Autumn 2024 pilot awardees are reporting progress in their projects

Assessing Parental Perceptions of Factors Exacerbating Disparities to Neurodevelopmental Follow-up of High-Risk Newborns in Washington State

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 update
This study will clarify barriers and facilitators for parents bringing their high-risk children to neurodevelopmental follow-up care after NICU discharge. We will utilize these findings to develop targeted efforts to overcome the obstacles and disparities related to neurodevelopmental follow-up, including improvements to existing referral and care pathways and developing novel neurodevelopmental care models (e.g., remote assessments). We are collaborating with the Department of Health and the Washington State Perinatal Collaborative, where these results will include potential legislative and/or advocacy campaign efforts throughout Washington State.

Aim 1: 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 NDD. Using the Consolidated Framework for Implementation Research (CFIR), we will conduct these individualized interviews to identify multi-level barriers to neurodevelopmental follow-up.

Aim 2: Identify and characterize facilitators to neurodevelopmental follow-up among families of children at high-risk for NDD. Similar to Aim 1, utilizing the CFIR, we will conduct these individualized interviews to identify multi-level facilitators (also known as enablers) to neurodevelopmental follow-up.

Aim 3: Evaluate factors (e.g. socioeconomic, insurance type, primary language spoken, first child, reason for high-risk referral, among others) that predict follow-up (or lack thereof) to neurodevelopmental services. We will perform N=200 chart reviews of infants meeting criteria for high-risk infant follow-up and discharged from the University of Washington NICU. We will collect demographic, socioeconomic and other factors among n=100 families of children who did not follow up versus n=100 who did. These will be performed utilizing generalized linear models (e.g., logistic regression) to determine significant associations.

We have obtained UW and SCH IRB approval and onboarded and trained two research assistants on the data extraction for the database portion of this study (Aim 3). Utilizing the database generated for Aim 3, we will identify families of infants who did or did not follow up for neurodevelopmental follow-up care, and reach out to a subset of these families for consent to a series of qualitative interviews (Aims 1 and 2). Our research assistants have abstracted and entered approximately 100 charts into the REDCap (for a goal of 200). We are beginning to approach families to schedule their initial interviews for Aims 1 and 2.

Understanding unmet needs for equitable access to antibiotic allergy testing services in hospital and community settings

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

Project update
Penicillin allergies are commonly reported, but over 90% are found to be inaccurate after formal allergy testing. Unverified antibiotic allergies are associated with increased antimicrobial resistance and increased 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.

This project seeks to 1) quantify trends and inequities related to antibiotic allergy labeling and access to antibiotic allergy testing for clients served by the University of Washington and affiliated Seattle & King County Public Health Centers, and to 2) qualitatively identify determinants that may influence a future implementation of task-sharing antibiotic allergy evaluations with non-allergist providers.

To date, we have obtained IRB approval for all analyses in the study. We have completed data collection from electronic health record-based datasets and are in the process of cleaning and analyzing this quantitative data to examine prevalence of antibiotic allergies among patients receiving infectious disease specialty care in various clinical inpatient and outpatient settings. We have additionally completed development of semi-structured interview question guides and are currently actively recruiting participants for interviews. Next steps will include interview audio transcription, review and analyses.

Collaborative development of a community advisory board focused on serious cardiac illness in the Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) region

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 update
This project has made significant strides in developing a community advisory board (CAB) for adults with serious cardiac illness (SCI) throughout the Washington, Wyoming, Alaska, Montana, and Idaho (WAMMI) region. Our goal with this project is to explore the needs, preferences, and priorities of patients, family members/caregivers, and health care team members about participating in community engaged research and to identify research priorities as a first step in developing a CAB focused on SCI in the WWAMI region.

To accomplish our goal, we have assembled a multidisciplinary team of experts in serious cardiac illness, clinical, and community engaged research. This has included the hiring of a research assistant, a UW social work graduate student with a background in community health, to facilitate communication and participant onboarding. Our team has successfully recruited patients (n=9), family members (n=3), and clinicians (n=8) to participate in the project.

We held an initial virtual informational session for potential participants in February 2025 (and carried out seven 1:1 calls with those unable to join the informational session) and a first virtual workshop to identify potential research priorities in April 2025. Two additional virtual workshops are planned (in May and July 2025) as well as a two-day in-person workshop in June 2025.

