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Adolescent Behavioral Health Research Program

The Adolescent Behavioral Health Research Program focuses on three primary areas of research: translational science, intervention and implementation science, and applied technology.

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Dr. Zach Adams discussing with another person at a conference with poster for Behavioral Health behind him

Translational Science

 Faculty members affiliated with the Adolescent Behavioral Health Research Program have expertise in translating basic science research to the community. Areas of expertise include the neuroscience of adolescent addiction, the role of discrimination and stress on inflammation processes, and utilizing technology for behavioral health intervention.

BHP Leaders, Tamika Zapolski and Zack Adams

Intervention and Implementation Science

A central goal of the Adolescent Behavioral Health Research Program is to improve the lives of adolescents through improved intervention and implementation science. Over several years, faculty members have developed and implemented improved substance use treatment for adolescents, implemented prevention programs within school settings, and implemented behavioral health screening for detained youth across Indiana.

hands typing on a keyboard

Applied Technology

The adolescent mental health and addiction fields are facing a workforce shortage, making task shifting and workforce development important areas of study for researchers. Adolescent Behavioral Health Research Program faculty lead statewide initiatives to improve access to and utilization of medication-assisted treatment for substance use disorders through online facilitation, developing and testing app-based mindfulness interventions, and utilizing computer decision support within pediatric primary care centers.

Current Projects

The Family-Based Justice Improvement Project is supported by funding from the Indiana University Grand Challenges Initiative: Responding to the Addiction Crisis. The primary purpose of this study is to compare the effectiveness of two evidence-based, brief substance use interventions among youth involved in the juvenile justice system who have mild to moderate substance use problems. Outcomes of interest include substance use, youth motivation/readiness to change, and criminal recidivism as assessed through youth and parent self-report as well as administrative justice system and treatment records. Implementation outcomes of treatment adoption and sustainability are also assessed.

Indiana’s Extension for Community Healthcare Outcomes focused on opioid use disorder (Opioid Project ECHO) is a workforce development project funded by the State of Indiana with support from the federal 21st Century Cures Act to bolster state capacity for outpatient management of opioid use disorder. The project uses technology, including web-based meetings and content to connect addiction experts at IU School of Medicine with clinicians, behavioral healthcare providers, and community health workers to educate them about opioid use disorder and best practices in treatment.

Aalsma Lab Projects

ADAPT aims to improve treatment linkages and mental health care coordination within eight county juvenile justice systems across Indiana. To address gaps in identification of need and access to care, the study is implementing a Learning Health System to improve collaboration between juvenile justice agencies and community mental health centers, using interagency data-sharing to help identify specific local gaps and opportunities to implement evidence-based interventions.

The goal of this study is to identify mechanisms to improve interagency collaboration; enhance prevention and treatment service delivery along the opioid care cascade; and improve outcomes for justice-involved youth at high risk of developing a substance use disorder.

e-Connect is a single, integrated system that enables real-time identification of youth needs and targeted, county-specific referral and linkage of those at various levels of risk for suicidal behavior. The implementation of a self-administered, evidence-based screen on a tablet allows probation staff to quickly identify youth in crisis and connect them with needed services. Between 2019 and 2021, e-Connect was implemented in 10 counties in upstate New York. Over 1,000 youth were screened as part of the project.

e-Connect Scale Up examines the feasibility of implementing e-Connect in probation settings beyond New York state. The aims of the project include examining if it improves justice-involved youth behavioral health service use, improves probation officer practice outcomes, reduces health disparities, and compares the implementation of e-Connect to the established model. The IUSM research team will train and support Local Facilitators in 9 Indiana counties to ensure the successful transfer of knowledge and skill in delivering e-Connect to new systems and geographic contexts, utilizing implementation strategies to support more widespread, sustained, and rigorous adoption of e-Connect.

FORTRESS seeks to address the overdose epidemic by working with overdose fatality review (OFR) teams. The goal of FORTRESS is to improve standard OFR practices by equipping them with a data dashboard built on real-time aggregate data, record-linked across multiple sources and presented in a way that helps identify and visualize common “overdose touchpoints,” or opportunities to deliver harm-reduction services or engage individuals at risk for overdose in evidence-based treatment. We will also be training key OFR team members in data-driven decision-making principles that can be applied to the OFR team setting to supplement the use of the data dashboard tool.

