Reducing Risks for Mental Disorders Frontiers for Preventive Intervention Research (1994) / Chapter Skim
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12 INFRASTRUCTURE FOR PREVENTION: FUNDING, PERSONNEL, AND COORDINATION
12 INFRASTRUCTURE FOR PREVENTION: FUNDING, PERSONNEL, AND COORDINATION
Pages 437-466
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Basic research, risk identification studies, preventive interventions, treatment, and maintenance are all included in the U.S. Public Health Service's definition of "prevention research." Some agencies use this inclusive definition, and others do not.
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~. In the CRISP files, prevention research is classified by type: mental disorder prevention, alcoholism prevention, and drug abuse prevention.
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Only 24 of 80 grants funded from 1988 to 1992 by the NIMH Prevention Research Branch (PRB) were even listed by CRISP as having a main/primary area of emphasis on prevention.
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A few of the agencies identified by CRISP as having scientific projects in mental disorder prevention, drug addiction prevention, or alcoholism prevention have received only contracts, not grants. For example, see the column on drug addiction prevention in Table 12.1 for FY 1992.
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Alcoholism Drug Addiction Prevention (0080 8999~) Prevention (0962 7764~)
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Drug Addiction Prevention (0962 7764a) Number of Number of Number of Dollars Projects and Dollars Projects and Dollars Projects and Awarded Subprojects Awarded Subprojects Awarded Subprojects FY 1992 NCNR194,672 125,000 1 NCRR 49,866 1 NIAAA- 13,915,829 471,540,862 5 NICHD1,773,029 3 - NIDA373,728 12,793,995 632,396,908 64 NAZI13,444,251 40487,432 5487,432 5 OSAP -93,548,289 19102,112,353 22 OTI 18,952,129 1419,516,671 16 Totals15,785,680 45129,M,540 93156,054,226 112 Abbreviations used are as follows: DM-BHP - Division of Medicine - Bureau of Health Professions NCNR - National Center for Nursing Research NCRR - National Center for Research Resources NIAAA - National Institute on Alcohol Abuse and Alcoholism NICHD - National Institute of Child Health and Human Development NIDA - National Institute on Drug Abuse NIDR - National Institute of Dental Research NIMH - National Institute of Mental Health NINDS - National Institute of Neurological Disorders and Stroke OSAP- Office of Substance Abuse Prevention OTI - Office for Treatment Improvement aCodes used by CRISP to identify areas of emphasis.
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Table 12.2 shows the prevention expenditures reported by ADAMHA for each of the research institutes in 1989, 1990, and 1991. It also shows the grants funded by the Prevention Research Branches within those institutes during those years and 1992.
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The division has conducted several large, well-known epidemiological studies, but several of those have now been moved to SAMHSA; the division continues to sponsor risk identification research, and preventive intervention research at the individual, social environment, and community levels. A new initiative within this PRB is an effort to create prevention centers focused on testing culturally and ethnically sensitive preventive interventions.
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446 o _' in Pa to an Q)
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8 11 15 2 3 2 3 2,231,974 6,004,495 4,498,796 202,664 282,839 197,618 206,136 19 1,112,993 5,461,425* 1,063,574 o 70 21,262,514 intervention research, whereas at NIDA two focus on risk research and four focus on preventive intervention research.
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Table 12.6 lists the federal agencies that are involved, though to varying degrees, in TABLE 12.6 Federal Agencies Involved in Preventive Intervention Research and/or Preventive Intervention Services Related to Mental Disorders Department of Agriculture Department of Defense Department of Education Department of Health and Human Services Administration for Children and Families Administration on Children, Youth and Families Head Start Bureau National Center on Child Abuse and Neglect Public Health Service Centers for Disease Control and Prevention Health Resources and Services Administration Maternal and Child Health Bureau Indian Health Service National Institutes of Health National Center for Nursing Research National Institute on Aging National Institute on Alcohol Abuse and Alcoholisma National Institute of Child Health and Human Development National Institute on Drug Abusea National Institute of Mental Healtha Office of Disease Prevention Office of Health Promotion and Disease Prevention Substance Abuse and Mental Health Services Administration Center for Mental Health Services Center for Substance Abuse Preventiona b Department of Housing and Urban Development Department of Justice Office of Juvenile Justice and Delinquency Prevention Department of Transportation Department of Veterans Affairs aFormerly under the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA)
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Conclusions Rational planning for the nation's prevention research agenda requires much more accurate monitoring and reporting of prevention activities related to mental disorders. The Computer Retrieval of Information on Scientific Projects (CRISP)
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access to quality maternal and child health services; (b) to reduce infant mortality and the incidence of preventable diseases and handicapping conditions among children, to reduce the need for inpatient and long-term care services, to increase the number of children appropriately immunized and the number of low income children receiving health assessments and follow-up diagnostic and treatment services, and otherwise to promote the health of mothers and children (especially by providing preventive and primary care services for low income children, and prenatal, delivery, and postpartum care for low income mothers)
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The index of the 1991 book of abstracts does not include some of the main terms and definitions used in this report. For example, there is no mention of mental disorders, mental health, risk, risk reduction, mental health promotion, or universal/selective/ indicated preventive interventions.
