Full Text MH-94-009

MULTI-SITE STUDY OF MENTAL HEALTH SERVICE USE, NEED, OUTCOMES, AND
COSTS IN CHILD AND ADOLESCENT POPULATIONS

NIH GUIDE, Volume 23, Number 15, April 15, 1994

RFA:  MH-94-009

P.T. 34, AA

Keywords: 
  0730057 


National Institute of Mental Health

Letter of Intent Receipt Date:  May 1, 1994
Application Receipt Date:  July 12, 1994

PURPOSE

The National Institute of Mental Health (NIMH) invites cooperative
agreement applications for a five-year study of child and adolescent
mental health services.  Applications are invited for two types of
studies.

One type involves multi-site, collaborative, longitudinal,
community-level studies of the types and patterns of mental health
service use by children and adolescents, ages 4 to 17, the extent of
unmet need for services, and the ways in which the organization and
financing of services influence access to, use of, and outcomes of
mental health services.  The major goals of this study are to
encourage investigations of the following overarching questions:  How
do community factors (poverty levels, rates of unemployment,
rural/urban), service system variables (range, degree of
coordination, types of interrelationships), economic constraints
(methods of financing), cultural influences (degree of acculturation,
contextual factors), and family factors (roles, structures, supports,
functioning) influence the need, access, use, and outcomes of mental
health services across several service sectors for children and
adolescents?  To what extent are children's mental health needs
enduring or transient?  What is the impact of services on the
relative persistence of children's mental health needs?

The other type of study involves a national survey to address issues
related to the prevalence and incidence of specific mental disorders
among children and adolescents, ages 4 to 17, rates of mental health
service utilization across major service sectors, and costs and
financing of care.  In view of the scale and complexity of the
research tasks involved, applications to conduct both types of
studies concurrently are not encouraged.

Meeting the goals of this Request for Applications (RFA) will require
the collaboration of multidisciplinary research teams at both the
community and national sites.  Further, this RFA will enable
independent teams of investigators to work together to develop a
common study protocol.

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,
Multi-site Study of Service Use, Need, Outcomes, and Costs in Child
and Adolescent Populations (UNO-CAP), is related to the priority
areas concerning the prevention of mental disorders and suicide in
children and adolescents.  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 202/783-3238).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic public and private, for-
profit and non-profit institutions, such as a university, college,
community agency, State and local governments, and eligible agencies
of the Federal government.  Eligibility under this program is limited
to applications from institutions of the United States, its
territories and commonwealths.  Minority and women investigators are
encouraged to apply.

MECHANISM OF SUPPORT

A cooperative agreement mechanism (U01) will be used for this study
program.  The NIMH will work jointly with the awardees in a
partnership role, to support, coordinate, and facilitate the
awardees' activities, and to assist in moving the study through its
phases.  Direction and principal responsibility for the conduct and
implementation of the study will rest with the awardees.  Details of
the responsibilities, relationships, and governance of the study are
discussed later in this document under the section "Terms and
Conditions of the Award."

This RFA is a one-time solicitation.  However, because some of the
goals of UNO-CAP will require a longitudinal design beyond the first
five years of funding outlined in this RFA, the NIMH anticipates that
there will be a renewed competition for an additional five years.  If
the NIMH does not continue the program as a cooperative agreement,
awardees may submit grant applications through the usual
investigator-initiated grants program.

FUNDS AVAILABLE

It is estimated that up to $7 million in total costs will be
available for the first year of support.  The exact amount of funding
available will depend on the quality of applications and program
priorities at the time of the award.  Five to seven awards are
anticipated.

The total project period is five years.  It is anticipated that
awards will be made in September 1994.  Final budgets are subject to
administrative adjustments, based on the scope of the proposed work
and the final study protocol.  Because the nature and scope of the
research proposed in response to this RFA may vary, it is anticipated
that the sizes of awards will vary also.

