Collaborative Research in Mental Health

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Administration and Policy in Mental Health Vol. 20, No. 6, July 1993 COLLABORATIVE RESEARCH IN MENTAL HEALTH Bentson H. McFarland, M.D., Ph.D., Frederick A. DiBlasio, Ph.D., and John R. Belcher, Ph.D. ABSTRACT: This paper describes advantages and disadvantages of the National Institute of Mental Health's program for Public Academic Liaison (PAL). Useful administrative lessons gleaned from longstanding connections between state mental health agencies and universities in Ohio, Virginia, and Oregon are reviewed. Important issues such as budgeting and staffing for both agency and university administrators to consider when establishing collaboration are outlined. At the end of the last decade, the National Institute of Mental Health proclaimed a new initiative entitled "Public Academic Liaison" (Bevilacqua, 1991; Glick, 1989). The purpose of the Public Academic Liaison (PAL) program is to enhance the relationship between academic researchers and the public mental health system. Since PAL is emphasized in National Institute of Mental Health (NIMH) requests for applications (RFAs), mental health ad- ministrators will benefit from learning more about this program. It will also be of interest to review results from three states which have had longstanding public academic linkages designed to facilitate research. While there is growing literature on public academic collaboration with Bentson McFarland is Director of the Western Mental Health Research Center at Oregon Health Sciences University and Investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon. Frederick DiBlasio is Associate Professor and John Belcher is Assistant Professor, both at the School of Social Work and Community Planning at the University of Maryland, Baltimore. Address correspondence to Bentson McFarland, Dept. of Psychiatry, Mail Code OP-02, Oregon Health Sciences University, Portland, OR 97201. This paper was presented in part at the National Conference on Mental Health Statistics in San Diego on June 2, 1989, and at the 141st Annual Meeting of the American Psychiatric Association in New York on May 15, 1990. Support from the National Institute of Mental Health grant number P50 MH43458 to the Western Mental Health Research Center is gratefully acknowledged. Dr. McFarland is Burroughs- Wellcome Scholar in Pharmacoepidemiology. 421 9 1993 Human Sciences Press, Inc. 422 Administration and Policy in Mental Health regard to training (Boust, 1991; Cutler, Bloom, & Shore, 1981; Faulkner et al., 1987; Keefer, Kraus, Parker, Elliot, & Patton, 1991; Talbott & Ra- binowitz, 1986; Weintraub, Nyman, &Harbin, 1991; Yank et al., 1991), little has been written about collaborative research endeavors (Pardes, 1990). Of course, there are many examples of successful collaborative research enter- prises (Bloom, 1989; Peterson, 1991). However, the recent emphasis on public-academic liaison from the NIMH has resulted in a need for mental health administrators to better appreciate the subtleties of these collaborative enterprises. University and mental health administrators recognize the value of research for developing and evaluating mental health programs. Despite this shared recognition, a gap exists in the structure of universities and mental health agencies in the process of doing collaborative research. This process is hindered by many conceptual and pragmatic obstacles that seldom are addressed and resolved. However some scholars have noted that as states' budgets shrink, state funding for research will also decrease (Jerell & Larsen, 1985), and new challenges will generate the need for unique ways of promoting agency and academic liaison relationships. From the universities' perspective, graduate schools are increasingly depen- dent upon direct funding from student enrollments. Moreover, decreased financial support for graduate professional education has reduced enrollments. The National Institute of Mental Health and the National Institutes of Health once provided major financial support for graduate professional education; such funds are now largely non-existent (McPheeters, 1983). Reduced enroll- ments pressure universities to reduce faculty lines, which leave remaining faculty with increased responsibility. As funds decrease and responsibilities increase for both the state and univer- sity systems the relationship between the two becomes more distant. McPhee- ters (1985) suggests that the two systems have been distant for more than 30 years partially because of the perceived differences in goals. Public agencies are usually concerned with direct service delivery and universities are interested in education and research. This paper summarizes some of the practical and ideological concerns in designing a collaborative research system and suggests initial approaches to resolve issues that block collaboration. Many of the issues presented here were evident in Colorado's (Shern & Glover, 1984) and Virginia's (DiBlasio, 1985) experiences in setting up a process for collaboration. Experiences from