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Washington State University Health Sciences Spokane

Grant and Contract Awards

FY2024, 2nd Quarter Summary
(October 1 – December 31, 2023)

Scroll down to read, or use these links to jump directly to a section/principal investigator (PI):

NEW & TRANSFER AWARDS

(New grants, funding transferred from a PI’s previous institution, and NIH competitive renewal funding)

Celestina Barbosa-Leiker (PI); Ekaterina Burduli; Janessa Graves; Charles Anderson; Olivia Brooks; Ross Bindler – College of Nursing; Elson S. Floyd College of Medicine
Washington State Health Care Authority
“Research and Analysis of Neonatal Abstinence Syndrome”
As part of this project, the WSU research team will analyze the prevalence of neonatal abstinence syndrome (NAS) in Spokane County, identify existing limitations and challenges with accurately measuring NAS, and provide potential recommendations for improving measurement and monitoring. It will also include an evaluation of 18 months of current data exploring infant and maternal health outcomes associated with services provided at Maddie’s Place, a Spokane-based transitional care facility that provides care and support for babies who are exposed to drugs in utero and their caregivers. The analysis will include both quantitative and qualitative data and will explore how the services provided at Maddie’s Place may avoid more costly medical interventions.

Shawna Beese (PI); Sheila Hurst; Janessa Graves – College of Nursing
American Association of Colleges of Nursing/National Institutes of Health
“Increasing the Impact of the All of Us Research Program through Focused Student Mentoring”
This grant provides funding for a pilot project that provides a mentored research experience for four honors students enrolled in the Bachelor of Science in Nursing (BSN) program. The goal of the project is to increase the impact of the NIH All of Us Research Program by mentoring nursing honors students to use the All of Us Researcher Workbench—a cloud-based data storage and sharing platform—to conduct research for their honors thesis. The All of Us Research Program is an effort to build one of the most diverse health databases that will help researchers study how our biology, lifestyle, and environment affect health. Research Student participants will present their research findings at the April 2024 Western Institute of Nursing Research Conference Research & Information poster exchange.

Dawn DePriest (PI) – College of Nursing
Washington Student Achievement Council
“Nursing Simulation Lab Modernization Grant 2025 Biennium”
This grant provides funds to update and expand the College of Nursing’s simulation spaces and equipment on the Spokane and Yakima campuses, which will increase its capacity for more experiential learning through simulation activities. This expansion will also help address challenges in securing enough clinical placement hours for pediatric and obstetric specialty rotations. New equipment funded by this grant includes a high-fidelity newborn manikin, an infant warmer, intravenous pumps, a bladder scanner, and other medical equipment. The grant will also pay for an auscultation trainer to teach students stethoscope placement and help familiarize them with heart, lung, and other body sounds, as well as virtual reality googles to help students develop critical skills like time management and prioritization.

Denise Dillard (PI) – Elson S. Floyd College of Medicine/IREACH
Southcentral Foundation
“Southcentral Foundation Staff Assignment Agreement”
This staff assignment contract provides funding for Denise Dillard to continue serving in her previous position as the Southcentral Foundation’s director of research until her replacement has been identified. In this capacity, she will review proposals and present them to the foundation’s Executive Committee, serve on the Alaska Area Institutional Review Board, and provide training and mentoring to SCF research staff and the new director of research.

Denise Dillard (PI) – Elson S. Floyd College of Medicine/IREACH
Oregon Health and Sciences University/National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development
“Diet and the CPT1A arctic variant: Impact on the Health of Alaska Native Children”
This subcontract provides funding for the investigator’s role in a project aimed at better understanding high rates of infectious disease and mortality in Alaska Native infants in Western and Northern Alaska. Led by Oregon Health and Science University, the research team has previously identified the arctic variant, a mutation of the CPT1A gene, as contributing to these health problems. The arctic variant has been shown to be the most common form of the CPT1A gene in the Yup’ik and Inupiaq Alaska Native people of Western and Northern Alaska. This study will determine whether reduced intake of traditional subsistence foods rich in n-3 polyunsaturated fatty acids may be linked to the detrimental health effects associated with the arctic variant. The researchers will achieve this by studying a cohort of Alaska Native children who will be followed prenatally through the first two years of life. The goal of the study is to identify ways to reduce the negative effects of this genetic mutation on the health of Alaska Native children.

