Public-Academic Partnerships: A Rapid Small-Grant Program for Policy-Relevant Research: Motivating Public-Academic Partnerships

A junior faculty member (CIR)—an assistant professor in the Anxiety Disorders Clinic (ADC) at NYSPI whose research focuses on developing novel treatments for individuals with obsessive-compulsive disorder and hoarding disorder—applied for an OMH Policy Scholars Program grant for estimating the community prevalence of hoarding disorder. The scholar applied for this grant during her postdoctoral research fellowship, mentored by the ADC director (HBS). She became interested in a newly proposed diagnosis for DSM-5, hoarding disorder (2), but needed pilot funding to start developing this new research direction.

Hoarding behaviors (such as difficulty discarding items and accumulating large volumes of clutter) so extreme as to be impairing are quite common, with lifetime prevalence estimated at 2%–5% (2). Behaviors cause public health problems and can lead to home eviction due to code violations, and thus they are of particular interest to OMH because they can cause homelessness in the population it serves. Even though these behaviors cause significant safety risks and effective treatments are available, including selective serotonin reuptake inhibitors and specialized cognitive-behavioral therapy, many individuals keep their disorder hidden until an emergency (for example, a fire) or threat of eviction attracts the attention of landlords or family members (3). In her grant proposal, the applicant hypothesized that the population seeking help from a community agency that serves individuals with housing problems would have a high prevalence of hoarding disorder and that these individuals might be unusually open to treatment when they contact the agency.

The study confirmed a high prevalence of hoarding disorder among 115 clients seeking help from the agency: 22% clinician-rated and 23% self-rated prevalence, about five to ten times higher than the general population prevalence (2%–5%) (4). Of the 25 persons who met criteria for hoarding disorder, 32% were currently in legal eviction proceedings, and yet only 48% were currently seeking mental health treatment (4). These results suggest that such community organizations may be a fertile site for identifying individuals with hoarding disorder when they may be unusually open to treatment.

The study was an important first step to gaining greater understanding of hoarding disorder, the associated eviction risk, and the timing of an effective intervention. Extending this work, the scholar used pilot data from the project to obtain a second OMH Policy Scholars Program grant plus a larger grant from New York Presbyterian Hospital Empire Clinical Research Investigator Program to develop a time-limited, novel evidence-based intervention for individuals with hoarding disorder. For this project, the scholar, with guidance from her policy mentor (AA, director of the OMH New York City field office) and research mentors in the ADC (HBS) and DMHSPR (DBH and SME) and in collaboration with providers identified via OMH, will pilot test an adaptation of critical time intervention (CTI) (5). CTI is an evidence-based, time-limited care coordination model that helps ensure continuity of support to persons with severe mental illness during critical transition points.

Through the OMH Policy Scholars Program project, the scholar generated two first-authored manuscripts and one external grant and developed new research collaborations with researchers from DMHSPR, the OMH field office, and community housing providers. In addition, this project strengthened the budding partnership between research in the DMHSPR and the ADC. The scholar is exploring these partnerships to further refine and evaluate the impact of the CTI adaptation, thus building on pilot feasibility studies and expanding her emphasis on services research while bringing knowledge and training about treating this disorder to community providers.

A junior faculty member (MRA), associate training director for resident education in psychiatry, applied for an OMH Policy Scholars Program grant focusing on training psychiatry residents in measurement-based care and quality improvement. Her academic and research interests had moved from basic science toward medical education and health services delivery. She was interested in teaching residents how to “evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning,” a core requirement within residency training (6).

Despite increasing evidence of the ability of patient assessment instruments to influence treatment decisions and improve patient outcomes, few psychiatrists routinely use standardized assessments in their clinical practice (7). This scholar’s project included an initial survey of residents and supervising faculty regarding their opinions about using standardized patient assessments in clinical practice. She followed this with a three-week didactic seminar and year-long quality improvement project for residents aimed to increase depression screening and monitoring in the resident outpatient clinic. Within six months, residents showed an increase in screening from 4% to 92% of patients. In addition, they increased monthly monitoring of outpatients with diagnoses of depression from 1% to 76%. The scholar’s policy mentor was the OMH medical director (LIS), whose office oversees continuing education for hundreds of psychiatrists employed by OMH. Hence this match of scholar and mentor brought together individuals from the research and policy worlds who were both very interested in educational interventions to improve treatments provided by psychiatrists. The scholar’s research mentor (SME) provided guidance on implementation efforts.

The scholar received program grants for two more projects, building on this work by developing, implementing, testing, and disseminating an educational curriculum in quality improvement, with the OMH medical director continuing as her policy mentor. Even though there is a need to improve the rigor of education research, national funding for such research has been limited. Less than .04% of federal spending in graduate medical education is allocated to education research (8). Program funds were invaluable in launching this scholar’s research efforts. Her research has resulted in multiple national presentations, including workshops and posters, and in three first-authored papers currently under review or in press. In addition, the quality improvement curriculum developed from her research was selected by the American Association of Directors of Psychiatric Residency Training as a model curriculum.

Along with promoting measurement-based care in the emerging state workforce, this project provided residents with the skills necessary to adopt future evidence-based practices. As a natural extension of this work, the scholar turned her interest in quality improvement and training toward continuing medical education for practicing clinicians. She has continued to partner with her policy mentor (LIS) and research mentor (SME) and is now exploring linking OMH quality improvement initiatives with new maintenance of certification requirements established by the American Board of Psychiatry and Neurology, whereby practicing psychiatrists must now demonstrate ongoing participation in quality improvement (9).