Clinical Research at South County Psychiatry

A core part of our mission at South County Psychiatry (SCP) is the active engagement of our clinicians with the review, conduct, and dissemination of research intended to improve the quality of lives for people under our care.

Most research is conducted in large hospital and university settings, which doesn’t fully capture the “real life” experience of patients’ participating in treatment for mental health. At SCP we embrace the active role of private practice clinicians as consumers and producers of treatment research. We aim to better represent your experience to the research community, and therefore to actively contribute to improved outcomes for everyone we treat.

South County Psychiatry (SCP) is delighted to provide the first private practice branch of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project.

The MIDAS project is a massive clinical research undertaking with the goal of fully integrating high quality, evidence-based research assessment methods into routine clinical practice. Under the direction of Dr. Mark Zimmerman, the MIDAS project has been ongoing for over 40 years and has enrolled more than 10,000 psychiatric patients presenting for treatment across a variety of settings.

Instead of a typical clinical intake, individuals presenting for care in this context receive a comprehensive evaluation including the SCID for Axis I disorders, SIDP for Axis II disorders, psychiatric family history evaluation, childhood trauma assessment, psychosocial functioning assessment, and collection of demographic features. Data on the patient experience such as satisfaction is also actively collected and used for ongoing program evaluation and improvement.

To date, over 350 scientific publications speaking to diagnosis, functioning, and the patient experience in routine clinical care have been generated from this work.

The focus of this project is ambitious, and the ultimate goal is the prediction of treatment course and outcome from baseline characteristics (e.g., diagnoses, symptoms, and demographics). This project serves as a clinical laboratory wherein the course and comparative outcome of psychological and psychiatric treatment can be monitored. An important component of this research effort is to examine which variables are most strongly predictive of patients’ overall evaluation of treatment efficacy.

The primary goal of our scale development effort is the development of clinically useful scales for routine practice. Thus far we have developed and published the Clinically Useful Depression Outcome Scale (CUDOS), Clinically Useful Anxiety Outcome Scale (CUXOS), Clinically Useful Social Anxiety Disorder Outcome Scale (CUSADOS), and Clinically Useful Anger Outcome Scale (CUANGOS). More recently, the Remission from Depression Questionnaire (RDQ) has been developed from funding from NIMH and a pharmaceutical company. Most recently, our group has developed the Difficult to Treat Depression Questionnaire (DTDQ)—a measure of the recently described concept of difficult to treat depression and which predicts treatment outcome.

We have published multiple papers assessing treatment outcomes, including on the effectiveness of partial hospital (PHP) level care and studies showing equivalent outcomes comparing in-person to virtual treatment delivery. With our recent shift from PHP level to intensive outpatient (IOP) care it will be important to compare outcomes in treatment programs that significantly differ in cost and intensity. The results of this comparison have the potential to significantly impact how intensive treatment is delivered in an outpatient setting.

Mark Zimmerman is the Chief of Psychiatry and Behavioral Health and Director of the Intensive Outpatient Program at South County Psychiatry, and a professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University.

Dr. Zimmerman is the principal investigator and director of the MIDAS project which seeks to integrate research methodology into routine clinical practice (described above).  His research interests are broad, and include accurate and balanced psychiatric diagnoses, psychopharmacological and psychotherapeutic treatment outcomes, psychiatric assessment issues, and the implementation and design of measurement-based care.  Currently he is examining the effectiveness and variables predicting outcomes of treatment in an intensive outpatient (IOP) setting. Dr. Zimmerman is the author of more than 450 articles published in peer-reviewed journals and is on the editorial board of 10 journals. He is the associate editor of the Journal of Personality Disorders and was the section editor of the Personality Disorders chapter in the upcoming revision of DSM-5. He is also the author of the widely utilized Interview Guide to Diagnose DSM-5 Psychiatric Disorders and the Mental Status Examination.

Zimmerman, M. (in press). The value and limitations of self-administered questionnaires in clinical practice and epidemiological studies. World Psychiatry.

Zimmerman, M. & Spitzer, R. (in press). Psychiatric classification. In B.J. Sadock and V.A. Sadock (Eds) Kaplan and Sadock’s Comprehensive Textbook of Psychiatry (ninth edition). Lippincott Williams & Wilkins, Baltimore, MD.

