kristoff@GENBANK.BIO.NET (Dave Kristofferson) (04/12/91)
$$XID RFA CA9114 CA-91-14 P1O1 *****************************************
REQUEST FOR APPLICATIONS
RFA: CA-91-14
P.T. 34; K.W. 0715035, 0745020, 0745027, 0745035
PUBLIC HEALTH APPROACHES TO BREAST AND CERVIX SCREENING
National Cancer Institute
Letter of Intent Receipt Date: June 7, 1991
Application Receipt Date: August 2, 1991
I. INTRODUCTION
The Division of Cancer Prevention and Control (DCPC) of the
National Cancer Institute (NCI) invites grant applications from a
consortium of public health agencies or institutions to develop,
implement, and evaluate programs designed to increase breast and
cervical cancer screening of older, low income, low education,
and minority women. Priority will be given to applications
specifically designed to include evaluation of breast and
cervical screening utilization of women over the age of 65 and
those targeting populations residing in rural areas. Among
Hispanic women, priority will be given to applications targeting
Puerto Rican and Cuban populations to provide more comprehensive
information on Hispanic populations. The NCI currently funds
projects targeting Hispanic women of Mexican descent.
The Request for Applications (RFA) method of grant application
solicitation is used to encourage projects of special importance to the
National Cancer Program, and awards are made in accordance with the
policies of the National Institutes of Health (NIH) grant-in-aid and
applicable Public Health Service (PHS) policies. This RFA is limited to
applicants from within the U.S.
The 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 RFA is
related to the priority area of Cancer.
This project proposes to demonstrate how a consortium of
community agencies can develop and evaluate strategies to
increase the availability, accessibility, awareness, and
utilization of breast and cervical cancer screening regimens,
including mammography, clinical breast examination, breast self-
examination, and Pap smears by low income, low education,
and minority women over 40 years of age. Health agencies are
expected to provide or arrange for funding for screening
procedures.
The intent of this RFA is to invite applications from official
health agencies or institutions, such as health departments,
community health centers, or public hospitals, in collaboration
with other community agencies or institutions capable of
addressing early detection of breast and cervical cancers in the
target population. The lead agency must demonstrate experience
with disease control and must indicate how coordination of
agencies will be conducted.
II. BACKGROUND INFORMATION
The Cancer Control Program, NCI, is
located within the Division of Cancer Prevention and Control.
This program is authorized under the National Cancer Act and
calls for cooperation with health agencies in the prevention,
control, and eradication of cancer.
Cancer control is defined as the reduction of cancer incidence,
morbidity, and mortality through an orderly sequence of
research on interventions and their impact in defined populations
to the broad, systematic application of the research results.
Activities supported under this RFA will involve the application
of valid interventions.
Research Rationale
Each year 41,000 women die of breast cancer and 4,500 die from
cancer of the cervix. The women most likely to die are the least
likely to have been screened. Among women 40 years of age and
older, those of lower income, less education, and members
of minority groups are less likely to have been screened for
cancer. Socioeconomic factors appear to play an important role
in cancer survival as well. Cancer mortality rates are higher
for patients of low socioeconomic status (SES) than for those
of higher brackets. Data suggest that much of the difference in
survival rates is due to late diagnosis of cancer among lower
SES patients. Clearly, there is a need to develop effective
screening programs for lower SES and minority segments of the
population.
NCI's Early Detection Guidelines indicate:
"That beginning at age 40, all women should be encouraged to have
a mammogram every one to two years until age 50 after which it
should become annual."
"That all women who are, or have been sexually active, or have
reached 18 years, have an annual Pap test and pelvic examination.
After a woman has had three or more consecutive satisfactory
normal examinations, the Pap test may be performed less
frequently at the discretion of her physician."
National data indicate that subgroups of women (e.g., older
women, minority women, and women lower in socioeconomic status) at
risk for breast cancer or cervical cancer do not receive
preventive services to detect these conditions early. The lack
of preventive care does not appear to be due to a lack of
physician contact, however. Rather, these data suggest failure
to integrate routine preventive care with other services being
provided to unscreened segments of the population, and/or
behavioral barriers in unscreened populations that prevent them
from utilizing screening, even if it is available.
Public agencies or institutions, such as health departments,
community health centers, outpatient clinics, and public hospitals
frequently serve as providers of health care for lower SES
populations, or have the responsibility for ensuring that health
services are available to them through other channels in the
community. However, many of these agencies have not been
actively developing and evaluating strategies to increase the
availability, accessibility, awareness, and utilization of
mammography and Pap smears by women over 40 years of age.
Although not identical, the overlap in risk status for breast and
cervical cancers based on age provides strong justification for
linking efforts in these two areas. This research, therefore, is
intended to stimulate public health and community agencies to
demonstrate approaches to increasing the use of mammography and
cervical cytology among these unscreened women.
III. RESEARCH GOALS AND SCOPE
Objectives
The goal of this project is to develop, implement, and evaluate
programs designed to increase breast and cervical cancer
screening of older, low income, low education, and minority
women.
The primary objectives of this research are to demonstrate how a
consortium of community agencies can:
1) Characterize utilization patterns for breast and cervical
screening in the target population through baseline surveys.
These data will establish frequency of screening, as well as
assess barriers to utilization.
2) Design and pilot test interventions to recruit women in need
of breast and cervical cancer screening regimens that can
o be integrated with other health services used by these women
o affect the behavior of non-health agency clients.
3) Evaluate the effectiveness of specific interventions to reach
the target population for breast and cervical cancer screening.
4) Ensure compliance with follow-up recommendations for women
with anything but completely normal mammograms (i.e.,
indeterminate or suspicious findings) and smears (i.e., further
action recommended).
5) Establish a mechanism to describe prospectively the screening
behavior of the targeted women in view of current NCI
recommendations, i.e., establish whether or not women are coming back at
recommended intervals for screening.
Project Description
This research will stimulate the development and evaluation of
strategies to increase and sustain the utilization of screening
mammograms and Pap smears in the least likely to be screened
women 40 years of age and older and in geographically defined
population areas. This approach will permit extrapolation of
research results to other communities nationwide. Exceptions to
the geographic focus may be proposed, if generalizations can be
made from the applicant's defined population to the larger
community.
