INTEGRATING MH SERVICES RESEARCH AND BEHAVIORAL SCIENCE

Release Date:  March 18, 1999

PA NUMBER:  PA-99-073

P.T.

National Institute of Mental Health

PURPOSE

The purpose of this program announcement (PA) is to solicit applications for
multidisciplinary research that integrate the theory and methods of the social
and behavioral sciences with the questions of mental health services research.
This PA is issued in response to the growing evidence that mental health
services research has reached a stage in its development where the assumptions
and approaches of the last decade are not significantly improving the quality
of care, knowledge assimilation, or outcomes. The goals of this PA are to
encourage services researchers to collaborate with basic social and behavioral
scientists and to incorporate the theory and methods of their fields of study
into the fundamental questions of mental health services research.

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health promotion
and disease prevention objectives of "Healthy People 2000," a PHS-led national
activity for setting priority areas.  This PA, Integrating Mental Health
Services Research and Behavioral Science, is related to the priority areas of
mental health and mental disorders.  Potential applicants may obtain a copy of
"Healthy People 2000" at http://www.crisny.org/health/us/health7.html

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic and foreign, for-profit and non-
profit organizations, public and private, such as universities, colleges,
hospitals, laboratories, units of State and local governments, and eligible
agencies of the Federal government.  Foreign institutions are not eligible for
Small (R03) awards.  Racial/ethnic minority individuals, women, and persons
with disabilities are encouraged to apply as principal investigators.

MECHANISM OF SUPPORT

This PA will use the National Institutes of Health (NIH) individual research
project grant (R01) and small grant (R03) mechanisms.  Responsibility for the
planning, direction, and execution of the proposed project will be solely that
of the applicant.  The total project period for an R01 application submitted
in response to this PA may not exceed five years.

Small Grants are for no longer than 2 years and no more than $50,000 direct
costs per year.

There are additional eligibility requirements, application formats, and review
criteria for R03 grants.  Applicants are strongly encouraged to consult with
program staff listed under INQUIRIES and to obtain the appropriate additional
program announcement for the R03 grant mechanism
http://grants.nih.gov/grants/guide/pa-files/PAR-97-015.html.

Specific application instructions have been modified to reflect the "MODULAR
GRANT APPLICATION AND AWARD" process which has been adopted by the NIH (see
the NIH Guide, December 15, 1998).

For this PA, funds must be requested in $25,000 direct cost modules.  A
feature of the modular grant is that no escalation is provided for future
years, and all anticipated expenses for all years of the project must be
included within the number of modules being requested.  Only limited budget
information is required and any budget adjustments made by the Initial Review
Group will be in modules of $25,000.

More detailed information about modular grant applications, including a sample
budget narrative justification pages and a sample biographical sketch, is
available via the Internet at:
http://grants.nih.gov/grants/funding/modular/modular.htm

RESEARCH OBJECTIVES

Mental health services research has traditionally focused on the study of the
impact of the organizational structure, financing, and management of mental
health services on the quality, cost, access to, and outcomes of those
services.  Efforts to improve services have focused on tests of various
structural, financial, and management strategies.  Recently, results have
become available from large-scale, randomized, controlled trials of these
strategies;  they show that changes in structure and financing alone fail to
make significantly greater improvements in clinical outcomes for those in the
experimental group than for those in the treatment-as-usual group.

With this program announcement, NIMH is encouraging services researchers and
social and behavioral scientists to work together to try to understand these
findings and address the fundamental question underlying all of mental health
services research:  How can we improve the mental health care provided to
those suffering from mental disorders so that their functioning and quality of
life improve?  All of the social and behavioral sciences -- psychology,
sociology, economics, anthropology, decision and management sciences,
communications, social work, history, political science -- have perspectives,
assumptions, theory, and methods that can be used to address this critical
question.

Input from the social and behavioral sciences will make it possible to examine
how characteristics of the individual, his or her family, and his or her
social and cultural environment affect how, when, where, and if that
individual will seek care, what types of care are chosen or provided, what
happens during the delivery of care, and what outcomes result.  It will be
possible to address how the social, cultural, and psychological
characteristics of the provider interact with those of the patient or client
and to examine how the variable nature of the economic, social, political, and
cultural environments in which services are delivered affect (a) the
organization, financing, management, and delivery of services; (b) access to
services; and (c) the process, cost, and outcomes of care.

