Full Text PA-95-068 RESEARCH ON VIOLENCE AND TRAUMATIC STRESS NIH GUIDE, Volume 24, Number 20, June 2, 1995 PA NUMBER: PA-95-068 P.T. 34 Keywords: Stress Violent Behavior Risk Factors/Analysis Etiology Disease Prevention+ National Institute of Mental Health PURPOSE Through this Program Announcement, which addresses the three major programs of the Violence and Traumatic Stress Research Branch, the Division of Epidemiology and Services Research, the National Institute of Mental Health (NIMH) seeks to encourage investigator-initiated research to enhance the scientific understanding of and effective interventions for perpetrators and victims of interpersonal violence and trauma. This program announcement both reaffirms the NIMH 40-year program of research concerning violence and trauma and reflects recent recommendations of scientific advisors to NIMH in support of research on violence, particularly in the areas of youth and family violence. The 1994 Panel on NIH Research on Anti-social, Aggressive, and Violence-Related Behaviors and Their Consequences strongly recommended increased support for violence research and for more involvement of communities and minorities in this research. The three major areas of concern are: (1) perpetrators of youth violence, serious adult crime, sexual offenses (adult and juvenile), and intimate partners assaults; (2) victims of child abuse, rape, sexual assault, family violence, and other kinds of interpersonal violence and crime; and (3) victims of major traumatic events, such as combat and war, natural and technological disaster, refugee trauma and relocation, and torture. The populations of concern include children, youth, adults, and the elderly, males and females, and all racial and ethnic groups. Because the consequences of violence and traumatic stress typically involve several factors, applications are encouraged from a wide range of disciplines. Multidisciplinary applications are especially encouraged so that a more comprehensive understanding of the role of specific factors can be determined. Research is encouraged on the prevalence, incidence, characteristics, course, mental health consequences, etiological and risk factors, and correlates of violence and trauma. Well-developed intervention research is especially encouraged to help reduce the extent and consequences of interpersonal violence and trauma. HEALTHY PEOPLE 2000 The Public Health Service (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 PA, Research on Violence and Traumatic Stress, is related to the priority areas of violence, traumatic stress, abusive behavior, and mental disorders. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No.017-001-00474-0 or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238). ELIGIBILITY REQUIREMENTS Applications may be submitted by foreign and domestic, for- profit and non-profit organizations, public and private, such as universities, colleges, hospitals, laboratories, units of State and local governments, and eligible agencies of the Federal government. Foreign institutions are not eligible for small research grants (R03s), First Independent Research Support and Transition (FIRST) Awards (R29s), and research program and Center (P) awards. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as Principal Investigators. MECHANISM OF SUPPORT Applications focused specifically on the study of mental health issues related to violence and trauma are encouraged, including research project grants (R01), small grants (R03), program project grants (P01) and center grants (P20 or P30), Interactive Research Project Grants (IRPG), FIRST (R29) awards, exploratory/developmental grants for Psychosocial Treatment (R21), and Rapid Assessment Post-Impact of Disaster (RAPID) grants (R03). If an IRPG is proposed, it must consist of a minimum of two independent applications (see PA-94-086, NIH Guide for Grants and Contracts, Vol. 23, NO. 28, July 19, 1994). An IRPG may consist of a combination of R01s and R29s or R01s only, but may not consist solely of R29 applications. An IRPG may also contain shared interactive resources (Cores), which must serve at least two of the research projects to facilitate achievement of the Group's common research goals. Other NIMH mechanisms are also often available to potential applicants; for more specific and detailed information about different mechanism requirements, i.e., eligibility, application format, review criteria, and review dates, applicants are strongly encouraged to consult with NIMH staff persons (listed under INQUIRIES) and obtain specialized announcements. Copies of all announcements may be obtained from the Division of Extramural Activities, National Institute of Mental Health, 5600 Fishers Lane, Room 9C-04, Rockville, MD 20857, telephone (301) 443-4673, or electronically from the NIH Guide to Grants and Contracts (gopher.nih.gov). Because the nature and scope of the research proposed in response to this program announcement will vary, it is anticipated that the size of the awards will also vary. The small grant (R03) is especially suited for initial research by junior investigators and pilot research prior to large-scale studies. The R21 mechanism may be used for methods development (pilot) studies of psychosocial treatment, where the research methodology (e.g., instruments, protocols) requires further development prior to systematic assessment of intervention strategies. The IRPG mechanism may be used where such collaboration will clearly facilitate the design and evaluation of high-quality, multi-faceted intervention packages (e.g., to facilitate recruitment of sufficient numbers of hard-to-reach participants to test hypotheses) and/or study of these interventions with diverse