A Problem-Solving Intervention for Family Caregivers in Palliative Oncology

David Albright
University of Missouri
Project Period: August 1, 2015 – June 30, 2017

Funded by a grant to Missouri from NIH – National Institutes of Health Palliative oncology providers are ideally situated to improve the cancer journey for the millions of family members and friends who are vital to the care of seriously ill patients. In recent decades, the primary setting for cancer care has shifted from the hospital inpatient unit to the outpatient clinic,leaving family caregivers responsible for providing the majority of patient care in the home, often with little support or preparation. The numerous stressors associated with family caregiving often give rise to caregiver anxiety, depression, fatigue, neglect of self-care and, for particularly strained caregivers, psychological symptoms that mirror those experienced by trauma survivors. In congruence with the National Cancer Institute’s commitment to supporting families of individuals with cancer across the full disease trajectory, we seek to examine the feasibility of a technologically-mediated problem-solving intervention designed to improve the quality of life and decrease the psychological distress of family caregivers of cancer patients receiving outpatient palliative care.Specifically, we aim to 1) examine the feasibility of the intervention relative to recruitment,randomization, retention, and fidelity to core intervention components; 2) investigate the impact of the intervention on family caregiver anxiety, depression, and quality of life; and 3) explore the benefits and challenges associated with the intervention from the perspective of participants. To accomplish these aims, we will recruit and randomly assign 82 family caregivers of cancer patients receiving outpatient palliative care into two groups (usual care and intervention) and collect quantitative and qualitative data, which will be analyzed to inform a future large-scale randomized clinical trial of the problem-solving intervention.


South Alabama Veterans Needs Assessment

David Albright and Karl Hamner
Community Foundation of South Alabama
Project Period: September 15, 2015 – November 7, 2016

The South Alabama Veterans Needs Assessment identified the unmet needs and perceived gaps in available services of veterans and their families located in an eight-county area in southern Alabamain which approximately 65,000 veterans reside. The needs assessment was conducted in two phases using an exploratory sequential design in which methods were mixed during data collection and interpretation. The findings include: (1) Veterans are not prepared for their military-to-civilian transition, especially minority and women veterans; (2) Veterans are unemployed and seeking

employment above Alabama’s average unemployment rate, especially for post-9/11 and women veterans; (3) Veterans are experiencing financial difficulties, including associated food insecurity; (4) Veterans need expanded and evidence-supported mental health and substance abuse services; (5) Veterans are largely uninformed or under-informed on available services; (6) Veterans need more local healthcare and support resources, especially in the rural counties; (7) Veterans need assistance to mitigate moral injury, especially older veterans; (8) Veterans continue to report inconsistent, limited, or the lack of housing options, especially for minority veterans; (9) Family members are serving as family caregivers for veterans; and (10) Family members need additional caregiver support services. The findings underscore the need for developing local capacity to provide healthcare and support services, especially for minority, rural, and women veterans.


Service Member to Civilian

David Albright and Karl Hamner
NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development
Project Period: April 1, 2014 – April 30, 2017

