdose response with naloxone. Community partners recruited students for the group throughout the fall semester. Starting in February 2025, a group of 7-10 students met weekly to plan OEND projects for their peers. In the summer, the peer educators doubled the impact of the resident-led initiative; they presented in 46 classrooms, created a pamphlet with overdose response basics to distribute at tabling events and created information for their school radio. Naloxone distribution from the health center also increased 2.5-fold, with a total of 150 kits distributed during student-led initiatives.

Investigators
Shengruo Zhang, Department of Epidemiology
Rachel L. Winer, Department of Epidemiology
Linda K. Ko, Department of Health Systems and Population Health
Julia Colson, Seattle/King County Clinic
Brendan Lo, International Community Health Services

Project summary
The aim of our project is to understand the barriers and facilitators to cervical cancer screening among Mandarin-speaking Chinese individuals in western Washington with limited English proficiency. To achieve this, we conducted a qualitative study in partnership with the Seattle/King County Clinic (SKCC) and International Community Health Services (ICHS). Our community partners were actively involved in designing the study, reviewing all study materials, supporting its implementation and disseminating the study findings.

We recruited participants at the SKCC annual free health clinic and ICHS clinics, as well as through outreach in public libraries and local Asian supermarkets. Overall, we screened 56 participants for eligibility and interviewed 20 study participants, with data collected from May 2025 – November 2025. During the interviews, participants were asked about their thoughts and experiences with cervical cancer screening, including HPV and Pap tests, as well as barriers and facilitators such as interpreter support, provider recommendations and social influences. Participants also reviewed HPV self-sampling kits and Mandarin-language instructions and shared their perspectives on their usability, effectiveness in addressing barriers and preferences for receiving health information.

Qualitative analysis identified several key themes regarding barriers and facilitators to cervical cancer screening. Cultural factors posed challenges such as stigma surrounding sexually transmitted infections, fear of detecting disease, discomfort with exposing intimate body areas and illness-related shame. Social influences included family and community experiences, social media and overall health awareness. At the individual level, participants described practical barriers such as cost and insurance coverage, difficulty navigating the healthcare system, need for language support, long wait times, perceived health status and concerns about infection.

Investigators
Janessa M. Graves, Department of Family Medicine
Carmen Gonzalez, Department of Communication
Jody O. Early, School of Nursing & Health Studies

Project summary
This project aimed to build collaborative research connections between the WWAMI Rural Health Research Center, UW Bothell School of Nursing & Health Studies and the Health Equity Action Lab to improve mental health service access in diverse rural communities and establish a foundation for future health equity-focused grant applications. We successfully completed both project aims.

For Aim 1, we analyzed 2-year and 3-year evaluation data from the Mental Health Matters intervention in Skagit County, WA and conducted a qualitative assessment of the Peer Mental Health Navigator training program. We presented findings at the American Public Health Association Annual Meeting in October 2025 and produced two peer-reviewed manuscripts, one accepted for publication in Health Promotion Practice and a second currently under review.

For Aim 2, we conducted key informant interviews and focus group discussions with interest-holders working in rural agricultural communities across Washington State to inform adaptation and scaling of the intervention.

We exceeded our evaluation benchmarks by producing two manuscripts rather than the planned one and submitting a letter of intent for a future grant to advance this work. These accomplishments demonstrate effective cross-institutional collaboration and position our team for competitive future grant applications addressing the rural mental health workforce and barriers to access.

Investigators
LaShawnDa Pittman, Department of American Ethnic Studies
Wadiya Udell, School of of Interdisciplinary Arts & Sciences (UW Bothell)
Barb Taylor, King County Kinship Collaboration
Cynthia Green, King County Kinship Collaboration
Mary Prescott, King County Kinship Collaboration

Project summary
We proposed to develop a multicomponent stress reduction intervention that increases Black kinship caregivers’ utilization of informal and formal resources (financial navigation services and resourcefulness training), knowledge and tools to address children’s developmental needs across the life course (parenting training), and strategies to decrease daily stressors unique to their families (mindfulness-based stress reduction training).