Census and/or survey data should permit the characterization of
both the female population of a defined service area and its
sources of health care. Moreover, the applicant's choice of
communities and consortium members should provide opportunities
to test a variety of promotional strategies. Of particular
interest is the effectiveness of approaches that utilize contacts
with women who are already receiving care in public health
clinics, or other public facilities, for problems unrelated to
cancer screening ("inreach"), compared to strategies to
encourage women in the community who are at risk to come in for
screening examinations ("outreach"). Both approaches to the
problem must be proposed and tested.
Investigators must be able to enumerate unscreened women in the
population. They must propose a feasible and technically sound
means for measuring the effect of their proposed inreach and
outreach interventions. A variety of experimental and quasi-
experimental designs may be employed in testing interventions,
including the use of control communities, clinics, or health
centers. An adequate design must be employed to reliably
demonstrate the effectiveness of interventions in reaching the
target population. An assessment of current utilization patterns
must be conducted before any intervention is undertaken.
An evaluation of the effectiveness of the intervention must be
undertaken by the applicant per se or by one or more
subcontractors. During the baseline period, before any
intervention is undertaken, survey or medical audit data should
permit an assessment of current usage patterns for mammography
and cervical cytology within the target population. If self-
report of mammography and Pap smear utilization is to be an
outcome measure of the proposed interventions, investigators must
propose methods of assessing the validity of this measure for the
target population. Investigators also should consider developing
methods that have the potential to improve the accuracy of self-
reported measures.
Applicants must provide a detailed description of how they
propose to monitor the effectiveness of the interventions over
time, including follow-up, in terms of the number of women
scheduled for repeat exams at recommended intervals. It can be
assumed for the purposes of application that NCI funds for the
intervention activity will expire in three years. However, the
evaluation effort should be budgeted for an additional year --
four years altogether. However, investigators should briefly
outline mechanisms of how, through continuation of the project
beyond the four-year period, they will be able to prospectively
study maintenance of screening behavior. NCI will encourage
investigators to study this important aspect of behavior through
a competitive renewal process.
Sample size calculations for the purpose of the evaluation must
take into account the need for data on the behavior and attitudes
of appropriate subgroups within the target population. NCI
expects that the baseline and post-baseline evaluations of
utilization patterns will include assessments of barriers to the
use of mammography and cervical cytology as well as expediting
factors. Thus, the applicant must address the measurement of
process variables that link the interventions to behavioral
change or nonchange among specific groups of women and their
health care providers.
To control for behavioral change that occurs independent of the
intervention strategies, applicants must address the issue of
control communities or subcommmunities. Control groups may be
proposed as an integral part of the experimental design or simply
as a means of evaluating the impact of a particular intervention
strategy.
In developing the interventions, researchers must identify and
consider barriers to the utilization of mammograms and Pap smears
among the target population, as well as mechanisms needed to
overcome them. It is anticipated that interventions will be
designed for the women as well as their health care providers or
the existing health care system.
Investigators will be required to document that they have access
to and can recruit a population of unscreened women 40 years of
age and older who are of low SES or minority status. Priority
will be given to proposals specifically designed to include
evaluation of breast and cervical screening utilization among
women 65 years and over and proposals targeting women residing in
rural areas. Among Hispanic women, proposals addressing Puerto
Rican and Cuban populations also will be given priority.
Additionally, applicants will have to provide or arrange for the
necessary screening and follow-up services. A feasible plan to
integrate interventions into the usual practice of the health
care facility also will be required.
For cases with any but normal screening results, investigators
will be required to provide a specific plan for implementing
procedures that will ensure compliance with appropriate follow-up
recommendations. This must include how and where women will be
referred for necessary treatment and follow-up, as well as
mechanisms to pay for the procedures.
With respect to quality and safety issues, all clinical,
laboratory, and radiologic procedures performed in relation to
the grant-supported interventions must meet state-of-science
levels. Agencies already incorporating physical examination
and/or breast self-examination in their breast health programs
will be expected to continue to do so. Where feasible, these
features must be incorporated into newly developed programs.
The discussion in the application must include a
series of quality assurance criteria and certify that
facilities involved in the project meet the current state and
Federal requirements for mammography and cervical cytology. In
addition, applicants must include an implementation plan for
quality assurance.
This research will be accomplished by official health agencies or
institutions, such as health departments, community health
centers, or public hospitals, in collaboration with other
community agencies or institutions capable of addressing early
detection of breast and cervical cancers in the target
population. The lead agency must demonstrate experience with
disease control and must indicate how coordination of agencies
will be conducted. In many communities, the lead agency is
likely to be the health department or a community health center,
although other public agencies could fill this role. Consortia
will be comprised of a variety of organizations that will vary
according to site. If it is feasible, these agencies should
collaborate with research institutions or research efforts, such
as the Community Clinical Oncology Program (CCOP), cancer
centers, and SEER registries in the population proposed,
especially when addressing professional education as a means to
increase utilization of screening procedures. The lead agency
does not necessarily have to be the direct provider of screening
services and may cooperate/contract with private practices or
hospitals for these services. It is not the intention of this
research to offset the cost of screening procedures. However, in
order for the results of this research to be of benefit to other
communities, applicants must document that they will be able to
provide these procedures in significant numbers at low cost.
Investigators must explain mechanisms to be used for payment of
screening and follow-up procedures, such as self-insurance,
Medicaid or Medicare, and describe approaches that will be
used to pay for women who do not have any coverage.
Investigators must maximize all sources of third-party payment,
including Medicare or Medicaid, private insurance payments, and
self-insurance. Reimbursement must be used to offset appropriate
expenses. Applicants must describe methods by which low-income
and uninsured women will be provided the full range of services.
To ensure a sustained reduction in breast and cervical cancer
mortality, utilization of effective screening technologies must
be sustained within the population. High priority will be given
to research designs that ensure continuation of the intervention
beyond the funded period.
IV. MECHANISM OF SUPPORT
Support of this program will be through a National Institutes of
Health (NIH) grant-in-aid (RO1). Applicants will be responsible for
the planning, direction, and execution of the proposed project.
Allowable direct costs for the intervention will not include
funds to pay for mammograms and Pap smears. However, expenses
incurred in developing and promoting the utilization of these
services, such as baseline and follow-up surveys, design of
materials, and public and professional education are considered
allowable costs. Except as otherwise stated in this
RFA, awards will be administered under PHS grants
policy as stated in the Public Health Service Grants Policy
Statement, DHHS Publication No. (OASH) 90-50,000, revised October
1, 1990.
