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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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
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
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
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