Topics in Mental Health Services Research
Instructor: Barbara M. Rohland, M.D.
Spring 2000
3 credit hours (2- 90 minute seminar periods per week)
15 weeks
Format: Class discussion of weekly reading assignments
Grading:
Class Quizzes (20%)
10 point quiz at the beginning of each class period to review objectives of
previous lesson and pretest knowledge of assigned readings; final quiz score
for grade calculation will be the average of the highest 20 test scores
Exam, Part I (20%)
Exam, Part II (20%)
Exam, Part III (20%)
Final Project (20%): Develop a Proposal for the Evaluation of a Mental Health
Program. A written report (approximately 10 pages) and an oral presentation
(approximately 30 minutes) will be due at the end of the semester.
Course Objectives:
At the completion of this course, the student will demonstrate a conceptual and
technical knowledge of:
 The organization of the mental health delivery system in the United States
 The nature of mental health services that are recommended for the treatment
of serious mental disorders
 The assessment of clinical quality in a given mental health service system
 The fundamental principles of psychiatric epidemiology and its application of
to the critical evaluation and conduct of mental health services research
In addition, the student will
 Understand the relationship of Mental Health Services Research to the
assessment of quality in mental health services
 Be able to critically evaluate Mental Health Services Literature
 Be able to conduct (design, implement, and analyze) a mental health services
research project
 Be able to compare and contrast instruments for the assessment of mental
health status for research purposes
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Reading Assignments:
A copy of assigned textbook chapters and journal articles will be provided to
students
Text References:
Integrated Mental Health Services: Modern Community Psychiatry. William. R.
Breakey, editor. Oxford University Press, 1996
Mental Health Services: A Public Health Perspective. Bruce Lubotsky Levin &
John Petrila, editors. Oxford University Press, 1996
Outcomes Assessment in Clinical Practice. Lloyd Sederer and Barbara Dickey,
editors. Williams & Wilkins Press, 1996
Managing Managed Care: Quality Improvement in Behavioral Health. Institute of
Medicine. National Academy Press, 1997
Textbook in Psychiatric Epidemiology. Ming Tsuang, Mauricio Tohen &
Gwendolyn Zahner, editors. Wiley-Liss Press, 1995
Selected Articles from the following journals:
Psychiatric Services
Schizophrenia Bulletin
Archives of General Psychiatry
Medical Care
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Part I (Weeks 1-4): Overview of the Mental Health Delivery System
Week 1
Course Introduction
Introduction to Mental Health Services Research
Reading Assignment:
Textbook in Psychiatric Epidemiology. Ming Tsuang, Mauricio Tohen &
Gwendolyn Zahner, editors. Wiley-Liss Press, 1995
Chapter 8: Mental Health Services Research. Jack D. Burke, Jr. (pp. 199209)
Integrated Mental Health Services: Modern Community Psychiatry.
William R. Breakey, editor. Oxford University Press, 1996
Chapter 8: Mental Health Services Research. Mark Olfson & Howard H.
Goldman (pp. 103-119).
Steinwachs DM: Consumer Outcomes and Managed Behavioral Health
Care: Research Priorities. In: Managing Managed Care: Quality
Improvement in Behavioral Health. Institute of Medicine. National
Academy Press, 1997 (pp. 312-335)
Week 2
Organization of Mental Health Services
Reading Assignment:
Mental Health Services: A Public Health Perspective. Bruce Lubotsky
Levin & John Petrila, editors. Oxford University Press, 1996
Chapter 1: Mental Health Services: Epidemiology, Prevention, and Service
Delivery Systems. John Richard Elpers and Bruce Lubotsky Levin (pp. 522)
Regier DA, Narrow WE, Rae DS, et al: The de facto US mental and
addictive disorders service system. Archives of General Psychiatry 50:
85-94, 1993
Narrow WE, Regier DA, Rae DS, et al: Use of services by persons with
mental and addictive disorders. Archives of General Psychiatry 50: 95107, 1993
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Weeks 3-5
Services to Special Populations
1. SPMI
Reading Assignment:
Practicing Psychiatry in the Community: A Manual. Jerome V. Vaccaro &
Gordon H. Clark, Jr., editors. American Psychiatric Press, Inc., Washington DC,
1996. Chapter 10: Contemporary Treatment of Individuals with Chronic Mental
Illness. Jerome V. Vaccaro & Alexander S. Young (pp173-190)
Lehman AF, Steinwachs, and the Co-Investigators of the PORT Project: AT
Issue: Translating Research into Practice: The Schizophrenia Patient Outcomes
Research Team (PORT) Treatment Recommendations. Schizophrenia Bulletin
24(1): 1-10, 1998
2. Ethnic Minorities
Reading Assignment:
Integrated Mental Health Services: Modern Community Psychiatry. William. R.
