Carole Siegel, PhD, Director

Center leadership changes

A transition in the Center's leadership occurred September 1 when Carole Siegel, PhD, assumed the position of Center Director upon the resignation of David L. Shern, PhD, as Center Director. Head of the Epidemiology and Health Services Research Laboratory at the Nathan S. Kline Institute for Psychiatric Research, Dr. Siegel played a pivotal role in the Center's establishment in late 1993.

In addition to being an active member of the Center's Executive Committee, she serves as Co-Director of the Methodology Core, where she has devoted time to the review of progress on proposals, convened meetings of faculty to conceptualize new projects, helped structure activities to contribute to the cross-fertilization of research ideas, and led efforts to provide researchers with assistance in utilizing appropriate research methods in mental health services related projects.

Dr. Siegel's research interests include modeling and simulation and reimbursement methods. Currently, she is principal investigator of the NIMH-funded study, "Statistical Methods in Mental Health Cost-Benefit Analysis." In her new role, Dr. Siegel will oversee all Center operations, and, working with the Assistant Director and the Executive Committee, will continue to assure the scientific integrity and coordination of Center activities.

Dr. Shern, who will continue to serve as a member of the Center's Executive Committee, resigned his position as Director of the Bureau of Evaluation and Services Research with the New York State Office of Mental Health (OMH) to assume the position of Dean and Director of the Florida Mental Health Institute at the University of South Florida. As a member of the Executive Committee, he will remain involved in assuring the continuity in Center themes and strategies as well as several research projects.

Another transition at the Executive Committee level has also occurred. Dr. Andrea Blanch, Co-Director of the System Initiatives Core, resigned her position as Co-Director because of her departure from OMH as Director of Community Support Programs to assume the position of Associate Commissioner of Mental Health and Mental Retardation for the state of Maine. As with Dr. Shern, Dr. Blanch will remain an active member of the Center's Executive Committee.

Faculty appointments

Recent appointments to the Center's faculty include Ronald Bassman, PhD, Dorothy Goldstein, PhD, John Kastan, PhD, Irene Levine, PhD, Kristina Muenzenmaier, MD, and Dave O' Neill, PhD. Drs. Bassman, Kastan, Muenzenmaier, and O' Neill are serving as members of the System Initiatives Core; Dr. Levine, as a member of the Special Populations Core; and Dr. Goldstein, as a member of the Methodology Core.

As director of the Collaborative Empowerment Project for the New York State Psychological Association (NYSPA), Dr. Bassman is working toward developing a collaborative educational relationship between ex-patients and psychologists, removing the stigma barrier that prevents many professionals in recovery from serving as role models, and making possible real input into policy and treatment decisions on the part of recipients of services. Before joining NYSPA, he was executive director of a seven-county comprehensive mental health center located in Watertown, South Dakota.

Dr. Goldstein is co-founder and currently the president of the Huntington/Oyster Bay, New York, affiliate of the Alliance for the Mentally Ill. Among her committee appointments are membership on the Suffolk County Mental Health, Mental Retardation and Developmental Disabilities Planning and Advisory Board and the Quality Assurance Workgroup of the OMH Man-aged Care Sub-committee. Between 1977 and 1988, she was a member of the Program Evaluation staff of Central Islip Psychiatric Center, serving as director for the last two years of her tenure.

Dr. Kastan recently accepted a position as New York Director of Continuum Behavioral Healthcare, a subsidiary of Medco, where he is responsible for setting up joint ventures and other relationships with providers. In his previous position, he had responsibility for over-all operations, financial management and program development in the Department of Psychiatry, St. Luke's-Roosevelt Hospital Center in New York City. He is an adjunct assistant professor in the School of Public Health at Columbia University and he chairs the Committee on Mental Health Services for the Health-care Association of New York State.

