RESEARCH ON INTEGRATING MENTAL HEALTH AND RELATED SERVICES FORPERSONS WITH SEVERE MENTAL HEALTH DISORDERS



NIH GUIDE, Volume 22, Number 19, May 21, 1993



PA NUMBER:  PA-93-088



P.T. 34



Keywords:

  Health Services Delivery 

  Mental Disorders 



National Institute of Mental Health



PURPOSE



The purpose of this announcement is to encourage research grant

applications for studies that extend current knowledge about the

effects on the service system, providers, consumers, and family

members and the effectiveness of alternative approaches of

integrating mental health, rehabilitation, substance abuse, general

health, income support, and/or housing services for children,

adolescents, adults, and/or elderly persons who suffer from severe

mental disorders.  The goal of this initiative is to increase the

quality, appropriateness, cost-effectiveness, sensitivity, and

accessibility of mental health services.



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 program

announcement, Research on Integrating Mental Health and Related

Services for Persons with Severe Mental Disorders, is related to the

priority areas of mental health and mental disorders and diabetes and

chronic disabling conditions.   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 organization and by for-profit organizations,

including universities, colleges, hospitals, laboratories, units of

State and local governments, and eligible agencies of the Federal

government.  Women and minority investigators are encouraged to

apply.  Foreign institutions are not eligible for First Independent

Research Support and Transition (FIRST) awards (R29).



MECHANISM OF SUPPORT



Research support may be requested through applications for a regular

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

the Multi-Institutional Collaborative Research Project (R10).



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

regarding eligibility, application format, and review criteria,

applicants are strongly encouraged to consult with program staff

listed under INQUIRIES and obtain specialized announcements.  The

small grant (R03) is especially suited for initial research by junior

investigators and pilot research prior to large-scale field trials.



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



Children, adolescents, adults, and elderly persons with severe mental

disorders living in the community require many types of services.

However, most service agencies are specialized, provide a limited

range of services, and do not coordinate their services with those of

other service agencies.  Agencies providing services may also have

requirements and eligibility rules that make it difficult for people

with severe mental disorders to obtain needed services.  The

fragmentation and lack of accountability make existing services far

less effective than they should be.



There is a growing consensus that what is needed is an integrated

system of care for people with severe mental disorders.  This

requires integrating basic life supports, such as food and shelter,

with specialized services, such as medical and mental health

services; linking services at the client and systems levels;

coordinating Federal, State, and local resources; and providing a

clear delineation of authority and of clinical, fiscal, and

administrative responsibility.



A first test of the effects and effectiveness of integrated systems

of care was begun in 1986 by the Robert Wood Johnson Foundation

(RWJF), in conjunction with NIMH.  RWJF selected nine cities to

participate in a five-year program to develop community-wide systems

of care that would integrate all levels of the service

system--client, local, State, and Federal--for people with severe

mental disorders.  In addition to integrating services and

establishing the administrative, fiscal, and clinical responsibility

for providing services to individuals with severe mental disorders,

housing integration was promoted through the contribution of Section

8 housing certificates to the program participants by the Department

of Housing and Urban Development (HUD).  The NIMH-sponsored

evaluation shows that much more information is needed about the

process of integrating systems and the effectiveness and utility of

various components of integrated systems.



Another opportunity to study the effect and effectiveness of

comprehensive services integration is being provided by the Access to

Community Care and Effective Services and Supports (ACCESS) grants,

which are administered and will be evaluated by the Center for Mental

Health Services (CMHS).  The Department of Health and Human Services,

in collaboration with HUD and the Departments of Labor, Education,

Veterans Affairs, and Agriculture, is making grants available to

States to help communities explore ways to make services integration

possible for people who have severe mental disorders and are also

homeless.



This announcement invites research applications to study the effect

and/or cost-effectiveness of these and other examples of integrated

service systems for children, adolescents, adults, and elderly

persons with severe mental disorders.



Listed below are examples of research topic areas focusing on the

effectiveness of integrating mental health services for children,

adolescents, adults, and elderly persons with severe mental disorders

with other types of services.  The list of examples is illustrative,

not exhaustive; it is expected that additional important research

topics will be identified by researchers who respond to this

announcement.



o  Research on the effect and effectiveness of efforts to integrate

services under the ACCESS and other preexisting service integration

programs



o  Studies of the effectiveness of different levels of service

intensity, within integrated service programs, for individuals with

severe mental disorders who have different diagnoses, functional

abilities, and sociodemographic characteristics



o  Research on the effects of different structural relationships

among components of integrated service systems on providers,

consumers, families and organizational functioning



o  Studies of the relative cost-effectiveness of integrated programs

and systems of care



o  Research on the effects of alternate approaches to consumer and

family involvement in integrated care



o  Studies of the effectiveness and cost-effectiveness of integrating

substance abuse treatment with mental health treatment



o  Research on the effects of integrated mental health and substance

abuse services in jails, prisons, and parole systems



o  Research on factors that are barriers to and facilitators of the

service integration process



o  Development of improved methods for measuring and analyzing

service integration, and within integrated systems, for measuring

service intensity and service outcomes



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-XX) and the title of this

announcement, Research on Integrating Mental Health and Related

Services for Persons with Severe Mental Health Disorders, must be

typed in item 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

forms may be obtained from the 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.



In addition, preference in funding will be given to projects that

include, but do not necessarily focus on, American Indian, Alaska

Native, and Native Hawaiians living in urban settings and projects

that include females in study populations.



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 application

development before or during the process of preparing an application.

Potential applicants should contact the 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.



Charles Windle, Ph.D.

Services Research Program

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, as implemented through DHHS regulations at 45 CFR Part

100, or Health Systems Agency Review.



.

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