This RFA is a one-time solicitation. Future
competing renewal applications will compete with all
investigator-initiated applications and be reviewed by the
Division of Research Grants (DRG). However, if the NCI
determines that there is a sufficient continuing program need, a
request for renewal applications will be announced. Only
recipients of awards under this RFA will be eligible to apply.
Approximately $5,400,000 in total costs for four years
($1,200,000 for year one and for year four, $1,500,000 for year
two and for year three) will be committed to specifically fund
applications submitted in response to this RFA. It is
anticipated that three to four awards will be made dependent on
the receipt of a sufficient number of applications of high
scientific merit. The total project period for applications
submitted in response to the present RFA should not exceed four
years. The earliest feasible start date for the initial awards
will be April 1992. Although this program is provided for in the
financial plans of the NCI, the award
of grants pursuant to this RFA is also contingent upon the
availability of funds for this purpose.
V. SPECIAL REQUIREMENTS
It is expected that awardees will
participate in a series of collaborative meetings at NCI and that
some components of the evaluation protocols will be common to all
areas. Although independence and originality are encouraged in
the approaches of the various investigators, they are expected to
share ideas, experiences, and information in attempting to reach
their common goal. Funds must be budgeted to permit travel of
senior staff to Bethesda, Maryland, twice a year over the course
of the grant. Funds awarded for travel to these meetings will be
restricted for this purpose only. Failure to participate in
these meetings may adversely affect NCI evaluation of the
project's progress when the non-competing continuation
application for the following year is reviewed.
SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF
NIH POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN
CLINICAL RESEARCH STUDY POPULATIONS
The following is the NIH and ADAMHA policy regarding the
inclusion of women and minorities in study populations.
Applications that are responsive to this RFA will, by definition,
meet the requirement for inclusion of women. The inclusion of
minorities must be addressed in application submitted responding
to this RFA.
NIH and ADAMHA policy is that applicants for NIH/ADAMHA clinical
research grants and cooperative agreements will be required to
include minorities and women in study populations so that
research findings can be of benefit to all persons at risk of the
disease, disorder or condition under study; special emphasis
should be placed on the need for inclusion of minorities and
women in studies of diseases, disorders and conditions which
disproportionately affect them. This policy is intended to apply
to males and females of all ages. If women or minorities are
excluded or inadequately represented in clinical research,
particularly in proposed population-based studies, a clear
compelling rationale should be provided.
The composition of the proposed study population must be
described in terms of gender and racial/ethnic group. In
addition, gender and racial/ethnic issues should be addressed in
developing a research design and sample size appropriate for the
scientific objectives of the study. This information should be
included in the form PHS 398 in Section 2, A-D of the Research
Plan AND summarized in Section 2, E, Human Subjects.
Applicants/offerors are urged to assess carefully the feasibility
of including the broadest possible representation of minority
groups. However, NIH recognizes that it may not be feasible or
appropriate in all research projects to include representation of
the full array of United States racial/ethnic minority
populations (i.e., Native Americans (including American Indians
or Alaskan Natives), Asian/Pacific Islanders, Blacks, Hispanics).
The rationale for studies on single minority population groups
should be provided.
For the purpose of this policy, clinical research includes human
biomedical and behavioral studies of etiology, epidemiology,
prevention (and preventive strategies), diagnosis, or treatment
of diseases, disorders or conditions, including but not limited to
clinical trials.
The usual NIH policies concerning research on human subjects also
apply. Basic research or clinical studies in which human tissues
cannot be identified or linked to individuals are excluded.
However, every effort should be made to include human tissues
from women and racial/ethnic minorities when it is important to
apply the results of the study broadly, and this should be
addressed by applicants.
For foreign awards, the policy on inclusion of women applies
fully; since the definition of minority differs in other
countries, the applicant must discuss the relevance of research
involving foreign population groups to the United States'
populations, including minorities.
If the required information is not contained within the
application, the application will be returned.
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 to the application.
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.
VI. ELIGIBILITY REQUIREMENTS
Grants-in-aid may be awarded to profit and nonprofit
organizations and institutions, and governments and their
agencies within the United States. However, it should be noted
that this RFA is primarily targeted at a consortium
approach, involving public agencies or institutions, such as
health departments, community and migrant health centers or
public hospitals with established linkages to the target
population (e.g., the health department or community health
center may have experience with providing or contracting for the
health services, a regional agency on aging may have established
networks with elderly women, and a voluntary organization may
have experience with providing public education campaigns). This
approach seeks to address the problem in a coordinated fashion
while taking advantage of the public agency's role as
noncompetitive collaborator, stimulator, convenor, and
facilitator of existing resources to increase mammography and Pap
smear utilization in women least likely to be screened. The lead
agency must demonstrate experience with disease control, but does
not necessarily have to be the direct provider of the screening
services. In many communities, the lead agency is likely to be a
health department, although other public agencies could fill this
role. Among the team of applicants or consortium, one
institution must be proposed as the lead institution to serve as
the applicant and assume responsibility for the conduct of the
award.
VII. REVIEW PROCEDURES AND CRITERIA
REVIEW PROCEDURE
Upon receipt, applications will be examined by the DRG for completeness.
Incomplete applications will be returned to the applicant without
further consideration. Evaluation for responsiveness to the program
requirements and criteria stated in the RFA is an NCI program staff
function. Applications that are judged non-responsive will be returned
to the applicant but may be submitted as investigator-initiated research
grants at the next receipt date. Questions concerning the
responsiveness of proposed research to the RFA should be directed to
program staff (see Section X).
If the number of applications is large compared to
the number of awards to be made, the NCI may conduct a
preliminary scientific peer review to eliminate those
applications that are clearly not competitive. The NCI will
remove from competition those applications judged to be
noncompetitive and notify the applicant and institutional
business official.
Those applications judged to be both competitive and responsive
will be further evaluated according to the review criteria stated
below for scientific and technical merit by an appropriate peer
review group convened by the Division of Extramural Activities,
NCI. The second level of review by the National Cancer Advisory
Board considers the special needs of the Institute and the
priorities of the National Cancer Program.
REVIEW CRITERIA
The applications will be evaluated on the basis of the following
criteria:
1. Extent to which proposed research will meet the project goal of
developing, implementing, and evaluating the effectiveness of
interventions designed to increase breast and cervical cancer
screening of older, low income, low education, or minority women.
