Key Dates

Related Announcements

NOT-MH-22-295 - Notice of Participation of NIMH in NOT-DA-23-008,"Notice of Special Interest (NOSI) HEAL Initiative: Workforce Interventions to Improve Addiction Care Quality and Patient Outcomes"

NOT-DA-23-007 - Notice of Special Interest (NOSI): HEAL Initiative: Opioid Use Disorder Care Pathways for Individuals with Histories of Exposure to Violence

RFA-DA-23-053 - HEAL Initiative: Translating Research to Practice to End the Overdose Crisis (R61/R33 - Clinical Trial Optional)

RFA-DA-23-054 - HEAL Initiative: Translating Research to Practice to End the Overdose Crisis (Parent R33 - Clinical Trial Optional)

Issued by

National Institute on Drug Abuse (NIDA)

National Institute on Aging (NIA)

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

National Center for Complementary and Integrative Health (NCCIH)

National Institute of Mental Health's (NIMH)

Purpose

Through the National Institutes of Health (NIH) Helping to End Addiction Long-Term (HEAL) initiative seeks studies that identify, develop, and/or evaluate strategies to address challenges with recruiting, training, and retaining a robust and highly qualified behavioral health workforce. Strategies explored through this initiative should focus on increasing recruitment and retention, improving provider training, reducing stigma among providers, increasing access to care and number of patients served, improving quality of care, and/or improving patient outcomes.

Background

The NIH HEAL Initiative:

This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions to the national opioid public health crisis. The NIH HEAL Initiative bolsters research across NIH to (1) improve treatment for opioid misuse and addiction and (2) enhance pain management. More information about the HEAL Initiative is available at: https://heal.nih.gov/.

This opportunity addresses a critical barrier to addressing the overdose crisis: ensuring a robust workforce to deliver interventions and services to people with substance use disorders and related comorbidities. Recruiting, training, and retaining a robust and highly qualified behavioral health workforce is essential to delivering effective services that address opioid misuse and addiction. However, workforce shortages and high rates of turnover among behavioral health services staff and increases in demand for care have substantially impacted access to, cost of, and quality of services. Further, these barriers undermine efforts to implement innovative approaches to care. In 2018, the Health Resources and Services Administration (HRSA) projected that demand for addiction counselors will exceed supply by approximately 38% in 2030; this trend has likely worsened in response to the COVID-19 pandemic. Workforce challenges were highlighted as one of the top priorities listed in the Office of National Drug Control Policy (ONDCP) 2022 Drug Control Strategy and an effective workforce undergirds all four elements (primary prevention, harm reduction, evidence-based treatment, recovery support) of the HHS Overdose Prevention Strategy.

There are numerous individual-, organizational-, and system-level challenges to recruiting, training, and retaining behavioral health professionals. Unfortunately, little research has been conducted to develop and evaluate strategies to addressing these challenges. Therefore, research funded through this initiative must focus on interventions or strategies aimed at addressing barriers to recruiting, training, and retaining a highly qualified behavioral health workforce, with the ultimate goal of improving care quality and patient outcomes for people who use drugs.

For the purposes of this funding opportunity announcement (FOA), the behavioral health workforce is defined as practitioners who deliver substance use and mental health treatment or prevention services or who play critical roles in connecting people who use drugs to services that can reduce their risk of overdose and death. This could include, but is not limited to: addiction counselors; mental health counselors; addiction medicine specialists; buprenorphine prescribers, including primary care physicians and nurse practitioners; social workers; peer recovery workers; harm reduction interventionists; prevention interventionist; etc.

