David Chambers, D.Phil.
Chief Services Research and Clinical Epidemiology Branch
Chief,
Division of Services and Intervention Research
National Institute of Mental Health
June 29, 2010
AcademyHealth 2010
Presentation Outline
Services Research at NIMH
 Ongoing
g g Division Initiatives
 Moving Forward

NIMH’ss Strategic Plan
NIMH

Strategic Objective 1: Promote
Discovery
y in the Brain and Behavioral
Sciences to Fuel Research on the
Causes of Mental Disorders

Strategic
g Objective
j
2: Chart Mental
Illness Trajectories to Determine When,
Where, and How to Intervene

Strategic
g Objective
j
3: Develop
p New and
Better Interventions for Mental
Disorders that Incorporate the Diverse
Needs and Circumstances of People
with Mental Illness

Strategic Objective 4: Strengthen the
Public Health Impact of NIMH-Supported
Research
A Broader Context for Services
Research at NIMH
Consistent with the Strategic Plan of
NIMH
 Consistent with the Division of Services
and Interventions Research

 Develops research that establishes the
effectiveness of interventions and the
optimal access, quality, and outcomes of
mental health services
Snapshot of NIMH Services Research

Key priority areas
 Improving
g access, quality,
y and outcomes of





care
Economics of mental health care
Reducing Health Disparities
Enhancing capacity for services research
Clinical Epidemiology
Dissemination and Implementation of EBPs
NIMH Services Research

Breadth of Contexts
 Schools, Corrections, Child Welfare, Primary
Care, C
C
Community
it MH
MH, N
Nursing
i H
Homes,
workplace (current)
 Virtual
Vi t l environments,
i
t A
Anywhere
h
(f
(future)
t )

From Service Use to Service Impact
 Clinical Epidemiology focus on current need,
utilization, disparities
 Services ITVs on directly improving MH care
RESEARCH PROGRAMS:
1.
2.
3
3.
4.
5.
6.
7.
Child and Adolescent Services Research Program
Dissemination and Implementation Research Program
Financing and Managed Care Research Program
Methodological Research Program
Primary
y Care Research Program
g
Disparities in Mental Health Services Research Program
Systems Research Program
Description of the Programs is available at:
http://www.nimh.nih.gov/about/organization/dsir/ser
http://www
nimh nih gov/about/organization/dsir/ser
vices-research-and-epidemiologybranch/index.shtml
National Advisory Mental Health Council’s
p on Services Research ((2006))
Report
RECOMMENDATION:
NIMH should improve
impact of research on
policy
li and
d ffacilitate
ilit t
policy research
SOURCE: http://www.nimh.nih.gov/researchfunding/scientific-meetings/recurringg
g
g
meetings/namhc/reports/road-ahead.pdf
Policy Research Opportunities
Healthcare Reform
 Parity
 Implementation of Effective Practices
 Impact of Other Sector Initiatives
 Workforce Training

ONGOING INITIATIVES

Developing a Longitudinal Tracking System for
M t l Disorders
Mental
Di
d

NIMH-08-DS-009: Recovery After an Initial
Schizophrenic Episode (RAISE)

Leveraging Existing Healthcare Networks to
T
Transform
f
Effectiveness
Eff ti
Research
R
h
Longitudinal Tracking System

Enhancing Existing Survey Platforms to:
 Collect national,
national state and local estimates of incidence,
incidence prevalence,
prevalence
services use
 Follow individuals over time to understand MH trajectories
 Study influence of major seminal events on MH outcomes

Shift in NIMH’s Epidemiology Priorities
 Past:
P t Cross-sectional,
C
ti
l Periodic
P i di
 Future: Ongoing, Longitudinal

Opportunities to measure local variation
 Measurement development (e.g. disparities index)
 Enhancing
g ongoing
g
g local data collection efforts
 Combining clinical, administrative data
Recovery After an Initial Schizophrenic Episode
(RAISE)



Develop and test a comprehensive intervention for firstepisode psychosis to fundamentally alter the trajectory of the
illness
Focus on Recovery, Symptomatic Remission, Improved
Functional Outcomes
3-Phase Study




2 Funded Teams



Development
p
and refinement of Intervention (CURRENT
(
PHASE))
Feasibility test of intervention and ability to perform large trial
Large RCT of intervention versus comparison
PI: John Kane, Feinstein Institute (TX)
PI: Jeffrey Lieberman, NYSPI and Lisa Dixon, U MD
NIMH is working to involve policy and practice on front-end to ease path to
uptake (SAMHSA, SSA, CMS, ASPE as necessary collaborators)
Leveraging Healthcare Network to Transform
Effectiveness Research





Develop an efficient method for conducting large-scale studies
of the effectiveness of treatment
treatment, preventive
preventive, and services
interventions
Emphasis on IT infrastructure
Locate within General Healthcare Systems
Improve ability to identify, recruit and enroll consumers and
providers in research studies
Goal: Improve efficiency and quality of effectiveness and
services research
ACTIVITIES:
 RFA-MH-10-030
 ARRA supplements to existing HC networks to include MH
Moving Forward:
The next generation of studies
Optimal
MH
p
Care
Typical MH
Care
Understanding the Gap
The extent and nature of gap between
optimal and typical care
 How differs across disorders, ITVs, care
settings provider types
settings,
types, etc
etc…
 Conceptual frameworks to underlie and
e plain the gap
explain
 Driver to close disparities in mental
health care (May 5th summit)

Closing the Gap
Policy
 Economics and Financing
g
 Organization, Mgmt, Delivery of
Services
 Disparities in MH Care
 Community Integration and Re-entry
 Technology

Improving Methods and
Measurement
Valid, actionable measures
 Valid and useful indicators of value of
MH services
 Quality-of-care
Q lit f
measures att individual,
i di id l
org and system levels
 Innovative sampling strategies, surveys,
non-experimental
p
study
y designs
g

David Chambers
dchamber@mail.nih.gov
301-443-3747