2. Scientific merit of the research approach, design, and
methodology, including appropriateness of the proposed plans and
methods to characterize utilization of screening and evaluate the
effectiveness of both inreach and outreach strategies to screen
the target population at recommended intervals over time.
3. Appropriateness of quality assurance procedures for
mammography and cervical cytology.
4. Appropriateness and feasibility of ensuring adequate follow-up
procedures for positive screenees.
5. Documented access and ability to recruit participation of the
target population.
6. Evidence that the applicant will be able to provide screening
procedures in significant numbers at low cost, as well as
evidence that the applicant will maximize all sources of third-
party payment, including Medicare or Medicaid, private insurance
payments, self-insurance, and other grants. Applicants must also
describe methods by which low-income and uninsured women will be
provided the full range of services.
7. Availability of resources to conduct proposed interventions.
8. Research experience and competence of the Principal
Investigator and staff and adequacy of time (effort) that they
will devote to proposed project.
9. Relevant experience within the consortium in conducting
chronic disease control programs.
10. Documented support for the project from participating community
agencies, including previous relationship and relevant experience
in conducting other collaborative efforts with the lead agency,
as well as a clear delineation of each agency's responsibilities
with regard to the project.
11. Feasibility of approach to work, including how tasks are to
be carried out by different community agencies, project
management, and anticipated problems and proposed solutions.
12. Extent to which study design will ensure continuation of the
intervention beyond the funded period.
13. Extent to which relationships have been, or will be, developed
with existing cancer centers, CCOPs, and SEER registries in the
proposed study area.
14. Originality of approach to the research, i.e., does not
duplicate past or current breast and cervical cancer intervention
research funded by the NCI or any other institution.
15. Provision for the protection of human subjects.
The review group will critically examine the submitted budget and
will recommend an appropriate budget and period of support for
each approved application.
VIII. METHOD OF APPLYING
The research grant application form PHS 398 (revised
10/88) must be used in applying for these grants. These forms
are available at most institutional business offices; from the
Office of Grants Inquiries, Division of Research Grants, National
Institutes of Health, Room 449, Westwood Building, 5333 Westbard
Avenue, Bethesda, Maryland 20892 (301) 496-7441; and from the NCI
Program Director named below.
State Health Departments may submit applications on either Form
PHS 398 (revised 10/88) or PHS 5161-1. If the PHS 5161-1 is
used, it is requested that the budget pages from PHS 398 (pages 4
and 5) be used. In addition, separate detailed budgets must be
provided for contracts/coalitions as described in PHS 398
(revised 10/88).
The RFA label available in the 10/88 revision of application form
PHS 398 must be affixed to the bottom of the face page. Failure to
use this label could result in delayed processing of your
application such that it may not reach the review committee in
time for review. In addition, the RFA number and title must
be typed on line 2 of the face page of the application form.
Submit a signed, typewritten original of the application,
including the Checklist, and four (4) signed, exact photocopies,
in one package to the DRG at the address below. The photocopies
must be clear and single sided.
DIVISION OF RESEARCH GRANTS
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD 20892**
At time of submission, send two (2) additional copies of the
application to:
REFERRAL OFFICER
Division of Extramural Activities
National Cancer Institute
Room 848, Westwood Building
5333 Westbard Avenue
Bethesda, MD 20892
Applications must be received by August 2, 1991. If an
application is received after that date, it will be returned.
If the application submitted in response to this RFA is
substantially similar to a research grant application already
submitted to the NIH for review, but has not yet been reviewed,
the applicant will be asked to withdraw either the pending
application or the new one. Simultaneous submission of identical
applications will not be allowed, nor will essentially identical
applications be reviewed by different review committees.
Therefore, an application cannot be submitted in response to this
RFA that is essentially identical to one that has already been
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.
IX. LETTER OF INTENT
Prospective applicants are asked to submit, by June 7, 1991, a
letter of intent that includes a descriptive title of the
proposed research, the name and address of the Principal
Investigator, the names of other key personnel, the participating
institutions, and the number and title of the RFA in response to
which the application is being submitted.
Although a letter of intent is not required, is not binding, and
does not enter into the review of subsequent applications, it is
requested in order to provide an indication of the number and
scope of applications to be reviewed.
The letter of intent must be sent to:
Helen I. Meissner, Sc.M., C.H.E.S.
Program Director
Public Health Applications Research Branch
National Cancer Institute
EPN, Room 239G
Bethesda, MD 20892
Telephone: (301) 496-0273
X. INQUIRIES
Written and telephone inquiries concerning the objectives and
scope of this RFA or inquiries about whether or not specific
proposed research would be responsive are encouraged and should
be directed to the program director at the above address. The
program director welcomes the opportunity to clarify any issues
or questions from potential applicants. Grants management
inquiries should be directed to:
Marian F. Focke
Grants Management Specialist
Grants Administration Branch
EPS, Room 242
Grants Administration Branch
National Cancer Institute
9000 Rockville Pike
Bethesda, MD 20892
Telephone: (301) 496-7800, ext. 46
This program is described in the Catalog of Federal Domestic
Assistance No. 93.399. Awards are under authorization of the
Public Health Services Act, Title IV, Part A and administered
under PHS grant policies and Federal Regulations 42 CFR 52 and 45
CFR Part 74. This program is not subject to the
intergovernmental review requirements of Executive Order 12372 or
Health Systems Agency review.
$$XID RFA MH9114 MH-91-14 P1O1 *****************************************
MENTAL HEALTH CLINICAL TRAINING GRANTS:
INDIVIDUAL FACULTY SCHOLAR AWARDS
National Institute of Mental Health
REQUEST FOR APPLICATIONS
P.T. 44; K.W. 0720005, 0715129, 0414000, 0785185, 0730050
RFA: MH-91-14
Catalog of Federal Domestic Assistance 93.244
Under the authority of Section 303, Public Health Act,
U.S.C. 242a and regulations at 42 CFR Part 64, the
National Institute of Mental Health will accept
applications in response to this request under the single
receipt date of June 12, 1991.
Darrel A. Regier, M.D., M.P.H.
Director
Division of Clinical Research
Alan I. Leshner, Ph.D.