Zimmerman, M., D’Avanzato, C., & King, B. (2023). Telehealth treatment of patients with major depressive disorder during the COVID-19 pandemic: comparative safety, patient satisfaction, and effectiveness to prepandemic in-person treatment. Journal of Affective Disorders, 323, 624-630.

Zimmerman, M. & Becker, L. (2022). Psychiatric patients who do not believe they deserve to get better. Journal of Clinical Psychiatry, 83(4), 1-3.

Zimmerman, M.., Benjamin, I., & Seijas-Rodriguez, C. P. (2022). Psychiatric diagnoses among transgender and gender diverse patients compared to cisgender patients. Journal of Clinical Psychiatry, 83(6), 14062.

Zimmerman, M., Ward, M., D’Avanzato, C.,  & Tirpak, J.W. (2022). Telehealth treatment of patients with borderline personality disorder in a partial hospital setting during the COVID-19 pandemic: comparative safety, patient satisfaction, and effectiveness to in-person treatment. Journal of Personality Disorders, 36(3), 277–295.

Ward, M., Benjamin, I. & Zimmerman, M. (2022). The clinical characteristics of patients with borderline personality disorder in different treatment settings? Journal of Personality Disorders, 36(2), 217-229.

Zimmerman, M. (2021)Using screening scales for bipolar disorder in epidemiologic studies: lessons not yet learned. Journal of Affective Disorders, 292, 708-713.

Zimmerman, M., Benjamin, I., Tirpak, J.W., & D’Avanzato, C. (2012). Patient Satisfaction with Partial Hospital Telehealth Treatment During the COVID-19 Pandemic: Comparison to In-Person Treatment. Psychiatry Research, 301, 113966

Zimmerman, M., Terrill, D., D’Avanzato, C.,  & Tirpak, J.W. Telehealth Treatment of Patients in an Intensive Acute Care Psychiatric Setting During the COVID-19 Pandemic: Comparative Safety and Effectiveness to In-Person Treatment. Journal of Clinical Psychiatry, 2021;82(2):20m13815

Zimmerman, M., Kerr, S., Kiefer, R., Balling, C., & Dalrymple, K. (2019). What is anxious depression? Overlap and agreement between different definitions. Journal of Psychiatric Research, 109, 133-138.

Zimmerman, M., Mehring, L.B., Moon, S., & Guzman Holst, C. (2019). Measuring psychiatric patients satisfaction with the initial evaluation. Psychiatry Research, 273, 509-513.

Zimmerman, M., Balling, C., Chelminiski, I., & Dalrymple, K. (2018). Understanding the severity of depression: which symptoms of depression are the best indicators of depression severity? Comprehensive Psychiatry, 87, 84-88.

Abigail K. Mansfield Marcaccio is Chief of Psychology and Behavioral Health at South County Psychiatry.  She served for over 10 years as the director of Family Therapy Training at Lifespan, and was also coordinator of the Family Research program at Rhode Island Hospital, where she oversaw several studies on family functioning and mood disorders.

Dr. Mansfield Marcaccio has published peer reviewed articles on many topics, including family functioning and mood disorders, measurement of family functioning, supervision of family therapy, and ultrabrief measures of wellbeing and family functioning.  Current interests include effectiveness of family therapy, brief assessment measures of family functioning, dissemination of the McMaster Approach to evaluating and treating families, effectiveness of psychotherapy more generally, and principles that guide effective psychotherapy. She has recently begun working with colleagues on a revision of the book Evaluating and Treating Families:  The McMaster Approach (Ryan etal, 2005).

Keitner, G.K., Mansfield, A.K. & Kelley, J.E. (2023).  The Brief Multidimensional Assessment Scale (BMAS):  A broad measure of patient well-being.  American Journal of Psychotherapy. https://doi.org/10.1176/appi.psychotherapy.20220032

Mansfield, A.K., Keitner, G. K. & Sheeran, TS (2018).  The Brief Assessment of Family Functioning Scale (BAFFS):  A three item version of the General Functioning scale of the Family Assessment Device.  Psychotherapy Research,  https://doi.org/10.1080/10503307.2017.1422213.