Amber Fyfe-Johnson (PI) – Elson S. Floyd College of Medicine/IREACH
George B. Storer Foundation
“Health Outcomes in Preschool: INnovative Geospatial Modeling Approaches to Quantify Access to GREENSPACE (HOP-IN GREENSPACE)”
This award provides funding for a postdoctoral research associate who will help analyze and publish data from an NIH-funded project to evaluate the impact of an outdoor preschool model on health outcomes and academic achievement in early childhood. The Health Outcomes in Preschool: INnovations for Obesity Prevention (HOP-IN) partners with Tiny Trees, a preschool in Seattle, Washington, with an entirely outdoor, play-based curriculum. The study collects data on the physical activity, sleep, body mass index, gut microbiome, and academic performance of 200 children ages 3 to 5 for a period of five years. This includes 100 children attending Tiny Trees and a control group of 100 waitlisted children who are attending a traditional indoor preschool. The researchers will compare various outcomes between the two groups and will also perform a cost-benefit analysis to evaluate the longer-term sustainability of the Tiny Trees outdoor preschool model. The grant will also fund costs associated with a pilot project for a new collaboration with the Academy for Global Citizenship Head Start preschool program.

Lois James (PI); Stephen James; Dawn DePriest; Connie Nguyen-Truong; Julie Postma – College of Nursing; Elson S. Floyd College of Medicine
National Institutes of Health, National Institute on Minority Health and Health Disparities
“Counter Bias Training Simulation (CBTsim) Healthcare: A Novel Approach for Reducing the Impact of Implicit Bias on Healthcare Delivery”
This grant funds a three-year study aimed at reducing the impact of implicit bias on healthcare delivery. Unconscious biases based on race, ethnicity, gender, socioeconomic status, LGBTQ+ status, disability, addiction, and other factors influence how healthcare providers treat patients, which impacts their health outcomes. James and others previously developed CBTsim, a simulation-based training program to reduce the impact of implicit bias on how people interact and make decisions that affect others. Versions of CBTsim have been used to help police officers and 911 dispatchers interact with diverse groups of community members in unbiased ways. For this study, the research team will develop CBTsim healthcare scenarios based on a review of literature on healthcare disparities and interviews with community members. They will then conduct a randomized controlled trial with 100 hospital nurses to test the effectiveness of the new CBTsim Healthcare module at reducing bias in how nurses treat their patients.

Matthew Layton (co-PI); Marian Wilson (co-PI); Raymond Quock; Devon Hansen – Elson S. Floyd College of Medicine; College of Nursing
WSU Office of Research, Alcohol and Drug Abuse Research Program
“Hyperbaric Oxygen Treatment (HBOT) during Methadone Tapering in Human Subjects with Opioid Use Disorder”
Addiction to prescription opioids, heroin, and now fentanyl has continued to escalate. Methadone provided via opioid treatment programs is still the primary medication-assisted treatment for opioid use disorder. However, when patients attempt to taper or discontinue methadone, they frequently experience intolerable withdrawal symptoms. This can cause them to relapse or have their methadone dose increased back to baseline or higher. The WSU team previously did a small clinical study that suggested that hyperbaric oxygen therapy—a treatment that involves breathing pure oxygen in a pressurized environment—may help to reduce opioid withdrawal symptoms in individuals with opioid use disorder who were on methadone. The goal of this new study is to provide additional evidence of the potential usefulness of hyperbaric oxygen therapy as a treatment to reduce opioid withdrawal symptoms during methadone dose tapering. Participants in this randomized controlled trial will receive either hyperbaric oxygen therapy or a sham treatment the day before and the day of two planned 5 percent methadone dose reductions spaced two weeks apart. They will rate their opioid withdrawal symptoms through twice-daily surveys for the first four weeks and again a month and three months after starting the study. Findings from the study may be used to apply for funding for a larger clinical trial to test the efficacy of hyperbaric oxygen therapy associated with methadone dose reductions, as well as for individuals dependent on other opioids such as fentanyl.

