Location
            The Center for Mental Health Services Research's offices are housed on Washington University in St. Louis' main hilltop campus, within the George Warren Brown School of Social Work, Alvin Goldfarb Hall, area 46, downstairs in the "garden level".    Directions to the School of Social Work are available at this link. You can refer to this map of the campus, and link to building #21.

Overview:  The George Warren Brown School of Social Work, Washington University in St. Louis, with support from the National Institute of Mental Health (NIMH), is pursuing a research agenda to improve mental health care in the social services. This agenda is supported 09/04–07/09, through a P30 award (P30 MH068579), via the Advanced Centers for Interventions and Services Research (ACISR) funding mechanism.

Leadership:  The CMHSR’s national team of investigators are based at the School of Social Work. Enola K. Proctor, Frank J. Bruno Professor of Social Work Research, is Center PI, and directs its Operations and Principal Research Cores. J. Curtis McMillen, Associate Professor of Social Work, is Center Associate Director and Director of the Research Methods Core.  Dr. John Landsverk, Director, Child and Adolescent Services Research Center, San Diego Children's Hospital, chairs the Center’s national Scientific Advisory Board.  Dr. Arlene Stiffman leads the Communications/Translations Unit, and Dr. Luis Zayas leads the Ethnocultural Research Unit.  The CMHSR’s investigators include 37 PhD/MD level researchers, including 9 from the School of Social Work, 5 from other Washington University departments, and 24 in St. Louis and across the nation. There are several roles in which individuals can become involved in the CMHSR.

Mental Disorder in Social Services. Recovery from mental illness is now a real possibility, yet too many Americans suffer the disabilities associated with mental disorder due to a fragmented, disconnected, and often-inadequate system of mental health care.  Clinical epidemiological studies suggest that one-fourth to one-half of clients in social service settings experience significant mental disorder. As in primary medical care, quality of care for mental disorder in the social services is compromised by competing demands, co-occurring psychosocial problems, and resource constraints.  Older adults, children and adolescents, individuals from ethnic minority groups, and low-income clients in public sectors are particularly plagued by difficulty in accessing quality care for mental disorders. While these groups often lack regular contact with a primary medical care provider, they are heavy consumers of the social services where they have recurring, front-line contact with providers who could play a pivotal role in the detection and treatment of mental disorder. Thus, our research agenda offers unique opportunity to meet the challenge posed in the Surgeon General’s Report and in the Bridging Science and Services Report--extending evidence-based care to the most vulnerable of our society’s members. As a way to help ensure access and earlier treatment to persons with undetected mental disorder, the President’s New Freedom Commission Report on Mental Health recommends introducing screening and early intervention programs in readily accessible and low-stigma settings where a high level of risk for mental health problems exists, especially all Federally funded adult and child health and human services. Improving the quality of mental health care to social service clients has enormous potential to ensure treatment to persons whose disorder currently goes undetected, to extend evidence-based care to those who are now served poorly, and to reduce racial disparities in care.
 

Background. Our proposed research agenda builds on and extends our prior decade of mental health research in the social services. In 1993, NIMH awarded Washington University the nation's first “social work research development center.” The Center for Mental Health Services Research has been very effective in carrying out funded research projects.  Since 1995, the Center has supported 94 externally funded, faculty-initiated projects (58 NIH, 12 other publicly funded and 24 privately funded) representing approximately $63 million in direct funding.  There are currently 24 active projects with cumulative direct funding of over $22 million.  These projects represent some of the pioneering clinical epidemiological, service systems, and quality of care research at the mental health-social service intersect.  Our studies document the need for mental health care and challenges in mental health services.  These studies provide a base for the next generation of research, developing and testing quality improvements to care.  In September 2004, the School of Social Work became the nation’s first school of social work to receive NIMH funding as an advanced center for interventions and services research (NIMH - P30 MH068579).

Approach.  The CMHSR will support practice and service systems research aimed at improving the quality of mental health care for persons with psychiatric disorders. Working in and partnering with community-based social service agencies, we will develop and test interventions to help improve their response to mental disorder. The research agenda requires that we confront and creatively address critical conceptual and methodological challenges across two potential divides: (1) the divide between systems of care—in our case, the social service system and the mental health system, and (2) the divide between research and practice, or “bench and trench.” To meet these challenges, we have engaged the expertise of a variety of disciplines, including social work, anthropology, epidemiology, gerontology, health economics and policy, journalism, public health, library science, biostatistics, medicine, psychiatry, psychology, law, bioethics and sociology.  Studies will coalesce and learn from diverse stakeholders, employ a variety of mixed research methods, and establish partnerships with social service and mental health provider agencies.