Studies proposed for this FOA may target individual-, organizational-, system- and macro-level dynamics, which include but are not limited to:

• Individual-level dynamics: emotional stressors such as burnout, compassion fatigue, vicarious and secondary trauma, and feeling unqualified to provide effective treatment

• Organizational-level dynamics: staffing shortages, leadership and clinical supervision, task-shifting, integration of peer interventionists

• System-level dynamics: low wages, reimbursement rates that are not on par with other medical services, billing constraints, limited resources to provide trainings for practitioners, shifts to telehealth during the COVID-19 pandemic, X waiver requirements, licensure requirements, and scope of practice laws

• Macro-level dynamics that cut across all levels of possible intervention: stigma toward individuals with substance use disorder, impacts of COVID-19 on service providers, role of technology in service delivery, workforce diversity and relationship to disparities in care, geographic disparities in care access, interorganizational service linkages and relationships among practitioners

By addressing these dynamics, studies should seek to improve recruitment, retention, or training of the behavioral health workforce in ways that translate to improved patient outcomes. Examples of specific goals include, but are not limited to:

• Increase the number of people recruited into the behavioral health workforce

• Improve retention in the behavioral health workforce

• Improve the training of people in the behavioral health workforce such that training is aligned with current evidence and reduces stigma toward people who use drugs

• Improve knowledge and expertise of and reduce stigma among practitioners working closely with the behavioral health workforce

• Improve availability and accessibility of behavioral health services

• Improve the quality of services delivered

• Increase the number of people receiving services

• Improve patient outcomes

Strategies can include practitioner-level interventions, organizational-level policy and practice changes, and existing, emerging, or potential system-wide policy changes. Multi-method designs are encouraged (e.g., including survey or modeling work), but this opportunity is intended to encourage efforts to identify and intervene on modifiable factors that can improve workforce recruitment, training, and retention. Examples of study designs include but are not limited to: efficacy and effectiveness trials, hybrid implementation-effectiveness trials, implementation trials, and natural experiments.

Additional Considerations:

• In addition to assessing the impact of these strategies on recruitment, training and retention, applicants are encouraged to assess how these strategies impact care quality and patient outcomes, where relevant.

• Applicants are strongly encouraged to take end-user perspectives into account where relevant

• Of note, individuals from racial/ethnic minority groups are significantly underrepresented in the behavioral health workforce, and research has shown that patient-provider racial/ethnic concordance is associated with better outcomes. Therefore, there is an important need to recruit and retain a behavioral health workforce that will better reflect the composition of treatment caseloads. ,Applicants are strongly encouraged to ensure that their proposed research examines how practitioners (and potential practitioners) from diverse backgrounds would be impacted by the strategies being developed and explored through this initiative.

• Applicants are strongly encouraged to focus on questions that can lead to more equitable care for minority health and NIH-designated populations that experience health disparities See https://www.nimhd.nih.gov/about/strategic-plan/nih-strategic-plan-definitions-and-parameters.html

• Applicants to this program will be strongly encouraged to form multidisciplinary teams, including, for example, experts in organizational behavior or other disciplines who may be able to bring important transdisciplinary insights to this critical topic.

• Applicants are encouraged to consider the sustainability and scalability of the strategies they are developing or testing, where relevant.

National Institute of Mental Health

The National Institute of Mental Health (NIMH) is interested in applications relevant to priorities described in this RFA, that support the NIMH Strategic Plan for Research Goal #4, and that supports a workforce charged to deliver high quality care to people who have or are at risk for SUDs and who have co-morbid mental health conditions and/or suicide risk.

Topic of this research could include (but not be limited to):

• Studies to develop and test strategies for training, supervision, and/or consultation in the management and treatment of people with co-occurring substance use disorders in mental health treatment settings, where providers may be less versed in SUD treatment.
• Studies that evaluate and seek to identify putative change mechanisms associated with provider recruitment, retention, job satisfaction, competence, and patient outcomes.

