SERVICES AND INTERVENTION RESEARCH WITH HOMELESS PERSONS HAVING 
ALCOHOL, DRUG ABUSE, OR MENTAL DISORDERS

RELEASE DATE:  August 16, 2002

PA NUMBER: PA-02-150

EXPIRATION DATE: This PA expires on August 15, 2005, unless reissued.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)
 (http://www.niaaa.nih.gov)
National Institute on Drug Abuse (NIDA)
 (http://www.nida.nih.gov)
National Institute of Mental Health (NIMH)
 (http://www.nimh.nih.gov)

THIS PA CONTAINS THE FOLLOWING INFORMATION

o Purpose of this PA
o Research Objectives
o Mechanism(s) of Support 
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Where to Send Inquiries
o Submitting an Application
o Peer Review Process
o Review Criteria
o Award Criteria
o Required Federal Citations

PURPOSE OF THIS PA

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), the 
National Institute on Drug Abuse (NIDA), and the National Institute of 
Mental Health (NIMH) invite applications for health services research 
projects designed to increase understanding of the efficiency, 
effectiveness and diffusion of services provided to homeless persons 
(adults, adolescents, children, or families) with alcohol, drug abuse 
and/or mental (ADM) disorders.  This program announcement (PA) 
encourages innovative and theory-driven empirical research to examine 
the organization, management, integration, and financing of services as 
well as the impact of these factors on the quality, cost, access, 
utilization, outcomes, cost analyses of care. Of particular interest 
are investigations of services for persons who suffer from co-occurring 
alcohol, drug abuse, and mental disorders and for persons at risk for 
or who have HIV/AIDS or other serious health problems. 

This PA also encourages research that will expedite the dissemination, 
implementation, and adoption of effective treatment and prevention 
efforts for homeless persons with ADM disorders. Inter-disciplinary 
research teams, and research partnerships with providers and consumers 
across multiple systems in community settings are strongly encouraged. 
Such settings may include but are not limited to shelters and food 
programs, parole and correctional settings, non-traditional or ad hoc 
service settings, or street-based, transitional, and special housing 
programs. 

Proposed research may focus on any of the identified disorder areas, 
either alone or in combination with each other or with HIV/AIDS or 
other serious medical conditions.  In fact, the joint sponsorship of 
this PA by NIAAA, NIDA, and NIMH results from the recognition that the 
co-occurrence of multiple problems and disorders among homeless persons 
is more typical than the presence of a single disorder by itself.

RESEARCH OBJECTIVES

A growing body of empirical literature has documented that homelessness 
and inadequate/unstable housing conditions significantly affect persons 
with alcohol, drug abuse, or mental (ADM) disorders, interfere with 
effective treatment and pose significant barriers to achieving optimal 
outcomes. The challenges posed by ADM disorders are often compounded by 
other life difficulties (e.g., HIV/AIDS or other serious medical 
conditions, lack of personal and financial resources, paucity of social 
support systems, limited availability of housing options, trauma, 
stigma, etc.) which further compromise treatment outcomes.  These 
multiple factors are often co-occurring, fluctuating, and interactive 
in complex ways.  This complexity has remained an on-going challenge to 
the development, implementation, and sustainability of effective, 
empirically based services, interventions and prevention efforts for 
the identified population.

In addition, existing knowledge has not yet been applied to the 
development of interventions that affect the structural characteristics 
of the service systems that attempt to treat homeless persons with ADM 
disorders. In fact, public and private health care systems that serve 
homeless persons continue to struggle with ongoing changes in the 
patient population, new service technologies and new financing 
programs.  These challenges present the opportunity for a new 
generation of research to develop more effective services and service 
delivery approaches.  This next generation of research will need to 
investigate the structures, processes and functioning of service 
systems in the context of system and inter-system, community, agency, 
and provider and consumer factors with the goal of improving  access, 
utilization, quality, effectiveness, cost-effectiveness and outcomes of 
services to treat homeless persons who suffer from alcohol, drug abuse, 
and mental health disorders.

Consequently, this PA encourages health services research to 
investigate the effectiveness, long-term outcome and sustainability of 
services, interventions, and preventive and rehabilitative strategies 
targeted to homeless or unstably housed persons with ADM disorders.  
Research should address relevant factors from a developmental 
perspective as well as across systems (e.g., health care, 
parole/correctional, foster care, shelter programs, etc.). This may 
include the adaptation of pharmacological, psychosocial, behavioral, or 
environmental approaches -- individually or in combination -- and 
should target functional and symptomatic outcomes.  

