RESEARCH ON EMERGENCY MENTAL HEALTH SERVICES FOR CHILDREN ANDADOLESCENTS



NIH Guide, Volume 22, Number 15, April 16, 1993



PA NUMBER:  PA-93-075



P.T. 34



Keywords:

  Health Services Delivery 

  Emotional/Mental Health 

  Adolescents 

  Children (Patients) 

  Trauma 

  Psychiatry 



National Institute of Mental Health



PURPOSE



The purpose of this announcement is to encourage research grant

applications on emergency mental health services to children and

adolescents who are in need of acute psychiatric and/or psychosocial

intervention for one or more of the following reasons: (1) they have

suffered a physical injury that may be associated with an antecedent

emotional disturbance; (2) they have other physical conditions (such as

AIDS or drug abuse) or physical trauma that place them and/or their

families at risk for mental health problems; (3) they are the victims

of or witnesses to violence; (4) they are the victims of physical

and/or sexual abuse; (5) they have attempted suicide; or (6) they are

victims of larger scale catastrophes, such as natural disasters,

technological emergencies, accidents, or riots.



HEALTHY PEOPLE 2000



The Public Health Service (PHS) is committed to achieving the health

promotion and disease prevention objectives of "Healthy People 2000,"

a PHS-led national activity for setting priority areas.  This PA,

Research on Emergency Mental Health Services for Children and

Adolescents, is related to priority areas alcohol and other drugs,

mental health and mental disorders, and violent and abusive behaviors.

Potential applicants may obtain a copy of "Healthy People 2000" (Full

Report:  Stock No. 017-001-00474-0) or "Healthy People 2000" (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 any domestic and foreign, public and

private, non-profit and for-profit organizations, including

universities, colleges, hospitals, laboratories, units of State and

local governments, and eligible agencies of the Federal Government.

Foreign institutions are not eligible for the First Independent

Research Support and Transition (FIRST) award (R29).  Women and

minority investigators are encouraged to apply.



MECHANISMS OF SUPPORT



Research support may be requested through applications for a research

project grant (R01), a small grant (R03), the FIRST award (R29),

research demonstrations (R18), the Multi-Institutional Collaborative

Research Project (R10), and the Rapid Assessment Post-Impact of

Disaster (RAPID) Program.



Since the R03, R29, R10, and RAPID mechanisms have special requirements

regarding eligibility, application format, review criteria, and, in the

case of the RAPID Program, review dates, applicants are strongly

encouraged to consult with program staff (listed under INQUIRIES) and

obtain specialized announcements.



Because the nature and scope of the research proposed in response to

this announcement will vary, it is anticipated that the size of the

awards will also vary.



RESEARCH OBJECTIVES



The report by the Institute of Medicine's Committee for the Study of

Research on Child and Adolescent Mental Disorders, issued in 1989,

noted that there is a paucity of research on services provided to

children and adolescents and particularly on the impact of these

services.  In March 1990, the National Institute of Mental Health

(NIMH), in conjunction with the Bureau of Maternal and Child Health,

issued a request for applications (RFA) soliciting research

demonstration applications on emergency mental health services for

children and adolescents.  Through this program announcement, the NIMH

is reemphasizing the importance of this topic as an area of research

and expanding the focus of the original announcement to include

emergency mental health services for (a) children and adolescents who

are the victims of or witnesses to violence; (b) children and

adolescents who are the victims of physical and/or sexual abuse,

including rape; and (c) children and adolescents who are victims of

disaster, accidents, riots, or other traumatic events.



Listed below are examples of research projects that could advance

knowledge about the provision of emergency mental health services for

children and adolescents.  The list is not exhaustive; it is expected

that additional important topics will be identified by investigators

who respond to this announcement.  Projects may focus on:



o  the effectiveness of mental health services for children and

adolescents and/or their families who are experiencing acute medical

crises such as those associated with diabetes, cancer, or hemophilia



o  the effectiveness of mental health services for children and

adolescents and/or their families in cases where the youth have

suffered disabling or disfiguring injuries, such as burns, loss of

limbs, or spinal cord injury



o  the effectiveness of enhanced mental health services for children

and adolescents with AIDS and for their families who go to emergency

rooms seeking services for medical crises associated with the HIV

infection



o  the effectiveness of mental health emergency services provided to

children and adolescents, including those who have been abusing illicit

drugs and/or alcohol, who are coping with physical trauma



o  the effectiveness of emergency mental health services for children

and adolescents who have experienced sexual and/or physical abuse



o  the effectiveness of emergency mental health services for children

and adolescents who have been victims of violence, including youth who

have participated in the violence, or who are experiencing psychiatric

or psychosomatic symptoms as a result of witnessing violence



o  the effectiveness of emergency mental health interventions, based

either in emergency rooms or in detention facilities for juveniles, for

children and adolescents who attempt suicide or display symptoms of

post-traumatic stress disorder



o  the effectiveness of emergency mental health services for children

and adolescents exposed to natural disaster, technological hazards,

accidents, riots, or other large-scale traumatic events



STUDY POPULATIONS



SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH

POLICIES CONCERNING INCLUSION OF FEMALES AND MINORITIES IN RESEARCH

STUDY POPULATIONS



Applications for grants and cooperative agreements that involve human

subjects are required to include minorities and both genders in study

populations so that research findings can be of benefit to all persons

at risk of the disease, disorder or condition under study; special

emphasis should be placed on the need for inclusion of minorities and

women in studies of diseases, disorders and conditions which

disproportionately affect them.  This policy applies to all research

involving human subjects and human materials, and applies to males and

females of all ages.  If one gender and/or minorities are excluded or

are inadequately represented in this research, particularly in proposed

population-based studies, clear compelling rationale for exclusion or

inadequate representation should be provided.  The composition of the

proposed study population must be described in terms of gender and

racial/ethnic group, together with a rationale for its choice.  In

addition, gender and racial/ethnic issues should be addressed in

developing a research design and sample size appropriate for the

scientific objectives of the study.



