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    2001-2002   
    2002-2003    

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Sponsored Research Projects

The Center’s major activities involve a range of research on services-related issues for persons with SMI. The following projects were active during the past year and many will continue into the coming year.  These projects have been funded by NIMH, AHRQ, SAMHSA, the Robert Wood Johnson Foundation, the State of Maryland, and other sources.  Most of these projects have grown out of pilot and developmental studies funded by the core grant in previous years.

Epidemiology, Treatment Outcomes

Evolution of Psychopathology in the Population. 
NIMH, 4/1/92 - 3/31/02, $4 million. 
P.I.  William W. Eaton, Ph.D.
In a follow-up of 3,481 participants in 1982-83 Eastern Baltimore Mental Health Survey, one of 5 NIMH Epidemiologic Catchment Area sites, this study (1) estimates the incidence and risk factors for psychopathology; (2) describes patterns of remission, and risk factors for continuation; (3) assesses potential endpoints in terms of mortality and morbidity due to diseases of middle and later life such as heart disease and cancer; (4) assesses the risk for onset of cognitive impairment; and (5) searches for syndromes of depression which depart from the DSM-III configuration and are important in the elderly.

Family Impact of Olanzapine in First-Break Schizophrenia. 
Lilly Research Laboratories, 12/1/97- 7/31/02, $120,000 (annual).
P.I., Lisa Dixon, M.D.
This study will compare the change in family impact of mental illness in first break schizophrenia in two cohorts of patients, one randomly assigned to olanzapine, the other randomly assigned to haloperidol.

Morbidity in Schizophrenia: A Focus on Diabetes. 
NIMH, 4/1/99 - 3/31/02, $955,000.  
P.I., Lisa Dixon, M.D.
This study is comparing persons who have schizophrenia and diabetes and  persons with diabetes and depression to persons with diabetes and no mental illness on health outcomes and health beliefs.

Somatic Co-Morbidity and Health Problems in Schizophrenia and Affective Disorders.
NARSAD, 9/15/99 - 9/14/01, $100,000.
P.I., Lisa Dixon, M.D.
In order to understand the extent to which schizophrenia specifically contributes to the phenomenon, we are comparing persons diagnosed with schizophrenia and affective disorders on medical co-morbidity rates, physical health status, use of somatic services, and health behaviors.

Effectiveness of NAMI Family-to-Family Education. 
Robert Wood Johnson Foundation, 11/1/99 - 10/31/01, $202,000. 
P.I., Lisa Dixon, M.D.
This study aims to determine the effectiveness of the National Alliance for the Mentally Ill Family-to-Family Education Program (FFEP) in increasing family well-being, knowledge and satisfaction with services, and in decreasing subjective family burden and depression.

The Process of Change in Drug Abuse by Schizophrenics. 
NIDA, 4/20/99 - 2/28/04, $300,000. 
P.I., Alan S. Bellack, M.D.
The purpose of this project is to examine the process of change in substance abuse use among schizophrenia patients who abuse cocaine.  It entails a 1-year naturalistic assessment study of schizophrenia and major affective disorder patients who meet DSM-IV criteria for cocaine dependence. It will examine the validity of the Transtheoretical Model of Change with this population and correlates of behavior change.

Behavioral Treatment for Substance Abuse in Schizophrenia. 
NIDA, 9/30/99 - 8/31/04, $242,000.
P.I., Alan S. Bellack, M.D.
This project involves a controlled trial to evaluate a new treatment for substance abuse in schizophrenia.  Schizophrenia patients who meet DSM criteria for dependence on opiates, cocaine or cannabinoids will be randomly assigned to a 6-month trial of the new treatment versus a manualized control condition. A 6-month follow-up will also be conducted to evaluate durability of treatment effects.

Mental Health Service Systems

Patterns and Outcomes of Care for Medicaid Mentally Ill. 
NIMH award, 9/30/93 - 4/30/03, $2.3 million. 
P.I.s, Donald M. Steinwachs, Ph.D., Anthony Lehman, M.D., M.S.P.H.
This study is assessing the impact of the implementation by the State of Maryland of managed care for its Medicaid enrollees, including all disabled persons (SSI) who are not on Medicare.  The aims of the project are (1) to determine the extent to which patterns of treatment change, (2) to assess the effects these changes have on outcomes (quality of life, symptoms, costs), and (3) to examine consumer satisfaction with access, services, providers and quality of care received under the new arrangements.

Economic Analysis of Cost and Effectiveness of Schizophrenia Treatment. 
Subcontract from The MEDSTAT Group under Eli Lilly & Co. grant,
10/1/98 - 6/30/03, $436,440. 
P.I.s, David Salkever, Ph.D., Eric P. Slade, Ph.D.
The work under this subcontract study to analyze costs and effectiveness of alternative treatment paths for 2,400 patients with schizophrenia followed over a 3-year time period.

Evaluation of Mental Health and Substance Abuse Parity in the Federal Employees Health Benefit Plans. 
ASPE contract to ROW Sciences, 10/1/00 - 9/30/03, $5 million. 
P.I., Howard Goldman, M.D., Ph.D.
A team of mental health services researchers from ROW Sciences, Westat, RAND and Harvard Medical School, is evaluating the implementation and impact of a new policy of parity coverage of mental health and substance abuse services for the nine million beneficiaries of the FEHB Program.  The evaluation includes analysis of archival data on service use and expenditures, and collection of data on plan benefits, beneficiary views of their experience with care, and provider experiences with care.

