RESEARCH ON EFFECTIVENESS OF CHILDREN'S MENTAL HEALTH SERVICES

NIH GUIDE, Volume 23, Number 33, September 16, 1994



PA NUMBER:  PA-94-094



P.T. 34, AA



Keywords:

  0730057 

  Adolescents 



National Institute of Mental Health



PURPOSE



This program announcement, based on recommendations set forth in the

National Plan for Research on Child and Adolescent Mental Disorders, is

intended to encourage investigator-initiated research grant

applications for studies of the effectiveness of mental health services

that are being provided to children, adolescents, and their families

through the Center for Mental Health Services (CMHS) Comprehensive

Community Mental Health Services Program initiative.



The purpose of this program announcement is to encourage research

applications for studies that assess the impact of services funded

under this major CMHS program initiative, yield data that can be used

in health care reform efforts, and contribute to the development of

more effective mental health service delivery systems for children.



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 the Effectiveness of Children's Mental Health

Services, is related to the priority area of mental health and mental

disorders.  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



Applications may be submitted by 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 First Independent Research

Support and Transition (FIRST) (R29) awards and small grants (R03).

Women and minority investigators are encouraged to apply.



MECHANISMS OF SUPPORT



Research support may be requested through applications for regular

research project grants (R01), small grants (R03), and FIRST award

(R29).  Since the R03 and R29 mechanisms have different requirements

regarding eligibility, application format, and review criteria,

applicants are strongly encouraged to consult with program staff (see

INQUIRIES) and obtain specialized announcements.  The small grant (R03)

is especially suited for initial research by junior investigators and

for pilot research prior to large-scale field trials.  The

Investigator-Initiated Interactive Research Project Grant (IRPG) may be

used (see PA-94-086, NIH Guide, Vol. 23, No. 28, July 29, 1994).

Because of the recent revisions to the IRPG, applicants who are

considering this mechanism are particularly advised to consult with

program staff.



An application may request support for up to five years for regular

research project grants (R01).  A small grant (R03) is limited to two

years and may not be renewed.  A FIRST award (R29) is for five years

and are not renewable.  Annual awards will be made, subject to

continued availability of funds and progress achieved.



RESEARCH OBJECTIVES



Background



Recent reviews of prevalence studies indicate that approximately 14 to

20 percent of children and adolescents in the United States have a

diagnosable mental, emotional, or behavioral disorder.  Because

children with serious emotional disturbances frequently manifest

problems in many domains, including home, school, and community, they

require the intervention of other agencies and systems to provide

special education, child welfare, health, substance abuse, vocational,

and, often, juvenile justice services.  Service-providing agencies

often have requirements and eligibility rules that make it difficult

for families whose children have mental health needs to obtain

requisite services.  Consequently, in the past decade, a growing

interest has emerged favoring the provision of a comprehensive array of

mental health and other services to meet the needs of these youth and

their families.



In response to this interest, the Comprehensive Community Mental Health

Services Program for Children with Serious Emotional Disturbances was

created (as part of the ADAMHA Reorganization Act--P.L. 102-321,

Sec.119).  This program is administered by the Center for Mental Health

Services (CMHS) of the Substance Abuse and Mental Health Services

Administration (SAMHSA).  Under this authority, grants are provided to

States, political subdivisions of States, Indian tribes, or tribal

organizations to provide a broad array of comprehensive community-based

services for children with serious emotional, behavioral, or mental

disorders in order to enable communities to develop local systems of

care consisting of mental health, child welfare, education, juvenile

justice, and other appropriate agencies.



Funds for the CMHS program are authorized to be spent on services that

are underdeveloped or nonexistent in most communities:  respite care;

day treatment; therapeutic foster care; intensive home-based services;

school or clinic-based services; emergency services; and diagnostic and

evaluation services.  Additionally, each child must have an

individualized service plan, developed with the participation of family

and, where appropriate, the child.  The plan must designate a case

manager to assist the child and family by coordinating services among

several systems.



To date, 11 sites have been awarded five-year grants by CMHS under the

Request for Applications that was announced in the Spring 1993.  Up to

10 additional sites may be awarded by September 30, 1994, under a new

CMHS Request for Applications.  An evaluation plan that will encompass

all of the sites is being developed by CMHS.



Through this program announcement, NIMH invites applications for

studies of the effectiveness, including cost-effectiveness, of these

comprehensive service models.



