Annual Report- Year 1

View the Annual Report as a PDF.

EXECUTIVE SUMMARY

The Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP) was established as the newest Center of Emphasis by the Harborview Medical Center (HMC) Board of Trustees in January, 2006 with the appointment of Peter Roy-Byrne, MD as Director.  CHAMMP’s focus is on research and training.  Its primary mission is to improve the quality and coordination of care of disadvantaged patients with co-morbid medical and mental health (including addictions) problems at Harborview Medical Center (HMC), in King County, and across Washington State.

CHAMMP has three integrated goals:  (1) Funded research collaborations that design and test innovative programs of evaluation and treatment, (2) Partnerships with community stakeholders that develop new projects and disseminate findings from previous projects through expert training, and (3) Expansion of data linkages and treatment coordination throughout the state using a pilot integrated database at HMC as a template.

This report contains a review of CHAMMP’s first year.  Because funding started in January, 2006, the first year was actually six months instead of twelve, January 2006 through June, 2006. 

Accomplishments
Goal #1:  Funded Research Collaborations

• Paul Ciechanowski, MD, MPH, successfully recruited to serve as CHAMMP faculty
• Four new funded collaborative projects underway since January 2006
• Three small grant awards made to non-psychiatry HMC faculty
• Seven new grant proposals submitted between January and July 2006
• Monthly CHAMMP Research Presentations established

Goal #2:  Partnerships with Community Stakeholders

• Formal relationship established with Washington Institute for Mental Illness Research & Training (WIMIRT), both Western and Eastern Branches
• Formal relationship with Washington State Mental Health Division established
• Center faculty have been active participants in the state’s Mental Health Transformation Grant, a federally funded initiative administered by the Governor’s Office to transform the state’s mental health system

 Goal #3:  Expansion of Data Linkages and Treatment Coordination

• A methodology core has been established with a director and two research analysts
• Joan Russo, PhD has been selected to serve as Methods Core Director
• A contract between CHAMMP and the state Department of Social and Health Services (DSHS)  has been finalized to carry out a collaborative project involving the sharing of data from state databases
• There have been several meetings between DSHS and CHAMMP faculty to discuss the potential of broader data sharing in the future

Center Operations, Management, and Pubic Relations

• Toni Krupski, PhD was hired as CHAMMP Associate Director
• CHAMMP has been incorporated into the HMC Centers of Emphasis website
• CHAMMP administrative meetings are held regularly

Some Future Goals
   Year 2 Goals (July 1, 2006 – June 30, 2007)

• Create stand-alone CHAMMP website with links to the HMC website
• Fund 3 to 5 new seed grants
• Produce a report summarizing data on prevalence and types of mental health/addiction problems among patients served with HMC’s ambulatory and hospital/medical/surgical settings and the care received
• Develop and submit more CHAMMP collaborative grant applications to federal agencies

   Year 3 Goals (July 1, 2007 – June 30, 2008)

• Hold a Fall conference
• Continue to develop and submit CHAMMP collaborative grant applications to federal agencies
• Prepare application to obtain fellowship funding
• Create mechanisms to disseminate findings from collaborative projects to health care providers at HMC

   Year 4 – Year 6 Goals (July 1, 2008 – June 30, 2011)

• Create mechanisms to disseminate findings from collaborative projects to the community of health care providers
• Produce a report that summarizes data on gaps in treatment and the level of treatment success for patients with mental health/addiction problems served within HMC’s ambulatory and hospital/medical/surgical settings
• Pursue the establishment of an endowed chair to be located at HMC for support of the Center’s director

Expenditures & Funding

• In Year 1, HMC committed $100,000 for start-up CHAMMP core funding.  These funds did not become available until January, 2006 so that Year 1 actually consisted of five months rather than twelve.  Of the $100,000, $71,158 was expended prior to the end of the fiscal year (June 30, 2006), leaving $28,842 unspent
• For Year 2, HMC has committed $400,000 for CHAMMP core funding.  Additional funding is expected to be provided by other sources such as federal grants and state contracts.
• For Years 3 through 6, HMC has committed $500,000 per year for CHAMMP core funding.  As in previous years, additional funding is expected to be provided by other sources such as federal grants and state contracts.

