Catherine W. Striley, PhD, MSW, MPE – Grants and Contracts
Shands Foundation – Preventing Hospital Readmissions through CHWs
February 1, 2014 – January 31, 2015
Patients of a diverse community practice will be randomized to care as usual or care supplemented by a Community Health Worker to reduce future emergency department visits and hospital admissions. The intervention period of 6 weeks is followed by an 18 week maintenance phase. Assessments at 4 time periods and information abstracted from clinical charts will be used to compare outcomes.
Transformative Approach to Reduce Disparities Towards Drug Users
R01DA027951 (September 1, 2009 – May 31, 2014)
PI: Cottler, Co-I: Striley
Although individual researchers and projects have focused on underrepresented populations and populations critically in need of services, drug users remain excluded from research studies and unlinked to services. This study is changing the research landscape through the CTSA. This new NIDA initiative is extending our successful NIDA model to actively recruit and enroll multi-generational underrepresented populations, specifically drug users, into research studies and will link them to needed health and social services. This project will recruit, enroll and follow up participants to achieve these specific aims: 1.) Conduct a Needs Assessments among investigators, coordinators, IRB members and Human Research Protection Office (HRPO) staff to understand attitudes toward excluding, enrolling and retaining underrepresented populations, including drug users, in research; 2.) Evaluate the findings from the Needs Assessment to formulate educational guidelines and recommendations to make research more inclusive. These two aims were completed at Washington University. 3a.) Extend the CTSA street-based outreach model to target persons with recent illicit drug use and link them to the CCBR, where they will be referred to health services, assessed for medical and psychiatric history, and invited to participate in University of Florida research studies; 3b.) Randomize 200 study-eligible participants to either the newly established navigator model of referral to a relevant study, or to an enhanced navigation model where a “study ambassador” guides the participant through all research stages. Effectiveness will be assessed at 30 days, 2 months and 3 months after randomization; 3c.) Evaluate the effectiveness of the model to refer participants to primary care homes and other needed services, to increase satisfaction with navigation, to reduce perceived discrimination, and to report fewer barriers to participation. This grant will provide the opportunity to further translate and disseminate evidence- based practices across all arenas of public health for drug users. This project will enhance public health by increasing the generalizability of medical research studies by developing, using and evaluating innovative methods to recruit and enroll multi- generational underrepresented populations, including drug users, into relevant research studies. These community-based research services will reduce researchers’ perceptions that enrolling and retaining underrepresented populations is difficult, provide a catalyst to revise stringent inclusion/exclusion criteria to include these underrepresented populations, and link participants with critical and previously unattainable services.
Comorbidity and Diagnostic Communication Preferences Among Patients with Movement Disorders Pilot study from NIH/NCATS Clinical and Translational Science Award to the University of Florida
UL1 TR000064 (2012 – 2013)
Individuals with Essential Tremor and Dystonia, neurological movement disorders, have poorly characterized mental and behavioral health comorbidities. Those diagnosed with Tourette Syndrome Disorder have better characterized comorbidities, but may be less likely to receive care for these comorbid conditions. This project, proposed by Dr. Catherine Striley, Department of Epidemiology, with the consultation and assistance of Dr. Michael Okun (Department of Neurology) and Dr. Cynthia Morton (College of Journalism and Communications) aims to:
1. Conduct in-person diagnostic interviews of 45 consecutively recruited patients from the UF Movement Disorder Clinic with Essential Tremor (n=15), Tourette Syndrome (n=15), or Dystonia (n=15), to ascertain behavioral health comorbidities and medical care received;
2. Understand communication preferences among the 45 TS, ET and Dystonia patients to develop communication plans that empower them to engage interaction with their medical health specialists through open-ended questions on the survey, that emphasize
a. Message strategies to patients,
b. Current behaviors in information-seeking about ET/TS, and
c. Preferences for information delivery;
3. Utilize medical record reviews to compare their diagnosed and undiagnosed conditions, medical care treatment needed versus received; and
4. Host a town hall meeting for the participants to review aggregate results and to provide referrals for any medical services they may want, or that might be helpful, including back to the Center for Movement Disorders and Neurorestoration (CMDNR) clinic.
