VISN 16 Fellowship Program

Special Fellowship in Advanced Psychiatry

South Central Mental Illness Research, Education, & Clinical Center (MIRECC)

Contact | Goals and Framework | Organizational Structure | Mentoring Team | Educational Resources | Health Services Emphasis | Psychopharmacology Emphasis | Evaluation

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Contact

Mark E. Kunik, MD, MPH
Director, MIRECC Special Fellowship in Advanced Psychiatry
Veterans Affairs Medical Center
2002 Holcombe, 116MHCL
Houston, TX 77030
713-794-8639
fax 713-794-8769
email mkunik@bcm.tmc.edu

Direction and Framework of the Fellowship Program

The overarching goal of the fellowship program is to train future VA leaders for research careers in a rapidly evolving health care arena by providing a firm foundation in mental health research, education, and clinical care. Within this overall context, the fellowship will offer two specialty tracks—one in Health Services Research and one in Clinical Psychopharmacology. The goal of the Health Services Research track is to train researchers who are well-versed in the issues of access, utilization, outcomes, and effectiveness across a broad spectrum of mental health disorders. The specific educational activities will service to enhance knowledge of the clinical issues underlying the health services issues. The goal of the Clinical Psychopharmacology track is to help investigators to translate discoveries in brain science into clinically effective treatments for the brain-based illnesses like depression and bipolar disorder.

For all trainees, core components of the program will include: 1) BCM’s Faculty Education Initiatives Skill Building Program; 2) mentored research and educational activities; 3) clinical supervision and participation in clinical seminars within the mental health services clinics of the Houston VAMC; and 4) specialty course work relevant to the specific track to which the fellow is assigned. (See Figure 1, Master Schedule.)

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Organizational Structure

The organizational structure of the fellowship program will allow for considerable coordination and shared infrastructure across specialty tracks. The fellowship program will be co-directed by Mark Kunik, MD, MPH, who will lead the Health Services emphasis track, and Lauren Marangell, MD, who will lead the Psychopharmacology track.

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Mentoring Team

The fellowship training program is designed to create an environment that fosters professional growth and development in young investigators, allowing them to mature into independent researchers capable of and interested in pursuing independent research that contributes to the overall VA mission of health care. Each fellow will have a committee of mentors, consisting of two investigators and a clinical supervisor. Consultants from off-site faculty may be included. The co-leaders of each emphasis area, in collaboration with members of the Internal Review Committee and the fellow, will appoint the mentoring team. Drs. Kunik or Marangell will be on each fellow's committee to provide administrative oversight, to monitor the fellow's progress toward completing each specific task required by the fellowship (discussed below), and to assist the fellow in identifying a research area and in fulfilling other postdoctoral training requirements. The second committee member will be the primary mentor, who will have experience conducting research in the topic areas that the fellow chooses to pursue. The third committee member will be a clinician who supervises the fellow in clinical activities in one of the major mental health clinics at the Houston VAMC. The clinical mentor will provide clinical experiences and feedback regarding the fellow's development in assessment and treatment of specific mental disorders. Fellows will meet with their primary mentor on a biweekly basis and with their mentoring committee quarterly. The program co-directors will meet with the fellow semiannually to review the fellow's progress.

At the beginning of the fellowship year, the mentoring committee will meet with each fellow to individualize the training experience, with the goal of compensating for any academic or clinical deficits, and to enhance the fellow's existing expertise, academic preparation, and research interests. All fellows are expected to:

1. complete course work specific to their specialty track
2. participate in ongoing research projects and grant writing in their area of interest
3. participate in one of the seven disorder-specific MIRECC groups (schizophrenia, posttraumatic stress disorder [PTSD], substance abuse, geropsychiatry, neuroimaging/neurocognition, psychopharmacology, families)
4. develop a research project in their area of interest that should result in a publication in a peer-reviewed journal and/or grant application
5. make a presentation at a national meeting
6. participate in clinical activities as assigned
7. attend the annual MIRECC retreat
8. attend the annual fellowship national meeting
9. participate in teaching opportunities (e.g., Faculty Education Initiatives Skill Building Program; Psychiatry Journal Clubs); and attend biweekly MIRECC Fellowship video teleconferences.

