Adolescent Behavioral Health Research Program

Drs. Matthew Aalsma and Amy Knopf are Co-Is for the NIH Community Network-Driven COVID-19 Testing of Vulnerable Populations in the Central US. (C3) RADxUP project. This multi-site project includes teams in Indiana, Illinois, Arkansas, Texas, and Virginia and aims to increase COVID-19 testing in underserved areas by providing education and local testing services, as well as support to individuals and families that test positive. Additionally, with COVID-19 vaccine rollouts, we will be examining vaccine acceptability, medical mistrust, and rates of vaccination among our sample. Indiana will be home to three of the research sites (all in Marion County) and are the only adolescent-focused juvenile justice sites in the larger project. Recruitment is anticipated to begin by May 2021.

MacKenzie Whitener (whitener@iu.edu) is the project manager and point-of-contact for the Indiana sites.

The Family Based - Justice Improvement Project (FB-JIP) is a Grand Challenges funded project headed by Principal Investigator Dr. Matthew Aalsma. FB-JIP recruited and trained two rural Community Mental Health Centers (CMHCs) in two evidence based adolescent substance use programs: ENCOMPASS (for high-risk substance users) and Teen Intervene (for low-risk substance users).

Our study monitors the effectiveness of these programs within their respective communities by enrolling local adolescents and their parents to complete surveys with our research team. Adolescents are identified as potential participants if they'd recently completed an intake and substance use screener at their local Juvenile Justice (JJ) Intake Center and scored a 1 or above on the screener. Youth and their parents who choose to participate in the baseline survey are then referred to either the ENCOMPASS or Teen Intervene program in their county based on their survey responses and risk level for substance use, but participation in the program is voluntary and not required. Surveys are administered at baseline, 3-month, and 6-month.

In total our study monitors the implementation of the substance use programs at the local level by administering surveys and conducting interviews with the CMHCs and JJ personnel, as well as facilitating surveys and interviews with local juvenile justice involved youth and their parents. Project recruitment and implementation is ongoing.

Alliances to Disseminate Addiction Prevention and Treatment (ADAPT) is part of the Justice Community Opioid Innovation Network (JCOIN), funded by the National Institute on Drug Abuse (NIDA). There are 8 Indiana counties participating in ADAPT, all of which are Juvenile Detention Alternative Initiative (JDAI) sites. ADAPT uses a learning health system approach to form alliances between juvenile justice staff (JJ) and community mental health centers (CMHC). The primary goal of ADAPT is to increase access to and use of evidence-based addiction services for youth involved in the juvenile justice system. ADAPT will directly address the public health problem represented by the “Substance Use Disorder Care Cascade” (i.e., Cascade). Of all justice-involved youth struggling with substance use problems, the need for addiction services is identified for only a fraction. Fewer are referred to services in the community, with the smallest proportions of youth initiating in, engaging in, and completing care. Each step down in the Cascade represents a gap in care for justice-involved youth in need of services and a corresponding opportunity for ADAPT to improve the Cascade. Alliances (formed with JJ & CMHC representatives) meet regularly to discuss opportunities for improvement along the Cascade, and use county-level data to guide continuous quality improvement.

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.

• PI: Zachary Adams, PhD
• Website: https://oudecho.iu.edu/
• Contact: oudecho@iu.edu

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.

• PI: Zachary Adams, PhD
• Website: https://vapingecho.iu.edu/
• Contact: vapeecho@iu.edu

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.

• PI: Zachary Adams, PhD
• Website: https://oudecho.iu.edu/tracks/
• Contact: oudecho@iu.edu

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.

• PI: Zachary Adams, PhD
• Website: https://research.indianactsi.org/clinicaltrial/11161/telehealth-covid-19-trauma-telehealth-recovery-and-resilience-program-opioid-extension-trrp-o-in-adolescent-and-young-adult-trauma-survivors/?qd=472929C
• Contact: trrp@iupui.edu, 317-220-1288

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.

• PIs: Zachary Adams, PhD & Rachel Yoder, MD
• Website: https://medicine.iu.edu/psychiatry/clinical-care/behavioral-health
• Contact: behappy@iupui.edu ; Note: Providers may contact 317-278-7700 (Weekdays, 9 am - 5 pm) to request a consultation

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.

• PIs: Leslie Hulvershorn, MD & Zachary Adams, PhD
• Website: https://research.indianactsi.org/clinicaltrial/11186/decision-makingdecision-making-impulsive-decision-reduction-training-for-youth-idrt-y/?qd=473688
• Contact: risklab@iupui.edu, 317-278-0503

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.

• PIs: Zachary Adams, PhD & Leslie Hulvershorn, MD
• Contact: adamslab@iupui.edu, 317-278-0503

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.

Descriptions of projects within the Hulvershorn lab can be found here.

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.

https://www.iupuiprismlab.com/