Uncovering Disparities in TS Prevalence And Identification Between Caucasians And African-Americans
Tourette Syndrome Association, Inc. (2010-2012)
Large studies of the prevalence of Tourette Syndrome (TS) and Chronic Tic Disorder (CTD) in representative minority populations are lacking; such a gap may be attributable to two methodological problems. First, large scale epidemiologic studies of the prevalence of TS and CTD require reliable case finding and such case finding is limited by the expense of expert examination. Second, studies of the prevalence of TS and CTD require representative samples so that screenings can be conducted for unbiased detection and treatment. To date, studies have not recruited sufficient minority respondents leading to an unknown prevalence of TS and CTD among minority populations. This proposal will address these problems and will test the use of the Video-Integrated Screening Instrument for Tics and Tourette Syndrome (VISIT-TS) and incorporate a strategy for recruiting underrepresented populations in community settings.
Specifically, in two phases, we will:
1. Test the feasibility and acceptability of the VISIT-TS 10 minute screening among participants recruited door-to-door in an African-American majority community (Phase 1)
2. Test the demand for the use of the VISIT-TS as a free health screening provided through Health Fairs in the City of St. Louis and other health screening settings (Phase 2) and in Gainesville, Florida.
3. Estimate the prevalence of Tourette Syndrome and Chronic Tic Disorders among this community ascertained sample (n=200) of 5 – 70 year old men and women expected to have a high percentage of minority subjects.
4. Prepare a natural study of the prevalence, course and treatment of TS, CTD and their correlates with adequate power to compare prevalence between racial and ethnic groups.
Immigrant Family Violence Institute
Administration for Children and Youth (2008-2012)
Project-specific coalitions of domestic violence and immigrant service providers in six US cities will develop and disseminate culturally appropriate promising practices for domestic violence services to immigrant women in 18 cities around the nation. Subordinate objectives are:
• 1,400 immigrant women (100% increase in present capacity) will receive project specific services in St. Louis, Kansas City, Boston, Philadelphia, Jersey City (NJ), or in the California Bay Area from one of six premier service providers and their 70 local coalition partners.
• These locations will be centers of excellence for domestic violence services to immigrants.
• Standardized outcome data will lay the groundwork for research in experimental design research.
This goal will be achieved through the following strategies:
• Development of framework for common practices in outreach and engagement, prevention, and intervention to address DV in immigrant communities;
• Impact evaluation of framework
• Services to 1,250 immigrant women in six sites; and,
• Dissemination of findings on service delivery framework, training of providers, fidelity monitoring and other elements needed for a trial will be provided to researchers interested in pursuing more rigorous and controlled trials on the developed service framework.
Development of a Nationally Implementable, Locally Deliverable Human Research Participants Training Workshop for Community-Based Researchers, Collaborators and Staff
PI: Shanley, Sub-contrator: Striley
The goal of this project is to develop a nationally implementable, locally deliverable human research participants training workshop for community-based researchers, collaborators, and staff that will provide relevant learning while meeting national training requirements. The purpose of the program is to increase the ethical quality of community-based research while engaging and preparing community partners for better relationships with the IRB as well as performing ethical research practices in their community settings. Through our HealthStreet setting, this subcontract allowed up to pilot test the program in Gainesville with community partners, members and advocates.
Services for Victims of Human Trafficking, St. Louis
Office of Victims of Crime (2006-2011)
This research plan will provide data on the capacity of service providers to serve victims of human trafficking in a 10 county region surrounding the City of St. Louis Missouri and on the quality and efficacy of service provision from the standpoint of victims and service providers. Data from the community will be captured at baseline, with a smaller sample followed-up during the last year of the project to document improvements in service system capacity and network development. The services provided to victims during project implementation will be documented and described. The data analyzed will provide evidence on effective community network development, and effective service provision. This data will become the basis of a research/evaluation report.
Data gathered and analyzed will improve communities understanding of how to provide quality services to this population. Data will come from the community activities conducted by the Rescue and Restore Coalition and Trafficking Task Force, including meeting and subcommittee meetings, and outreach education sessions. Data will also come from service provision and satisfaction with services. The process of implementing this grant will be documented as will all outcomes.