Ohio and Oregon are also pertinent. TYPES OF COLLABORATIVE RESEARCH Some definitions will be helpful. In this context public refers to state mental health agencies, state mental hospitals, and community mental health pro- Bentson H. McFarland, Frederick A. DiBlasio, and John R. Belcher 423 grams. Academic generally refers to universities which may be public or private. Also included in the academic sector are research institutions which may be public or private, non-profit, or for profit. It should be noted that some agencies in fact encompass both roles, i.e., public and academic. For example, a university may be chiefly interested in teaching and research, but could also operate a community mental health program. Private providers such as a general hospital might operate a public mental health program under contract to a state agency. Paying for Research One means of categorizing collaborative public-academic research is by the way in which it is financed (Table 1). Internally financed studies will typically be relatively small projects-perhaps involving record review or other types of retrospective data analysis. Usually the work will in fact be done by students, residents, or fellows seeking research training in the public sector while being supervised by academic professionals. Program evaluation is another impor- tant area for collaborative research. It is not uncommon for public sector agencies to contract with academic institutions to evaluate specific mental health projects. Finally, a collaborative pilot project may be launched in order to obtain data prior to beginning a large research program. External financing for collaborative research typically comes from the private sector such as foundations or the pharmaceutical industry or from federal agencies such as the NIMH. Program Evaluation There is, of course, a large literature on program evaluation (Table 2). With regard to collaborative efforts it is important to distinguish between formative program evaluation and summative evaluation (King, Morris, & Fitzgibbon, 1987). Formative evaluation typically takes place early in a project and is used to clarify the objectives of the program. It is not uncommon for a formative evaluation to lead to changes in the program. In contrast, summative evalua- TABLE 1 Collaborative Research 1. Internally Financed a. Students, residents, fellows b. Program evaluation c. Pilot projects 2. Externally Financed a. Private (1) Foundations (2) Pharmaceutical b. Federal (NIMH) 424 Administration and Policy in Mental Health TABLE 2 Program Evaluation* 1. Formative a. Clarifies objectives b. Early in program's life c. May lead to program changes 2. Summative a. Recapitulates objectives b. Later in program's life c. Evaluates accomplishments *Modified fi'orn Randolph (1990) tion is done toward the end of a project, is designed to evaluate its accomplish- ments, and hopefully recapitulates the objectives of the program (Randolph, 1990). In conducting collaborative program evaluation it is essential that both parties understand the nature of the evaluation to be performed. Specifically, it is important for the academic evaluator to determine whether the public agency is interested in formative or summative evaluation. With regard to program evaluation, it is important to understand that the mission of direct practice agencies is the delivery of services to directly meet needs of clients suffering from mental health problems, many of whom are the chronic mentally ill. The mission of universities is to generate new knowledge and to produce graduates. Ultimately, the mental health system must provide long-term care for mentally incapacitated people, who carry negative stigma and are viewed as burdens to taxpayers. The disparity between end products creates tension between the two systems as agencies sometimes view the universities as uncaring and removed from the everyday struggles of service delivery, while universities often view agencies as bureaucratic and resistant to the scientific process. Conflicts in missions lead to disagreement as to the purpose and direction of research. Administrators often desire to participate in research that is directly applicable to their clinical setting to implement prevention strategies or meet immediate service delivery needs. In addition, they emphasize the evaluative aspect of applied research, particularly to evaluate the effectiveness of an intervention program or strategy. Shern and Glover (1984) reported that providers of services viewed academically housed research as abstract and contrived, and for the most part not applicable in applied settings. University researchers also are skeptical as they question the scientific quality of many of the evaluative research designs. Evaluative designs are often time-limited, compromised in design and conceptualization, and therefore restrict gener- alizability (Shern & Glover, 1984). Bentson H. McFarland, Frederick A. DiBlasio, and John R. Belcher 425 Research Nomenclature Service providers and administrators should understand the vocabulary used in describing research