About the VISN 5 MIRECC - VISN 5 MIRECC

Definition of Mental Illness Research, Education, and Clinical Centers (MIRECCs):

MIRECCs are Mental Illness Research, Education and Clinical Centers established by Congress in October 1996 through public law 104-262. There are currently ten MIRECCs. Each MIRECC focuses on mental illnesses that are common in veterans. MIRECCs investigate the causes of mental illness, develop new treatments and evaluate both established and new treatments with the goal of bringing best practices in veteran mental health care into the clinical settings of the VA. (From National MIRECC website, www.mirecc.med.va.gov)

The purpose of the VA Capitol Healthcare Network (VISN 5) MIRECC is to develop a center for research, training, and service for veterans with schizophrenia and their families. Our work, particularly in regard to substance abuse, and mental health service systems and health care economics, extends to veterans with other severe and persistent mental illnesses (SPMI) as well. The center is based at the Baltimore Division of the Veterans Affairs Maryland Health Care System (VAMHCS), and involves substantial integration with the scientific expertise on schizophrenia and mental health services at the University of Maryland School of Medicine and the Johns Hopkins University School of Public Health. Active research, educational and clinical program links are maintained across VISN 5 facilities including the Perry Point Division of the VAMHCS, the Martinsburg, West Virginia VAMC and the Washington DC VAMC.

The VISN 5 MIRECC represents an integrated, multilevel program that extends from development and testing of new antipsychotic medications through psychosocial treatment and rehabilitation, and mental health services research. New findings are disseminated through comprehensive educational programs for VISN staff, veterans, their families, and other VAMCs. Clinical demonstration programs are established to test new strategies and to serve as models for dissemination. Consistent with the overall mission of the VISN 5 MIRECC to improve the quality and cost-effectiveness of services for veterans with schizophrenia and their families, the MIRECC Research Program will emphasize research that promotes the translation of research findings into evidence-based practice.

The ultimate goal of our MIRECC is to improve the care of all veterans with schizophrenia within VISN 5, and by extrapolation, within the entire VA system. While our primary focus is on schizophrenia, our work will have considerable applicability for veterans with other serious and persistent mental illnesses as well. Our decision to focus on schizophrenia is based on the fact that veterans with this illness have a unique pattern of deficits and special needs that are not addressed in many programs designed for the broader population of mentally ill veterans. Conversely, chronicity and severity of illness are important common factors that permit information gleaned in research and clinical programs for people with schizophrenia to be applied to other seriously mentally ill veterans.

While veterans living with schizophrenia have multiple problems, we have elected to target five areas that are especially relevant to veterans and the VA, and on which we can bring considerable research and clinical expertise to bear (substance abuse, psychopharmacology, neurocognitive factors in rehabilitation, health behaviors, and service delivery systems). Each of these areas will be the subject of research, educational activities, and enhanced clinical services. Our activities will encompass development and evaluation of new interventions in these domains, and evaluation of their costs and impact on systems of care.

The VISN 5 MIRECC is organized around Cores that provide expertise and services that support programs and projects. The structure includes: 1) an Administrative Core that oversees the MIRECC and insures that the mission is achieved; 2) a Research Core that includes (a) a Biostatistics Core, that provides statistical and data management expertise, (b) an Assessment Core, that i.) assists MIRECC Investigators in selecting instruments, ii.) fosters consistency across projects where possible to facilitate training and supervision of project assessment staff, and iii) makes MIRECC investigators aware of new instruments, procedures, and psychometric issues that will enhance their research; and (c) a set of Research Projects; 3) an Education Core and 4) Clinical Core that insure dissemination and clinical application of MIRECC findings and developments.

The VISN 5 MIRECC supports and facilitates research, educational programs, and clinical demonstration projects in the key areas of scientific interest, including: substance abuse, psychopharmacology, neurocognitive factors in rehabilitation, health behaviors, and service delivery systems. Given the breadth of expertise on schizophrenia in our system, we will also support projects on other topics that are consistent with our mission, including work with families of veterans with schizophrenia and on homelessness.

Administrative Core

The Administrative Core is the operational center of the MIRECC. Led by the MIRECC Director, Alan S. Bellack, Ph.D. and the MIRECC Coordinator, Wendy Tenhula, Ph.D., the Administrative Core oversees all aspects of MIRECC activities, including research, education, clinical service, and evaluation. It serves as the primary link: a) between MIRECC investigators and staff working in the diverse projects, programs, and sites; b) between MIRECC staff and investigators; c) between MIRECC staff and the Network Service Line Director (Dr. Stephen Deutsch) and the Network Director (Dr. James Nocks); and d) between the MIRECC and the Advisory Committee. The Administrative Core is responsible for managing the MIRECC budget, space, and resources, overseeing recruitment of all MIRECC investigators and staff, implementing policy, facilitating the work of MIRECC investigators and staff, and leading the MIRECC in achievement of its goals. The Administrative Core also includes Mary Lupi, Administrative Officer, and Fran Broomall, MIRECC Secretary.

Research Core

The Research Core consists of three components: the Biostatistics Core, the Assessment Core, and the Research Program. The latter is the organizational structure for all of the research projects conducted under the auspices of the MIRECC. The Associate Director for Research, Lisa Beth Dixon, MD, MPH, oversees and is responsible for each of these three components. Dwight Dickinson, PhD, JD, is the Assistant Director for Research.