Acting Director
National Institute of Mental Health
PURPOSE
There is a marked disparity between the need for
treatment of persons with major mental disorders and the
availability of appropriately trained mental health
professionals to assess, provide, and supervise the
treatment. For this reason, the National Institute of
Mental Health (NIMH) supports the Individual Faculty
Scholar Awards program to develop a cadre of academically
based faculty scholars who will guide the training of
professionals in the core mental health disciplines
(psychiatry, social work, psychology, psychiatric
nursing, and marriage and family therapy) and who will
play major leadership roles in the continued development
of their professions.
TRAINING OBJECTIVES
It is anticipated that these faculty scholar awards will
help ensure the successful preparation, development, and
advancement of the academic careers of the awardees of
this program. By funding a new group of faculty
scholars, well-grounded and experienced in modern mental
health diagnostic, treatment, and rehabilitation
techniques, research methodologies and findings, and the
delivery of care within community-based systems, the
program will serve to strengthen the scope and quality
of the preparation of future direct providers of mental
health services. The training and experience of the
faculty scholars should be well integrated and include
clinical, academic, and research activities.
This program is designed for an individual faculty
nominee who holds, or has been assured of, a full-time,
non-tenured faculty position, at least at the assistant
professor level, that he or she will continue, or assume,
after the period of the award. The training may take
place at the scholar's home institution and/or other
institutions that possess the necessary expertise in the
designated priority area. Candidates whose home
institutions do not offer highly developed programs in
the designated priority areas should consider educational
plans that incorporate substantial periods of training
at other institutions where the required advanced
preparation can be obtained. Each faculty scholar will
be expected to improve and participate in the appropriate
clinical training program of the institution with which
he or she is affiliated upon completion of the award and
to serve as an expert resource person in the priority
area at that institution and elsewhere.
The program prepared for the nominee must contain a mix
of clinical education, research training, and other
experiences appropriate to meet the career development
goals established for him or her. Individual Faculty
Scholar Awards are intended to support the preparation
of those seeking careers combining research and clinical
practice exclusively.
Information regarding NIMH programs of support for
advanced training for careers exclusively in research or
clinical training may be obtained from other NIMH and
ADAMHA announcements and/or the NIMH staff listed below.
Concentration in one of the four specified priority areas
must be the predominant feature of a faculty scholar
nominee's development program.
PRIORITY AREAS
Schizophrenic Disorders
Schizophrenia is one of the most severe and disabling of
the chronic major mental disorders. The clinical course
commonly includes repeated psychotic episodes with
chronic impairment of social and occupational
functioning. Despite ongoing research efforts, the
etiology (or etiologies) of schizophrenia remains largely
unknown. The treatments available for schizophrenia are
important in relieving some of the suffering for many of
the people affected. Antipsychotic medications have
proven to be crucial in decreasing the severity of
positive symptoms of schizophrenia such as
hallucinations, delusions, and incoherent speech, but
they do not consistently relieve all the symptoms of the
disorder. Many patients continue to suffer from the
deficit or negative symptoms of schizophrenia, e.g., lack
of goal-directed behavior, and verbal paucity; and from
disordered personal relationships, e.g., inability to
establish and maintain social relationships, social
isolation, and withdrawal. However, aspects of
schizophrenic disorganization have been successfully
treated with integrated psychoeducation, behavioral, and
family approaches if combined with maintenance
medications. Overall, it is estimated that up to 25
percent of those afflicted with schizophrenia will never
recover their ability to function independently. An
additional 50 percent or more will experience some form
of disability in an intermittent course of the illness
throughout their lives.
NIMH has designated schizophrenia as one of its foremost
research priorities. In so doing, NIMH recognized the
enormous public health challenge posed by schizophrenia,
acknowledged the immense and chronic burden borne by
people with this disorder and by their families, and made
a commitment to advance rapidly the state of knowledge
and clinical training relative to this major mental
illness. Faculty who are expert clinicians and
researchers are needed to train additional mental health
professionals to provide services for those
affected by this illness.
Mood, Anxiety, and Personality Disorders
Mood, anxiety, and personality disorders rank among the
most serious and pervasive public health problems in the
United States. Depressive disorders affect one in twenty
American adults in any one-month period, and the figures
for anxiety are even higher. Most persons with
depression also have an anxiety disorder. Depressive
disorders are the most frequent antecedent of suicide,
and the suicide rate increases among people with several
psychiatric disorders. Personality disorders are thought
to be pervasive and debilitating, but less is known about
this class of mental illness. The personal and economic
cost to the patients with these disorders, to their
families, and to the Nation is estimated to be greater
than such ailments as arthritis, ulcers, diabetes, and
hypertension. Although effective psychotherapeutic and
pharmacological treatments exist, research shows that
most depressed and anxious persons are undiagnosed, often
untreated, and frequently treated inappropriately.
Improved service provider training is needed and
possible. Faculty with clinical and research expertise
in these disorders are needed to train service providers
and researchers.
Severe Mental Disorders of Children and Adolescents
Because the mental disorders of childhood and adolescence
are among the most devastating and least understood
disorders of humankind, the NIMH has embarked on a
"National Plan for Research on Child and Adolescent
Mental Disorders," a major program designed to expand
greatly its research activities on child and adolescent
mental disorders. At least 7.5 million children and
adolescents in the U.S. under 18 years old suffer some
sort of mental disorder or developmental impairment
(about 12 percent of our children). Because of a combination
of factors, including a lack of awareness on the part of
some investigators of the critical needs and
opportunities in this area, as well as a relative lack
of qualified clinicians and investigators, the progress
in mental health research and treatment for child and
adolescent disorders has not kept pace with related
research in adults.
Major efforts are needed to increase understanding of the
causes and determinants of child and adolescent
psychopathology, determine the effectiveness of biologic,
psychotherapeutic, and social treatments, develop more
effective service delivery systems, and enlarge our cadre
of qualified, committed researchers and clinicians.
>From a clinical perspective, the child and adolescent
disorders are often devastating in their compromising of
the child's personal, cognitive, and social development
as well as the impact on family and society. The direct
costs to society are enormous because of the financial
outlays required to support the intensive care needed by
those children who suffer from the most devastating
illnesses such as pervasive developmental disorders,
autism, and childhood psychoses. The disruptive behavior
disorders are a particular burden on society as they are
frequently associated with tragic consequences such as
delinquency, substance abuse, family disruptions, lack
of educational attainment, and the corresponding failure
to achieve the social and occupational accomplishments
that could otherwise be expected. There is increasing
awareness of the morbidity associated with the mood
disorders/anxiety disorders and their protracted course,
co-morbidity, and resistance to therapeutic intervention.
