Partnered Research Center for Quality Care

University Of California Los Angeles, Los Angeles CA

Investigators

Linked publications & trials

Abstract

DESCRIPTION OVERALL (provided by applicant): This application for an Advanced Center for Services and Intervention Research, "NIMH Partnered Research Center for Quality Care," is a collaboration of UCLA, RAND, and USC, and health plan, services agency, and community and consumer partners in Los Angeles and other. The Center focuses on two themes: 1) improving access to quality mental health services in communities through studying the impact of interventions at policy, practice, and community levels;and 2) partnerships in research and program development, implementation, and evaluation to achieve science that is formed by and can inform community-based services delivery. We propose a partnered center structure, with academic and community co-leaders for all cores, units, and pilots. We focus on signature conditions (e.g., depression/anxiety, schizophrenia, and youth exposure to violence), and respond to partner priorities. We will apply principles of community partnered participatory research, including equal power in all research stages, trust development, and assuring mutual benefit and capacity building. The Operations Core will promote joint leadership of the Center, provide administrative and technical support, support theory and intervention development and application, develop new academic and community leaders, and facilitate research development with public partners. The Methods Core will provide design and biostatistical methodological support for partnered research, including qualitative, mixed methods, and rapid evaluation response, measures development and application, and use of policy analysis;and sponsor a partnered Methods R34 on organizational networks and a New Investigator pilot on cost-effectiveness measures. The Principal Research Core will support 3 partnered R34s and host a unit to enhance the translation of research into state use. The R34s develop a consumer-provider intervention to support recovery in severe mental illness, analyze data from a natural experiment to understand consumer decisions to enroll in consumer-based health plans, and examine factors affecting dissemination of an evidence-based school intervention for child trauma. The Network Core will support the application of CPPR principles, develop partnership strategies, support consumer research leadership, and evaluate Center impact on community and academic members. This core includes a Partnered New Investigator Pilot in New Orleans and hosts an annual Community Quality Forum to identify priorities for and initiate new partnered studies. RESUME OF INDIVIDUAL PROJECTS AND CORES CORE 1: Operations Core (PI: Kenneth Wells): The Operations Core of this ACISIR application supports center leadership and consists of five units: Administration;Data Management, Analysis, and Technology;Theory and Intervention Development and Application;Investigator Development;and Public Liaison. Although not particularly innovative in structure, these units are appropriate and well positioned to complete their roles within the center. The Investigator Development Unit, with a focus on training of new investigators, is a particular strength. The Center describes what is called a Community Partnered Participation Research (CPPR) approach to involving community members in the planning and running of the center, including in leadership positions. Although similar to the participatory action research (PAR) approach used in other research enterprises, this model is relatively new for mental health and particularly for this type of center mechanism. The involvement of community stakeholders in leadership of the center is laudable, the focus of the partnership to Health African American Families (HAAF), an organization partially created by UCLA, reduces potential generalizability of the effort to other types of community organizations. A potential weakness of the Operations Core is that it is apparently set off as one arm of the center, rather than as a central entity guiding the work of other cores. Overall, this Core was considered to be very strong, but with some weaknesses as noted (Score: 164). CORE 2: Research Methods Core (PI: Thomas Belin): The Research Methods Core (RMC) proposes four units: biostatics, qualitative/mixed-methods, measurement, and policy. Each unit is led by investigators at the top of their field and there is evidence of integration of the work of this Core with the Operations Core. The RMC has particular strengths in the public health significance of the model and the innovativeness of the Core and the R34 Methods Pilot that is likely to improve dissemination to diverse stakeholders and agencies. The Policy Unit appears to be particularly integrative for the center as a whole, indicating the key role of public policy issues within the framework of the center. Some questions persist regarding the commitment to ethnic and cultural issues within this Core (much of that discussion appears to be elsewhere in the application but not as clear here). Although it appears that the methodologists leading this Core are clearly engrained into the functioning of the center as a whole, it also appears that the Core PI is not part of the Operations