Research centers have become a key component of the research infrastructure in schools of social work, including the George Warren Brown School of Social Work at Washington University. In 1993, that school's Center for Mental Health Services Research (CMHSR) received funding from the National Institute of Mental Health (NIMH) as a Social Work Research Development Center (R24 MH50857), with a renewal in 1999 for five more years of support. After the program announcement for the social work research development center mechanism expired, the center applied under an 'advanced' mechanism and in 2004 was awarded five years of funding as an NIMH Advanced Center for Interventions and Services Research (P30 MH068579).This article describes the background for developing the center, the center's aims and research agenda, its structure and functioning, and outcomes of CMHSR from 1993 to the present.
KEY WORDS: faculty mentoring; mental health services; National Institute of Mental Health; research center; research infrastructure
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In 1993, the George Warren Brown School of Social Work at Washington University, St. Louis, Center for Mental Health Services Research (CMHSR) received funding from the National Institute of Mental Health (NIMH) as a Social Work Research Development Center (R24 MH50857), with a renewal in 1999 for five more years of support. After the program announcement (PA) for the social work research development center mechanism expired, the center applied under an 'advanced' mechanism and in 2004 was awarded five years of funding as an NIMH Advanced Center for Interventions and Services Research (P30 MH068579).
BACKGROUND, PURPOSE, AND FUNDING FOR THE CMHSR
Although social work has long been recognized as one of the dominant professions providing mental health services, it has lacked a commensurate level of research activity in mental health. In the late 1980s, a national Task Force on Social Work Research (1991) challenged the profession to increase its research activity in mental health, so that the services provided by social workers might be informed by research conducted by social work researchers and thus shaped by social work perspectives. The task force also called for the National Institute of Mental Health (NIMH) to launch new initiatives aimed at advancing social work's research capacity. NIMH responded through several activities targeted to social work, including a PA for Social Work Research Development Centers (SWRDCs).The announcement was widely disseminated within the social work community, and NIMH convened meetings to inform interested deans and doctoral program directors about the PA and application requisites.
These national events triggered extensive discussion within the Brown School about interest in and capacity for mental health research. Mental health was one of the schools' largest curriculum concentrations in the MSW, and several faculty members identified mental health as one of their research interests. The school's strong research culture and publication record notwithstanding, it had received very few external research or training grants in the area of mental health. The dean of the Brown School (Shanti K. Khinduka, 1974-2004) asked Enola K. Proctor to lead a planning process to develop an application in response to the NIMH SWRDC announcement. Planning meetings were open to all interested faculty and included leadership of the Missouri Department of Mental Health, researchers at the University's Department of Psychiatry, and staff from local mental health organizations and agencies. An application resulted; after two submissions, the Center was established as the nation's first SWRDC in September 1993. Its mental health services research agenda reflected the interests of faculty members who developed pilot projects for the grant application. NIMH staff members, Drs. Juan Ramos and the late Kenneth G. Lutterman, were instrumental in the formation of this NIMH program announcement. As associate director of the Division of Services and Intervention Research at NIMH, Dr. Lutterman provided generous and helpful technical assistance to the Brown School leadership as we shaped our application (Proctor, 2002). Denise M. Juliano-Bult, MSW, program chief with the NIMH Services Research and Clinical Epidemiology Branch, has been our program officer since the Center's inception, providing continuing advice and guidance.