projects. Pharmaceutical research is especially notewor- thy since much terminology devised by the Food and Drug Administration is now employed in other areas (Table 3). Pharmaceutical studies are typically divided into pre-clinical and clinical components (Nightingale, 1981; Young, Norris, Levitt, & Nightingale, 1988). The pre-clinical work is done in the laboratory involving extensive animal tests. Upon completion of pre-clinical studies the pharmaceutical manufacturer typically applies to the Food and Drug Administration for an investigational new drug (IND) permit. Once the IND has been obtained the manufacturer will begin phases I, II, and III of the clinical research. Phase I is the safety study done in healthy male volunteers. Phase II is efficacy research usually done in an open fashion in patients. Phase III is typically a double blind randomized clinical trial attempting to determine both safety and efficacy in patients. Upon completion of phase III the manu- facturer then obtains marketing approval from the Food and Drug Administra- tion. Approval may perhaps be contingent upon conducting further studies which would be termed phase IV. There are analogies between pharmaceutical research and studies of psycho- social treatment programs. Specifically, phase II pharmaceutical studies for efficacy are similar to demonstration projects. The idea in a demonstration project is to determine whether a theoretically appealing program can actually be provided to the population in question. A secondary objective of the demonstration project is to determine (roughly) whether the desired interven- tion appears to have some efficacy in the target population. In federally sponsored demonstration projects it is usually the case that 95 % of the funding will go for service and 5 % will be assigned to research-evaluation. Typically in a federally funded demonstration project the grantee must be a public agency. A recent development in federally financed projects is the research- demonstration grant (Table 4). This type of grant (labeled R-18 by the TABLE 3 Pharmaceutical Research Phase Purpose Subjects Method Investigational New Drug I Safety Healthy Open II Efficacy Patients Open III Safety and Efficacy Patients Blind New Drug Application Approved IV Indications New Patients Blind IV Surveillance All Patients Cohort 426 Administration and Policy in Mental Health TABLE 4 Federally Financed Research Mechanism Number Phase Grantee % Service % Research Demonstration -- II State 95 % 5 % Research-Demo R 18 III Anyone 60 % 40 % Research R01 IV Anyone 5 % 95 % NIMH) corresponds to the phase III pharmaceutical trial. Specifically, the idea in the research-demonstration project is to compare the efficacy of a well defined treatment program against a control condition. Typically in a research-demonstration project the intervention will be "model-driven." In other words, it is presumed that the researcher will have assimilated and/or generated a large body of theory and preliminary data that will motivate the intervention's development as well as give one hope that the new program will be successful. On the average, 60% of the federal research dollars in a research-demonstration project can go for service, but at least 30-40% must be for research purposes. Randomized designs with well defined treatment and control groups are key parts of the research-demonstration project. It is also important that the intervention being tested is generalizable. Having a manual of procedures that specifies the intervention is one way to achieve this gener- alizability. The research-demonstration project should be conducted in a well- defined population so that the intervention can be easily replicated by others working in the field. Finally, the traditional research project (R01 in the federal nomenclature) corresponds to a phase IV pharmaceutical trial. Generally in an R01 project at least 95 % of the budget is dedicated to research. One expects that the interven- tion in question will be well defined and will have been shown to be efficacious in previous work. Often an R01 project is aimed at testing the application of a well-defined intervention to a new target population. With this terminology we now review advantages and disadvantages of collaborative research. ADVANTAGES OF PUBLIC ACADEMIC COLLABORATION There are considerable benefits to both sides in public academic liaison. Persons in the public sector can collaborate with academic specialists and can consult with individuals who may have particular skills or knowledge that are not generally available. Furthermore, the academic sector can deliver profes- sional education, continuing education, and specialized training to workers in the public sector. The academic side may also assign students to work in the Bentson H. McFarland, Frederick A. DiBlasio, and John R. Belcher 427 public sector. In addition, PAL can help academic institutions fulfill their mandate to provide trained workers for the public sector. From the research perspective, the public sector also has substantial poten- tial gains in linking with