Research Topic Areas



Listed below are examples of research topic areas.  The list is

illustrative, not exhaustive; it is expected that additional important

research topics may be identified by researchers who respond to this

program announcement.



o  Research on the functional, clinical, or service system outcomes of

comprehensive services provided to children, adolescents, and their

families, including factors that mediate the outcomes of such services



o  Studies of the effectiveness of different levels of service

intensity within service programs, for children and adolescents with

different diagnoses, functional abilities, and sociodemographic

characteristics



o  Research on the effects of different structural relationships among

components of the service systems on providers, children, adolescents,

families, and organizational functioning



o  Studies of the relative cost-effectiveness of intervention programs

and systems of care



o  Studies of the quality of care or appropriate matching of services

to level of impairment



o  Research on the organization and delivery of mental health care

across different community settings



o  Studies of the effectiveness and cost-effectiveness of integrating

interventions or programs provided by other child-serving sectors, such

as substance abuse, schools, child welfare, or juvenile justice, with

mental health agencies



o  Research on the family context of mental health service delivery for

children and adolescents, such as impact of parent training on families

and siblings



o  Research on the effectiveness of interventions designed to prevent

adverse mental health outcomes in family members and caregivers



o  Research on factors that are barriers to or facilitators of service

integration



o  Studies of the impact of co-occurring conditions, such as

emotional/behavioral disorders, drug or alcohol abuse, AIDS, or

homelessness on service delivery



o  Development of improved methods for measuring and analyzing service

integration and, within comprehensive systems, for measuring service

intensity and service outcomes



o  Research on the financing of services for children and adolescents,

including financial burden, cost of services for specific mental

disorders, and adequacy of services for the uninsured or underinsured



o  Studies of the impact of Medicaid regulations on the delivery of

mental health services to children, youth, and families



STUDY POPULATIONS



INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS



It is the policy of the NIH that women and members of minority groups

and their subpopulations must be included in all NIH supported

biomedical and behavioral research projects involving human subjects,

unless a clear and compelling rationale and justification is provided

that inclusion is inappropriate with respect to the health of the

subjects or the purpose of the research.  This new policy results from

the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43)

and supersedes and strengthens the previous policies (Concerning the

Inclusion of Women in Study Populations, and Concerning the Inclusion

of Minorities in Study Populations) which have been in effect since

1990.  The new policy contains some new provisions that are

substantially different from the 1990 policies.  All investigators

proposing research involving human subjects should read the "NIH

Guidelines for Inclusion of Women and Minorities as Subjects in

Clinical Research," which have been published in the Federal Register

of March 28, 1994 (FR 59 14508-14513), and reprinted in the NIH GUIDE

FOR GRANTS AND CONTRACTS of March 18, 1994, (Volume 23, Number 11).



Investigators may obtain copies from the program staff or contact

persons listed below.  Program staff may also provide additional

relevant information concerning the policy.



Peer reviewers will address specifically whether the research plan in

the application conforms to these policies.  If the representation of

women or minorities in a study design is inadequate to answer the

scientific question(s) addressed AND the justification for the selected

study population is inadequate, it will be considered a scientific

weakness or deficiency in the study design and will be reflected in

assigning the priority score.



All applications for clinical research submitted to NIH are required to

address these policies.  NIH funding components will not award grants

or cooperative agreements that do not comply with these policies.



APPLICATION PROCEDURES



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

9/91).  The number (PA-94-094) and the title of this program

announcement, "Research on Effectiveness of Children's Mental Health

Services," must be typed in item number 2a on the face page of the PHS

398 application form.  Applicants must also specify the mechanism under

which they are applying (e.g., R01, R03, R29).



FIRST (R29) applications must include at least three sealed letters of

reference attached to the face page of the original application.  FIRST

applications submitted without the required number of reference letters

will be considered incomplete and will be returned without review.



Application kits containing the necessary forms may be obtained from

offices of sponsored research at most universities, colleges, medical

schools, and other major research facilities and from the Office of

Grants Information, Division of Research Grants, National Institutes of

Health, Westwood Building, Room 449, Bethesda, MD 20892, telephone

301/710-0267.



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 following the standard PHS review procedures.  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.



Review Criteria



Criteria to be considered in evaluating applications for

scientific/technical merit are:



o  Scientific and technical 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 subjects



AWARD CRITERIA



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 in advance of or during the process of preparing an

application.  Potential applicants may contact NIMH as early as

possible for information and assistance in initiating the application

process and developing an application.



Direct inquiries regarding programmatic issues to:



Kimberly Hoagwood, Ph.D.

Child and Adolescent Mental Health Services Research Program

National Institute of Mental Health

5600 Fishers Lane, 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-08

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 Parts 74 and 92.  The program is not subject to

the intergovernmental review requirements of Executive Order 12372, as

implemented through DHHS regulations at 45 CFR Part 100.



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