populations. Research Center Grants (P20 or P30) provide support for multidisciplinary, long-term research programs with a particular major objective, with the intention that the Center serve as a regional resource for special research purposes. Applicants may request support for up to five years for research project grants (R01). Small grants (R03) are limited to two years and may not be renewed. RAPID grants are typically limited to one year only. Exploratory/Developmental Grants for Psychosocial Treatment offer support for up to three years. Annual awards will be made, subject to continued availability of funds and progress achieved. FUNDS AVAILABLE For 1995, it is estimated that $3,500,000 will be available for approximately 20 awards. Some mechanisms have restrictions regarding the maximum period of support. Grant funds may not be used to operate a treatment, rehabilitation, or other service program. Prospective applicants are encouraged to contact NIMH staff (listed under INQUIRIES) before preparing an application to ascertain the dollar limitations associated with each award mechanism. Applicants are strongly encouraged to contact program staff before submitting any application requesting $500,000 or more in total costs for any year of support requested; however, this dollar trigger excludes indirect costs of any subcontracts that are reported as a direct cost on the application budget page summary. Opportunities for cross-collaborative studies and funding may also be available (e.g., through the National Institute of Justice); applicants are encouraged to contact program staff about such opportunities as well. RESEARCH OBJECTIVES The effects of violence and trauma constitute a major public health problem for all Americans, with consequences of severe psychological and social dysfunction as well as injury and death. Moreover, certain segments of the population appear to be disproportionately at greater risk than others for violence perpetration and/or victimization, namely, children, youths, families, and women. Little is known about effective approaches to preventing the occurrence and re-occurrence of violence or to ameliorate its deleterious effects on victims. This need and the deficits in scientific knowledge it represents provide the impetus for this announcement. The past two decades have witnessed an increasing recognition of the magnitude of interpersonal violence and its mental health consequences, in youth violence as well as in the underreported areas of domestic violence, rape, and sexual assault. With increasing documentation of its scope and dimensions, interpersonal violence has in recent years come to be widely viewed as a serious public health problem. Studies have shown that many youth who commit serious violent acts do so in the context of an array of anti-social behaviors, sometimes of many years duration. Self-report surveys have indicated that millions of children are physically abused each year, and hundreds of thousands are victims of sexual abuse. An estimated 22 million women are victims of rape or sexual assault in their lifetimes; and other forms of intimate partner violence, such as the assaults on women by their husbands or other male partners, are widespread. Studies have shown that homicide is the leading cause of death in Black males, aged 15-24, and that approximately one-quarter of all homicides are committed against family members. Exposure to other types of traumatic events also constitutes a major public health problem. Although precise estimates of the incidence of exposure to traumatic events are not known, a recent study of four southeastern cities found that 69 percent of the adults sampled had been exposed to at least one major traumatic event at some time in their lives, and fully 21 percent had experienced one or more such events in the past year. Lifetime rates of post-traumatic stress disorder (PTSD) have been found to vary for different types of traumatic events (e.g., 57 percent following rape, 30 percent following combat), and a recent study of a general population (Detroit HMO) found a lifetime prevalence of 9.2 percent. Individuals with PTSD are at increased risk for other psychiatric disorders as well. Although these selective findings highlight the public health significance of interpersonal violence, many aspects of trauma and violence have not been adequately studied. Through this announcement, studies are encouraged that will address critical gaps in knowledge concerning the accurate measurement of the perpetration of violence in various domains; the role of intrapersonal, biological, family, peer, community, and cultural factors, and the interaction of these factors in the initiation, escalation, and cessation of violent behavior; the impact of these factors on the response to violence and traumatic events; and the development and evaluation of research-based prevention, treatment, and management approaches that will provide more effective, humane, replicable, and cost-effective intervention approaches. The topics listed below are examples of studies that cut across all of the areas of violence perpetration, victimization, and exposure to trauma that are the focus of this program announcement. The list is not exhaustive; it is expected that additional important topics will be identified by investigators who respond to this program announcement. Projects may focus on: o Studies of the incidence and prevalence of violent behavior and of victimization experiences of all types o Studies of the etiological, risk, protective, and ameliorative factors for violence perpetration and victimization of all types o Studies of the interactions among psychosocial and biological risk factors that contribute to