OVERVIEW

The Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP) was established as the newest Center of Emphasis by the Harborview Medical Center (HMC) Board of Trustees in January, 2006 with the appointment of Peter Roy-Byrne, MD as Director.  CHAMMP’s focus is on research and training.  Its primary mission is to improve the quality and coordination of care of disadvantaged patients with co-morbid medical and mental health (including addictions) problems at Harborview Medical Center (HMC), in King County, and across Washington State.

CHAMMP has three integrated goals:  (1) Funded research collaborations that design and test innovative programs of evaluation and treatment, (2) Partnerships with community stakeholders that develop new projects and disseminate findings from previous projects through expert training, and (3) Expansion of data linkages and treatment coordination throughout the state using a pilot integrated database at HMC as a template.

The report that follows contains a review of CHAMMP’s first year, including a summary of accomplishments, future directions, and expenditures & funding.  Because funding started in January, 2006, the first year was actually six months instead of twelve, January 2006 through June, 2006. 

YEAR 1 ACCOMPLISHMENTS 

Goal #1:  Funded Research Collaborations (new, since January, 2006)

• Paul Ciechanowski, MD, MPH, Associate Professor, Psychiatry and Behavioral Sciences, and nationally recognized expert in patient-provider relationships was successfully recruited to serve as CHAMMP faculty.  Dr. Ciechanowski has already developed collaborative efforts with Department of Medicine faculty.  A recently funded project from the Centers for Disease Control will study the effectiveness of a community-based in-home depression treatment for relatively home-bound patients with epilepsy.  This randomized controlled trial will recruit subjects attending the Regional Epilepsy Center at Harborview Medical Center.  Another project, funded by the National Institute of Diabetes and Digestive and Kidney Diseases, will explore the benefits of providing a patient “ombudsperson” to underserved patients with diabetes and poor glucose control who attend Harborview’s Ambulatory and Allied Care Services.  Effects of such a service on treatment adherence, self-care, and diabetes outcomes in patients who may not be apt to collaborate effectively around their chronic illness(es) will be a primary focus of this project.

• CHAMMP Investigators Rick Ries, MD,  Kate Comtois, PhD, and Joan Russo, PhD received a contract from Washington State to evaluate the Global Appraisal of Individual Needs Short Screener (GAIN-SS), a 10 minute clinical screening tool to establish low versus high severities of mental and addictions disorders.  A second purpose was to find the “fit” between scores on the GAIN-SS and the Co-occurring Disorders Matrix, a tool developed by Dr Ries for co-occurring addictions and mental disorder treatment planning.   The GAIN-SS is mandated to be used for all publicly funded mental health and addictions programs as well other select social service programs throughout Washington State.  Data from this study are already being used statewide in GAIN-SS trainings.

• CHAMMP Investigator, Doug Zatzick, MD, is collaborating with Dedra Buchwald, MD, Professor of Medicine, Internal Medicine, on a project that will enhance the care of vulnerable American Indian survivors of physical trauma. The project will bridge acute trauma center care with distant American Indian primary care and community clinics across Washington State.

• A small grant program was set up to provide small (under $15,000) grants for HMC investigators in other (i.e., non-psychiatry) departments to pursue collaborative projects.  Three awards were made.  The first recipients, awarded grants in July 2006 were:  Chia Wang, MD, MS, Elizabeth Phelan, MD, MS, and Jordan Firestone, MD, PhD, MPH in collaboration with Stephen C. Hunt, MD, MPH.

• Dr. Wang, Assistant Professor of Medicine, Allergy and Infectious Diseases, works with Hepatitis-C patients, many of whom engage in intravenous drug abuse and who also have depression.  Her CHAMMP-funded study is designed to define and explore the utility of two inventories in the diagnosis of depression in ex-intravenous drug users with chronic Hepatitis-C Virus.  It is hoped that the results of this study will increase understanding of the implications of depression with regards to antiviral treatment, outcome, and status of the medical condition.  A related aim of the study is to explore the relative contribution of somatic and non-somatic self-reported symptoms to the overall results obtained with these tools.