RESEARCH AGENDA AND AIMS
Over its 14-year history, the CMHSR has supported an evolving and maturing research agenda in mental health services research, as illustrated in Figure 1. The initial research agenda was broad, consistent with a program goal of increasing faculty involvement in mental health research. Studies focused on issues of need for mental health services, unmet needs among various populations, access and barriers to care, preferences for services and service providers, and coordination of care. Consistent with the purpose of NIMH SWRDCs to develop faculty capacity for mental health research, the CMHSR enabled faculty members to address mental health issues within the context of their current research, much of which was focused on social service sectors of care, such as child welfare, homelessness, aging services, juvenile justice, and public schools. Center resources enabled faculty to conduct clinical epidemiologic studies within those service settings, documenting the unmet needs for mental health care among vulnerable populations in public social services. These studies provided a solid foundation for the second round of SWRDC funding, which stimulated studies of system barriers and in turn paved the way for the current center's agenda of practice and service systems research on quality of mental health care in social service settings. Working in and partnering with community--based social services agencies, center faculty develop and test interventions, including service system level interventions, to help improve the quality of mental health care for public social services clients. Center research addresses detection of mental disorder and access to evidence-based treatments for clients who are unserved or poorly served by specialty mental health and primary medical care. This agenda filled a unique niche in that NIMH had long funded research on mental health in primary medical care, but these questions had not been systematically addressed by any other NIMH-supported research center. The social services are one of several nonspecialty settings of care in which significant proportions of clients experience psychiatric disorders but do not receive adequate care (Kessler et al., 2003).The center's agenda responds directly to recommendations from a number of federal reports, including the Institute of Medicine reports on the quality chasm (Committee on Crossing the Quality Chasm, 2006; Committee on Quality of Health Care in America, 2001) the NIMH Road Ahead report (U.S. Department of Health and Human Services, 2006) and the Bridging Science and Service report (NIMH, 1999), which call for research that addresses the interface between services, the architecture of services, quality of care, and outcomes.
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The center's research agenda addresses conceptual and methodological challenges across two potential divides: (1) the divide between systems of care--in this case, the social service system and the mental health system; and (2) the divide between research and practice or 'bench and trench' To meet these challenges, the center's faculty engages the expertise of a variety of disciplines, engages diverse stakeholders, uses a variety of mixed (including inductive) research methods, and establishes partnerships with social service and mental health provider agencies.
The specific aims of the CMHSR, reflected in the 2003 grant application for advanced center status, include the following three: (1) advance understanding of quality mental health care in social service sectors through research projects that capture stakeholder perspectives on what constitutes quality of care for mental disorder in social service settings, identify how and why it varies, and shape and test sustainable improvements to mental health care; (2) develop, enhance, and provide state-of-the-art methodological expertise to all research projects affiliated with the CMHSR; and (3) strengthen the research infrastructure of community-based research partners. As members of an NIMH advanced center, we work with a national cohort of scientists from a variety of disciplines to advance this scientific niche, no longer striving primarily to advance the research capacity of social work faculty.
FOSTERING A RESEARCH-PRODUCTIVE CULTURE: A CONCEPTUALIZATION OF RESEARCH CENTERS
The Brown School has a long and strong research tradition. For decades, our faculty has been active in conducting research and publishing peer-reviewed articles in the area of mental health, primarily in social work journals. However, prior to 1990, most studies were supported by small school pilot funds or were not funded at all, relied on data from local agencies, and were led by an individual faculty member with support from student research assistants. We recognized that making an impact on services, policy, and practice would require external funding, multidisciplinary teams, and the most robust research methodology. Moreover, research at a scientific frontier--in our case, the largely uncharted field of mental disorder in the social services--would demand new knowledge, some shift in culture or the 'way we do things,' and perseverance.
The literature characterizes research centers as high-performing, dynamic, and information-rich environments that demand continual, intensive learning and high levels of productivity from their members (Ott, 1989). Research centers stimulate new thinking, bolster productivity, attract talented investigators with convergent and complementary interests, and maximize the buying power of resources and expertise. We drew on this literature for a conceptual understanding of organizational culture for the CMHSR. Organizational culture has four elements: shared knowledge, values, behavioral norms, and artifacts (Ott, 1989). Perhaps the most important, shared knowledge, is the source of 'competitive edge' and key to sustaining creativity (Amabile, 1998; Conti, Coon, & Amabile, 1996). The center works to advance the depth and currency of faculty knowledge in three domains: (1) substantive knowledge about mental health services, including clinical epidemiology, service delivery systems, quality of care, and implementation of quality improvements; (2) methodological knowledge, including methods for agency collaboration, data collection procedures, measurement, quality improvement methods, statistical analysis, incorporation of data from multiple systems and levels, and mixed methods; and (3) procedural knowledge, including how to write NIH grant proposals, knowledge of funding sources and mechanisms, and understanding of the proposal review process.The center relies heavily on expert consultants and scientific advisers from other universities and research centers and on sending a critical mass of faculty and staff to key national conferences, including particularly the NIMH Services Research Conference, the Academy Health Conference, and the Office of Behavioral and Social Science Research Conference on Dissemination and Implementation Research. The center also expands knowledge through seminars, mentoring, and consultation with NIH program staff. All center resources are tools for advancing research ideas and projects.
