Since receiving my doctorate in Cognitive and Experimental Psychology in 2003, I have been designing, conducting and publishing high-quality experimental alcohol research. Over the past few years, I have become increasingly interested in applying my alcohol research skills to addressing real-world clinical problems. I am therefore submitting this proposal for a K01 Mentored Career Development Award to support my burgeoning interest and independent research program in community-based, clinically focused alcohol intervention research. The K01 will facilitate my acquisition of trainin and knowledge in community and clinical theory, research and design and compliment my foundation in experimental alcohol research, which will thereby help me reach my research training goals and longer-term career objectives. The career development plan that I am proposing for the K01 includes a) obtaining training in community and clinical theory, research and practice; b) enhancing my scientific publication and research dissemination record in community-based, clinically focused alcohol intervention research; and c) honing my grant-writing skills to secure independent funding in this new area. My primary mentor, Dr. Mary Larimer, is a well-established leader in clinically focused alcohol intervention research, and my proposed team of expert collaborators and consultants is well-qualified to provide me with the supervision and support I need to work towards my career objectives and successfully complete the proposed research. Additionally, the UW research and academic environment, where the proposed career and research plans will be implemented, is internationally recognized for its collegial environment and excellence in research and academic training. Most important, my proposed research and career goals are relevant to larger public health issues, because I intend to design, implement, evaluate and disseminate alcohol-specific interventions to improve alcohol, health and quality-of-life outcomes for severely affected, costly and marginalized populations. With my strong background in alcohol research and my burgeoning interest in clinically focused and community-based interventions, I believe I am a strong candidate for this K01 award mechanism. Within the context of the proposed K01, I will be designing, implementing, evaluating, leading, and disseminating innovative and clinically significant, community-based alcohol intervention research. Specifically, I am proposing to work with a community-based agency, the Downtown Emergency Service Center (DESC), and use a CBPR paradigm to develop and evaluate a comprehensive life enhancing alcohol- management program (LEAP) to improve alcohol, health and quality-of-life outcomes for formerly chronically homeless individuals with alcohol problems. Chronically homeless individuals with alcohol problems often have co-occurring medical and psychiatric disorders, which can translate into increased public costs due to greater use of emergency medical services, criminal arrests, and incarceration. DESC uses an innovative approach, project-based housing first (HF), to provide supportive housing for this severely affected and marginalized population. In project-based HF, individuals are offered permanent, low-barrier housing without preconditions such as alcohol abstinence or treatment attendance. This approach has been associated with reduced costs and improved alcohol, health and quality-of-life outcomes. While HF approaches are associated with improved outcomes for the target population and the larger community, most residents continue to consume alcohol and report clinically significant alcohol- related problems. This population also encounters various barriers to alcohol treatment, and traditional treatment options are generally ineffective. One reason why traditional treatment may not engage this population is that its exclusive focus on abstinence neglects individuals' overall quality of life and the larger biopsychosocial context for their alcohol use. To more comprehensively and effectively address the needs of this population, I am proposing a 5-year project to develop and test the treatment effectiveness and integrity of the LEAP in improving alcohol, health and quality-of-life outcomes. This intervention will be compatible with and integrated into the low- barrier HF approach currently in place in DESC housing. Phase I will involve baseline qualitative data collection to identify potential points for intervention enhancement (year 1). Phase II will entail community-based LEAP manual development (year 2). Phase III will consist of a 12-month, nonrandomized controlled trial (NRCT) testing LEAP effectiveness compared to a project-based HF control (years 3,4). Latent growth models will be used to test LEAP effectiveness compared to IAU in improving alcohol-use, health, and quality-of-life outcomes from baseline through the 3-, 6- and 12-month follow-ups. Phase IV will comprise treatment integrity analyses, including manual adherence and competence as well as participants' treatment receipt and enactment (years 4,5). This study will build a foundation for longer- term research objectives: a multisite, cluster-randomized controlled trial of the LEAP and wider dissemination of this comprehensive, evidence-based program. In summary, my proposed career development and research plan are an excellent fit with the K01 mechanism as well as with the NIAAA mission to further scientific knowledge to improve and address public health-related research needs of our nation.
The research plan proposed in this K01 Mentored Research Scientist Career Development Award describes an innovative and clinically significant community-based project that will support the development and evaluation of a comprehensive life enhancing alcohol-management program (LEAP) for formerly chronically homeless individuals with alcohol problems who are housed in a low-barrier Housing First project. This study has the potential to make significant contributions to public health policy, to build collaborative relationships with a community-based organization that serves the target population, and to advance high-quality, innovative and clinically significant biomedical research.
