STATE IMPLEMENTATION OF EVIDENCE-BASED PRACTICES – BRIDGING SCIENCE AND SERVICE
RELEASE DATE: August 16, 2002
RFA: MH-03-007
National Institute of Mental Health (NIMH)
(http://www.nimh.nih.gov/)
Substance Abuse and Mental Health Services Administration (SAMHSA)
(http://www.samhsa.gov/)
LETTER OF INTENT RECEIPT DATE: September 29, 2002
APPLICATION RECEIPT DATE: October 29, 2002
THIS RFA CONTAINS THE FOLLOWING INFORMATION
o Purpose of this RFA
o Research Objectives
o Mechanism(s) of Support
o Funds Available
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Where to Send Inquiries
o Letter of Intent
o Submitting an Application
o Peer Review Process
o Review Criteria
o Receipt and Review Schedule
o Award Criteria
o Required Federal Citations
PURPOSE OF THIS RFA
The National Institute of Mental Health (NIMH) and the Substance Abuse and
Mental Health Services Administration (SAMHSA) have entered into a partnership
to promote and support implementation of evidence-based mental health treatment
practices into state mental health systems. NIMH seeks to enhance the research
agenda of state mental health systems by focusing on activities that yield
knowledge about the most effective and feasible methods for implementing
evidence-based practices into state clinical practice settings. SAMHSA seeks to
provide direct support to states and localities that are ready and committed to
adopting evidence-based practices. This Request for Applications (RFA) is
designed to accomplish both objectives.
This RFA is to provide funding to states for planning grants to bridge science
and service focusing on the implementation of Evidence-based Practices (EBPs).
Some states are actively implementing EBPs despite limited information about
what factors contribute to successful adoption. There is substantial variation
in states" readiness to implement EBPs, and this RFA is intended to allow states
at various levels of implementation readiness to participate in bridging science
to service activities that will further their specific agendas. In order to
ensure that the funding goes directly to the state, state offices (e.g.,
Departments of Mental Health, Medicare/Medicaid offices) will be required to be
the applying organization, and a state officer will be required to be the
Principal Investigator. Examples of activities may include: 1) meetings to
convene state and local stakeholders to learn about implementation and plan EBP
implementation strategies, 2) small pilot studies on research areas such as
fidelity measurement assessment, and innovative cost analyses, 3) establishment
networks of administrators and key leaders to share information about
implementation or plan for alternative models of information management and
process and outcome measurement, and 4) planning of training, financing, and
policy initiatives that will advance implementation of EBPs. It is expected
that the one-year planning grant will lead to the submission of a research
application for an R01, R21, or R03 grant and/or applications for SAMHSA
Targeted Capacity Development, Community Action and other Best Practice
Development Grants.
RESEARCH OBJECTIVES
In response to key recommendations from the NIMH "Bridging Science and Service"
report, and SAMHSA"s Science to Service goals, the Services Research and
Clinical Epidemiology Branch (SRCEB) of NIMH and SAMHSA are issuing this RFA to
offer awards through the P20 mechanism to stimulate science to service
development activities within state mental health agencies. Applications will
be solicited from individual state offices to plan activities leading toward the
development of a unique science to service agenda around the implementation of
evidence-based mental health services into local practice settings. The purpose
of this RFA is to enable states in varying stages of readiness to perform
research and/or build research capacity to undertake studies that will add to
the evidence base on implementation of EBPs and improve their service delivery.
Bridging science to service activities may include methods of convening state
and local stakeholders to learn about implementation and plan their efforts,
efforts to enhance collection and aggregation of data, creation of mechanisms to
facilitate the implementation of research findings by clinicians and practices,
and creation of partnership networks of administrators, key leaders and
researchers to share information and plan implementation. It is anticipated
that after completion of these exploratory science to service planning grants,
recipient organizations will be in a position to compete for a variety of
research and service enhancement mechanisms to assist states in carrying out
their individualized plans.
Evidence-based practice remains a central focus of mental health research and
policy. Within the last few years, research has demonstrated the effectiveness
of a number of mental health treatments within clinical trials and other
valuable studies. However, difficulties remain in transporting and translating
these treatments to fit into real-world settings (Frist, W.H., 2002, "Federal
Funding for Biomedical Research," JAMA, 287(13): 1722-24). While the language
of evidence-based practice is so often used in research publications and
strategic plans, the knowledge base about how to disseminate evidence and
implement EBPs is still vastly underdeveloped. State mental health officials
have demonstrated an interest in implementing EBPs within their systems, but
have been constrained by limited resources in their ability to develop the
knowledge base of how EBPs can fit within their system. Given the great
difficulty of determining how EBPs can fit within real-world settings, state
research efforts toward implementation of EBPs can provide a wealth of
information about the factors that affect implementation. These efforts can
build a foundation for the next generation of interventions that more
effectively accommodate the complexities of everyday practice settings.