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Educational Resources

Acquisition of Knowledge

The fellowship education program will have several components: 1) an optional 4-week (32-hour) course on the Fundamentals of Clinical Investigation, 2) an optional 28-week (48-hour) course, Clinical Investigation for the Career Scientist, 3) a required 6-hour Ethics in Research seminar, and 4) recommended additional coursework to meet individual needs of trainees. Fellows will also have the opportunity to attend the monthly Houston VAMC Mental Health Conference and the weekly BCM Psychiatry Grand Rounds.
The Fundamentals of Clinical Investigation and the Clinical Investigation for the Career Scientist courses will be taught at Baylor College of Medicine through the Clinical Scientist Training Program (CSTP), a multidisciplinary didactic training program for researchers (http://www.bcm.tmc.edu/ cstp/index.htm). The Fundamentals of Clinical Investigation is a 32-hour course that offers the essentials of research design, statistics, and ethical issues (see Lecture Schedule attachment). The Clinical Investigation for the Career Scientist course is comprised of three components: a 24-hour Scientific Writing module, a 12-hour Clinical Decision Analysis module, and a 12-hour Health Service Research module (schedule attached). The biweekly Mental Health Research course will supplement the course from the Clinical Scientist Training Program and will be more specific to research issues in mental health research and career development. The seminar will address mental health topics such as sampling, measurement, analytic strategies, legal and ethical concerns, and policy issues. These will be addressed through directed readings, faculty and student presentations of current literature, and presentations of current or potential research projects. The seminar will include representatives from mental health agencies and consumer groups. The content of these biweekly seminars will also be guided by the curriculum established by the hub site. The Ethics in Research seminar is required of all BCM scientists. This 6-hour seminar covers topics such as data ownership and management, authorship, plagiarism and peer review, scientific misconduct with specific reference to conflicts of interest and policies, and ethical considerations in animal and human subjects research. Finally, coursework will be recommended based on prior education, clinical experience, and areas of competency which trainees bring to the program as outlined in the (c) Customized learning section. Faculty will individualize the academic and research programs for postdoctoral trainees with the goal of compensating for any academic or clinical deficits and enhancing trainees’ existing expertise, academic preparation, and research interests. In particular, mental health services fellows need to have an understanding of basic concepts in epidemiology, and all fellows need competence in statistics before fellowship completion. There is a rich selection of relevant coursework available to trainees from the University of Texas School of Public Health, University of Houston, and Rice University. All applicants will be able to complete an MPH through the University of Texas School of Public Health or a Masters in Clinical Investigation through the Graduate School of Baylor College of Medicine, if so desired. Fellows may also attend content-specific courses in Health Services Research or Psychopharmacology. These courses are outlined below.

Teaching Competence

Fellows will participate in the Faculty Education Initiatives Skill Building Program at Baylor College of Medicine. This program includes a two-hour orientation lecture, a bimonthly Medical Education Seminar Series, and a two-hour interactive Teaching Skills Workshop (http://www.bcm.tmc.edu/ fac-ed/skill_building.htm) (Master Calendar attached). Fellows will also have the opportunity to co-lead and participate in the bimonthly Psychiatry Journal Clubs. Finally, fellows will be given teaching responsibilities by their clinical mentors and will receive feedback on their teaching.

Customized Learning

To customize each fellow’s learning experience, a rich selection of relevant coursework is available from the University of Texas School of Public Health, University of Houston, and Rice University. All fellows will be able to complete an MPH through the University of Texas School of Public Health, if so desired. Fellows may also attend content-specific course in Health Services Research or Psychopharmacology, as outlined below in the Health Services and Psychopharmacology emphasis sections.