Integrated Behavioral Health (IBH) is a multifaceted project designed to address the mental health crisis by providing immediate and continuing mental health resources to pediatric patients in the primary care setting. Patients who indicate as having some sort of mental health concern either verbally to their provider, through provider assumption or through parental referral begin their treatment by utilizing an assessment tool called K-CAT. This tool will help patients better identify their stressors and allow providers to gain more insight to the challenges (depression, anxiety, mania, ADHD, conduct disorder, oppositional defiant disorder, substance use disorder and suicidality) the patient is experiencing.

Patients who indicate as having a mental health concern are then met, while still in clinic, with a behavioral health counselor who will administer FIRST. FIRST (Feeling Calm, Increasing Motivation, Repairing Thoughts, Solving Problems and Trying the Opposite) is a transdiagnostic treatment approach which builds on five core principals found in evidence-based treatment for internalizing and externalizing problems. From FIRST, the patient will be referred to Virtual Therapy/Groups or Specialty/Higher level of care for additional assessment and treatment of more severe/unique disorders.

IBH will be piloted within selected IUH locations within the South Central, West Central, East Central, and Indy Suburban areas. Working within each of those regions, together we will choose at least 20 locations. The research on IBH is focused on the implementation of these mental health resources. To measure fidelity and use in each primary care location. To help ensure that the resources are used appropriately to better treat mental health problems before they reach a crisis level.

Adams Lab Projects

Thousands of Hoosiers are affected by opioid use disorder (OUD) and other substance use disorder (SUDs). However, like many states, Indiana has a shortage of addiction psychiatrists and other behavioral health specialists, particularly in rural and other historically underserved communities. To help ensure people with OUD can access high quality clinical services statewide, our team has partnered with the IU School of Public Health-Bloomington and IUPUI Fairbanks School of Public Health to offer the Indiana OUD ECHO program. With support from the State of Indiana Family and Social Services Administration-Division of Mental Health and Addiction (FSSA-DMHA), the program includes a set of no-cost, virtual learning sessions where community-based professionals from across Indiana are connected with a multidisciplinary panel of specialists to learn from each other about best practice management of OUD. Each live, interactive session involves discussion of a de-identified case and a brief presentation on an applied topic to help participants build competence and confidence in managing OUD in their own practices and communities. The overall focus of the program is on promoting evidence-based care for OUD – including medications for OUD (MOUD) – across a range of settings (ex: primary care, emergency department, jails, first responders) and populations (ex: adolescents, pregnant women) through case-based learning and collaboration.

According to the Indiana Youth Survey, in 2020, 23.0% of Indiana 12th grade students reported monthly use of vaping products. The high prevalence of vaping among Indiana teens poses a critical public health challenge that is magnified by the shortage of substance use treatment providers in Indiana. Our IU School of Medicine Department of Psychiatry team, with generous support from the Indiana Department of Health, is proud to offer the Indiana Teen Vaping ECHO Program to help providers and other youth-serving professionals learn more about the management of vaping/e-cigarette use and related conditions in adolescents. Through this free series, participants learn from a multidisciplinary team of specialists and each other to build confidence and knowledge in best practice care for youth who vape, so that patients across the state can receive the treatments they need in their home communities.

Comprehensive services – including behavioral healthcare and OUD treatments – can be difficult for women with OUD to access during pregnancy and the postpartum period, especially in rural areas. There is a need to increase availability and accessibility of best practice care for women with OUD statewide, especially in light of shortages of maternity care and substance use treatment providers for pregnant and parenting women with OUD covered by Medicaid. Our IU School of Medicine Department of Psychiatry team, in partnership with the State of Indiana FSSA Maternal Opioid Misuse Indiana Initiative (MOMII), is proud to offer three continuing education series aimed at improving the quality of care for women with OUD across Indiana: the Indiana Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome (NAS/NOWS) ECHO Clinic, Indiana OUD in Pregnancy ECHO Clinic, and the Case Management for OUD in Pregnancy ECHO Clinic. Collectively, these free programs aim to support healthcare professionals and care managers statewide to learn more about caring for women with OUD while pregnant and for infants with NAS/NOWS symptoms.