RESEARCH OBJECTIVES

Background

Research to date on service use by children and adolescents with
mental health problems has shown that several service sectors are
often involved: general health, education, child welfare, juvenile
justice, substance abuse, and mental health.  Community surveys have
shown that between 6 and 16 percent of children and adolescents with
diagnosable mental disorders have received some type of mental health
service in the past year.  However, much is unknown about both the
children and adolescents who receive care and those who do not.

For those who do receive mental health services, there is limited
scientific knowledge about the care they are receiving; the patterns
of their service use and pathways into services; the factors
influencing access to and sources of care; and the costs and quality
of care.  Further, there is currently insufficient knowledge about
the effectiveness of care for children with various types of
disorders and about the extent to which the care that is received is
clinically or culturally appropriate.

For those who do not receive mental health services, there is little
scientific understanding of the social, cultural, financial, or
geographic barriers experienced by the children and their parents;
the alternative sources of care used; and the consequences in either
the short or long term of lack of specific types of care.

An additional important scientific research issue that has not been
addressed sufficiently in studies of service use is how developmental
factors influence expression of symptoms, initial source of care,
subsequent patterns of care, continuing need for care, and the
eventual manifestations of mental disorders. Recent studies of risk,
vulnerability, and protective factors suggest that there may be
multiple pathways into care; these factors also shape children's
ongoing need for services and the eventual outcomes for children with
mental disorders.

To obtain a more precise scientific understanding of the scope of
services available to children and adolescents and of the
effectiveness of the services that exist, a multi-site community
study is needed.  In addition, to determine the adequacy and
distribution of those services, as well as the level of unmet need
for services across the United States, a study of mental disorders,
using a nationwide probability sample and linking prevalence to
utilization and costs of services, is necessary.

The Community Study

Objectives and Scope

This study program will be the first major multi-site collaborative
study to investigate the ways in which multiple factors influence
child and adolescent use of mental health services and the outcomes
associated with the use and non-use of mental health services.
Through use of a common study protocol, to be developed and agreed
upon by investigators participating in the research, the study will
make it possible to pool data from the different community sites and
compare the community and national data.  The study will also permit
linkage of child, family, community and service system variables,
including organizational and financial characteristics of service
systems, thus creating a broad picture of the impact of services on
children, adolescents, and families in differing neighborhoods and
communities.

The main questions in this study program concern the influence of
multiple community, service system, cultural, and family variables on
child and adolescent service use and outcomes of care.  The following
are examples of the types of study questions that applicants may seek
to address in their study proposals:

o  Service use.  What are the major types of services provided across
the major service sectors for youth (e.g., mental health, education,
general health, child welfare, juvenile justice, substance abuse
settings)?  What are the patterns of services within and across the
major service systems?  What factors, such as socioeconomic status,
age, gender, ethnicity, source of initial referral, presenting
problem, family background or functioning, community characteristics,
service system organization, influence entry into one or more service
sectors?  What is the mental health status of children receiving
services within and across service sectors?  What is the level of
family/caregiver and child/adolescent satisfaction with services
received and with the type of service system organization?  What is
the impact on families of caring for children with mental disorders?
What is the relationship between family functioning and service use
or access to care?

o  Service need.  What is the extent of unmet need for services?
What is the level of impairment among children without services?
What is the extent of unmet need among children who are receiving
services through other service sectors?  What barriers do families
face in accessing needed services?  What are the risk and protective
factors that operate singly or in combination to predict the need for
services?  What are the service needs of children as defined by
exposure to risk, diagnosis alone, and diagnosis plus impairment?

o  Service outcomes.  What are the clinical, developmental, and
functional outcomes for children who receive services through single
or multiple service sectors?  What are the service-related outcomes,
such as changes in placement patterns, reduction in out-of-home
placements or in restrictiveness of placements, for children and
adolescents in different models of service systems?  What are the
clinical, developmental, and functional outcomes for children who do
NOT have access to or do not receive care?  What are the critical
age-specific periods during which service provision or risk factors
exert differential effects on children's psychosocial outcomes,
functional impairment, or need for subsequent services?  What is the
impact of different organizational structures on outcomes for
children and their families?

o  Service costs and financing.  What is the average cost per service
unit across program elements in the various sectors?  What is the
total annual direct treatment cost per child/adolescent user by
combining service use data with service unit cost data?  What are the
total annual direct treatment costs to families and to agencies
associated with providing services?  What are the methods by which
services are financed, including the distribution of public and
private funds?  What is the effect of different models of service
system organization on costs of care?  What is the influence of
insurance coverage or program eligibility criteria on entry,
continuation, or outcomes of care?

