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U.S. Department of Health and Human Services: 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 (R34)

Deadline: June 16, 2017

The Pilot Studies to Test the Initiation of a Mental Health Family Navigator Model program proposes to develop and pilot 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 pilot 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 purpose of the initiative is to support pilot work in preparation for future larger scale projects that will develop and pilot test factors that facilitate the effectiveness and implementation of a family navigator model designed to promote early access, engagement, and coordination of mental health treatment and services for children and adolescents who are experiencing early symptoms of mental health problems. Applications focused on developmental work that would enhance the probability of success in a subsequent larger scale project are encouraged. Developmental work might include: refining details of the navigator model; examining the feasibility of novel approaches and technologies; enhancing the protocol for the comparison group and randomization procedures (if appropriate); examining the feasibility of recruiting and retaining participants into the study condition(s); and developing supportive materials such as training curricula for navigators. Therefore, collection of preliminary data regarding feasibility, acceptability and target engagement 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 the Pilot Studies program is to support pilot work on navigator models that might support the design and implementation of a subsequent larger scale project to: (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; and (4) work with youth and families over an extended period of time to ensure that therapeutic gains 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 develop and pilot test personalized 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. For more information about measurement of target engagement, see: Pilot Effectiveness Trials for Treatment, Preventive and Services Interventions.

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 applicant should propose the developmental work to be performed that would enhance the probability of success in a full-scale trial. Designs need not be reduced scope versions of the anticipated larger study, but should instead attempt to develop and refine the research strategies to be utilized in the subsequent large-scale study. The Pilot Study competition provides the opportunity for “high risk, high reward studies” that may be of high priority to the National Institute of Mental Health. Given the intended pilot nature of this FOA, conducting a fully powered test of outcomes is not required and obtaining an estimate of an effect size may not be possible.

Note that a companion R01 – Initiation of a Mental Health Family Navigator Model to Promote Early Access, Engagement and Coordination of Needed Mental Health Services for Children and Adolescents (https://grants.nih.gov/grants/guide/pa-files/PAR-17-265.html) is also posted, which supports empirical testing of navigator model strategies in full-scale trials in this topic area.

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 from $225,00-$500,000 over the three year project period.

Eligibility: Higher education institutions; nonprofits with or without 501(c)(3) IRS Status (other than Institutions of Higher Education); 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 16, 2017.

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