Nicole E. Werner, Ph.D. - US grants

DESCRIPTION (provided by applicant): In recent years, studies have shown that children as young as age 3 use relational aggression in their peer relationships, that these behaviors are moderately stable, and that relational aggression is associated with concurrent and future adjustment difficulties (e.g., peer rejection). These results point to the need for investigations of developmental antecedents of relational aggression in early childhood, particularly those that focus on central contexts of development such as parent-child relationships. The few existing studies in this area have shown that broad parenting styles and practices (e.g., warmth, psychological and coercive control) are associated with relational aggression and physical aggression. Processes within the family that contribute uniquely to child relational aggression have not yet been identified. The proposed study extends prior research in several ways. First, we focus on "direct" parental influence processes, or the explicit ways in which parents meet specific socialization goals in children, in addition to broad parenting styles. In particular, we are interested in parent-child conversations about peer conflicts as an important context in which parents may communicate values and expectations, provide interpretations of social situations, and offer explicit instruction on how to interact with peers - a process called "social coaching". Second, this study will employ a short-term longitudinal design and observation methods, which will allow us to examine whether parenting behaviors predict changes in children's relational aggression and other indices of social competence over a one-year period. Finally, this study draws on social information-processing theory to make predictions about processes that contribute to parents'coaching (e.g., attributions about children) and those that might mediate the association of coaching and child relational aggression (e.g., children's normative beliefs about aggression). In the proposed study with 140 preschoolers and their primary caregivers, we will assess parents'social coaching using an adapted laboratory paradigm, and parenting styles will be assessed using observation and self-reports. We expect that the qualities of parent-child discourse about relational aggression will predict young children's use of relational aggression above and beyond the influence of broad parenting styles. A combination of multiple regression and observed variable structural equation modeling techniques will be used. This study will increase our understanding of basic processes in the development of relational aggression, in addition to informing prevention efforts targeting relational aggression in early childhood. PUBLIC HEALTH RELEVANCE: Previous research has demonstrated that relational aggression poses significant risk to children's social and psychological health and well-being, particularly among females, yet little is understood about the developmental antecedents of this behavior. This study - which focuses on processes within parent-child relationships - is expected to contribute information that will inform the development of prevention and intervention programs targeting relational aggression in early childhood.

PROJECT ABSTRACT Family caregivers face daunting challenges in caring for persons with Alzheimer?s disease. Currently, there is no widely available mechanism to provide real-time, context sensitive support to informal AD caregivers that can address the specific care needs of each AD patient. To address this critical gap, we developed CareVirtue, an innovative web/mobile application for family caregivers that also assists formal care providers helping these families. During this Phase I project we will validate the CareVirtue web/mobile application as a method for caregivers to document daily care interactions with AD patients, and establish the utility of the generated data to develop predictive models for an intelligent caregiver assistant application. Looking ahead, our long term goal is to commercialize an AI-enabled intelligent caregiver assistant application that provides on demand, highly-relevant information about AD patients to care teams, which will ameliorate caregiver stress & burden, reduce health care expenditures, and improve quality of care for both AD patients and their caregivers.

PROJECT ABSTRACT More than 16 million caregivers (?family members or friends?) of people with Alzheimer?s disease and related dementias (ADRD) face serious challenges in providing care. ADRD caregivers are frequently tasked with substantial and overwhelming legal and financial planning, and they face increased financial risk and strain as a result. Currently, there is no widely available web-based financial and legal training that can be personalized to meet caregivers? specific needs. During this Fast Track project, we will begin with a deep discovery of legal planning and financial management needs of ADRD caregivers, conduct participatory co- design sessions with diverse caregivers groups, create multimedia training solutions, design an AI-enabled recommender system to match caregivers with the right training content, and then conduct rolling field trials with a diverse groups of caregivers to confirm the feasibility, usability, and acceptability of our legal planning and financial management training solution. Looking ahead to Phase 3, we expect our solution will support financial stability through delivery of personalized and actionable training for estate planning and financial management needs. We anticipate a combination of B2B partnerships and B2C strategies will yield a sustainable revenue model for our caregiver training solution.