academia. Specifically, the public sector may have research or policy questions that need to be answered quantitatively. The academic collaboration may provide special data (or specially processed data) to the public sector for program management. Finally, academicians tradi- tionally are skilled at writing grants and at obtaining external support to fund research activities. For the academic side, collaboration with the public sector also has several potential benefits. From an educational standpoint, the public sector can provide research questions that graduate students could address as part of their dissertations. Trainees may come from the public sector seeking specialized instruction in the academic community. The public sector might also provide stipends for such training. From the research point of view, working in the public sector offers academic professionals the chance to grapple with impor- tant and policy-relevant questions. Also, the public sector provides many challenging unknown situations that can be addressed by interested academi- cians. Typically the research will result in publications as well as in subjects for future grant writing. In fact, PAL works best when both sides collaborate in the pursuit of external research funding. There is a long tradition of psychopharmacology research conducted in specialized wards of state mental hospitals funded by the N IMH or the pharmaceutical industry. More recently, public and academic professionals have collaborated in applying for grants from the N IMH or from private organizations such as the Robert Wood Johnson Foundation. Collab- oration in applying for external funding is often a situation in which the whole becomes much more than the sum of the parts. Ohio is an example of a state that has forged a collaborative research relationship. State sponsored research in conjunction with a university fosters long-standing links that enhance capacities for continued research. For exam- ple, the Ohio Department of Mental Health (ODMH), through its sponsor- ship, is able to guide research in the state so that important problems are targeted for study. The ODMH sets the priorities and is able to provide an agenda to the legislature about which projects, e.g., case management, should receive increased funding (Celeste, Hyde, & Roth, 1990; Roth & Hyde, 1988). One of the ways the state of Ohio has been able to facilitate research efforts is for its state department of mental health to provide small grants for dissertation research. Often, because Ph.D. students are interested in producing an exten- sive piece of work, they are willing to invest sufficient time along with their university advisors. This approach can be a cost effective way for an agency to promote quality research, which can be useful to both the provider and the student. 428 Administration and Policy in Mental Health One such doctoral student involvement provided insight into homelessness after psychiatric hospitalization (Toomey & Belcher, 1990). This work enabled the state to understand gaps in care for the chronically mentally ill and helped develop more appropriate services. It also led to further research, which was supported by the NIMH (Lehman, 1990). Ohio's experience in developing and implementing a working collaborative process includes executive leadership that views research as important in the overall scheme of government decision making. In addition, Ohio has engaged in setting a research agenda that acts as a guide so that state departments can send out Requests for Proposed RFPs that meet departmental needs. Lastly, Ohio has developed funding mechanisms, such as dissertation research and small grants, that facilitate cost effective research that can be used to generate other studies. Formal ties and joint efforts establish the necessary link between the two systems. To this end, universities and state systems benefit from joint depart- ments that act as a direct conduit for communication and information to flow (Pardes, 1990). Positions that involve joint appointments to both the faculties of universities and to the administration of agencies assist in formalizing communication between the two systems. Some brief examples from Oregon will also be instructive. For several years, the Oregon Health Sciences University has constructed and maintained a specialized data base which records information on individuals found not guilty by reason of insanity. This project is supported by the NIMH and has provided an opportunity for detailed examination of a model program. Oregon manages individuals found not guilty by reason of insanity using a Psychiatric Security Review Board (PSRB). The PSRB maintains jurisdiction over men- tally ill offenders in both in-patient and out-patient settings. The PSRB can mandate treatment including hospitalization. Other states have implemented programs similar to the Oregon model. The PSRB research project conducted by the university has enabled the compilation of mental health, criminal justice, and diagnostic interview data on this special population. The data base can be used to answer many