and Human Services (HHS)
EXPIRED
GENETICS, BEHAVIOR, AND AGING RELEASE DATE: May 23, 2003 PA NUMBER: PAS-03-128 EXPIRATION DATE: May 25, 2006, unless reissued. National Institute on Aging (NIA) (http://www.nia.nih.gov/) CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER(S): 93.866 THIS PA CONTAINS THE FOLLOWING INFORMATION o Purpose of the PA o Research Objectives o Mechanism of Support o Funds Available o Eligible Institutions o Individuals Eligible to Become Principal Investigators o Special Requirements o Where to Send Inquiries o Submitting an Application o Peer Review Process o Review Criteria o Award Criteria o Required Federal Citations PURPOSE OF THE PA This program announcement (PA) solicits novel research integrating genetics, behavior and aging. Human and non-human studies are needed to advance our understanding of the genetic and environmental influences and processes affecting variability in behavior and its functional sequelae with age. This includes studies that help elucidate the relationships of levels and change in behavior to health, functional competence, and quality of life of older adults. This PA is framed around two broad categories of questions: (1) gene-to-behavior questions concerning the nature and role of genetic influences on behaviors at older ages, and how these genetic effects vary with age; and (2) questions about dynamic processes including gene-environment interactions, gene-environment covariation, age-related genetic effects, and how behaviors interact with and affect genetic expression. The behaviors that are eligible for study under this PA should be critical to quality of life among the aged, either as outcomes or as mediators of physical or cognitive health and function. Examples of relevant behavioral domains include, but are not limited to, social behaviors, resilience, vitality, adaptivity, personality, vulnerability to stress, health behaviors, social cognition, human and social capital accumulation, economic savings for retirement, risk-taking, happiness, coping, caregiving, cognitive abilities, cognitive flexibility, cognitive reserve, learning, and functional abilities. This PA is intended to stimulate methodologically rigorous research integrating genetics, other biological sciences, and the behavioral and social sciences. To be considered responsive to this announcement, interdisciplinary perspectives must be unambiguous, the relationship between the behaviors or social processes under study and healthy aging should be articulated, and the proposed study should be embedded within a well articulated set of questions or hypotheses generated from social science and behavioral research. This announcement updates and replaces a previous Program Announcement, Behavior Genetics in Adulthood and Old Age (PAS-98-076, issued May 21, 1998). RESEARCH OBJECTIVES Behavior and age-related changes in behavioral processes are integral to how well we age. Many behavioral phenotypes, such as resilience, cognitive and functional abilities, social connectedness, happiness, longevity and loneliness are intrinsic to maintaining health and quality of life. Behavior also plays a critical mediating role (e.g. smoking, alcohol use, exercise, risk taking behaviors, adherence, social engagement) in health and disease. Understanding the causes of variation in behavioral development, plasticity, stability, adaptation and change with age is essential to maintaining and enhancing quality of life throughout old age. Family and twin studies on aging have demonstrated the importance of genetic influences for variation in a large array of behavioral phenotypes related to personality, well-being, functional abilities, cognitive aging, longevity and health. More recent findings based on the longitudinal twin design indicate the importance of genetic influences on functional stability and the importance of environments for change. To move beyond these findings innovative studies are needed that investigate genetic effects within the context of the dynamic aging processes in which they are expressed. This will involve diverse approaches that: integrate molecular and quantitative methods, focus on behavioral systems for which known or candidate genes are identified, explore social processes that affect individual environments, include measures of biological intermediaries of the behaviors, and use non- linear analytic approaches to study genes, social factors and environments in developmentally dynamic ways. The underlying conceptual model is multifactorial, highlighting the combined action of multiple genetic and environmental influences where phenotypic variation arises as a function of genotypic and environmental differences between people within a particular population. Features of this model are an assumption that environmental influences, ranging from intracellular conditions to larger socio/cultural effects, and genetic influences operate through the same causal field of biological structures and processes. The intricacies of this causal field can lead to complex relationships between genetic factors, environmental influences, and phenotypic outcomes. These complexities include time-related changes in the relative influence of genetic and environmental factors, non-linear interactions among genes, interactions and correlations between genes and environments and environmentally induced gene expression. The need to examine genetic and environmental influences and behaviors in the context of dynamism of interactive aging systems is increasingly apparent, and unprecedented opportunities to do so are now available. Dramatic advances have been made by molecular geneticists in the explication of hereditary phenomena, by quantitative geneticists in the assessment of aggregate effects of genes and environments, by behavioral and social scientists in identifying intermediary phenotypes (endophenotypes) and in defining and measuring complex behavioral domains, and by statisticians in the measurement of change. Progress in understanding gene-behavior relationships in aging will rely on integrating the theoretical