Because they affect scientific work, values are also an important part of research culture (National Academy of Sciences, 1995). Among the values fostered by the center are empirical development and testing of knowledge, the engagement of agency partners, the critique of ideas to refine faculty's thinking and improve real-world care, and NIH R01 funding for its potential to support work with impact. The consistency of the center's values with those of the school and university helps sustain the motivation and commitment of the faculty and research staff (Greenlick, Freeborn, & Pope, 1999). At the center, we value working on behalf of vulnerable populations and sharing knowledge with peers and community partners. Because much of culture can remain implicit, we make our values explicit and use outside consultants to challenge tacit assumptions (Schein, 2000).
Center resources are used to reinforce behaviors consistent with our core values. Specifically, the center reinforces the construction of individual studies within the context of an overarching and long-range research agenda, collaboration and teamwork, community-based studies, critical peer and expert review of all products, and communication of findings for maximum impact. The center funds pilot projects that are expected to lead to submission of an external application for NIH funding. These pilot studies are competitively reviewed, and center funds are used to create multidisciplinary research teams. Once grants are submitted, small publication grants are funded to support faculty in preparing manuscripts that are spawned from faculty's grant preparation work. We engage agency staff in study design, interpretation, and dissemination of findings. 'Relational socialization' occurs through mentoring and teamwork, which helps to foster the individual growth, commitment, and task motivation required for creative work (Amabile, 1998; Conti et al., 1996). Finally, at the center, we cultivate a collegial atmosphere, as this stimulates innovation (Amabile, 1997a, 1997b) and advances task accomplishment. Faculty routinely review each other's grant proposals before submission.
The artifacts of organizational culture constitute the accommodations (physical setting), records of products, and organizational charts (Ott, 1989).We use physical space purposefully to facilitate interaction, the exchange of information and ideas, and task accomplishment. These considerations inform the office locations for research support staff and postdoctoral fellows. The center has a clear and functional organizational structure and faculty regularly self-monitor, celebrate accomplishments, and reflect these through reports and Web sites (Ashkanasy, Broadfoot, & Falkus, 2000).
CENTER LEADERSHIP
The center is led by a director (Enola Proctor has served as director since the center's founding), associate director (Arlene Stiffman served as associate director from 1993 to 2001 and Curtis McMillen has served since 2001), and center administrator. The CMHSR director and associate director are responsible for scientific direction of the center's research agenda, resource procurement and allocation, liaison with NIMH staff, quality control of products (for example, research proposals, projects, and reports), information sharing (seminars, written communication, presentations representing the center nationally), faculty mentoring and staff development, and relationship development and maintenance (internal and external). As recommended by Pelz and Andrews (1976), they serve as sounding boards to experienced faculty--interested and available to discuss research but not determining the specifics of research. However, with newer investigators they are more often active in stimulating or advancing ideas and giving direction. Among the directors' most important decisions is the selection of new projects for center funding, as they shape and extend the larger research agenda.
The center's director of administration (Sally Haywood, MPA, has served as director of administration since 1994) is responsible for the day-to-day operations of the center and use of its resources consistent with aims and objectives. She supervises center staff and graduate student research assistants (doctoral and MSW students) and supports the development, implementation, and maturation of pilot studies toward full research proposals. Accordingly, she meets regularly with pilot principal investigators (PIs) to assess and supply their resource needs and serve as a liaison to the center leadership, consultants, and university offices. As described below, the center is organized into four cores. Each core is led by a director, a faculty member who is responsible for the core's research planning and monitoring, for creating an infrastructure that supports research, and for providing opportunities for investigators to work on crosscutting themes and issues.
The center also benefits from the guidance of a Scientific Advisory Board. Comprised of national research center directors, providers, and researchers, the board advises on overall scientific direction; helps identify gaps in project aims, conceptualization, and approaches; and identifies opportunities for funding, collaboration, and partnership. Members also provide periodic consultation on issues pertinent to their area of expertise. The board meets face to face in St. Louis once a year. Between annual meetings, members of the scientific board consult periodically with the center's core directors and investigators by telephone and at national conference meetings. The board helps guard against insularity, challenges implicit assumptions, and stimulates the research direction and new initiatives.
