This funding opportunity announcement (FOA) is part of the Helping to End Addiction Long-term (HEAL) Prevention Initiative, a portfolio of research focused on the prevention of opioid misuse and opioid use disorder funded under NIH’s HEAL Initiative. The National Institute on Drug Abuse (NIDA) seeks to address the urgency and magnitude of the opioid crisis by developing and testing new or adapted interventions to prevent opioid misuse among patients served by community health centers (CHCs), and/or developing and testing implementation strategies for screening and referral to preventive interventions for misuse of opioids and other substances among patients served by CHCs. Research will be supported through exploratory/developmental phase awards (R61/R33) that may not exceed 5 years, allocating up to two years of funding for development of the project and up to four years for a full test of the research aims.
CHCs are well positioned to serve as a formal point of entry into evidence-based opioid misuse prevention services because they reach a large population impacted by the opioid crisis and are located across the nation in areas with limited health care resources. CHC patients are more likely to experience social and health conditions (e.g., mental disorder diagnosis) that are risk factors for substance misuse and negatively impact their overall health, suggesting prevention may be beneficial for this population. In recent years, CHCs have increased their capacity to provide mental health and substance use treatment services, with 93% of health centers providing mental health treatment and 67% providing substance use treatment services. Despite this capacity, screening for substance use risk (rather than treatment need) and referral to prevention services is uncommon.
This initiative seeks research that will ultimately enhance the capacity of CHCs to screen patients for opioid and substance use risk and refer them to or provide opioid and other substance use prevention services. The two areas of research interest are studies to: (1) develop and test new or adapted interventions to prevent opioid misuse among patients served by community health centers (CHCs), and/or (2) develop and test implementation strategies for screening and referral to preventive interventions for misuse of opioids and other substances among patients served by CHCs.
Research projects should be developed in consultation and partnership with CHCs. Strong partnerships are critical for ensuring that proposed research activities are responsive to the needs of the community and maximize the likelihood that interventions developed and tested can be sustained. Applicants are strongly encouraged to address issues of patient/stakeholder engagement; scalability beyond the study sites/settings; sustainability beyond the funding period; and whether the proposed implementation strategy/process reduces inequities in service availability, access, utilization, cost, quality, or outcomes.
Applications should focus on primary prevention, developing and testing strategies that CHCs can take to scale in order to prevent the initiation of opioid/substance use or misuse and/or the progression to opioid or other substance use disorder. Applications may include universal prevention interventions that are intended to be delivered to the entire CHC patient population (or all CHC patients in a particular age range) or selective or indicated prevention interventions that focus on a particular sample with demonstrated risk factors for substance use. Investigators should provide a rationale for their level of intervention and a description of how they are defining their target population within the CHC setting.
Examples of priority areas for the two categories of research supported are identified below.
Intervention research applications should be theory based, developing and testing prevention intervention strategies that can be easily integrated into the CHC setting, addressing the unique needs of the community served. Intervention studies may test new interventions or include efficacy and/or effectiveness studies of established interventions that are adapted for CHCs. Intervention studies should test critical components of the prevention strategies for CHC patients to understand the intervention components that impact outcomes. Additionally, the measurement of implementation outcomes and inclusion of economic analyses is encouraged where feasible.
Topics of interest include but are not limited to:
- Studies to test models of integrating into CHCs existing, effective or promising, substance use prevention strategies that use established techniques (e.g., motivational interviewing, skill building). The integration should involve the inclusion of natural providers for the delivery of the intervention.
- Research on interventions designed to prevent substance misuse by directly addressing known risk factors for substance misuse, such as:
- Interpersonal violence, community violence, and/or maltreatment
- Mental disorders (e.g., depression, anxiety, post-traumatic stress disorder, serious mental illness, suicide ideation and behaviors)
- Attention deficit and hyperactivity disorder (ADHD)
- Acute or chronic pain
- Social determinants of health that impact substance use, including experiencing racism, homelessness, and/or economic and food insecurity
- Studies of evidence-based substance use prevention interventions that are adapted to incorporate technology, such as mobile health and telehealth delivery or models of consultation, or program delivery.
- Testing of strategies to overcome stigma related to substance use and its consequences, such as discrimination based on risk factors for substance misuse and substance using behavior. This might include incorporation of content and activities to reduce self-stigma on the part of participant populations, stigma in delivery of basic services for people experiencing risk for substance use (e.g., discriminatory channels for service; interactions withadministrative/non-service provider staff).
Implementation research applications should inform strategies to increase uptake, effectiveness, and sustainability of screening and referral to prevention among patients served by CHCs. Implementation research topics of interest include, but are not limited to:
- Research to test implementation factors that support evidence-based prevention interventions in CHCs that have been tested in other settings, including:
- Research to address system fragmentation that impacts referral to prevention services (e.g., gaps for persons transitioning from pediatric or adolescent medicine practices to adult medicine practices; access for persons in specialty settings or social services systems who need linkage to health/behavioral health and prevention services)
- Studies of organizational and provider factors that contribute to implementation and sustainability of prevention interventions
- Testing of screening and referral strategies to improve enrollment and completion of prevention services delivered by the CHC
- Testing of implementation strategies to support CHC-based screening and referral to preventive services provided by other entities (e.g., local health department, community behavioral health center)
- Research of instruments or strategies to identify individuals at risk for substance use, including research to test
- risk-profiles from electronic health records to facilitate case identification, active referral and linkage to prevention interventions, and or consultation models
- innovative tools for identifying individuals at risk for substance misuse and engaging them in prevention services, including in prenatal care, dental care, specialist pain management, and other specialties
- Application of human factors research to test strategies to improve screening effectiveness, reduce provider burden, and improve implementation feasibility and sustainability of prediction algorithms, electronic health record tools, clinical decision support tools, or other technology
- Research to understand whether, to what extent, and under what conditions policies and/or novel funding strategies (e.g., Medicaid waivers, reimbursement for telehealth or consultation) improve uptake and sustainability of screening and referral to prevention interventions.
While not required, projects that capitalize on funding streams and technical assistance resources available to CHCs that promote sustainability are highly encouraged.
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Filed Under: Funding Opportunities