Elizabeth Medina (PI) – Elson S. Floyd College of Medicine
National Institutes of Health, National Institute of Neurological Disorders and Stroke
“Understanding the Consequences of Sleep Loss in an Autism Mouse Model”
This award represents an NIH Blueprint and BRAIN Initiative Diversity Specialized Predoctoral to Postdoctoral Advancement in Neuroscience (D-SPAN) Award that supports outstanding graduate students from diverse backgrounds. This F99 phase of the two-phase award provides two years of funds for Elizabeth Medina, a PhD student in the laboratory of Lucia Peixoto, to complete her doctoral dissertation. Upon successful completion, Medina will have the opportunity to apply for up to four more years of K00 funding to support a transition to a neuroscience postdoctoral position. Medina’s dissertation research is aimed at better understanding sleep problems in autism spectrum disorder. Up to 93 percent of individuals with autism spectrum disorders report sleep problems, which worsen quality of life and core autism symptoms and can precede an autism diagnosis. Medina will use a genetic mouse model of autism spectrum disorder to study the adverse effects of early-life sleep deprivation on gene transcription and underlying molecular processes in autism spectrum disorder, which have been poorly understood. Findings from this research could potentially open the door to targeted interventions to mitigate the negative consequences of disturbed sleep in autism spectrum disorder.

Pablo Monsivais (PI); Ofer Amram; Douglas Call – Elson S. Floyd College of Medicine/Dept. of Nutrition & Exercise Physiology; College of Veterinary Medicine
Washington State Department of Health
“Neighborhood-Scale Wastewater Surveillance for Understanding Social Inequities in COVID-19 Burden”
Public health agencies and decision-makers have limited data to help them grasp the full extent of COVID-19 infection in communities, which is a key concern given that the disease can be spread asymptomatically. Based on a partnership between WSU researchers, the City of Spokane and Spokane County, and the Spokane Regional Health District, this study will determine the feasibility of measuring and monitoring the presence of the SARS CoV-2 virus in wastewater to identify neighborhood-level disparities in COVID-19 disease burden in Spokane County.  The researchers will measure SARS CoV-2 in wastewater samples and relate these measurements to area-level demographic and health profiles to determine whether sociodemographic risk factors such as a higher percentage of poverty are tied to an increased COVID-19 disease burden in certain neighborhoods. This approach will provide more spatially detailed information about SARS-CoV-2 infection to assist decision-makers, as well as lay the groundwork for mass monitoring SARS-CoV-2 infection using a low-cost, non-invasive method that complements diagnostic testing.

Julie Postma (PI) – College of Nursing
University of Washington, Pacific Northwest Agricultural Safety and Health Center
“Smoke Hazards in the Agricultural Workplace: Survey translation”
This mini-grant provides funding to support professional translation of a survey about wildfire smoke hazards in the agricultural workplace from English to Spanish. WSU researchers are using the survey to determine the perspectives of agricultural employers on the source, understanding, adoption, and communication of Air Quality Index readings and hazardous work conditions. The survey has been limited to responses by English language speakers. Translation of the survey will support ongoing data collection from Spanish-speaking supervisors in Washington state agriculture regions, which will help the researchers identify best practices to enhance workplace safety and promote occupational health during wildfire smoke events.

Bhagwat Prasad (PI) – College of Pharmacy & Pharmaceutical Sciences
Boehringer Ingelheim
“Proteomics-based research initiative on non-CYP enzymes 4.0 (PRINCE 4.0)”
This grant provides funding for the PRINCE (Proteomics-based Research Initiative for Non-CYP Enzymes) program, a research collaboration between WSU and the pharmaceutical industry to elucidate the role of non-cytochrome P450 (non-CYP) enzymes in the disposition, efficacy, and toxicity of drugs. The overarching objective is to develop physiological models to predict drug disposition, which could help reduce the number of animal and clinical studies needed before new drugs can be approved. Boehringer Ingelheim is one of five pharmaceutical companies supporting the PRINCE program for the 2023-2025 grant period.

Ellen Romesburg (PI); Marian Wilson – College of Nursing
International Society of Nurses in Genetics
“Exploring Communication of Genomic Information by Primary Care Nurse Practitioners in Rural Settings”
Advances in genomics and precision medicine have led to an increased genetic curiosity and popularity of direct-to-consumer genetic testing. This has changed the landscape for health care, but also increases the potential for misinterpretation of results and misunderstanding of the meanings and implications of those results. Patients often lack access to genomic specialists. This is especially true in rural areas, which also have lower medical literacy. As a result, patients often rely on their primary care providers to provide them with explanations and guidance on complex genomic information. Discussing genomic testing and information is within nurse practitioners’ scope of practice, but most feel underqualified to do so. The goal of this study is to gain insight and understanding of nurse practitioners’ experiences and challenges in discussing genomic information with patients in rural settings. Findings from this study will inform future research and implications and may ultimately lead to improved patient outcomes in rural settings.