the occurrence of violent behavior, and influence the course (escalation, persistence, and cessation) of violent behavior (e.g., biological factors related to neurochemistry, neuroendocrinology, and neuroimmunology, genetic vulnerabilities, neural deficits and differences, exposure to neural toxins, poor nutrition; fetal exposure to alcohol or drugs); factors related to individual and social contexts, (e.g., personality traits, parental child-rearing practices, poverty, racial discrimination, peer influences); and individual life experiences, (e.g., exposure to violence and other traumatic events as a victim and/or witness, educational deficits, unemployment) o Studies of factors that ameliorate symptom severity or dysfunction resulting from exposure to violence or traumatic events (e.g., individual strength and resilience factors, response of significant others, social support, community and service sector response) o Studies of the relationships between developmental processes and aggressive/violent behavior and of the impact of different types of victimization on developmental processes in different age groups o Studies of the type and incidence of mental disorders resulting from exposure to violence and traumatic events, including studies of psychological or biological changes; also studies of the diagnosis, assessment, and course of PTSD and other trauma-related disorders and the appropriate threshold for clinical significance o Studies of psychosocial and psychobiological risk factors associated with differential risk of negative effects in different victim subgroups, as well as studies of psychosocial and psychobiological parameters and processes that examine the mechanisms by which interventions work, or help identify which subgroups of at risk populations can benefit from particular interventions o Studies investigating the effects of violence within the community (e.g., workplace violence, gang violence, hate crimes, cults, and terrorism) o Development of nomenclature and classification schemes (e.g., DSM categorical diagnoses, dimensional assessments) for describing types of violent behavior, that can be useful in predicting, preventing, treating, and managing different types of violent behavior and response to violence and other traumatic events o Development of assessment and screening instruments to guide treatment planning and management plans for perpetrators and victims of violence and traumatic events o Intervention studies testing the efficacy and refinement of individual, family, and/or community-level models and methods of intervention for violent behaviors (e.g., pharmacological and other medical procedures, psychosocial methods, family support and crisis intervention programs, home visitation programs, psychiatric and social service placements, mentoring programs, and community-based efforts) o Studies of the effectiveness of interventions for violence perpetration or victimization in various social and community settings, and the influence of social, institution, and community settings on the availability of interventions, program participation, and outcomes; use of different conceptual and intervention models with various social and cultural groups o Development of innovative, effective, and ethical methods of obtaining and maintaining the participation in research of perpetrators and victims of violence and traumatic events In addition to these cross-cutting objectives, other research priorities specific to each at-risk population will be highlighted in succeeding sections of this announcement. Perpetrators of Interpersonal Violence Within the area of perpetrator research, the scope of interpersonal violence encompassed by this announcement includes child aggression and anti-social behavior, youth delinquency and violence, adult criminals with records of serious and chronic offending, spouse batterers, sex offenders, including rapists and child molesters, and hate crimes. Studies have shown that child and youth conduct problems account for one-third to one-half of all child and adolescent clinical referrals. Serious youth violence, especially assaults and homicides, has shown dramatic increases in the last decade, with the result that youth violence is a critical problem in many communities. Among African Americans, homicide is the leading cause of death for adolescent and young adult males. For both adolescents and adults, a small number of perpetrators perform a substantial proportion of the serious, often violent offenses, and a significant proportion of all offenses. Effective approaches for these serious and chronic offenders thus has enormous potential for reducing violence. Intimacy and family membership are no bar to the perpetration of interpersonal violence. Self-report surveys have indicated that approximately 1,500,000 children are physically abused each year, 700,000 are victims of sexual abuse, and hundreds of thousands of women are severely beaten by their husbands or a significant male intimate. A recent national survey estimated that 22 percent or 21.7 million American women have been victims of rape or attempted rape during their lifetime. Two-thirds were assaulted before the age of 18. While data on hate crimes have only recently begun to be collected systematically, early reports indicate that this is a growing and serious problem. Through better scientific understanding of the factors associated with those who commit interpersonal violence, NIMH hopes to reduce the prevalence of such acts. By enhancing the scientific knowledge base, more effective interventions, treatment, and management models can be developed and applied. Through rigorous scientific evaluations of policies, interventions, treatments, and