The social and behavioral sciences will provide frameworks for services
researchers to ask old questions in new ways.  The literatures on emotion and
motivation; personality development; perception, attention, learning and
memory; reasoning, judgment, and communication; social influence and social
cognition; family processes and social networks; and sociocultural and
environmental processes may all lead to questions that services researchers
would not have considered but may provide avenues for understanding what types
of care work for whom, under what circumstances, and why.

Listed below are examples of questions that integrate the issues of mental
health services research with those of behavioral and social science.  The
list of examples is illustrative, not exhaustive; it is expected that
additional important research questions will be identified by investigators
who respond to this announcement.  Questions include:

o  How is intrinsic motivation associated with functioning and behavior
maintenance during treatment and recovery?  Does this differ across disorders
or cultural groups?  Can intrinsic motivation be modified?  What factors
(e.g., culture, friends, family, personal experiences, socio-economic status)
are most critical in shaping and modifying motivation?

o  How does the type of motivation (intrinsic or extrinsic þ or even coercive)
influence clinical and economic outcomes of treatment?

o  To what extent is motivation to participate in treatment and/or family
therapy associated with the degree to which the nature of the illness and its
long term course are understood, at least initially?

o  How do stable personality traits influence the process and outcomes of
treatment and rehab?  Which are most valuable?  Do personality traits actually
remain stable after a psychotic episode?  How do the clinically perceived
changes in personality affect treatment responsiveness and outcomes?

o  How do coping (active/assertive vs. passive) and relational (e.g.,
openness; capacity to interact; reciprocity; attention) styles affect ability
to benefit from treatment and rehabilitation?

o  Is high self-esteem necessary for improvement in functioning or are the
treatment technologies sufficient?  Does it matter if the source of the esteem
is competency at tasks or relational closeness to another person?  Are there
other constructs of self concept (e.g., locus of control) that better predict
outcomes?

o  What role do deficits in cognitive (perceptual, attentional, learning) and
emotional functioning have in ability to benefit (improve functioning) from
what types of treatment and rehabilitation?

o  How do patient/client experiences or histories (positive vs. negative) in
the mental health system affect behavior related to treatment and
rehabilitation (e.g., interaction with clinician; continuation of treatment;
approach to problems encountered?

o  Which cognitive and emotional deficits are subject to improvement through
treatment and which ones of these are most important for increasing
participation in treatment and improving functioning?

o  What are the dominant components of perception that influence patient
satisfaction  - a commonly used outcome variable?

o  How do decision making biases influence the diagnostic abilities and
treatment decisions chosen by clinicians?  Are some biases more common than
others with particular populations of patients/clients and/or with particular
types of physicians?

o  Does problem solving ability (including both affective and instrumental
tasks/problems) affect willingness to participate in treatment, response to
treatment, functioning/disability, and other outcomes?

o  How do interpersonal communication styles of clinicians (e.g.,
authoritarian, egalitarian) and patient preferences for particular styles
interact to affect willingness to participate in treatment, response to
treatment, functioning/disability, and other outcomes?  Are patient
preferences for clinical style consistent across mental health professionals?

o  How can clinicians be influenced to adopt, in their treatment of
patients/clients with mental disorders, the information from efficacy trials?
Does issuing official practice guidelines make it more or less likely that
clinicians will use best practices?  What other strategies might be used to
improve practice?

o  What mechanisms can be used to get people to seek care for themselves or
family members, when they need it, even if their social or cultural
environment discourages it?

o  What dynamics within families, other than negative constructs like
expressed emotion, are important in understanding patient/client recovery? 
How do those dynamics interact with personality and disorder characteristics?
What mechanisms or patterns of relating within families best help
patients/clients cope with stresses in the environment, such as emotional,
financial, work, treatment, and legal?  Are successful patterns culture-
specific or person-specific?

o  Do psychoeducational approaches work for all types of families?  For what
types of families should individual family psychoeducation be used instead of
group? How can psychoeducation and other family therapies be modified to
address the cultural and educational diversity of various family groups?

o  Does acceptance or non-acceptance of the dominant culture by the
patient/client and/or his/her family affect use of services, patient/client
goals, response to clinical providers, degree of independence achieved, and
improvement in functioning during and after treatment?

o  How do the perceptions of caretaker burden (psychological and economic)
differ by family structure, family dynamics, and culture?

o  How do cultural explanations for disorder affect receptivity and response
to treatment, particularly when patient/client and family explanations differ
from those of the mental health clinicians?

o  Do culture and socioeconomic status influence the decision-making
strategies used by patient/clients, their families, and clinicians?  If these
approaches differ, does this increase the risk of distrust, confusion,
noncompliance, and/or treatment dropout?