Empowering Social Workers to Promote Secure Firearm Storage: Developing a Culturally Resonant Training Program

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 update
The goal of this project is to adapt, refine, and preliminarily test a pilot training program for social workers in Washington state on secure firearm storage. We have made substantial progress toward these goals, and are conducting four trainings May 2nd-9th, 2025.

Aim 1: Adapt existing secure firearm storage training programs for social workers.

• Completed 19 in-depth semi-structured interviews with practicing social workers experienced in SFS counseling across racially, geographically, and socioeconomically diverse caregiving contexts.
• Conducted a rapid qualitative analysis of all interview transcripts.
• Developed a six-step counseling framework to guide social workers in assessing firearm access and supporting clients in temporarily reducing access, when appropriate.
• Identified four case examples representing priority learning domains from social work interviews to model counseling sessions in the training. Drafted scripts using the six-step framework that were reviewed by clinical social workers, and filmed/edited four 5-minute training videos.
• Partnered with certified firearm safety trainers to produce a 15-minute educational video on firearm types and storage options. Trainers also delivered two optional, in-depth safety sessions to students.
• Packaged the training into four modules: (1) Background and rationale, (2) Firearm vocabulary and storage basics, (3) Counseling options and access reduction tools, and (4) The six-step counseling framework.
• Derived a set of core counseling competencies from interviews and training content, to be used in evaluating training effectiveness in Aim 2.
• Developed a set of printable and digital handouts aligned with each of the four training modules to support knowledge retention and practical application of key concepts.

Aim 2: Preliminarily evaluate the effectiveness of the developed training program by assessing changes in knowledge, attitude, confidence and skills among Master of Social Work (MSW) students at UW and EWU.

• Recruited over 80 advanced-year MSW students from the University of Washington and Eastern Washington University.
• Developed and fielded a pre-training survey assessing prior firearm-related experiences, training history, baseline knowledge, policy awareness, counseling attitudes and self-efficacy.
• Designed a standardized client interview protocol, including a detailed scenario, participant brief, and structured assessment rubric aligned with Aim 1 competencies.
• Conducted 8 pre-training standardized client interviews.

Evaluation of claims-based data for evaluating the prescribing practices of physicians for the use of antiresorptive medications and filling of these medications by patients with osteoporosis

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 update
Our PICO 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 C – Patients who did not fill a prescription for antiresorptive medication within 6-months of the diagnosis of osteoporosis or fragility fracture 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.

Retrospective claims-based data from the Center for Medicare and Medicaid Services (CMS) for individuals over the age of 65 enrolled in Medicare and Merative Marketscan® for commercial health insurance carriers for individuals from age 50 to 65 from January 1, 2018, to December 31, 2018, were used to identify patients diagnosed with osteoporosis (ICD-10 M81.0X), and fragility fractures of any bone (ICD-10 codes M80.X – multiple codes based on fracture site).

People were included if they had an ICD-10 diagnosis of osteoporosis or fragility fractures involving any bone from January 1, 2018 to Dec 31, 2018 in either dataset. Patients were excluded if they had an osteoporosis/fragility fracture diagnosis or if they had taken antiresorptive medication in the year prior indicating their osteoporosis was not incident, or if they had prior diagnoses of cancer or Paget’s disease, disenrolled from their insurance coverage or had died(mortality data available in the CMS dataset but not in the Marketscan dataset) during this period. The data was de-identified, and patients divided into two groups – 50-64 years old and ≥65.

We identified the number of patients in each group who were filling prescriptions for antiresorptive medications (Bisphosphonates – oral and parenteral and Denosumab) within 6 months of their diagnosis. We then evaluated how many filled prescriptions for an antiresorptive medication in 6-month increments (>6-12 months, >12-18 months, >18-24 months, etc) for 4 years (for the CMS data) and 5 years (for the Marketscan data). Patients who changed prescriptions were kept in the study. Study covariates included patient demographics (age, sex, and race (available in CMS data). Amongst the patients with a diagnosis of fragility fracture at index, we evaluated the proportion who were on antiresorptive medications at the time of fracture and those who were not but filled a prescription in 6-month increments until the end of the study. The data was also evaluated to look at the antiresorptive prescription filling characteristics of patients who had a re-fracture due to osteoporosis during follow-up.

