This proposal is a request for an NIMH Independent Scientist Award (K02) to develop an integrated approach to clinical services research focused on how individuals move through the service system and connect these experiences back to their lives in the community. The long term objective of the proposed research is understanding how social relationships in the community (external social networks) and in treatment programs (internal social networks) influence access to care, adherence, continuity, and outcomes. Treatment services researchers, focusing on persons with serious mental disorders, provide solid evidence of what types of treatment work. Previous mental health research on social networks offers building blocks on the nature and effects of external or community ties. Future research would be strengthened by tying previous research to social networks formed during clinical interventions as well as MH research on expressed emotion, therapeutic alliance, coercion and clinical cultures. The ISA builds on the Network-Episode Model, developed by the Candidate, which details a social influence process linking consumers to families, friends, clinicians and social service providers in clinical and community settings. Supportive preliminary results document the patterns and pathways to care and the influence of social networks on service use. Further advancement requires the development standardized, tested instrumentation and viable empirical methods to analyze changing networks and pathways. The ISA will free the Candidate from administrative and teaching responsibilities and provide four opportunities to increase knowledge of clinical issues and processes, particularly Assertive Community Treatment: (1) 3 yearly clinical internships in national centers of innovative community-based care and research excellence; 2) an ongoing local clinical internship; 3) consultation with national experts on the perspective of different mental health stakeholders; and 4) selected statistical and ethics coursework. The research program, organized by """"""""career"""""""" stage of consumers, is supported by state, federal, and foundation funds. The career enhancement plan benefits from a variety of institutional supports but depends on reorganization of Candidate's time and responsibilities.
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