This is a proposal to establish a center for research on the organization and financing of care for the seriously mentally ill. The purpose of the center is to promote research, on the service systems providing care for the seriously mentally ill. The center will have a specific focus on systems of care in rural and small city environments. Research will be promoted through three separate but highly interrelated efforts: 1) supporting individual researchers, networks of researchers, and the necessary research infrastructure, 2) building a care data base on publically funded seriously mentally ill, and 3) promoting specific research projects on special problems and populations. Support for researchers, networking among researchers, and the research infrastructure will be accomplished establishing seminars on service delivery issues, organizing interdisciplinary research work groups, distributing newsletter material, supporting preprint and monograph series, running small annual conferences on selected topics such as rural systems of care, inviting visiting scholars to the center, promoting library acquisitions in the area, enlarging computing capabilities, and providing training opportunities for mental health services trainees in three NIMH funded programs. The Care Data Base will provide opportunities to address key theoretical issues in service delivery, using data from nine Wisconsin county systems. This naturalistic, non-experimental data base will be built around data on county and Medicaid expenditures, specialty mental health treatment services, patient outcomes, and service system characteristics (system structure characteristics, administrative processes, and financing mechanisms). It will contain data on a years experience of about 3000 chronically men- tally ill patients. Secondary analyses of this data will be promoted. Special problems/populations research projects will be encouraged through aid in pilot studies, feasibility studies, links to the Care Data Base, and help in proposal writing for the purposes of further resources for subsequent major studies. Research topics to be stimulated and supported include family coping and burden across treatment systems, psychotropic drugs and other treatments for the severely mentally ill in nursing homes, patient outcomes as related to different ways of coordinating CSP care, services received by the severely mentally ill in HMOs, and patterns of inpatient treatment in public, for profit, and non-profit hospitals.
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