A Near-Peer Train-the-Trainer Model to Create Effective Opioid Overdose Prevention in High Schools

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 update
The stated goals of this project are to:

1. Capacity building within Seattle University (SU) peer health educator program such that they are empowered to sustain partnership with Garfield High School (GHS).
2. Define research aims of the GHS student-led group through continued buy-in from GHS stakeholders with an evaluation design that measures the goals of their community to be outlined within a CDHE grant.
3. Disseminate findings from our pilot evaluation of the train-the-trainer model of SU health educators to GHS and Seattle Public Schools (SPS) Prevention and Intervention department to secure permission from SPS to conduct research on the high school student group and initiative participants during 2025-2026 academic year.

Ten high school seniors have met weekly with faculty and staff to develop overdose prevention initiatives to share with peers. They are currently working with teachers to coordinate classroom time to teach their high school classmates about overdose prevention. Our team has trained the college peer educators in opioid overdose prevention; some have observed community opioid overdose prevention education and then implemented it under supervision with feedback. The college students met with the high school students to provide guidance on their initiatives. The high school students begun making four projects for peer education: a 15-minute classroom presentation, an Instagram page for FAQs, a short video to be played on morning announcements, and small print outs advertising naloxone that will be stapled to prom tickets. In preparation for their peer education sessions, the high school students have presented for both the PTA and a group of physicians to receive feedback.

Understanding barriers and facilitators of cervical cancer screening among Mandarin-speaking patients with limited English proficiency in western Washington

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 update
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 are conducting a qualitative study in partnership with the Seattle/King County Clinic (SKCC) and International Community Health Services (ICHS). Our goal is to conduct interviews in Mandarin with 20-25 individuals with limited English proficiency.

In terms of progress to date, we held a kickoff meeting with our SKCC and ICHS partners to establish a shared understanding of the study and outline collaboration plans. We also obtained insight and approval from our SKCC and ICHS community partners on participant recruitment strategies and received feedback on a recruitment flyer, consent form, screening form and interview guide. We used this feedback to revise and finalize study materials.

We recruited potential study participants at the 2025 SKCC that was held April 24-27. To date, we have screened 18 participants for eligibility and determined that 8 are eligible to be interviewed. In preparation for scheduling and conducting interviews, we have secured private meeting rooms in multiple locations, including the UW Seattle, Bothell, and Tacoma campuses, the Fred Hutch Cancer Center and local libraries.

Building partnerships for rural mental health access and health equity community-engaged research

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

Project update
Our project aims to build collaborative connections between the WWAMI Rural Health Research Center (RHRC), Health Equity Action Lab (HEAL) and UW Bothell School of Nursing & Health Studies to improve access to mental health services in diverse rural communities. The overarching goal is to lay the groundwork for competitive grant applications focused on health equity, particularly digital health equity. To date, we have successfully completed Aim 1 of our two primary objectives. Specifically, we have:

1. Held team meetings to build meaningful research connections across our three research groups.
2. Obtained IRB approval and amalgamated the data needed for Aim 1 analysis.
3. Conducted analyses to evaluate the impact of the Mental Health Matters (MHM) intervention in Skagit County, WA. This included analyzing 2-year and 3-year evaluation data from the community-based, bilingual intervention and conducting a qualitative assessment of the Peer Mental Health Navigator (PMHN) training program.

By conducting this evaluation, we have increased our understanding of the program’s scalability potential and provided insights for future modifications that will inform the next steps of this project. We are currently preparing a manuscript related to the MHM evaluation, which will be ready for submission at the end of April. We are now moving toward Aim 2, which will assess the scalability and tailoring of MHM throughout the WWAMI region.

Stress Reduction Intervention for African American Kinship Caregivers in Skipped-Generation Households

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 update
This project 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).

Goal: Form a Community Advisory Board (CAB) of kinship care workers and kinship caregivers to help guide intervention development. Achieved: We formed our CAB and had our first retreat (January 2025) and a second meeting (March 2025). Our CAB members include four kinship caregivers.

