ences, undated). The committee believes such discussions are critical to strengthening the appropriate use of all of the above types of research in building the evidence base on effective treatments for M/SU illnesses. However, the committee also believes that the methodologically sound use of these different research designs can produce empirical evidence useful for guiding initiatives to improve the delivery of M/SU care. The committee notes that care will continue to be delivered even in the absence of empirical evidence on the best (or better) ways of doing so; until further funding is made available for more rigorous (and more expensive) research designs, quasi-experimental and observational studies in usual settings of care can help inform improvements in care and its delivery.

Consistent with these conclusions, the committee makes the following recommendations.

Recommendation 9-1. The secretary of DHHS should provide leadership, strategic development support, and additional funding for research and demonstrations aimed at improving the quality of M/SU health care. This initiative should coordinate the existing quality improvement research efforts of the National Institute of Mental Health, National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism, Department of Veterans Affairs, Substance Abuse and Mental Health Services Administration, Agency for Healthcare Research and Quality, and Centers for Medicare and Medicaid Services, and it should develop and fund cross-agency efforts in necessary new research. To that end, the initiative should address the full range of research needed to reduce gaps in knowledge at the clinical, services, systems, and policy levels and should establish links to and encourage expanded efforts by foundations, states, and other nonfederal organizations.

Recommendation 9-2. Federal and state agencies and private foundations should create health services research strategies and innovative approaches that address treatment effectiveness and quality improvement in usual settings of care delivery. To that end, they should develop new research and demonstration funding models that encourage local innovation, that include research designs in addition to randomized controlled trials, that are committed to partnerships between researchers and stakeholders, and that create a critical mass of interdisciplinary research partnerships involving usual settings of care. Stakeholders should include consumers/patients, parents or guardians of children, clinicians and clinical teams, organization managers, purchasers, and policy makers.

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