Of particular interest are studies that examine treatment and 
prevention interventions that address HIV/AIDS and other infectious 
diseases as well as interventions aimed at reducing health and services 
disparities related to age, gender or minority status. Also of great 
interest are studies that address significant questions for homeless 
persons involved in the criminal justice system and homeless persons 
with co-occurring disorders.

Listed below are examples of research topic areas that can advance 
knowledge on improving outcomes for the identified populations. This 
list is not prioritized, nor is it exhaustive; rather, it is expected 
that investigators who respond to this announcement will identify 
additional questions.  

o What are the beneficial components of commonly practiced but 
relatively unstudied community practices (e.g.-informal and non-
traditional housing, care and assistance arrangements, etc) with 
homeless persons, with which sub-populations, and in what settings? How 
these can be incorporated into strategies for delivery of services and 
interventions?

o What are the impacts of program and system characteristics (e.g., 
financing; jail diversion programs; specialized clinical or behavior-
change services, interventions, or housing programs) on short- and 
long-term clinical, functional, and housing outcomes for 
homeless/unstably housed persons with ADM disorders?

o How do social or other environmental contexts influence functioning 
and treatment including interactions among factors at the individual, 
family, sociocultural, provider, community, and systems levels? 

o How can behavioral, psychosocial, or environmental risk and 
protective factors be modified to improve outcomes for the identified 
populations?

o What preventive intervention models can be tailored to focus on at-
risk or HIV-infected homeless persons with co-occurring alcohol, drug 
and mental disorders (assessed at individual, system, network, care 
provider and community levels)?

o What strategies can minimize the impact of trauma on homeless persons 
and reduce any subsequent barriers to providing effective services?

o Which consumer, provider, service setting, and community factors and 
mechanisms contribute to successful outreach and engagement? 

o How do the competing demands posed by ADM and medical disorders 
interfere with help seeking or care across various settings?

o How can assessment of treatments and services delivered be used to 
better understand the needs and clinical characteristics of subgroups 
(e.g., persons with subsyndromal conditions or comorbidity)?

o How and why do the structure and financing of services affect quality 
of care and clinical outcomes?  How do organizational behaviors and 
management policies foster communication, collaboration and service 
integration across different agencies to improve clinical, housing, and 
health outcomes?

o How can evidence-based interventions and services be more readily 
adopted into ongoing clinical and community-based practice?

o How can tools designed to measure the quality of care better assist 
policymakers, clinicians, and consumers with decision making?

MECHANISMS OF SUPPORT

This PA will use the National Institutes of Health (NIH) research 
project grant (R01), small grant (R03), and Exploratory/Developmental 
Research Grant (R21) award mechanisms. Responsibility for the planning, 
direction, and execution of the proposed project will be solely that of 
the applicant.  Certain Career Development award mechanisms (K01, K02, 
K05, K08, K23, and K24) may also be eligible for consideration in 
response to this PA at the discretion of the awarding Institute.
Institute policies and requirements for each of these support 
mechanisms may differ among NIAAA, NIDA, and NIMH. Therefore, 
prospective applicants are strongly encouraged to contact the program 
and grants management contacts listed below for specific information 
early in the application process. 

ELIGIBLE INSTITUTIONS 

You may submit (an) application(s) if your institution has any of the 
following characteristics:
	
o For-profit or non-profit organizations 
o Public or private institutions, such as universities, colleges, 
hospitals, and laboratories 
o Units of State and local governments
o Eligible agencies of the Federal government  
o Domestic or foreign
o Faith-based organizations

Foreign institutions are not eligible for small grants (R03), but are 
eligible for the R01 and R21 mechanisms.

INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS

Any individual with the skills, knowledge, and resources necessary to 
carry out the proposed research is invited to work with their 
institution to develop an application for support.  Individuals from 
underrepresented racial and ethnic groups as well as individuals with 
disabilities are always encouraged to apply for NIH programs.