• Dr. Phelan is Assistant Professor of Gerontology and Geriatric Medicine.  Her CHAMMP-funded project represents a collaboration with CHAMMP-investigator Mark Snowden, M.D., and is focused on prospectively evaluating the performance of the Patient Health Questionnaire-9 (PHQ-9) in diagnosing depression in elderly patients with multiple co-morbidities being served in primary care.  Late life depression is known to be under-recognized and inadequately treated.  If the PHQ-9 is shown to be useful with this patient population, it could lead to improvements in identification and treatment of depression in elders which may, in turn, lead to improved function, survival, and quality of life.

• Dr. Firestone is Acting Assistant Professor of Neurology, Acting Assistant Professor of Medicine, General Internal Medicine, Occupational and Environmental Medicine, and Acting Director of the Harborview Occupational and Environmental Medicine Clinic (OEMC).  He is collaborating on this project with Dr. Hunt who is Clinical Assistant Professor of Medicine, General Internal Medicine, Occupational and Environmental Medicine.  In their CHAMMP-funded project, these investigators will evaluate whether more effective recognition and treatment of mental health conditions can minimize functional impairment and improve employment performance among individuals being seen in the OEMC.  An important aim of this study is to describe a model of enhanced, integrated, multidisciplinary treatment that addresses mental health conditions in the Harborview OEMC patient population. 

These investigators also aim to characterize the mental health conditions and assess the needs for mental health treatment in their study.  Finally they hope to identify and develop instruments for tracking information necessary to analyze the effects of co-morbid mental and physical conditions on employment-related outcomes.

• Grant proposals submitted since January 2006:
• Kate Comtois, PhD, “Dialectical Behavioral Therapy-Accepting the Challenges of Exiting the System:  Evaluation of Feasibility”, submitted to NIH/NIMH in May, 2006 and requesting funding in the amount of $234,000.00. 

This project is focused on persons who have severe borderline personality disorder. Its goal is to assess an advanced level of Dialectical Behavioral Therapy (DBT) designed to provide skills leading to improved self-sufficiency and employment.  Earlier work with this intervention has produced anecdotal success with the majority of clients.  The specific objective of this proposal is to take this promising intervention to the next level by further codifying the treatment in a manual, measuring adherence to the program, and determining how feasible it will be to conduct a randomized controlled trial of its efficacy. 

• Kate Comtois, PhD, “The Caring Letter Intervention:  Evaluation of Feasibility”, submitted to NIH/NIMH in May, 2006 and requesting funding in the amount of $701,125.00.  

The purpose of this project is to evaluate the feasibility of implementing an intervention that consists of sending a series of non-demanding but caring letters hand-signed by the hospital-based psychiatrist to high risk patients discharged from the facility following treatment of suicidal behavior.  Previous research suggests that this intervention may reduce suicide and self-inflicted injuries.

• Rick Ries, MD, “Contingency Management of Psychostimulant Abuse in the Severely Mentally Ill”, submitted to NIH/NIMH in January 2006 and requesting funding in the amount of $1,931,627.

The purpose of this project is to carry out a randomized clinical trial designed to assess the efficacy of a contingency management strategy focused primarily on treating stimulant (methamphetamine, amphetamine, and/or cocaine) abuse in individuals with severe mental illness who are attending an urban Community Mental Health Center.  The primary aim is to determine if the intervention is successful in stopping or decreasing illicit drug use.

• Doug Zatzick, MD, “Disseminating Organizational Screening and Brief Intervention Services (DO-SBIS) at Trauma Centers”, submitted to NIH/NIAAA in February, 2006 and requesting funding in the amount of $3,820,735.

