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A Multidisciplinary Public-Academic Liaison to Improve Public Mental Health Services in South Carolina
Abstract
The state of South Carolina is in the process of transforming its core services for people with severe and persistent mental illnesses to a community-based model. This paper describes the planning and on-going implementation of an alliance of academic programs, mental health advocates, and service providers forged by the state department of mental health in 1990. Goals of the consortium are to develop graduates who possess the needed knowledge, skills, and attitudes to work in the public sector; to undertake collaborative research to improve services in that sector; and to maintain the effectiveness and satisfaction of current workers in the public system. The authors describe activities of the consortium to achieve these goals and give examples of enhanced academic involvement in the public mental health system as a result of the consortium's activities.
... Researchers have demonstrated that PALs are essential for both clinical and research endeavors (Hanson et al. 1998), and may result in greater numbers of trainees entering community psychiatry after residency (Santos et al. 1994). General consensus is that collaborations between public mental health authorities, academic institutions , and mental health advocacy groups yield the most effective and positive training opportunities for psychiatric residents (Bray and Bevilacqua 1993). Whereas these publications detail integrating community psychiatry training programs and PALs into pre-existing psychiatric residency training programs, there are few specific descriptions of community psychiatry fellowship training opportunities, and we know of no such descriptions of fellowships designed to train PGY-4s, PGY-5s, or PGY-6s specifically in both community psychiatry and public health. ...
The Emory University Fellowship in Community Psychiatry/Public Health is a unique training opportunity whose mission is to train future leaders in the arena of community psychiatry. To complement the recent description of the Public Psychiatry Fellowship of New York State Psychiatric Institute at Columbia University Medical Center, this report describes the key features of Emory's fellowship-its academic curriculum, practicum experiences, site visits and other opportunities for collaboration, and ongoing mentoring and career development. Congruencies between these four key features and the seven core elements of Columbia's fellowship are highlighted, as are several important differences. Such descriptions of innovative training programs in community and public psychiatry are essential in promoting excellence in education, which will translate into vital enhancements in programs, policy, and community-based approaches to mental health services.
... Despite the popularity in the early 1990s of public-academic liaison centers (Hanson, Stone, Penk, Flannery, & Goldfinger, 1998;Santos et al., 1994;Bray & Bevilacqua, 1993), no studies have been conducted that compare teaching and non-teaching facilities regarding the quality of mental health care. This study compares three facilities that differ on two domains (state versus federal funding, and stronger versus weaker academic affiliation) on the patterns of service delivery and clinical outcomes. ...
This study compares mental health services in three facilities on two domains: federal versus state funding and academic affiliation. Data from a cross-sectional study of psychiatric outpatients is utilized to compare 196 VA patients to 337 non-VA patients treated in two state mental health agencies. The strength of academic affiliation of the facilities and the degree of participation in research and training activities differs significantly across facilities but is not associated with quality of care, clinical outcomes, or satisfaction with care. Compliance with schizophrenia PORT treatment recommendations is low but similar across sites. These findings suggest that, unlike findings from the general medical literature, academic affiliation is unrelated to the quality and delivery of mental health care.
State mental health agencies in the United States manage increasingly larger and complex systems of care. This requires an increasingly sophisticated workforce and decision support infrastructure. However, with the exception of larger states with their own research and evaluation offices, few states have the necessary resources to develop these important elements. Bringing in talent from academic organizations who have research as a priority may be the preferred direction for many states. The unique approach developed in South Carolina is the first systematic collaboration between a state mental health system and a multi-institutional, inter-disciplinary academic group oriented towards developing a comprehensive, statewide infrastructure for policy-relevant mental health services research.
The effects of multisystemic therapy (MST) in treating violent and chronic juvenile offenders and their families in the absence of ongoing treatment fidelity checks were examined. Across 2 public sector mental health sites, 155 youths and their families were randomly assigned to MST versus usual juvenile justice services. Although MST improved adolescent symptomology at posttreatment and decreased incarceration by 47% at a 1.7-year follow-up, findings for decreased criminal activity were not as favorable as observed on other recent trials of MST. Analyses of parent, adolescent, and therapist reports of MST treatment adherence, however, indicated that outcomes were substantially better in cases where treatment adherence ratings were high. These results highlight the importance of maintaining treatment fidelity when disseminating complex family-based services to community settings.
Our experiences suggest the viability of the Ohio Research Fellows approach to public-academic collaboration. This approach to research collaboration is appropriate for states with established research programs as well as state mental health departments with limited resources that may be reluctant to apply for other types of public-academic opportunities. Moreover, the Ohio Research Fellows Program approach may also be cited by administrators or policymakers who wish to advocate at the federal level for increased funding of a greater variety of state initiated approaches to public-academic liaison. Funds may be allocated to assist states in tailoring efforts at public-academic collaboration to their individual needs using aspects of the Ohio Research Fellows approach.
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