Clinical Resources

Clinical activities: All fellows will spend 25% of their time in clinical activities within one of several mental health clinics at the Houston VAMC. Their assignment will be determined by the fellow’s interest and with the input of the Internal Review Committee and the fellow’s mentors. Regardless of discipline, fellows will be assured of discipline-specific supervision. In addition, fellows will be given an opportunity to participate in the clinical teaching of other trainees. The clinics include the Integrated Mental Health Program, Trauma Recovery Program, Geriatric Psychiatry Program, Substance Dependence Treatment Program, Psychosocial Rehabilitation Program, and the Neuropsychology Laboratory. Directors of these programs have indicated enthusiastic support for participation in the fellowship program (see letter of support).

A brief description of each of the programs follows:

Integrated Mental Health Program (Director: Loretta Coonan, LMSW-ACP) .

This program provides ongoing care in both inpatient and outpatient settings to veterans who have severe and persistent mental illness, including schizophrenia, bipolar disorder, and other related disorders. The program’s Psychiatric Evaluation and Admission Clinic (PEAC) offers inpatient and outpatient evaluation and crisis services 24 hours a day, 365 days a year.

Trauma Recovery Program (Director: Sara Bailey, PhD) .

Recognizing the special risk of posttraumatic stress disorder (PTSD) and related illnesses in the veteran population, this program has a broad range of outpatient, day hospital, and acute inpatient services available for veterans suffering from PTSD and other anxiety disorders. Program staff members work closely with the two Veterans Outreach Centers in Houston.

Geriatric Psychiatry Clinic (Director: Ellen Barr, LMSW) .

This program is designed for the special needs of older veterans with mental health problems. A thorough medical evaluation, careful consideration of medications, and specialized psychological evaluation and treatment are available in inpatient and outpatient settings, with community follow-up by an outreach nurse.

Substance Dependence Treatment Program (Director: Janine Shaw, PhD)

This program offers three levels of care for drug and alcohol use disorders, inpatient and outpatient detoxification, and opiate replacement treatment. The clinic is open 6 AM to 8 PM, and patients are enrolled immediately upon application. Staff work as a team to provide individualized treatment to the recovering veteran.

Psychosocial Rehabilitation Program (Director: Jennie Hall, MD)

For those veterans with severe mental illness who have been repeatedly hospitalized and have not responded to usual treatments, this program offers partial hospitalization, residential rehabilitation, and assertive community treatment (ACT). The goal is to help veterans change their social behavior so that they may live successfully in a community setting.

Neuropsychology Laboratory (Co-Directors: Andrea Cohen, PhD, and Jeff Lindeman, PsyD)

This clinic provides neuropsychological consultation to all the Houston VAMC inpatient units and outpatient clinics, including specialized assessments for HIV, Gulf War, and spinal-cord-injured veterans.

All of these clinics function through an interdisciplinary team approach. The Houston VAMC is a major training site for BCM residents, medical students, and physician assistant students, as well as psychology interns, psychology practicum students, social work students, and nursing students. Involvement of trainees in the therapeutic activities of the clinics is a highly valued activity by staff members. Trainees will have a multitude of training activities available to them, depending on their interest and training needs. Fellows can function within interdisciplinary teams, gain experience in clinical settings with varying levels of treatment intensity, provide individual and group therapies, learn specialized assessment techniques, and provide medication management. Fellows will also have the opportunity to be involved in the myriad of clinical educational programs available in the Texas Medical Center (e.g., BCM Psychiatry Grand Rounds, continuing education conferences, monthly VAMC Mental Health Conference, brain dissection rounds, and psychology assessment and therapy seminars).

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Content Specific Education and Research Opportunities:

Health Services Emphasis

Philosophy

As the United States undergoes a dramatic restructuring of private and public mental health and substance abuse treatment systems, it has become necessary to monitor individual and aggregate patient outcomes to determine whether the ongoing treatment being delivered is appropriately targeted, cost-effective, and capable of addressing the specific concerns of patients, payers, and purchasers. In spite of significant external pressure for monitoring processes of care, the integration of outcomes assessment into routine mental health care is still in the early stages. Although there are several training sites for preparing researchers in mental health service systems research, there are few programs for preparing clinical mental health services researchers. There is a great need for training clinicians in mental health services research. To help fill this research gap, we will offer a Mental Health Services emphasis within our VA Special Fellowship in Advanced Psychiatry and Psychology. For all trainees with a Mental Health Services emphasis, core components of the program will include 1) a mental health services research seminar, 2) mentored research activities, 3) required coursework at the University of Texas School of Public Health in statistics, epidemiology, and health services, and 4) elective coursework to meet individual needs of trainees.

