Compared to majority whites with serious mental illness (SMI;e.g., schizophrenia), racial/ethnic minorities with SMI are at higher risk for cardiovascular disease (CVD). Although promising treatments (e.g., care manager interventions) exist to improve the health of people with SMI, limited attention has been paid to the process of making these interventions culturally relevant to Hispanics with SMI and to promote their use in the public mental health system. The objective of this Mentored Research Scientist Development Award (K01) is to prepare the candidate to become an independent investigator in implementation research to address the disparities in physical health care faced by underserved minorities with SMI. A mentoring team, led by Drs. Lewis-Fernandez and Druss, will guide the candidate in achieving the following training objectives: 1) obtain training in implementation research, focusing on community-based participatory research (CBPR) approaches as a translational strategy;2) develop expertise on the integration of physical and mental health care for people with SMI;3) acquire new skills in using intervention mapping and qualitative methods to inform intervention research;and 4) obtain training in clinical trial methodology and longitudinal data analysis. The application integrates course work, mentorship from established investigators, and mentored research activities. The research plan uses a collaborative intervention planning framework that blends principles of CBPR and intervention mapping to modify and assess the feasibility and acceptability of an existing care manager intervention. This 12-month intervention focuses on improving patient activation and the coordination of medical care between outpatient mental health clinics and primary care. The proposed project uses a multiphase approach supported by the candidate's training plan. In Phase 1, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. During Phase 2, qualitative methods - patient focus groups and stakeholder interviews - will be used to ensure that the modifications are acceptable to all stakeholders. In Phase 3, results from Phase 2 are used to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase 4 consists of a 12-month open pilot study (N = 30) to assess the feasibility and acceptability of the modified intervention and explore its effect. Lastly, Phase 5 will focus on analysis of pilot study data and preparation of an R01 proposal. The research plan will yield pilot data for a subsequent R01 to conduct a randomized controlled trial to test the effectiveness and implementation of the modified intervention.
This K01 prepares the candidate to develop an independent program of research focused on the implementation of integrated physical and mental health services in the public mental health system to improve the physical health and wellness of underserved minorities with SMI. This project responds to objectives 3 and 4 of the NIMH Strategic Plan which call for the development of better interventions that incorporate the needs of diverse people with mental illness and ensures the translation of research findings into clinical practice to enhance NIMH's public health mission.
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