models and methodologies of these research domains to provide powerful tools for combining reductionist approaches (that explore the nature of specific genetic and environmental influences) and integrationist approaches (that explore effects within the larger context of complex systems). Among many examples, improved strategies now exist to identify genes and map quantitative trait loci (QTL); to assess specific genetic and environmental sources of variation; to quantify these specific effects relative to background variation due to the aggregate influence of still-anonymous genes and environments; to conceptualize and examine non-linear and dynamic processes such as epistasis, gene-environment interaction, gene- environment correlation, and behaviorally or environmentally induced genetic expression; to investigate how social worlds and behavioral factors modulate gene expression; to characterize population differences according to sequence (SNP) and haplotype diversity; to detail the structure of behavioral domains; to measure phenotypic change; and to assess age-related changes in influence of both specific and aggregate genetic and environmental domains. A wide range of designs is relevant to the objectives of this program announcement, including augmented family studies with combinations of twins, parents, siblings, children and adoptees; sibling studies using highly selected samples for phenotypic indices of similarity/dissimilarity; extended pedigrees; special populations (i.e. inbred groups, cultural and genetic isolates); sub-populations such as the oldest-old; studies that utilize the extensive genome databases and genetic analyses resources that are becoming available; and animal model studies using cross-fostering, selective breeding, inbred strains, recombinant inbred strains or specific genotypic manipulations (e.g. transgenic, knock-outs, knock-ins). Research is also encouraged that builds upon ongoing studies of aging cohorts whereby supplemental data collection would allow new hypotheses to be addressed at the intersection of genetics, behavioral and social science and research. Major methodological considerations should be well articulated, including the implications for aging of the behavioral phenotypes being studied, documentation of solid measurement characteristics, presentation of power analyses to reveal that sample sizes suffice for analyzing the genetic effects being studied, and clear descriptions of the analytical procedures to be employed must be provided. The research team should be multidisciplinary and, at a minimum, reflect expertise in genetics (molecular and/or quantitative), and the social/behavioral sciences. Among the many research avenues pertinent to studying the behaviors of relevance to this PA are: o Studies that explore the genetics of behavioral interventions and address how genetic differences moderate responses among the elderly to health promoting behaviors (e.g. exercise, social connectedness, cognitive training). o Studies to elucidate behavior-gene (i.e. individuate loci and QTLs) relationships for behaviors affecting quality of life with aging. Novel, hypothesis-driven research is needed to: 1) investigate how genes or QTLs implicated in aging processes (e.g. oxidative stress) affect behavioral function and change, and 2) explore age effects in the genes or QTLs implicated in behavioral functioning (e.g. DRD4 and novelty-seeking, APOE and cognitive function). o Behavioral genetic designs (using human or animal models) that combine quantitative and molecular techniques to resolve variance and covariance structures more finely than has previously been accomplished by quantifying the influences of specific genes, QTLs and specific measured environments. o Behavioral genetic studies (using human or animal models) that investigate genetic variation and QTLs affecting rates and shapes of change in behavioral functioning. o Studies of specific environmental influences in genetically informative research on aging. Despite the importance of dynamic processes involving gene-environment interaction and covariation, measured environments are rarely included in human studies. Research is needed that incorporates critical features of diverse environments (i.e. social, economic, physical and cultural environments) into behavioral genetic studies of aging for the purpose of analyzing gene- environment dynamics. o Studies (using human or animal models) to investigate gene by environment interaction. Examples include research exploring whether and how social environments or enriched experiences (quality of education, etc.) mediate progression to disease among those with genetic predispositions to disease; studies investigating the effects of socially or experientially enriched or restricted environments on genetic expression; research testing whether protective health effects conferred by education prevail in the presence of genetic risk, and genetic research that builds upon and bridges findings from established fields of environmental inquiry (e.g. health disparities) to explore gene by environment interactions. o Studies elucidating the genetic regulation of neural mechanisms, and their modulation by environmental circumstances, that impact upon cognitive function, cognitive reserve and flexibility, learning, and memory. o Studies to investigate gene by environmental covariation. Individuals shape and select their environments throughout development, and these processes are affected by many factors including age, and aging transitions such as retirement, chronic care giving, bereavement, isolation and functional loss. Research is needed that develops analytical models by which to study gene-environment covariation in the context of these age-related changes in abilities to define and select one's environment. MECHANISM OF SUPPORT This PA will use the NIH R01 award mechanism. As an applicant, you will be solely responsible for planning, directing, and executing the proposed project. This PA uses just-in-time concepts. It also uses the modular as well as the non-modular budgeting formats (see http://grants.nih.gov/grants/funding/modular/modular.htm). Specifically, if you are submitting an application with direct costs in each year of $250,000 or less, use the modular format. Otherwise follow the instructions for non-modular research grant applications. FUNDS AVAILABLE The NIA intends to commit at least $2 million for an initial round of funding of applications of high scientific merit in FY 2004. An applicant may request a project period of up to 5 years. Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size and duration of each award will also vary. Although the financial plans of the NIA provides support for this program, awards pursuant to this PA are contingent upon the availability of funds and the receipt of a sufficient number of meritorious applications. ELIGIBLE INSTITUTIONS You may submit (an) application(s) if your institution has any of the following characteristics: o For-profit or non-profit organizations o Public or private institutions, such as universities, colleges, hospitals, and laboratories o Units of State and local governments o Eligible agencies of the Federal government o Domestic or foreign INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS Any individual with the skills, knowledge, and resources necessary to carry out the proposed research is invited to work with their institution to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH programs. SPECIAL REQUIREMENTS An overarching goal of this PA is to encourage innovative research integrating knowledge and methodologies from genetics, gerontology, and the behavioral and social sciences. Applications should articulate the interdisciplinary dimensions and components of the proposed research, and explain how the collective expertise of the research team meets these interdisciplinary requirements with regards to the specific aims to be investigated. The sharing of unique resources such as phenotypic data, DNA, and genome scans in a timely manner contributes greatly to progress in understanding the genetics of complex phenotypes. The NIH encourages data sharing (http://grants.nih.gov/grants/guide/notice-files/NOT-OD- 03-032.html) and requires all applications from October 1, 2003 that request $500,000 or more in direct costs in any single year to address data sharing. For this program announcement, investigators are encouraged to submit a data-sharing plan regardless of the size of the requested budget. The NIH data sharing and implementation guidelines policies can be found at http://grants.nih.gov/grants/policy/data_sharing/ data_sharing_guidance.htm. NIH staff will evaluate the adequacy of the proposed data sharing and access plan, and consider it in making award decisions. Staff will also consider waivers as appropriate to the conditions of data collection. Also, except under circumstances where the data are likely to be of unique value and importance to other investigators, staff will accept requested costs under $500,000 a year as sufficient reason for a waiver. The sharing plan approved by NIH staff, after negotiation with the applicant when necessary, will become part of the terms and conditions of the award. NIH staff will also evaluate compliance with the sharing plan and scientific progress in the non-competing continuation of the grant award application. WHERE TO SEND INQUIRIES We encourage your inquiries concerning this PA and welcome the opportunity to answer questions from potential applicants. Inquiries may fall into two areas: scientific/research, and financial or grants management issues: o Direct your questions about scientific/research issues with primary emphasis on behavioral and social research on aging to: Angie Chon-Lee, MPH Behavioral and Social Research Program National Institute on Aging Gateway Building, Room 533 Bethesda, MD 20892-9205 Telephone: (301) 594 5943 FAX: (301) 402-0051 Email: [email protected] o Direct your questions about scientific/research issues related to the nervous system as well as mechanisms underlying cognitive functioning to: Marilyn M. Miller, Ph.D. Neuroscience and Neuropsychology of Aging Program National Institute on Aging Gateway Building, Suite 350 7201 Wisconsin Avenue Bethesda, MD 20892-9205 Telephone: (301) 496-9350 FAX: (301) 496-1494 Email: [email protected] o Direct your questions about financial or grants management matters to: Linda Whipp Grants and Contracts Management Office National Institute on Aging Gateway Building, Room 2N212 Bethesda, MD 20892 Telephone: (301) 496-1472 FAX: (301) 402-3672 Email: [email protected] SUBMITTING AN APPLICATION Applications must be prepared using the PHS 398 research grant application instructions and forms (rev. 5/2001). The PHS 398 is available at http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive format. For further assistance contact GrantsInfo, Telephone (301) 435-0714, Email: [email protected]. APPLICATION RECEIPT DATES: Applications submitted in response to this program announcement will be accepted at the standard application deadlines, which are available at http://grants.nih.gov/grants/dates.htm. Application deadlines are also indicated in the PHS 398 application kit. SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: Applications requesting up to $250,000 per year in direct costs must be submitted in a modular grant format. The modular grant format simplifies the preparation of the budget in these applications by limiting the level of budgetary detail. Applicants request direct costs in $25,000 modules. Section C of the research grant application instructions for the PHS 398 (rev. 5/2001) at http://grants.nih.gov/grants/funding/phs398/phs398.html includes step- by-step guidance for preparing modular grants. Additional information on modular grants is available at http://grants.nih.gov/grants/funding/modular/modular.htm. SPECIFIC INSTRUCTIONS FOR APPLICATIONS REQUESTING $500,000 OR MORE PER YEAR: Applications requesting $500,000 or more in direct costs for any year must include a cover letter identifying the NIH staff member within one of the NIH institutes or centers who has agreed to accept