Goal: Review existing interventions, theories and research evidence with input from the CAB, to identify core components and assessments to include in the intervention. Achieved: As a prerequisite for accomplishing this goal, we have built out our research team. We hired the undergraduate research assistant that we included in the grant budget. We have onboarded two additional undergraduates who will be supporting the project. The undergraduate researchers are assisting with data collection (focus groups), secondary data research, data management and analysis, and with organizing and facilitating the Community Advisory Board meetings, among other things.

Our project was also one of four that was selected by the Population Health Initiative Social Entrepreneurship Fellowship program, which is run in partnership with the Buerk Center for Entrepreneurship and CoMotion. Our fellow will work with us for 10 weeks over the summer helping us to think about our project in ways that we have not, including about issues pertaining to replicability, scalability, and translation.

Goal: Conduct focus groups with 30 kinship caregivers to incorporate their input into the intervention development process as presented by Zauszniewski1 and O’Cathain and colleagues,2 including intervention content, intervention format (e.g., length and number of sessions), and data collection methods (e.g., biomeasures, financial assessment tools). Achieved: A) Secured IRB approval: We submitted our IRB application and received IRB approval (April 29, 2025) for conducting our focus groups this summer. B) Devised a Study Participant Recruitment and Data Collection Plan: We met with our CAB and reviewed our recruitment plan and material, focus group interview questions, and consent forms. We integrated their feedback and submitted the revised documents as part of our IRB application. C) Met Monthly as a Research Team: Our research team has met every other month to work on a) building our CAB (e.g., composition, recruitment), best practices (e.g., formation and operations, key considerations, letters of agreement, readiness, membership engagement, etc.) and retreat activities; b) devising a study participant recruitment and data collection plan.

Creating A World Worth Living In: An Exploratory Sequential Mixed Method Approach to Understanding Black Youth Suicidality Through the Lens of Policy

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 update
The goal of this project is to address a critical gap in understanding how intersecting power relations (e.g., racism and heterosexism) embedded in policy shape Black youth’s experiences with suicidality. Specifically, the project is employing a modified Delphi method with Black community advocates and mental health professionals to identify the most impactful policies that influence the key drivers and protective factors of suicidality risk among Black youth and characterize legal and statistical epidemiologic trends of select policies most salient for Black youth suicidality.

We have recruited 47 Black professionals who work across multiple sectors to advocate for the mental health of Black youth in practice and policy. Participants work in Washington, Oregon, California, Tennessee, the District of Columbia, Maryland, Missouri, New Jersey, Wisconsin, Illinois, Georgia, North Carolina, Florida and Arizona. I have worked with the Community Experts to develop and distribute two of the four surveys.

Putting the Pieces Together: Pairing Ecological Momentary Assessment with Culturally Sensitive Screening Questions to Improve the Accuracy and Equity of Autism Screening in Toddlers-A Pilot Study Examining Autism Likelihood in Children from Culturally and Linguistically Diverse Families

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

Project update
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 will be 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 will report on social communication behaviors that fit their cultural expectations, as determined in our previous pilot study. Our goal is to develop EMA procedures that will be (i) practical for use by caregivers and (ii) effective for identifying autism. We will use this information to pursue funding to examine how we can expand EMA autism screening at a larger scale. Our hope is that all autistic children, regardless of background, will access the benefit of early intervention that timely identification of the condition allows.

To date, we have developed a bespoke EMA platform for this study. The platform is designed to survey caregivers 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). The EMA platform 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. The Qualtrics survey uses culturally sensitive question items about social communication that were developed in our previous pilot to correct for documented bias in the questions used in current autism screeners. All documents and data related to the EMA software are encrypted and use HIPAA compliant software provided by the University of Washington. Mother Africa, our local non-profit organization, has assisted with recruiting eligible families from King County for this study. As of 05/01/25, 33 caregivers and their children have enrolled in the study and currently receive the EMA battery, and another 24 caregivers have completed our eligibility survey and are the in the enrollment process. Across participants, our EMA survey has been completed 804 times.

Understanding the Role of AI-Integrated Information Seeking Tools in Users' Evaluation of Health (Mis)information

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 update
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. We developed and preregistered an online experimental study to test how AI-generated summaries—varying in position (top, middle, or absent) and issue-sidedness (emphasizing benefits or harms)—shape users’ risk perceptions/attitudes, behavioral intentions, and policy support across four controversial health topics: raw milk, water fluoridation, artificial sweeteners and GMOs.