The agenda responds directly to recommendations from the Bridging Science and Practice Report, that NIMH should expand its portfolio to include research that: addresses the interface between the architecture of services, quality of care and outcomes; is informed by multidisciplinary perspectives; advances new conceptualizations of quality; and employs mixed-methods. Ultimately, our research aims to inform treatments and system modifications in public social service agencies that will result in better detection of mental disorder and access to evidence-based treatment.

Four Center for Mental Health Services Research Cores:

(1) The Operations Core bridges and integrates the scientific and infrastructure arms of the CMHSR.  As the CMHSR’s nucleus, it serves as the locus for the CMHSR’s administrative and research support functions through a variety of units and research support services, including those focused on data management, field research, cultural appropriateness of methods, dissemination of findings, and training.  CMHSR products include scientific publications, projects funded by NIMH and other funding agencies, and pilot studies. The CMHSR also has various roles for involvement, and offers doctoral research training grants, an NIMH-supported doctoral research training grants, an NIMH-supported post-doctoral research position, and employment / practicum opportunities for master's level students.

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(2) The Principal Research Core (PRC) coordinates the “heart” of the center’s work—the generation and execution of our substantive research agenda. Principal Research Core studies address three overarching aims: (1) developing new understandings of what constitutes quality of care for mental disorder in the social services from the perspective of key stakeholders—payers, administrators, front-line providers, consumers, and family members; (2) within the context of competing demands, assessing practice variation in quality of care for mental disorder in the social services and identify provider, client, and system ecostructure influences, including financing, on that variation; and (3) working “trench to bench and back to trench,” developing and testing a menu of quality improvements for mental health care in the social services (link to a detailed listing of the PRC aims). Principal Research Core pilot studies include:

1. Early Childhood Intervention Connections (ECIC)
   Melissa Jonson-Reid, PhD, PI; Brian McKean, Project Coordinator (NICHD R01)

2. Evidence-Based Interventions to Support the Parenting Skills of Families in the Child Welfare System
   Patricia Kohl, PhD, PI; Jennifer Bellamy, PhD, Investigator; Jennifer Schurer, MSW and NIMH pre-doctoral trainee; Samantha Books, MPE, Field Coordinator (10/06-07/07)

3. Quality Assurance Professionals in Mental Health Organizations
   Curtis McMillen, PhD, PI; Luis E. Zayas Rivera, Investigator; Madeline Lee, MSW and NIMH pre-doctoral trainee; Samantha Books, MPE, Field Coordinator (08/06-07/07)

4. Stakeholder Perspectives of Collaborative Care in CLTC
   Nancy Morrow-Howell, PhD, Enola Proctor, PhD, Martha Shumway, PhD, Co-PIs; Brian Carpenter, PhD, Sue Pfefferle, PhD, Paul Sacco, MSW, Investigators (NIMH R01).

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(3) The Research Methods Core (RMC) advances the requisite methodology for quality of care research in non-specialty settings. Since the scientific aims of our Principal Research Core take us into infrequently researched issues, we have both the need and opportunity to develop new methods that will be applicable to researchers in and beyond social service sectors of care (link to a detailed listing of the RMC aims). The Statistical Methods Unit, led by Dr. Ed Spitznagel, Professor of Mathematics and Biostatistics at WU, addresses new challenges in statistical analyses derived from our research agenda. Dr. Norma Ware, Associate Professor in the Departments of Psychiatry and Social Medicine at Harvard Medical School, leads the CMHSR’s Qualitative Methods Unit.  Methods teams also assist CMHSR investigators in three areas: assessing  stakeholder preferences, developing quality indicators for mental health services, and in organizational research methods (link to membership of RMC Units & Teams).  In addition to providing methods support for projects in our Principal Research Core, the Research Methods Core will launch several research projects, including:

1. Intersection of Mental Health and Social Service Professionals, Dr. Curtis McMillen, PI:  An ethnographic study of the barriers to communication and collaboration among social service and mental health providers;

2. Priorities and Preferences in Homecare, Dr. Enola Proctor, PI & Dr. Nancy Morrow-Howell, Co-PI:  The development of stakeholder preferences assessment procedures appropriate for the social services; and

3. Organization Receptivity to Evidence Based Practice, Dr. Greg Aarons, PI:  The development of a measure to assess an organization's receptivity to evidence based treatments.

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(4) Research Network Development Core (RNDC) is designed to build a research-related infrastructure with public social service agencies.