Breakey, editor. Oxford University Press 1996. Chapter 11: Cultural and Ethnic
Sensitivity. Annelle B. Primm, Bruno R. Lima & Cyprian L. Rowe (pp. 146-159)
3. Children/Adolescents
Reading Assignment:
Integrated Mental Health Services: Modern Community Psychiatry. William. R.
Breakey, editor. Oxford University Press 1996. Chapter 26: Community Service
Systems for Children and Adolescents. Michael Bogrov & Raymond L. Crowel
(pp. 353-369)
4. Geriatric
Reading Assignment:
Mental Health Services: A Public Health Perspective. Bruce Lubotsky Levin &
John Petrila, editors. Oxford University Press 1996.
Chapter 12: Epidemiology of Psychiatric Disorders and Mental Health Services
Use Among Older Americans. Jane A. Scott-Lennox and Linda K. George
(pp253-289)
5. Rural
Reading Assignment:
Chapters 2-4: Mental Health and Rural America: 1980-1993. Office of Rural
Health Policy (HRSA) and Office of Rural Mental Health Research (NIMH)
 Chapter 2: Mental Disorders in Rural Areas: A Review of Epidemiologic
Evidence (pp. 8-16)
 Chapter 3: Alcohol and Other Drug Abuse in Rural Areas: A review of
Epidemiologic Evidence (pp. 17-20)
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
Chapter 4: Mental Health Service Delivery in Rural Areas: Organizational and
Clinical Issues (pp. 21-28)
6. Substance Abuse
Reading Assignment:
Mental Health Services: A Public Health Perspective. Bruce Lubotsky Levin &
John Petrila, editors. Oxford University Press 1996. Chapter 18: Alcoholism and
Alcohol Abuse Services Research. Jack E. Scott pp. 375-391
Drake RE, Mercer-McFadden C, Mueser KT, McHugo GJ, and Bond GR: Review
of Integrated Mental Health and Substance Abuse Treatment for Patients with
Dual Disorders. Schizophrenia Bulletin 24(4): 589-608, 1998
7. Homeless
Reading Assignment:
Integrated Mental Health Services: Modern Community Psychiatry. William. R.
Breakey, editor. Oxford University Press 1996. Chapter 28: Homelessness and
Mental Health Services. Pamela J. Fischer, Paul Colson and Ezra Susser (pp.
384-403)
8. HIV
Reading Assignment:
Integrated Mental Health Services: Modern Community Psychiatry. William. R.
Breakey, editor. Oxford University Press 1996. Chapter 29: Patients with HIV
Disease. Constantine G. Lyketsos, Marc Fishman, and Glenn J. Treisman (pp.
404-418)
Week 5: EXAM – PART I
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Part II (weeks 6-8): Psychiatric Epidemiology
Week 6
The Epidemiologic Catchment Area (ECA) Study
The Diagnosis, Treatment, and Natural History of Major Psychiatric Disorders
Reading Assignment:
Textbook in Psychiatric Epidemiology. Ming Tsuang, Mauricio Tohen &
Gwendolyn Zahner, editors. Wiley-Liss Press, 1995
Chapter 5: The Epidemiologic Catchment Area (ECA) Program: Studying the
Prevalence and Incidence of Psychopathology. Darrel Regier & Charles T.
Kaelber (pp. 135-155)
Weeks 7-8
Research Methods in Psychiatric Epidemiology
Reading Assignment:
Integrated Mental Health Services: Modern Community Psychiatry. William. R.
Breakey, editor. Oxford University Press 1996. Chapter 9: Quantitative Methods
in the Evaluation of Community Mental Health Services. Graham Thornicroft and
Paul Bebbington (pp. 120-138)
Textbook in Psychiatric Epidemiology. Ming Tsuang, Mauricio Tohen &
Gwendolyn Zahner, editors. Wiley-Liss Press, 1995
Chapter 2: Introduction to Epidemiologic Research Methods. Gwendolyn EP
Zahner, Chung-Cheng Hsieh, and Jerome A. Fleming. Pp. 23-53
Mental Health Services: A Public Health Perspective. Bruce Lubotsky Levin &
John Petrila, editors. Oxford University Press 1996. Chapter 6: Evaluating
Alcohol Abuse, Drug Abuse, and Mental Health Services. Robert G. Orwin and
Howard H. Goldman (pp. 97-137)
WEEK 8: EXAM- PART II
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Part III (Weeks 9-14): Assessment of Quality in Mental Health Services
Week 9
Assessment of Quality in Mental Health Care
Reading Assignment:
Blumenthal D: Quality of care: Part 1, what is it? NEJM 335:891-894, 1996
Brook RH, McGlynn EA, Cleary PD: Quality of health care: part 2, measuring
quality of care. NEJM 335:966-970, 1996
Chassin MR: Quality of health care: part 3, improving the quality of health care.