This training will be based in the Houston HSR&D Center and will be richly supported by the University of Texas School of Public Health, the Little Rock Center for Mental Healthcare and Outcomes Research: A VA HSR&D Center of Excellence (hereafter referred to as the Little Rock Center of Excellence or Little Rock HSR&D Center), and the Mental Health Quality Enhancement Research Initiative (MH-QUERI). Trainees will learn state-of-the-art mental health services research methodologies and analytical procedures in the context of mental health care delivery. These opportunities will provide an environment conducive to attracting qualified postdoctoral applicants, thereby increasing the number of researchers prepared to address critical questions in the organization, financing, delivery, and outcomes of mental health services.

Resources

Houston Center for Quality of Care and Utilization Studies: A VA HSR&D Center of Excellence: The Houston HSR&D Center has become a highly regarded site for the development of clinician and nonclinician health services researchers. At this writing, sevenclinician-researchers are supported by prestigious VA Career Development Awards from the Health Services Research and Development Service (Drs. Anita Deswal, Hashem El-Serag, Howard Gordon, Paul Haidet, Rebecca Beyth, and Lynn Snow), an eighth is supported by the SmithKline Beecham Foundation and a Minority Medical Faculty Development Award from the Robert Wood Johnson Foundation (Dr. Traci Collins). A clinical psychologist, Jeffrey Cully, PhD, was recently awarded a VA HSR&D Associate Investigator Award. In addition, the center has an active post-doctoral training program for nonclinician scientists funded by the VA Office of Academic Affairs. The Houston Center is dedicated to the training of health services researchers and has an intensive and systematic mentoring program for all young scientists. The size and diversity of the research staff at the Center include 31 research team leaders representing various disciplines including medicine, psychology, sociology, economics, and biostatistics. Staff members also include 8 affiliate investigators and 45 other program and project staff. Over the past two years the Center has invested in increasing support for mental health services research. The Center currently has four Associate Directors (Mark Kunik, Rebecca Beyth, Marvella Ford, Maria Suarez-Almazor), two clinical psychologists health service investigators (Jeff Cully, Lynn Snow), two educational psychologists (Robert Morgan, Adam Kelly) and a social psychologist (Marvella Ford) interested in mental health assessments and outcomes.

Little Rock VA HSR&D Center for Mental Healthcare and Outcomes Research (CeMHOR): A VA HSR&D Center of Excellence: The Little Rock VA HSR&D CeMHOR has a tradition of excellence in mental health services research, focusing on access, quality, and outcomes of care for prevalent and serious mental disorders. The CeMHOR mission is to develop, implement, and disseminate policy and clinically relevant health services research to improve the mental health and care of veterans within the VA and nationwide. CeMHOR investigators have become national experts in the study of quality and outcomes of care for dementia (Cornelia Beck, PhD, RN, and Marisue Cody, PhD, RN), depression (Jeffrey Pyne, MD, John Forthney, PhD, and Jo Ann Kirchner, MD), schizophrenia (Richard Owen, MD, and Ellen Fischer, PhD), and substance use disorders (Brenda Booth, PhD). CeMHOR investigators have directed the development and/or field testing of outcomes assessment instruments (modules) for each of these conditions. In addition, CeMHOR investigators are directing studies to assess the effectiveness of guidelines implementation strategies and guideline concordant care for depressive disorders and schizophrenia. The Mental Health Quality Enhancement Research Initiative (QUERI) Coordinating Center,directed by Dr. Owen, focuses on quality improvement for schizophrenia and major depressive disorder and is located within CeMHOR. At present, three investigators are supported by HSR&D Career Development Awards ( Kathleen Richards, PhD, RN, Jeffrey Pyne, MD, and Mark Edlund, MD, PhD). Additionally, Dr. Booth is supported by a K02 career award from the National Institute for Drug Abuse. CeMHOR has an active post-doctoral training program for non-clinician scientists funded by the VA Office of Academic Affairs. The goal of the fellowship program is to train researchers in the area of mental health services research, capitalizing on the unique features of the VA health care system.