The Biostatistics Core is the methodological cornerstone of the MIRECC. At the conceptual level it contributes to the design of studies, provides statistical guidance, and translates scientific questions into statistically testable hypotheses. At the methodological level it engages in the statistical analyses of data, provides consultative services to investigators and project statisticians, and manages the MIRECC database. The Biostatistics Core serves as the primary statistical resource for the MIRECC. It provides consultation in research design, statistical analysis, statistical concepts, database technology and management, and it takes the lead in computer systems development in each of the MIRECC programs and projects. Clayton Brown, PhD, is the director of this core.

The Assessment Core facilitates and integrates the assessment functions of the MIRECC research and clinical programs implemented across the VISN. The core creates a structural framework for assuring the uniformity of clinical evaluations across these programs through its multiple functions. First, it enables the various programs to share in: a) the selection of rating instruments; b) centralized training in the use of the instruments; c) ongoing reliability exercises; and d) development of assessment methods in those instances where existing scales do not meet the specific needs of MIRECC investigators. Second, the core oversees collection of a common data set on patients entering MIRECC-related protocols through the use of index assessments. The selection of index assessments is driven by the theoretical concept of domains of psychopathology, and by the desire to ensure that there is an adequate diagnostic and clinical description of all subjects entering MIRECC protocols. Third, the Core makes available a common set of clinical, neurobehavioral, social competence, and family assessments to MIRECC investigators. We propose to develop a "formulary" of measures, such that investigators will select measures for specific purposes from a standard menu of instruments. The standardization of assessments across the different programs and projects reduces the variability in measurement, thus promoting cross-program comparisons and facilitating scientific collaboration. Moreover, the collection of a common data set across programs allows an examination of the applicability of findings over a wider spectrum of schizophrenic patients as well as more macro analyses of service utilization and costs.

The Research Program, in keeping with the overall mission of the VISN 5 MIRECC to improve the quality and cost-effectiveness of services for veterans with schizophrenia and their families, emphasizeS research that promotes the translation of research findings into evidence-based practice. We view the link between research, education, and clinical service as a continuum with an ongoing feedback loop, in which research leads to new educational curricula, which are then translated into new and more effective clinical interventions; at the same time, clinical and educational activities generate ideas for new research. Thus, our research program has an ongoing influence on our educational and clinical efforts.

Education Core

The Education Core is directed by the MIRECC Associate Director for Education, Paul Ruskin, MD. The VISN 5 MIRECC Educational Core includes a multi-faceted and coordinated program of education, training, dissemination, evaluation, community networking and technical assistance to help achieve the overall MIRECC mission of improving the quality and cost-effectiveness of services for veterans with schizophrenia and their families. The Education Core targets a large audience of participants including VISN 5 clinicians, research scientists, providers, and trainees from across a wide variety of disciplines (e.g., general medicine, psychiatry, psychology, nursing, and social work), veterans living with schizophrenia and their families, as well as community based support and advocacy organizations working with veterans in the VISN 5 area. Drawing on the findings from the MIRECC's Clinical Core and Research Program, the Education Core plays an important role in promoting the translation of research and clinical findings into improved evidence-based practice. The specific goals of the Education Core are to:

Provide education, resources, and support to veterans living with schizophrenia, and their families and caregivers.
Expand and coordinate opportunities for educating and training VA-based clinicians, researchers and policy makers from a variety of disciplines who work with schizophrenia patients and their families.
Enhance and coordinate the training and education programs available to student interns, residents, and post-doctoral research fellows.
Disseminate MIRECC generated findings and products to the VA and non-VA Community. Also, establish the VISN 5 MIRECC as a regional and national resource for information, education, materials and technical assistance in the area of schizophrenia.
Coordinate collaborative exchanges of information and resources between the various VISN 5 sites and the neighboring communities they serve.
Establish and coordinate evaluation efforts for all MIRECC Educational programming.

Clinical Core

The Clinical Core is the operational arm of the VISN 5 MIRECC for all activities that involve clinical services and programs. Richard Goldberg, PhD, is Director of the Clinical Core. Much of its activity involves linkage with the Education Core and research programs in order to generate ideas and targets, and to enable their operations. The Mission of the MIRECC Clinical Core is to:

Facilitate implementation of clinical research protocols, including linking investigators with program directors.
Facilitate implementation of training programs, including linking members of the Education Core with program directors.
Represent the MIRECC to clinical services and relevant administrative units within the VISN.
Conduct needs assessments to generate ideas for new clinical, research, and educational programs.
Conduct demonstration projects and field trials of innovative clinical services.
Evaluate these activities.

The Primary Activities of the Clinical Core are divided into three domains: a) Needs Assessments; b) Clinical Demonstration Programs; and c) Clinical Research Projects. The demonstration programs and research projects will often be developed in response to the needs assessments, but they can also evolve in response to requests from the VISN administrators and program directors, from Mental Health Performance Improvement Councils, and from research findings generated within the VISN 5 MIRECC and elsewhere.

Dedication Ceremony

On Wednesday, November 29, 2000, we hosted the official dedication ceremony and ribbon cutting for the VISN 5 MIRECC. Speakers for the day included: US Senator Barbara Mikulski; Larry Lehman, MD, Chief Consultant Mental Health Strategic Health Care Group, Department of Veterans Affairs, VA Central Office; James J. Nocks, MD, MSHA, Director, VA Capitol Health Care Network (VISN 5); Robert M. Malone, Jr., Acting Director, VA Maryland Health Care System (VAMHCS); Donald E. Wilson, MD, Dean, School of Medicine University of Maryland, Baltimore.