Every project associated with the center, whether externally funded or a center--supported pilot, is based on strong, interdisciplinary collaboration. The CMHSR has gathered a team of researchers from the fields of social work, anthropology, business, epidemiology, gerontology, health economics, health financing, health policy, hospital/health administration, public administration, public health, library science, linguistics, industrial engineering, mathematics, biostatistics, medicine, psychiatry, nursing, psychology (clinical, counseling, developmental, industrial/organizational, systems, and quantitative), and sociology. Research is carried out by a mix of Washington University faculty and external collaborators. Of the 49 PhD/MD level researchers named in the advanced center, 10 were from the School of Social Work, 10 were with other Washington University departments, and 29 were from other institutions--local (5) and nationwide (24).
CENTER STRUCTURE
Consistent with the requirements of an NIMH-supported Advanced Center for Interventions and Services Research, the center is structured through four cores. The operations core serves as the center's nucleus for administrative and research support through seven units: administrative, research support collections, data management, statistical analysis, field operations, communications, and training. The principal research core (PRC) coordinates the 'heart' of the center's work--the generation and execution of the substantive research agenda. Currently, PRC studies address three overarching aims: (1) develop new understandings of what constitutes quality of care for mental disorder in the social services from the perspective of key stakeholders--payers, administrators, frontline providers, consumers, and family members; (2) within the context of competing demands, assess practice variation in quality of care for mental disorder in the social services and identify provider, client, and system ecostructure influences, including financing, on that variation; and (3) working 'trench to bench and back to trench,' develop and test a menu of quality improvements for mental health care in the social services. The PRC supports pilots at Washington University as well as pilots that have been competitively selected and are then conducted at other sites, including another school of social work. The research methods core (RMC) advances the requisite methodology for quality of care research in nonspecialty settings. The RMC is shaped by the CMHSR's scientific aims, its conceptualization of quality of care (Megivern et al., 2007), and the state of knowledge about mental health in the social services. Because the scientific aims of the center's principal research core direct investigators into infrequently researched issues, the center has both the need and opportunity to develop new aims. The RAVIC addresses aims in five methods areas: qualitative methods, statistical analysis, assessment of stakeholder preferences, development of quality indicators for mental health services, and organizational research. The RMC team includes senior faculty from other universities to guide qualitative research, stakeholder preference assessment, organizational research, and measures of quality of care. Finally, the research network development core (RNDC) supports infrastructure development in partnering agencies. Its stakeholder network, which includes specialty mental health, helps bridge science--service gaps in support of improving mental health care. RNDC collaborative efforts focus on the State of Missouri's Department of Health and Senior Services, Division of Senior and Disability Services, and Department of Social Services, Children's Division. These are the largest providers of publicly funded, nonprimary care services in the state of Missouri, particularly for low--and moderate-income families. The Department of Mental Health is a key stakeholder. The bulk of research network development core resources directly support agency infrastructure development for research collaboration with the center (Wendy Auslander is director and Nancy Morrow--Howell is associate director of the RNDC).
FUNCTIONAL MECHANISMS: HOW THE CENTER WORKS
Center Participation and Membership
The center has permeable walls. Accordingly, anyone who seeks to develop a research project consistent with the center's overall mission and agenda is welcomed as a member of the center and a user of its resources. Thus the roster of center faculty is always evolving. Center supports are leveraged with the purpose of moving ideas from concept to pilot study, to grant proposal, and finally to externally funded and self-sustaining research projects.
Stimulation, Support, Development, and Quality Control of Pilot Projects
The center is a project incubator. The center periodically stimulates, reviews, funds, and develops new pilot projects. Investigators proposing new pilot projects typically submit a concept paper for formal review, feedback, and evaluation by a pilot selection committee. The concept paper details scientific aims, significance, targeted funding source and mechanism, preliminary study needs, anticipated methodology, and timetable for submitting a proposal for external funding. Concept papers are formally reviewed for scientific merit, consistency with the center's research agenda, and feasibility. Because every pilot seeking core funding is viewed as a grant in the making, the center invests only in projects that are expected to culminate in independently funded (and preferably NIH-funded) research projects. Thus the selection of pilot projects for core funding is a key element in the center's quality control. The center director chairs the pilot selection committee; additional members typically include the associate director, another core director or center faculty member, members of the Scientific Advisory Board, and center external consultants. The pilot applicant receives written reviews, along with a funding decision from the center director. Pilot awards range from $3,000 to 40,000.