In January 2005, the American College of Surgeons passed a landmark resolution mandating that level 1 trauma centers screen injured patients for an alcohol use disorder and provide an intervention to those who screen positive.  The goal of this project is to take early steps to insure high quality evidence-based screening and brief intervention (SBI) procedures are implemented and outcomes assessed.  Two specific aims are to describe changes in SBI services before and after the mandate and to assess readiness for widespread SBI dissemination for level 1 trauma centers nationally.  A third aim is to conduct a randomized clinical trial with 20 level 1 trauma centers where outcomes of evidence-based SBI services are evaluated.

• Paul Ciechanowski, MD, MPH, “Diabetes CAReS:  Care Aligned with Relationship Styles”, submitted to Nordisk Pharmaceuticals, Inc. in April, 2006, and requesting funding in the amount of $199,988.

Non-adherence to medication and glucose-testing are important reasons for poor outcomes in patients with diabetes.  This project is designed to test the effectiveness of an intervention—Care Aligned with Relationship Styles (CAReS)--in the treatment of insulin-using patients with diabetes.  The CAReS intervention is delivered by a “patient care facilitator” who enhances existing diabetes treatment by closely aligning care with patients’ relationship style characteristics through patient coaching, motivational interviewing-enhanced problem solving, and point-of-service question prompts provided to clinicians at the time of diabetes health visits.  Specific aims of the project include:  1). Recruiting, training, certifying, and supervising a patient care facilitator; 2). Conducting a randomized controlled trial to test the effectiveness of the CAReS intervention versus usual care with 100 study-eligible patients as a way of improving insulin adherence, diabetes self-management and outcomes; 3). Determining the intervention’s acceptability and feasibility at the patient, provider, patient care facilitator and clinic level for eventual broad dissemination within tertiary care and community-based primary care clinics.

• Craig Sawchuk, PhD, “Improving Primary Care Treatment for American Indians with Anxiety and Depression”, submitted to NIH/NIMH in May, 2006 in the amount of $695,829.

Over 60% of American Indians live in urban areas where access to mental health care is typically limited and quality is poor. Yet anxiety and depression are common and management of these conditions occurs largely in the primary care sector where screening and intervention protocols are virtually non-existent. The educational, training, and research activities outlined in this proposal will provide Dr. Sawchuk with the required skills in clinical psychiatric research to begin to appropriately address these inequities.  The specific aims of this program are to 1). Learn strategies to assess culturally-relevant manifestations of anxiety and depression; 2). Learn methods to deliver skill-based treatment for anxiety and depression in primary care; and 3). Develop, implement, and assess the feasibility of a culturally-relevant, skill-based intervention for anxiety and depression in an urban American Indian primary care setting. 

• W. R. Murray Bennett, MD in collaboration with Eric Strachan, PhD, “Treatment of Stimulant Dependence in HIV Infected Patients with Prize-Based Contingency Management” submitted as a small grant proposal to the University of Washington Alcohol and Drug Abuse Institute in March, 2006 in the amount of $20,000.

Stimulant use is associated with both negative health outcomes and risky behaviors that are linked with the spread of HIV.  This project is designed to evaluate the feasibility, acceptability, and efficacy of using contingency management to decrease stimulant use and increase engagement with routine medical care among HIV-positive patients at Harborview’s Madison Clinic.  This project is viewed as a pilot that will serve as a demonstration for a larger grant to develop a low-cost stimulant treatment and medical engagement program for HIV clinics.

• Monthly CHAMMP-related research presentations have been ongoing since July, 2006.  They are held from 8:00 am to 9:00 am on the first Friday of the month.  All investigators, collaborators, and other interested persons are invited to attend to learn about ongoing CHAMMP research and to provide input. 