Building on our previous studies identifying financial, parenting and daily stressors among kinship caregivers in skipped-generation households (consisting only of grandparents and grandchildren), we proposed to: 1) Form a CAB of kinship care workers and kinship caregivers to help guide intervention development (Aim 1); 2) Review existing interventions, theories and research evidence with input from the CAB, to identify core components and assessments to include in the intervention (Aim 2); and 3) Conduct focus groups with 30 kinship caregivers to incorporate their input into the intervention development process (Aim 3).

We formed our CAB and met 5 times from January to November 2025. CAB members included kinship caregivers and professionals with experience supporting kinship families, demonstrating that there are knowledgeable kinship care workers and caregivers with the skills, expertise and willingness to advise on this project. For the parenting component, the research team reviewed the Triple P parenting intervention for necessity, acceptability, adaptability and feasibility, with CAB members providing critical feedback and recommending modifications to improve feasibility. Focus group findings revealed that caregivers of school-aged children reported typical daily stressors that were not highly concerning, while caregivers of teenagers described significant challenges including school misconduct and risk behaviors, indicating a need for targeted support for this group.

For the financial component, we conducted interviews and analysis to explore sustainable approaches and identified the need to develop a financial tool integrated with the Washington Connection portal to assess finances, identify unused resources, determine eligibility and address barriers to accessing services. Focus groups and interviews highlighted that financial stress was the most significant stressor affecting caregivers’ ability to provide resources and engage in health-promoting activities.

The team conducted 6 focus groups with 27 caregivers to gather input on intervention content and feasibility, finding that virtual formats improved participation and engagement. These findings confirmed the need for a stress-reduction intervention addressing financial challenges, parenting difficulties and behavioral strategies to manage stress.

Investigators
Zeruiah Buchanan, Department of Epidemiology
Kelechi Ubozoh, Suicide Prevention Consultant & Advocate
Canada Taylor Parker, Multnomah County
Mienah Z. Sharif, University of California, Berkeley School of Public Health
Elle Lett, Department of Health Systems and Population Health

Project summary
The goal of this study was to investigate how intersecting power relations (e.g., racism and heterosexism) embedded in policy shape Black youth’s experiences with suicidality. We accomplished this by working with Black community leaders to identify the most impactful policies influencing the key drivers and protective factors of suicidality risk among Black youth, and by characterizing legal and statistical epidemiologic trends for select policies most salient for Black youth suicidality.

In partnership with 47 Black community leaders (across 22 states and DC) who work with or advocate for Black youth, we identified the 4 most impactful policy areas (harmful, protective and liberatory) on Black youth’s experience with suicidality. Additionally, we created a database highlighting aspects of one of the policy areas across 4 states (2018-2025), as well as the state of suicidality among multiply marginalized Black youth across 2 states. We continue to develop this database by adding state-level data from the 22 states represented in the Delphi study.

This project has thus far produced 3 manuscripts that will soon be submitted to journals. The first manuscript details the four surveys administered across the Delphi process and explains how the 4 policy areas were prioritized. To properly select which state youth surveys to use for the statistical characterization of suicidality among multiply marginalized Black youth, we conducted a 50-state (and DC) review of youth surveillance surveys. The second manuscript documents what demographic and suicidality questions are included in, and how, in each state’s youth surveillance surveys. The third manuscript covers the cross-classification analysis of suicidality among multiply marginalized Black youth, conducted using Washington’s Health Youth Survey.

Investigators
Shana Attar, Department of Psychology
Wendy Stone, Department of Psychology
Chun Wang, College of Education
Risho Sapano, Mother Africa

Project summary
Early, specialized intervention before age three is associated with long-term gains in learning, communication and everyday living skills for autistic children. However, up to 60% of children with autism who would be eligible for these services are not identified on time. A major barrier to accurate autism identification is that social communication behaviors (e.g., gesture use or imitation), which are the earliest indicators of autism, vary from situation to situation across early toddlerhood – and traditional screeners that are administered only once and in one setting may be unable to capture this variability. As such, a new screening strategy sensitive to these subtle and inconsistent social communication behaviors is urgently needed. This project was the first to explore ecological momentary assessment (EMA) as a method for identifying autism in toddlers. In EMA, caregivers respond to short text-messages on their cellphone in real-time to report on their child’s social communication behaviors across various routines and settings (e.g., breakfast at home, play at park). Importantly, caregivers reported on social communication behaviors that fit their cultural expectations, as determined in our previous pilot study.