The Mental Health Quality Enhancement Initiative (MH-QUERI): The MH-QUERI is based in the South Central VA Healthcare Network and is available to support research efforts that seek to enhance the quality of care for veterans with schizophrenia and major depressive disorder (MDD). The MH-QUERI conducts studies of variation in practices and outcomes of care, and develops and tests interventions to translate research findings into clinical practice. The QUERI location in South Central VA Healthcare Network will offer unique opportunities for fellows to recognize and compete for QUERI initiatives.

The University of Texas School of Public Health: The School of Public Health is within the Texas Medical Center and is only one quarter mile from the Houston VAMC. The School of Public Health was established in 1967 and has had a consistently strong affiliation with the Houston Center of Excellence for the past ten years. The School of Public Health offers MPH, DrPh, MS, and PhD degrees. Its Health Services Organization faculty is well known for their teaching, mentoring, and productivity.

Faculty

Houston HSR&D Center and Houston VAMC (on-site faculty)
Carol M. Ashton, MD, MPH. Dr. Ashton is a physician investigator, Director of the Center , and a Professor of Medicine at Baylor College of Medicine. Her research interest is in the use of VA databases to assess variations in quantity and quality of care.
Rebecca J. Beyth, MD, MS. Dr. Beyth is an Associate Director of HSR&D and is an Associate Professor of Medicine at Baylor College of Medicine. She is also the Director of the CHF QUERI. Her research interest is in improving outcomes for patients and patient-physician interactions in clinical decision-making.
Ursula K. Braun, MD. Dr. Braun is a physician investigator and an Assistant Professor of Medicine at Baylor College of Medicine. Her research interests are dementia, end-of-life care and improving quality of end-of-life care, and surrogate decision-making.
Traci C. Collins, MD, MPH. Dr. Collins is a physician investigator and an Assistant Professor of Medicine at Baylor College of Medicine. Dr. Collins’ research interests include the quality of care for patients with peripheral arterial disease, racial variation in the process of care, and doctor-patient communication.
Jessica Davila, PhD. Dr. Davila is an Assistant Professor of Psychiatry at Baylor College of Medicine. Dr. Davila’s research interests include evaluating outcomes associated with hepatocellular and colorectal cancers.
Anita Deswal, MD, MPH. Dr. Deswal is a physician investigator and an Assistant Professor of Medicine at Baylor College of Medicine. Her research interests include racial variations in heart failure therapy and outcomes, diastolic heart failure clinical trials, and the role of cytokines in heart failure.
Nancy Jo Dunn, PhD. Dr. Dunn is a clinical psychologist and is a Clinical Assistant Professor of Psychiatry at Baylor College of Medicine. Her research interest is the outcomes of group psychosocial interventions for the combination of PTSD and depression.
Hashem B. El-Serag, MD, MPH. Dr. El-Serag is a physician investigator and an Assistant Professor of Medicine at Baylor College of Medicine. His main research interests include epidemiology, management, and outcomes of gastroesphageal reflux disease as well as hepatocellular carcinoma.
Marvella Ford, PhD, MS, MSW. Dr. Ford is a social psychologist, Associate Director of HSR&D, and Assistant Professor of Medicine at Baylor College of Medicine. Her research efforts focus on examining social psychological processes affecting the use of health services among African-Americans.
Thomas Giordano, MD. Dr. Giordano is a physician investigator and an Assistant Professor of Medicine at Baylor College of Medicine. Dr. Giordano’s research focuses on the racial disparity in outcomes in persons with HIV/AIDS, and on ways to improve the effectiveness of the treatment of HIV/AIDS.
Laura Goetzl, MD, MPH. Dr. Goetzl is a physician investigator and an Assistant Professor of Obstetrics and Gynecology at Baylor College of Medicine. Her main area of interest is in improving maternal-fetal outcomes perioperatively.