Dr. Levine is a research scientist with the Nathan S. Kline Institute for Psychiatric Research, where she is conducting research and policy analysis to improve the effectiveness and delivery of public mental health services. Previously she served as deputy director of the Center for Mental Health Services, serving as the principal advisor to the director in policy, planning, pro-gram development and management operations, and as director of the Office of Programs for the Homeless Mentally Ill at the National Institute of Mental Health, directing research, program development, technical assistance, consultation and policy efforts focused on homelessness and mental illness.

Assistant clinical professor of psychiatry at Columbia University and chief psychiatrist in the out-patient department of Creedmoor Psychiatric Center, Dr. Muenzenmaier is conducting research in the areas of childhood, physical, and sexual abuse. She is principal investigator of research on "Childhood Abuse Histories among Women with Chronic Mental Illness" and "Intervention for Women with Sexual Abuse Histories and Persistent Mental Illness."

Dr. O' Neill is an economist with the Epidemiology and Health Services Research Laboratory of the Nathan S. Kline Institute for Psychiatric Research, where he is conducting research on the role of work in recovery. Prior to joining Nathan Kline in 1994, Dr. O' Neill was a senior research associate at the Center for the Study of Business and Government, directing studies in the areas of health policy, labor economics, and education. He has extensive experience as a economist in both the policy and academic sectors and is adjunct professor of economics for Baruch College.

Reports from the Research Cores

Special Populations Core
Core Directors: Kim Hopper, PhD, and Ethel Davis Chambers, RN, MS

• Specific problems faced by "special populations" of the public mental health system continue to be the focus of the Special Populations Core. In particular, this year there has been growing attention given to the organized voice on the part of recipients of services, an attention embodied in the growing number of collaborative projects undertaken or planned. In direct response to last Fall's "Work of Recovery" conference, three new projects were added to the activities of the core:

  • Targeted Center funding enabled us to resuscitate one of the two U.S. Centers participating in the WHO Collaborative Study of Long-term Course and Out-come in Schizophrenia. The overall objective of the WHO collaborative project is to describe the long-term course and outcome of a diverse cross-cultural sample of individuals diagnosed with schizophrenia and related disorders. The study cohort was first diagnosed 15 years ago as part of the WHO Determinants Outcome of Severe Mental Disorders (DOSMed) study. Subjects will be located by field researchers in 15 centers distributed across 11 countries. Careful assessments of clinical history and social functioning of surviving members of the DOSMed study will be made, using an extensive battery of diagnostic and assessment instruments. Where possible, designated family members will be interviewed as well. We will be working with 116 original cohort members at the Rochester site.
  • A collaborative effort among researchers, recipients and clinicians occurred to develop a semi-structured questionnaire to tap dimensions of recovery and coping and identify them from the recipient's stand-point. (See the Methodology Core section.) Several versions have been constructed, piloted, and a working prototype has been added to the Rochester Recovery Project.
  • A collaborative proposal was submitted and ultimately selected for funding with Policy Research Associates, Inc., and the Duke University Medical Center in response to a request for proposals issued by New York City, to evaluate the Bellevue Pilot Program in Involuntary Outpatient Treatment for the years 1995-1998. Our responsibility is chiefly to supervise the ethnographic component and collaborative work on the analysis. This effort follows up some preliminary inquiries into the issue of coercion -- formal and informal -- raised by recipients in the working group that developed the recovery instrument prototype.

  Other core research projects actively under way include: Engaging the Homeless Poor with Severe Mental Illness: A Feasibility Study of Shelter Seekers in a Sub-urban County; Substance Use among Psychiatric Patients: Extent of the Problems and Nature of the Service Networks; Estimating the Prevalence of Substance Abuse among Mental Health Clients; and Impact of Individual, Organizational and Interorganizational Factors on the Use of Mental Health Services by Parolees with Mental Illness.