management programs, NIMH hopes to further contribute to a reduction of interpersonal violence. Because research has shown that the perpetration of interpersonal violence usually involves several factors, including individual, family, and community variables, investigators from a variety of disciplines are encouraged to contribute to a scientifically sound and comprehensive approach to the development of effective interventions for interpersonal violence. These disciplines include, but are not limited to, psychology, psychiatry, biology, anthropology, social work, and psychiatric nursing. Variables of major interest include (but are not limited to) individual variables (e.g., behavioral, biological, and personality factors) and social and relationship variables (involving elements within the family and community, such as employment, poverty, and racism/sexism issues). While investigations of the role of possible individual risk and protective variables are encouraged, a multidisciplinary approach is often indicated. Similarly for intervention studies, while rigorous evaluations of the effects of single variable interventions are encouraged, the role of several variables in most interpersonal violence points to the need for interventions that address several risk factors through a multi-component intervention. Listed below are examples of research topic areas within the perpetration research area. This list is illustrative, not exhaustive; it is expected that additional important research topics will be identified by researchers who respond to this program announcement. o Studies of risk and protective factors for various aggressive, anti-social and violent behaviors, including intrapersonal, biological, family, community, and other variables, their course, incidence, and interactions. Biological variables of interest include central nervous system functioning; autonomic nervous system functioning; the role of hormones; the impact of toxins such as lead, fetal exposure to alcohol or drugs, and trace minerals; physical trauma (e.g., head injuries) and diseases. Social factors include parenting practices, exposure to violence (as a victim and as a witness), educational deficits, peer influences, the social network of the community, and economic and employment variables o Studies of risk factors for acute episodes of violent behavior, e.g., hormone variation, thought disorder, depression, pervasive anger, or intoxication, that have potential for targeted preventive interventions and long-term management programs o Studies of existing diagnostic schemes and development of new reliable and valid schemes and methodologies for identifying subgroups, with distinct implications for etiology, assessment, diagnosis, prognosis, and intervention; extension of research laboratory procedures for reliable and valid clinical use o Development of scientifically sound measures of individual, family, community, and other factors, including the various forms of aggressive, anti-social, and violent behaviors; development of measures of relevant ethnic and cultural variables; modification of existing measures for ethnic and cultural sensitivity and validity o Development of a brief and psychometrically robust measure of psychopathy; extension of measurement of psychopathy to youth; more precise determination of basic behavioral, biological, emotional, and social aspects of psychopathy; and prevalence and course studies that assess the role of other variables as they affect functioning and outcomes o Development and testing of innovative, effective, humane, and cost-effective interventions, including pharmacological, psychosocial, psychiatric, and social service-related approaches for chronic offenders; community interventions to reduce violence, e.g., changes in the physical environment to facilitate monitoring of public areas, increased recreational programs, job programs for the unemployed. (Because violence is multiply determined and resistant to change, successful treatments are likely to be multi-phased and intensive. Accordingly, once the effectiveness of such an intervention is demonstrated, research is needed to determine the critical key components for cost-effective dissemination.) o Development and pilot testing of specific treatments (preferably manual-based), including the development or modification of interventions for appropriate use with different cultural and ethnic groups o Studies of preventive interventions to counteract or ameliorate the contribution of violence in the media (television, movies, print, video-game) to the development of violent behavior and related attitudes, including desensitization to the adverse effects of violence o Studies of approaches for the effective dissemination and utilization of assessment and intervention programs in clinical, social service, community, and other settings. Victims of Interpersonal Violence Physical and sexual violence on children and adults can arise from the direct experiencing or witnessing of such violence or, indirectly, through the impact of violence on people significant in the individual's life, e.g., loss of parent, child, or intimate partner resulting from violence. Much of such violence occurs in the home; other violence occurs among friends, acquaintances, or from strangers in the community. Studies of the incidence and prevalence of physical and sexual violence in the lives of children and adults have documented the severity of the problem. In 1992, State agencies reported approximately 211,000 confirmed cases of child physical abuse and 128,000 cases of child sexual abuse. At least 1,200 children died as a result of child maltreatment. The Second National Survey of Family Violence estimated that, in 