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of the NIH that women and members of minority groups and
their subpopulations must be included in all NIH supported biomedical and
behavioral research projects involving human subjects, unless a clear and
compelling rationale and justification is provided 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 research involving human subjects should read the
"NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical
Research," which have been published in the Federal Register of March 28, 1994
(FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Vol. 23,
No. 11, March 18, 1994 available on the web at the following URL address: 
http://www.nih.gov/0grants/guide/1994/94.03.18/notice-nih-guideline008.html

NIH POLICY AND GUIDELINES ON THE INCLUSION OF CHILDREN AS PARTICIPANTS IN
RESEARCH INVOLVING HUMAN SUBJECTS.

It is the policy of NIH 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 was published in the NIH Guide for
Grants and Contracts, March 6, 1998, and is available at the following URL
address: http://grants.nih.gov/grants/guide/notice-files/not98-024.html

Investigators also may obtain copies of these policies from the program staff
listed under INQUIRIES.  Program staff may also provide additional relevant
information concerning the policy.

APPLICATION PROCEDURES

Applicants are strongly encouraged to contact the program contacts listed
under INQUIRIES with any questions regarding their proposed project.

Applications are to be submitted on the grant application form PHS 398 (rev.
4/98) and will be accepted on the standard receipt dates indicated in the
application kit.  Application kits are available at most institutional offices
of sponsored research and from the Division of Extramural Outreach and
Information Resources, National Institutes of Health, 6701 Rockledge Drive,
MSC 7910, Bethesda, MD 20892-7910, telephone (301) 435-0714, Email:
GrantsInfo@nih.gov.  Applications are also available on the World Wide Web at:
http://grants.nih.gov/grants/forms.htm.

BUDGET INSTRUCTIONS

o  FACE PAGE:  Items 7a and 7b should be completed, indicating Direct Costs
(in $25,000 increments) and Total Costs [Modular Total Direct plus Facilities
and Administrative (F&A) costs] for the initial budget period.  Items 8a and
8b should be completed indicating the Direct and Total Costs for the entire
proposed period of support.

o  DETAILED BUDGET FOR THE INITIAL BUDGET PERIOD - Do not complete Form Page 4
of the PHS 398.  It is not required and will not be accepted with the
application.

o  BUDGET FOR THE ENTIRE PROPOSED PERIOD OF SUPPORT - Do not complete the
categorical budget table on Form Page 5 of the PHS 398.  It is not required
and will not be accepted with the application.

o  NARRATIVE BUDGET JUSTIFICATION - Use a Modular Grant Budget Narrative page.
(See http://grants.nih.gov/grants/funding/modular/modular.htm for sample pages.)
At the top of the page, enter the total direct costs requested for each year.

o  Under Personnel, list key project personnel, including their names, percent
of effort, and roles on the project. No individual salary information should
be provided.

For Consortium/Contractual costs, provide an estimate of total costs (direct
plus facilities and administrative) for each year, each rounded to the nearest
$1,000.  List the individuals/organizations with whom consortium or
contractual arrangements have been made, the percent effort of key personnel,
and the role on the project.  The total cost for a consortium/contractual
arrangement is included in the overall requested modular direct cost amount.

Provide an additional narrative budget justification for any variation in the
number of modules requested.

o  BIOGRAPHICAL SKETCH - The Biographical Sketch provides information used by
reviewers in the assessment of each individual's qualifications for a specific
role in the proposed project, as well as to evaluate the overall
qualifications of the research team.  A biographical sketch is required for
all key personnel, following the instructions below.  No more than three pages
may be used for each person.  A sample biographical sketch may be viewed at:
http://grants.nih.gov/grants/funding/modular/modular.htm

- Complete the educational block at the top of the form page;
- List current position(s) and then previous positions;
- List selected peer-reviewed publications, with full citations;
- Provide information, including overall goals and responsibilities, on
research projects ongoing or completed during the last three years.

o  OTHER SUPPORT - Form Page 7.  This form must be completed for applications
in response to this PA to allow awards to be negotiated and made on or before
September 30, 1999.

o  CHECKLIST - This page should be completed and submitted with the
application.  If the F&A rate agreement has been established, indicate the
type of agreement and the date. It is important to identify all exclusions
that were used in the calculation of the F&A costs for the initial budget
period and all future budget years.

