A Program of Interdisciplinary Clinical Services Research to Reduce Disparities in Access to Care: What Works, What Would Advance the Program Kathleen Ell School of Social Work

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Funding and Interdisciplinary and Community Collaborators

National Cancer Institute, National Institute of Mental Health, Centers of Disease Control and Prevention K. Ell, PI

  USC Oncology: D. Quinn, MD, L. Muderspach, MD, C. Russell, MD USC Psychiatry & Behavioral Science: B. Quon, MD, I. Lagomasino, MD; U Washington: M. Dwight-Johnson, MD, W. Katon, MD, J. Unützer, MD         USC Endocrinology: A Harmel, MD, R. Mathur, MD USC Anesthesiology: A. Ryan, MD USC Pharmacy: J. Hay, PhD (Economics); M. Schoenbaum, PhD (RAND) Medical Anthropology: L. Palinkas, PhD (SSW) Biostatistics: B. Xie, PhD (SSW), J. Mintz, PhD (UCLA) SSW: L. Cabassa, PhD Community Clinical Research Collaborators: M. Royball, MD, (Roybal Cl), S. Leung, MD, (El Monte Cl), N. Gibbs, MD (Kaiser), M. Hoffing, MD (Desert Medical Group), S. Guller, MN (Sunplus Home Health) Research Training/Mentoring: NIH Minority Supplements to parent grants: I Lagomasino, MD, M. Aranda, PhD, K. Sanchez, PhD, A. Wells, Doctoral Student

Efficacy research

Treatment and Clinical Services Research

Figure 1: Treatment and Services Research* Effectiveness research Practice research Clinical services research Service systems research * Adapted from: Bridging Science and Service, (1999), NIMH Report #99-4353.

    Efficacy designed to establish the effect of service or treatment Effectiveness – test care delivered across broad range of populations in “real world systems”, can include anthropologic, cultural competency and cost-effective studies Practice – clinical epidemiology, quality of care, dissemination, cost-utility studies Health systems – organization, financing, resource allocation, utilization, and outcomes

Interdisciplinary Opportunities Illustrated by a Conceptual Framework of Clinical Services Research

Figure 2: Mental Health Clinical Services Research Conceptual Framework Service Providers

• • • • • • • • Demographics Bilingual, cultural competence Training, skill Attitudes, knowledge Satisfaction with care Organizational factors Personnel characteristics Professional characteristics • • • •

SERVICE SYSTEM STRUCTURE

Organization/Financing Resources Provider incentives Service Environment: mental health specialty, general health care, social service, community based

Interventions

• • • • • • Tested in efficacy trials Developed and implemented indigenously Practice guidelines & protocols Quality Improvements Practitioner training Service characteristics

Clinical Process

• • • • • • • Therapy/program characteristics Care Organization/management Therapeutic strategy/goals Therapy/program model fidelity Client adherence Client/service provider alliance Therapeutic relationship

Outcomes

• • • • • Clinical status Functioning Well-being, subjective outcomes Satisfaction with care direct economic costs • • • • • • •

Client Characteristics

demographics attitudes knowledge problem solving skills type of disorder disorder history personal characteristics

Client Networks

• • social network influences personal network influences • • •

Sociocultural Influences

sociocultural preferences, beliefs sociocentrism familism

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Current Incentives and Resources Needed to Advance Interdisciplinary Research

Favorable Funding Environment: NIH Roadmap

 Overarching Aims: Fundamental discovery and translation building blocks of biological systems, facilitating and training interdisciplinary research teams, re-engineering the clinical research enterprise and training the clinical research workforce, and facilitating translational research    Recent PAs: Developing Centers for Innovation in Services and Intervention Research (Exploratory Center P20; PAR-05-144); Biobehavioral Methods to Improve Outcomes Research (PA-05 142); Advanced Centers for Innovation in Services and Intervention Research (PAR-05-161) RFAs: Institutional Clinical and Translational Science Award (CTSA) (RFA-RM-06-002); Planning Grants for Institutional CTSAs (RFA-RM-006-001) NIH research training initiatives

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Major Government and Private Foundation Reports Identifying Need and Pathways to Success USC Facilitating Factors

     Consistent with Strategic Plan Already Demonstrated Successful Centers/Programs Established Links to Community Health Systems and Community Partnerships Health Collaborative Resources Needed    Incentives for senior investigators to take time from what they are doing to advance an interdisciplinary effort Faculty Mentoring/Training, e.g., time and opportunity to work with existing successful investigators, programs Developmental Funding, e.g., pilot and supplementary studies