1985, at least four percent of couples engaged in acts of physical aggression towards each other severe enough to cause serious physical injury. Surveys have shown that from 20 to 30 percent of urban hospital emergency room visits by women are the result of injuries received in domestic violence. Spousal homicides comprised approximately 10 percent of the total homicides in the United States in the past decade. It has been estimated that at least one in four women may experience a sexual assault. For children, an estimate is that about one in five females and one in ten males may experience sexual molestation. Recent studies of exposure to community violence indicate relatively high percentages of direct and indirect exposure to assaults, especially among children and adolescents in high-crime urban areas, with significant impact on children's psychiatric symptomatology. Moreover, these studies also indicate that the children and adolescents who are victims of or witness violence in their communities, also experience high rates of violence in their homes. Approximately 10 percent of children will experience episodes of bullying at their schools. One study estimated that approximately 10 percent of sexual assaults that occurred at home were witnessed by children. As the scope of America's violence problem has reached epidemic proportions, its mental health impact on victims is equally severe. Studies have indicated that children who are physically abused in childhood display deficits in cognitive performance, peer social relationships, and managing aggression and hostility as compared to nonabused children. Studies of the short-term consequences of sexual abuse in clinically referred samples indicate a large number of psychological symptoms, including depression, anxiety, and sexual acting out, occurring acutely and then decreasing gradually over a year period. Recent research has reported high rates of PTSD in children who have experienced severe violence, e.g., up to 50 percent of children exposed to a playground sniper attack, and from 10 percent to 50 percent in sexually abused children. As many as 80 percent of rape victims experience post-traumatic stress symptoms after the assault, and one-third suffer chronic PTSD in the year following the assault. Moreover, the consequences of childhood violence may be such that psychological disturbance might not be prominent at the age of occurrence, but may affect functioning at later stages of development, especially in adolescence when sexual and aggressive issues become prominent, creating long-term adjustment problems for individuals. Clinic studies indicate that adults who have experienced childhood abuse are over-represented in samples with serious mental health symptomatology, such as substance abuse and addiction, depression, suicide, and sexual dysfunction, and with such psychiatric diagnoses as dissociative disorders, multiple personality disorder, borderline personality disorder, somatic disorders, and antisocial personality disorder. Moreover, other non-clinical but dysfunctional groups, such as violent criminals and prostitutes, have high percentages of sexually or physically abused individuals. Community surveys have indicated that women who report sexual abuse in childhood have more psychiatric symptoms, greater severity of symptomatology, and higher rates of utilization of mental health services than do nonabused women. Other studies indicate that sexually abused women represent a relatively high percentage -- as much as 25 percent -- of women seeking outpatient treatment and up to one-half of women psychiatric inpatients, although sexual abuse usually is not the presenting complaint for the latter. In addition to physical trauma resulting from acts of physical abuse, battered women suffer mental health consequences from abusive experiences, including higher levels of depression, drug and alcohol abuse, suicide attempts, and low self-esteem. Many of the mental health consequences of spousal violence result from chronic intimidation and fear, which are often as significant as the actual acts of physical aggression. Witnessing spousal violence contributes to the cycle of violence within families and outside the home. Children in violent families may learn aggression as a means of solving interpersonal problems and as a response to stress and frustration. Both the batterer and the battered spouse can become role models for the child's later adult relationships. Studies of battered women indicate that more than half of battered women were also abused as children. In addition, there is an increased likelihood of child abuse in homes where there has already been spouse abuse. Significant research progress has been made in studying the incidence and prevalence, risk factors, characteristics and course, and consequences of various forms of violent victimization. However, there are significant gaps in knowledge of each of these areas. In many areas of violent victimization only a few well-designed studies exist, making generalizability of results tenuous. Accordingly, through this announcement, NIMH seeks to encourage investigator- initiated research on the epidemiology of violence victimization; characteristics and course of response to victimization; etiological, risk, protective, and ameliorative factors for severe reactions to traumatic violence; mental health and other consequences of exposure to different types of violent victimization; and interventions to prevent exposure to violence and to reverse, ameliorate, or compensate for the short-term and long-term effects of exposure to violence among victims. Studies may focus on the individual experiences of victims of violence; the dynamics of the relationship