The center directors and the director of administration guide each approved pilot project to completion and to submitted grant application for external funding. The director of administration assists this process by expediting planning sessions, offering to structure external consulting arrangements, including the possibility of a 'proposal conference' (intensive work day involving all key participants, including external collaborators or consultants by telephone), and securing needed resources from the center by in-house experienced NIH reviewers. The pilot PI and director of administration typically meet approximately monthly from the time they state their intention to prepare for an NIH proposal, biweekly beginning six months before submission, and weekly the two to three months before submission. The pilot PI confers with the center's director of database management (described below) and research methods core experts, as indicated previously. The pilot culminates in completion of preliminary studies, usually data collection and analysis, and preparation of a grant proposal for NIH external funding. The directors and director of administration help with engaging external consultants, scheduling and taking notes at meetings to critically review proposal drafts, consulting with NIH project officers, and submitting and resubmitting, if needed, the proposal.
Completing a proposal for external funding triggers a second critical point for the center's scientific review and quality control. Before any NIH proposal submission date, proposals are subject to review by an external consultant paid through center core funds; review, usually through telephone conference call, by an NIH project staff member; and formal mock peer review at the center by in-house experienced NIH reviewers. The project team, one or both center directors, director of administration, one or more PRC/RMC consultants, all postdoctoral fellows, and other center investigators attend the mock review, at which the proposal may be scored and notes taken of changes deemed important before submission. The center leadership and PI may meet before submission; review the notes generated from the mock review, consultants, and NIH staff member; and mutually assess the proposal's readiness for submission.
Data Management Unit
The director of data management (Peter Dore, MA, has served as the director of data management since the center's inception) is responsible for designing research database applications that span multiple projects, maximizing survey design for electronic collection, securing data (backup procedures and confidentiality issues), archiving data, distributing data management protocols, and training personnel regarding data issues. The Data Management Unit (DMU) provides six services and supports to CMHSR projects: (1) data management applications and resources, (2) software selection and training, (3) data quality control, (4) data security, (5) data management training, and (6) data monitoring plans. Although fully funded projects are expected to purchase percentages of DMU staff time, the CMHSR DMU meets the needs of pilot projects and supports or supplements the data management and analysis of small grants (R03s, R21s) with capped budgets. The DMU provides full data documentation services including survey design and format; code book creation; data analysis and documentation; creation and maintenance of audit trails; and inventories of data sets, programs, output, and variables. Research assistants help develop and conduct data entry. When offsite projects require their own data personnel, the DMU ensures the compatibility of equipment and software across sites and the efficient transfer of information. The contribution of the DMU, along with other units in the operations and research methods core, to center pilot projects is reflected in Figure 2.
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Statistical Analysis Unit
The CMHSR research agenda involves a number of complexities that require top-rate statistical consultation, analysis, and innovation. These include how to best represent convergence and divergence of stakeholder views, characterize change and stability in longitudinal data, analyze nested data, account for case mix in comparing outcomes, and account for and address issues of missing values. The statistical analysis unit is led by a senior mathematics and biostatistics professor who guides investigators in these issues. Since its inception, the center's Statistical Analysis Unit has been led by Edward Spitznagel, PhD, professor of mathematics and biostatistics at Washington University.
He has expertise in the analysis of longitudinal data, the use of mixed regression models, the development of new indices to measure illness severity, accommodation of missing values, and innovative sampling methods. Moreover, he is an experienced mental health services researcher. His expertise is supplemented as needed by external consultants and other university biostatisticians. The statistician consults with study PIs with regular office hours at the center. As with all the units, his involvement in multiple mental health services projects also facilitates transfer of knowledge across projects. Fully funded projects are expected to sufficiently budget their data management and statistical analysis, but the CMHSR budget meets the needs of pilot projects and often supplements the statistical methods of small grants (R03s, R21s) with capped budgets.
