The role of state agencies in mental health services for individuals with co-occurring intellectual and developmental disabilities and mental illness

项目总结/摘要 拟议的奖学金的目标是准备申请人，伊丽莎白斯通，一个独立的 研究生涯侧重于改善服务和系统，为服务不足的精神疾病人群， 包括那些同时患有精神疾病和智力或发育障碍（IDD）的人。的 拟议中的奖学金将帮助斯通女士为独立调查员的职业生涯做好准备， 为实现三个目标提供个性化培训机会：（1）熟练应用混合方法 将先进的统计技术与深入的定性方法相结合的方法，（2）建立 在为同时患有缺碘症和精神疾病的个人提供精神卫生服务方面的专门知识， 以及（3）深入了解国家精神卫生管理的法律的和监管框架， 卫生和缺碘症机构，独立和协调，影响个人的心理健康服务， 缺碘症和精神疾病并存。为了实现这些目标，斯通女士将完成以下活动： 指导研究，教学和非正式培训，体验式学习，以及出席和演讲， 研讨会和会议。在整个培训期间，她将获得丰富的资源支持， 在约翰霍普金斯彭博公共卫生学院和一个强大的导师团队与互补 卫生服务研究的专业知识，混合方法，先进的因果推理方法，以及相关问题 为同时患有缺碘症和精神病的个人提供精神病服务。 指导研究将包括一个混合方法的研究，重点是国家机构的作用， 为同时患有缺碘症和精神疾病的个人提供精神健康服务。尽管患病率升高， 与一般人口相比，患有IDD的人患有精神疾病， 疾病在接受精神保健方面面临重大障碍。这部分是由于分散的精神 保健和缺碘症服务提供系统。为了解决分裂问题，德克萨斯州重组了他们的 卫生和人类服务（HHS）系统在2017年，消除国家的IDD机构和移动这些 卫生和公众服务部的规划和监管职责，该部门还设有精神卫生机构。的 这种整合的目的是通过减少行政管理， 负担，更好地整合类似的服务和计划，并明确责任和绩效 措施拟议的研究探讨了这种机构整合对精神卫生服务的影响 同时患有碘缺乏病和精神疾病的个人的利用和质量指标 混合方法设计，结合对国家机构工作人员和IDD和精神疾病的深入定性访谈， 健康倡导者与行政保险索赔数据的增强综合控制分析。这 拟议的研究与NIMH的战略计划目标4.1保持一致，以支持改善研究 通过研究扩大精神卫生服务的覆盖面，重点关注重要和得不到充分服务的人口。

PROJECT SUMMARY/ABSTRACT The goal of the proposed fellowship is to prepare the applicant, Elizabeth Stone, for an independent research career focused on improving services and systems for underserved populations with mental illness, including those with co-occurring mental illness and intellectual or developmental disabilities (IDD). The proposed fellowship will help Ms. Stone prepare for a career as an independent investigator by allowing opportunities for individualized training toward three goals: (1) to attain proficiency in applying mixed methods approaches that integrate advanced statistical techniques with in-depth qualitative methods, (2) to build expertise in issues related to mental health services for individuals with co-occurring IDD and mental illness, and (3) to develop an in-depth understanding of the legal and regulatory framework through which state mental health and IDD agencies, independently and in coordination, impact mental health services for individuals with co-occurring IDD and mental illness. To achieve these goals, Ms. Stone will complete activities including mentored research, didactic and informal training, experiential learning, and attendance and presentations at seminars and conferences. Throughout the training period, she will be supported by a rich array of resources at the Johns Hopkins Bloomberg School of Public Health and a strong mentorship team with complementary expertise in health services research, mixed methods, advanced causal inference methods, and issues related to psychiatric services for individuals with co-occurring IDD and mental illness. The mentored research will consist of a mixed methods study focused on the role of state agencies in mental health services for individuals with co-occurring IDD and mental illness. Despite elevated prevalence of mental illness among people with IDD compared to the general population, those with both IDD and mental illness face significant barriers to the receipt of mental health care. This is due, in part, to fragmented mental health and IDD service delivery systems. In an attempt to address fragmentation, Texas restructured their Health and Humans Services (HHS) system in 2017, eliminating the state’s IDD agency and moving those programmatic and regulatory responsibilities to HHS, which also houses the mental health agency. The purpose of this integration was to improve access to and quality of services by decreasing administrative burden, better integrating similar services and programs, and clarifying lines of accountability and performance measures. The proposed research examines the effects of this agency integration on mental health service utilization and quality indicators among individuals with co-occurring IDD and mental illness using a concurrent mixed methods design combining in-depth qualitative interviews with state agency staff and IDD and mental health advocates with augmented synthetic control analyses of administrative insurance claims data. This proposed research is well-aligned with NIMH’s Strategic Plan Objective 4.1 to support research on improving the reach of mental health services through research with a focus on an important and underserved population.