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In the last two years, NIMH has written and rewritten program announcements (calls for funding applications) to support its new emphasis on looking at treatment effectiveness for real-world situations. The following announcements exemplify that new focus.

Exploratory/development grants for intervention research. NIMH is requesting grant applications to develop and do preliminary testing on somatic, pharmacologic, psychosocial or combination interventions for prevention, rehabilitation, treatment and/or management of mental disorders, emotional or behavioral problems, and the co-occurrence of mental, physical and substance abuse problems, and the functional consequences across the life span. Examples of possible topics include defining and standardizing a credible, active placebo or other control treatment condition, including patient preferences, to improve intervention designs; developing family-based education, maintenance and rehabilitative strategies that can be added and tested with individual intervention; determining the feasibility and dosing range of new or existing interventions to prevent or minimize consequent symptoms (such as brief psychosocial and/or pharmacological treatment of trauma victims seen in emergency rooms to prevent later post traumatic stress disorder); and developing innovative rehabilitative strategies to address neurocognitive, neuromotor, perceptual or other regulatory deficits that contribute to functional impairment or treatment compliance.

Children and disruptive behavior. NIMH invites grant applications to examine implementation of prevention strategies for disruptive behavior disorders in children and adolescents in real-world settings. Eligible settings include schools, pediatric health-care settings, mental health clinics, foster-care settings and detention facilities, to name a few. The purpose of the research is to study practices, barriers to implementation of interventions, costs, organizational and environmental factors and replicating prevention programs for use with diverse ethnic populations.

Adherence to interventions for mental disorders. A major problem in mental health treatment is ensuring patients adhere to an intervention until it is completed. Research has developed theoretical models to describe the processes of adherence and behavior change, but researchers have not fully exploited those models for designing pharmacological, behavioral and psychosocial interventions. NIMH is calling for grant applications to build on that fundamental research and look at this problem in terms of motivation, persuasion, social cognition, family and community support and the character of alliances between providers and clients. The research may also look at mechanisms and processes underlying providers' strategies and behaviors.

Exploratory or developmental projects for intervention research. NIMH seeks research projects to develop interventions for various disorders and do preliminary tests of their feasibility, acceptability, and efficacy or effectiveness. The outcomes to be measured may include performance at school or work, functioning in relationships, disability, quality of life, morbidity, mortality, institutionalization and health-care resource use. The agency encourages testing the effectiveness of commonly used but relatively unproven self-treatments such as self-help and support groups. It also would like to see intervention approaches to understudied high-risk behaviors and events, such as suicide attempts or exposure to traumatic events and understudied problems such as obsessive-compulsive disorder and anorexia nervosa.

Integrating basic behavioral sciences and public mental health. The agency solicits applications to integrate basic behavioral science and public health expertise in research on mental health and disorders. Some of the pertinent areas of expertise include emotion and motivation, cognitive and emotional functioning, persuasion, family processes and networks, and socio-cultural and environmental processes. Examples of potential topics include: how mental illnesses and treatment affect individuals' abilities to function in diverse settings and roles; how providers' interpersonal communication styles (authoritarian, egalitarian, etc.) and clients' preferences affect willingness to participate and other outcomes; approaches to decreasing stigma, including studies on the social context of stigma and individuals who are stigmatized; and cultural explanations for disorders and the effects of those explanations.

--K. FOXHALL