Methodological Considerations

Applicants should consider the following issues in their application:

Definition of study area(s).  For the purposes of this RFA, the term
"study area" or "community" may include a city, township, county,
combination, or subsection thereof.  It may include neighborhoods
within larger urban areas, as well as smaller aggregates of rural
areas.  Applicants may wish to consider selecting two study areas in
order to provide a wider range of population, geographic, and service
system characteristics.  In this case, separate budgets should be
developed for the different study areas.

Issues to consider include the following:  What is the optimal area
(or "community") within which to capture a range of service settings,
including a mix of public and private agencies or providers?  What
are the major population, geographic, and system dimensions that can
be compared across study areas?  Population characteristics of
interest may include variations in ethnicity, socioeconomic status,
economic base, mobility, etc.  Geographic variations of interest may
include urban, suburban, and rural locations.  Service system
dimensions may include:  coordination/integration, centralization (in
location, management, or provision of services), comprehensiveness,
intensity, sources of financing, public vs. private, commitment to
community-based delivery, cultural competence, and aspects of quality
or appropriateness of care.

Definition of service sectors.  Applicants may wish to consider
sampling from a range of service sectors, including schools, general
medical, child welfare, juvenile justice, substance abuse, and mental
health.  Issues to consider include:  Is it possible to capture an
adequate population of children and adolescents receiving mental
health services across a range of sectors and settings?  Is it
possible to identify a range of service program types, ranging in
levels of restrictiveness, across the service sectors?

Selection and recruitment of the sample.  Applicants should
specifically describe their rationale for the sampling method they
select and provide a justification for any oversampling.  Applicants
must demonstrate access to an adequate pool of eligible subjects.
Preliminary NIMH estimates suggest that to examine service use, a
sample size of 900 or more per site may be necessary.  To examine
extent of unmet need, estimates suggest that between 2000 and 3000
subjects may be necessary.  A rationale for all estimates of these or
other samples, must be determined by the applicants, based upon
adequate power analyses.  It will be important that the final
sampling frame and recruitment strategies be replicable across all
sites, and that applicants employ a common core assessment battery,
common survey methodology, and common sampling strategies.  Specific
eligibility criteria for inclusion and exclusionary criteria should
also be specified.

Racial/ethnic populations:  Efforts should be made to include all
minority groups that are represented at the site in the sample.
Oversampling with specified probability weights of certain
populations may be used to ensure adequate representation of these
groups.  Applicants should consider issues of cultural diversity,
particularly with respect to racial/ethnic minority populations, in
their selection of measures, sampling, recruitment, and proposed data
analytic strategies.  Appropriate strategies for achieving community
outreach, visibility, and support in their recruitment and
participation strategies should be specified.

Data collection and sample retention.  Applicants are expected to
propose methods for recruitment, retention, and tracking of
respondents, and demonstrate an ability to collect an adequate sample
size to address the study questions.  During the first year of the
project, the collaborators will plan the methods for training,
recruitment, and hiring of interviewers, and procedures for
verification, monitoring, and supervision which can be maintained
across sites.

This RFA provides the opportunity for investigators to propose
following specific subsamples longitudinally to examine the impact of
services on children, adolescents and caregivers.  Specific questions
to be addressed by studying these subsamples should be carefully
delineated and should draw upon the strengths of the longitudinal
nature of the data.  All minority groups must be followed, and
procedures for obtaining adequate representation of these groups
should be described.