Howard S. Gordon, MD. Dr. Gordon is a physician investigator and an Assistant Professor of Medicine at Baylor College of Medicine. His research interest is in improving the understanding of racial variations in health care.
Paul M. Haidet, MD, MPH. Dr. Haidet is a physician investigator and is an Assistant Professor of Medicine at Baylor College of Medicine. His research interest is in developing innovative methods for teaching communication skills and evidence-based medical practice.
Joseph DeVance Hamilton, MD. Dr. Hamilton is the Mental Health Care Line Executive and is an Associate Professor of Psychiatry at Baylor College of Medicine. His interests are in the pharmacologic and psychotherapeutic treatments of PTSD, as well as in psychiatric education.
Thomas B. Horvath, MD, FRACP. Dr. Horvath is Chief of Staff at the Houston VAMC and Professor of Psychiatry at Baylor College of Medicine. His primary area of interest is in mental health policy issues.
Michael L. Johnson, PhD. Dr. Johnson is a statistician and is an Assistant Professor of Medicine at Baylor College of Medicine. His research interests include quality assessment of patients hospitalized for chronic diseases, pharmacoeconomics, and monitoring of performance of health care providers.
P. Adam Kelly, PhD, MBA. Dr. Kelly is a psychometrician in health services and is an Assistant Professor of Medicine at Baylor College of Medicine. Dr. Kelly also has experience in test and item design, item writing, factor analysis, and mixed-methods research methodology.
Mark E. Kunik, MD, MPH. Dr. Kunik is an Associate Director of HSR&D and is an Associate Professor of Psychiatry at Baylor College of Medicine. His research interest is in developing best practices of assessment and treatment of disruptive behaviors in patients with dementia. He is also interested in psychological interventions to improve quality of life and optimize service use in patients with chronic medical diseases. He is Co-director of the Fellowship.
Lauren B. Marangell, MD. Dr. Marangell is an Associate Professor of Psychiatry at Baylor College of Medicine. Her research interest is understanding and treating mood disorders, such as depression and bipolar disorder. She is Co-director of the Fellowship.
Maurice L. Moffett, PhD. Dr. Moffett is a health economist and Assistant Professor of Psychiatry at Baylor College of Medicine who just recently joined the Houston HSR&D.
Robert O. Morgan, PhD. Dr. Morgan in an educational psychologist and is an Associate Professor of Medicine at Baylor College of Medicine. His area of expertise is in evaluating service use in Medicare databases. He will be available to mentor fellows and to assist in projects that use Medicare databases.
Laura A. Petersen, MD, MPH. Dr. Petersen is a physician investigator and is an Associate Professor of Medicine at Baylor College of Medicine. Her research interest is in the evaluation and development of risk adjustment methodology in patients with medical and psychiatric disorders. She will assist in the training of the use of VA databases.
Nancy J. Petersen, PhD. Dr. Petersen is a statistician and an Assistant Professor of Medicine at Baylor College of Medicine. She has 15 publications. She is interested in variations of care in the VA. She will be available for statistical consultation.
Ken Pietz, PhD. Dr. Pietz is an Assistant Professor of Psychiatry at Baylor College of Medicine. Dr. Pietz serves as a statistician at the VAMC.
A. Lynn Snow, PhD. Dr. Snow is an Assistant Professor of Psychiatry at Baylor College of Medicine. Her research interest is in the evaluation of pain in patients with dementia. She is also interested in developing and evaluating assessments and treatments of psychosocial disorders in demented individuals.
Julianne Souchek, PhD. Dr. Souchek is an Associate Professor of Psychiatry at Baylor College of Medicine. Her interests are statistical methodologies applicable to health services research.
Maria Suarez-Almazor, MD, MSc, PhD. Dr. Suarez-Almazor is an Associate Director of HSR&D and an Assistant Professor of Medicine at Baylor College of Medicine. Her research interests include health services research and clinical epidemiology in the field of musculoskeletal disorders.