Jessica Ullrich (PI) – Elson S. Floyd College of Medicine/IREACH
Iowa State University/National Science Foundation
“Responding to Energy Insecurity in the Arctic housing using community-based participatory research”
This is a subaward of an NSF-funded project led by Iowa State University that seeks to address housing challenges in rural Alaskan communities. Many homes in these communities are highly energy inefficient, poorly designed for the harsh Alaskan climate, old, and overcrowded. Combined with the high cost of electricity and heating fuel, this makes many rural Alaskan homes highly energy burdened, meaning that a high percentage of household income is used for energy costs. Climate change is further exacerbating these challenges. This study will use community-based participatory research methods to identify better, more culturally appropriate ways to adapt rural Alaskan housing to alleviate the energy burden. It will be conducted in participation with three Alaskan villages—Unalakleet, Nome, and Quinhagak—and other stakeholders. The ultimate goal of the project is to increase participation in energy efficiency programs in rural Alaska and improve the wellbeing of communities by reducing stresses related to energy costs. The WSU team’s role in this project is to recruit residents in each of the three villages for participation in the study, conduct photo-voice interviews, analyze data, and communicate research findings to the participating communities.

Jessica Ullrich (PI) – Elson S. Floyd College of Medicine/IREACH
University of Washington/National Institutes of Health, National Institute on Drug Abuse
“Co-Developing a Connectedness Curriculum for Personal and Collective Wellbeing”
This grant funds work to further the development of a connectedness curriculum aimed at improving the wellbeing of welfare-involved Alaska Native children and their communities and protecting them from harm. The curriculum is based on a previously developed indigenous connectedness framework that highlights the relationships children need with family, community, ancestors, future generations, spirit, the earth, and themselves. It provides six one-hour modules that teach about connectedness relationships and traditional values and was drafted based on feedback and guidance from Nome Eskimo Community elders and community members who live in Anchorage, Alaska. This award provides funding to hold focus groups to gain additional input from Nome Eskimo community members who reside in Nome, which will ensure that the curriculum is relevant to both urban and rural settings. Participants in these focus groups will include parents and caregivers who have past involvement with Alaska child welfare. Findings from this research will be used to adapt the curriculum and get it ready for future pilot testing.

Marian Wilson (PI); Fionnuala Brown; Connie Remsberg; Dawn DeWitt; Skye McKennon Jennifer Anderson; Brad Schwarz; Ross Bindler – College of Nursing; College of Pharmacy & Pharmaceutical Sciences; Elson S. Floyd College of Medicine
Washington State Health Care Authority
“RELIEF: Resources and Education Leading to Improved Pain Care Equity For Washingtonians”
This grant funds an 18-month project to support healthcare provider training and education to reduce inappropriate opioid prescriptions while maintaining access for people who need opioids. As part of the project, the WSU team will develop and implement web-based opioid and pain prevention training for all health sciences students in the state and develop a central, web-based repository of resources for pain self-management for patients, providers, and community members. In addition, the team will offer evidence-based programs to help primary care providers better manage people with pain and allow them to continue to provide care to patients on chronic opioid therapy. This work will support the goals outlined in Washington State’s Opioid and Overdose Response Plan, which include prevention of opioid misuse and ensuring and improving the health and wellness of people who use opioids and other drugs.

AWARDS FOR ONGOING WORK

(Renewal, continued, and supplemental funding for projects awarded previously)

Ofer Amram (PI) – Elson S. Floyd College of Medicine/Dept. of Nutrition & Exercise Physiology
Oregon State University/National Institutes of Health, National Institute of Environmental Health Sciences
“Evaluating and Applying Google Timeline Location Data for Built Environment and Physical Activity Research”
This subaward renews supplemental funding for a project led by Oregon State University that seeks to leverage Google Location History Timeline data collected from Android and Apple smartphones to improve research related to the built environment’s influence on health. The supplement provides funding for the researchers to determine how individual outdoor physical activity behaviors changed before and during the stay-at-home orders early in the COVID-19 pandemic. Their analysis will use data from a subset of participants in the Washington State Twin Registry who completed a survey regarding changes in outdoor physical activity and mental health during the COVID-19 pandemic. The goal is to determine whether outdoor physical activity and exposure to green space may buffer against stress and mental health issues, which could inform future stay-at-home policies and decision-making around park/public space closures.