Mansfield, A.K., Keitner, G.I. & Dealy, J.A. (2015).  The Family Assessment Device:  An Update.  Family Process 54(1), 32-93. DOI: 10.1111/famp.12080

Archambault, R., Mansfield, A.K., Evans, D. & Keitner, G.I. (2014).  Using the Tenets of the Problem Centered Systems Therapy of the Family (PCSTF) to Teach the McMaster Approach to Family Therapists.  Family Process 53, 640-655. DOI: 10.1111/famp.12065

Mansfield, A.K., Dealy, J.A. & Keitner, G.I. (2012).  Family Functioning and Income:  Does Low-Income Status Impact Family Functioning?  The Family Journal, 21(3), 297-305. https://doi.org/10.1177/1066480713476836

Mansfield, A.K., Dealy, J.A. & Keitner, G.I (2012).   Family interventions for bipolar disorder:  A review of the literature.  Neuropsychiatry, 2(3),. 231-238. DOI:10.2217/npy.12.27

Mansfield, A. K., & Cordova, J. V. (2007). A contemporary behavioral perspective on adult intimacy disorders. In D. Woods & J. Kanter (Eds.), Understanding behavior disorders: A contemporary behavioral perspective. Reno, NV: Context Press.

Theresa A. Morgan is the Assistant Director of the Intensive Outpatient Program at South County Psychiatry. She is committed to the integration of research and clinical practice, and believes each can inform the other as a standard of psychological service. She is particularly interested in the evidence surrounding processes of change in acute care settings, such as partial hospital and intensive outpatient programs like SCP’s.

Dr. Morgan has authored and co-authored publications in the areas of Acceptance and Commitment Therapy (ACT), personality pathology, psychological measurement, and clinical outcomes research. She has current, specific interests in adapting ACT to an intensive outpatient program model, and variables affecting the diagnosis, treatment, and outcomes for individuals with symptoms of Borderline Personality Disorder. She is an active member of multiple national and international societies supporting this work, and maintains academic affiliations with both Brown University and the University of Rhode Island.

Becker, L. G., Asadi, S., Zimmerman, M., Morgan, T. A.,  & Rodriguez-Seijas, C. (2023). Is there a bias in the diagnosis of borderline personality disorder among racially minoritized patients? Personality Disorders: Theory, Research, and Treatment, 14, 339–346. doi:10.1037/per0000579

Rodriguez-Seijas, C., Morgan, T. A., & Zimmerman, M. (2021). A population-based examination of criterion level disparities in the diagnosis of borderline personality disorder among sexual minority adults. Assessment, 28, 1097-1109. doi: 10.1177/1073191121991922

Morgan, T. A.; Dalrymple, K.; D’Avanzato, C.; Zimage, S., Balling, C., Ward, M. & Zimmerman, M. (2020). Conducting clinical outcomes research in a clinical practice setting: The acceptability and effectiveness of acceptance and commitment therapy (ACT) in a partial hospital program as an example. Behavior Therapy, 52, 272-285. doi: 10.1016/j.beth.2020.08.004

Dalrymple, K. L., D'Avanzato, C., & Morgan, T. A. (2020). Implementing ACT in a partial hospitalization program. In Levin, M. E., Twohig, M. P., & Krafft, J. (Eds), Innovations in Acceptance and Commitment Therapy: Clinical advancements and applications in ACT. Oakland, CA: New Harbinger. ISBN: 9781684033102

Morgan, T. A. & Aljabari, R. (2019). Using acceptance and commitment therapy in the treatment of borderline personality disorder: Rationale, preliminary evidence, and future directions. Current Treatment Options in Psychiatry, 6, 271-283. doi:10.1007/s40501-019-00185-9

Morgan, T. A.,  Dalrymple, K., Multach, M. & Zimmerman, M. (2016). Relations between mindfulness process, psychiatric symptoms and functioning in psychiatric and pre-surgical outpatients. Mindfulness, 8, 417-432. doi: 10.1007/s12671-016-0614-9

Molly Meth has research interests that broadly comprise optimizing the psychological care that patients receive through empirically-supported clinical practice. More specifically, she focuses on maximizing clinician’s effectiveness in brief interactions with patients by increasing patients behavioral change in their life. Much of her research has focused on how to communicate feedback well to patients after undergoing a neuropsychological examination and how to increase adherence to recommendations in order to maximize clinical outcomes. Along with this goal, her research has centered on different settings such as in hospitals, after a neuropsych assessment, and primary care with the goal of increasing access to behavioral health resources to patients who might not otherwise be connected and benefit from therapy: for example, patients who suffer from chronic pain, and seek medication, but have not been exposed to third wave cognitive behavioral strategies that are also relevant to living their life to the fullest.