WHERE TO SEND INQUIRIES

We encourage your inquiries concerning this PA and welcome the 
opportunity answer questions from potential applicants.

o Direct your questions about scientific issues to:

Harold I. Perl, Ph.D. 
Health Services Research Branch 
Division of Clinical and Prevention Research 
National Institute on Alcohol Abuse and Alcoholism 
6000 Executive Boulevard, Suite 505, MSC 7003 
Bethesda, MD 20892-7003 
Telephone: 301-443-0788 
FAX: 301-443-8774 
E-mail: perl@nih.gov

Jerry Flanzer, D.S.W.
Services Research Branch
Division of Epidemiology, Services and Prevention Research
National Institute on Drug Abuse
6001 Executive Boulevard, RM 4219, MSC 6504 
Bethesda, MD 20892
Telephone: 301-443-4060
FAX: 301-443-2636 
E-mail: jflanzer@nida.nih.gov

Denise Juliano-Bult, M.S.W.
Services Research and Clinical Epidemiology Branch
Division of Services and Intervention Research
National Institute of Mental Health
6001 Executive Boulevard, RM 7137, MSC 9631
Bethesda, MD 20892-9631
Telephone: 301-443-1638
FAX: 301-443-4045 
E-mail: djuliano@nih.gov

David Stoff, Ph.D. 
Center for Mental Health Research on AIDS
Division of Mental Disorders, Behavioral Research and AIDS
National Institute of Mental Health
6001 Executive Boulevard, RM 6210, MSC 9619 
Bethesda, MD 20892-9619
Telephone: 301-443-4625
FAX: 301-443-9719 
E-mail: dstoff@nih.gov

Direct inquiries regarding fiscal matters to:

Judy Simons
Chief, Grants Management Branch
Office of Planning and Resource Management
National Institute on Alcohol Abuse and Alcoholism
Willco Building, Suite 504
6000 Executive Boulevard, MSC 7003
Bethesda, MD 20892-7003
(301) 443-4704 (telephone)
(301) 443-3891 (fax)
email:  jsimons@willco.niaaa.nih.gov

Gary Fleming, J.D., M.A.
Grants Management Branch
Office of Planning and Resource Management
National Institute on Drug Abuse
6001 Executive Boulevard, Room 3131, MSC 9541
Bethesda, MD  20892-9541
Telephone:  (301) 443-6710
FAX :  (301) 594-6847
E-mail: gf6s@nih.gov

Diana S. Trunnell
Grants Management Branch
Division of Extramural Activities
National Institute of Mental Health
6001 Executive Boulevard, Room 6115, MSC 9605
Bethesda, MD 20892-9605
Telephone: (301) 443-2805
FAX:  (301) 443-6885
Email:  Diana_Trunnell@nih.gov

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant 
application instructions and forms (rev. 5/2001).  The PHS 398 is 
available at http://grants.nih.gov/grants/funding/phs398/phs398.html in 
an interactive format.  For further assistance contact GrantsInfo, 
Telephone (301) 435-0714, Email: GrantsInfo@nih.gov.

APPLICATION RECEIPT DATES: Applications submitted in response to this 
program announcement will be accepted at the standard application 
deadlines, which are available at 
http://grants.nih.gov/grants/dates.htm.  Application deadlines are also 
indicated in the PHS 398 application kit.

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: Applications 
requesting up to $250,000 per year in direct costs must be submitted in 
a modular grant format.  The modular grant format simplifies the 
preparation of the budget in these applications by limiting the level of 
budgetary detail.  Applicants request direct costs in $25,000 modules.  
Section C of the research grant application instructions for the PHS 398 
(rev. 5/2001) at http://grants.nih.gov/grants/funding/phs398/phs398.html 
includes step-by-step guidance for preparing modular grants.  Additional 
information on modular grants is available at 
http://grants.nih.gov/grants/funding/modular/modular.htm.

SPECIFIC INSTRUCTIONS FOR APPLICATIONS REQUESTING $500,000 OR MORE PER 
YEAR: Applications requesting $500,000 or more in direct costs for any 
year must include a cover letter identifying the NIAAA staff member who 
has agreed to accept assignment of the application.   

Applicants requesting more than $500,000 must carry out the following 
steps:
	
1) Contact the IC program staff at least 6 weeks before submitting the 
application, i.e., as you are developing plans for the study; 

2) Obtain agreement from the IC staff that the IC will accept your 
application for consideration for award; and,
  
3) Identify, in a cover letter sent with the application, the staff 
member and IC who agreed to accept assignment of the application.  