between perpetrator and victim; the relationship between victims and others in the family or larger social system; or the larger social contexts in which violence occurs and its impact on victims. Listed below are examples of research projects that could advance scientific knowledge on the effects of victimization. The list is not exhaustive, and it is expected that additional important research topics may be identified by those who respond to the announcement. Studies in these areas can include, but are not limited to: o Studies of the interactions among psychosocial and biological risk factors that contribute to the individual's reaction to violence victimization and that influence the short-term and long-term mental health effects of violence exposure o Studies of specific traumatized populations (e.g., victims of child sexual and physical abuse, witnesses to violence, culturally/ethnically diverse samples, male victims, and victims of hate crimes) to determine similarities and differences within and across groups in terms of their rates of exposure to different types of violence, their response to exposure to violence, and to examine cumulative effects of exposure to multiple incidents, chronic, or multiple types of violence o Studies of the impact of exposure to violence on individual psychological, biological, and psychosocial development and progress during infancy, childhood, adolescence, or adulthood, and on the development and persistence of psychiatric symptoms, distress, and dysfunctional behaviors o Development of more adequate instruments or procedures to assess psychological, biological, and psychosocial consequences of exposure to physical and sexual violence, including co-morbidity of types of symptoms o Development of identification and assessment approaches for individuals likely to experience acute trauma reactions versus chronic disorders (e.g., PTSD, depression, anxiety, substance abuse) resulting from exposure to violence o Development and testing of intervention models at the individual, family, group, and community levels, to reduce exposure to violence and to treat the short-term and chronic effects of exposure to violence o Development of measurement instruments and procedures to assess more adequately the consequences of violent victimization, characteristics of victims correlated with their response to victimization, and response of victims to interventions Victims of Traumatic Events Studies of traumatic stress in general and PTSD in particular have assumed a heightened importance in recent years, attributable to the frequency of psychiatric sequelae resulting from exposure to traumatic events. Events associated with the growing numbers of natural and technological disasters in the United States and the rising national and international rates of trauma associated with war underscore the importance of the problem. NIMH expects to support research designed to promote an understanding of victims' psychological responses to traumatic events, as well as to encourage the development of interventions to assist victims with mental health problems resulting from this exposure. Traumatic events whose effects are the focus of this announcement include mass violence (e.g., war, terrorism, forced relocation), natural disaster (e.g., flood, earthquake, hurricanes), human-made hazards (e.g., toxic spill, dam break, explosion), transportation accidents (e.g., air crash, train crash, automobile collision), and other individual and collective traumatic events. Studies focusing on the measurement and diagnosis of PTSD are also a focus of this announcement. Research supported in this program includes studies of the immediate and long-term psychopathological and stress reactions in victims, families, service workers, and community members; individual (behavioral, biological, personality) and environmental risk factors associated with the development and perpetuation of mental and physical disorders; informal support networks and coping mechanisms as mediators of traumatic stress; and design, implementation, and effectiveness of formal intervention programs to prevent and treat mental health problems. Listed below are examples of research projects that could advance scientific knowledge on the effects of exposure to traumatic events. The list is not exhaustive, and it is expected that additional important research topics may be identified by those who respond to the announcement. Some applications may address more than one of these topics in the same study. o Studies of the type and incidence of mental disorders resulting from exposure to traumatic events; also studies of the diagnosis, assessment, and course of PTSD and other trauma-related disorders, and the appropriate threshold for clinical significance o Studies of changes in life functioning and other early behavioral problems following exposure to traumatic events which may or may not lead to a mental disorder in victims o Studies of psychosocial and psychobiological risk factors associated with differential risk of negative effects in different victim subgroups o Studies of environmental risk factors associated with collective emergencies, such as community and agency response, origin, duration, severity and type of emergency event, threat or potential for re-occurrence o Studies of both short-term crisis intervention and long- term mental health treatment for male and female victims of all ages and racial and ethnic groups o Studies evaluating mental health treatment modes designed to avoid burnout or other psychological disturbance among human service personnel working under conditions of extreme stress o Studies of social support systems and coping mechanisms as mediators of psychological