Center to Accelerate Translation of Interventions to Decrease Premature Mortality in SMI

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Persons with serious mental illness (SMI) comprise one of the most highly vulnerable groups in the US, dying 10 to 20 years earlier and with mortality rates two to over three times higher than the overall population. Much of this premature death is attributable to cardiovascular disease (CVD) and is potentially preventable; all CVD risk behaviors (unhealthy diet, physical inactivity, tobacco smoking) and risk factors (obesity, hypertension, diabetes and dyslipidemia) are markedly elevated in persons with SMI. Concomitantly, persons with SMI often receive poor quality of care for these conditions. While these health and mortality gaps are widely recognized as a public health crisis, individual, provider, organizational, and policy level barriers impede progress. While many persons with SMI receive most of their care from the public mental health sector, tailored interventions to decrease CVD risk shown effective in clinical trials for those with SMI (e.g., for weight loss, smoking cessation) have not been widely adopted in community mental health settings. Meaningfully advancing health and decreasing mortality disparities for persons with SMI requires urgent development and testing of implementation strategies for scale-up of practical, effective interventions. In response to this extraordinary burden of years of life lost, our goal is to create the Center to Accelerate Translation of Interventions to Decrease Premature Mortality in SMI that will use cutting-edge transdisciplinary methods towards short and long-term progress to reduce CVD risk in this highly vulnerable population. The Center’s uniquely qualified team will conduct 3 R34 studies to develop and pilot test innovative implementation strategies to address all CVD risk behaviors and risk factors in persons with SMI in community mental health settings. The R34s will focus on evidence-based approaches for: 1) behavioral weight loss with diet and physical activity; 2) tobacco smoking cessation treatment; 3) care delivery for diabetes, hypertension and dyslipidemia. The Methods Core will use a transdisciplinary approach incorporating clinical and behavioral intervention research, implementation science, human factors engineering, systems science, and health services research to support Center research. The Methods Core will also advance research methods in 1) human factors engineering to support implementation; 2) avatar-assisted training and assessment in motivational interviewing; 3) quantitative methods to support intervention scale-up; 4) and systems science. The Administrative Core will engage stakeholders, building on well-established partnerships in Maryland and nationally, and bring together all of the Center’s activities. The gaping differential in life expectancy and CVD risk factor burden in persons with SMI calls for concentrated, transdisciplinary approaches to solutions. This Center will create a nexus of innovation and momentum around T2 translation to reduce premature mortality in SMI. Our vision is health equity – that persons with SMI, similar to persons without SMI, live long healthy lives.