Dr. Meth is proud to work at South County Psychiatry IOP which continues to prioritize evidence based practice, and is actively engaged in research in line with continued learning about what constitutes best practice.

Meth, M. Z., Bernstein, J. P., Calamia, M., & Tranel, D. (2018). What types of recommendations are we giving  patients? A survey of clinical neuropsychologists. The Clinical Neuropsychologist, 1-18.

Bernstein, J.P., Calamia, M., Meth, M., & Tranel, D. (2018). Recommendations for Driving After  Neuropsychological Assessment: A Survey of Neuropsychologists. The Clinical Neuropsychologist.

Hadlandsmyth, K., Stewart, K., Paez, M., Steffen, M., Meth, M., Schacht, R., & Mosher, H. (2018) Patient  Perspectives on Opioids: Views of Inpatient Veterans with Chronic Pain. Pain Medicine, 1141-1147.

Meth, M., Calamia, M., & Tranel, D. (2015). Does a Simple Intervention Enhance Memory and Adherence for  Neuropsychological Recommendations? Applied Neuropsychology: Adult, 1-8.

Kristin Davidoff is a Clinical Psychologist in the Intensive Outpatient Program (IOP) at South County Psychiatry. She is interested in the integration of research and practice, and the provision and dissemination of evidence-based care for mental health conditions. Her research interests involve microaggressions and their impact on the mental and physical health of marginalized populations, including people of color, LGBTQ+ individuals, and people who identify as transgender or gender non-conforming, as well as the expansion of the literature to microaggressions against individuals with mental illness. Her research and scholarship has been conducted with the purpose of increasing awareness, reducing discrimination and stigma, and enacting change.

Davidoff, K. C. (2017). Criminalization of gender non-conformity. In The SAGE Encyclopedia of Psychology and Gender. Thousand Oaks, CA: Sage.

Nadal, K. L., Whitman, C. N., Davis, L. S., Erazo, T., & Davidoff, K. C. (2016): Microaggressions toward lesbian, gay, bisexual, transgender, queer, and genderqueer people: A review of the literature. The Journal of Sex Research, 53, 488-508. doi: 10.1080/00224499.2016.1142495

Nadal, K. L., Davidoff, K. C., Davis, L. S., Wong, Y., Marshall, D., & McKenzie, V. (2015). Intersectional identities and microaggressions: Influences of race, ethnicity, gender, sexuality, and religion. Qualitative Psychology, 2, 147–163.

Gonzales, L., Davidoff, K. C., Yanos, P., & Nadal, K. L. (2015). Microaggressions experienced by persons with mental illness: an exploratory study. Psychiatric Rehabilitation Journal, 38, 234-241.

Gonzales, L., Davidoff, K. C., DeLuca, J. S., & Yanos, P. T. (2015). The Mental Illness Microaggressions Scale—Perpetrator Version (MIMS-P): Reliability and validity. Psychiatry Research, 229, 120-125. doi: 10.1016/j.psychres.2015.07.061

Nadal, K. L., Davidoff, K. C., Davis, L. S., & Wong, Y. (2014). Emotional, behavioral, and cognitive reactions to microaggressions: Transgender perspectives. Psychology of Sexual Orientation and Gender Diversity, 1, 72-81.

Thomas Sheeran is a clinical psychologist at South County Psychiatry.  He earned his PhD at the University of Virginia and completed postdoctoral training at Brown Medical School.  He then completed a research fellowship at Weill Cornell Medical College.  Dr. Sheeran’s research has focused on geriatric mental health services.  In particular, he has focused on improving mental health care among community-dwelling seniors and their families.  He has provided services to older adults in long term care, partial hospital, intensive outpatient and general outpatient settings. Dr. Sheeran’s research has been funded by the National Institute of Mental Health, the National Center for Research Resources, and a number of foundations.  He has served on faculty at Weill Cornell Medical College, Brown University and as a clinician educator at the University of Rhode Island Geriatric Education Center.