Little Rock HSR&D Center (off-site faculty consultants)

Cornelia Beck, PhD, RN. Dr. Beck is a Professor in the College of Nursing and the Department of Psychiatry at the University of Arkansas Medical Sciences. Her research expertise is the assessment of functioning in dementia and interventions for caregivers of dementia patients.
Brenda Booth, PhD. Dr. Booth is a statistician and Professor in the Department of Psychiatry and Behavioral Sciences at the University of Arkansas for Medical Sciences. Her research interests include health care utilization and outcomes management for individuals with substance abuse and mental health disorders.
Marisue Cody, RN, PhD. Dr. Cody is an Assistant Professor in the College of Nursing and the Department of Psychiatry at the University of Arkansas for Medical Sciences. She is also the Associate Director of the Little Rock HSR&D Center of Excellence. Her research interests are the outcomes of services of individuals with dementia and quality improvement programs.
Geoffrey Curran, PhD. Dr. Curran is a sociologist and an Assistant Professor in the Department of Psychiatry at the University of Arkansas for Medical Sciences. Dr. Curran’s research focus is on the etiology, identification, and treatment of comorbid depression and substance use disorders.
Ellen Fischer, PhD. Dr. Fischer is an epidemiologist and an Associate Professor of Psychiatry at the University of Arkansas for Medical Sciences. Her area of interests are in the outcomes, assessment, and preferences of patients with schizophrenia, and development of the Schizophrenia Outcomes Module.
John Fortney, PhD. Dr. Fortney is a medical geographer and is an Assistant Professor in the Department of Psychiatry at the University of Arkansas for Medical Sciences. His area of interest is in the access and barriers to care in rural areas. He will be available to assist fellows who have interest in access issues.
JoAnn Kirchner, MD. Dr. Kirchner is a psychiatrist and an Assistant Professor of Psychiatry at the University of Arkansas for Medical Sciences. Her research interest is in the detection and treatment of depression and alcohol use disorders in the primary care setting.
Richard Owen, MD. Dr. Owen is an Associate Professor of Psychiatry at the University of Arkansas for Medical Sciences and is the Director of the Little Rock Center of Excellence. His area of interest is in improving the quality and outcomes of care for schizophrenia and depression.
Jeffrey Pyne, MD. Dr. Pyne is an Assistant Professor of Psychiatry at the University of Arkansas for Medical Sciences. His research interest is in measuring quality of life in patients with mental disorders.
Greer Sullivan, MD, MSPH. Dr. Sullivan is an Associate Professor of Psychiatry at the University of Arkansas for Medical Sciences. She is Co-director of South Central MIRECC. Her research interests are in the delivery and evaluation of mental disorders in high-risk populations. Dr. Sullivan will be available to mentor fellows and aid in grant writing.

Educational Opportunities

Within the Centers there is a strong tradition of collaboration, mutual assistance, and team-building. Weekly Health Services Research Conferences, which feature research presentations by local faculty members or outside speakers, offer a unique forum for disseminating the latest information from ongoing projects and study results, and create an environment that promotes collaborative efforts and constructive peer review. Individual faculty members regularly request “Consultation Conferences,” ad hoc meetings to discuss and critique research methods for proposed grant applications or papers. Trainees will be provided these same mechanisms to assist in their development of research ideas, proposals, and papers.
In addition to the courses on the Fundamentals of Clinical Investigation, Clinical Investigation for the Career Scientist, Ethics in Research seminar, and biweekly mental health research course required of all fellows, the fellows in the Health Services emphasis will also be required to take four other courses at the School of Public Health: Epidemiology (PH2610), Intermediate Statistics (PH1725), Health Services Delivery and Performance (PH5110), and Medical Outcomes Assessment (PH3998). Other courses will be recommended based on the fellow’s needs and interests and may include Intermediate Statistics (PH1726), Measurement Theory (PH1130), Statistical Methods in Epidemiology (PH1730, PH1731), Health Survey Research Design (PH1115), Health Economics (PH3910), and Health Policy (3810).