System Initiatives Core
Core Directors: Mary E. Evans, PhD, and Edward Knight, PhD

• Research projects in the System Initiatives Core continue to reflect recent shifts nationally in the political and policy environments and resonate to the major features of policy changes in New York and other states. Most of these changes involve system redesign, emphasizing managed care strategies to control costs and to increase the integration and responsiveness of the services offered.

  The formation of service networks that include a full range of treatment and support services is a key strategy for system redesign. While many important boundary issues between service systems are yet to be negotiated in forming networks, researchers working on the Comparison of Three Integration Strategies on Intervention Processes and System Change Outcomes study are testing a new group model building technology to facilitate system integration.

  Quality and effectiveness of services offered, particularly in capitated reimbursement schemes, are of central concern to state mental health authorities. One strategy for helping to ensure quality of services that is being employed throughout the managed care industry involves the development of treatment guidelines. The Crisis Decision Making project has collected data that will be used to capture and quantitatively express decision processes that underlie current practice in emergency room settings. Simultaneously with this data collection, researchers in the crisis decision area have received additional funding to complete a structured group process with experts in crisis decision making that has resulted in a set of guidelines for crisis decision making. These guidelines have been operationalized in a computerized decision support system that may be used to help standardize decision processes in emergency room settings. These two projects may ultimately be integrated in a research project that tests the effectiveness of this decision support technology in changing the emergency department practices. To the degree to which these strategies are effective in changing clinician behavior, this process may provide important new technology for the development and implementation of treatment guidelines.

  Self-help offers an adjunct to professional services that may be particularly appealing to cost-conscious managed care firms. Also, the flexibility that may ac-company capitated financing schemes may permit funding alternative services that are not currently sup-ported in Medicaid financed systems. The study investigating selection factors in self-help, Self-Selection Distinguishing Factors: Participants and Nonparticipants of Mental Health Self-Help Groups, is providing important insights into the characteristics of individuals who are served in self-help programs as contrasted with persons served in traditionally financed services. This project should help to provide an important foundation for understanding the role of alternative services in reformed systems.

  Finally, the System Initiatives Core has two research projects that directly address Medicaid financing schemes and managed care (Financing Mental Health Reform and Implementation of Managed Care Programs for Persons in Need of Mental Health Services). These projects involve researchers and policy staff who are intimately involved with the reforms in New York and who have been actively involved in documenting the issues that are emerging in New York and else-where. Their work is providing insights into the New York strategy and developing the foundation for future work that will systematically describe state interventions and the financial as well as human impacts of these reform efforts.

Methodology Core
Core Directors: Carole Siegel, PhD, and Russell Massaro, MD

• The Methodology Core continues its involvement in the development of methods of general use to the field of mental health services research and of specific use to projects presently being conducted within the Center. The Rate Setting for Managed Care project, which includes the design and testing of reimbursement methodologies for capitation or managed care scenarios emerging under state Medicaid and national health care reform, has been expanded to incorporate a project on the development of risk adjustment groupings for ambulatory care populations receiving mental health services. This new effort will provide insight into the cycles and patterns of mental health services utilization and mental illness, which will be valuable for calculating rate schedules differentiated by patient risk, whether reimbursement payments are made on a fee-for-service, diagnostic-related group, capitation, or any other basis. Work on the Development of a Service System Net-work Instrument continues to build on our knowledge of formal and informal service systems for individuals who have severe mental illness and are homeless and individuals who have severe mental illness and abuse alcohol and other drugs. An instrument incorporating the dimensions and specific items derived from the recently completed concept maps will be incorporated into an instrument that is based on theoretical constructs. The overall objective is to better understand and address the features of the service system that extrude target populations from treatment and support services.

