This is a request for an NIMH Midcareer Patient-Oriented Investigator Award (K24). The purpose of the award is to enable Dr. Stein, an experienced and productive researcher in adult anxiety disorders clinical trials and epidemiology, to 1) enhance his knowledge of health services research theory and methods, and 2) to enhance his experience in developing and testing interventions for children and adolescents. The purpose of acquiring this additional expertise is to enable the candidate and his trainees to move more rapidly and successfully into effectiveness research, and to include children and adolescents in their studies. The research program builds upon an R01 held by the applicant as well as other ongoing studies aimed at improving care for patients with anxiety disorders in medical systems. Anxiety disorders, among the most common of all mental disorders, are associated with tremendous functional disability and reduced health-related quality of life. The working model for the applicant's research is that the primary care setting is the venue where anxiety disorders can and should be most successfully treated. Treatment, however, must be provided in a form that suits the context of the primary care healthcare delivery system. At the present time, this means that interventions must be relatively brief, they must be fairly easy to administer (i.e., extensive training of specialized mental health therapists is rarely feasible), and they must be generalizable to a wide array of patients and practice settings. Because anxiety disorders so often begin early in life, strategies to detect and treat anxiety disorders in pediatric healthcare settings are needed. The applicants work is geared toward the development, implementation, and testing of methods for detecting and treating anxiety and related disorders in medical (adult and pediatric) settings. The primary career goals that will be met by this award are: 1) To provide the applicant with protected time to continue his extensive mentorship of junior investigators in the conduct of outcome studies in anxiety disorders; 2) To provide the applicant with the opportunity to upgrade his research skills in several specific areas requisite to his transition into effectiveness research in adults and youth. These goals will be met through continued and expanded research activities, collaboration and individual consultation with senior scientists (in effectiveness research, and in treatment of behavioral disorders in children and adolescents) both locally and nationally, and graduate level course work in epidemiology, health services, biostatistics, and health economics at the San Diego State University School of Public Health. A K24 Award at this stage of the applicant's career will provide the time and resources needed to achieve these goals.
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