Improving Health Services for Veterans with Schizophrenia. 
Department of Veterans Affairs (HSR&DC),
4/1/00 - 3/31/03, $100,000.
P.I., Alan S. Bellack, MD., Anthony Lehman, M.D.
The purpose of this project is to examine patterns of care among veterans with schizophrenia and to determine the extent to which their treatment adheres to widely accepted treatment guidelines. It includes both a chart review component for existing patients and a prospective trial throughout hospitals in VISN 5. 

Evidence-Based Mental Health Policy. 
John D. and Catherine T. MacArthur Foundation,
1/1/01 - 12/31/03, $3 million.
P.I., Howard Goldman, M.D., Ph.D.
This grant is to expand a network of investigators to support their meetings four times a year and to fund pilot research. Studies focus on providing evidence to inform mental health policy designed to improve access to effective mental health services. Research is on the organization and financing of mental health services.

Mental and Somatic Illness: Needs, Services and Outcomes. 
NIMH, 3/1/00 - 2/28/05. $122,867.
P.I., Gail L. Daumit, M.D.
The primary goals of this study are (1) to assess the contribution of patient sociodemographic factors to needs for care and study the provision of care by different provider types in the Baltimore epidemiologic Catchment Area Follow-up Study and also the Maryland Medicaid Patterns and Outcomes Study; (2) to identify characteristics of high risk patients who may benefit from better integrated care systems and (3) to conduct focus groups with patients, providers and administrators to explore options for effective mental, medical and addiction care models, ultimately leading to the planning of an intervention to improve care.

Dissemination Research

Psychiatrists’ Adoption of Schizophrenia Guidelines.
NIMH, 4/1/02 - 3/31/05, $725,000.
P.I. Donald M. Steinwachs, Ph.D. and Anthony Lehman, M.D.
This study will survey psychiatrists in Maryland to determine the sources and methods they use to learn about advances in diagnosis and treatment of psychiatric disorders; their readiness to adopt evidence-based guidelines, particularly those for schizophrenia; and their willingness to participate in educational opportunities to advance their knowledge about and implement guidelines. The objective is to increase adherence to evidence-based guidelines and thus improve care for people with schizophrenia.
Children and Adolescents

Effects on Children of Treating Maternal Depression.
NIMH, 4/15/98-2/28/03,$2,244,573.  
P.I., Anne W. Riley, Ph.D.
This study examines the effects of treating major depression in mothers on the functioning, psychiatric status, and health of their children 5-11 years old.  It involves a sample of African-American, Hispanic and white low-income, working mothers who are receiving one of three approaches, paroxetine medication, cognitive-behavioral group therapy, or treatment-as-usual.  A non-depressed sample is matched on ethnicity and other demographic characteristics.  Families will be followed for two years.

Parental Investments and Children’s Mental Health.
NIMH K award, 1/15/99 - 1/14/04, $482,000. 
P.I., Eric P. Slade, Ph.D.
The main goal of this project is to evaluate the effects of parental behaviors on child behavior problem outcomes and adolescent delinquency outcomes. In particular, the aim of the project is to develop models of parenting behavior and labor supply that may explain the dynamics of household income and children’s behavioral outcomes.

Behavioral Enhancement Through Training and Treatment to Expand Resiliency.  SAMHSA, 9/30/99-9/29/01, $488,000.
P.I., Philip Leaf, Ph.D.
This prevention intervention, the BETTER (Behavioral Enhancement Through Training and Treatment to Expand Resiliency) Program, uses a sequential set of behavioral health interventions including an adaptation of Effective Black Parenting Program, the Families and Schools Together Program, and targeted mental health services to reduce the consequences of exposure to substance abuse and violence, and to prevent emotional and behavioral problems in children attending two Head Start centers in Baltimore City and their families.

Safe Schools Health Students Initiative. 
US Department of Education, 10/1/99 - 9/30/02, $2.6 million. 
P.I., Philip Leaf, Ph.D.
This is a demonstration project to provide preventive and remedial services to reduce the prevalence of violence in Baltimore City public schools and the consequences of exposure to violence.

Screening for Service Needs and Linkage of Services for DJJ Youth. 
Maryland Governor’s Office for Crime Control and Prevention, 1/1/01 - 12/31/01; $599,000.
P.I., Philip Leaf, Ph.D.
The objective of this project is to develop procedures for screening and assessing needs for mental health, health, substance abuse, educational, vocational, or family services for youth entering the state’s juvenile justice system.

Elderly

Outcomes of Dementia Assessment and Treatment. 
NIA and NIMH, 10/1/97-4/30/03, $2.4 million.
P.Is, Peter Rabins, M.D., Judith Kasper, Ph.D.
This project is determining variations in the practice of caring for persons with dementia and whether these variations affect important outcomes: nursing home placement, reduction of non-cognitive symptoms of dementia, and quality of life.  The practice variations include (1) whether persons meeting criteria for dementia have been diagnosed, (2) whether a full clinical assessment has been done, (3) use of pharmacologic treatment for symptom management, (4) use of specialty physician care, and (5) use of community-based services.