Core, leading to questions about the overall organization of the center. Overall, however, the weaknesses were considered very minor given the significant strengths of this Core (Score: 134). CORE 3: Principal Research Core (PI: Jeanne Miranda): The Principal Research Core (PRC) has as its goals to promote development of new investigators, and to conduct research through three R34-like studies. The importance of the first R34 study of the Role of Psychiatric History in Selection of and Experience with Consumer-Driven Health Plans is an important topic of study, but the application does not make a convincing case for the significance of the particular pilot study being proposed. The other two pilots provide well justified arguments for the importance of the proposed efforts. The link between the pilot projects and the conceptual model of the center was not entirely clear to all reviewers, and there was a sense that the projects were not clearly integrated into the center. The goal of new investigator development might also be described more clearly. The affiliated studies piece is insufficiently described, but appears to involve the types of pilot projects described in the program announcements. These might have been more clearly delineated. Despite these weaknesses, the PRC has a number of strengths, particularly related to the investigators and environment presented. The need to advance knowledge about implementation of evidence based strategies in various areas of activity and various communities while simultaneously developing capacity is strongly argued and supported. Overall, the Principal Research Core was considered to be very strong, but with some weaknesses as noted (Score: 168). CORE 4: Network Core (PI: Paul Koegel): The specific aim of the Network Core is both to support real partnerships between the Research Center and community based partners and advance the knowledge of how partnerships can be most effectively utilized. The purpose in doing this is the belief that a "quality chasm" exists between knowledge of the best practices and the translation of this knowledge into services. A major strength of the Network Core is this goal to cross the quality chasm and the clear attempts made to do so. There is a well-thought out plan to involve community stakeholders and to build on to the existing network by expanding connections. The Network Core's goals are truly central to the goals of the center as a whole in terms of creating a participatory structure for research planning and engagement. Although the rationale for undertaking some of the activities described is not as clear as in other parts of the center, overall this Core was considered to be very strong with few weaknesses (Score: 134). OPERATIONS CORE DESCRIPTION (provided by applicant): This is an application for the Operations Core of the NIMH "Partnered Research Center for Quality Care," a proposed Advanced Services and Interventions Research Center. We propose a Center that is partnered throughout components with community and academic co-leads. The Operations Core will facilitate collaboration in leadership, foster new collaborations within Los Angeles and with other sites, support the administrative and technical operations of partnered pilots and major affiliated studies, and help assure benefits from research products for community and academic stakeholders. The core's leadership includes the PI's of the lead academic institutions (Wells, Sherbourne, Lagomasino) and a lead community partner (Daly). The Core supports Center leadership, which includes a 7-member Steering Committee of senior investigators and community leaders, and an Executive Council that includes the academic and community leaders of all cores, units, and pilots. We will institute a leadership approach to support consensus decisions while assuring accountability, rigor, and productivity. The Core will have 5 units. The Administration Unit will provide Core leadership, support community liaison functions, provide high quality administrative support for partnered research, disseminate Center findings and products, and build collaborations with other groups and sites for partnered research. The Data Management, Analysis, and Technology Unit will provide high quality data management and analysis services, develop and maintain data sets, and support high-quality information technology. The Theory and Intervention Development and Application Unit will facilitate selection and use of theories, including a Center framework for diffusion of interventions to diverse stakeholders in a community context;facilitate adaptation of Center intervention resources;help match theory and interventions for diverse populations, and conduct partnered research on the feasibility of developing an intervention to extend the benefits of quality improvement interventions for depression by activating social networks. The Investigator Development Unit will use mentoring, seminars, and protection of time and resources to develop new academic and community leaders for partnered research. A Public Liaison unit will help initiate new partnered research studies fitting the priorities of the Los Angeles County Department, of Mental Health Services and the Los Angeles County Department of Health Services + University of Southern California Healthcare Network.