The COVID-19 pandemic has created an overwhelming shift to using technology to connect with others. Coinciding with a growing mental health crisis among youth, mental health therapy has been largely moved to digital spaces. Three years later, providers are having to choose if they will provide their services through in person, remote, or hybrid interventions. My initial hypothesis is that there will be access barriers for youth of certain demographics when utilizing digital interventions. I conducted a systematic literature review to look at the effectiveness of the use of digital mental health therapy services among adolescents using PubMed, PsychInfo, and UW Libraries databases. The journals assess barriers and facilitators of digital mental health services for youth. Articles are found through systematic searches using combinations of the MeSH terms ‘digital mental health’, ‘adolescents’, ‘accessibility’ and ‘depression’. The demographics of the adolescents are compared with their preferences for digital therapy. Preliminary results indicate that youth who identify as lower income, rural residents, or BIPOC will face greater barriers to accessing mental healthcare and may benefit from continuing digital therapy. This synthesis of peer reviewed journals will prove to be useful in helping providers move forward with their practice in a way that aligns with their client’s needs.

Seriously ill hospitalized patients and their families experience elevated stress, anxiety, and depression, resulting from factors like the complexity of serious illness, fragmented medical care, and transitions across settings. They struggle to navigate treatment options, make difficult decisions, and express their values and goals to their clinicians. In addition to communication challenges between patients and clinicians, poor communication among healthcare team members exacerbates the stress associated with serious illness. The aim of this study was to continue work from previous Facilitating Communication Studies to gain knowledge from bedside nurses' experiences with collaborative communication (CC) between patients and families and their healthcare team, and to elicit ideas from nurses about what might improve CC within the hospital system. We defined CC as patients and families being active participants with their healthcare team working towards shared goals of care. We recruited and interviewed 15 bedside nurses from ICU and acute care units at Harborview Medical Center. Following each interview, we input each participant's audio-recorded content into a matrix table, created summaries of each transcript, and synthesized content across transcripts to distill major themes. Nurses reported that breakdowns in CC most often occur when multiple clinicians are involved, during transitions of care, and during the discharge process, resulting in confusion and distress for the patient, family, and bedside nurse. Suggested solutions to overcome these barriers include (1) promoting in-person interactions by rounding as an interprofessional team, (2) inviting bedside nurses to goals of care meetings, (3) implementing a CC training program for clinicians to standardize the CC approach among team members, and (4) empowering patients and families to initiate CC by educating them about their role in their healthcare. These suggestions should be implemented in a future Facilitating Communication Study to reduce distress for seriously ill patients, their families, and their healthcare team. 

Alzheimer's Disease (AD) is a relentless neurodegenerative condition for which there is presently no known cure. Latino and Hispanic individuals are at a higher risk of developing Alzheimer's Disease or related dementia (ADRD). By 2060, the number of Latino people living with dementia (PLWD) is expected to increase by 832%. With an uptake in PLWD, there will be an increase in the number of Latino families caring for PLWD. Latino families face unique barriers in accessing support and care, which can increase their vulnerability to adverse health outcomes. This study identifies the structural obstacles hindering the use of supportive services among Latino caregivers of PLWD. The seven-week intervention provided fifteen family caregivers from across the nation with information on how to manage the behavior of those with memory loss, including crying, arguing, refusal of care, and irregular sleep patterns. The program also teaches family caregivers how they can better care for themselves. Each week, the caregivers received one video to watch at their convenience. After reviewing the module, caregivers were asked to complete a survey to identify the effectiveness and usability of the intervention. Once the intervention was completed, participants were interviewed and asked a series of questions regarding the intervention and how it could be improved to provide better access to Latino caregivers caring for PLWD. Preliminary data indicates that Latino caregivers, balancing multiple responsibilities while caring for family members with dementia, often face challenges in maintaining consistent attendance at supportive service appointments due to unpredictable schedules. Overall, we aim to improve the quality of life for both the person with memory loss and their family caregivers through the use of a tailored online program that provides support and empowers caregivers in the Latino community.

The climate crisis is predicted to increase the occurrence of extreme weather events such as heat waves and polar fronts, which will disproportionately affect vulnerable populations such as people experiencing homelessness (PEH). As climate change increases social and economic instability, policymakers need to be informed on how to effectively protect the interests of our most vulnerable populations. Building off of studies that have analyzed the impact of heat and cold on hospitalizations among PEH, I examine the health effect of extreme weather events in King County, San Francisco County, and Los Angeles County. Temporary emergency shelters are one of the main strategies used to protect the wellbeing of the PEH population during extreme weather events. Moreover, I intend to determine the effectiveness of emergency shelters in reducing the impact of extreme weather on the death toll and/or health complications of PEH. Utilizing data on health impacts among PEH, daily maximum/minimum temperatures, and cooling shelters, I will use regression models to determine the relationship between maximum/minimum daily temperature and health outcomes and if cooling shelters reduce negative health impacts during extreme weather events. I expect to find a positive relationship between extreme temperatures and hospitalizations, as prior studies have observed, but that this relationship will be weaker on days on which cities open emergency shelters. However, it is plausible that because emergency shelters have restrictions on access, limited bed capacity, or inadequate public outreach, the impact of emergency shelters on hospitalizations may be insubstantial. My results will contribute to a growing body of literature that points to a relationship between extreme weather and poor health outcomes for PEH. This evidence will have implications for the importance of allocating funding towards the shelter system and other social service efforts, while clarifying the effectiveness of the emergency shelter system.