The Mentored K23 Clinical Scientist Development Award from the National Institute on Drug Abuse (NIDA) will train me as an independent investigator of theory-based motivational approaches to women with the co-morbid, cyclically-related conditions of Substance Use Disorder (SUD), HIV and/or Hepatitis C (HCV), and trauma histories. I bring a unique perspective as an internist caring for underserved women in combination with my research in theory-based motivation applied to HCV services utilization and intimate partner violence (IPV) safety behaviors. I am interested in the underlying motivation impacting health services utilization of women in criminal justice settings from both the clinical and public health perspectives. I will be examining this motivation in the Drug Treatment Court setting. Self Determination Theory (SDT) is the empiric motivational model informing my research. This research will require increased expertise in health services, research design, quantitative assessment and analysis, SDT, and the cycle of co-morbid conditions impacting women defendants. My approach combines an empiric strategy, the criminal justice setting, and a gender and trauma-informed approach to needed healthcare services. I will adapt my SDT-based motivational intervention to create a program I call the Women's Initiative Supporting Health (WISH). Under-treatment of HIV and HCV among individuals in criminal justice settings is a major public health issue.1 While treatments differ, similar risks exist for HIV and HCV infection and under-treatment.2,3 The NIDA, CDC, and American Public Health Association are calling for effective and generalizable approaches for HIV and HCV treatment as a research priority in the criminal justice population. The institutes'recommendations support addressing combined risks in women, in the context of a high prevalence of child abuse or IPV histories. Furthermore, they recommend adapting services to meet individual needs. The goals of my proposed research project are consistent with these national priorities.1, 4-7 Evidence shows that women with SUD, while in long-term incarceration, can adhere to treatment of HIV and HCV. However, an unmet challenge is their post-release health services utilization. Additionally, to break the cycle of substance abuse, HIV, HCV, medical under-treatment, incarceration, and trauma, concurrent interventions are needed.8 Effective strategies are needed to engage this complex population in treatment. Drug Treatment Courts have been effective with a reward and sanction model in engaging participants while decreasing substance use and recidivism.9-11 Yet they usually do not address healthcare utilization. Motivational interventions have proven effective in difficult-to-treat populations suffering from SUD, nicotine addiction, HIV, and diabetes.12-16 They support destigmatization of targeted behaviors across varied ethnic, socio-economic, and marginalized populations.17-19 This is key in the criminal justice setting. However, the theoretical model underlying motivational approaches is not widely understood. SDT is an evidence-based theoretical model which establishes autonomous motivation as a mediator for improved health behavior in populations, including those with SUD or HIV.14, 20 Health conditions of subsets of the criminal justice populations are poorly understood. For example, women in criminal justice settings are medically under-studied. The prevalence of HIV and HCV is unknown in the Drug Treatment Court population. In my proposed K23 project I will begin my long-term career plan by examining the feasibility and effects of WISH in under-treated women Drug Treatment Court defendants. I will investigate the role of SDT in predicting changes in motivation for treatment influencing HIV and HCV-related services. Exploring proximal motivation outcomes insures the relevance of my proposal regardless of the effect of WISH. During the K23 mentored period, I will obtain research training and knowledge through mentoring and directed coursework. I will build upon my knowledge and experience using the Stage Model of Behavioral Therapies.21 I will establish myself as an independent investigator by studying promotion of appropriate service utilization. The K23 Mentored Clinical Scientist Award will allow me to accomplish the following goals: 1. Adapt and describe WISH in the criminal justice setting. 2. Obtain training in research methods: a) relevant to the unique needs of persons with co-morbid SUD, HIV, HCV or criminal justice involvement (ethics, CBPR, health services);b) advanced quantitative approaches 3. Become expert in SDT regarding approach, measures, and outcomes. 4. Provide background data to inform an R01 award application to be written during year 4 of the project. With departmental mentor and research resources in substance abuse, HIV, SDT-based health behavior change, criminal justice collaborations, women's health, services utilization, and clinical research methods, I am ideally suited to benefit from this K23 award. My background provides me the depth of understanding and the ideal timing to undertake this career development research plan effectively addressing complex service needs of women with SUD, HIV, HCV, and IPV risk, and trauma histories. The compelling public health needs of these women defendants mandate a creative, broad based approach.

Public Health Relevance

This K23 mentored project builds the foundation for Dr. Morse's research career by addressing theory-based motivation mechanisms for drug-using women in criminal justice settings to engage in HIV and HCV-related services. Women's Initiative Supporting Health has the potential to improve autonomous motivation, needed service utilization, and clinical outcomes in a complex, under-treated population caught in a criminal justice, SUD, and trauma cycle by reaching them outside clinic walls. Increased service utilization could reduce overall costs associated with HIV and HCV, and improve individual and public health.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
AIDS Behavioral Research Subcommittee (NIDA)
Program Officer
Wiley, Tisha R A
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University of Rochester
School of Medicine & Dentistry
United States
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Morse, Diane S; Wilson, John L; Driffill, Nicole J et al. (2018) Outcomes among pregnant recently incarcerated women attending a reentry transitions clinic. J Community Psychol :
Morse, Diane S; Wilson, John L; McMahon, James M et al. (2017) Does a Primary Health Clinic for Formerly Incarcerated Women Increase Linkage to Care? Womens Health Issues 27:499-508
Bedell, Precious; Wilson, John L; White, Ann Marie et al. (2015) ""Our commonality is our past:"" a qualitative analysis of re-entry community health workers' meaningful experiences. Health Justice 3:19
Morse, Diane S; Silverstein, Jennifer; Thomas, Katherine et al. (2015) Finding the loopholes: a cross-sectional qualitative study of systemic barriers to treatment access for women drug court participants. Health Justice 3:12
Kothari, Catherine L; Butkiewicz, Robert; Williams, Emily R et al. (2014) Does gender matter? Exploring mental health recovery court legal and health outcomes. Health Justice 2:12
Morse, Diane S; Cerulli, Catherine; Bedell, Precious et al. (2014) Meeting health and psychological needs of women in drug treatment court. J Subst Abuse Treat 46:150-7
McDaniel, Susan H; Morse, Diane S; Reis, Shmuel et al. (2013) Physicians criticizing physicians to patients. J Gen Intern Med 28:1405-9
Morse, Diane S; Lafleur, Ross; Fogarty, Colleen T et al. (2012) ""They told me to leave"": how health care providers address intimate partner violence. J Am Board Fam Med 25:333-42