Pediatric AIDS and homelessness of children and
adolescents are increasing mental health problems. The
critical shortage of mental health professionals trained
to diagnose, treat, and rehabilitate children and
adolescents with severe mental disorders requires focused
clinical and research training programs.
Mental Disorders of the Aging
Risk factors for mental disorders multiply through old age
along such dimensions as physical limitation, social
disruption, and psychological loss. Many surveys have
shown increases in the prevalence of symptoms of
depression, in Alzheimer's disease and other dementing
disorders, and in behavioral problems such as
sleeplessness, agitation, and confusion that are
disruptive to established patterns of family and
community life. Furthermore, the duration of
schizophrenia and other chronic mental disorders of
adulthood can be lifelong; and except for the potential
risk of suicide, life expectancy is generally thought to
be unaffected by the presence of a mental disorder,
assuming there is adequate care of the mentally ill older
person. The death rate for suicide, however, increases
by age, with those over age 55 accounting for 32 percent
of all completed suicides. An estimated 80 percent of
those age 65 and older in nursing homes have some degree
of mental impairment, with Alzheimer's disease being the
most common condition. Faculty leadership to establish
research and training programs in geriatric mental health
is extremely limited; growth in this area represents a
significant priority in NIMH.
In addition to these four priority areas, scholars are
encouraged to focus on specific subgroups that continue
to be underserved. The problem of co-morbidity (i.e.,
the mentally disordered who are also substance abusers)
is recognized as a challenge since 32 percent of persons with
mood disorders and 47 percent of persons with schizophrenia also
have an addictive disorder. Other subgroups include
minority and rural populations.
Another area of interest is the development of strong
ties between academic mental health training institutions
and public mental health facilities. These systems offer
a rich opportunity for enhanced services in the public
sector. Thus, NIMH strongly encourages faculty scholar
applications that demonstrate collaborative linkages between
academic centers and those public mental health service
settings where the seriously mentally ill receive
treatment.
ELIGIBILITY
On behalf of a qualified nominee, applications may be
submitted by an academic department or professional
school in a U.S. college, university, or nonprofit mental
health training institution.
Qualifications of the applicant department by discipline
are:
o a department of psychiatry in a college or
university school of medicine, a division of child
psychiatry, or a free-standing mental health institution
with an approved university-affiliated psychiatric
residency or an approved university-affiliated child
psychiatry residency
o a university-based department or school of
professional psychology or university-affiliated
internship program with appropriate accreditation for
training in clinical, counseling, or school psychology
o an accredited college or university school of
nursing that offers training through a graduate program
in psychiatric nursing
o an accredited school of social work offering
graduate education
o a college or university-based accredited graduate
program in marriage and family therapy
Nominees must meet the following minimal qualifications:
o psychiatry - completion of general psychiatry
residency training or, in child psychiatry, completion
of child and adolescent fellowship training, and the
appropriate Board certification or Board eligibility
o psychology - completion of a Ph.D. or a Psy.D.
degree from an APA-accredited graduate psychology
program, and a year of clinical internship
o nursing - completion of a doctoral degree, preceded
by a master's degree in psychiatric mental health
nursing, or a doctoral degree in psychiatric mental
health nursing
o social work - completion of a doctoral degree in
social work or a doctoral degree in a related discipline
preceded by a master's degree in social work
o marriage and family therapy - completion of a
doctoral degree in marriage and family therapy or a
related field
Nominees must be U.S. citizens or have been lawfully
admitted to the United States for permanent residence.
Nominees must have a full-time academic appointment or
be assured of such an appointment upon completion of this
award. Women and minority candidates are particularly
encouraged to apply.
Faculty Scholar nominees are typically expected to be at
a point in their careers no more than five years after
completion of medical residency or doctoral education,
because the emphasis here is on new faculty scholars.
Under exceptional circumstances, more senior candidates
may apply, in which case the nominees and sponsoring
institutions must present a very strong rationale for
excepting nominees from the earlier stated requirement.
While other justifications are conceivable, a principal
one would be a nominee's intention, supported by firm
evidence, to make a major career change to focus on an
NIMH priority area. Tenured associate and full professors
are not eligible to apply under this RFA.
SPECIAL APPLICATION CHARACTERISTICS
The following outline must be used to prepare a
description of the training program in the narrative
portion of the application:
Nominee
Instead of the Biographical Sketch, the nominee should
submit a comprehensive curriculum vitae to precede the
narrative proposal. In addition, the nominee should
indicate his or her strengths and weaknesses in the
designated priority area and provide a statement of goals
for clinical and research training for the period of
award and nominee's subsequent career. A clear, strong
commitment to a career in the identified priority area
should be demonstrated in the application. A record of
research and other scholarly pursuits appropriate to the
nominee's professional level, especially in the priority
area, will greatly strengthen an application, as will
demonstrated potential for enhanced future scholarly
contributions and leadership in the profession. The
nominee's background, beyond the foregoing, should also
show evidence of superior clinical and teaching
capabilities and research interests.
Program Plan
The nominee must submit a proposed program of
development, the goal of which will be a successful
career as clinician/teacher/researcher and faculty
scholar in an academic setting. The nominee must
describe areas of additional experience that will be
required to meet the stated educational goals. He or she
may include such activities as participation in formal
academic courses, consultation with experts in the
priority area, visits to other academic centers with
recognized educational and research expertise in the
priority area, and other training efforts appropriate to
the nominee's developmental goals. A letter from
institutions other than the sponsoring institution
agreeing to participate in the program must be
included. In addition, the nominee must outline as
precisely as possible the clinical, academic, and
research experiences that will comprise the training
program. A research project is required of each nominee,
who must submit a research design in sufficient detail for a review
committee to judge its scientific merit. Attention must
be given by nominees to considerations of inclusion of
women and minorities, informed consent, confidentiality,
subject rights and welfare, and subject risks. (Grants
under this RFA are subject to the regulations of 45 CFR
46, Protection of Human Subjects.) The nominee must
also outline an area of concentration within the priority
area, e.g., schizophrenia, that he or she proposes
to develop as a special area of expertise with regard to
clinical, academic, and research activities. Such a
focus could be concentrated on a specific disorder (e.g.,
diagnosis and treatment of manic depressive disorders);
a modality focus (psychopharmacology, psychotherapy); a
conceptual focus (health and behavior, prevention); or
a community health care system focus (community-based
services, including psychosocial rehabilitation, mental
health administration, consultation-liaison, and crisis
care). The nominee must furnish his or her perceptions
of how the benefits of the proposed training plan
will be expressed in the nominee's later career as a
faculty scholar.