Our goals were to develop EMA procedures that will be (i) practical for use by caregivers and (ii) effective for identifying autism. First, we collaborated with a data specialist to develop a bespoke EMA platform that uses python code to integrate technology across Qualtrics (i.e., a platform for developing surveys) and Twilio (i.e., a mass-messaging platform) into a seamless workstream. Second, we recruited 41 caregivers to respond to text messages 3x/day for 12-days on, 5-days off and 12-days on, at four month-long time points (i.e., 15-, 18-, 21- and 24-months).

Regarding whether our EMA platform is practical for use with caregivers, results were mixed. Promisingly, once recruited, caregivers consistently responded to the text-messages to report on their children’s social communication behaviors. Across participants, our EMA survey was completed more than 3,200 times. However, recruitment of caregivers into our longitudinal study which required 4-months of responding to near daily text-messaging was difficult. This suggests that more work is required on the framing and presentation of EMA to engage parents in this novel form of early childhood developmental surveillance.

Regarding the effectiveness of identifying autism in young children, initial results were promising. Preliminary data analyses suggests that our EMA paradigm can differentiate between the frequency and use of social communication in young children. For example, there was a significant difference in social communication usage between high-frequency and low-frequency communicators. Additionally, children whose caregivers indicated that they were concerned for their child’s development had significantly lower levels of social communication usage. Finally, our survey questions showed evidence of strong internal consistency.

Investigators
Yiwei Xu, Information School
Xinyi Zhou, Paul G. Allen School of Computer Science & Engineering
Saloni Dash, Information School
Emma S. Spiro, Information School
Amy Zhang, Paul G. Allen School of Computer Science & Engineering,
Wang Liao, Department of Communication

Project summary
This project investigates how generative AI search tools influence users’ perceptions of health information, particularly on controversial health topics. As AI-generated content becomes increasingly integrated into platforms like Google and Bing, understanding its effects on public health judgment is essential. Funding supported the design and execution of two studies, with two papers currently under review.

In the first study, we preregistered a randomized controlled experiment, where participants (N = 2,004) viewed mock search result pages varying in the presence (vs. absence), placement (top vs. middle) and stance (benefit-framed vs. harm-framed) of AI-generated summaries across four publicly debated health topics: raw milk, water fluoridation, artificial sweeteners and GMOs. Compared to a no-summary control group, participants exposed to AI-generated summaries reported issue attitudes, behavioral intentions and policy support that aligned more closely with the AI summary stance. In addition, users perceived the AI summaries as more useful when they emphasized health harms versus benefits. These findings suggest that AI-generated search summaries can significantly shape public perceptions of health issues, raising important implications for the design and regulation of AI-integrated information ecosystems.

In the second study, we preregistered another experiment (N = 1200) and found that AI summaries of politically polarizing health topics (abortion, vaccine mandates, universal healthcare and firearm regulation) broadly reduced information seeking as measured by research results clicked on. AI summaries that were manipulated to be incongruent with participants’ prior attitudes on the topic reduced attitude polarization, compared to attitude-congruent AI summaries. Notably, attitude-incongruent AI summaries were also evaluated less favorably than attitude-congruent AI summaries. These findings underscore the persuasive potential of AI summaries and have critical design and societal implications — from influencing users’ attitudes and information-seeking behaviors to broader concerns surrounding polarization and trust in AI-driven information ecosystems.

Investigators
Kushang V. Patel, Department of Anesthesiology & Pain Medicine
Dakotah Lane, Lummi Nation Health Center
Megan Moore, School of Social Work
Elise Hoffman, Department of Anesthesiology & Pain Medicine
Aspen Avery, Harborview Injury Prevention & Research Center

Project summary
In collaboration with the Lummi Nation Health Center, we conducted a falls-focused, asset-based health assessment utilizing an appreciative inquiry approach to identify community strengths to leverage for fall prevention as well as current gaps in fall prevention activities. Appreciative inquiry is an asset-based approach to a community issue focused on identifying assets, strengths and successes while simultaneously identifying community needs.

