Bruce Lubotsky Levin

Transforming research education for translational science and implementation of evidence-based practices

Statement of the problem Children’s mental health researchers have made great gains in demonstrating the effectiveness of interventions that result in desirable outcomes for children with behavioral health issues. However, despite proven efficacy, empirically supported treatments are not widely adopted in community practice settings. There is a growing body of evidence in support of guiding principles for participatory research and, at its core is the development of academic-community partnerships for more effective health disparities research.

Rural Mental Health Services

Health and mental health care in America have come under increasing scrutiny during the last half of the 20th century from a vast array of stakeholders, including consumers, providers, employers, community leaders, policymakers, administrators, educators, as well as lawmakers at the state and federal levels of government. Proposals for national and state health care reform have been prompted, in part, by the need to control the rising costs of health care and to address the obstacles and inequities in accessing health and mental health services. Although the United States Congress did not pass major comprehensive health care reform legislation in the 1990s, significant health care initiatives (particularly in association with entitlement programs) have been proposed and implemented by various individual states.

Mental Health Coverage within Prepaid Health Plans.

The authors examine the extent and nature of mental health coverage within health maintenance organizations. Information was gathered on staffing and referral patterns, service location, and planning and administration of mental health services within health maintenance organizations. Findings from this national survey help clarify the present extent to which mental health services are integrated within health maintenance organizations in the context of the growing importance of health maintenance organizations as an alternative health care delivery system.

Moving treatment into the community: Implications for psychiatry

A consistent theme of the previous art icles has been the significant changes tha t have t a k e n place in the public men ta l hea l th sys tem in recent years. Lefley, 1 for example, ta lks about changes both in the locus of t r e a t m e n t (movement away from state hospitals and into communit ies) and the mode of t r e a t m e n t (towards more rehabi l i ta t ion and psychosocial t r e a t m e n t approaches, part icular ly for the chronical ly men ta l ly ill). P l a t m a n 2 emphasizes t ha t whi le Mary land has succeeded in increasing the number of Amer icant ra ined psychiatr ic g radua tes work ing in its state hospitals, this has not necessar i ly resu l ted in an improvement in the system, par t icu la r ly because of the need to move towards more communi ty-based services. These are impor tan t points tha t mer i t fu r the r discussion in this concluding paper in the series. Al though opinion regard ing men ta l hea l th services in the Uni t ed States is typical ly divided into numerous factions, curren t ly the re seems to be one th ing about which the re is s t rong agreement : the a t t empt to rep lace ins t i tu t ional (mainly state hospital) services for the seriously and chronical ly men ta l ly ill has been a fai lure. Moreover, the re are m a n y wi th in this consensus

A research and training needs assessment of Florida's mental health system.

The authors conducted an assessment of mental health training, consultation and research needs in Florida. The purpose was to document the current training, consultation, and information needs within the mental health care delivery system. The data collection included a six-page, self-administered mail questionnaire and a structured telephone interview of selected key informants throughout the state. The questions on the survey instrument asked for background information on the respondents as well as their training and research priorities for mental health services. Accountability procedures, financing issues, and clinical diagnostic and assessment techniques were among the most frequently rated priorities for training and research. Results are discussed with emphasis on the statewide dissemination of study findings, a national standardization of the needs assessment process, and the importance of systematic decision-making for administrators in the mental health service delivery system.

Challenges and Benefits in Designing and Implementing a Team-Based Research Mentorship Experience in Translational Research

Background. Translational research seeks to build bridges between research and practice to address public health issues efficiently and effectively. The purpose of this article was to evaluate a newly formed institute that provided graduate students and adolescent behavioral health community professionals with a translational research service-learning opportunity through the creation of a community–university mentoring partnership. Goals of the team-based research mentorship approach included (1) providing students the skills for implementing translational research, (2) providing research opportunities for community agencies to enhance operations and to encourage ongoing research involvement, and (3) developing relationships between university faculty and community agency professionals for further research collaborations. Method. The Institute used the National Institute on Drug Abuse’s Mentoring Mosaic to select a diverse group of community and academic mentors. The research mentorship experience of the initial cohort was evaluated based on the Research Mentorship Conceptual Framework and Self-Assessment Tool. Results. As a direct result of the research mentorship, outcomes for the academic and community mentors and scholars (i.e., those seeking a graduate certificate) included improved working relationships/networking and research experience. Through experiential learning, scholars also discovered career trajectory clarity, the need for community collaboration in research, opportunities for continuing professional development, a greater understanding of public health competencies and how they align with community-based research, and skill development in best practices for translational research. Conclusion. The team mentoring approach is a form of pedagogy that holds promise to enhance translational research and community-based research efforts while developing public health competencies.

Public Health and Women's Mental Health

Mental disorders are significant contributors to the global burden of disease. Worldwide, it is estimated that approximately 450 million people suffer from a mental disorder (World Health Organization 2001). In developing countries, mental disorders are second only to cardiovascular diseases in contributing to lost years of life (World Health Organization 2003). Although mental disorders have a potential impact upon all individuals, it is important to recognize gender differences in the rates, experience, and course of mental disorders. For example, a recent Substance Abuse and Mental Health Services Administration (SAMHSA) report states that:

Underlying Mechanisms and Trajectory of Comorbid ADHD and Eating Disorders: Proposing an Innovative Systems Framework for Informing Research

ADHD and eating disorders are both significant public health issues. Emerging evidence suggests that ADHD and eating disorders may be comorbid resulting in increased severity of associated health issues. Although several hypotheses have been proposed with respect to the underlying mechanisms of the comorbidity, there is a need for a conceptual model, which presents the simultaneous investigation of the trajectory of onset and multiple hypotheses. The current paper proposes an innovative conceptual model that can be used to simultaneously explore hypothesized underlying mechanisms by triangulating current literature with aspects of the biopsychosocial model, life course approach, Risk Regulator Framework, research domain criteria matrix, and the person-environment transaction theory. Designated within the model are proposed pathways that serve to describe how various psychosocial and psychiatric risk regulators and genetic risk factors combine to influence the comorbidity across the lifespan. The proposed conceptual model can provide the foundation for further research regarding comorbid ADHD and eating disorders in addition to translation for use among other comorbid conditions.

Navigating the worlds of information

During the past several decades, major federal reports have repeatedly prioritized two areas of critical importance for improving the health and mental health of Americans: (1) promoting women’s mental health services as an essential component of overall health; and (2) the development of a national telecommunication system for surveillance of health and mental health data. Women seek treatment for services across a variety of health and specialized mental healthcare settings, both formal and informal, and each encounter generates data. Although the healthcare field is being encouraged to develop national health information systems, each agency, organization, and delivery system has its own databases, formatting structure, and data collection and reporting requirements, often broken down by gender, age, and ethnicity. Further, each reporting stream may not relate to users and collectors of data across the variety of health and mental healthcare settings.