significant policy questions in this area. More recently, workers from the public and the academic sectors have used the framework of the Western Mental Health Research Center to collaborate on devising projects that implement and evaluate psychosocial rehabilitation. Academic based researchers have provided advice regarding experimental design, instrumentation, and data analysis. Public sector professionals have contributed their clinical skills as well as their knowledge of local programs. The immediate product of this collaboration has been grant applications to external funding sources. The aim is that this collaboration will be extended to facilitate development and evaluation of pilot programs in psychosocial reha- bilitation. Finally, psychopharmacology has been a traditional field for worthwhile collaboration between public and academic sectors. There are several examples Bentson H. McFarland, Frederick A. DiBlasio, and John R. Belcher 429 of state mental hospitals that have specialized research wards supported by the NIMH, the pharmaceutical industry, or both. Academic workers have assisted the public sector in establishing institutional review boards, in budgeting for research projects, and in monitoring clinical trials. Clinicians working in the public sector have been able to participate in the studies. Often there is a "Hawthorne effect" in this work. The Hawthorne effect implies that many individuals involved in research projects tend to experience some improvement in their level of functioning due to the extra attention provided them. It also goes without saying that persons with the more severe forms of mental illness receive much of their mental health treatment in the public sector. Accord- ingly, there is considerable value in collaborative research aimed at devising medications that will be useful for these individuals. PROBLEMS IN COLLABORATIVE RESEARCH There are several challenging aspects to collaborative public-academic re- search (Table 5). It is vital to lay the groundwork for any linked research project. Specifically, it is important that service providers are aware of the research and agree with its utility. From the academic perspective, it is equally important that if an intervention is to be tested it should be "model-driven." In other words, the collaborative researcher needs to have appreciated at least some theory and hopefully have generated some preliminary evidence which would suggest the viability of the intervention to be tested. There is also considerable value in having an intervention be provided by one component of the collaboration (typically the public sector) and the evaluation be done by an independent entity (typically the academic collaborator). In all too many instances the lines of communication between service delivery agencies and the higher educational system simply do not exist. Staff and faculty who do not know each other often cannot communicate. Few states have consistent systems or processes whereby communication linkages are TABLE 5 Collaborative Research Challenges 1. Design Disputes a. Generalizability (manualizability) b. Validity (randomization) 2. Budget Brokerage a. Indirect costs (overhead) b. Follow-on costs (end of project) 430 Administration and Policy in Mental Health established and nourished. In many states there is simply no mechanism, impetus, or process for facilitating or maintaining collaborative relationships between the higher educational system and public and private agencies. Recognizing this problem, Virginia's department of mental health began a series of conferences where administrators, providers, and faculty members could interact on a personal and professional basis (DiBlasio, 1985). They identified issues and concerns about potential collaboration, and negotiated resolutions. This process resulted in the appointment of a coordinator of research collaboration to help match faculty interests with agency needs. In addition, a scholar was selected for a joint appointment with the department of mental health and Virginia Commonwealth University (American Psychiatric Association, 1991; Yank et al., 1991). The state of Oregon has also taken advantage of joint efforts by developing extensive state-academic research liaisons (Faulkner, 1987). In many instances, there is substantial mythology pertaining to public academic liaison which would best be dispelled. For example, academic au- thorities often look covetously at the large public mental health budget and think, "Why couldn't one percent or one-tenth of one percent of this $100 million budget be devoted to training and research (i.e., funneled toward the university)?" From the other perspective, public sector workers may look at the university and note that, for example, the medical school is building a $30 million eye clinic and has just purchased a $5 million brain scanner. The public sector may wonder why the university cannot contribute money (or hospital beds or staff time) for the operation of public programs. Different Constituencies There are, in fact, several areas of misperception between public