This policy applies to all investigator-initiated new (type 1), 
competing continuation (type 2), competing supplement, or any amended 
or revised version of these grant application types. Additional 
information on this policy is available in the NIH Guide for Grants and 
Contracts, October 19, 2001 at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-004.html. 

SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten 
original of the application, including the checklist, and five signed 
photocopies in one package to:

Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (for express/courier service)

APPLICATION PROCESSING: Applications must be received by or mailed on 
or before the receipt dates described at 
http://grants.nih.gov/grants/funding/submissionschedule.htm. The CSR 
will not accept any application in response to this PA that is 
essentially the same as one currently pending initial review unless the 
applicant withdraws the pending application.  The CSR will not accept 
any application that is essentially the same as one already reviewed.  
This does not preclude the submission of a substantial revision of an 
application already reviewed, but such application must include an 
Introduction addressing the previous critique.

PEER REVIEW PROCESS

Applications submitted for this PA will be assigned on the basis of 
established PHS referral guidelines.  An appropriate scientific review 
group convened in accordance with the standard NIH peer review 
procedures (http://www.csr.nih.gov/refrev.htm) will evaluate 
applications for scientific and technical merit.  

As part of the initial merit review, all applications will:

o Receive a written critique
o Undergo a selection process in which only those applications deemed 
to have the highest scientific merit, generally the top half of 
applications under review, will be discussed and assigned a priority 
score
o Receive a second level review by the appropriate national advisory 
council or board
	
REVIEW CRITERIA

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  
In the written comments, reviewers will be asked to discuss the 
following aspects of your application in order to judge the likelihood 
that the proposed research will have a substantial impact on the 
pursuit of these goals: 

o Significance 
o Approach 
o Innovation
o Investigator
o Environment
  
The scientific review group will address and consider each of these 
criteria in assigning your application's overall score, weighting them 
as appropriate for each application.  Your application does not need to 
be strong in all categories to be judged likely to have major 
scientific impact and thus deserve a high priority score.  For example, 
you may propose to carry out important work that by its nature is not 
innovative but is essential to move a field forward.

(1) SIGNIFICANCE:  Does your study address an important problem? If the 
aims of your application are achieved, how do they advance scientific 
knowledge?  What will be the effect of these studies on the concepts or 
methods that drive this field?

(2) APPROACH:  Are the conceptual framework, design, methods, and 
analyses adequately developed, well integrated, and appropriate to the 
aims of the project?  Do you acknowledge potential problem areas and 
consider alternative tactics?

(3) INNOVATION:  Does your project employ novel concepts, approaches or 
methods? Are the aims original and innovative?  Does your project 
challenge existing paradigms or develop new methodologies or 
technologies?

(4) INVESTIGATOR: Are you appropriately trained and well suited to 
carry out this work?  Is the work proposed appropriate to your 
experience level as the principal investigator and to that of other 
researchers (if any)?

(5) ENVIRONMENT:  Does the scientific environment in which your work 
will be done contribute to the probability of success?  Do the proposed 
experiments take advantage of unique features of the scientific 
environment or employ useful collaborative arrangements?  Is there 
evidence of institutional support?

ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your 
application will also be reviewed with respect to the following:

PROTECTIONS:  The adequacy of the proposed protection for humans, 
animals, or the environment, to the extent they may be adversely 
affected by the project proposed in the application.

INCLUSION:  The adequacy of plans to include subjects from both 
genders, all racial and ethnic groups (and subgroups), and children as 
appropriate for the scientific goals of the research.  Plans for the 
recruitment and retention of subjects will also be evaluated. (See 
Inclusion Criteria included in the section on Federal Citations, below)

BUDGET:  The reasonableness of the proposed budget and the requested 
period of support in relation to the proposed research.

AWARD CRITERIA

Applications submitted in response to a PA will compete for available 
funds with all other recommended applications.  The following will be 
considered in making funding decisions:  

o Scientific merit of the proposed project as determined by peer review
o Availability of funds 
o Relevance to program priorities

REQUIRED FEDERAL CITATIONS 

MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research 
components involving Phase I and II clinical trials must include 
provisions for assessment of patient eligibility and status, rigorous 
data management, quality assurance, and auditing procedures.  In 
addition, it is NIH policy that all clinical trials require data and 
safety monitoring, with the method and degree of monitoring being 
commensurate with the risks (NIH Policy for Data Safety and Monitoring, 
NIH Guide for Grants and Contracts, June 12, 1998: 
http://grants.nih.gov/grants/guide/notice-files/not98-084.html).  

