HSR&D Research Career Scientist Award Application

Veterans Admin Palo Alto Health Care Sys, Palo Alto CA

Investigators

Abstract

Renewal of my VA HSR&D Senior Research Career Scientist (SRCS) Award will facilitate continuation of my research, mentoring, and VA service efforts that are of direct benefit to the VA's mission of providing high- quality and cost-effective health care to Veterans. My activities will continue to move forward the mission of VA HSR&D to understand and improve the quality, cost-effectiveness, and outcomes of treatments for disorders that are prevalent among Veterans. I focus on patients with substance use and other mental health disorders, which are present in over 25% of VA patients. I have obtained continuous VA, NIH, and private foundation funding to address these important issues since joining the VA Palo Alto Health Care System in 1987, and will continue to do so with the renewal of my SRCS Award. My projects involve interdisciplinary teams from different institutions and use a variety of sophisticated methodologies (e.g., hybrid trials, long-term observational studies, large surveys, reviews), while focusing on practices that are practical and feasible to implement in real-world clinical and other settings. Thus, they have high relevance for improving the quality of care for Veterans with substance use and other mental health conditions. My research and mentoring focuses on (1) facilitating health care transitions; (2) improving services for family members of Veterans with substance use and mental health disorders; (3) improving services for mental health and medical patients on the unhealthy substance use continuum; and (4) improving health care for Veterans involved in the criminal justice and civil legal systems. Specifically, with renewal of my Award, plans in each focus area are: (1) Continue my multi-VA collaborations to implement Intensive Referral, an evidence-based intervention I developed, in new health care and criminal justice settings; these collaborations involve former HSR&D postdoctoral fellows and Career Development Award (CDA) recipients. Our main VA operations partners for these projects are Mental Health Services (MHS), the National Center for PTSD, and Women's Health Services (WHS). (2) Evaluate an adapted Intensive Referral intervention to facilitate the utilization of peer-based resources among family and friends of Veterans and civilians in treatment for alcohol (NIH/NIAAA project slated for funding) and drug (NIH/NIDA proposal) use disorders. The purpose is to improve health outcomes for family, friends, and substance use patients, and examine mechanisms by which family and friend functioning is associated with patient outcomes. These studies include 3 VA and 3 non-VA (community) matched treatment programs at 3 US sites. (3) Complete the HSR&D CREATE project I am leading at 2 sites to evaluate outcomes of Enhanced Telephone Monitoring among inpatients undergoing detoxification from alcohol or drugs. I will also conduct a planned project to link medical-surgical inpatients with alcohol use disorders to addiction services, in a 2-site collaboration with MHS. (4) Fulfill my mentorship/Co-Investigator roles on projects with justice-involved veterans, led by former and current CDA recipients, to improve access to care, health outcomes, and criminal recidivism risk. I plan to lead another project on VA-legal clinic partnerships, which emphasize helping Veterans to resolve their legal issues that negatively impact their ability to receive health and social services. These clinics may offer a setting to identify and transition Veterans who are at risk for cyclical involvement in the justice system, homelessness, and intensive use of health services such as acute inpatient and emergency department care. Our operations partner is the VA's Veterans Justice Program. With the RCS and SRCS Awards, I have become a distinguished leader in each of my foci, as demonstrated by memberships on federal and international advisory panels and study sections for NIH, VA, and private foundations; and editorial positions for leading addiction journals. With renewal of the Award, I will continue to make key, fundamental contributions, leading to improvements in VA health care.