John Clarke (PI); Bhagwat Prasad – College of Pharmacy & Pharmaceutical Sciences
National Institutes of Health; National Institute of Environmental Health Sciences
“Mechanisms of microcystin-induced hepatocellular carcinoma in nonalcoholic steatohepatitis”
This continuing study builds off of data from a previous NIH-funded project that showed that microcystin-LR—a toxin produced by blue-green algae commonly found in in lakes and other freshwater bodies—can drive the progression of non-alcoholic fatty liver disease (NAFLD) to a more severe form. In this current project, the researcher will try to unravel the underlying mechanisms that change the disease progression in response to microcystin-LR exposure and determine their impact on the development of liver cirrhosis and a form of liver cancer known as hepatocellular carcinoma. Outcomes from this research have the potential to impact millions of people worldwide who are exposed to microcystin-LR through oral consumption and/or recreation.

Gary Ferguson (PI) – Elson S. Floyd College of Medicine/IREACH
University of Colorado Denver/National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases
“Center for American Indian and Alaska Native Diabetes Translation Research (CDTR) – Research”
This renewal award provides funding for the Pacific Northwest satellite center of the Center for American Indian and Alaska Native Diabetes Translation Research, which is based at the University of Colorado Denver. The goal of the main center is to improve the diabetes-related health of American Indian and Alaska Native people by extending evidence-based research on diabetes prevention and management to both clinical and community settings in American Indian/Alaska Native communities. The Pacific Northwest satellite center will engage local tribes in activities aimed at increasing awareness related to diabetes translational research among American Indians and Alaska Natives; organize and sponsor annual regional conferences and biannual one-hour webinars about diabetes translational research among American Indian and Alaska Native populations; disseminate the work and research findings of the center within the region; and identify early-stage investigators who would benefit from pilot funding and mentor them through the development of proposals and completion of research projects.

Marcos Frank (PI); Chris Hayworth – Elson S. Floyd College of Medicine
National Institutes of Health, National Eye Institute
“Exploratory studies of spontaneous cortical activity in visual cortical development”

This continuing grant funds exploratory studies of the role of different brain states and spontaneous activity in the development of the visual cortex. The goal is to investigate developmental processes in the visual cortex that do not require visual experience but are influenced by endogenous neuronal activity. This initial stage of development is critically important for the formation of rudimentary circuits that are then sculpted by visual experience. Newborn mammals spend most of their time in rapid-eye-movement (REM) sleep, which suggests that REM sleep provides a key source of endogenous activity to the developing brain. This idea has not been explored in depth using current neurobiological methods. As part of this study, the researchers will use an animal model to measure visual cortex activity in early development to determine if spontaneous activity in REM sleep is structured in a way that may instruct or maintain developing circuits. They will then directly test the role of REM sleep visual cortex activity in the development of visual response properties. The findings of this research will provide important new insights into how sleep and experience together shape developing brain circuitry and how abnormal sleep during infancy may adversely impact brain development.

Devon Hansen (PI); Hans Van Dongen; Stephen James; Matthew Layton – Elson S. Floyd College of Medicine/Sleep and Performance Research Center
Google
“Objective Fatigue Measurement with Phone-Based Eye Tracking”
This award provides incremental funding for a study aimed at determining whether Google’s smartphone-based gaze-tracking algorithm can accurately quantify objective fatigue. Using human volunteers in a controlled laboratory setting, the researchers will induce various degrees of sleep-loss-related fatigue over periods of prolonged wakefulness, comparing the algorithm’s output to independent objective assessments of fatigue. In addition, the researchers will explore the potential of a fatigue assessment that incorporates multiple measurements—including facial features, pupillary constriction, voice analysis, typing analysis (cadence, error rate, and so on), mental acuity, and ocular measures—during simulated driving performance. They will also explore whether features of sleep as monitored by wearable and contactless devices could predict next-day neurocognitive performance as measured by existing tools used to assess subjective sleepiness and impairment from sleep deprivation.

