RESEARCH ON COMMUNITY REINTEGRATION FOR PEOPLE WITH PSYCHIATRIC DISABILITIES

July 2003

RELEASE DATE: June 20, 2003

PA NUMBER: PA-03-144

EXPIRATION DATE: June 2006, unless reissued.

National Institute of Mental Health (NIMH) (http://www.nimh.nih.gov/)

CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 93.242

THIS PA CONTAINS THE FOLLOWING INFORMATION

• Purpose of the PA
• Research Objectives
• Mechanism(s) of Support
• Eligible Institutions
• Individuals Eligible to Become Principal Investigators
• Where to Send Inquiries
• Submitting an Application
• Peer Review Process
• Review Criteria
• Award Criteria
• Required Federal Citations

PURPOSE OF THIS PA

The National Institute of Mental Health (NIMH) invites research grant applications for multidisciplinary/translational research, especially mixed-methods research, that will explore (a) the individual, social, and service system conditions necessary for people with psychiatric disabilities to reintegrate into community life; (b) the organizational and service system conditions necessary to enable service providers to facilitate that reintegration; and (c) the effectiveness of rehabilitation strategies and programs in helping socioculturally diverse individuals who have widely varying goals, material and social resources, and clinical needs. This research has typically been called "disability" or "psychiatric rehabilitation" research.

Historically, however, this research has focused fairly narrowly on the use of services; compliance; symptom reduction; easily assessed criteria of social and vocational success; and cost. The goal of this program announcement (PA) is to encourage researchers to think beyond usual assumptions underlying "psych rehab," program fidelity, and outcomes assessment and to encourage a focus on the individuals within and outside rehabilitation programs, who must function within personal, organizational, service system, cultural, and societal boundaries to achieve a return to community life.

RESEARCH OBJECTIVES

For more than 30 years, the research in psychiatric rehabilitation has Become increasingly sophisticated and rigorous. However, the conclusions that one can draw from the literature that are relevant to consumers remain unchanged: People with severe psychiatric disorders can learn skills and adaptive behaviors that make community living possible; drug treatment alone is not sufficient; neither the diagnostic label nor the symptomatology determines adaptive capabilities; the benefits of therapies received and skills learned in one context do not automatically transfer to other contexts; and the academic credentials of the mental health professional providing care do not predict consumer outcomes. Recent reviews of the literature support these conclusions.

However, it is now time to focus on research that will do more than replicate old findings. This PA is designed to encourage researchers to move beyond traditional questions, perspectives, and methods of research. The goal is to change the focus from assessing therapies, skills training, service models, and program fidelity to a focus on research designed to expedite and ease the reintegration into the community of those with psychiatric disabilities.

The research should address the social and physical isolation experienced by consumers who need to develop socioculturally meaningful and useful bridges back to valued social roles. It also needs to deal with the regulatory, organizational, and professional barriers that case workers, whether they are licensed social workers or peer providers, experience in trying to do their jobs.

Research Topics

The following are examples of broad research topics that might be the focus of research on reintegration of people with psychiatric disabilities. This list is not meant to be comprehensive, nor are the examples meant to be exclusive of other topics.

o Using social and behavioral science theories, such as those on social support, social networks, and culture, determine under what conditions self-help, peer providers, and peer-run programs and organizations can improve outcomes for consumers. Determine under what conditions nonprofessional, nonpeer, community-based supporters can improve outcomes.

o Determine how organizational culture and climate impact the effectiveness of self-help organizations, Assertive Community Treatment (ACT) teams, Independent Placement and Support (IPS) programs, and other rehabilitation programs.

o Identify system, organizational, dyadic, and individual components that are necessary to maximize consumer engagement in rehab programs, the transition to rehab readiness, and an alliance of trust between the provider and client. Identify necessary components of community support and how these components vary across individuals from various sociocultural and economic backgrounds.

o Identify and test strategies to help employers accept, train, and support employees with mental illnesses who are working to reintegrate into the community. Using behavioral science theory as a guide, identify conditions required in employment situations for coworkers to accept those with severe mental illness as fellow employees.

o Test assessment strategies (such as computerized adaptive testing), validation techniques (such as cognitive testing), and measurement theories (such as Item Response Theory (IRT)) to improve the assessment capabilities of DSM Axes IV and V, across populations and settings.

o Investigate methods to allow for outcome measurement based on consumer preferences and reintegration goals.

o Improve the measurement validity of concepts critical to reintegration: continuity of care; alliance/trust/attachment; readiness; recovery; meaningful, though not necessarily dramatic, measures of progress (smiling, joining a group); empowerment; self-determination; quality of life (a quality that is contextually and personally relevant); future orientation (goals, hopes, dreams for a life beyond illness). Develop or adapt measures that assess the social and psychological context in which a person with psychiatric disabilities lives (such as the presence of acceptance, warmth, respect, understanding, an "environment of opportunities"; and an "atmosphere of dependency".

o Using behavioral and social theories to understand the underlying dynamics, test the components of multicomponent rehabilitation interventions (such as ACT and IPS) across populations and settings to determine how and why they work when they do. Determine if there are components of a program that are culturally inappropriate or irrelevant for some populations.

o Determine how, when, and with whom neurocognitive testing can be used to identify specific remedial strategies to further client reintegration into the community. Develop and test interventions that specifically target cognitive deficits to determine their effectiveness. Investigate the links among remediation strategies, cognitive test results, brain scan changes, and improved functioning.

o Investigate methods for disseminating programs to populations in sociocultural environments, economic circumstances, and geographic regions different from those in which the programs were created. Investigate the validity and utility of mixed methods approaches for determining whether a program is adhering to standards (fidelity) and improving client outcomes.

MECHANISMS OF SUPPORT

This PA will use the NIH Research Project Grant (R01), Exploratory/ Developmental Grant (R21), and Small Grant (R03) award mechanisms. As an applicant, you will be solely responsible for planning, directing, and executing the proposed project.

Information on the Small Grant (R03) is available at: http://grants.nih.gov/grants/guide/pa-files/PA-03-108.html.

Information on the Exploratory/Developmental Grant (R21) is available at: http://grants.nih.gov/grants/guide/pa-files/PA-03-107.html.

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.

ELIGIBLE INSTITUTIONS

You may submit (an) application(s) if your institution has any of the following characteristics:

• For-profit or non-profit organizations
• Public or private institutions, such as universities, colleges, hospitals, and laboratories
• Units of State and local governments
• Eligible agencies of the Federal government
• Domestic or foreign
• Faith-based organizations

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.

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.

Direct your questions about scientific/research issues to:

Ann A. Hohmann, Ph.D., M.P.H.
Division of Services and Intervention Research
National Institute of Mental Health
6001 Executive Boulevard, Room 7135, MSC 9631
Bethesda, MD 20892-9631
Telephone: (301) 443-4235
Email: ahohmann@nih.gov

Direct your questions about financial or grants management 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

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: GrantsInfo@nih.gov.