assignment of the application. Applicants requesting more than $500,000 must carry out the following steps: 1) Contact the IC program staff at least 6 weeks before submitting the application, i.e., as you are developing plans for the study; 2) Obtain agreement from the IC staff that the IC will accept your application for consideration for award; and, 3) Identify, in a cover letter sent with the application, the staff member and IC who agreed to accept assignment of the application. This policy applies to all investigator-initiated new (type 1), competing continuation (type 2), competing supplement, or any amended or revised version of these grant application types. Additional information on this policy is available in the NIH Guide for Grants and Contracts, October 19, 2001 at http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-004.html. SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of the application, including the checklist, and five signed photocopies in one package to: Center for Scientific Review National Institutes of Health 6701 Rockledge Drive, Room 1040, MSC 7710 Bethesda, MD 20892-7710 Bethesda, MD 20817 (for express/courier service) APPLICATION PROCESSING: Applications must be received by or mailed on or before the receipt dates described at http://grants.nih.gov/grants/funding/submissionschedule.htm. The CSR will not accept any application in response to this PA that is essentially the same as one currently pending initial review unless the applicant withdraws the pending application. The CSR will not accept any application that is essentially the same as one already reviewed. This does not preclude the submission of a substantial revision of an application already reviewed, but such application must include an Introduction addressing the previous critique. Although there is no immediate acknowledgement of the receipt of an application, applicants are generally notified of the review and funding assignment within 8 weeks. PEER REVIEW PROCESS Applications submitted for this PA will be assigned on the basis of established PHS referral guidelines. An appropriate scientific review group convened in accordance with the standard NIH peer review procedures (http://www.csr.nih.gov/refrev.htm) will evaluate applications for scientific and technical merit. As part of the initial merit review, all applications will: o Receive a written critique o Undergo a selection process in which only those applications deemed to have the highest scientific merit, generally the top half of applications under review, will be discussed and assigned a priority score o Receive a second level review by the appropriate national advisory council or board. REVIEW CRITERIA The goals of NIH-supported research are to advance our understanding of biological systems, improve the control of disease, and enhance health. In the written comments, reviewers will be asked to discuss the following aspects of your application in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals: o Significance o Approach o Innovation o Investigator o Environment The scientific review group will address and consider each of these criteria in assigning your application's overall score, weighting them as appropriate for each application. Your application does not need to be strong in all categories to be judged likely to have major scientific impact and thus deserve a high priority score. For example, you may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. (1) SIGNIFICANCE: Does your study address an important problem? If the aims of your application are achieved, how do they advance scientific knowledge? What will be the effect of these studies on the concepts or methods that drive this field? (2) APPROACH: Are the conceptual framework, design, methods, and analyses adequately developed, well integrated, and appropriate to the aims of the project? Do you acknowledge potential problem areas and consider alternative tactics? (3) INNOVATION: Does your project employ novel concepts, approaches or methods? Are the aims original and innovative? Does your project challenge existing paradigms or develop new methodologies or technologies? (4) INVESTIGATOR: Are you appropriately trained and well suited to carry out this work? Is the work proposed appropriate to your experience level as the principal investigator and to that of other researchers (if any)? (5) ENVIRONMENT: Does the scientific environment in which your work will be done contribute to the probability of success? Do the proposed experiments take advantage of unique features of the scientific environment or employ useful collaborative arrangements? Is there evidence of institutional support? ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your application will also be reviewed with respect to the following: PROTECTION OF HUMAN SUBJECTS FROM RESEARCH RISK: The involvement of human subjects and protections from research risk relating to their participation in the proposed research will be assessed. (See criteria included in the section on Federal Citations, below). INCLUSION OF WOMEN, MINORITIES AND CHILDREN IN RESEARCH: The adequacy of plans to include subjects from both genders, all racial and ethnic groups (and subgroups), and children as appropriate for the scientific goals of the research will be assessed. Plans for the recruitment and retention of subjects will also be evaluated. (See Inclusion Criteria in the sections on Federal Citations, below). ADDITIONAL CONSIDERATIONS BUDGET: The reasonableness of the proposed budget and the requested period of support in relation to the proposed research. AWARD CRITERIA Applications submitted in response to a PA will compete for available funds with all other recommended applications. The following will be considered in making funding decisions: o Scientific merit of the proposed project as determined by peer review o Availability of funds o Relevance to program priorities (including adequacy of plans to share data). REQUIRED FEDERAL CITATIONS INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: 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 