  Where possible and meaningful, Methodology Core activities have been extended to incorporate the consumer's perspective. As a result of the "Work on Recovery" conference last year, for example, a small working group was formed (anthropologist, statistician, two administrators from OMH, four recipients, research psychiatrist, and research assistant) to design, pilot test, and revise a prototype of a recovery instrument. Specific areas addressed included an individual's own under-standing of what his/her problem has been, social relations and reciprocity, modes of coping with recurring symptoms, the impact of illness/stigma on various do-mains of everyday life and relationships, and experience with psychiatric coercion. The instrument is being used as part of the Rochester WHO Collaborative Follow-Up Study.

  Other projects actively under way in the Methodology Core are Needs Assessment as Individual and Systems Interventions and Differential Treatment Effects for Subgroups: Pre and Post Hoc Statistical Analyses.

MHPOLICY Forum off to an active start

In just over three months, the Center's newly established Internet discussion group, MHPOLICY Forum, has grown in size from an initial group of nine to just over 100 members. Sponsored by the Center and the Nathan S. Kline Institute for Psychiatric Research, the discussion group's purpose is to facilitate and encourage an open dialogue between mental health services research, administrators, policy analysts, practitioners, and consumers.

Participants of the discussion group have expressed interest in a range of policy-relevant mental health topics, but managed care seems to be of highest priority. Specifically, they have begun discussion on Medicaid managed care, consumer and family perspectives on Medicaid and Medicare managed care, consumer involvement in quality assurance and quality improvement, and interventions to improve collaboration among players of the emerging behavioral health/mental health managed care industry.

Among other issues raised by participants have been:

• Application of theories and methodologies appropriate to studying mental health populations living in diverse cultural contexts
• Development of measures that are sensitive to the needs and problems of persons with disabilities
• Reform of the mental health delivery system
• Federal developments affecting mental health policy and funding
• Design, development, and evaluation of collaborative preventive interventions for adolescents at risk for mental health problems
• Violence and mental illness
• Emerging models of recovery

MHPOLICY Forum is intended to provide researchers with more timely information on issues or data needs of policy makers as well as to inform policy makers on research findings that may prove useful for policy deliberations. It is hoped that through the active exchange of knowledge participants may contribute to ultimately improving the integration of mental health services for individuals with severe mental illnesses

Participation in MHPOLICY is free of charge. If you are interested in participating, send an e-mail message to:

• LISTSERV@IRIS.RFMH.ORG
  containing the words:

  SUBSCRIBE MHPOLICY firstname lastname

Questions about MHPOLICY should be directed to the discussion group's administrator, Judith Samuels. She can be reached by e-mail (samuels@iris.rfmh.org), by telephone at (914) 365-2000, Ext. 1739, or by mail at the Nathan S. Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962.

Center seminars

Two seminars were held at the Nathan S. Kline Institute for Psychiatric Research during May. Featured speakers were Norman Sartorius, MD, former head of the Mental Health Division of the World Health Organization and President of the World Psychiatric Association , and Donald Rubin, PhD, professor and chairman of the Department of Statistics at Harvard University.

Dr. Sartorius spoke on the methodological considerations in the study of the long-term outcome of schizophrenia and Dr. Rubin addressed methods of analysis of naturalistic studies.

Public policy roundtable discussions focus on recovery, mental health report cards, and managed care

Several public policy roundtable discussions aimed at stimulating dialogue between researchers, practitioners, recipients and policy makers were sponsored by the Center this spring and summer in Albany. The round-tables were designed to promote the free exchange of ideas about important issues of public policy and mental health, so that the Center's research continues to be timely, meaningful and actionable, and so that individuals involved in formulating policy decisions are aware of relevant and current findings from research.

Recovery
In late April, Dr. Courtenay Harding, a member of the faculty of the University of Colorado School of Medicine and principal investigator of the Vermont Longitudinal Research Project, presented findings from her study on the long-term course and prognosis of schizophrenia. The study is one of the world's longest follow-up efforts at determining the very long-term course of schizophrenia. It includes 269 patients followed an average of 32 years. It was recently replicated with patients from the Augusta State Hospital in Maine, to learn more about the effects of rehabilitation.