Prescription Drug Misuse, Abuse and Dependence – Research Supplement for Retired Professional NFL Football Players
R01DA020791 (September 30, 2006 – April 30, 2011)
PI:Cottler, Co-I/Clinician: Striley
Prescription drug abuse is among the nation’s most important drug problems due to its physical, social and psychiatric consequences. Increases in non-medical use and presumably the consequences of these drugs have been found especially among younger and older adults. NIDA’s PA 04-110, Prescription Drug Abuse, was an attempt to stimulate research in this area, and to understand the populations most at risk for abuse and its consequences. While publications have recently focused on the prevalence of this misuse, methodological efforts aimed at assessing the associated problems have been lacking. As the field has moved forward with prevalence studies, the foundation on which these rates have been built requires attention. With our team’s years of experience in assessment development and nosological science, we addressed this critical need to aid in the interpretation of findings. This team proposed methodological aims among 400 individuals who used prescription drugs, primarily stimulants, sedatives, or opioids non-medically, such as when they were not prescribed for them, in larger amounts than prescribed, more often than prescribed, or for longer than prescribed. A community based sample of younger and older users was enrolled. The aims of this proposal were to: 1) Conduct qualitative research on prescription drug users and health professionals to understand contextual factors related to prescription drug (stimulants, sedatives and opioids) misuse and its consequences. The data informed revisions to the Substance Abuse Module (SAM) and Risk Behavior Assessment (RBA) for the quantitative study. Focus group topics for user groups (n=4) and health professional groups (n=2) included those salient to the field. An ethnographic sub-study was also conducted (n=40) to explain the findings of the quantitative study. 2) Evaluate the inter-rater reliability and validity of the SAM questions, criteria, and abuse of and dependence on each category of prescription drugs. Compare the reliability and validity of these drugs to that for other illicit drugs assessed in the SAM. 3) Understand reasons for poor reliability and misunderstood questions through the use of our computerized Discrepancy Interview Protocol (DIP) and Debriefing Interview, to “perfect” assessments. 4) Evaluate nosological issues about prescription drug abuse, and dependence.
Training Program in Psychiatric Epidemiology and Biostatistics
T32DA007313 (July 1, 1999 – June 30, 2011)
Director: Cottler, Associate Director: Striley
The initial NIDA training grant period, 1999-present, has provided training for 2 Pre-Doctoral and 5 Post-Doctoral fellows. A good record of achievement has been noted to date. The Training Faculty, of 14 interdisciplinary scientists, will continue to: 1) Increase the opportunities for interdisciplinary research training with the broadest range of research opportunities for persons wishing to specialize in substance abuse research; 2)Train in areas of perceived shortage in drug abuse research (biostatistics, prevention, epidemiology, comorbidity, services research, infectious diseases, other public health risk factors such as high risk sexual behaviors and violence and assessment of substance use); 3) Recruit and equip researchers from diverse academic backgrounds with skills needed to address challenging problems related specifically to drug use disorders; 4) Provide trainees with an apprentice-type education to master the skills needed to critically evaluate data, to conduct every aspect of drug abuse research in order to become successful and independent investigators; and 5)Train individual to maintain the highest ethical standards in their academic community. The areas of research training that we offer are areas of enormous potential future growth in research activity, but are presently underserved in the drug abuse training field. The Program also offers trainees the opportunity to obtain a Master in Psychiatric Epidemiology degree from Washington University, School of Medicine, as well as the opportunity to interact and learn from faculty and trainees from 5 other Department of Psychiatry Training Programs and 2 programs from the School of Social Work. This program’s focus on the consequences of drug abuse provides a unique training experience that fulfills NIDA’s public health mission.
Finding Tics in the Community without Putting a Doctor on Every Corner
Tourette Syndrome Association, Inc.
