Full Text DA-98-002 ORGANIZATION AND MANAGEMENT OF DRUG ABUSE TREATMENT SERVICES NIH GUIDE, Volume 26, Number 16, May 16, 1997 RFA: DA-98-002 P.T. 34 Keywords: Drugs/Drug Abuse Health Services Delivery National Institute on Drug Abuse Letter of Intent Receipt Date: September 29, 1997 Application Receipt Date: October 28, 1997 PURPOSE The purpose of this Request for Applications (RFA) is to encourage research on the organization and management of drug abuse treatment services. This field is concerned with understanding the structure of organizations and the management of services as they impact the access, use, quality, costs, and outcomes of service provision; how the organizational environment (including patients and their families, payers and insurers, federal and state policies, and other treatment and service organizations) impact the development and management of services and staff, intervention approaches, and linkages with other programs/systems; the impact of special needs patients, especially patients with HIV/AIDS and co-occurring disorders, on organizational planning and service delivery; and how the environmental and organizational context impacts clinical decision-making within organizations that treat people with drug abuse problems. Applications are sought that employ a wide variety of organizational and management analyses to address critical challenges facing specialty and non-specialty organizations providing treatment services to drug abusing patients and their families. 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 RFA, Organization and Management of Drug Abuse Treatment Services, is related to the priority area of alcohol and other drugs. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0 or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (Telephone 202-512-1800). ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic and foreign for-profit and nonprofit organizations, such as universities, colleges, hospitals, laboratories, units of State and local governments, and eligible agencies of the Federal government. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as Principal Investigators. Foreign institutions are not eligible for the First Independent Research Support and Transition (FIRST) (R29) award. MECHANISM OF SUPPORT Research support mechanisms include the research project grant (R01), small grant (R03), and FIRST awards (R29). There are special requirements for FIRST and R03 mechanisms; the applicant intending to apply utilizing either of these mechanisms should contact the program officer listed under INQUIRIES for further information. This RFA is an one-time solicitation. Future unsolicited applications will compete with all investigator-initiated applications and will be reviewed according to customary peer review procedures. FUNDS AVAILABLE It is anticipated that approximately $2.0 million will be available to support the research grants under this request for applications. Because of the nature and the scope of the research proposed in response to requests for applications may vary, the size of award will also vary. However, it is anticipated that approximately six to eight new awards will be made under this RFA. RESEARCH OBJECTIVES Background The system of service delivery for drug abuse treatment is comprised of various private and public service organizations including specialty treatment, health and mental health care, social service, correctional, and self-help organizations. Though there has been some progress in the study of organizations that serve drug abusing patients(see D'Aunno & Price, 1986; D'Aunno & Vaughn, 1992; 1995; and Timko, 1995), treatment organizations remain one of the least studied areas in drug abuse health services research. Given the profound changes that these organizations are currently experiencing, there is a critical need for knowledge to help inform the debate about how to best structure and manage service delivery to ensure positive patient outcomes. This information must, however, build upon proven organizational and management research findings across multiple disciplines. In addition to larger changes in the health care system, the continued pandemic of HIV/AIDS remains a major challenge for organizations providing drug abuse treatment services. During the last decade, many programs have expanded services to meet the growing need to reduce and prevent the spread HIV/AIDS. And though drug abuse treatment remains a central anchor point in the effort to protect against HIV/AIDS (NIH, 1997), it remains to be seen how these changes to the system of care will impact on both intermediate and long-term patient outcomes. Concurrently, there has been a tremendous increase in the role of correctional organizations in the delivery of services to drug abusing patients. There is evidence that combining sanctions with drug abuse treatment can be effective in decreasing drug use and related criminal behavior (Anglin, 1988; Anglin and Hser, 1989). However, little research has been carried out to determine the most effective strategies to aid patients in transitioning between organizations/systems to ensure continuity of care and improve long-term outcomes. The association between retention and positive outcomes is well established. Less well understood is how organizational structures and management strategies affect accessibility, engagement, retention, quality, cost, and continuity of service provision and how to develop systems that optimize resources to create conditions for positive outcomes for patients and their families. Applications submitted under this request for applications may focus on specialty and/or non-specialty (e.g., health and mental health care, correctional, social, and welfare programs) settings that provide drug abuse treatment services. In addition, research may also focus on factors that facilitate or impede effective and efficient linkages across service organizations and settings. Research projects that examine innovative organizational and management models that enhance the quality, cost-effectiveness, access, and outcomes of services to drug abusing patients, particularly to