During her presentation, Dr. Harding detailed aspects of Vermont's experience with its evolving model of rehabilitation and recovery. She described strengths underlying the system -- a clear mission, a comprehensive policy and conceptual framework. But, when asked what really made the difference in an individual's recovery, she said, "These sturdy old people, after looking down at their feet and shuffling around, said, 'Well, somebody told me I might have a chance to get better. Somebody believed in me and my own persistence.'" What this translates into, Dr. Harding said, is hope, adding that this is a very critical issue to which systems should give attention.

What patients in Vermont said they also needed for recovery, she added, were decent food, clothing and housing; a way to be productive and integrated into the community; individualized treatment; flexible systems to go in and out of like a general medical practice; case management and continuity of care; psycho-education for family, friends, and employers; and clinic treatment teams that were valued.

Discussion following the presentation focused on the concept of hope and policy implications for the transition of clients from state hospitals into the community.

Mental health report cards
Assessing the performance of mental health special needs plans using the mental health report card was the focus of a May public policy discussion sponsored by the Center and the Office of Mental Health.

During the session, presentations were made by Russell Massaro, MD, OMH's deputy director for managed health care and the Center's co-director of the Methodology Core, and John Hornik, PhD, director of the Bureau of Planning Assistance & Coordination. Dr. Hornik provided an overview of the evolution of report cards and work of the Mental Health Statistics Improvement Program task forces on mental health report cards.

Issues raised during discussion included the rationale for indicators, who the report card is designed for, the weight given to "outcomes" vs. "process," and the role of the state entity in developing and implementing quality assurance standards and system performance.

Managed care
Members of the New York State Legislative and Executive staff met with members from the Center's faculty in mid-June for a public policy discussion on man-aged care and implications for the public mental health system.

Presentations were made by Dr. James Fossett, associate professor in the Department of Public Administration, Rockefeller College of Public Affairs and Policy, and Dr. Russell Massaro, OMH's deputy commissioner for health and managed care. Dr. Fossett, who has published extensively on Medicaid and state and local budgeting, highlighted issues and concerns of national significance in the use of managed care for the provision of mental health services. Dr. Massaro is OMH's leading official in areas of policy and program development for mental health managed care in New York.

Dr. Fosset noted that there isn't much of a record within private-sector managed care in the provision of mental health services for individuals who have severe mental illness. Therefore, care must be taken not to generalize from populations in private-sector managed care. He also added that the financial incentive for managed care plans to underserved populations with whom the plans have had very little experience may be strong, and there is enough of a record in medical care of this happening so there is a need to proceed slowly and pay attention to quality. "As of yet we don't have well-developed standards to indicate quality of care. Let the standards come first and don't rely on managed care as a source of budget savings," he added. The role of the state as a regulator and partner in quality assurance was discussed by participants.

Recent Faculty publications

Below is a listing of faculty members' recent publications and manuscript submissions that are relevant to the Center's research agenda. Citations from faculty for the next issue of Center Update may be faxed to Betty Pease at (518) 474-9965 or sent to her at the Center for the Study of Issues in Public Mental Health, 75 New Scotland Avenue-Unit B, Albany, NY 12208.

Alexander, M.J. (in press). Dually diagnosed women: A review. American Journal of Orthopsychiatry.

Alexander, M.J., Bank, R., Laska, E.M. (in press). Information support for community-based mental health systems. In I. Lavori (Ed.), Community mental health. Geneva: Pan-American Health Organization.

Alexander, M.J., Craig, T.J, MacDonald, J., & Haugland, G. (1994). Dual diagnosis in a state psychiatric facility: Risk factors, correlates and phenomenology of use. American Journal on the Addictions, 3, 314B324.

Banks, S.M., Shern, D.L ., & Felton, C.W. (1995). Estimating power in a repeated measures design. Submitted for publication.

