The proposed ADAMHA Scientist Development Award for Clinicians is designed to further the growth of my research skills in the area of mental health services for children. The award will be a natural extension of my Clinical Services Research Training fellowship by providing intensive ongoing research supervision during the formation of a research program in pediatric mental health services and consultation- liaison child psychiatry. A major component of my research training will be the supervised implementation of research focused on the detection and management of mental disorders in tertiary care pediatric settings. The five year plan includes (1) a longitudinal study followed by (2) a service intervention trial. The main points of the study are to: (a) extend the findings of Costello and other (in pediatric primary care settings) by describing the prevalence, detection, and natural history of mental disorders in children in an ambulatory and inpatient tertiary care setting: (b) define risk factors associated with the presence of significant mental disorders among tertiary care patients; and (c) to use this information in altering the character of a consultation-liaison service and evaluating the efficacy of these changes in fostering a higher rate of recognition of mental disorders by pediatricians. The intervention study will take advantage of a unique opportunity at Stanford University Medical Center to study the effects of a major institutional reorganization on the use of mental health services in pediatrics. Additional research training components entail: (a) consultation and practical with recognized experts in clinical services research, child psychiatry, and pediatrics- essential resources for a comprehensive program in services research in children: (b) formal coursework aimed at developing more advanced skills in research design and methodology relevant to the study of clinical services: (c) consultation in grant proposal development: and (d) skill-building in publication and presentation of research findings. At the end of the award, I expect to have the research skills to enable me to be an independent investigator in mental health services research in children; to have received funding as an independent investigator; and to have developed a network of accomplished research collaborators. My primary career goal as a scientist and teacher is to be a leader in scientific exploration at the interface of pediatrics and child psychiatry with a broad view of the salient issues and ramifications for both fields.
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