Issues to consider include the following:  What are the optimal
intervals over which to obtain mental health status information,
including onset of psychiatric symptomatology, behavioral problems,
and associated impairment?  What are the appropriate intervals over
which to obtain prospective data on mental health service use?  What
is the optimal method for assessing developmental precursors of later
psychopathology in younger children?  How should instruments be
combined for children of differing developmental ages?  Should child
psychiatric diagnosis for younger children be assessed through parent
interviews?

Measurement.  Applicants should propose a common core battery of
measures and provide psychometric justification for their selection
of all instruments.  In addition, all assessments will need to be
justified in terms of their appropriateness for use with children of
varying ages and ethnicities, relevance to the overall study
questions, and fit with the other measures being collected.

To ensure a broad-based examination of the central research
questions, multiple domains will need to be assessed at the child,
family, service system, and community level.  Applicants may wish to
consider the advantages and disadvantages of including assessment of
these or other factors in their applications:  mental health status
of the child; physical health; social competence; family structure,
stability, strengths, and functioning; impact on family of caring for
a child with mental disorders; psychosocial risk and protective
factors; access and barriers to care; reasons for seeking services;
satisfaction with services; quality of care; costs of care; types,
levels, frequency and duration of services used; service system
structure and functioning.

Data management and analysis.  Applicants should pay particular
attention to the size and complexity of the dual tasks of data
management and analysis.  The data plan should include a description
of how data quality and security will be assured; specific data
analytic plans for each stage of the research; and justification for
specific data analytic techniques, particularly those for analyzing
nested longitudinal data.

The National Survey

The purpose of the National Survey is to provide estimates of the
prevalence and incidence of specific mental disorders and behavioral
problems among children and adolescents, degree of associated
functioning impairment, rates of mental health service utilization,
and costs of care for children and adolescents with mental disorders.
It is anticipated that one site may be selected to conduct the
national survey.  The selected site will be expected to work with the
community sites as part of the multi-site collaborative research
team.  Preliminary power analyses suggest the need for approximately
7000 total subjects for this survey.

Like the community sites, applicants to conduct the national survey
should propose a common core battery for use by all sites, as
indicated under "Measurement" above.  A non-core battery may also be
developed by the site, taking into account respondent burden and the
expected constraints of a nationally representative survey design.
It is expected that the community sites will be able to gather much
more detailed information on local service systems, local factors,
organizational and financing features of the systems, outcomes of
service use by children, and the relationships among these variables
than will be possible with the national survey.

Methodological issues to consider include:  Would placing the
community study subjects into the sampling frame for the national
study be an efficient or inefficient method of accruing adequate
sample size?  How would such a procedure affect the resulting sample
weights?  Are there efficient, feasible strategies whereby the
national sample might obtain reliable rates of service utilization?
If so, what would be the advantages and drawbacks of such strategies?

Timetable

The first year of the collaborative effort will focus on:  (a)
developing a common protocol across sites and the national survey;
(b) developing consistent implementation procedures; and (c) refining
service use instruments to ensure cross-site consistency and
appropriateness, as well as valid linkages to diagnostic
instrumentation.  The common protocol will be designed to maximize
the potential of the cross-site and national data to address the
major goals of the study.

Study Phases:  Applicants are encouraged to consider four phases in
their study proposal:

o  Phase I (during year 1):  (a) methodological pilot work to refine
and pre-test the assessments; (b) development of a common protocol
for use by all sites, including the national site; and (c) start-up
of data collection for the first half of the sample.

o  Phase II (year 1 to year 3):  continuation of longitudinal data
collection.

o  Phase III (year 3 to year 4):  data cleaning and editing of the
first waves of data.  Follow-up of the selected outcome samples may
occur during this year.

o  Phase IV (year 4 to year 5):  data analyses and preparation of a
competing continuation application, if justified by preliminary
analyses.