Leila Harrison (PI) – Elson S. Floyd College of Medicine
Oregon Health and Sciences University/US Department of Health and Human Services, Health Resources and Services Administration
“Northwest Native American Center of Excellence”
This continuing grant funds the development, implementation, and operation of a post-baccalaureate program for American Indian/Alaska Native scholars that provides conditional acceptance into the Elson S. Floyd College of Medicine’s MD program. The WSU team will spend two years developing the post-baccalaureate program before admitting three cohorts into the program annually. This work will be done in collaboration with the Northwest Native American Center of Excellence (NNACoE) at Oregon Health Sciences University, which works to increase the number of American Indians and Alaska Natives in the U.S. health professions workforce.

Amanda Lamp (PI) – Elson S. Floyd College of Medicine/Sleep and Performance Research Center
United Airlines
“Fatigue Risk Management System Route Studies”
This contract provides funding for multiple field studies of sleep and performance for United Airlines, as well as scientific consulting to United on all matters needed. Studied routes include short-haul, long-haul, and ultra-long-haul operations. This work also supports the airline’s use of fatigue risk management systems, a non-prescriptive approach to managing flight and duty times.

Kathryn Meier (PI) – College of Pharmacy & Pharmaceutical Sciences
American Society for Pharmacology and Experimental Therapeutics (ASPET)
“ASPET Summer Undergraduate Research Fellowship (SURF) Award”
This grant provides renewal funding for the ASPET Summer Undergraduate Research Fellowship (SURF) program offered by the WSU College of Pharmacy. The program provides undergraduate students with hands‐on experience in pharmaceutical or biomedical research to promote graduate education and research careers in the field.

Mary Paine (PI); John White; Matthew Layton – College of Pharmacy & Pharmaceutical Sciences; Elson S. Floyd College of Medicine
National Institutes of Health; National Center for Complementary and Integrative Health
“Natural Product-Drug Interaction Research: The Roadmap to Best Practices”
This award provides continued funding for the multidisciplinary Center of Excellence for Natural Product-Drug Interactions Research, which is led by WSU in collaboration with three other institutions. The center was established in collaboration with the National Center for Complementary and Integrative Health (NCCIH) to create a roadmap for best research practices for the study of potential unwanted interactions between natural products and conventional medications. Activities funded within the five-year project period for this award include new studies of potential natural product-drug interactions and their mechanisms, work to expand and optimize the functionality of the center’s website and data repository, and efforts to broaden the dissemination of knowledge to national and international research communities and the public.

Sergey Tolmachev (PI) – College of Pharmacy & Pharmaceutical Sciences
US Department of Energy, Office of Environment, Health, Safety & Security
“Manage and Operate the United States Transuranium and Uranium Registries”
This award provides incremental funding for a five-year renewal award to manage and operate the United States Transuranium and Uranium Registries (USTUR). Designed as a program to improve radiation protection of nuclear workers, the USTUR studies the biokinetics and internal dosimetry of actinides (uranium, plutonium, and americium) in occupationally exposed individuals who volunteer their bodies, or portions of them, for scientific use after their death. These donations provide an opportunity to set up bases for safety standards in radiological protection and to support radiation epidemiological studies. Published results of the Registries’ research contribute to the development of recommendations and standards issued by the International Commission on Radiological Protection (ICRP) and National Council on Radiation Protection & Measurements (NCRP).

Jessica Ullrich (PI) – Elson S. Floyd College of Medicine/IREACH
Spaulding for Children/US Department of Health; Administration for Children and Families
“Quality Improvement Center on Engaging Youth in Permanency (QIC-EY) Site Consultant for Hawai’i”
This award provides renewal funding for the investigator to serve as a site consultant for the Hawai’i site of the Quality Improvement Center on Engaging Youth in Finding Permanency (QIC-EY). Led by Spaulding for Children in partnership with other agencies, QIC-EY is charged with advancing child welfare programs and practice to ensure that they are engaging and empowering children and youth in foster care throughout the U.S., especially concerning decisions around permanency—a child’s legal relationship with a parenting adult. Ullrich will assist with implementation of the QIC-EY workforce training, coaching model, court training, program model, and capacity building for systems change.