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Month: April 2024

iTRAC Emotion Regulation + Substance Use Prevention

iTRAC Emotion Regulation + Substance Use Prevention

Klein Buendel Investigators, Ms. Julia Berteletti and Dr. W. Gill Woodall, are collaborating with Dr. Chris Houck from Rhode Island Hospital and Dr. Stephanie Parade from Brown University on a new 5-year project to integrate substance use content with iTRAC emotion regulation material to reduce substance use among child welfare involved youth. The web-based intervention is being developed and evaluated in partnership with the Rhode Island Department of Children, Youth, and Families.

Nearly 700,000 children experience maltreatment each year, and youth with a maltreatment history are at heightened risk for substance use across the lifespan. Emotion regulation is a modifiable mechanism underlying the impact of maltreatment on risk behaviors but is often impaired in youth with a maltreatment history due to the neurotoxic effects of early trauma/neglect and inconsistent modeling of adaptive emotion regulation strategies. Emotion regulation is related to substance use in adolescence, and interventions to support the development of adaptive emotion regulation in youth with a maltreatment history have outstanding potential to interrupt trajectories of risk and prevent substance use. However, youth with a maltreatment history often face structural and psychosocial barriers to engagement. Furthermore, the child welfare system, which is designed to protect and support youth with maltreatment histories, is under resourced and often unable to meet the critical needs for prevention in this population. Interventions targeting substance use with this population must be acceptable, easily accessible, and low resource for the child welfare system.

During the Planning and Intervention Enhancement Phase (R61), the investigators will interview adolescents, caregivers, and child welfare professionals to obtain diverse perspectives regarding the integration of emotion regulation and substance use. They will create and program this content within the iTRAC framework, followed by acceptability testing to ensure usability and understanding. Upon completion of Phase 1, the team will begin Phase 2 (R33), during which a Stage III real-world efficacy (hybrid efficacy-effectiveness) trial of 200 youth with maltreatment histories will evaluate the iTRAC for Substance Use (iTRAC-SU) intervention.

Phase 1 – Planning and Intervention Enhancement (R61) Specific Aims

Aim 1: To create and integrate digital content linking substance use with ER into existing iTRAC modules. Information gathered via qualitative interviews with adolescents, caregivers, and staff in the child welfare system will be used to develop the substance use content.

Aim 2: To assess acceptability and usability with 10 adolescents (representing diverse backgrounds) over two iterative rounds of feedback.

Aim 3: To ensure successful completion of the Phase 2 Aims, planning activities with Rhode Island Department of Children, Youth, and Families. will take place to establish procedures for developing the workforce for the project, recruiting families, and avoiding interference by research in the critical mission of Department of Children, Youth, and Families programs.

Phase 2 – Randomized Trial (R33) Specific Aims

Aim 4: To conduct a randomized controlled trial examining the impact of the iTRAC-SU intervention on substance use relative to a waitlist control among 200 adolescents ages 12 to 15.

Aim 5: To examine iTRAC-SU relative to a waitlist control in enhancing theoretically important emotional competencies (such as emotion regulation, emotion recognition, distress tolerance) that mediate risk as measured by self-report, performance measures, caregiver report, and respiratory sinus arrhythmia.

Aim 6: To examine the feasibility, acceptability, uptake, and costs of iTRAC-SU when implemented with child welfare involved youth.

This research project was awarded to the Rhode Island Hospital by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (DA059785; Dr. Chris Houck and Dr. Stephanie Parade, Multiple Principal Investigators). Collaborators include Ms. Julia Berteletti and Dr. W. Gill Woodall from Klein Buendel, and the Rhode Island Department of Children, Youth, and Families. The enhanced iTRAC modules will be designed and programmed by the Creative Team at Klein Buendel.

Just Care for Dementia in Prison

Just Care for Dementia in Prison

A research team from The Penn State University Ross and Carol Nese College of Nursing and Klein Buendel made two presentations related to formative research on the development of Just Care for Dementia at the 36th Annual Scientific Sessions of the Eastern Nursing Research Society April 4-5, 2024 in Boston, MA.

Presentation 1

Title: Dementia Care Training Needs for Corrections Staff and Peer Caregivers

Dr. Susan Loeb, Penn State University

Presenter: Dr. Susan Loeb

The number of people living in prison with Alzheimer’s Disease and Related Dementias (ADRD) is growing. Care inequities for ADRD between prisons and community settings exist and warrant addressing. A standardized, evidence-based, feasible, and acceptable ADRD e-training program is needed to prepare corrections staff and peer caregivers for better managing and caring for people with ADRD in prisons. 

The purposes of this study were to (1) identify three priority learning needs of corrections staff and peer caregivers who manage and/or care for people living with ADRD in prisons; (2) identify a logo for the Just Care for Dementia training that was desirable to end-users; and (3) translate best practices from community-based ADRD care into evidence-based, accessible, and relevant ADRD content for prison settings. The end goal was to program prototypes for three highly interactive e-learning modules that fit within the restrictive context of corrections.