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy 
of the NIH that women and members of minority groups and their sub-
populations must be included in all NIH-supported clinical research 
projects unless a clear and compelling justification is provided 
indicating that inclusion is inappropriate with respect to the health of 
the subjects or the purpose of the research. This policy results from 
the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43).

All investigators proposing clinical research should read the AMENDMENT 
"NIH Guidelines for Inclusion of Women and Minorities as Subjects in 
Clinical Research - Amended, October, 2001," published in the NIH Guide 
for Grants and Contracts on October 9, 2001 
(http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); a 
complete copy of the updated Guidelines are available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_
2001.htm.  The amended policy incorporates: the use of an NIH 
definition of clinical research; updated racial and ethnic categories 
in compliance with the new OMB standards; clarification of language 
governing NIH-defined Phase III clinical trials consistent with the new 
PHS Form 398; and updated roles and responsibilities of NIH staff and 
the extramural community.  The policy continues to require for all NIH-
defined Phase III clinical trials that: a) all applications or 
proposals and/or protocols must provide a description of plans to 
conduct analyses, as appropriate, to address differences by sex/gender 
and/or racial/ethnic groups, including subgroups if applicable; and b) 
investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN 
SUBJECTS:  The NIH maintains a policy that children (i.e., individuals 
under the age of 21) must be included in all human subjects research, 
conducted or supported by the NIH, unless there are scientific and 
ethical reasons not to include them. This policy applies to all initial 
(Type 1) applications submitted for receipt dates after October 1, 
1998.

All investigators proposing research involving human subjects should 
read the "NIH Policy and Guidelines" on the inclusion of children as 
participants in research involving human subjects that is available at 
http://grants.nih.gov/grants/funding/children/children.htm. 

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS:  
NIH policy requires education on the protection of human subject 
participants for all investigators submitting NIH proposals for 
research involving human subjects.  You will find this policy 
announcement in the NIH Guide for Grants and Contracts Announcement, 
dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: 
The Office of Management and Budget (OMB) Circular A-110 has been 
revised to provide public access to research data through the Freedom 
of Information Act (FOIA) under some circumstances.  Data that are (1) 
first produced in a project that is supported in whole or in part with 
Federal funds and (2) cited publicly and officially by a Federal agency 
in support of an action that has the force and effect of law (i.e., a 
regulation) may be accessed through FOIA.  It is important for 
applicants to understand the basic scope of this amendment.  NIH has 
provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this PA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application 
should include a description of the archiving plan in the study design 
and include information about this in the budget justification section 
of the application. In addition, applicants should think about how to 
structure informed consent statements and other human subjects 
procedures given the potential for wider use of data collected under 
this award.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and 
proposals for NIH funding must be self-contained within specified page 
limitations. Unless otherwise specified in a NIH solicitation, Internet 
addresses (URLs) should not be used to provide information necessary to 
the review because reviewers are under no obligation to view the 
Internet sites.   Furthermore, we caution reviewers that their 
anonymity may be compromised when they directly access an Internet 
site.
HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to 
achieving the health promotion and disease prevention objectives of 
"Healthy People 2010," a PHS-led national activity for setting priority 
areas. This PA is related to one or more of the priority areas. 
Potential applicants may obtain a copy of "Healthy People 2010" at 
http://www.health.gov/healthypeople.

AUTHORITY AND REGULATIONS: This program is described in the Catalog of 
Federal Domestic Assistance No. 93.273, and is not subject to the 
intergovernmental review requirements of Executive Order 12372 or 
Health Systems Agency review.  Awards are made under authorization of 
Sections 301 and 405 of the Public Health Service Act as amended (42 
USC 241 and 284) and administered under NIH grants policies described 
at http://grants.nih.gov/grants/policy/policy.htm and under Federal 
Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. 

The PHS strongly encourages all grant recipients to provide a smoke-
free workplace and discourage the use of all tobacco products.  In 
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits 
smoking in certain facilities (or in some cases, any portion of a 
facility) in which regular or routine education, library, day care, 
health care, or early childhood development services are provided to 
children.  This is consistent with the PHS mission to protect and 
advance the physical and mental health of the American people.
http://grants.nih.gov/grants/guide/pa-files/PA-02-015.html. 


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