This approach resonates with the partnering Tribe as cultural traditions and strengths are key to effectively addressing community health. Specifically, the goal of this assessment was to engage with the Tribal health system, local community health organizations, healthcare professionals and elders to (1) understand existing fall prevention activities, (2) identify gaps in fall prevention and (3) identify unique cultural and community strengths to address fall prevention needs.

The Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit was used as a guiding framework to identify existing fall prevention activities, resources and gaps in screening, risk assessment and treatment. Our research team engaged with a range of interest-holders working within Tribal systems through informal interviews and site visits (n=19). Specifically, we engaged with the Chief Medical Officer, Directors of the Community Nursing and Physical Therapy programs, primary care providers, community nurses, physical therapists, pharmacists and other staff at the tribal health system. In addition, we engaged with the Director of Family Services for the Tribe, the manager and assistant manager of the Tribe-affiliated fitness center, as well as the Director, Manager, staff and elder residents of the Tribe-affiliated elder living facility. This assessment also engaged elders in informal interviews (n=18) and a survey (n=37) to learn more about their fall-related experiences and preferences for fall prevention strategies, including exercise. Qualitative data from community engagement activities and interviews, in addition to research team notes, were used to map existing fall prevention activities, resources and gaps to the STEADI framework.

Through this community-engaged process, we identified current fall prevention activities, gaps in fall prevention and opportunities to leverage existing community and Tribal health system resources to fill these gaps. Critical strengths including an integrated health system that is responsive to community needs, a strong ethos of teamwork and care coordination, a current home visit program involving home modification assessment for elders who are homebound or medically complex, robust physical therapy services, participation in the Special Diabetes Program for Indians (SDPI), a well-equipped exercise facility with capacity to expand group-based programming for elders and importantly a community-wide reverence for and commitment to serving elders. Identified gaps in fall prevention activities included lack of a systematic fall risk screening and risk identification and workflows to support regular treatment follow-ups.

A range of opportunities to further leverage the Tribe’s existing programs and resources for fall prevention were identified, including using home visits to complete comprehensive fall screening assessments, implementing systematic fall risk screening such as the 3-item STEADI screening questionnaire in primary care and creating warm handoff referrals from clinical care to community-based exercise programs. Community exercise programming was identified as a key opportunity to maintain mobility function and address fall-related risk factors, aligning with existing programs and community priorities, with strong interest and engagement from elders and community partners.

Investigators
Beth Dawson-Hahn, Department of Pediatrics
Anisa Ibrahim, Department of Pediatrics
Jasmine Matheson, Washington State Department of Health
India Ornelas, Department of Health Systems and Population Health

Project summary
Our UW PHI: Tier 1 project intended to build a foundation for a Center for Migration Health, a UW – WA DOH collaborative education, research and public health practice center to promote, strengthen and sustain the health and well-being of people in WA who have experienced international migration. We approached this with two primary goals: 1) The Center will establish cross-sector partnerships across public health, health care, social service and community organizations to inform the Center’s priorities; and 2) The Center will create guiding principles to inform the development of a proof of concept proposal to fund the Center.

Over the project period we strengthened our collaboration with the WA Department of Health – Refugee and Immigrant Health Program; interviewed 29 professionals from community-based organizations, public health and social services agencies that serve immigrant populations in WA; surveyed 51 UW faculty about their expertise in migration health; and hosted two convenings to present our findings and discuss what is missing from them — 1 with over 40 community members and an academic convening with 29 participants from 14 departments and programs.

Our analysis of the interviews, surveys and convenings identified the following key findings: strong community and academic interest in migration health with activities occurring across many organizations, departments and programs; need for physical and virtual spaces to convene and to continue to share information including topics such as program evaluation and research, mental health support for immigrant communities, opportunities for student engagement and discussion of the current migration context and its implications for research and practice; need for online presence to disseminate information from our Tier 1 project and for others to share information to work collaboratively; and community-facing organizations identified need to develop training content about migration to be shared across organizations.