SPECIAL REQUIREMENTS

To assist in the development of collaborative activities among the
selected sites, applicants should consider the following issues:

o  Documentation of previous experience of proposed study groups in
working together and with other research partners (e.g., academic
institutions collaborating with State or local agencies or
organizations)

o  Documentation of ability to recruit and interview a sufficient
number of participants for all aspects of the study

o  Delineation of a detailed analytic plan for the analyses and
interpretation of data generated in the study.  The data analytic
team at each site must be experienced in data management, in
state-of-art data processing, and in bio-statistical analytic
techniques suitable for use with complex sampling designs.  Data
analysis plans should take into account the complex sampling plan and
the longitudinal nature of the data.

o  Letters of support from local or State agencies or service
providers regarding access to records, and participation in the
study.

Active collaborations between academic researchers and public
agencies, as evidenced by previous collaborations or written
agreements, will enhance the application.  However, one institution
must be proposed as the lead organization to assume fiscal and
programmatic responsibility for each application.

Terms and Conditions of Award

The following special terms of award are in addition to, and not in
lieu of, otherwise applicable OMB administrative guidelines, HHS
Grant Administration Regulations at 45 CFR Part 74 and 92, and other
HHS, PHS, and NIH Grant Administration policy statements.

1.  Designation as a Cooperative Agreement.  This study is designed
as a cooperative agreement involving collaboration among several
sites funded under the program and including participation by
appropriate NIMH staff.  A cooperative agreement is an assistance
mechanism, involving NIMH scientific and programmatic involvement
with the awardees beyond the levels usually accorded regular research
grants.  NIMH involvement will be for the purposes of assisting
awardee activity through partnership with the awardees.  However,
principal responsibility for the direction of the study rests with
the awardees.

2.  Awardee Rights and Responsibilities.   Awardees have primary
authorities and responsibilities to define objectives and approaches,
and to plan, conduct, analyze, and publish results, interpretations,
and conclusions of studies from their sites.  Awardees shall retain
custody of and primary rights to the data developed under their
award, subject to Government rights of access and consistent with
current HHS, PHS, and NIH policies.  Awardees will engage in
collaborative activities through participation in Steering Committee
meetings and conference calls in the development and implementation
of a common protocol establishing a shared data set.  Protocols
developed by the Steering Committee will define rules regarding
access to data and publication of findings from analyses of the
shared data set.  The data from this cooperative agreement will be
analyzed and interpreted first by the collaborators in the project.
However, since the creation of the data set is funded through public
monies and because the data set will constitute a national scientific
resource for the research community, it will be made available to the
larger research community 36 months after each wave of data has been
cleaned.

Awardees will be responsible for planning and participating
collaboratively with NIMH and other award recipients under this
cooperative agreement.  Participating investigators will agree to
follow a uniform, collaborative study protocol with standardized data
collection procedures.  Applicants are expected to propose a
tentative design and specific assessment methods and measures.  The
final protocol will be developed during the initial project year by
the Steering Committee.

3.  NIMH Responsibilities.  Four NIMH staff collaborators are
anticipated to have scientific/programmatic involvement during
conduct of this activity, through technical assistance, scientific
monitoring, quality control, and assistance in the coordination of
the overall project.  The participation of NIMH staff is intended to
assist the Steering Committee in its efforts to ensure that the broad
scientific goals of the collaborative program are reflected in the
final design, implementation, and dissemination of products from the
study.  NIMH cooperation will be for the purpose of encouraging
comparable and cooperative work among sites and providing assistance
in the development and refinement of the final protocol.  NIMH staff
collaborators will participate in all major project meetings.  NIMH
staff may cooperate with awardees as authors or coauthors of
resulting publications in accordance with publication policies
developed by the Steering Committee. Publications involving NIMH
staff must follow NIH publication policies.