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Content Specific Education and Research Opportunities:

Psychopharmacology Emphasis

Philosophy

The Mood Disorders Center (MDOC) is an interdisciplinary academic psychiatry service located at Baylor College of Medicine. The mission of the MDOC is to serve as a community resource in advancing our understanding and treatment of mood disorders, such as depression and bipolar disorder. The MDOC is involved in many ongoing research projects. The purpose is to help translate discoveries in brain science into clinically effective treatments for the brain-based illnesses like depression or bipolar disorders. Current projects include 1) bipolar depression study: lithium versus lamictal; 2) systematic treatment enhancement program in bipolar disorder (STEP-BD); 3) olanzapine in bipolar disorder (http://www.mdoc.org).

Resources

Mood Disorders Center

The Mood Disorders Center (MDOC) is a clinic located at 6655 Travis Street, Suite 560, in the Texas Medical Center, staffed by Lauren B. Marangell, MD, and James M. Martinez, MD, in addition to research coordinators and office staff. Currently, the MDOC is conducting the following research studies:

1. Bipolar Depression Study: Lithium versus Lamictal. This is a 16-week study comparing lithium and lamictal (lamotrigine) for the treatment of bipolar depression. Both medications are FDA-approved and are currently used in the treatment of bipolar disorder. Study-related medication, doctors’ visits, and parking are provided at no cost.
2. Systematic Treatment Enhancement Program in Bipolar Disorder (STEP-BD). STEP-BD is a large, multi-site, NIMH-initiated program designed to provide optimal care for patients with bipolar disorder and to collect long-term data on the most effective treatment(s) for bipolar disorder. Approximately 5,000 individuals with bipolar disorder will be followed for 5-8 years in 20 centers throughout the U.S. It is anticipated that the results obtained from this program will double the currently available information on the treatment of bipolar disorder and answer many unanswered questions.
3. Olanzapine in Bipolar Disorder. This is a study using Olanzapine (Zyprexa) in treatment of mania in bipolar disorder. The course of the study is 7 visits within 3 months. Participants will receive free study medication during the course of the study.

Faculty (on-site)

Lauren B. Marangell, MD. Dr. Marangell is an Associate Professor of Psychiatry at Baylor College of Medicine. Her specific research interests include psychopharmacology, omega-3 fatty acids, novel drug delivery systems and devices for the treatment of mood disorders. She is Co-director of the Fellowship.
James M. Martinez, MD. Dr. Martinez is an Assistant Professor of Psychiatry at Baylor College of Medicine. His major academic interests include psychopharmacology and affective disorders.

Faculty (off-site)
Teresa Hudson, PharmD. Dr. Hudson is an Instructor at the University of Arkansas for Medical Sciences. Her research interests focus on medication adherence, quality of care, and treatment of schizophrenia.

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Evaluation

We will collaborate with the fellowship hub site in developing and implementing formative and summative evaluation plans for the program and the individual fellows. Below are our current strategies for addressing these evaluation domains:

Outcome Evaluation of Fellows

Individual meetings of the fellow with the Program Co-Directors will occur at six-month intervals. The purpose is to obtain information for making any needed changes in the individual fellow’s program and to identify possible revisions of the fellowship program that should be discussed by the Implementation Committee. The fellow will be encouraged to assess candidly the fellowship experience and to suggest changes that should be made. Prior to each meeting, the Program Co-Directors will contact the individual mentor to obtain the mentor’s evaluation of the fellow’s performance, and that evaluation, too, will be discussed. The evaluation includes input from other faculty (e.g., secondary mentors) with whom the fellow has been working. The performance evaluation will include objective criteria (e.g., presentation at national meeting, manuscript submitted for publication) that have been established at the outset of the fellowship program. Additional oversight is provided by the Health Services and Psychopharmacology Co-Leaders and the Internal Review Committee who are responsible for ensuring that the evaluations are completed in time for a review of the fellow every six months.

Clinical Scientist Training Program - Baylor University

http://www.bcm.tmc.edu/cstp/courses.htm