Project Summary/Abstract The long-term objective of this K01 Mentored Research Scientist Development Award is to support Dr. Tessa Frohe, in building an independent research career focused on adapting, designing, and implementing efficacious telehealth alcohol interventions among marginalized communities. To date, Dr. Frohe’s research has focused on risk factors associated with pain and substance use. During her postdoctoral training, she has begun working within a community-based and qualitative methods framework to examine alcohol use specifically among people experiencing homelessness and AUD; however, Dr. Frohe seeks to expand her training from basic alcohol research to implementing and testing technology-based interventions informed by community stakeholders and user-centered design to improve treatment delivery among this population. This long-term objective will be achieved through a five-year training and research plan involving a carefully selected mentor team, targeted coursework, and hands-on training experiences. The proposed research aims to adapt an in-person harm reduction intervention (HaRT-A) into a telehealth platform (eHaRT-A) and test it among individuals with lived experience of homelessness and AUD. This project will occur in two phases: Phase 1 will entail codevelopment with iterative usability testing of the telehealth platform with a community advisory board (e.g., Housing First residents) to leverage stakeholder ideas to inform and build the eHaRT-A prototype (Aim 1) and to make design changes that will improve the feasibility and acceptability of the eHaRT-A platform (Aim 2). In Phase 2, a randomized controlled trial will be conducted to test the efficacy of eHaRT-A compared to “supportive services as usual” in improving alcohol-related outcomes (i.e., peak alcohol use, alcohol-related harm, AUD symptoms, and positive urinary ethyl glucuronide tests) and health related quality of life over time (Aim 3). This proposal aligns with national (NIH; NOT-AA-20-011) health initiatives to integrate technology-based interventions for vulnerable and marginalized communities with pre-existing substance use treatments. If successful, this study will develop a clinically relevant intervention that is more easily transportable to marginalized community settings because it will be developed for, by, and with the community it aims to serve. The training plan for this application will focus on intervention development and testing, innovative methods to enhance technology-based intervention implementation, and advanced statistics. Mentors (Drs. Clifasefi, Collins, Comtois, Hsieh) and collaborators (Drs. Larimer, Hallgren) are committed to Dr. Frohe’s training and each will provide unique expertise to her proposed research and training plan. Support from this award will be essential to Dr. Frohe’s development as an independent scientist who can contribute to alcohol research by codeveloping, adapting, and testing successful technology-based interventions to ameliorate alcohol-related harm and improve individuals’ quality of life. The University of Washington is well suited to provide a stellar training experience and will promote NIH’s mission to develop early investigators who can be competitive for long-term research funding.

Project Narrative The unprecedented global pandemic has highlighted the digital divide and limited access to alcohol-related treatments among marginalized communities, specifically individuals with lived experience of homelessness. In line with the NIAAA health initiative seeking to integrate technology-based interventions among vulnerable populations, this study directly addresses this mission by proposing innovative methods (i.e., user-centered design + a community based participatory research framework) to adapt an in-person harm reduction for alcohol (HaRT-A) intervention into a telehealth platform (eHaRT-A) that can then be tested and successfully implemented into low-barrier Housing First settings. As healthcare continues to move more services online, it is essential to understand ways to successfully adapt and implement rigorously tested telehealth treatment services for marginalized communities to ameliorate alcohol-related harms.