and academic professionals. One way of describing this situation is to note that there are different "constituencies" in the public versus the academic sector. Here a constituent is defined to be an individual who may influence a profes- sional's job performance and or remove the professional from office. Workers in the public sector must answer to several constituents not the least of whom are the general public, third party payers, the Health Care Financing Adminis- tration, the Joint Commission on Accreditation of Health Care Organizations, mental health consumers, family members, legislators, governors, the media, providers, advocates, unions, and the like. While the academic professional must also answer to bureaucrats and ad- ministrators (including department chairpersons and deans), there are other, different constituents in academia. The rule of"publish or perish" remains very much a part of academic life. Accordingly, the academician needs to satisfy manuscript reviewers and journal editors. Research is a traditional part of academic work and these days is almost a necessity. Accordingly, the academi- cian must devote time to grant writing. Grants in turn are reviewed by Bentson H. McFarland, Frederick A. DiBlasio, and John R. Belcher 431 committees such as the NIMH's Initial Review Groups. Hence, grant re- viewers are also the academician's constituents. Human Subjects Locally, research projects must be approved by Institutional Review Boards (National Commission, 1979; Office of Protection, 1983; President's Commis- sion, 1988). These human subject committees also have considerable influence over an academician. Naturally, the academic professional must also answer to research subjects, to the media, and, in some cases, to clinical services pro- viders. Collaborative research typically raises many questions pertaining to use of human subjects. It may not be immediately obvious (particularly in collab- orative retrospective studies) whether the data to be analyzed are actually generated in the routine course of events by an operating public mental health agency or if the data are being specifically generated for purposes of research. In the latter case it may be necessary to have the project approved by an Institutional Review Board (also known as a human subjects committee). It is imperative that the research process adequately protect clients' time, energy and confidentiality. Many clients struggling with difficulties and the symptoms that bring them to seek intervention are already burdened and perhaps at the edge of their coping capacities. A research project that asks clients to extend themselves further must account for how the additional expenditure of time and energy will affect their well-being. Client involvement is facilitated when direct ways are found to make research participation a rewarding experience. Grant Writing The grant writing process deserves additional comment. In general, public sector workers are interested in addressing research questions that pertain to their state or local community and that have immediate relevance. On the other hand, many funders of research (for example, the NIMH) may well be more interested in questions that are of national relevance with future implica- tions. In other words, the public sector worker may be concerned with here and now, whereas the academician is traditionally directed to everywhere and the hereafter. These differences in priorities can easily lead to conflict in the grant writing process as well as disappointment if funding is not forthcoming. Other areas of disagreement between public and academic workers include questions such as: (a) who is in charge, (b) who owns the data, (c) who is the expert, and (d) what is the answer. It is important that there be a clear delineation of research responsibilities as early as possible in the collaboration. Ideally, this determination of authority should take place during the grant writing. At this stage it will also be of value for the parties to determine who, if anyone, should publish the data and who should present the results to higher authorities and/or legislators. Policies on publication become particularly im- 432 Administration and Policy in Mental Health portant when (as is often the case in the public sector) the question is important and the answer is controversial. Publications Reporting research findings should be a shared responsibility and privilege of both providers and researchers. However, professional writing for publica- tion is not allotted in the schedules of most administrators and service providers. Public and private agencies should create policy that fosters professional writing by their personnel through compensatory time and other job-related benefits. As criteria for publication acceptance become more difficult, researchers need to assess the publication possibilities of a research project prior to their involvement. Some projects will have a low appeal to editorial boards of professional journals, regardless of the success achieved. Therefore, academi- cians must be concerned with some of