While learning more about the factors that contribute to successful
implementation of evidence-based practices, these grants also simultaneously
provide states with opportunities to begin planning concrete service improvement
strategies. To this bridging science to service end, states may choose from
numerous service improvement objectives, including (but not limited to):
o Assessing, adapting, and evaluating the impact of practical forms of evidence
such as practice guidelines
o Assessing and planning long-term sustainability from the inception of service
improvement change
o Implementing accountability mechanisms in linking EBP implementation with
achievable client outcomes
We envision that state efforts facilitated by these science to service planning
grants will contribute to our understanding of what factors affect the
implementation of Evidence-based Practices. Responses to the RFA will be
referred to the NIMH Dissemination and Implementation Research or Outcomes and
Quality of Care Programs within the Services Research and Clinical Epidemiology
Branch of Division of Services and Intervention Research. NIMH and SAMHSA will
provide oversight of science to services grants jointly.
OVERVIEW OF THE FIELD OF RESEARCH
A large body of evidence across relevant disciplines forms the basis for
addressing the need of this RFA. Over the past several decades, mental health
services and intervention research has seen tremendous growth in the number of
empirically-supported treatments, as defined by successful patient outcomes in
scientifically-rigorous randomized controlled trials (RCTs). Further, research
studies have established, to a lesser degree, the generalizability of some
treatment and prevention programs through effectiveness studies.
However, state systems continue to implement far fewer "evidence-based"
treatments than expected by the research community. State mental health
departments have demonstrated tremendous interest in the implementation of these
treatments, but hesitate about whether the treatments are suitable for their
public mental health services. Questions remain about the appropriate fit
between the state systems and the treatments, as defined within the RCT.
Evidence is lacking about the implementation of evidence-based mental health
treatments within state care settings, and this is making decision-making
difficult about whether to implement treatment programs within state systems.
Some have argued that the lack of evidence stems from the small role that state
departments have played in research. As a result, many important implementation
questions are not being asked (and need to be) within research studies.
However, some important field approaches to implementing evidence-based
practices are emerging, supported by efforts from large state and local networks
of researchers, providers, consumers, family members, policy makers, and program
officials (e.g., the National EBP project supported by SAMHSA and others).
These approaches bring unique opportunities to add scope and different
dimensions to their promised knowledge through this RFA.
In addition to supporting development of EBP capacity, this RFA gives an
opportunity for additional questions to emerge, for partnerships with
researchers to be cultivated, and important implementation studies to be planned
for future grant submissions.
KNOWLEDGE TO BE GAINED THROUGH THIS INITIATIVE
As indicated above, many of the research questions about implementing evidence-
based mental health treatments into public care settings have been slow to
emerge. Several recent NIMH and SAMHSA reports and related grant initiatives
have signaled the importance of involving more practitioners and important
stakeholders in research, as a method of making the resulting studies more
relevant to the real world.
This RFA enables monies to be used by state agencies for the specific activities
of developing these questions into viable research studies and service
enhancement projects. The resulting knowledge will build on the existing
efficacy and effectiveness data for a variety of interventions, and will improve
the capacity for state agencies to inform and conduct research, and raise the
awareness of researchers and policymakers about real-world implementation
importance.
Activities appropriate to this RFA include, but are not limited to:
o Use of sophisticated survey methodologies to solicit research questions from
key target audiences, specifically targeting the implementation of evidence-
based practices in state mental health care settings
o Development of innovative and sustainable partnerships with researchers from
multiple disciplines, including organizational change and development, knowledge
management, marketing, technology transfer, information technology, etc
o Use of existing and emerging technology transfer mechanisms to plan and
sponsor enhanced EBP service capacity
o Development of rigorous and effective dissemination strategies (e.g.,
training, technical assistance) that support and sustain adoption of evidence-
based practices
o Innovative, highly-focused meetings reaching out to target adopter groups
(e.g., providers, policymakers, administrators), in preparation for the bridging
science and service agenda development. Use of multiple methods (e.g., virtual
meetings, online discussion groups, conference calls, research seminars) to
discuss implementation issues and obtain input on research questions from these
stakeholders
o Development of a highly-focused science to service agenda, including short-
term and long-term goals for researching evidence-based mental health practice
implementation in state settings, based on a theoretical or conceptual framework
of state-wide implementation. It is expected that the planning activities will
lead to one or more R01, R03, or R21 grant application submissions to NIH and to
SAMHSA grant submissions
o Development of initial pilot studies to gather data on evidence-based
implementation-related issues which will lead to the submission of R01s
MECHANISM OF SUPPORT
This RFA will use the NIH P20 award mechanism. As an applicant you will be
solely responsible for planning, directing, and executing the proposed project.
