Research on Child and Adolescent Mental Health

need for additional ethical precautions, the
necessary involvement of families, the use of proxy
informants, and sample size issues; (2) child
psychiatric training requires longer training periods
than traditional programs because trainees in many
disciplines must complete regular programs and
then complete additional pediatric training; and (3)
free-standing children’s hospitals and general
hospitals and their child training programs, in
general, are not reimbursed by Medicare for
graduate training similar to other clinical programs,
and thus bear a higher portion of all training costs.
Funding Trends at NIMH—
<strong>Research</strong> and Training Grants
Funding trends at NIMH highlight some of these
issues. Overall, there has been an increase in the
number of grants on research related to children
and adolescents over the decade since the first
NIMH National Plan for <strong>Research</strong> on Child and
Adolescent Mental Disorders. From 1989 to 2000,
the number of child-related grants funded by NIMH
increased from 460 to 775 (see Figure A), and the
amount of funding increased from $95 million to
$262 million (see Figure B). The increase in
research in the child area is proportionate to the
increase in the overall NIMH research portfolio. In
other words, despite the increase in numbers, the
percentage of grants related to children and
adolescents has actually remained steady as a
proportion of the overall NIMH portfolio, both in
terms of number of grants (approximately onequarter;
see Figure A) and amount of funding
(approximately one-third; see Figure B).
Training funds include career awards (K grants),
individual fellowships (F’s), and institutional
training grants (T’s). Over the past decade, the
distribution of training funds has shifted. Of the
research funds related to children and adolescents
(see Figure C), institutional training grants have
not kept pace over the last 10 years. The proportion
of institutional training grants has decreased in
comparison to the total child portfolio, while career
awards (K’s) targeted at bringing in new researchers
have increased proportionately. Training
fellowships aimed at supporting pre- and
postdoctoral trainees have remained quite constant
(at or below 0.5 percent). When viewed in context
of how training grants are funded across the whole
Institute (Figure D), it appears that the trend of
decreased institutional training grants and
increased K awards over the past 10 years is
reflected Institute-wide. However, individual child
training fellowships have not kept pace with the
fellowship-funding pattern of the overall Institute.
The percentage of funds allocated for fellowship
training across the Institute is consistently double
the percentage for child research. A second trend is
the shift in funding from institutional training
awards to career awards. Because institutional
training grants are important in preprofessional
training, the implication of this shift is that less
money for training is available early on in the
careers of potential child mental health
investigators, a time when critical career choices
are being made. At the same time, K awards are
critically important to research career development.
Currently, no formal mechanism is available to
support interdisciplinary research training.
Training Issues From the
Perspective of Professional
Associations
The workgroup considered a wide range of trainingrelated
problems and issues central to research in
child mental health. In its deliberations, the
workgroup solicited input from approximately 10
major professional associations involved in training
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