PI: Black, Co-PI: Striley
Certain important questions about Tourette syndrome (TS) require large-scale population studies. Two examples are research on racial epidemiology of TS, and population-based studies of first-ever tics. However, TS diagnosis requires expert assessment, which is generally impractical in large populations. The aims of Year 1 of the current TSA research grant were to develop and validate a new, multimedia-enhanced screening interview for population-based ascertainment of tic disorders by specially trained lay interviewers. This approach was based on the premise that survey respondents would respond more accurately about tics in themselves or their children when the questions were integrated with a DVD that shows and describes tics. We have dubbed it the VISIT TS (Video-Integrated Screening Instrument for Tics and Tourette Syndrome), and the video portion is in production now. The diagnostic validation work is planned to begin February 1, 2009, and to conclude by the end of the first grant period.
We now request support for taking the VISIT TS to the community with the intent to gather pilot data for two potential NIH R01 applications. One will focus on racial epidemiology of TS and the other on predictors of conversion to TS from a first-ever tic. The epidemiology pilot study will benefit the pathophysiological study in terms of finding children with recent-onset tics, and increasing the diversity of the sample studied.
Deconstructing HIV Interventions for Female Offenders
R21DA19199 (September 30, 2004 – July 31, 2007)
PI: Cottler, Co-I: Striley
HIV prevention interventions have not delivered the desired level of behavior change to female offenders for several reasons: the women may not perceive any need for interventions; the interventions may not appear relevant to their specific needs, or there may be client, setting, and environmental factors precluding enrollment, engagement and retention. Responding to RFA-DA-04-015, this project explored factors related to engagement in prevention efforts to develop behavioral interventions adapted specifically to female, drug-abusing offenders. Deconstructing HIV Interventions Among Female Offenders aimed to understand what components of an intervention developed for drug using women are particularly relevant for female offenders sentenced to community-based Court supervision. With this insight, we restructured existing HIV prevention interventions for these women. To deconstruct aspects of the intervention that hold the greatest likelihood for success for this specific at-risk population, our team: 1. Conducted secondary analyses of a recently recruited sample of women in the St. Louis Female Drug Court to determine: a. Differences in the characteristics of women (including demographic, sexual behavior, and medical, psychiatric and substance use) enrolled from the Drug Court compared with non-offending women recruited from an HIV prevention study (DA11622); b. The client-level, environmental and intervention process factors associated with intervention participation and compliance, as well as attrition at the 4 and 12-month follow-up among both female drug-using offenders and Non-offenders. 2. Re-interviewed a subset of female offenders using a combination of qualitative and quantitative methods to ascertain the most salient factors predicting participation and compliance. 3. Synthesized the results of aims 1 and 2 to revise our intervention specifically for female drug using offenders at high risk for HIV/AIDS, for a future study of behavior change.
Adolescent American Indian Multisector Help Inquiry (AIM-HI)
R01DA13227 (September 10, 2000 – August 31, 2005)
PI: Stiffman, Researcher: Striley
Despite high rates of drug and other co-occurring mental health problems among American Indian youths, we know little about their service utilization. Their health care system (The Indian Health Service) developed separately from other federal and state programs. Although they are eligible to receive state-funded services, political resistance, difficulty in accessing Medicaid reimbursement, and lack of on-reservation services impede access differentially for urban and reservation-based youths. The AIM- HI (Adolescent American Indian Multisector Help Inquiry) study will collect service use and drug-use information over a 4-year period (from adolescence to young adulthood) on urban and reservation-based American Indian youths. The samples are both from Arizona, providing stability in state financed services, yet one lives on the Salt River Pima-Maricopa Tribal lands and the other in urban Phoenix. The project will interview 1,000 youths in Year 1, sample 400 of the 1,000 for intensive longitudinal interviewing, and survey 600 of these youths’ gateway service providers. Multisector service use will be studied in the specialty sectors of drug/alcohol and mental health; the nonspecialty sectors of child welfare, education, juvenile justice, and primary health; the informal sector comprised of parents, relatives and friends; and the traditional sector of Native healers. The study will achieve three aims: 1. To test two service use hypotheses: a) Youths’ use of services for their drug or comorbid problems is determined by their need, their predisposing characteristics, and service enabling characteristics; their need as perceived by gateway providers; and those gateway providers’ resources, service connections, and service knowledge. and b) After controlling for baseline environmental factors and needs, American Indian youths who have accessed and utilized more extensive and intensive services for their drug use and related behavioral problems will be less likely to have impaired functioning and substance misuse, abuse or dependence. 2. To test a hypothesis concerning the consequences of service reimbursement: The use of specialty substance-use services is positively associated with the availability and accessibility of Medicaid and managed care reimbursement to those services. 3. To document: a) the prevalence, severity and duration of substance abuse and other problems, as well as the protective and risk factors, b) The multisector configurations of services and their complementary or supplementary relationships; and c) The relationship between barriers and changes in the configurations of services. AIM-HI’s impact is accelerated by the participation of American Indian community representatives; the association of its PIs with the George Warren Brown School of Social Work’s Center for Mental Health Services Research, and the Buder Center for American Indian Studies; and the collaboration of key researchers in the field.
