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 301-435-0714, 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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