NIH opportunities (2) – Multi-Site Studies for System-Level Implementation of Substance Use Prevention and Treatment Services (R01, R34)

October 7, 2016 by School of Medicine Webmaster

The description below was taken from the R01 version of this FOA.  The R34 version seeks applications for pilot and feasibilities in this area.

Implementation science is a growing field. An early area of emphasis for addiction health services researchers was to move beyond training of individual clinicians or service providers as a default implementation strategy, and develop interventions that would achieve broader, sustainable implementation at the organizational level. Some research has begun to look at intra-organizational implementation strategies to further accelerate the implementation of evidence-based practices (or de-implementation of unsupported or harmful practices). However, to date, a major remaining challenge is how to facilitate – in a systematic, scalable, sustainable way – the delivery of evidence-based prevention and treatment services at a system level.

This FOA seeks research projects that will move beyond a focus on how individual clinics or organizations implement a given change, and beyond implementation of interventions that target only a single evidence-based intervention (EBI). The purpose of this FOA is to identify efficacious and effective strategies or techniques for facilitating systems-level change within or across networks of organizations to promote broad use of evidence-based practices for the prevention and/or treatment of substance use disorders or HIV. This FOA seeks applications that can address implementation on a larger, system-level scale that is more analogous to the way policy changes lead to system-level changes in prevention and treatment service delivery. Achieving system-level improvements requires implementation strategies that are sufficiently flexible to address the variation in settings and context across a given system, but that are also generalizable across settings. The multi-site studies supported by this FOA should contribute both practical and conceptual advances.  In practical terms, these studies should provide strategies that can be used to effectively deploy guidelines, practices, and policies across entire systems of care.  In conceptual terms, these studies should also leverage the multi-site platform to test implementation science hypotheses, explore novel methodological approaches, or test new measures or models that can inform future implementation research in this or other health domains.

Applicants may address a range of addiction health services including, but not limited to, tobacco-cessation services, substance use prevention services, medication assisted treatments, HIV/AIDS services, polysubstance use treatment, treatment of co-occurring disorders, etc.  Likewise, a wide variety of settings could be targeted, including traditional behavioral health service settings, primary care settings, health care settings where substance use or use disorders are relevant (e.g., cancer treatment), and other settings where individuals are routinely referred for substance use prevention or treatment services (e.g., child welfare, juvenile justice, criminal justice). Meaningful system-level outcomes should be targeted and measured (e.g., rates of screening for substance use or related health issues, successful transitions between service systems). All applications should focus on system-level or large-scale implementation, however, as defined below.

For the purpose of this FOA, “system” can be defined in the following ways:  (1) A formally-defined system of organizations sharing a common overarching management or funding structure (e.g., county health boards within a state, school health clinics, or Federally Qualified Health Centers, HMOs, etc.);  (2) A group of organizations that operate independently but share a common mission (e.g., addiction treatment programs or HIV clinics); or  (3) A set of independent organizations in a defined geographic area that provide services to the same individuals and that often must collaborate to meet the needs of these  individuals through a system of care. A “system of care” may be viewed as occurring within the health care or behavioral health system or may include organizations that do not provide behavioral health services, but that routinely refer clients for substance use prevention or treatment. Examples of a system of care include a community coalition involving multiple agencies in a community to address substance use prevention, relationships between child welfare and community-based service providers to address substance-use related needs for parents and children, collaborative care models for complex patients that involve multiple organizations (e.g., smoking cessation treatment for cancer patients).

It is not required that participating organizations have pre-existing working relationships at the time of application; developing these relationships may be a targeted outcome. However, it is expected that a multi-site system-level approach will necessitate a design that extends beyond any single organizational entity, and that the study design will attend to the implications of meaningful differences in context, funding, internal policies, geography, and local regulations, etc. that influence implementation outcomes.

This FOA requires applications to propose multi-site studies involving two or more performance sites that are part of the targeted system or system of care (e.g., addiction clinics, FQHCs, juvenile justice systems). This FOA is intended to encourage conceptual and practical insights from efforts to examine implementation at a large scale. Beyond the multi-site requirement, this FOA does not require a predetermined minimum number of sites. However, projects should aim to test implementation approaches that can reasonably be expected to generalize beyond the sites involved, and applicants should describe the potential for system-level scale-up beyond the project. Proposed studies are expected to attend to the multi-level contextual factors that would be informative in understanding the generalizability of the proposed study. Applicants are expected to select the most rigorous study design appropriate for their research question and proposed settings. While randomized controlled trials are welcomed and encouraged, there are instances in which RCTs are neither optimal nor feasible for implementation research studies.  Selection of an alternative study design should be well-justified on the basis of appropriateness, relevance, rigor, and reproducibility.

This FOA is intended to support rigorous studies that will provide insights into large-scale implementation via multi-site studies. Specific examples of the types of research supported under this mechanism include, but are not limited to:

  • Rigorous designs evaluating innovative approaches to implementing large-scale change, including technology–based approaches
  • RCTs and/or other rigorous designs evaluating sustainable and scalable large-scale approaches to implementing health information technologies and clinical decision support (CDS) tools to enhance coordination and continuity of substance use care, including linkages across data systems that allow assessment of meaningful relevant outcomes (e.g., engagement in care, cause of death, etc.)
  • RCTs and/or other rigorous designs comparing multiple change strategies or attempting to determine “active ingredients”  or “minimal intervention needed to produce change (MINC)” in existing change interventions, strategies, frameworks, or models
  • Longitudinal designs addressing the sustainability of the targeted improvements in evidence-based practice, de-implementation of existing non-evidenced based programs or practices, or phased implementation of multiple EBPs
  • Tests of new or evidence-based operating systems or implementation models for large-scale delivery of evidence-based drug abuse treatment or prevention interventions in novel systems and settings (e.g., primary care, juvenile justice, child welfare, criminal justice)
  • Studies that take advantage of policy changes and/or new  practice guidelines for addressing behavioral health and provide opportunities for innovative approaches to large-scale implementation of drug abuse prevention and treatment services (e.g., the Affordable Care Act Community Benefit requirement, Bright Futures guidelines for well-child visits, coordinated care through Accountable Care Organizations)

All applications that propose analyses of costs or financing should be consistent with current NIH priorities for health economics research. Seehttps://grants.nih.gov/grants/guide/notice-files/NOT-OD-16-025.html for more details.

This FOA is a Collaborative Research on Addiction at NIH (CRAN) Initiative. Addiction-related research has traditionally been supported separately by the National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), and, in specific areas, by National Cancer Institute (NCI). In 2012, the CRAN initiative was conceived as a trans-NIH partnership involving NIDA, NIAAA, and NCI to facilitate a functional integration of support for the research related to substance use, abuse, and addiction.  The main goal for CRAN is to create strong collaborative framework that enables NIDA, NIAAA, and NCI to pool resources and expertise in order to create synergies in addiction science, address new research opportunities, and meet public health needs.  CRAN currently supports FOAs that promote collaborative research on crosscutting topics relevant to alcohol, tobacco, and other drug (ATOD) use.  Applications that address multiple substances of abuse are encouraged through this FOA. More details on the CRAN and CRAN priorities can be found at: http://addictionresearch.nih.gov/cran-strategic-plan-2016-2021

Deadlines for both FOAs:  December 15, 2016; July 18, 2017; November 13, 2017; July 17, 2018; November 13, 2018; July 17, 2019; November 13, 2019; July 17, 2020; November 13, 2020

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Filed Under: Funding Opportunities