NEJM 335:1060-1063, 1996
McGlynn ER, Norquist GS, Wells KB, et al: Quality-of-care research in mental
health: responding to the challenge. Inquiry 25:157-170, 1988
Week 10
Outcome Measurement
Reading Assignment:
Managing Managed Care: Quality Improvement in Behavioral Health. Institute of
Medicine. National Academy Press 1997. Outcomes (Chapter 7, pp. 226-240)
Outcomes Assessment in Clinical Practice. Lloyd I. Sederer and Barbara Dickey,
editors. Chapter 5: Outcome Evaluation in Psychiatric and Substance Abuse
Treatments. Concepts, Rationale, and Methods A. Thomas McLellan & Jack
Durell (pp. 34-44)
Young AS, Sullivan G, Burnam MA, et al: Measuring the quality of outpatient
treatment for schizophrenia. Archives of General Psychiatry 55: 611-617, 1998
Week 11
Satisfaction
Reading Assignment:
Cleary PD, McNeil BJ: Patient satisfaction as an indicator of quality care. Inquiry
25:25-36, 1988
Herman RC, Ettner SL, Dorwart RA: The influence of psychiatric disorders on
patients’ ratings of satisfaction with health care. Medical Care 36:720-727, 1998
Druss BG, Rosenheck RA, and Stolar M: Patient Satisfaction and Administrative
Measures as Indicators of the Quality of Mental Health Care. Psychiatric
Services 50:1053-1058, 1999
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Ruggieri M: Patients’ and relatives’ satisfaction with psychiatric services: the
state of the art and its measurement. Social Psychiatry and Psychiatric
Epidemiology 29:212-227, 1997
Week 12
Instruments
Reading Assignment:
Dickey B, Wagenaar H, Stewart A. Using Health Status Measures with the
Seriously Mentally Ill in Health Services Research. Medical Care 1996, 34:112-6
Tunis SA, Croghan TW, Heilman DK, Johnstone BM, Obenchain RL: Reliability,
Validity and Application of the Medical Outcomes Study 36-Item Short-Form
Health Survey (SF-36) in Schizophrenic Patients Treated with Olanzapine versus
Haloperidol. Medical Care 1999; 37:678-691
Outcomes Assessment in Clinical Practice. Lloyd Sederer and Barbara Dickey,
editors. Williams & Wilkins Press, 1996
 SF-36 (Chapter 8, pp. 61-64)
 BPRS (Chapter 19, pp. 105-109)
 BDI (Chapter 18, pp. 100-104)
 CSQ-8 (Chapter 23, pp. 120-128)
 GAF (Chapter 11, pp. 76-78)
Weeks 13-14
Evaluation of Service Systems

Case Management
Reading Assignments:
Mueser KT, Bond GR, Drake RE, and Resnick SG: Models of Community Care
for Severe Mental Illness: A Review of Research on Case Management.
Schizophrenia Bulletin 24(1): 37-74, 1998
Rohland BM, Rohrer JE and Etsey YK: Impact of Case Management on
Utilization of Community Support Services in a Rural State. Administration and
Policy in Mental Health 26(2): 125-135,1998.
Rohland BM, Rohrer JE and Tzou H: Broker Model of Case Management for
Persons with Serious Mental Illness in Rural Areas. Administration and Policy in
Mental Health 25 (5): 549-553, 1998.
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
Medicaid Managed Care
Reading Assignments:
Rohland BM and Rohrer JE: Evaluation of Managed Mental Health Care for
Medicaid Enrollees in Iowa. Psychiatric Services 47:1185-1187,1996.
Rohland BM: Implementation of Medicaid Managed Mental Health Care in Iowa:
Problems and Solutions. Journal of Behavioral Health Services and Research
25(3): 293-299,1998.
Rohland BM: Quality Assessment in a Medicaid Managed Mental Health Care
Plan: An Iowa Case Study. American Journal of Orthopsychiatry: 69(3): 410-414,
1999

Telemedicine
Reading Assignments:
Ruskin PE, Reed S, Kumar R, et al: Reliability and acceptability of psychiatric
diagnosis via telecommunication and audiovisual technology. Psychiatric
Services 49:1086-1088, 1998
Blackmon LA, Kaak HO, Ranseen J: Consumer satisfaction with telemedicine
child psychiatry consultation in rural Kentucky. Psychiatric Services 48:14641466, 1997
Rohland BM: If We Build It, Will They Come? Assessment of Quality in Rural
Telepsychiatry. Submitted and in Review (8/12/99) Psychiatric Services (Ms. #R5453).
Week 14: EXAM – PART III
Week 15:
Final Projects Due
Class Presentations
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