Bartsch, D.A., Shern, D.L., Coen, A.S., & Wilson, N.Z. (in press). Service needs, receipt and outcomes for types of clients with serious and persistent mental illness. Journal of Mental Health Administration.

Bertollo, D.N., Bank, R., Laska, E.M., Siegel, C., & Gulbinat, W. (1994). The NKI/WHO mental health information system. In T. B. Ustun (Ed.), Computers in Mental Health. Geneva: World Health Organization.

Carpinello, S.E. (in press). A focused discussion with members of a Latino Self-Help Group. Psychosocial Rehabilitation Journal.

Carpinello, S.E., Knight, E.L., Videka-Sherman, L., Blanch, A., Sofka, C., & Markowitz, F. (in press). A contrasting profile: Participants and nonparticipants of mental health self-help groups. Proceedings of The Fifth Annual Conference on State Mental Health Agency Services Research and Program Evaluation. Alexandria VA: NASMHPD Research Institute.

Carpinello, S.E., & Markowitz, F. (in press). What factors are associated with participation in mental health self-help groups for individuals with severe mental illness? Research Bulletin: Center for the Study of Issues in Public Mental Health.

Evans, M.E. (1995). Nursing research: Influencing public policy. Journal of the New York State Nurses Association, 26(1), 54B56.

Felton, C..J., Stastny, P., Shern, D.L., Blanch, A., Donahue, S.A., Knight, E., & Brown, C. (in press). Peer specialists as members of intensive case management teams: The impact of consumer-providers on client out-comes. Psychiatric Services.

Fossett, J. (in progress). Medicaid and mental health re-form: Financial deinstitutionalization in New York. Health Affairs.

Fossett, J. (in progress. Do private hospitals substitute for public institutions? Journal of Health Politics, Policy and Law.

Fossett, J. (in progress). When is growth not growth? Medicaid and mental health expenditure reporting in New York. Administration and Policy in Mental Health.

Grosser, R.C. and Conley, E.K. (1995). Projections of housing disruption among adults with mental illness residing with aging parents. Psychiatric Services, 46(4), 390B394.

Grosser, R.C. (1994). Federal definitions and criteria related to adults with serious mental illness. Report prepared for the Center for Mental Health Services, Department of Health and Human Services.

Grosser, R.C. (1994). Review of "Measuring Mental Health Needs" by G. Thornicroft, C.R. Brewin & J. Wing. Journal of Nervous and Mental Disease, 182(7), 422B423.

Hopper, K. [Corresponding editor]. Monthly column of the Society for Urban Anthropology. Anthropology Newsletter.

Hopper, K. (in press). Unearned keep: A historical reading of provisions for homeless men in New York City. In P. Marcuse (Ed.), Reform and reality: Working class housing in New York City. Philadelphia: Temple University Press.

Hopper, K. (in press). Revisiting the unseen. SUNY-Stony Brook Distinguished Lecture Series.

Hopper, K. (in press). Margins within margins: Notes on homelessness among American-African men. In S. Nolutshungu (Ed.), The international security of marginal populations. University of Rochester Press.

Hopper, K. (in press). Commentary: Unresolved issues of informed consent in field settings. City and Society.

Hopper, K. (in press). Regulation from without: The shadow side of coercion. In D. Dennis & J. Monahan (Eds.), Coercion and Aggressive Community Treatment.

Hopper, K. (in press). Definitional quandaries and other hazards in Devine and Wright's "Housing Dynamics of Homeless Persons....." American Journal of Orthopsychiatry.

Hopper, K. (in press). Comment on U. Wikan, "Sustainable Development in the Mega-City." Current Anthropology.

Hopper, K. (in press). Essay review of recent books on homelessness, Culture, Medicine and Psychiatry.

Hopper, K. (1995). A presence effaced: Invisible homeless black men. Manuscript in preparation for volume in the Culture/Power/History series, Princeton University Press.