Project Summary/Abstract The combination of the aging population with increasingly complex care needs produces a major challenge for the healthcare delivery system. Older patients are at high risk for patient safety issues and healthcare- associated harm, especially when receiving care in the Emergency Department (ED) and the hospital. Our project focuses on vulnerable older patients over 65 who are diagnosed with fall or suspected urinary tract infection (UTI) in the ED (AHRQ priority population). These patients experience a range of patient safety issues, such as repeated falls, diagnostic and medication errors (e.g. unnecessary use of antibiotics or drugs that increase fall risk), venous thromboembolism related to immobilization, and healthcare-associated infections (e.g., C-difficile). Our transdisciplinary team of engineers, health services researchers, nurses, physicians and pharmacists will collaborate with UW Health, a large health system with both academic and community EDs, to create and evaluate a system of care that supports the safe journey of older adults after presentation to the ED. In order for older adults to transition safely in their journey that begins in the ED, we propose to create a `patient safety passport' that will provide opportunities for error detection and recovery, for anticipating patient safety issues in the subsequent steps of the journey, and for improving communication and coordination. We will use the SEIPS (Systems Engineering Initiative for Patient Safety) model as the conceptual framework for addressing multiple patient safety issues and healthcare-associated harm experienced by older adults during their care journey. We will apply a participatory human-centered design approach to implement the 5- step methodology described in the AHRQ RFA (problem analysis, design, development, implementation and evaluation). This will involve the creation of a multidisciplinary Intervention Implementation Team (IIT) with representatives from (1) patients/caregivers, (2) clinicians and staff from ED, hospital and SNF, (3) UW Health stakeholders, and (4) researchers. We will evaluate the impact of the patient safety passport on the most frequent and inter-related patient safety issues experienced by older adults in the domains of fall, VTE, diagnostic and medication errors, and HAIs. In line with the SEIPS model, the evaluation will assess care process and outcomes (EHR data), the perspective of patients and caregivers (survey and interviews), and the perspective of ED, hospital and SNF clinicians and staff (survey and focus groups). We will develop a transdisciplinary PSLL aimed at engineering safe care journeys for vulnerable patients, including older adults. Our PSLL will build on long-standing, strong research collaboration between engineering and the health sciences at the University of Wisconsin-Madison, which led to the official launch of the Wisconsin Institute for Healthcare Systems Engineering (WIHSE) in 2017.

PROJECT SUMMARY A majority of the nearly 6 million people living with Alzheimer's disease and related dementias (ADRD) in the US are reliant upon informal (family and friend) caregivers to help manage their medications. Comorbidities are highly prevalent in people with ADRD, often requiring the management of multiple simultaneous medications and complex medication regimens. Caregivers are often untrained, under-resourced, and unsupported to perform the medication tasks people with ADRD rely upon. Studies have reported that caregiver-assisted medication management is associated with caregiver burden and stress and potentially inappropriate medication use in a third of people with ADRD. Unfortunately, most caregiver support interventions do not address ADRD caregivers' roles in managing medications for people with ADRD. Moreover, the few interventions for ADRD caregivers addressing medications do not leverage information technology (IT), despite national recognition of IT's vital role in ADRD care and caregiving. To address this gap, the intent of the proposed project is to develop an IT-based intervention to support caregivers managing medications for people with ADRD. According to the NIH Stage Model, behavioral interventions including IT solutions must be built upon a solid empirical record. Therefore, we propose to employ the three phases of user-centered design to address the first two stages of the NIH Stage Model. First, we will use a combination of user-centered design methods to conduct a user needs assessment (Stage 0) of ADRD caregivers who manage medications for people with ADRD. Second, we will use participatory co-design (Stage IA) to co-design a prototype IT intervention to support caregiver-assisted medication management collaboratively with ADRD caregivers. Third, we will conduct user testing (Stage IB) to feasibility test the prototype IT intervention with ADRD caregivers. User-centered design is the gold standard (e.g., FDA-mandated for all medical devices) process for designing products by involving representatives of the end-user population to better address user needs. Completion of the aims will lead to a hybrid efficacy/effectiveness Stage 3 randomized clinical trial of the intervention, powered to test changes in medication adherence and safety, with secondary outcomes of neuropsychiatric symptoms, acute care utilization, and caregiver burden.