Combining Two Passions: Clinical Service and Clinical Research

This column provides advice from well-established experts in the field of child and family policy on issues of interest to our early career members. We express our sincere gratitude to the two expert contributors of this column: Melissa E. DeRosier, PhD (president and executive director of the 3-C Institute for Social Development and 3-C Family Services) and Diane J. Willis ( professor emeritus of pediatrics at the University of Oklahoma Health Sciences Center ). The topic covered in this issue may be of general interest to the society as well as to student members in particular. If you have an ECP-related question for which you would like some expert advice and perspective, email them to Amy Damashek, chair of the ECP Committee.

Dear Abbey,

I would be interested in advice pertaining to starting a research-clinical setting. I plan to return to my hometown for postdoc following internship. My question pertains to long-term goals (not necessarily just postdoc). I ultimately want to provide clinical research and practice combined. However, my hometown does not have health science settings or similar settings that provide this type of service in the area I am interested in — or even close to the area I am interested in. Thus, I believe I will need to get creative and do a lot of networking and other professional development activities to create my dream job. Do you have advice on what steps to take to getting a combined program of clinical/research work in a particular area started (perhaps from scratch), when one is not in academia?

Sincerely,

Dreaming Big

Dear Dreaming Big,

This question is one that resonates with many of us in the field. While Div. 37 psychologists range from very research-focused to very clinically-focused, many of us are passionate about both areas. The search for ways to combine these two passions can be a continual but rewarding one. We asked a couple of psychologists who have made the choice to explore both their clinical and research passions to share their advice. They applauded your initiative in wanting to establish a new clinical-research undertaking. Indeed, Drs. DeRosier and Willis have themselves done ground-breaking work that combines research and clinical practice in their own careers. They shared advice both for establishing a research-practice balance in one's individual career and for establishing a larger program that combines both aims.

Both acknowledged the challenges of establishing a balanced career and creating a setting where clinical research and clinical service work side by side. As Dr. DeRosier says, “Too often, one or the other is seen as subordinate or secondary. In academic research settings, research has the upper hand, whereas in clinical services settings, research is secondary if present at all.” Collaboration and equality is key: “If we want to truly meld research and practice…each must work collaboratively and cooperatively with equal value and input.”

Creating your dream clinical/research career also takes initiative. As both respondents say, networking, reaching out and taking risks are necessary ingredients. Dr. Willis suggests reaching out to local institutions, such as hospitals. She writes, “Sometimes we must take a proposal to the administration of a hospital or to selected pediatricians and sit down with them to convince them of our research ideas. If there are large hospitals in your area, you might present an outline showing what you can do, the value of your proposal, and see what they say.”

In addition to hospitals, governmental offices and social services agencies may also be good potential collaborators, said Dr. Willis. For instance, if you are interested in child maltreatment research, you could approach a large Department of Human Services office, the Child Protective Services office, or the Developmental Disorders unit about working together on a project. If your interests lie in developmental problems, learning disabilities, or socio-emotional development, local school systems might also be open to working with you.

Dr. DeRosier notes, “I recommend you try to tease apart whether your true wish is to attain a dream job or a dream organization.” If you want to find the clinical research-clinical service balance within your own job, she strongly recommends a 50/50 split: “anything less equitable and the pull on your time and energy from the larger side will eat away at your productivity and focus on the smaller side.” If, on the other hand, you want to establish a combined research/practice setting, then “a variety of talents will be needed that probably weren't taught in your graduate program,” such as finance and management. Know that you may spend at least half your time doing administrative tasks. But the advantage is that “your efforts will have broader impact by leveraging the talents of many compared to what you can accomplish alone.”

There are rewards that can come from a proactive, entrepreneurial approach to creating the balanced career you desire. Dr. DeRosier's own path to balancing both clinical service and clinical research provides a fine example. She writes, “Twelve years ago, I had this dream also: to create a setting where clinical research and clinical service worked side by side, on equal footing. … To achieve my dream, I decided to found two separate companies…one focused on providing mental health services to families (3-C Family Services ) and one focused on conducting clinical research on mental health interventions (3-C Institute for Social Development).”

Dr. DeRosier's experience offers several lessons, both specific and general, for creating a combined clinical service and clinical research enterprise. Structurally, “for many practical reasons, it makes sense to keep these very different business models separate. A clinical service setting is driven by fees for service—from patients directly and through insurance companies—and generating this revenue requires a great deal of face-to-face marketing with referral sources and community outreach. Reputation, the skills of your clinical staff and word of mouth (by patients and referral sources) regarding the quality of your services will determine whether a clinical service setting is successful.” In contrast, she notes, “a clinical research setting is driven by grant funds which support the research. The scientific staff's skills at grant writing and conducting research, along with their publication and presentation track record, will determine whether a clinical research setting is successful.” As she points out, “each of these businesses requires unique legal, accounting, and administrative procedures, so keeping them separate helps maintain focus and avoid confusion.”

Dr. DeRosier's experience reveals the value of maintaining equal footing between practice and research. “Keeping the two entities separate and independent means they have equal status with neither beholden to the other.” Meanwhile, the advantages to an arrangement in which clinical service and clinical research coexist are innumerable: “the clinical and research staff can learn from one another and each can benefit from the resources, opinions, and expertise of the other” and “patients receive the most effective and appropriate treatment that science has to offer.” Moreover, “working with people with diverse perspectives translates into greater creativity and innovation on all sides. For example, research savvy clinicians can provide researchers with practical feedback so their intervention model is doable in real-world clinical settings. Researchers can also share recent advances in science directly with clinicians, so they can quickly put it into use with patients.”

Whatever path you choose, Dreaming Big, your respondents emphasize that a balanced frame of mind, encompassing both research-based and practice-based ideals, can be achieved. As Dr. DeRosier says, “even in a job where you must spend 100% of your day-to-day work hours completely on one side, it is possible to nurture a science-practitioner model through an active appreciation of the other side and an active engagement with individuals on the other side.”