Qualitative Methods Unit
Since its designation as an advanced center, the CMHSR has developed a qualitative research methods unit to facilitate state-of-the-art qualitative methods. This unit's leaders consult on the choice of qualitative method, qualitative sampling strategies, data collection, theoretical approach to data analyses, coding efforts, data analyses, and presentation of qualitative data. (Dr. Norma Ware, a medical anthropologist and mental health services researcher from Harvard Medical School, leads this unit. Dr. Luis Zayas Rivera, a Washington University cultural anthropologist also works full-time as a center research assistant professor.) They also train interviewers and observers for specific projects and center faculty in broader qualitative methodologies. In some pilot projects, qualitative experts conduct focus groups, individual semistructured and unstructured interviews, and observations. They also write the qualitative methods sections of some grant applications. The role of cores and units in supporting pilot projects, from pilot conceptualization through the process of communication of findings, is reflected in Figure 2.
Research Support Staff
The composition of research support staff varies over time according to the research agenda and flow of 'soft dollars,' given the center's nearly exclusive dependence on external funding. The center typically employs data managers, field research coordinators, a large core of research assistants, and staff focused on developing and documenting research materials (surveys, conference presentations, publications). Field coordinators maximize the efficiency and effectiveness of each study by ensuring the successful transfer of field operation skills and procedures from one study to others, easing researchers' logistical burdens in implementing field research so they can focus more on scientific and methodological issues, supporting projects with constrained staff budgets (pilots, R03s, R21s, R34s), and supporting junior investigators in their first field studies.
Work Groups
The center uses work groups on both an ad hoc and a standing basis to support scientific work on new topics or topics that crosscut several different projects and investigators, including topics such as mental health and comorbidity, quality of care conceptual models, sector-to-sector collaboration, measurement of organizational factors, and ethnocultural issues in mental health care. Anyone may volunteer to participate in a work group. Work groups organize topics for ongoing discussions, support the empirical and theoretical literature, critique papers and proposals, and sponsor research presentations by members of the center and invited experts from other institutions. Work groups have led to published articles (for example, McMillen et al., 2005; Megivern et al., 2007).
Research Support Collections
The center works to advance faculty knowledge and provide resources needed for research generation through a variety of collections, including a bibliography on mental health services research, a collection of abstracted measures for constructs central to the center's work, a collection of practice guidelines or consensus statements about evidence-based mental health treatment, and research methodology resources. Because these collections are designed to meet the scientific needs of center projects, the topics of faculty research shape the collections' content and study PIs are the customers. The purpose of the collections is to cut corners for investigators and provide state-of-the-art information, both published and fugitive (for example, conference presentations, unpublished papers, and proceedings).
OUTCOMES
The center has helped create a culture of collaborative, multidisciplinary, methodologically rigorous, externally funded mental health services research. The topics of study respond to national policy developments and scientific reports. Nearly all research studies are conducted in real-world settings of care, and they are aimed at improving the quality of mental health care. Thus the culture of the school's mental health research has changed substantially since the center was founded.
The center works toward the following outcomes or 'products': pilot studies, peer-reviewed publications, research proposals submitted to NIMH and other external funders, and knowledge that improves the quality of mental health care. In 14 years, the center has directly supported proposals leading to 104 externally funded, faculty-initiated projects representing over $63 million in direct funding (68 NIH funded, 36 other publicly funded or privately funded). Eight NIH dissertation applications, prepared with center support, have been funded. Ten faculty members received their first NIH funding (R-03, R-24, or R-01 research grants) with center support. The faculty has had four minority supplements to senior investigators' NIH proposals. The center contributed to a favorable environment for a National Institute on Drug Abuse (NIDA) social work program, the Comorbidity and Addictions Center (CAC), awarded to the school (09/00-02/07, 5R24DA013572). The center advanced research training in mental health services, providing a home base for two NIH T32 research training grants, one from NIDA (07/02-6/12, 5T32DA015035) and the other from NIMH (08/95-06/10,T32 MH19960), the nations's only NIMH-funded postdoctoral training program in a school of social work. The center's environment fosters socialization for research careers; projects with opportunity for hands-on skill acquisition for proposal writing; development of conceptual frameworks; measurement development; data collection, management, and analysis; and dissemination of findings. The center has employed hundreds of MSW students, giving them earning opportunities and exposure to research. Doctoral students serve as interviewers, research assistants, data analysts, primary and coauthors on papers, and project coordinators on center projects. Along with postdocs, they have the opportunity to meet with visiting consultants and participate in critique sessions of grant proposals. Postdocs, while focused on conceiving and launching their own research agendas (for example, preparing K applications, R03s), work on center projects, serve on study teams, attend seminars, work with consultants, and coauthor papers for publications.