This RFA is a one-time solicitation. Future unsolicited, competing-continuation
applications based on this project will compete with all investigator-initiated
applications and will be reviewed according to the customary peer review
procedures. The anticipated award date is July 2003.
FUNDS AVAILABLE
NIMH and SAMHSA intend to commit approximately $1 million in FY 2003 to fund 10
to 15 new and/or competitive continuation grants in response to this RFA. An
applicant may request a project period of up to 1 year and a budget for direct
costs of up to $100,000 per year. 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
NIMH and SAMHSA provide support for this program, awards pursuant to this RFA
are contingent upon the availability of funds and the receipt of a sufficient
number of meritorious applications. At this time, it is not known if this RFA
will be reissued.
ELIGIBLE INSTITUTIONS
You may submit (an) application(s) if your institution has any of the following
characteristics:
o Units of State governments
INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS/PROGRAM DIRECTORS
Any state mental health department, Medicare/Medicaid office, or state health
department full-time employee with the skills, knowledge, and resources
necessary to carry out the proposed science to service development 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.
WHERE TO SEND INQUIRIES
We encourage inquiries concerning this RFA and welcome the opportunity to answer
questions from potential applicants. Inquiries may fall into three areas:
science to service development, peer review, and financial or grants management
issues:
Direct your questions about science to service planning issues to:
David A. Chambers, Ph.D.
Division of Services and Intervention Research
National Institute of Mental Health
6001 Executive Boulevard, Room 7133, MSC-9631
Bethesda, MD 20892-9631
Telephone: (301) 443-3747
FAX: (301) 443-4045
Email: dchamber@mail.nih.gov
Crystal R. Blyler, Ph.D.
Division of Service and Systems Improvement
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
5600 Fishers Lane, Room 11C-22
Rockville, MD 20857
Telephone: (301) 443-3653
FAX: (301) 443-0541
Email: cblyler@samhsa.gov
Direct inquiries regarding peer review issues to:
Michael Kozak, Ph.D.
Chief, Extramural Review Branch
Division of Extramural Activities
National Institute of Mental Health
6001 Executive Boulevard, Room 6138, MSC-9608
Bethesda, MD 20892-9608
Telephone: (301) 443-1340
FAX: (301) 594-0702
Email: mkozak@mail.nih.gov
Direct inquiries regarding fiscal matters to:
Joy R. Knipple
Grants Management Branch
National Institute of Mental Health
6001 Executive Boulevard, Room 6115, MSC-9605
Bethesda, MD 20892-9605
Telephone: (301) 443-8811
FAX: (301) 443-6885
Email: jk173@nih.gov
LETTER OF INTENT
Prospective applicants are asked to submit a letter of intent that includes the
following information:
o Descriptive title of the proposed science to service planning activity
o Name, address, and telephone number of the Principal Investigator
o Names of other key personnel
o Participating institutions
o Number and title of this RFA
Although a letter of intent is not required, is not binding, and does not enter
into the review of a subsequent application, the information that it contains
allows NIMH and SAMHSA staff to estimate the potential review workload and plan
the review.
The letter of intent is to be sent by the date listed at the beginning of this
document. The letter of intent should be sent to:
David A. Chambers, Ph.D.
Division of Services and Intervention Research
National Institute of Mental Health
6001 Executive Boulevard, Room 7133 MSC-9631
Bethesda, MD 20892-9631
Telephone: (301) 443-3747
FAX: (301) 443-4045
Email: dchamber@mail.nih.gov
SUBMITTING AN APPLICATION
Applications must be prepared using the PHS 398 research grant application
instructions and forms (rev. 5/2001). Where the application asks for a
"Research Plan," describe the science to service planning activity for your
proposed project. The PHS 398 is available at
https://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive format.
For further assistance contact GrantsInfo, Telephone (301) 710-0267, Email:
GrantsInfo@nih.gov.
USING THE RFA LABEL: The RFA label available in the PHS 398 (rev. 5/2001)
application form must be affixed to the bottom of the face page of the
application. Type the RFA number on the label. 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. In addition, the RFA title and number must
be typed on line 2 of the face page of the application form and the YES box must
be marked. The RFA label is also available at:
https://grants.nih.gov/grants/funding/phs398/label-bk.pdf.
SENDING AN APPLICATION TO THE NIH: Submit a signed, typewritten original of the
application, including the Checklist, and three 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)
At the time of submission, two additional copies of the application must be sent
to:
Jean G. Noronha, Ph.D.