4.  Collaborative Responsibilities.  The Steering Committee will
serve as the principal decision-making body for the shared components
of the study.  The Steering Committee will have overall
responsibility for the study and will develop modifications in the
site-specific protocols to facilitate establishment of a common
protocol.  NIMH will have a single vote on the Steering Committee.
Likewise, each site will have one vote, although two persons from
each site (the PI and Co-PI) will be members of the Steering
Committee.  A quorum will require at least one NIMH representative
and at least one representative from at least three-fourths of
participating sites.  The Steering Committee may establish additional
by-laws or subcommittees for specific tasks.  NIMH staff
collaborators may NOT chair any committee or subcommittee.
Membership on the Steering Committee becomes effective for sites upon
receipt of notice of award.  All decisions will be made by majority
vote of a quorum, with an attempt for consensus when possible.  Since
the use of a Common Core Battery and common survey methods is
essential, all participating sites must agree to carry out the study
design, procedures, policies, etc. developed by this committee.  Any
committee member who considers a committee decision unacceptable may
appeal to the arbitration procedure described below.  The Steering
Committee will also establish subcommittees to oversee major
operational components of the study.  The Steering Committee will
meet every three to six months as needed.

It is anticipated that, at a minimum, the following committees will
be established:  a Steering Committee to organize and coordinate the
collaborative structure, provide scientific direction, and organize
additional committees as needed; a data management committee to
coordinate data coding, entry, and analysis; a publication committee;
and an implementation committee to ensure uniformity of procedures
across sites.  Each committee will include at least one
representative from each site.

5.  Arbitration Procedures.  If a decision related to a scientific or
programmatic issue between NIMH and awardees is not acceptable to an
awardee, the awardee may, within 30 days of notification of the
decision, request a review by an arbitration panel composed of one
arbitrator nominated by the awardee, one nominated by NIMH, and one
chosen by the first two nominees. This panel will make a decision
within 60 days of the request.  Failure to comply with the decision
of the panel may result in termination of support for the awardee by
NIMH.  This arbitration procedure in no way affects the awardee's
right to appeal an adverse action in accordance with PHS regulations
at 42 CFR Part 50, subpart D, and HHS Grant Administration
Regulations at 45 CFR Part 74, section 304, and HHS regulations at 45
Parts 16 and 75.  This procedure may also be used for disagreements
between awardees and the Steering Committee if the disagreement
relates specifically to a scientific or programmatic issue.

STUDY POPULATIONS

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 new policy results
from the NIH Revitalization Act of 1993 (Section 492B of Public Law
103-43) and supersedes and strengthens the previous policies
(Concerning the Inclusion of Women in Study Populations, and
Concerning the Inclusion of Minorities in Study Populations) which
have been in effect since 1990.  The new policy contains some new
provisions that are substantially different from the 1990 policies.
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 9, 1994 (FR 59 11146-11151), and reprinted
in the NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994, Volume
23, Number 11.

Investigators may obtain copies from these sources or from the
program staff or contact person listed below.  Program staff may also
provide additional relevant information concerning the policy.

LETTER OF INTENT

Prospective applicants are strongly encouraged to submit, by May 1,
1994, a letter of intent that includes a descriptive title of the
proposed research, the study type (i.e., community study or national
survey), the name, address, and telephone number of the Principal
Investigator, the identities of other key personnel and participating
institutions, and the number and title of the RFA.  This letter
should be received by the staff contact by May 1, 1994.

Although a letter of intent is not required, nor is it binding, it
allows the NIMH staff to estimate the potential review workload and
to avoid conflict of interest in the review.

The letter of intent is to be sent to Dr. Kimberly Hoagwood at the
address listed under INQUIRIES.

APPLICATION PROCEDURES

The deadline for submission is July 12, 1994.  Applicants are to use
the research grant application form PHS 398 (rev. 9/91).  Application
kits containing the necessary forms may be obtained from offices of
sponsored research at most universities, colleges, medical schools,
and other major research facilities and from the Office of Grants
Information, Division of Research Grants, National Institutes of
Health, Westwood Building, Room 449, Bethesda, MD 20892, telephone
301/710-0267.

The number and the title of this RFA must be typed in item 2a on the
face page of the PHS 398 application form; the YES box must also be
marked.  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.