Researchers, policy makers and federal agencies have been slow in coming to terms with the realities of being in a worldwide conflict in multiple countries with no end in sight and the impact that has on service members, veterans and their families. The Service Member to Civilian conference, to be held in 2014 and 2015, will examine how our nation’s service members from all branches of the military transition to civilian life and how we can improve that transition through translational science and service. Active duty service members experience a life of numerous changes in circumstance, with often multiple cycles of deployment and reunion/reintegration with their families and children, communities and employers and schools. The transitions of military life are difficult and exacerbated by mental and physical trauma. Since 44% of active duty service members are parents, these transitions have an enormous impact on families and children. The conference objectives are: 1) Build research consortia that include active duty service members, veterans, reservists, military and veteran-connected families and children, researchers, practitioners and community decision makers; 2) Present current research and best practice interventions that will be strategically more responsive to military personnel and families transitioned to civilian culture; 3) Examine the challenges facing both veterans and the institutions of higher education where they enroll upon separation from military service; and 4) Involve employers in critical dialogue to bridge the gap of misunderstanding that some employers have in regard to the emotional/mental stability and transferable experiential skills of veterans. The proposed Service Member to Civilian conference is the first national, interdisciplinary conference that focuses on translational research to better understand and improve the transition from military service to civilian life and the impact of that transition on the service member/veteran and their families and children. The conference incorporates four themes – the roles of higher education, families and children, communities, and employers in the transition –interactively. These themes collectively reflect the objectives and aims of the conference to build a research consortium, present current research, develop multidisciplinary future researchers, use current research to illuminate critical issues, identify research needs relevant to demographic shifts in the Armed Forces, and build a cadre of new professionals inclusive of current graduate students, interns, and diverse researchers underrepresented in the academy. Findings from the conference panel presentations and recommendations from participants via collaborative sessions will be developed in to a translational research agenda to move the field of understanding and improve service member and veteran reintegration. Finally, the committee members are committed to sustaining the focus on this key issue through their participation in the translational consortia that will be formed from the conference and continuing as steering committee members for the 2015 conference.


Jill Beck
Alabama Department of Youth Services and Youth Services Institute
Project Period: October 1, 2015 – September 30, 2016


Jill Beck
Alabama Department of Youth Services and Working on Womanhood.
Project Period: October 1, 2015 – September 30, 2016


Jill Beck
Alabama Department of Youth Services, Accountability-Based Sex Offender Program: Continuum of Care.
Project Period: October 1, 2015 – September 30, 2016


Jill Beck
Tuscaloosa County Schools, Evergreen School – Educational Services to Qualified Students.
Project Period: October 1, 2015 – September 30, 2016


Carol Drolen, Allison Curington, and Carroll Phelps
HRSA – Health Resources and Services Administration, Transitional Age Youth – University of Alabama (TAY-UA).
Project Period: September 30, 2014 – September 29, 2017.

The discipline seeking stipend support is an accredited master’s-level school of social work.

The Transitional-Age Youth-University of Alabama Project (TAY-UA) proposes to address the critical need to develop and expand a behavioral health workforce focused on the prevention of substance abuse and mental illness and the promotion of health and wellness in transition-aged youth, aged 16-25, including youth in both the civilian population and returning veterans. Specifically, the population group to be served is transition-aged youth, youth who are at risk for developing or who have developed problems with mental illness, substance abuse, suicide, and/or violent behavior. The goal of the TAY-UA Project is to produce a total of 56 MSW graduates, trained in interprofessional settings that are integrated with primary care, who are competent to work with transitional-age veterans and civilian youth and to place these graduates in career positions serving such youth in behavioral health settings in Alabama and the southeastern region.  Well trained behavioral health professionals are in very short supply in Alabama.  Every county in the state is currently designated as a full or partial Medically Underserved Area (MUA; HRSA 2012a), 59 of the 68 counties are whole or partial Health Professional Shortage Areas (HPSA; HRSA 2012b), 61 counties are Primary Care Shortage Areas, and 67 of the 68 counties are full mental health care professional shortage areas (http://adph.org/ruralhealth/assets/Mental_Health_HPSA_Map.pdf).

Measurable objectives of the proposed project are:

  • Recruit Students
  • Strengthen and Increase Field Placements Serving Transitional- Age Youth
  • Develop and Implement Specialized Clinical Training Program
  • Place Graduates in Career Positions Serving Transitional-Age Youth
  • Evaluate Program
  • Develop Mechanisms for Dissemination and Sustainability

TAY-UA Student Fellows will be recruited from the School’s second-year concentration in Social Work with Children, Adolescents, and their Families. They will be offered stipends to cover the approximate cost of one year of in-state tuition with the expectation that they will complete a specialized curriculum that includes the following courses: Social Work Practice with Children and Adolescents in Mental Health; Social Work Practice in Child Welfare and Family Services; Advanced Policy Analysis; Evaluation Research; Chemical Dependency; Psychopathology; Social Work Practice with Military Families; and Core Concepts of Child and Adolescent Trauma. Fellows will also complete a rigorous five-day orientation to working with transitional-age youth prior to entering a specially-designed 500 clock-hour field education placement providing behavioral health services to transitional-age youth in an interprofessional setting linked to primary care. A requirement of the placement will be students’ participation in interprofessional teams and completion of an online course in interprofessional education.