Division of Extramural Activities
National Institute of Mental Health
6001 Executive Boulevard, Room 6154, MSC 9609
Bethesda, MD 20892
Rockville, MD 20852 (For express/courier service)
Telephone: (301) 443-3367
FAX: (301) 443-4720
Email: jnoronha@mail.nih.gov
APPLICATION PROCESSING: Applications must be received by the application
receipt date listed in the heading of this RFA. If an application is received
after that date, it will be returned to the applicant without review.
The Center for Scientific Review (CSR) will not accept any application in
response to this RFA 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 substantial revisions of
applications already reviewed, but such applications must include an
Introduction addressing the previous critique.
PEER REVIEW PROCESS
Upon receipt, applications will be reviewed for completeness by the CSR and
responsiveness by NIMH and SAMHSA. Incomplete and/or non-responsive
applications will be returned to the applicant without further consideration.
Applications that are complete and responsive to the RFA will be evaluated for
scientific and technical merit by an appropriate peer review group convened by
the NIMH and SAMHSA in accordance with the review criteria stated below. As
part of the initial merit review, all applications will:
o Receive a written critique
o Undergo a process in which only those applications deemed to have the highest
scientific and technical merit, generally the top half of the applications under
review, will be discussed and assigned a priority score
o Receive a second level review by the National Advisory Mental Health Council.
REVIEW CRITERIA
The goals of NIH-supported research are to advance our understanding of
biological systems, improve the control of disease, and enhance health. The
goals of SAMHSA-supported projects are to increase the availability and quality
of mental health services. 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 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: Do your science to service planning activities address an
important problem? If the aims of your application are achieved, how do they
advance scientific knowledge and application of scientific knowledge? What will
be the effect of these planning activities on the concepts or methods that drive
this field?
(2) APPROACH: Are the conceptual framework, design, methods, and analyses
underlying the science to service planning activities adequately developed, well
integrated, and appropriate to the aims of the project? Do you acknowledge
potential problem areas and consider alternative tactics?
(3) INNOVATION: Do your science to service planning activities employ novel
concepts, approaches or methods? Are the aims original and innovative? Does
your project challenge existing paradigms or employ innovative methodologies or
technologies?
(4) INVESTIGATOR/PROGRAM DIRECTOR: 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/program director and to that of
other key personnel (if any)?
(5) ENVIRONMENT: Does the environment in which your work will be done
contribute to the probability of success? Do the proposed science to service
planning activities take advantage of unique features of the environment or
employ useful collaborative arrangements? Is there clear and unwavering
evidence of State support?
ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your application
will also be reviewed with respect to the following:
o PROTECTIONS: The adequacy of the proposed protection for humans, animals, or
the environment, to the extent they may be adversely affected by the project
proposed in the application.
o INCLUSION: The adequacy of plans to include participants from both genders,
all racial and ethnic groups (and subgroups), and children as appropriate for
the scientific and programmatic goals of the grant. Plans for the recruitment
and retention of research subjects will also be evaluated. (See Inclusion
Criteria included in the section on Federal Citations, below)
o DATA SHARING: The adequacy of the proposed plan to share data.
o BUDGET: The reasonableness of the proposed budget and the requested period
of support in relation to the proposed project.
RECEIPT AND REVIEW SCHEDULE
Letter of Intent Receipt Date: September 29, 2002
Application Receipt Date: October 29, 2002
Peer Review Date: February 2003
Council Review: May 2003
Earliest Anticipated Start Date: July 2003
AWARD CRITERIA
Award criteria that will be used to make award decisions include:
o Scientific and technical merit (as determined by peer review)
o Availability of funds
o Programmatic priorities
REQUIRED FEDERAL CITATIONS
MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: Research components
involving Phase I and II clinical trials must include provisions for assessment
of patient eligibility and status, rigorous data management, quality assurance,
and auditing procedures. In addition, it is NIH policy that all clinical trials
require data and safety monitoring, with the method and degree of monitoring
being commensurate with the risks (NIH Policy for Data Safety and Monitoring,
NIH Guide for Grants and Contracts, June 12, 1998:
https://grants.nih.gov/grants/guide/notice-files/not98-084.html).
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
(https://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html), a complete
copy of the updated Guidelines are available at
https://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
https://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
https://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.
HUMAN EMBRYONIC STEM CELLS (hESC): Criteria for federal funding of research on
hESCs can be found at https://grants.nih.gov/grants/stem_cells.htm and at
https://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-005.html. Only
research using hESC lines that are registered in the NIH Human Embryonic Stem
Cell Registry will be eligible for Federal funding (see http://escr.nih.gov).
It is the responsibility of the applicant to provide the official NIH
identifier(s)for the hESC line(s)to be used in the proposed research.
Applications that do not provide this information will be returned without
review.
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
https://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.
Applicants may wish to place data collected under this RFA 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.
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 RFA 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. 93.242 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 https://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 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.