the following questions: (a) will the research generate new knowledge, (b) will the sample of subjects be large enough, (c) how generalizable will the results be, (d) is the topic a timely issue, and (e) how many publications will the project generate when compared to the time and energy invested. Open dialogue and negotiation can lead to selection of topics and writing for publication that are mutually beneficial. In order for collaborative relation- ships to develop and survive there must be planned reciprocity based on mutual respect and understanding. Sometimes research data suggest less than optimal findings, or worse, generate evidence opposite to the expected direction of the results. This type of outcome may make certain intervention strategies suspect, and at times may put entire agency services in question. However, administrators must be aware of this potential eventuality and be committed to report findings, regardless of their nature, and to make recommendations for service improvements. Administrators and researchers differ on the freedom to advocate policy change that research findings may suggest. Academicians have more freedom to present and advocate provocative changes than do the service agencies because academicians are not usually held accountable to the systems requiring the change. Research Budgets Budgeting for collaborative research is another area with several potential pitfalls. As mentioned, it is important for the partners to distinguish between costs that are germane to service delivery versus those that are pertinent to research. While demonstration projects and research-demonstration projects by definition include funds for service delivery, other types of research may have budgetary restrictions. Bentson H. McFarland, Frederick A. DiBlasio, and John R. Belcher 433 Another area of contention is indirect costs (also known as overhead). It can be very helpful for both collaborative partners to realize that research as well as service generates indirect costs which must be paid for in some fashion. Particularly when an academic agency is sub-contracting to a public agency (or vice versa), it is useful to specify the indirect cost rate in the contract and also to indicate the method of its calculation. When doing collaborative research in the public sector it is important to have a long-term view. Specifically, one needs to plan for termination of the project. It should be understood initially whether the project will be expected to become self-sustaining or whether it should include a phase-out component. These issues are seen frequently in pharmaceutical research as well as in psychosocial clinical trials. In Oregon's experience with PAL, several features have been helpful. First, it has proven quite useful to have specific contracts drawn up between the state mental health agency and the university delineating the scope of work in research, consultation, or training (Bloom, 1989). Contracts specify particular individuals assigned from the academic sector to work in the public program. The contracts also identify a person in the public sector who is responsible for the collaboration. As noted, it is vital for collaboration that one or more individuals be identified as "linkers." These are persons who spend time in both environments (Godard & Hargrove, 1991). This individual must have the support of higher authorities in both the academic and the public sector. The linker facilitates collaboration between the two agencies. More specifically, the linker can reduce the inevitable tension that arises when two entities having different priorities attempt to work together harmoniously. The effective linker should spend at least one day per week in each sector. DISCUSSION Joint research promises considerable benefits for those directly involved as well as dividends from collaborative research and training. It must be recog- nized that the public and the academic sectors have different priorities. None- theless, collaboration between these two entities can be worthwhile. In the current fiscal environment of limited resources it is necessary for service providers and universities to maximize opportunities. Administrators are often interested in raising the quality of care to clients, while universities are inter- ested in expanding research opportunities for their faculties. This changing landscape of less funding for mental health services in which agencies have to do more with less has created a window of opportunity for universities inter- ested in enhancing their research capacities. Universities can provide free technical, clinical, managerial, and research support to agencies providing 434 Administration and Policy in Mental Health services. Administrators then gain these valuable resources for their agencies and universities gain access to subject populations and assistance in collecting data. Careful attention to the needs of both groups will yield a mutual reciproc- ity that ensures successful collaboration. REFERENCES American Psychiatric Association. (1991). Virginia state-university program honored for exemplary