Hyunjin Noh
The University of Alabama-Birmingham
(UAB) Minority Health and Health Disparities Research Center, Understanding Perceptions of Advance Care Planning by Race and Health Status.
Project Period: July 1, 2015 – May 15, 2017

Funded by a grant to UAB from NIA – National Institute on Aging.

African Americans have been more likely to pursue aggressive, life-sustaining treatment at the end of life and less likely to document their end-of-life care wishes compared to non-Hispanic Whites. Documentation of preferences for treatment in the end stages of an illness is the clearest way to ensure that individuals’ wishes are followed. Advance Directives have been recognized as an effective tool to facililtate end-of-life discussions among patients, families and health care providers. Alabama currently has an advance directive form endorsed by the state, the State of Alabama Advance Directive for Health Care. Through a focus group design using the Alabama Advance Directive form as discussion promt, this study explores knowledge, attitudes/beliefs and educational needs about life-sustaining treatments and end-of-life care options among African American and White older adults residing in Alabama and their perceptions of documenting treatment preferences near the end of life. This study fills a gap in prior research by focusing on what older adults know and would like to know about risks and benefits of life-sustaining treatments as well as end-of-life care options and by examining differences in these areas by race as well as health status. Utilizing qualitative approach in data collection and analysis, in-depth information will be acquired in the proposed areas adding to our knowledge about individuals’ beliefs, views and needs in advance care planning and any racial differences in them.


Amy Traylor
NIDA – National Institute on Drug Abuse, Developing Virtual Reality Environments for Marijuana – Using Adolescents.
Project Period: April 1, 2014 – June 30, 2017.

Cannabis is the most commonly used and misused drug among US adolescents1 and the primary drug of choice for adolescents entering substance abuse treatment21. Adolescents are highly vulnerable to adverse use and misuse consequences; it is important to understand factors causing continued cannabis misuse. One factor is the reaction (i.e., craving, physiological changes) adolescents experience when confronted with cannabis cues. This reaction, cue reactivity, occurs when drug users are exposed to proximal (e.g., drug or paraphernalia) or contextual (e.g., drug environments or social interactions)3 cues. Scant extant research on proximal cues suggests adolescents’ reactivity to cannabis cues is similar to adults’7,8, but no studies have examined reactivity to contextual cues. Further, incorporating cultural elements of adolescence (music, language, rituals, etc.) related to cues has been minimal.  Examining adolescent cue reactivity to culturally grounded combined contextual and proximal cannabis cues is likely to provide unique insight into cannabis-related behaviors, identifying opportunities to improve prevention and intervention. This study aims to identify common cannabis-related proximal and contextual cues adolescents encounter to develop and test virtual reality (VR) cue environments specifically aimed at these users. This study will collect pilot data identifying cannabis-related contextual (social and environmental) cues encountered by adolescents, leading to development of VR cannabis environments incorporating these proximal and contextual cues. It will also explore the feasibility of VR to measure effects of VR cannabis cue exposure on adolescents’ cue reactivity. The proposed research is innovative — the first to incorporate culturally grounded proximal and contextual cues into VR environments for adolescent cannabis-using populations. It will use a combination of focus group and cross-sectional design methods to develop and test VR cannabis cue environments specifically aimed toward adolescent cannabis users. Two focus groups of adolescents currently engaged in substance use treatment and a third group of providers will elicit insights on environments and interactions leading to cannabis use. This data will be used to develop VR environments containing combined proximal and contextual cues. These environments will be tested to determine feasibility of using VR to measure exposure to cannabis cues’ effects on adolescents’ self-reported craving, physiological response, mood state, and attention paid to virtual social cannabis interactions and proximal stimuli situations. Results will contribute to NIDA’s strategic goals on drug abuse prevention and treatment by developing a better understanding of environments in which adolescents use cannabis, then creating and testing similar VR environments to determine the level of cue reactivity elicited. This study focuses primarily on developing and testing a VR cannabis cue environment to elicit reactivity in treatment-seeking adolescent cannabis smokers. Ultimately, such environments could be incorporated into treatment to effectively prevent escalation of cannabis use, treat current addiction and abuse, and prevent relapse.