The applicant should provide the name and phone number of the individual to
contact concerning fiscal and administrative issues if additional information
is necessary following the initial review.

Applications not conforming to these guidelines will be considered
unresponsive to this PA and will be returned without further review.

Applicants planning to submit an investigator-initiated new (type 1),
competing continuation (type 2), competing supplement, or any amended/revised
version of the preceding grant application types requesting $500,000 or more
in direct costs for any year are advised that he or she must contact the
Institute program staff before submitting the application, i.e., as plans for
the study are being developed.  Furthermore, the application must obtain
agreement from the staff that the Institute will accept the application for
consideration for award.  Finally, the applicant must identify, in a cover
letter sent with the application, the staff member and Institute who agreed to
accept assignment of the application.

This policy requires an applicant to obtain agreement for acceptance of both
any such application and any such subsequent amendment.  Refer to the NIH
Guide for Grants and Contracts, March 20, 1998 at
http://grants.nih.gov/grants/guide/notice-files/not98-030.html

The title and number of the program announcement must be typed on line 2 of
the face page of the application form and the YES box must be marked.

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)

REVIEW CONSIDERATIONS

Applications will be assigned on the basis of established PHS referral
guidelines.  Applications that are complete will be evaluated for scientific
and technical merit by an appropriate peer review group convened in accordance
with the standard NIH peer review procedures.  As part of the initial merit
review, all applications will receive a written critique and undergo a process
in which only those applications deemed to have the highest scientific merit,
generally the top half of applications under review, will be discussed,
assigned a priority score, and receive a second level review by the
appropriate national advisory council or board, when applicable.

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 the application in order to judge the likelihood that the proposed research
will have a substantial impact on the pursuit of these goals.  Each of these
criteria will be addressed and considered in assigning the overall score,
weighting them as appropriate for each application.  Note that the 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, an
investigator 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 this study address an important problem?  If the aims
of the application are achieved, how will scientific knowledge be advanced? 
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?  Does the applicant acknowledge potential problem areas and consider
alternative tactics?

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

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

(5) Environment:  Does the scientific environment in which the 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?

In addition to the above criteria, in accordance with NIH policy, all
applications will also be reviewed with respect to the following:

o  The adequacy of plans to include both genders, minorities and their
subgroups, and children as appropriate for the scientific goals of the
research.  Plans for the recruitment and retention of subjects will also be
evaluated.

o  The reasonableness of the proposed budget and duration in relation to the
proposed research

o  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.

The initial review group will also examine the provisions for the protection
of human subjects and the safety of the research environment.

AWARD CRITERIA

Applications will compete for available funds with all other approved
applications.  The following will be considered in making funding decisions: 
Quality of the proposed project as determined by peer review, availability of
funds, and program priority.

INQUIRIES

Inquiries are encouraged.  The opportunity to clarify any issues or questions
from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Emeline Otey, Ph.D.
Division of Services and Intervention Research
National Institute of Mental Health
6001 Executive Blvd., Room 6180 MSC 9625
Bethesda, MD  20892-9625
Telephone:  301-443-9284
FAX: 301-443-4611
Email:  eotey@nih.gov

Direct inquiries regarding fiscal matters to:

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
6001 Executive Boulevard, Room 6115 MSC 9605
Bethesda, MD  20892-9605
Telephone: (301) 443-3065
FAX:  (301) 443-6885
Email:  Diana_Trunnell@nih.gov

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance No.
93.242.  Awards are made under authorization of the Public Health Service Act,
Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC
241 and 285) and administered under PHS grants policies and Federal
Regulations 42 CFR 52 and 45 CFR Part 74.  This program is not subject to the
intergovernmental review requirements of Executive Order 12372 or Health
Systems Agency review.  Awards will be administered under PHS grants policy as
stated in the NIH Grants Policy Statement (October 1, 1998).

The PHS strongly encourages all grant and contract recipients to provide a
smoke-free workplace and promote the non-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, and 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.


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