response to traumatic events o Studies of community programs for reducing or ameliorating emotional trauma and long-term consequences of traumatic events o Research on methodologies and/or techniques required to advance research in the understanding of the effects of exposure to traumatic events Research Plan Proposed studies should be based on a strong conceptual framework, drawing on existing literature and relevant theory, for both the selection of the research components and the specific research hypotheses. The design should include control or comparison groups as needed, and the data should be collected, analyzed, and interpreted in such a manner that scientifically valid inferences about the research results can be drawn. In addition, it is suggested that the following considerations be addressed in the preparation of an application: o Applicants are encouraged to propose the most rigorous research design possible as appropriate to the proposed study. For example, in instances where the study question lends itself to a controlled design, a controlled design should be used. o The selection of each component of the study (including its timing, duration, and strength) should reflect existing research findings, but may also include new components which focus on variables identified in basic studies as important to the progression of aggressive behaviors or traumatic stress responses. A variety of models may be proposed. o Applicants proposing intervention studies are encouraged to offer a standardized intervention package, including the development of manuals that clearly describe the content and procedures for all intervention components, so as to permit reliable implementation and potential replication. o Feasibility issues should be clearly addressed. Plans for implementation of the research should include procedures for obtaining and maintaining the necessary community relations, training and supervising project staff, insuring implementation fidelity, securing ongoing access to the subject population pool, recruiting a representative sample of the target population, recruiting minorities for the staff of the research intervention, and monitoring subject participation over time. o Applicants are encouraged to document the commitment, support, cooperation, and nature of proposed collaboration of community agencies or other entities or settings outside the applicant organization whose support is essential for the conduct of the research. For example, a university- based project could demonstrate a working relationship with existing community service projects which provide services to other high-risk populations. o In response to the recommendations of the DHHS Secretary's Blue Ribbon Panel on Violence Prevention, all applicants are strongly encouraged to include a representative community and scientific advisory panel in their applications to assist them during all phases of the project, including the development of the application itself. Special attention should be directed toward the unique needs and special concerns of racial and ethnic minority group members and females, so that services and opportunities are appropriate and acceptable to these individuals (where feasible and appropriate to the study question). Community Involvement In violence and traumatic stress research conducted in communities, the community itself may be an important source of innovative ideas for addressing sensitive social problems. Researchers should have the cooperation and participation of those who are the focus of their work. Working with a researcher or a community service agency that is viewed as an integral part of the community, and is well- respected in the community, may greatly enhance the quality of the research study. Opinions differ about how communities can most appropriately contribute to a research study. Community representatives may be given a voice in choosing research topics, collecting data, or interpreting results, among other possibilities. Community input may be most meaningful if it is built into the research process from the beginning. Basing the research project in the community being studied is a positive first step. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their subpopulations must be included in all NIH supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification is provided that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This new policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43) and supersedes and strengthens the previous policies (Concerning the Inclusion of Women in Study Populations, and Concerning the Inclusion of Minorities in Study Populations), which have been in effect since 1990. The new policy contains some provisions that are substantially different from the 1990 policies. All investigators proposing research involving human subjects should read the "NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical Research," which have been published in the Federal Register of March 28, 1994 (FR 59 14508-14513) and reprinted in the NIH Guide for Grants and Contracts, Volume 23, Number 11, March 18, 1994. Investigators also may obtain copies of the policy from the program staff listed under INQUIRIES. Program staff may also provide additional relevant information concerning the policy. APPLICATION PROCEDURES Applications are to be submitted on the grant application form PHS 398 (rev. 9/91) and will be accepted at the standard application deadlines as indicated in the application kit. Application kits are available at most institutional offices of sponsored research and may be obtained from the Office of Grants Information, Division of Research Grants, National Institutes of Health, 6701 Rockledge