Jones, K., et al. (1994). A preliminary cost-effectiveness analysis of an intervention to reduce homelessness among the mentally ill. Psychiatric Quarterly, 65(4).

Laska, E., Meisner, E., & Siegel, C. (1994). Simple designs and model-free tests for synergy. Biometrics, 50, 834B841.

Laska, E.M., & Siegel, C. (1995). Characterizing onset in psychopharmacology clinical trials. Psychopharma-cology Bulletin, 31(4), 29B35.

Loneck, B. (in press). Getting persons with alcohol or other drug problems into treatment: Teaching the Johnson intervention in the practice curriculum. Journal of Teaching in Social Work.

Loneck, B., Banks, S.M., Coulton, C.J., Kola, L.A., Holland, T.P., & Gerson, S.N. (in press). Stress and outcome in the alcoholism intervention: A preliminary investigation. Alcoholism Treatment Quarterly.

Loneck, B., Garrett, J.A., & Banks, S.M. (in press). A comparison of the Johnson intervention to four other methods of referral to outpatient treatment. American Journal of Drug and Alcohol Abuse.

Loneck, B., Garrett, J.A., & Banks, S.M. (1995). Referral, reactance, and retention: The special case of the Johnson intervention. Submitted for publication.

Loneck, B., & Way, B. (1995). A conceptual model of therapeutic process for clients with a dual diagnosis. Submitted for publication.

Massaro, R. (1994). Integrating public mental health programs with general health networks: A challenge of the nineties. Submitted for publication.

Shern, D.L., Tsemberis, S., Winarski, J., Cope, N., Cohen, M., & Anthony, W. (in press). Implementing a psychiatric rehabilitation research demonstration for individuals who are street dwelling and who have serious disability. In J. Thompson and W. Breakey (Eds.), Innovative Programs for the Homeless Mentally Ill. New York: Harwood Academic Publishers.

Shern, D.L., Trochim, W., LaComb, C.A. (1995). The use of concept mapping to assess the fidelity of model transfer: An example from psychiatric rehabilitation. Evaluation and Program Planning, 18(2), 143B153.

Shern, D.L., Donahue, S.A., Felton, C., Joseph, G.A., & Brier, N. (1995). The impact of differing reimbursement mechanisms on provider behavior and client out-comes. Submitted for publication.

Shern, D.L., Lovell, A.M., Tsemberis, S., Anthony, W., LaComb, C.A., Richmond, L., Winarski, J., & Cohen, M. (1994). The New York City street outreach project: Serving a hard-to-reach population. Making a difference: Interim status report of the McKinney demonstration program for homeless adults with serious mental illness. (DHHS Publication No. SMA 94-3014). Washington, DC.

O'Neill, D. (in press). Measuring changes in resource use in state hospitals, 1969B990: The effect of alternative deflators. Administration and Policy in Mental Health.

Siegel, C., Laska, E. & Meisner, M. (in press). Statistical methods for cost-effectiveness analyses alongside clinical trials. Controlled Clinical Trials.

Sommers, I., & Baskin, D. (1995). Social selection and mental health service utilization among mentally ill parolees: A research agenda. Psychiatric Quarterly, 66, 1B20.

Surles, R. C., Petrila, J., & Evans, M. E. (1994). Redesigning emergency room psychiatry in New York. Administration and Policy in Mental Health, 22(2), 97B105.

Tang, D., & Lin, S. (in press). On improving some methods for multiple endpoints. American Statistical Association 1994 Proceedings.

Tang, D., & Lin, S. (1994). An approximate-likelihood-ratio test for comparing treatments to a control. Submitted for publication.

Way, B. B., McCormick, C. T., Evans, M. E., Fasnacht, R., & Bigley, M. (1994). Where have all the children gone? Movement from the children's to the adult mental health system. Submitted for publication.

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Update Feb. 1995

Update Sept. 1996

Last updated on November 8, 1996, by Elizabeth Pease