Deadline: 07-Sep-24
The National Institutes of Health (NIH) is offering grants for Implementing and Sustaining Evidence-Based Mental Health Practices in Low-Resource Settings to Achieve Equity in Outcomes.
Purpose
- This Funding Opportunity Announcement (FOA) supports pilot work in support of subsequent studies testing the effectiveness of strategies to deliver evidence-based mental health services, treatment interventions, and/or preventive interventions (EBPs) in low-resource mental health specialty and non-specialty settings within the United States. The FOA targets settings where EBPs are not currently delivered or delivered with fidelity, such that there are disparities in mental health and related functional outcomes (e.g., employment, educational attainment, stable housing, integration in the community, treatment of co-morbid substance use disorders) for the population(s) served.
- Implementation strategies should identify and use innovative approaches to remediate barriers to provision, receipt, and/or benefit from EBPs and generate new information about factors integral to achieving equity in mental health outcomes for under-served populations. Research generating new information about factors causing/reducing disparities is strongly encouraged, including due consideration for the needs of individuals across the life span.
Research Objectives
- This initiative supports pilot work in support of subsequent studies testing the effectiveness of strategies to deliver EBPs in low-resource settings in the United States, in order to reduce disparities in mental health and related functional outcomes (e.g., employment, educational attainment, stable housing, integration in the community, treatment of co-morbid substance use disorders) for the population(s) served. Of interest are settings where a significant number of children, youth, adults, or older adults with or at risk for mental illnesses can be found and evidence-based mental health treatments or services are not currently delivered.
- Applications focused on developmental work that would enhance the probability of success in subsequent larger scale projects are also encouraged.
- Developmental work might include refining details of the implementation approach; examining the feasibility of novel approaches and technologies; examining the feasibility of data collection including administration of instruments, obtaining administrative or other types of data, etc.; enhancing the protocol for the comparison group and randomization procedures; examining the feasibility of recruiting and retaining participants into the study condition(s); and developing and testing supportive materials such as training curricula. Therefore, the collection of preliminary data regarding feasibility, acceptability and engagement of intervention targets is appropriate. However, given the intended pilot nature of the R34 activity code, conducting fully powered tests of outcomes or attempting to obtain an estimate of an effect size may not be feasible.
- The goal of this initiative is to conduct pilot work in support of subsequent studies that develop and test the effectiveness of scalable implementation strategies to achieve delivery of EBPs with high fidelity in low-resource settings and significantly improve clinical and functional outcomes toward greater equity with outcomes documented in the general population.
- Pilot work might include developing strategies for delivery of EBPs that focus on: access, quality/fidelity of care delivery, patient/family engagement, care management and coordination, or other innovative strategies and are empirically or theoretically justified. Implementation strategies might address EBP delivery barriers at one or more of the following: provider-, clinic-, organizational-, within- or cross-systems levels.
- Pilot studies submitted to this FOA should be structured to inform future studies of whether and how the implementation strategy achieves delivery of the EBP with fidelity, and measurement of whether receipt of EBP leads to improved mental health and related functional outcomes for the intended population(s). Relevant pilot work might include preliminary assessment of the feasibility, usability, and acceptability of 1) measuring change in the targeted proximal factors; 2) measuring fidelity in delivery of the EBP(s); 3) measuring improvement in clinical and functional outcomes in the populations served; and 4) any other factors relevant that will strengthen the success of a future larger scale study of sustained delivery of EBPs in under-resourced settings and determine the mechanisms that contribute to reducing or eliminating disparities through improved clinical and related functional outcomes.
- In addition, it is expected that the application/scope of work should be formulated following NIMH requirements for clinical trials and should address the following elements: 1) empirical/conceptual basis for the selection of the proximal targets of the implementation strategy, 2) plans for assessing preliminary changes in those proximal targets, and 3) plans for preliminary examination of whether changes in the targets are associated with more distal changes in clinical and functional outcomes that contribute to reducing disparities.
- Proposed studies are expected to test models, theories, and conceptual frameworks of the implementation process that account for the available resources of the targeted care settings and the potential for cross-system collaboration(s), using a deployment-focused approach that takes into account the perspective and needs of multiple stakeholders, including end-users. To that end, it may be productive to involve collaborations with and/or input from community partners including consumers, families, providers, administrators, payers and/or policy-makers to inform the research and help ensure that the ultimate results will have utility. The tested approaches should be developed with consideration for the realistic constraints in organizational structure, provider availability and training, organizational or provider capacity and other relevant factors specific to the type of under-resourced setting being addressed. Studies should be formulated to contribute generalizable strategies that, if effective, can be rapidly disseminated and implemented across a broad range of real-world settings.
- NIMH encourages research that utilizes novel technology to assist in the implementation, fidelity, delivery, and feedback of clinical and organizational processes in the implementation of EBPs. When indicated, strategies should incorporate health information technology (HIT) and electronic health records (EHR) to coordinate care and monitor outcomes.