• What HMC Populations are receiving clinical benefits from CHAMMP research?
• Improved Assessment:
• Hepatitis C (through projects led by Chia Wang, MD, MS)
• Geriatric Medicine (through projects led by Elizabeth Phelan, MD, MS)
• Occupational Medicine (through projects led by Jordan Firestone, MD, MPH, PhD & Stephen C. Hunt, MD, MPH)

• Enhanced Treatment
• Adult Medicine Clinic Patients (through projects led by Peter Roy-Byrne, MD)
• Trauma Surgery (through projects led by Doug Zatzick, MD)
• Epilepsy (through projects led by Paul Ciechanowski, MD, MPH)
• Diabetes (through projects led by Paul Ciechanowski, MD, MPH)
• Nursing Homes (through projects led by Mark Snowden, MD, MPH)

• A list of CHAMMP faculty and collaborators is included on pages 18-19 of this report.

CHAMMP Goal #2:  Partnerships with Community Stakeholders

• Relationships with the two branches of the Washington Institute for Mental Illness Research & Training (WIMIRT) have been enhanced over the last year in at least two ways:
• CHAMMP investigator, Kate  Comtois, PhD, has been named a member of the Leadership Team of the Western branch of WIMIRT
• CHAMMP investigator Rick Ries, MD has established ongoing research collaborations with the director of the Eastern branch of WIMIRT, John Roll, PhD

• CHAMMP investigator, Rick Ries’, MD, recent appointment as Medical Director for the state Mental Health Division coupled with his existing appointment as Medical Director for the State Division of Alcohol and Substance abuse will strengthen ties to the state divisions that focus on co-occurring (addiction/mental illness) disorders.  (See GAIN-SS project under Goal #1.)

• Several key center faculty have participated in the state’s Mental Health Transformation Grant, a federally-funded initiative administered by the Governor’s Office, which is focused on transforming the state’s mental health system. 
• Of particular note, Mark Snowden, MD, chaired the Evidence Based/Promising Practice Task Group while Peter Roy-Byrne, MD, Rick Ries, MD, and Kate Comtois, PhD served as members.  This was one of four task groups responsible for identifying strategies and initiatives that were considered in the preparation of the State of Washington’s Mental Health Comprehensive Plan.
• Joan Russo, PhD, served as a member of the Management Information Systems/Data Task Group.
• A number of key faculty have been ongoing participants in the Research Subcommittee of the Mental Health Transformation Grant including Peter Roy-Byrne, MD; Rick Ries, MD, Mark Snowden, MD, MPH; Kate Comtois, PhD; Joan Russo, PhD, and Debra Srebnik, PhD.

• CHAMMP was invited to collaborate with the Governor’s office (through the state Mental Health Transformation Grant) to provide training to a group representing the Substance Abuse and Mental Health Services Minority Fellowships Program which is part of the American Nurses Association.

CHAMMP Goal #3:  Expansion of Data Linkages and Treatment Coordination

• A methodology core that includes design, assessment and data analytic methodologists has been developed.  
• Joan Russo, PhD has been selected to head the methodological core.  She is a recognized methodologist, having over 20 years of experience consulting on methodological issues at HMC and the University of Washington Medical School. 
• Two research analysts have been hired, one of whom is currently being trained to provide consultation to investigators and collaborators.  A second is currently trained to query hospital automated data systems.  A full-time research coordinator is expected to be hired by the first of the year.

• A contract from the Washington State Department of Social and Health Services (DSHS) to University of Washington, CHAMMP to assess outcomes of patients screened at HMC in the Washington State Screening, Brief Intervention, Referral and Treatment Program (WASBIRT) was finalized in November 2006.  Joan Russo, PhD is the Principal Investigator.  The contract represents a collaboration between CHAMMP and the Washington State DSHS, Division of Alcohol and Substance Abuse (DASA), the organization that was funded to develop and implement the WASBIRT Project statewide.  Data sharing is an important component of this contract.  It is expected that the procedures developed in this project will serve as a prototype for future data sharing efforts.

• There have been two meetings with the DSHS Research and Data Analysis Division (RDA) to discuss the potential of broader data sharing in the future. 

RDA has data bases that contain linked service and cost data for all individuals receiving DSHS services in Washington State. This rich data source would permit a wide variety of research inquiries for CHAMMP investigators and collaborators.