The center's products include more than 350 mental health services publications since 1995 (from a cohort of investigators, many of whom were new to mental health services research), research presentations, dissemination of findings to providers and policymakers, collaboration with researchers in other disciplines, and national leadership to developing mental health research in social work.
CHALLENGES AND IMPLICATIONS
The center faces a number of continuing challenges. The primary scientific challenge is that of continually crafting and executing a research agenda at the forefront of knowledge development in mental health services. Working at the cutting edge requires staying current with an evolving and multidisciplinary literature, using the best possible methods, teaming with national experts from a variety of fields, and partnering with agencies who, themselves, face continual challenges in delivering care. Future projects must be forecast, while executing current projects and disseminating the results of completed projects. There is also a very real and pressing survival challenge, given the center's dependence on soft money. Fiscally, the reliance on external funding requires continuous grant-writing activity for both core support and individual research projects. The NIH environment is highly competitive, as for several years its budget has remained flat, while the number of new grant applications has markedly increased. The responsibility of writing and resubmitting grant applications falls to faculty members who have many competing demands, including teaching and advising. Faculty continue to pursue infrastructure support for the center through NIH mechanisms and by ensuring that all grants include resources for necessary methodological and logistical support. In this increasingly competitive NIH environment, there is the need to more actively pursue private funding to support research infrastructure.
We have found the task of refining and extending the center's research agenda to be one of the most stimulating, albeit taxing, tasks we face. Identifying issues at the boundaries of both knowledge and service, and shaping a plan of research to inform those issues, has proven to be highly stimulating, perhaps providing the upside of the continual funding challenge. The center's core group of investigators continues to expand in number and grow in its expertise and experience.
The center has benefited from very strong support of two deans, and the school has several research centers. Nonetheless, centers pose challenges to their host schools. Centers with external funding bring resources to a particular topic area, in our case, mental health. An unintended consequence or tension in the school is that faculty members pursuing research in other substantive areas may feel slighted or excluded. Centers require 'players,' and thus place recruitment demands on the school. The need to recruit researchers with substantive expertise that coincides with the center may be perceived as conflicting with other recruiting priorities of the school. Yet the ability to sustain a cutting-edge research agenda depends on talent, so our need for senior and junior mental health researchers persists. Another challenge stems from the fact that externally funded grants necessitate release of faculty time and effort from some other school responsibilities. Although externally funded grants bring indirect costs, they often bring a more than commensurate need for space to accommodate staff and support for grant fiscal management. To provide core research infrastructure supports across the board, our school established an office of research, with staff dedicated to budget preparation, assistance with grant compliance, funding searchers, and proposal preparation.
Of course, centers also bring many benefits to a school, including highly skilled research support staff, community and national visibility, opportunities for agency-partnered activities, research dollars for the budget, and a rich training environment. Ultimately, centers provide opportunity and resources to develop and sustain dynamic scholarship in areas of critical importance, thereby contributing to one of the core functions of the university.
Even though other schools may possess fewer fiscal resources or human capital to draw upon for center development purposes, they may benefit from the CMHSR experience. They can discern what infrastructure components might contribute to their research advancement, such as leadership; building interdisciplinary project teams; seeking more advice from funding agency staff and externally funded researchers; fostering a culture of shared knowledge, including productive peer reviews; and building a staff to help transfer knowledge across study teams.
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Enola K. Proctor, PhD, is Frank J. Bruno Professor of Social Work Research, associate dean for research, and Center for Mental Health Services Research (CMSHR) director; Curtis McMillen, PhD, is professor and CMHSR associate director; Sally Haywood, MPA, is CMHSR director of administration; and Peter Dote, MA, is CMHSR director of data management, Washington University, St. Louis. Address correspondence to Enola K. Proctor, Washington University, St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130; e-mail: ekp@wustl.edu.
Original manuscript received November 15, 2007
Final revision received April 16, 2008
Accepted May 9, 2008