• Studies of large-scale quality improvement efforts to identify clinicians with unmet mental health needs, who are at risk of burnout, and/or who are experiencing compassion fatigue, and that examine the effects of these initiatives on provider retention, quality and outcomes of care delivered to patients, and/or service utilization and mental health outcomes of providers.
• Studies of improvements to the addiction treatment workforce that are designed to improve the mental health care utilization or mental health outcomes of people receiving opioid addiction treatment.
• Studies to predict and reduce mental health workforce shortages (e.g., using machine learning or other big data analytics) across settings and geography and to increase the supply of culturally and linguistically competent care providers for racial and ethnic minorities
• Studies that develop and test policies and strategies to maintain continuity and quality of mental health care during times of organization transition and high staff turnover.
• NIMH is particularly interested in research to increase the number waivered providers and research to increase the number buprenorphine prescriptions by waivered provider for patients with co-occurring mental illness and/or suicide risk and for whom MOUD is indicated. Projects could include:
  • Testing incentives (to include financial incentives) that encourage more providers to seek a waiver and to encourage more providers with a waiver to see patients with OUD and when indicated, prescribe MOUD.
  • Evaluating the effects of policies and practices that limit the buprenorphine prescribers to Qualified Providers (e.g., Qualified practitioners include physicians, Nurse Practitioners (NPs), Physician Assistants (PAs), Clinical Nurse Specialists (CNSs), Certified Registered Nurse Anesthetist (CRNAs), and Certified Nurse-Midwifes (CNMs)) but exclude other non-physician prescribers such as prescribing psychologists (RxPs)
  • Assessing prescribing practices (e.g., safety, quality, frequency) of physician and non-physician prescribers (to include qualified providers and other non-physician prescribers like RxPs) who treat people with co-occurring mental illness and substance use disorders to inform polices that limit or facilitate MOUD prescribing.

All applications that propose clinical trials should follow the NIMH’s experimental therapeutics approach to intervention development and testing (seehttps://www.nimh.nih.gov/funding/opportunities-announcements/clinical-trials-foas/index.shtml). That is, the scope of work must include specification of targets/mechanisms and assessment of intervention induced changes in the presumed targets/mechanisms that are hypothesized to account for the intervention’s outcomes. In this manner, the results of the trial will advance knowledge regarding therapeutic change mechanisms and be informative regardless of trial outcomes (e.g., in the event of negative results, information about whether the intervention was successful at engaging its targets can facilitate interpretation).

NIMH is committed to supporting research that reduces disparities and advances equity in mental health interventions, services, and outcomes. Accordingly, this FOA encourages research studies that seek to reduce disparities for minority health and NIH-designated populations that experience health disparities. See https://www.nimhd.nih.gov/about/strategic-plan/nih-strategic-plan-definitions-and-parameters.html

NIMH encourages a deployment-focused model of intervention and services design and evaluation that takes into account the perspective of relevant stakeholders (e.g., service users, providers, administrators, payers) and the key characteristics of the settings (e.g., resources, including workforce capacity; existing clinical workflows) that are intended to implement optimized mental health interventions. This attention to end-user perspectives and characteristics of intended clinical and/or community practice settings is intended to ensure the resultant interventions and service delivery strategies are acceptable to consumers and providers, the approaches are feasible and scalable in the settings where individuals are served, and the research results will have utility for end users.

NIMH encourages research on potentially scalable preventive, therapeutic, and services interventions that focuses on practice-relevant questions. Accordingly, collaborations between academic researchers and clinical or community practice partners or networks are encouraged. When possible, studies should capitalize on existing infrastructure (e.g., practice-based research networks such as the NIMH-sponsored Mental Health Research Network (MHRN), electronic medical records, administrative data bases, patient registries, institutions with Clinical and Translational Science Awards) to increase the efficiency of participant recruitment (i.e., more rapid identification and enrollment) and to facilitate the collection of moderator data (e.g., clinical characteristics, biomarkers), longer-term follow-up data, and broader, stakeholder-relevant outcomes (e.g., mental health and general health care utilization, value and efficiency of intervention approaches).

Application and Submission Information

This notice applies to due dates on or after October 5, 2022 and subsequent receipt dates through September 8, 2025.

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcement through the expiration date of this notice.

• RFA-DA-23-053 - HEAL Initiative: Translating Research to Practice to End the Overdose Crisis (R61/R33 - Clinical Trial Optional)
• RFA-DA-23-054 - HEAL Initiative: Translating Research to Practice to End the Overdose Crisis (Parent R33 - Clinical Trial Optional)

All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:

• For funding consideration, applicants must include NOT-DA-23-008 (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.

Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.

Inquiries

Scientific/Research Contact(s)

Julia Zur, Ph.D.
National Institute on Drug Abuse (NIDA)
Telephone: (301) 443-2261
Email: julia.zur@nih.gov