Culture in Congruence and Substance Treatment Access
R03DA14398 (September 1, 2001 – August 31, 2002)
This dissertation research will investigate the interrelationships of culture, assessment and congruence (often called accuracy or detection) in service access for Native American substance using, high risk youth 13 -18, on both an urban and reservation setting. Although access to service does not insure improved functioning, without recognition of problems by gateway providers, and without subsequent access to services, treatment cannot be received. By explicating the role of the potentially modifiable culture-related predictors (youth cultural identity, provider cultural competence and sector culturally relevant services), this study provides needed knowledge to directly improve service 0access and continuance in youth with substance and mental health problems. Using the Adolescent American Indian Multisector Help Inquiry (Arlene Stiffman, Ph.D., PI), interviews of 400 American Indian youth (200 youth from the Pima-Maricopa Indian Reservation and 200 youth of mixed tribes from the Phoenix, Arizona area) and 600 people who helped them with their problems from multiple sectors, data will be used to construct variables for this research. In addition, some measures will be added to AIM-HI by this research, and providers will be interviewed a second time. This cross-sectional data will be used to test the following aims: 1. To examine how congruence between provider assessment and youth report is affected by three cultural factors: cultural identification; cultural competence; and culturally relevant services. 2. To examine how access to service for both substance abuse and mental health disorders is affected by culturally services and assessment congruence. Bivariate analysis, multiple regression and structural equation modeling will be used to test the aims. A model is specified based on access models and a model of how culture effects services (Andersen & Newman, 1973; Andersen, 1995; Aponte & Johnson, 2000; Costello et al., 1998). This dissertation research explicates factors which can be modified to improve access in an understudied, high need population of substance using American Indian youth.
Training Grant for Predoctoral and Postdoctoral Training in Mental Health Services Research
T32MH019960 (July 1, 1998 – June 30, 2001)
PI: Proctor, Predoctoral Fellow: Striley
Objectives are to train researchers who are knowledgeable about the history and trends in specialty and non-specialty, public and private service delivery; sources of variation in service use and quality; sources and patterns of funding; and the design, measurement and analysis issues in studying mental health services. We focus especially on mental health needs and services within the human service sectors of care. Our NIMH funded Center for Mental Health Services Research provides an excellent training environment. The Center is the nucleus for thirteen independently funded studies, five completed studies, several development projects, research enhancement tools, and interdisciplinary collaboration with the Department of Psychiatry and mental health services researchers nationally. Structured mentoring and guided experiences in grant writing and manuscript preparation further strengthen the training. The predoctoral training program requires (1) a course and seminars in mental health services research, three research design courses, four statistics courses including one specific to services research, two data management courses, courses in theory; plus a minimum of 15 credits taken outside of social work in the disciplines, particularly economics and psychiatry; (2) specialized advising and mentoring in grant proposal preparation; (3) three semesters of supervised, sequential research practicum, affording opportunity to learn directly from social work and psychiatry faculty across phases of the research process; and (4) consultation with nationally renowned Senior Scientist Collaborators. Postdoctoral training will draw on selected course work; faculty-supervised work on funded research, and structured mentoring. Recruitment efforts are directed toward individuals with prior training in social work or other behavioral or social sciences who demonstrate specialized interest in mental health services research and a strong aptitude for research. We will strengthen the nation’s supply of mental health service researchers by preparing a core of scholars who are ready to launch a research career in tenure-track faculty positions or post-doctoral fellowships with the requisite skills for scholarly publication, conference presentations, and grant proposal development.