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In contrast to these findings, and using the definitions and guidelines developed in Chapters 2, 7, and 10 of this report, the committee's best estimate is that the federal government's expenditure for rigorous preventive intervention research specifically targeted toward the prevention of mental disorders is approximately $20 million per year. For the reasons discussed in this chapter, it is difficult to precisely describe the current levels of expenditure by federal agencies.
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From FY 1985 through FY 1991, 112 researchers were funded by the NIMH PRB. Not all of them, however, were preventive intervention researchers, and some of them are no longer active in the prevention field.
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Although it is difficult to be precise, the steady-state national requirement of trained personnel, from various disciplines, is certainly at least 1,000 people. Educational Background of Current Researchers Few, if any, current researchers in preventive intervention research have completed a formal training program designed to produce researchers in the prevention of mental disorders.
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The Current Research Training Picture The current preventive intervention research training effort is organized in such a fashion and funded at such a low level that an outside observer could reasonably conclude that policymakers wish to phase out investment in this field. Current institutional training programs are small and typically involve a 2-year training period.
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Other federal agencies such as MCHB, CDC, and the Department of Defense (DOD) have the potential for developing research training programs with a clear focus on preventive interventions for mental disorders.
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By its nature, research in the prevention of mental disorders requires the ability to · assess evidence regarding risk and protective factors-both biological and psychosocial for onset of the various mental disorders; · transform this knowledge, if sufficient, into preventive interventions; · design, conduct, and analyze preventive interventions in the real world; and · incorporate sound decisions regarding cultural, ethical, and economic issues into preventive intervention research. As is clear from the description of the preventive intervention research cycle in Chapter 10, this research is inherently interdisciplinary, requiring knowledge of several core sciences (including genetics, epidemiology, and psychology)
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In addition to exposure to one or more of these basic approaches to a broad understanding of human behavior, training in preventive intervention research requires two other kinds of education or experience: (1) the design of interventions to prevent mental illness and (2)
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Training in preventive intervention research requires direct experience in established institutions or centers carrying out prevention studies. A central feature of this model training program is the incorporation of practicum or internship-like training, as well as classroom or other didactic instruction.
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The field of prevention research should be open to additional training models as experience accumulates; a narrow prescription for training would be inappropriate at this time. Conclusions The committee concludes that the national interest in the prevention of mental disorders requires the following general strategies for building training capacity: · A gradual increase in the number of investigators trained and experienced in preventive intervention research.
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The committee's 5-year goal is to produce enough trained investigators in prevention research to provide staff for the larger number of training programs it envisions, for additional specialized prevention research centers in organizations that support research generally, and for research positions in some education and social service departments that now are, or soon will be, able to use their talents as these departments increase their standards for rigorous evaluation of program effectiveness. The committee's 10-year goal is to provide preventive intervention researchers in high-quality programs in major academic settings, in many departments of education and other social service
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Finally, mechanisms must be created that make it feasible and even attractive for talented mid-career scientists to switch into preventive intervention research. Mechanisms to accomplish this include research scientist awards and awards to establish chairs for distinguished scientists in prevention research.
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A commitment to prevention, as distinguished from treatment and maintenance, is equally important in the lead agency. To place such a leading role outside the federal government does not seem possible, because the bulk of funds for preventive intervention research and service will continue to come from the federal government.
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No agency has both the expertise in mental disorder preventive intervention research and an established track record in working collaboratively with other agencies and departments on prevention. Therefore the committee concludes that an alternative mechanism is
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(1993) Prevention Activities of the Alcohol, Drug Abuse, and Mental Health Administration: Report to Congress FY 1989 to 1991; Draft received in 1993 through the Freedom of Information Act.
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