Center Operations, Management, and Public Relations

• Toni Krupski, PhD was hired as the Associate Director for CHAMMP Operations in October 2006.   Having worked as the Director of Research for the state Division of Alcohol and Substance Abuse for over a decade, she brings strong ties to state government, experience with state administrative data, and experience with policy to CHAMMP.

• CHAMMP has been incorporated into the HMC Centers of Emphasis website.

• CHAMMP administrative meetings have been held twice a month since August, 2006.  These meetings are used to obtain input from investigators on various operational issues related to the center such as website design, CHAMMP faculty recruitment, hiring Research Analysts for the methodological core, and the like.

FUTURE GOALS

Year 2 Goals
(July 1, 2006 – June 30, 2007)

• Create a stand-alone CHAMMP website with links to the HMC website
• Fund 3 to 5 new seed grants
• Follow-up on grants awarded in Year 1 to support their being used in the development of proposals for larger federal or foundation grants
• Establish a HMC quality assurance project that has as its first product a report providing data on prevalence and types of mental health/addiction problems among patients served within HMC’s ambulatory and hospital/medical/surgical settings.   The report would also include information about the care received.       
• Establish a computer network to support the development of a data base registry, data linkage functions, and data analytic functions of CHAMMP
• Develop collaborations with the Schools of Social Work and Nursing
• Develop and submit more CHAMMP collaborative grant applications to federal agencies such as National Institutes of Health (NIH), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute of Mental Health (NIMH), Centers for Disease Control and Prevention (CDC), and Agency for Healthcare Research and Quality (AHRQ)
• Establish regularly scheduled meetings with state staff to continue to build and nurture CHAMMP-state relationships (e.g., Liz Kohlenberg, PhD, Director, Division of Research and Data Analysis, Department of Social and Health Services (DSHS); Doug Allen, Director, DSHS Division of Alcohol and Substance Abuse; Ken Stark, Director, Mental Health Transformation Grant, Office of the Governor;  Richard Kellogg, Director, DSHS Mental Health Division; and Jeff Thompson, MD, Medical Director, DSHS Health and Recovery Services Administration)

Year 3 Goals
(July 1, 2007 – June 30, 2008)

• Hold a Fall conference to introduce CHAMMP to the public and various health professionals.   A focus on evidence-based treatments for disadvantaged patient populations with medical-psychiatric co-morbidity (including addictions)  is one possible theme for such a conference
• Continue to develop and submit CHAMMP collaborative grant applications to federal agencies
• Prepare application for a T32 fellowship focused on understanding and treating disadvantaged patients with medical, psychological, and substance use co-morbidities.
• Develop a plan that expands the HMC quality assurance project’s ability to track patients using methods of increasing complexity from the use of already available administrative data to successive phases which look to accessing other existing data sources as well as developing new sources
• Finalize plans for relocation of center infrastructure and leadership (at this time, infrastructure is in one place and leadership is in another)
• Identify a mechanism that has potential to provide long-term core center funding
• Develop a newsletter
• Decide on advisory board structure and membership
• Create mechanisms to disseminate findings from collaborative projects to health care providers at HMC

• Continue to develop and submit CHAMMP collaborative grant applications to federal agencies
• Create mechanisms to disseminate findings from collaborative projects to the community of health care providers
• Establish partnerships with community stakeholders to develop new ideas for future collaborative projects and to facilitate access to state and federal funds that could be leveraged with grant monies to improve quality of care
• Develop an aggregated data system, incorporating data elements from multiple sources within HMC  that will allow systematic data retrieval and free access to data tables
• Create a report that provides data on gaps in treatment/care and the level of treatment success for patients with mental health/addiction problems served within HMC’s ambulatory and hospital/medical/surgical settings.
• Pursue the establishment of an endowed chair to be located at HMC for support of the Center’s Director

EXPENDITURES & FUNDING

In Year 1, HMC committed $100,000 for start-up CHAMMP core funding.  These funds  did not become available until January 2006 so that Year 1 actually consisted of five months rather than twelve.  Of the $100,000, $71,158 was expended prior to the end of the fiscal year (July 30, 2006), leaving $28,842 unspent. 