patients with special needs, are of particular interest. Research Projects: Investigators are encouraged to utilize the most rigorous methodology consistent with the purposes of the research study. It is expected that applications may use quantitative or qualitative approaches, or both, to examine these systems. Examples of research problems include, but are not limited to the following under this announcement: Organizational Structures o The effects of organizational goals, priorities, and ownership on service availability, access, utilization, and patient outcomes; o How program policies and procedures impact drug users attitudes toward treatment, treatment engagement, entry, retention, and outcomes; o The impact of organizational structures (e.g., formalization of performance standards, size, and complexity) on management and organizational performance; o How staff credentialing, training, and incentives impact the perceived accessibility of services, use of services, and quality of care; o How can organizations improve their ability to adapt to changes in intervention technologies, funding sources and approaches, patient needs, and other factors in the environment. Management of Services o How alternative management strategies affect the cost and the cost-effectiveness of services delivered in specialty and non-specialty settings; o Research on the differential impact of management models on an organization's capacity to exploit resources and adapt to changing patterns in the community environment; o The types of management strategies that organizations delivering drug abuse treatment services use to distribute risk; How organizations develop and integrate standards of care for treatment services and the relationship to organizational goals for patient outcomes; o Research on innovative management strategies to improve the integration of emerging or underutilized service technologies (team approaches, new behavioral therapies, HIV testing and prevention, gender-specific programming) into new and existing specialty and non-specialty treatment organizations; o The development of methodologies and techniques to effectively match service organizations to resources in the community. Financing Issues o The impact of ownership, regulatory strategies, managed care and emergent financing mechanisms on structural patterns and models of service and patient management; o The impact of payer requirements on organizational development, performance and service delivery; o The impact of funding sources (public, private, insurance, self-pay) on the identified service population, assessment methodologies, service matching, service practices, and the quality, level and intensity of services provided; o The impact of integrated service/funding models on the continuity of care, service quality, patient outcomes, cost-effectiveness, and costs of care. Environmental Issues o The impact of environmental conditions (geographical, resource availability, organizational density) on organizational variation and subsequent effects on service availability within the community, access to care, service needs, and service quality; HIV/AIDS o Research which examines the impact of HIV and AIDS on organizations that treat drug abusing individuals including models for integrating HIV/AIDS prevention and treatment services; o The impact of staffing and training on access to and utilization of drug abuse treatment services by persons at risk for HIV and for persons who are HIV seropositive; o The role of organization in the development of linkages to other relevant agencies and service providers to ensure treatment retention and continuity of care for at risk and HIV positive patients; Special Populations o Research on innovative organizational development to enhance access, utilization, quality of care and outcomes of services to underserved populations including, but not limited to, persons with co-occurring disorders, adolescents, homeless persons, and Native Americans; o The impact of various management models for providing drug abuse treatment services to criminal justice involved populations; o Research to lessen organizational barriers to ensure access to and continuity of care for individuals with special needs including persons with co-occurring disorders and significant medical problems; Gender Specifity o How do female to male staff ratios, training, and patient population affect assessment and referral practices in organizations and what is the subsequent impact on engagement and retention in treatment; o Do specialty and non-specialty organizations differentially manage the care of drug abusing female patients, including pregnant and post-partum females. Topics not responsive to this RFA will be returned without review. Timely reporting of findings is emphasized with specific attention to the development of dissemination plans that facilitate access to current findings among researchers and practitioners. Applicants should be willing to participate in research coordination efforts aimed at enhancing the utility and review of dissemination activities. 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 sub-populations 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, Volume 23, Number 11, March 18, 1994. LETTER OF INTENT Prospective applicants are asked to submit, by September 23, 1997, a letter of intent that includes a descriptive title of the proposed research, the name, address, telephone number, and e-mail address of the Principal Investigator, the identities of the key personnel, consultants, and participating institutions, and the number and title of the RFA in response to which the application may be submitted. Although a letter of intent is not required, is not binding, and does not enter into the review of the subsequent application, the information that it contains allows IC staff to estimate the potential review workload and avoid conflicts of interest in review. The letter of intent is to be sent to: Director, Office of Extramural Program Review National Institute on Drug Abuse 5600 Fishers Lane, Room 10-42 Rockville, MD 20857 Telephone: (301) 443-2755 FAX: (301) 443-0538 APPLICATION PROCEDURES Applications are to be submitted on the grant application form PHS 398 (rev. 5/95). Application kits are available at most institutional offices of sponsored research and may be obtained from the Division of Extramural Outreach and Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301-710-0267, email: ASKNIH@ODROCKM1.OD.NIH.GOV. The RFA label available in the PHS 398 application form must be affixed to the bottom of the face page of the application. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, the RFA title and number must be typed on line 2 of the face page of the application form and the YES box marked. Applications for the FIRST (R29) award must include at least three sealed letters of reference attached to the face page of the original application. FIRST (R29) award applications submitted without the required number of reference letters will be considered incomplete and will be returned without review. FIRST award applications must use the Just-in-Time procedures outlined in the NIH Guide, Volume 23, Number 10, March 29, 1996 and Volume 25, Number 16, May 17, 1996. Submit a signed, typewritten original of the application, including the Checklist, and three signed copies to: DIVISION OF RESEARCH GRANTS NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 10-40 - MSC-7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for express/courier service) At time of submission, two additional copies of the application must be sent to: Director, Office of Extramural Program Review National Institute on Drug Abuse Parklawn Building, Room 10-42 5600 Fishers Lane Rockville, MD 20857 Applications must be received by October 28, 1997. If an application is received after that date, it will be returned to the applicant without review. The Division of Research Grants (DRG) will not accept any applications in response to this RFA that is essentially the same as one currently pending in initial review. This does not preclude the submission of substantial revisions of applications already reviewed, but such applications must include an introduction addressing previous critiques. REVIEW CONSIDERATIONS Applications that are complete will be evaluated for scientific and technical merit by a peer review group convened by the NIDA 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 board or council. Small grant applications do not receive a second-level Council review. Review Criteria o degree of relevance to the goals and objectives of this RFA; o scientific, technical, or medical significance and originality of proposed research; o appropriateness and adequacy of the approach and methodology proposed to carry out the research; o qualifications and research experience of the Principal Investigator and staff, particularly, but not exclusively, in the area of the proposed research; o availability and adequacy of the resources and collaborative arrangements necessary to perform the research; o appropriateness of the proposed budget and duration in relation to the proposed research; and o adequacy of the plans to include both genders and minorities and their subgroups as appropriate for the scientific goals of the research. The special review group will also examine the provisions for the protection of human and animal subjects, and the safety of the research environment. Schedule Letter of Intent Receipt Date: September 23, 1997 Application Receipt Date: October 28,1997 Scientific Review Date: January/February 1998 Council Meeting Date: May 1998 Earliest Award Date: July 1998 AWARD CRITERIA Award criteria that will be used to make award decisions include: scientific and technical merit of the proposal as determined by peer review, availability of funds, program needs and balance, and adequacy of provisions for the protection of human and animal subjects. INQUIRIES Inquiries are encouraged. The opportunity to clarify any issues or questions from potential applicants are welcome. Direct inquiries regarding programmatic issues to: Peter J. Delany, D.S.W. Services Research Branch National Institute on Drug Abuse 5600 Fishers Lane, Room 10A30 Rockville, MD 20857 Telephone: (3010 443-4060 FAX: (301) 443-6815 Email: PD32N@NIH.GOV Direct inquiries regarding fiscal matters to: Gary Fleming, J.D., M.A. Grants Management Branch National Institute on Drug Abuse 5600 Fishers Lane, Room 8A-54 Rockville, MD 20857 Telephone: (301) 443-6710 Email: GF6S@NIH.GOV AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.279. 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. Grants must be administered in accordance with the Public Health Service Grants Policy Statement (rev. 4/94). The PHS strongly encourages all grant recipients to provide a smoke-free work place 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, any portion of a facility) in which regular 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. References Anglin, M.D. (1988). The efficacy of civil commitment in treatment narcotic addiction, in C.G. Leukefeld & F.M. Tims, F.M., eds., Compulsary treatment of drug abuse: Research and clinical practice, NIDA Research Monograph 88, Washington, D.C.: Supt of Docs., U.S. Govt. Print. Off. Anglin, M.D. & Hser, Y.-I. (1989). Legal coercion and drug abuse treatment: Research findings and policy implications, in Handbook of drug control in the United States, Westport, CT: Greenwood Press. D'Aunno, T. & Vaughn, T.E. (1995). The organizational analysis of service patterns in outpatient drug abuse treatment units, Journal of Substance Abuse, 7: 27-42. D'Aunno, T. & Price, R.H. (1986). Linked systems: Drug abuse and mental health services. In W.R. Scott & B.L. Black (Eds.), The Organization of Mental Health Services: Societal and Community Systems. Beverly Hills, CA: Sage Publications. National Institutes of Health (1997). National Institutes of Health Consensus Development Conference Statement: Interventions to Prevent HIV Risk Behaviors, February 11-13: Rockville, MD. Timko, C. (1995). Policies and Services in residential substance abuse programs: Comparisons with psychiatric programs, Journal of Substance Abuse, 7: 43ff. .
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