- A variety of methodologically rigorous approaches may be indicated for a future study testing the impact of the implementation strategy being developed, and pilot work should be designed in support of a future study design. Approaches may include randomized controlled trials (RCTs), quasi-experimental designs with non-randomized comparison groups, time series designs, and other designs of equivalent rigor and relevance. Pilot studies should be designed to inform and test the feasibility of the research design for a subsequent, adequately powered test of the implementation strategy (e.g., determining whether randomization is feasible), taking into account practical constraints, ethical issues, and the trade-off between maximizing internal and external validity.
- It is anticipated that pilot work funded by this FOA will lead to larger studies that substantially contribute to the development of new, generalizable knowledge regarding strategies to reduce or eliminate disparities in mental health outcomes and functioning. Given this goal, applicants should propose pilot work that clarifies optimal and feasible approaches to measuring disparities reduction, keeping in mind that effectiveness in reducing disparities may be best demonstrated via examination of post-implementation outcomes/effect sizes among underrepresented, under-served individuals in comparison to those achieved in published research in the general population or through comparisons among subgroups. Applicants are strongly encouraged to propose EBP implementation strategies that identify factors that facilitate sustainability, scalability, and generalizability to other settings or geographic regions.
Areas of Interest
Areas of interest include, but are not limited to:
- Testing the effectiveness of strategies to achieve EBP delivery and sustainment through training and support for existing personnel in the targeted setting(s)
- Testing the effectiveness of strategies to achieve EBP delivery and sustainment through integrated E-health, M-health, internet or other types of technology
- Testing the effectiveness of strategies to achieve EBP delivery and sustainment through cross-system collaboration that brings EBP-trained interventionists or related expertise from affiliated systems into the targeted setting(s)
- Testing the effectiveness of strategies to impact organizational structure, climate, culture and processes to achieve implementation and sustainment
- Strategies to enable sustained delivery by reducing burn-out and turnover of trained staff to maintain organizational capacity and fidelity of delivery
- Studies of policies and/or service system organization or prioritization that influence the success of on-going implementation and delivery to improve outcomes
- Studies of the contribution of community participation and other types of partnerships in the successful engagement of clients in receipt of EBPs
- Strategies designed to overcome resource challenges associated with delivery/receipt/sustainment of EBPs in under-resourced settings
- Studies to test the effectiveness of implementing components of the learning health care system model, including but not limited to: provider feedback, continuous quality improvement, service coordination, etc., to achieve sustained EBP delivery and client engagement
- Studies to test the effectiveness of evidence-based data harmonization across service-providing to foster retention in care and care coordination in support of EBP delivery
- Studies of the effectiveness of strategies targeting the provider- or clinic-level factors that support sustained delivery of EBPs. Proposed studies should be statistically powered to provide a definitive test of the implementation strategy’s effectiveness in comparison to usual care practices in the setting.
Funding Information
- Funds Available and Anticipated Number of Awards
- NIMH intends to commit $2,000,000 in FY 2022 to fund successful applications.
- Award Budget
- Direct costs are limited to $225,000 per year and $450,000 over the 3-year project period.
Eligibility Criteria
- Eligible Organizations
- Higher Education Institutions
- Public/State Controlled Institutions of Higher Education
- Private Institutions of Higher Education
- The following types of Higher Education Institutions are always encouraged to apply for NIH support as Public or Private Institutions of Higher Education:
- Hispanic-serving Institutions
- Historically Black Colleges and Universities (HBCUs)
- Tribally Controlled Colleges and Universities (TCCUs)
- Alaska Native and Native Hawaiian Serving Institutions
- Asian American Native American Pacific Islander Serving Institutions (AANAPISIs)
- Nonprofits Other Than Institutions of Higher Education
- Nonprofits with 501(c)(3) IRS Status (Other than Institutions of Higher Education)
- Nonprofits without 501(c)(3) IRS Status (Other than Institutions of Higher Education)
- For-Profit Organizations
- Small Businesses
- For-Profit Organizations (Other than Small Businesses)
- Local Governments
- State Governments
- County Governments
- City or Township Governments
- Special District Governments
- Indian/Native American Tribal Governments (Federally Recognized)
- Indian/Native American Tribal Governments (Other than Federally Recognized)
- Federal Government
- Eligible Agencies of the Federal Government
- U.S. Territory or Possession
- Other
- Independent School Districts
- Public Housing Authorities/Indian Housing Authorities
- Native American Tribal Organizations (other than Federally recognized tribal governments)
- Faith-based or Community-based Organizations
- Regional Organizations
- Higher Education Institutions
- Foreign Institutions
- Non-domestic (non-U.S.) Entities (Foreign Institutions) are not eligible to apply.
- Non-domestic (non-U.S.) components of U.S. Organizations are not eligible to apply.
- Foreign components are not allowed.
For more information, visit Grants.gov.