To date, we have completed literature review, finalized the experimental design and conducted a preregistered pilot study with 2,000 participants. Data analysis and manuscript preparation are currently underway. We plan to disseminate findings at leading social computing venues or general social science journals. We are also preparing a follow-up proof-of-concept study for Summer 2025, which will be led by a graduate research assistant on this team. These findings will inform responsible AI design and health communication strategies, ensuring that emerging technologies support informed public health decision-making.

Assessment of Fall-related Injury Prevention Strategies in the Lummi Nation

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 update
Falls are the primary cause of injury and a leading cause of disability, hospitalization, and death among older adults in the United States. American Indian/Alaska Native (AI/AN) communities experience the highest rates of falls. The Lummi Nation Health Center (LNHC) and Lummi Nation Health Commission have identified fall prevention as a community priority. As an initial step to reducing fall-related injuries among Lummi elders, we are conducting a falls-focused, asset-based health assessment in the Lummi Nation. Through this assessment, we aim to learn about the existing fall prevention activities in the Lummi Nation and identify potential strategies for improving them, drawing on the strengths of LNHC and the broader community.

Since January 2025, we have engaged a range of interest-holders in the Lummi Nation, including leadership and staff of LNHC and Little Bear Creek, a retirement and assisted living facility for Lummi elders. At LNHC, we interviewed the Chief Executive Officer, the Directors of the Community Nursing and Physical Therapy programs, and several clinicians. In addition, we interviewed the Director of Family Services for the Lummi Nation, the Manager and Assistant Manager of the Lummi Fitness Center, as well as the Director, Manager, staff, and elder residents of Little Bear Creek. Through these interviews and tours of facilities, we identified several strengths and resources for fall prevention, including an integrated health system that is responsive to community needs, a strong ethos of teamwork and care coordination (e.g., daily huddle at LNHC), 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.

Our assessment has also identified opportunities to further leverage the Lummi Nation’s existing programs and resources for fall prevention. For example, while LNHC’s community nurses scan for fall hazards during home visits with elders, there is also opportunity to screen for falls and identify risk factors for the general population of Lummi elders though primary care visits at LNHC (e.g., integration of a 3-item screening questionnaire in Epic electronic health record system). In addition, with the Lummi Fitness Center less than 300 feet away from LNHC, a warm handoff referral from primary care or physical therapy to community-based exercise is feasible, as is tracking enrollment status and mobility function assessments in Epic. Due to potential capacity limitations in physical therapy services and varying patient preferences, LNHC staff felt a community exercise program is needed to help maintain mobility function among elders and/or address less severe impairments in gait, balance, and strength. This view is shared by leadership and staff of Lummi Fitness Center who welcome the opportunity to implement a multimodal, group exercise program that can not only address fall-related risk factors but also benefit elders with or at risk of diabetes, aligning with SDPI goals and efforts. In addition, we visited with 18 elder residents at Little Bear Creek who expressed enthusiasm for an exercise program, sharing preferences on location, length and frequency.

As we continue our assessment, LNHC has requested we begin designing an intervention to address gaps in falls prevention. Our team has discussed several potential programs and clinical pathways including screening, risk assessment, falls education, and treatment (physical therapy and/or community exercise). During the second half of the project, we plan to (1) further engage with staff and clinicians at LNHC, including pharmacists and primary care physicians, (2) develop a diagram of the existing fall prevention resources, gaps, and potential interventions in the Lummi Nation, (3) develop and present a community action plan to the Lummi Nation Health Commission for reducing fall-related injury among elders, and (4) develop and apply for funding to implement a fall prevention program to be implemented in LNHC, Lummi Fitness Center and Little Bear Creek.

A Center for Migration Health: Chartering a Course for Collaboration

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 update
We began our project in January 2025. Shortly after our project commenced, the new federal administration made a number of policy changes related to immigration that impacted our team members and project partners. We have worked with our project partners to identify an approach that feels feasible for them to engage in. Therefore, rather than hold stakeholder convenings in May – July 2025, we sought an extension and will be doing individual interviews and learning from our partners about what the next steps will be for our project taking into consideration their potential direct program impacts.