The proposed training plan, to which a faculty scholar
is required to devote full-time, i.e., 40 hours per week,
must represent a clear departure from the nominee's usual
work activities at the home institution.
Supervision/Sponsorship
The overall supervision and sponsorship of the nominee
will be the responsibility (direct or delegated) of the
dean, department chairperson, or other qualified faculty
member of the sponsoring institution. A description of
the role of the sponsor (supervisor) in relation to the
nominee's clinical, academic, and research activities and
goals during the period of the award must be included.
If supervision is to be delegated to someone other than
the sponsor, the relationship of the sponsor to the
supervisor must be described, including how the sponsor
proposes to oversee the faculty scholar's development.
Comments must also be supplied with regard to the
sponsor's perception of the future promise and current
strengths and weaknesses of the nominee relative to a
successful academic career, along with plans for
addressing the perceived areas of weakness.
Supervision provided by a sponsoring institution must
be contributed by the latter and not charged to the
grant. Supervisory costs to be incurred by cooperating
institutions participating in the training plan may be
requested as part of the grant budget.
Applicant Institution
The application must provide general information about
the applicant institution, including its current
educational, clinical service, and research programs and
emphasizing those in the nominee's designated priority
area. The availability of established faculty as
potential academic role models for the training program
at the applicant and other institutions must be
described. Additional resources, such as established
clinical, academic, and/or research centers or unique
clinical service programs, directed to the priority areas
must be included. Assurances must be provided that
ample time will be made available for the faculty
candidate to develop as an independent clinical educator
and scholar; the applicant institution must assure that
the nominee will be released from activities not directly
related to his or her development as a faculty scholar.
Documentation must be included regarding continuation
of the appointment of the nominee beyond the period of
the grant award, and it must be clear what professional
opportunities will be made available for the nominee to
fulfill his or her faculty scholar career objectives.
It must be shown that the nominee will not be performing
basic faculty tasks and roles and that his or her faculty
scholar training program does not repeat the
nominee's regular work assignment.
EVALUATION
Each application must include an evaluation component.
The evaluation component must include, at a minimum,
a statement regarding the process variables that will be
used to determine the progress of the faculty scholar
through a proposed program and the outcome variables to
assess the impact of the training program on the scholar
and the institution. An evaluation plan of high quality
is an essential element of the faculty scholar proposals.
TERMS AND CONDITIONS OF SUPPORT
Grants will be awarded directly to academic institutions
on behalf of specific nominees and are not transferable
from one institution or individual to another. The
applicant is the institution, although the nominee must
participate in preparing the application.
Grants must be administered in accordance with the PHS
Grants Policy Statement DHHS Publication No. (OASH) 90-
50,000 (Rev) October 1, 1990.
Period of Support
The period of support for an individual receiving the
NIMH Faculty Scholar Award is one to three years. Plans for
each year of the award, including detailed budgets,
must be fully presented in this application. However,
support for the second and third year of an award is
contingent upon the availability of funds and also upon
the receipt of an annual continuation application that
provides a summary of progress to date, plans for the
next year, and the sponsor's appraisal of the awardee's
progress. Continuation applications are due four months
before the end of the current budget period; application
forms will be sent routinely to the individual awardee.
Individual Faculty Scholar Awards may not be renewed
beyond the initial one- to three-year period of an award.
Salary Support
Salary support is based on a full-time, 12-month
appointment, consistent with the established salary
structure at the institution. The institution must
provide information specifying how the proposed salary
was derived.
Federal contribution to salary support is geared to the
institution's base as follows:
Base Institute Salary NIMH Contribution
Up to $45,000 100 percent of the
Institutional Salary
$45,001 - $60,000 $45,000
$60,001 and above 75 percent of the Base
Institutional Salary
up to a Maximum of
$75,000
Institutional supplementation of the Federal contribution
must be from non-Federal funds and may not require extra
duties or responsibilities that would interfere with the
purpose of the award, i.e., full-time commitment to
career development activities.
Fringe Benefits
Fringe benefits are paid out of grant funds in the same
proportion as the salary contribution. In addition,
practices related to partial payments of fringe benefits
shall be consistent with institution policies and not be
altered for these awards.
Professional Development Support
Costs for professional development support may be
provided when fully justified as essential for career
enhancement. Funds for this purpose, up to $25,000 per
year, will be provided. These funds may be used to pay
for secretarial or technical support, tuition, fees,
travel, per diem, and supervision for study at centers
other than the grantee institution. Relocation costs
from a place of residence to the applicant institution
are not allowable.
Indirect Costs
Indirect costs will be reimbursed at 8 percent of total
allowable direct costs or actual indirect costs,
whichever is less.
Payback
Any graduate or postgraduate trainee, including a Faculty
Scholar awardee, in psychology, psychiatry, nursing,
social work, or marriage and family therapy who receives
support in an established training program designed to
be for a period of 180 days or more under an NIMH
clinical training grant must pay back through a period
of obligated service equal to the length of support.
The period of support need not be continuous. Any
support received for any period of time under previous
NIMH clinical training grants, if the stipend was awarded
on or after September 1, 1981, will count toward this
total. The conditions of the obligated service
requirement are set forth in the 42 Code of Federal
Regulations Part 64a.
No trainee or Faculty Scholar awardee may receive a
stipend or other allowance from the grant until he or she
has signed and submitted both a payback agreement form
and a Statement of Appointment Form (PHS 2271), and a
certification of Non-delinquency on Federal Debt.
Further information on payback requirements and fiscal and
administrative matters is available
from:
Mr. Stephen Hudak
Chief, Grants Management Section
Grants Management Branch
National Institute of Mental Health
5600 Fishers Lane, Room 7C-26
Rockville, MD 20857
Telephone: (301) 443-4456
APPLICATION PROCEDURES
Application kits (PHS 398, rev. 10/88) are available from
the Education and Training Branch, Division of Clinical
Research, NIMH (see the final section of this
announcement).
The name of the nominee should be placed in line 3a of
the first page of the application. The type of grant,
e.g., Faculty Scholar (Psychiatry, Psychology, Nursing,
Social Work, or Marriage and Family Therapy) Award in
priority area (e.g., Schizophrenic Disorders) should be
identified on line 2 of the first page of the
application.