Focus group methodology guided potential future users in providing insights to ensure the content, design, and technology plans match the needs and constraints of prisons. Human subjects approvals were secured and participants’ signed informed consent was obtained. Settings were one men’s and one women’s state prison in the northeastern United States. Twelve corrections staff and 11 peer caregivers participated. Focus groups were audio recorded, transcribed, and deidentified.

Thematic analysis was completed independently by two researchers. The three priority content areas identified were fostering a safe and calm environment, addressing behavioral and psychological symptoms of dementia, and enhancing awareness of need. Participants identified two logo preferences. Advisory board consultation informed logo selection. Module content was developed via an iterative process to ensure contextual relevance of training, accessibility within the constraints of prisons, and the e-training matched identified training needs.

In summary, participants confirmed the need for ADRD training and indicated e-learning is a viable approach for addressing a pressing care need in prisons. 

This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging (AG057239; Dr. Susan Loeb from Penn State and Dr. Barbara Walkosz from Klein Buendel, Multiple Principal Investigators). Collaborators included Dr. Erin Kitt-Lewis and Sherif Olanrewaju from Penn State University; and Amanda Brice and Steve Fullmer from Klein Buendel. 

Presentation 2

Title: Small-Scale Usability Testing: E-learning modules for Peer Caregivers 

Presenter: Dr. Susan Loeb

Growing numbers of people will grow old and die while incarcerated. Research evidence supports using peer caregivers to assist staff with geriatric and end-of-life care. Peer caregivers training varies widely in content and duration. Evidenced-based, accessible, and contextually relevant materials are needed to effectively prepare peer caregivers. 

The purpose of this study was to conduct research and development for Just Care, a six-module e-learning program for peer caregivers and a single module to guide corrections staff in launching the program. Deputy Wardens identified people meeting our inclusion criteria. Nineteen people living in prison and 11 staff participated. Throughout usability testing, participants shared their thoughts aloud, while field notes were taken. Participants completed six open-ended questions, a demographic survey, and the System Usability Scale (SUS).

All users easily navigated through the program with minimal guidance. Many noted Just Care’s utility for future peer caregivers. Some users who were incarcerated had difficulty navigating the post-test assessments. A few staff users noted liking the additional resources available via links to PDFs. One staff user voiced concern about the safety of having incarcerated people help with care. Just Care received Round 1 SUS scores of 87.5 by users living in prison and 74.5 by staff. Following rapid refinement, Just Care received Round 2 mean SUS scores of 85.28 by users living in prison and 83.75 by staff. A SUS score of 68 is an above average score.

Overall, participants found Just Care innovative, useful, engaging, interactive, and relevant to providing geriatric and end-of-life care in prisons. Staff noted that Just Care raised awareness about the growing need for programming on geriatric care in prisons and that a peer caregiver program is a viable solution that is implementable by prison staff.  

This research was funded by an STTR grant to Klein Buendel from the National Institute on Aging (AG057239; Dr. Susan Loeb from Penn State and Dr. Barbara Walkosz from Klein Buendel, Multiple Principal Investigators). Collaborators included Dr. Erin Kitt-Lewis and Sherif Olanrewaju from Penn State University; and Brandon Herbeck, Peter Fu, and Steve Fullmer from Klein Buendel. 

Project SHINE Protocol

Project SHINE Protocol

A research team led by Dr. Yelena Wu from the University of Utah and the Huntsman Cancer Institute, and including Dr. David Buller from Klein Buendel, has published a detailed protocol for the project entitled, “Sun-safe Habits Intervention and Education” in Contemporary Clinical Trials. Project SHINE examines the efficacy of a personalized intervention targeting sun protection and tanning of high school students.

Adolescents infrequently use sun protection and engage in intentional tanning more frequently compared to other age groups, leading to increased ultraviolet radiation (UVR) exposure that heightens skin cancer risk across the lifespan. High schools are therefore an ideal setting for offering skin cancer prevention interventions. Yet, there are limited UVR protection interventions for high school students, especially those that are personalized, tested using randomized designs, and include long-term outcome assessment to determine the durability of intervention effects.

The SHINE cluster-randomized trial will test a novel, personalized intervention that targets high school adolescents’ sun protection and tanning behaviors, and tracks their outcomes for up to one year following intervention. Enrolled high schools will be randomized to receive either the personalized SHINE intervention, which includes facial UVR photographs and sun protection action planning, or standard education using publicly available materials. Students in both conditions will receive information about skin cancer, sun protection, and skin self-examination. Outcome variables will include students’ sun protection and tanning behaviors and sunburn occurrence. Potential moderators (such as race/ethnicity) and mediators (such as self-efficacy) will also be assessed and tested.

The investigators believe Project SHINE will lead to new scientific understanding of the theoretical mechanisms underlying outcomes and moderators of the intervention effects, which will inform future intervention tailoring to meet the needs of vulnerable subgroups.

This research is sponsored by the National Cancer Institute (Dr. Yelena Wu from the University of Utah and the Huntsman Cancer Institute, Principal Investigator). Dr. David Buller, Director of Research at Klein Buendel, is a Co-Investigator.