For Year 2, HMC has committed $400,000 for CHAMMP core funding.  Additional funding is expected to be provided by other sources such as federal grants and state contracts.

For Year 3 through Year 6, HMC has committed $500,000 per year for CHAMMP core funding.  As in previous years, additional funding is expected to be provided by other sources such as federal grants and state contracts.

Faculty
CHAMMP FACULTY
(Based at Harborview Medical Center)

	Director
	Peter Roy-Byrne, MD		Psychiatry and Behavioral Sciences
	Associate Director
	Toni Krupski, PhD		Psychiatry and Behavioral Sciences
	Methods Core Director
	Joan Russo, PhD		Psychiatry and Behavioral Sciences
	Investigators
	David Avery, MD		Psychiatry and Behavioral Sciences
	Lucy Berliner, LICSW		School of Social Work, Center for Sexual Assault & Traumatic Stress
	Dedra Buchwald, MD		Medicine, General Internal Medicine
	Paul Ciechanowski, MD, MPH		Psychiatry and Behavioral Sciences
	Naomi S. Chaytor, PhD		Neurology, Regional Epilepsy Center
	Lisa Chew, MD, MPH		Medicine, General Internal Medicine
	Kate Comtois, PhD		Psychiatry and Behavioral Sciences
	Heidi Crane, MD, MPH		Medicine, Allergy and Infectious Diseases
	Christopher Dunn, PhD		Psychiatry and Behavioral Sciences
	Jordan Firestone, MD, PhD, MPH		Medicine, General Internal Medicine, Occupational And Environmental Medicine and Neurology
	Robert Harrington, MD		Medicine, Allergy and Infectious Diseases
	Stephen C. Hunt, MD, MPH		Medicine, General Internal Medicine, Occupational And Environmental Medicine
	Daniel Lessler, MD, MHA		Medicine, General Internal Medicine
	James LoGerfo, MD, MPH		Medicine, General Internal Medicine
	Barbara McCann, PhD		Psychiatry and Behavioral Sciences
	John Miller, MD, PhD		Neurology, Regional Epilepsy Center
	Jagoda Pasic, MD		Psychiatry and Behavioral Sciences
	Elizabeth Phelan, MD, MS		Medicine, Gerontology and Geriatric Medicine
	Richard Ries, MD		Psychiatry and Behavioral Sciences
	Craig Sawchuk, PhD		Psychiatry and Behavioral Sciences
	Mark Snowden, MD, MPH		Psychiatry and Behavioral Sciences
	Debra Srebnik, PhD		Psychiatry and Behavioral Sciences
	Eric Strachan, PhD		Psychiatry and Behavioral Sciences
	Karina Uldall, MD, MPH		Psychiatry and Behavioral Sciences
	Chia Wang, MD, MS		Medicine, Allergy and Infectious Diseases
	Doug Zatzick, MD		Psychiatry and Behavioral Sciences

CHAMMP COLLABORATORS
(Based outside of Harborview Medical Center)

	Sharon Estee, PhD		Washington State Department of Social and Health Services, Research and Data Analysis Division
	Meg Cristofalo, MSW, MPA		School of Social Work
	Maria Monroe-DeVita, PhD		Psychiatry and Behavioral Sciences and Washington Institute for Mental Illness Research and Training (Western Branch)
	John Roll, PhD		Washington Institute for Mental Illness Research & Training (Eastern Branch), Washington State University
	Eric Trupin, PhD		Psychiatry and Behavioral Sciences and Washington Institute for Mental Illness Research and Training (Western Branch)

For further information about CHAMMP, please contact:

Toni Krupski, Ph.D.
Associate Director, CHAMMP &
Research Associate Professor
University of Washington at
Harborview Medical Center, Box 359911
325 9th Avenue
Seattle, Washington 98104
Telephone:  (206) 341-4215
Fax:  (206) 731-3236
e-mail:  krupski@u.washington.edu

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