Amy Traylor
The University of Alabama-Birmingham (UAB), Leadership Education in Adolescent Health.
Project Period: July 1, 2012 – June 30, 2017

Funded by a grant to UAB from – Health Resources and Services Administration.

Today’s adolescents struggle with a wide range of health care needs related to a variety of social, economic, and environmental factors. For youth with disabilities, these problems are compounded by special health care requirements related to chronic illness.  Primary care services in conjunction with prevention efforts that are cognizant of the socio-ecological environment of youth and their families are critical to help address the health needs of adolescents.

The purpose of the University of Alabama at Birmingham (UAB) Leadership Education in Adolescent Health Program (LEAH) is to improve the health status of adolescents, particularly those in the southeastern region of the U.S.  This purpose will be accomplished through:

  • Training health professionals, at the graduate and post graduate levels in the 5 core adolescent health disciplines (medicine, nutrition, nursing, psychology and social work), who show leadership potential in the area of adolescent health.
  • Coordinating the considerable resources of the university/area/region to develop a training program that focuses on comprehensive, culturally-competent, and interdisciplinary leadership.
  • Developing and implementing continuing education programs for health professionals in the region and nation as well as providing technical assistance and collaboration with Title V and MCHB agencies.
  • Pursuing research efforts integrating biological, developmental, mental health, social, economic, educational, and environmental issues within a preventive public health framework.
  • Providing exemplary clinical care services in environments that are adolescent-centered/family-involved, community-based, ethnically and culturally competent.

UAB LEAH training activities are also developed with a public health framework and are guided by our knowledge of the Life Course development. Training activities acknowledge the challenges and risks/resiliencies of the adolescents and young adults who represent our nation’s future. UAB LEAH activities are designed to develop, enhance, and improve adolescent-centered/family-involved, community-based care for youth in a wide geographic area by providing interdisciplinary training of health professionals in collaboration with an array of health, educational, and social service agencies and providers – public, private, and voluntary.


Vikki Vandiver
Alabama Department of Mental Health, Placement of Graduate SW Students at Taylor-Hardin Secure Facility.
Project Period: October 1, 2015 – September 30, 2017

The School of Social Work provides to Taylor-Hardin Secure Medical Facility students to conduct the following social work services:

  • Complete psychosocial assessments and annual psychosocial updates.
  • Participate in development of discharge/aftercare plans.
  • Participate in treatment team meetings.
  • Provide social work intervention including group therapy.
  • Participate in departmental and facility in-service training and orientation.
  • Complete all patients’ charting and documentation requirements.
  • Participate in departmental and facility meetings as required.
  • Attend and participate in weekly clinical supervision with Director of Social Work Services and/or other master level social work staff.


Vikki Vandiver and Kristy Holt
Alabama Department of Human Services, ADHR – Title IV-E FY16.
Project Period: October 1, 2015 – September 30, 2016.

The University will provide academic programs leading to the degrees of Master of Social Work and Bachelor of Social Work, which shall provide for further development of DHR social worker skill and knowledge, and will prepare students for social work positions with DHR as a source of potential employment. The training program may also include short term and long term training at educational institutions through grants to institutions or by direct financial assistance to students enrolled in institutions for employment with the state or local agency.