clinical research projects unless a clear and compelling justification is provided indicating 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 clinical research should read the AMENDMENT "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research - Amended, October, 2001," published in the NIH Guide for Grants and Contracts on October 9, 2001 (http://grants.nih.gov/grants/ guide/notice-files/NOT-OD-02-001.html); a complete copy of the updated Guidelines are available at http://grants.nih.gov/grants/funding/women_min/ guidelines_amended_10_2001.htm. The amended policy incorporates: the use of an NIH definition of clinical research; updated racial and ethnic categories in compliance with the new OMB standards; clarification of language governing NIH-defined Phase III clinical trials consistent with the new PHS Form 398; and updated roles and responsibilities of NIH staff and the extramural community. The policy continues to require for all NIH-defined Phase III clinical trials that: a) all applications or proposals and/or protocols must provide a description of plans to conduct analyses, as appropriate, to address differences by sex/gender and/or racial/ethnic groups, including subgroups if applicable; and b) investigators must report annual accrual and progress in conducting analyses, as appropriate, by sex/gender and/or racial/ethnic group differences. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS: The NIH maintains a policy that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines" on the inclusion of children as participants in research involving human subjects that is available at http://grants.nih.gov/grants/funding/children/children.htm. REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH policy requires education on the protection of human subject participants for all investigators submitting NIH proposals for research involving human subjects. You will find this policy announcement in the NIH Guide for Grants and Contracts Announcement, dated June 5, 2000, at http://grants.nih.gov/grants/guide/notice-files/ NOT-OD-00-039.html. PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The Office of Management and Budget (OMB) Circular A-110 has been revised to provide public access to research data through the Freedom of Information Act (FOIA) under some circumstances. Data that are (1) first produced in a project that is supported in whole or in part with Federal funds and (2) cited publicly and officially by a Federal agency in support of an action that has the force and effect of law (i.e., a regulation) may be accessed through FOIA. It is important for applicants to understand the basic scope of this amendment. NIH has provided guidance at http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm. Applicants may wish to place data collected under this PA in a public archive, which can provide protections for the data and manage the distribution for an indefinite period of time. If so, the application should include a description of the archiving plan in the study design and include information about this in the budget justification section of the application. In addition, applicants should think about how to structure informed consent statements and other human subjects procedures given the potential for wider use of data collected under this award. STANDARDS FOR PRIVACY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION: The Department of Health and Human Services (DHHS) issued final modification to the "Standards for Privacy of Individually Identifiable Health Information", the "Privacy Rule," on August 14, 2002. The Privacy Rule is a federal regulation under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 that governs the protection of individually identifiable health information, and is administered and enforced by the DHHS Office for Civil Rights (OCR). Those who must comply with the Privacy Rule (classified under the Rule as "covered entities") must do so by April 14, 2003 (with the exception of small health plans which have an extra year to comply). Decisions about applicability and implementation of the Privacy Rule reside with the researcher and his/her institution. The OCR website (http://www.hhs.gov/ocr/) provides information on the Privacy Rule, including a complete Regulation Text and a set of decision tools on "Am I a covered entity?" Information on the impact of the HIPAA Privacy Rule on NIH processes involving the review, funding, and progress monitoring of grants, cooperative agreements, and research contracts can be found at http://grants.nih.gov/grants/guide/notice-files/ NOT-OD-03-025.html. URLs IN NIH GRANT APPLICATIONS OR APPENDICES: All applications and proposals for NIH funding must be self-contained within specified page limitations. Unless otherwise specified in an NIH solicitation, Internet addresses (URLs) should not be used to provide information necessary to the review because reviewers are under no obligation to view the Internet sites. Furthermore, we caution reviewers that their anonymity may be compromised when they directly access an Internet site. HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2010," a PHS-led national activity for setting priority areas. This PA is related to one or more of the priority areas. Potential applicants may obtain a copy of "Healthy People 2010" at http://www.health.gov/healthypeople/. AUTHORITY AND REGULATIONS: This program is described in the Catalog of Federal Domestic Assistance No. 93.866, and is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. Awards are made under authorization of Sections 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284)and administered under NIH grants policies described at http://grants.nih.gov/grants/policy/policy.htm and under Federal Regulations 42 CFR 52 and 45 CFR Parts 74 and 92. The PHS strongly encourages all grant recipients to provide a smoke- free workplace and to discourage the 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 or routine 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.
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