Applicants are urged to assess carefully the feasibility of including

the broadest possible representation of minority groups.  However, NIH

recognizes that it may not be feasible or appropriate in all research

projects to include representation of the full array of United States

racial/ethnic minority populations (i.e., American Indians or Alaskan

Natives, Asians or Pacific Islanders, African Americans, Hispanics).

Investigators must provide the rationale for studies on single minority

population groups.



Applications for support of research involving human subjects must

employ a study design with minority and/or gender representation (by

age distribution, risk factors, incidence/prevalence, etc.) appropriate

to the scientific objectives of the research.  It is not an automatic

requirement for the study design to provide statistical power to answer

the questions posed for men and women and racial/ethnic groups

separately; however, whenever there are scientific reasons to

anticipate differences between men and women, and racial/ethnic groups,

with regard to the hypothesis under investigation, applicants should

include an evaluation of these gender and minority group differences in

the proposed study.  If adequate inclusion of one gender and/or

minorities is impossible or inappropriate with respect to the purpose

of the research, because of the health of the subjects, or other

reasons, or if in the only study population available, there is a

disproportionate representation of one gender or minority/majority

group, the rationale for the study population must be well explained

and justified.



NIH funding components will not make awards of grants, cooperative

agreements, or contracts that do not comply with this policy.  For

research awards that are covered by this policy, awardees will report

annually on enrollment of women and men, and on the race and ethnicity

of subjects.



APPLICATION PROCEDURES



Applicants are to use the research grant application form PHS 398 (rev.

9/91).  The number (PA-93-  ) and the title of this announcement,

Research on Emergency Mental Health Services for Children and

Adolescents, must be typed in item number 2a on the face page of the

PHS 398 application form.  Applicants must also specify which support

mechanism they are applying under, e.g., R29, R03, R10.



Application kits containing the necessary forms may be obtained from

IHS Area offices and business offices or offices of sponsored research

at most universities, colleges, medical schools, and other major

research facilities.  If such a source is not available, the following

office may be contacted for the necessary application material:



Grants Management Branch

National Institute of Mental Health

5600 Fishers Lane, Room 7C-05

Rockville, MD  20857

Telephone:  (301) 443-4414



The signed original and five legible copies of the completed

application must be sent to:



Division of Research Grants

National Institutes of Health

Westwood Building, Room 240

Bethesda, MD  20892**



REVIEW CONSIDERATIONS



Applications will be reviewed for scientific and technical merit by an

initial review group (IRG) composed primarily of non-Federal scientific

experts.  Final review is by the appropriate national advisory council;

review by council may be based on policy considerations as well as

scientific merit.  By law, only applications recommended for

consideration for funding by the council may be supported.  Summaries

of IRG recommendations are sent to applicants as soon as possible

following IRG review.



Criteria to be considered in evaluating applications for

scientific/technical merit include:



o  Scientific, technical, or medical significance and originality of

the proposed research



o  Appropriateness and adequacy of the research approach and

methodology proposed to carry out the research



o  Qualifications and research experience of the Principal

Investigators and staff, particularly, but not exclusively, in the area

of the proposed research



o  Availability of resources necessary to the research



o  Appropriateness of the proposed budget and duration in relation to

the proposed research



o  Adequacy of the proposed means for protecting against or minimizing

adverse effects to human and/or animal subjects



AWARD CRITERIA



As part of the NIMH Public-Academic Liaison (PAL) initiative, special

encouragement is given to applications that involve active

collaborations between academic researchers and public sector agencies

in planning, undertaking, analyzing, and publishing research pertaining

to persons with severe mental illness.  The PAL initiative is based on

the premise that important new advances in understanding and treatment

of severe mental illness can result from improved linkages between the

Nation's scientific resources and the public sector agencies and

programs in which many persons with severe mental illness receive their

care.  The scope of the PAL initiative encompasses public sector

agencies of all types that deal with children, adolescents, adults, and

elderly persons with severe mental disorders.



Factors considered in determining which applications will be funded

include IRG and Council recommendations, PHS program needs and

priorities, and availability of funds.



INQUIRIES



NIMH staff are available for consultation concerning the development of

an application in advance of or during the process of preparing an

application.



Potential applicants are encouraged to contact NIMH as early as

possible for information and assistance in initiating the application

process and developing an application.  The NIMH program staff member

listed below may be contacted for further information and assistance.



Kimberly E. Hoagwood, Ph.D.

Division of Epidemiology and Services Research

National Institute of Mental Health

5600 Fishers Lane, Room 10C-06

Rockville, MD  20857

Telephone:  (301) 443-4233



For further information on grants management issues, applicants may

contact:



Diana S. Trunnell

Grants Management Branch

National Institute of Mental Health

5600 Fishers Lane, Room 7C-15

Rockville, MD  20857

Telephone:  (301) 443-3065



AUTHORITY AND REGULATIONS



This program is described in the Catalog of Federal Domestic Assistance

93.242, Mental Health Research Grants.  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 announcement is not subject to the

intergovernmental review requirements of Executive Order 12372 or

Health Systems Agency review.



.

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