conducting controlled experiments, limiting randomness of outcomes, and producing findings that can be replicated by other scientists.

In contrast, the services world is driven by a desire to provide direct services to as many people as possible. Although the methods of service delivery are planned and evaluated, their internal integrity is often less important than the number of clients served. And while extensive reporting is often required by funding sources, this too is seen as less important to the mission of service providers than actually rendering the services—indeed, it is often seen as a distraction. Furthermore, unlike researchers, service providers are trained to be subjective, to identify with and to advocate for their clients. These fundamental differences in culture and orientation between researchers and service providers result in significant barriers to collaboration.

This situation is experienced at the federal level among agencies charged respectively with supporting research and services programs and is evidenced by the relatively limited collaborations between the AIDS research programs at NIAAA, NIDA, and NIMH and the AIDS services programs of SAMHSA, Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA), and the broader service-providing community. Even information exchange is limited. For example, each year the three research institutes sponsor many research exchange meetings, including research planning meetings, technical review meetings, workshops, and symposia. However, most of these meetings are designed to bring researchers together and very few reach beyond the research community to include service providers.

All but one (the CMHS demonstrations) of the examples of collaborations between research and services noted in Chapter 7 predate the reorganization of ADAMHA. Moreover, according to institute and agency staff, these collaborations came about as a result of informal communications between individual staff. No formal mechanism existed—or yet exists—to encourage interagency cooperation. Although within ADAMHA there had been tension between the research and services entities, some fear that the organizational separation of those entities will make collaboration even more difficult. In addition to cultural differences, legal and regulatory barriers also hinder collaboration between the institutes now at NIH and the services entities at SAMHSA (as well as HRSA and CDC).

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