Prospective applicants are encouraged to consult NIMH
staff on eligibility and assistance in developing
applications. The address and phone numbers for staff
consultation are listed in the final section of this
document.
Applications must be complete and contain all information
needed for initial and National Advisory Mental Health
Council review. No addenda will be accepted later,
unless specifically requested by the Executive Secretary
of the review committee. No site visits will be made.
The narrative section of the application may not exceed
20 single-spaced typewritten pages. Applications
exceeding this limitation will be returned. Appendices
containing such information as detailed resumes and
letters of support may be attached, but the appendices
may not be used to expand the narrative section;
extensive appendices are strongly discouraged. The
applicant should include a project abstract that should
not exceed one-half of a single-spaced typewritten page.
The original and five (5) copies of the application must
be submitted to:
Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD 20892**
Complete line 2 of the application by typing in the RFA number and
title. The RFA label (found in the 10/88 revision of application form
PHS 398) must be affixed to the bottom of the face page of the original
copy of the application. Failure to use this label could result in
delayed processing of your application such that it will not reach the
review committee in time for review.
Because of the very short time available for initial and
Council review, it is requested that an additional copy
of the application marked NIMH CLINICAL TRAINING should
be sent directly to:
NIMH Division of Extramural Activities
Parklawn Building, Room 9C-23
5600 Fishers Lane
Rockville, MD 20857
Attention: Edna Hardy-Hill
REVIEW OF APPLICATIONS
A dual review system is used to ensure expert, objective
review of the quality of applications. Initial peer
review for educational and technical merit is by Initial
Review Groups comprised of non-Federal mental
health authorities. Final review is by the National
Advisory Mental Health Council whose review may be based
on policy as well as educational and technical merit.
Each grant application is evaluated on its own merits.
The following general review criteria are used:
o background and potential of the nominee as a
clinical educator, researcher, and national leader in the
designated priority area
o clarity, depth, and appropriateness of the goals of
the proposed training program relative to the purposes
of this announcement
o appropriateness and feasibility of the content,
methods, and organization of the training plan
o appropriate assurances that the nominee will have
the time available to ensure development as a clinical
educator, investigator, and emerging leader in the
priority area selected
o appropriateness and strength of the evaluation plan
o viability of the research design
o commitment of the sponsor, supervisor, and
institution to the development of the nominee
o competence of the faculty sponsor, supervisors, and
consultants in the proposed areas of training
o one or more subgroups addressed within the priority
area
o commitment of the nominee, sponsor, supervisor, and
institution to public-academic linkages
o suitability of the clinical, educational, and
research facilities and environments, including
community-based programs, for carrying out the proposed
activities
o adequacy of the budget projections and other
resources for carrying out the project activities
o if the faculty scholar is to receive training at
another institution, assurance of the cooperation of the
other institution and competence of the faculty in the
proposed area of training
o potential of the nominee for a successful academic
career along with the capacity to provide faculty
leadership upon completion of award
RECEIPT AND REVIEW SCHEDULE
National Advisory
Receipt of Initial Mental Health Earliest
Application Review Council Review Start Date
June 12, 1991 July September September 1991
Applications received after the deadline specified above
will be returned to the applicant.
AWARD CRITERIA
It is anticipated that in fiscal year 1991 up to six new
Individual Faculty Scholar Awards (TO1) will be made. The
maximum total cost per award is estimated to be $117,000
per year. A disciplinary school or department in a
single institution may submit multiple faculty scholar
applications as long as each focuses on a different
priority area. In considering multiple requests, however,
applicants should be aware that NIMH
funding decisions are based, at least in part, on
disciplinary and geographic distribution considerations.
Awards will be limited to one per professional school or
academic department for each priority area.
The responsibility for award decisions on applications
recommended for approval by the National Advisory Mental
Health Council lies solely with authorized
NIMH program staff. The following basic criteria will
be used in making award decisions:
o quality of the overall application as determined
during the review process
o quality of public-academic linkages provision
o where appropriate, balance among disciplines,
geographic locations, and priority areas
o availability of funds
STAFF CONSULTATION
Application kits and staff consultation on all aspects
of clinical training in the core mental health
disciplines in relation to schizophrenic disorders, mood
disorders, and severe mental disorders of children and
adolescents, with the exception of specific research
issues bearing upon these populations, are
available from
General Information Lemuel B. Clark, M.D., Chief
Education and Training Branch
(301) 443-5850
Social Work and Marriage Neilson F. Smith, D.S.W., Chief
and Family Therapy Social Work Education Program
(301) 443-5850
Psychiatry Melvyn R. Haas, M.D., Chief
Psychiatry Education Program
(301) 443-2120
Psychology Paul Wohlford, Ph.D., Chief
Psychology Education Program
(301) 443-5850
Psychiatry Nursing Carol Bush, Ph.D., R.N., Chief
Psychiatric Nursing
Education Program
(301) 443-5850
The mailing address for all of the above is:
Education and Training Branch
Division of Clinical Research
National Institute of Mental Health
5600 Fishers Lane, Room 7C02
Rockville, MD 20857
For those wishing staff consultation on research issues,
such as NIMH-supported research grants in schizophrenic
disorders, mood disorders, and severe mental disorders
of children and adolescents, or information regarding
training support specifically for research careers in
these areas, the following may be contacted:
Schizophrenia Alice Lowery
Schizophrenia Research Branch
Room 10C-06
(301) 443-3524
Mood, Anxiety, and Barry Wolfe, Ph.D.
Personality Disorders Mood, Anxiety, and Personality
Disorders Research Branch
Room 10C-24
(301) 443-3568
Children and Adolescents Eleanor Dibble, D.S.W.
Child and Adolescent Disorders
Research Branch
Room 10-104
(301) 443-5944
Staff consultation on both general clinical training
matters and specific research issues in relation to
mental disorders of the aging is available from:
Enid Light, Ph.D.
Mental Disorders of the Aging
Research Branch
Room 11C-03
(301) 443-1185
The mailing address for the above four staff is:
Division of Clinical Research, NIMH
5600 Fishers Lane
Rockville, MD 20857
This announcement is not subject to the intergovernmental
review requirements of Executive Order 12372 as
implemented through DHHS regulations at 45 CFR Part 100.