People who experience traumatic injuries are at increased risk for developing behavioral health symptoms including posttraumatic stress, depression and problematic substance use. Many trauma patients, including adolescents and young adults, also receive opioid pain relievers at discharge which carry additional risk for addiction and overdose in some patients. Yet it can be difficult to predict who will need additional behavioral health supports, and various barriers such as workforce shortages prevent many hospitals from monitoring patients’ mental health or substance use after they leave the hospital. The Telehealth Resilience and Recovery Program (TRRP) is a technology-facilitated stepped, access-to-care program that was developed at the Medical University of South Carolina to address these gaps. The current project involves development and acceptability testing of an expanded version of the TRRP model to provide education about opioid safety and to assess substance use alongside other behavioral health symptoms in the weeks following a traumatic event. TRRP is initiated in the hospital and includes basic education about trauma reactions, enrollment in a “watchful waiting” daily text-message service to monitor emotional recovery, web-/phone-based surveys at 30- and 60-days post-discharge, and referral to behavioral health services for those people whose responses indicate they may benefit from additional care. This work is being carried out at Indianapolis area Level 1 trauma centers among adolescents and young adults who have experienced recent traumatic injuries or who have been directly affected by COVID-19.

Indiana ranks 48th in the U.S. in availability of child psychiatrists, presenting a critical barrier and shortage in access to mental health care. The Indiana Behavioral Health Access Program for Youth (BeHappy) is a FREE child psychiatry access program designed to address child and adolescent psychiatry shortages by facilitating provider-to-provider consultations between youths’ local primary care providers and IU-based psychiatric specialists. The goal of Be Happy is to increase the capacity of primary care providers to address the mental health and substance use related needs of children and adolescents in their care through delivery of educational consultations, community referrals, and other supports, thereby increasing the availability of best practice pediatric behavioral healthcare statewide in settings most familiar and accessible to patients. As of April 2021, Be Happy has provided over 775 consultations to PCPs across the State of Indiana since launching in mid-2019.

Making safe, healthy decisions can be a complicated process. People who are prone to inconsistent, erratic, or impulsive decisions are more likely to develop problematic substance use and other negative health outcomes. Research by our colleagues at IU Bloomington has shown that these decision-making processes may be targeted effectively through a brief, manualized therapy called Impulsive Decision Reduction Training (IDRT) to improve healthy, adaptive decision-making and reduce problematic substance use in young adults. Our team is working closely with the IDRT developers to adapt the intervention for youth and test its feasibility, acceptability and effects in a small-scale pilot study in adolescents aged 10-17.

The COVID-19 pandemic has led to a dramatic increase in the volume of virtual outpatient psychiatry visits delivered via secure tele-video platforms. Research evidence supports the use of motivational interviewing (MI), cognitive behavioral therapy (CBT) and contingency management (CM) – delivered in an integrated fashion to treat SUDs in adolescents, but developing a framework to offer CM via telehealth has posed significant challenges. This is problematic because CM has been shown to boost treatment effects, including increased treatment adherence and reduced substance use. reSET is an FDA-approved prescription digital therapeutic for adults with substance use disorders that delivers CBT and CM content. It is unknown whether reSET would be appropriate or acceptable for use in adolescents. The current study aims to evaluate the feasibility and acceptability of implementing reSET adolescents ages 12-18 with substance use disorders when combined with telehealth treatment services at the Riley Adolescent Dual Diagnosis Program.

Dir Lab Projects

Parent engagement in youth’s juvenile justice system involvement is crucial for positive youth development and positive system outcomes; however, there are multiple barriers to parental engagement with juvenile justice, including system mistrust, lack of resources and ancillary support, and complex system procedures that are difficult to navigate. Peer specialists, or those with lived experience, are effective in increasing service engagement among other systems and may increase parental engagement in youth juvenile justice. The goal of the KL2 is to examine the feasibility of developing and implementing a parent peer navigator program for parents of youth involved in the juvenile justice system. The project entails conducting a needs assessment with parents of youth currently involved in juvenile justice and juvenile justice staff, as well as collaborating with the juvenile court family advisory board to develop a protocol for a peer-based parent navigator program.

Hulvershorn Lab Projects

Descriptions of projects within the Hulvershorn lab can be found lab's website.

Zapolski Lab Projects

PRISM’s goal is to conduct research illuminating culturally relevant risk/resilience models for substance use and other risk behavior among racial/ethnic minorities to ultimately reduce health disparities and improve health outcomes. Specifically, PRISM examines the interactive effect of cultural variables (e.g., discrimination, racial socialization, racial identity) on physiological, individual level (e.g., personality, expectancies, perceptions of risk), interpersonal (e.g., access to drugs, school support, neighborhood disorganization) factors to better understand drug choice, course of use and consequences among diverse youth and young adult populations, particularly African Americans.

PRISM also aims to examine the effectiveness of school-based interventions to reduce substance abuse and related emotional and psychological problems among adolescents. PRISM provides a space for students at graduate and undergraduate levels to conduct translational research and receive mentorship in interdisciplinary topics, including minority health disparities, substance use, and psychosocial development.