Drive, Room 3032, MSC 7762, Bethesda, MD 20892-7762, telephone 301/435-0715. The title and number of the program announcement must be typed in Section 2a on the face page of the application. Applications for the FIRST award (R29) are instructed to include at least three sealed letters of reference attached to the face page of the original application. FIRST award (R29) applications submitted without the required number of reference letters will be considered incomplete and will be returned without review. If an IRPG is proposed, each application should be identified along with the number of the PA and the phrase "Investigator-initiated IRPG." All R01 or R29 applications constituting the proposed IRPG cohort must be submitted in a single package, whether or not the applications arise from the same institutions. For detailed instructions for preparation and submission of IRPG applications, refer to PA-94-086, NIH Guide for Grants and Contracts, Volume 23, Number 28, July 29, 1994. Applicants for the RAPID award are strongly encouraged to contact program staff following the acute traumatic event to be investigated; each application must be identified along with the number of the PA and the phrase "NIMH Expedited Review." Submission dates are linked to the date of the event and other circumstances surrounding the proposed study. For detailed instructions for preparation and submission of a RAPID application, refer to PA-91-04, NIH Guide for Grants and Contracts, September, 1990. The completed original application and five legible copies must be sent or delivered to: DIVISION OF RESEARCH GRANTS NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for courier/overnight service) REVIEW CONSIDERATIONS Applications that are complete and responsive to the program announcement will be evaluated for scientific and technical merit by an appropriate peer review group convened in accordance with the standard NIH peer review procedures. Incomplete and/or non-responsive applications will be returned to sender without review. As part of the initial merit review, all applications will receive a written critique and undergo a process in which only those applications deemed to have the highest scientific merit, generally the top half of applications under review, will be discussed, assigned a priority score, and receive a second level review by the appropriate national advisory council or board, when applicable. Review Criteria: o scientific, technical, or mental health significance and originality of the proposed research; o appropriateness and adequacy of the experimental approach and methodology proposed to carry out the research; o qualifications and research experience of the Principal Investigator and staff, particularly, but not exclusively in the area of the proposed research; o availability of the resources necessary to perform the research; o appropriateness of the proposed budget and duration in relation to the proposed research; o adequacy of plans to include both genders and minorities and their subgroups as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. The initial review group will also examine the provisions for the protection of human and animal subjects and the safety of the research environment. The review criteria for other grant mechanisms vary and potential applicants should obtain copies of the Program Announcements that describe those mechanisms from the address listed under INQUIRIES. AWARD CRITERIA Applications will compete for available funds with all other approved applications. The following will be considered in making funding decisions: Quality of the proposed project as determined by peer review, availability of funds, and program priority. INQUIRIES Inquiries are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Susan Solomon, Ph.D. Violence and Traumatic Stress Research Branch 5600 Fishers Lane, Room 10C-24 Rockville, MD 20857 Telephone: (301) 443-3728 FAX: (301) 443-1726 Email: Susan_Solomon@nih.gov) Program Officials for specific research areas: James Breiling, Ph.D. Perpetrator Research: Youth Aggression (prevention, risk factors, treatment) Community Violence (perpetrators) Email: James_Breiling@nih.gov Malcolm Gordon, Ph.D. Victims of Interpersonal Violence: Family Violence, Child Abuse, Community Violence (victims) Email: Malcolm_Gordon@nih.gov Ellen Gerrity, Ph.D. Victims of Traumatic Events: Natural and Technological Disasters, Veteran and War-related Research; Rape and Sexual Assault; Post-Traumatic Stress Disorder Email: Ellen_Gerrity@nih.gov Direct inquiries regarding fiscal matters to: Diana S. Trunnell Grants Management Branch National Institute of Mental Health Parklawn Building, Room 7C-08 Rockville, MD 20857 Telephone: (301) 443-3065 FAX: (301) 443-6885 Email: Diana_Trunnell@nih.gov AUTHORITY AND REGULATIONS These programs are described in the Catalog of Federal Domestic Assistance No. 93.242. Awards are made under authorization of the Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and 285) and administered under PHS grants 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. Awards will be administered under PHS grants policy as stated in the Public Health Service Grants Policy Statement (April 1, 1994). The PHS strongly encourages all grant and contract recipients to provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routing education, library, day care, health care or early childhood development services are provided to children. This is consistent with the PHS mission to protect and advance the physical and mental health of the american people. .
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Department of Health and Human Services (HHS) |
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