Applicants must submit, in one package, a signed original of the
application, including the Checklist, and three signed copies to:

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

At the time of the submission, two additional copies of the
application must also be sent to:

Althea Wagman, Ph.D.
Division of Extramural Activities
National Institute of Mental Health
5600 Fishers Lane, Room 9C-18
Rockville, MD  20857

REVIEW CONSIDERATIONS

Applications that are incomplete or nonresponsive to this RFA will be
screened out by DRG and NIMH staff upon receipt and returned to the
applicants without further consideration.  Applications that are
complete and responsive may be subjected to a preliminary evaluation
by a peer review group to determine their scientific merit relative
to the other applications received in response to this RFA (triage);
the NIMH will withdraw from further consideration applications judged
to be noncompetitive and notify the principal investigator/program
director and the official signing for the applicant organization.
Those applications judged to be competitive will be further evaluated
for scientific/technical merit by an initial review group (IRG)
consisting primarily of non- Federal experts.  Final review is by the
Mental Health National Advisory Council, whose review may be based on
policy as well as scientific considerations.  Notification of the
review outcome will be sent to the applicant by the NIMH.  Only
applications recommended by Council may be considered for funding.

Review criteria:  Criteria for scientific/technical merit review of
research applications will include the following:

o  scientific merit of the research design, approaches, and
methodology

o  qualifications and experience of the principal investigator and
proposed staff

o  adequacy of the conceptual and theoretical framework for the
research

o  feasibility of the research plan

o  adequacy of proposed procedures for protecting human subjects

o  appropriateness of the budget, staffing plan, and timeframe to
complete the project

o  adequacy of the existing and proposed facilities and resources

o  evidence of appropriateness of collaborative arrangements

o  plans for dissemination of research findings

o  evidence of ability to work with large data sets

AWARD CRITERIA

Factors considered in determining which research applications will be
funded are:  scientific and technical merit as determined in the
initial review, Council recommendations, responsiveness to the goals
of this RFA, significance of the topic under study to NIMH priorities
as announced in this or other special announcements or guidelines,
program balance, public health significance, and availability of
funds. In addition, because of the importance of being able to
minimize bias, make comparisons across sites with regard to key
service variables, and represent as fully as possible the range of
service system types, the final NIMH selection of sites will be based
in part on the extent to which major service dimensions are
represented in the final group of applications being considered for
award.

INQUIRIES

Written and telephone inquiries concerning this RFA are encouraged.
the opportunity to clarify any issues of questions from potential
applicants is welcome.

Direct inquiries regarding programmatic issues to:

Kimberly Hoagwood, Ph.D.
Division of Epidemiology and Services Research, Room 10C-06
Telephone:  (301) 443-4233
FAX:  (301) 443-4045
E-mail:  KHOAGWOO@AOAMH2.SSW.DHHS.GOV

Peter Jensen, M.D.
Child and Adolescent Mental Disorders Research Branch, Room 18C-17
Telephone:  (301) 443-5944
FAX:  (301) 443-6000

Kathy Magruder, Ph.D.
Services Research Branch, Room 10C-06
Telephone:  (301) 443-3364
FAX:  (301) 443-4045

William Narrow, M.D., M.P.H.
Epidemiology and Psychopathology Research Branch, Room 10C-09
Telephone:  (301) 443-3774
FAX:  (301) 443-4045

Grayson Norquist, M.D., M.S.P.H.
Division of Epidemiology and Services Research
Telephone:  (301) 443-3266
FAX:  (301) 443-4045

For information on grants management, applicants may contact:

Diana Trunnell
Grants Management Branch, Room 7C-08
Telephone:  (301) 443-3065

For information on grants review, applicants may contact:

Althea Wagman, Ph.D.
Grants Review Branch, Room 9C-18
Telephone:  (301) 443-4868

The mailing address for all persons listed above is:
National Institutes of Mental Health
5600 Fishers Lane
Rockville, MD  20857

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 and 92.  This program is not subject to the
intergovernmental review requirements of Executive Order 12372 as
implemented through Department of Health and Human Services
regulations at 45 CFR part 100 or Health Systems Agency review.

The Public Health Service (PHS) strongly encourages all grant
recipients to provide a smoke-free workplace and promote the non-use
of all tobacco products.  This is consistent with the PHS mission to
protect and advance the physical and mental health of the American
people.

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	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)
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