collab- oration. Hospital and Community Psychiatry, 42, 72-73. Bevilacqua, J. J. (1991). The NIMH public-academic liaison (PAL) research initiative: An update. Hospital and Community Psychiatry, 42, 71. Bloom, J.D. (Ed). (1989). State-university collaboration: The Oregon experience. New directions for mental health services (Number 44). San Francisco, CA: Jossey-Bass Inc. Boust, S. J. (1991). State-university collaboration in Nebraska: Public psychiatry residency training in a rural area. Hospital and Community Psychiatry, 42, 49-51. Celeste, R.F., Hyde, P.S., & Roth, D. (1990). New research in mental health, 9, 1988-1989 Biennium. Columbus, OH: Ohio Department of Mental Health. Cutler, D.L., Bioom, J.D., & Shore, J.H. (1981). Training psychiatrists to work with community support systems for chronically mentally ill persons. American Journal of Psychiatry, 138, 99-101. DiBlasio, F.A. (1985). Research related to the prevention of mental illness, mental retardation and substance abuse: Stimulating collaboration between university-based researchers and service providers. Richmond, VA: Department of Mental Health and Mental Retardation. Fanlkner, L.R., Bloom, J.D., Cutler, D.L., Shore, J.H., Bray, J.D., & Murray, j. (1987). Academic, community, and state mental-health program collaboration-The Oregon experience. Community Mental Health Journal, 23, 260-270. Fine, T., Pincus, H.A., Ridge, R., James, J.F., Gregory, D., & Ennis, J. (1989). Models of state funding for mental health research. Hospital and Community Psychiatry, 40, 383-387. Glick, I. (1989). Public academic liaison. Focus on Mental Health Services Research, 3, 4. Godard, S., & Hargrove, D.S. (1991): Public-academic linkages: A "linchpin" model. Community Mental Henlth Journal, 27, 489-500. Jerrell, J.M., & Larsen, J.K. (1985). Policy and organizational changes in state mental health centers. Administration in Mental Health, 12, 184-191. Keefer, B. L., Kraus, R. F., Parker, B. L., Elliott, R., & Patton, G. (1991). A state-university collaboration program: Residents' perspectives. Hospital and Community Psychiatry, 42, 62-66. King, S. A., Morris, L. L., & Fitzgibbon, C. T. (1987). How to assess program implementation. Newbury Park, CA: Sage Publications. Lehman, A.F. (1990). Baltiraore program for the homeless frontally ill. Baltimore, MD: Baltimore Mental Health Systems, Inc. McPheeters, H.L. (1985, January). Trends and issues in health care delivery and health manpower. Paper presented at the meeting of Health and Human Services, Southern Regional Education Board, Atlanta, Georgia. McPheeters, H.L. (1983, July). Relationships between universities and agencies to better meet public needs. Paper presented at the meeting of the Commission of Mental Health and Human Services, Williamsburg, VA. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research. Bethesda, MD: Office of Protection from Research Risks, National Institutes of Health. Nightingale, S.L. (1981). Drug regulation and policy formulation. MilbankMemorial Fund Quarterly~Health and Society, 59, 412-444. Office of Protection from Research Risks. (1983). Protection of human subjects. Code of Federal Regulations Title 45: Public Welfare Part 46: Protection of Human Subjects. Bethesda, MD: National Institutes of Health. Pardes, H. (1990). State-academic-research liaison. Psychiatric Quarterly, 61, 69-74. Peterson, P. D. (1991). State-university collaboration: Next steps. Hospital and Community Psychiatry, 42, 5. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. (1988). IRB Guidebook. Bethesda, MD: Office for Protection from Research Risks, National Institutes of Health. Randolph, F. (1990). Personal communication. Roth, D., & Hyde, P.S. (1988). Translating research into public policy: Ohio's coordinated response to the problems of homeIessness. Columbus, OH: Ohio Department of Mental Health. Bentson H. McFarland, Frederick A. DiBlasio, and John R. Belcher 435 Shern, D.L., & Glover, R.W. (1984). Higher education and the public mental health system: Opportunities for collaboration in applied research. Denver, CO: Division of Mental Health. Talbott, J.A., & Rabinowitz, C.B. (Eds.). (1986). Working together." State-university collaboration in mental health. Washington, DC: American Psychiatric Press, Inc. Toomey, B.G., & Belcher, J.R. (1990). Severely mentally disabled homeless: The process of moving into and living in unstable conditions after psychiatric hospitalization. Columbus, OH: Ohio Department of Mental Health. Weintraub, W., Nyman, G., & Harbin, H. (1991). The Maryland plan: The rest of the story. Hospital and Community PsychiatrT, 42, 52-55. Yank, G. R., Barber, J. W., Vieweg, W. V. R., Hundley, P. H., Spradlin, W. W., Harding, L. F., & Sutker, L. H. (1991). Virginia's experience with state-university collaboration. Hospital and Community Psychiatry, 42, 39-4-4. Young, F.E., Norris, J.A., Levitt, J.A., & Nightingale, S.L. (1988). The FDA's new procedures for the use of investigational drugs in treatment. Journal of the American Medical Association. 259, 2267.

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