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U.S. Department of Health and Human Services: Initiation of a Mental Health Family Navigator Model to Promote Early Access, Engagement and Coordination of Needed Mental Health Services for Children and Adolescents (R01)

Deadline: June 5, 2017

The Mental Health Family Navigator Model initiative proposes to develop and test the effectiveness and implementation of a family navigator model, defined as a health care professional or paraprofessional whose role is to deploy a set of strategies designed to rapidly engage youth and families in needed treatment and services, and to work closely with the family and other involved treatment and service providers to optimize care and monitor the trajectory of mental health symptoms and outcomes over time. Applicants are encouraged to develop and test the navigator model’s ability to promote early access, engagement, and coordination of mental health treatment and services for children and adolescents as soon as early symptoms of mental health problems are detected. The initiative aims to test navigator models that:

  1. Rapidly engage youth and families in needed treatment and services
  2. Work closely with the family members and other involved treatment and service providers to optimize care
  3. Utilize care coordination strategies and novel technologies to help identify, engage, and match youth to mental health treatment and services
  4. Work with youth and families over an extended period of time to ensure that therapeutic gains (e.g., reduction in symptoms; improved family, peer, and school functioning; and enhanced behavioral outcomes) are maintained

Navigator models will develop and test a set of strategies deployed by the navigator designed to promote early access, engagement, and coordination of mental health treatment and services. Models to be tested may include but are not limited to the following:

  • Mental health clinicians who provide evidence-based treatment directly to the youth and family and who also monitor the care coordination activities
  • Health care professionals with mental health expertise as the navigator (e.g., nurses, social workers, counselors) who are not responsible for providing the primary mental health treatment, yet are monitoring coordinated care and communication with the other involved treatment and service providers
  • Paraprofessionals trained in mental health education and in the application of proven engagement approaches (e.g., motivational interviewing) who monitor coordinated care and communication with the other involved treatment and service providers

Navigator model settings may be located in mental health clinics, public health agencies (e.g., child welfare and juvenile justice), schools, primary care, or other settings. Navigators should work closely and be integrated with other treatment and service providers to facilitate and monitor routine communication to the treatment providers, youth, and family members. It is anticipated that referrals to a navigator may occur through a range of referral sources (e.g., caregiver, teacher, healthcare provider), depending on the navigator model, and can occur before a formal mental health assessment or screening takes place. Navigator functions should include one or more of the following attributes: (a) overcoming systemic barriers to care (e.g., coordination of screening, diagnosis, and ongoing care from a range of treatment providers); (b) delivering mental health information, education, and psychosocial support to caregivers and youth; (c) utilizing engagement strategies to increase treatment adherence; and (d) problem-solving resource challenges (e.g., healthcare coverage, literacy, transportation, childcare).

The initiative is intended to support applications that test personalized navigation approaches that deliver the appropriate amount, intensity, and frequency of needed treatment and services as symptoms wax and wane over time. Proposed research efforts are encouraged to utilize novel technology (e.g., dashboards, outcome tracking, and therapeutic milestone measurement) to assist navigators in facilitating and optimizing personalized mental health care for each child and adolescent. When possible, applications should incorporate health information technology (HIT) and electronic health records (EHR) to coordinate care across delivery settings.

Applications must identify the variables (intervention targets) hypothesized to lead to the intended outcomes of the proposed navigator model, measure whether those variables are engaged during the navigator intervention delivery, and design the study to test whether target engagement mediates the outcome of the navigator intervention. Active elements of the model might occur at the navigator, treatment team (involved treatment and service providers), supervisor, interagency, and/or community level, and appropriate studies should clearly describe and include such factors in the conceptualization of the intervention and in the design of the study. For more information about measurement of target engagement, see: Clinical Trials to Test the Effectiveness of Treatment, Preventive, and Services Interventions (R01).

Applicants are strongly encouraged to propose a navigator model that identifies factors that facilitate sustainability (e.g., shared public and private funding, utilization of existing personnel or realignment of responsibilities to include the navigator role, effective economic strategies), scalability, and generalizability to other settings. Funded studies are anticipated to substantially contribute to the development of the following: a body of generalizable knowledge regarding effective mental health navigation models; identification of a set of research-informed strategies to improve care coordination; the use of novel technology to match youth with appropriate treatment and services; and generation of new knowledge regarding the impact of navigator models on reducing or eliminating mental health disparities among underserved populations.

The initiative is intended to support studies that are statistically powered to provide a definitive test of the navigator model’s effectiveness in comparison to usual care practices or alternative intervention/services approaches. Support for pilot studies to promote the development of and evaluate the initial feasibility, acceptability, and preliminary effectiveness of navigator models is provided via a companion R34 (Pilot Studies to Test the Initiation of a Mental Health Family Navigator Model to Promote Early Access, Engagement and Coordination of Needed Mental Health Services for Children and Adolescents, which supports pilot studies in preparation for the larger-scale studies that are the focus of this R01 competition.

Potential applicants are strongly encouraged to contact Scientific/Research contacts as far in advance as possible to discuss the match between potential research applications and current priorities.

Amount: A total of $2,160,000 is available to award up to six grants that can range up to $500,000 per budget year. The maximum project period is five years.

Eligibility: Higher education institutions; nonprofits with or without 501(c)(3) IRS status; for-profit organizations; governments (state, county, city or township, special district, Indian/Native American tribal, or U.S. territories or possessions); independent school districts; Public Housing Authorities/Indian Housing Authorities; Native American tribal organizations; faith-based or community-based organizations; and regional organizations.

Note: An additional cycle for this competition will be held with a deadline of October 5, 2017.

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