Rehabilitation Research and Training Center (RRTC) on Health and Function Among People with Serious Mental Health Conditions

Background:Anyone, regardless of age, gender, race, ethnicity, and socio-economic status can experience a serious mental health condition (SMHC). For people under the age of 18, SMHC refers to a diagnosable mental, behavioral, or emotional disorder that substantially interferes with or limits their role in family, school, or community activities (ISMICC, 2017). For people 18 or older, SMHC refers to a diagnosable mental, behavioral, or emotional disorder that results in functional impairment that substantially interferes with or limits one or more major life activities (ISMICC, 2017).In the U.S., one in six youth aged 6-17 (Whitney & Peterson, 2019) and 1 in 20 adults 18 years and older experience a SMHC each year (SAMHSA, 2022a). The most common age of onset of any SMHC is 14.5 years old, during the transition from childhood to adulthood (Solmi et al, 2022). Research has shown that nearly 50% of adults experiencing a SMHC began experiencing symptoms by age 14 and 75% experienced symptoms by age 20 (Fusar-Poli, 2019; Kessler, et al., 2007; McGrath et al., 2023).Individuals with SMHCs often face poor overall health outcomes and they are more likely than peers without SMHCs to develop preventable chronic physical conditions such as diabetes, hypertension, stroke, lung disease, and cardiovascular disease (Pizzol et al., 2023; Vancampfort et al., 2017). These comorbid chronic physical health conditions and SMHCs are increasingly occurring at younger ages, which exacerbates the prognosis for all conditions and significantly affects the severity of symptoms and functional impairment among youth (Bitsko et al., 2022; Ferro et al., 2019; Romano et al., 2021; Firth et al., 2019; Merikangas et al., 2015). Earlier onset can lead to significant long-term consequences (e.g., poor health, diminished function) in adulthood (Caspi et al., 2020; Romano et al., 2021; Thompson et al., 2023; Waddell et al., 2018).Chronic health conditions among people with SMHC are associated with factors such as adverse effects of psychotropic medications, lifestyle choices (e.g., smoking, diet, exercise), social determinants of health (e.g., poverty, being unhoused, social exclusion) (Jester et al., 2023; Skjærpe et al., 2023), and healthcare disparities (Luciano et al., 2021). People with SMHC experience more rapid functional decline, diminished quality of life, and a lifespan that is 15 to 20 years shorter than the general population (Skjærpe et al., 2023; Liu et al., 2017; Gronholm, et al, 2021).Research into strategies for improving health and function outcomes for people with SMHCs has expanded significantly over recent decades. This growth has led to the development of a variety of interventions and care models, each demonstrating varying levels of efficacy, feasibility, and dissemination. These include integrated mental and primary healthcare models (AHRQ, n.d.; SAMHSA-HRSA, 2020), integrated mental and physical health care for youth (McGorry, et al., 2024); self-directed care approaches (e.g., Cook et al., 2019; Cook et al., 2023; Shen et al., 2010; Slade, 2012), self-management techniques (e.g., Depp et al., 2016; Lean et al., 2019; Mueser et al., 2012), multi-dimensional wellness interventions (e.g., Zechner et al., 2019; Zechner et al., 2022) and lifestyle interventions (e.g., Manger, 2019; Walburg et al, 2023).Despite this progress, there is an ongoing need to further develop and implement interventions and models to fully address the complex health needs of people with SMHC. Some interventions and care models have been developed and preliminary efficacy established for their use. However, not all these interventions and models have strong evidence for their efficacy in real-life settings or for their long-term impact. In addition, substantial obstacles continue to restrict the availability of these interventions and models among individuals with SMHCs, especially those from underserved and under-resourced communities (Hodgkinson et al., 2017; McGorry, et al., 2024; Mongelli et al., 2020; SAMHSA, 2022b). These obstacles include system-level factors such as restricted access to healthcare, societal barriers, stigma, suboptimal quality of care, an inadequately trained workforce, and lack of effective care coordination, as well as individual-level lack of motivation to change health and lifestyle (AHRQ, n.d.; Coombs et al., 2021; Hodgkinson et al., 2017; Mongelli et al., 2020).As described in the NIDILRR Long Range Plan for 2024-2028, maximizing health and function outcomes among people with disabilities, including those with SMHCs, is critical to their general well-being and ability to meet personal goals for employment and community living. Achieving improved health and function outcomes among people with SMHCs will require refining policies, programs, practices, and technologies that reduce limitations and improve health and function outcomes. The purpose of this funding opportunity is to build on NIDILRR’s prior research investments in health and function among people with SMHCs, by supporting innovative and well-designed research and training projects that address these critical needs.References:Agency for Healthcare Research and Quality (AHRQ) (n.d.). The Academy Integrating Behavioral Health & Primary Care Health Equity and Behavioral Health Integration. https://integrationacademy.ahrq.gov/products/topic-briefs/health-equity…, R.H., Claussen, A.H., Lichstein, J., Black, L.I., Jones, S.E., Danielson, M.L., Jennifer M Hoenig, J.M. (2022). Mental Health Surveillance Among Children — United States, 2013–2019 Supplements / Morbidity and Mortality Weekly Report (MMWR), 71(2);1–42.Caspi, A., Houts, R.M., Ambler, A. (2020). Longitudinal assessment of mental health disorders and comorbidities across 4 decades among participants in the Dunedin Birth Cohort Study. 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Psychiatric Rehabilitation Journal. 45(2), 160–169. https://doi.org/10.1037/prj0000510.Priority:With the publication of this NOFO, the Administrator of the Administration for Community Living establishes a priority for a Rehabilitation Research and Training Center (RRTC) on Health and Function among People with Serious Mental Health Conditions (SMHC). For people under the age of 18, SMHC refers to a diagnosable mental, behavioral, or emotional disorder that substantially interferes with or limits a child’s role in family, school, or community activities. For people 18 and older, SMHC refers to a diagnosable mental, behavioral, or emotional disorder that results in functional impairment that substantially interferes with or limits one or more major life activities.The RRTC must contribute to maximizing the health and function outcomes of people with SMHCs.To contribute to this outcome, the RRTC must:Focus on people with SMHC as a group or on a specific clinical or demographic subpopulation of people with SMHC. Subpopulations may include children with SMHC, adults with SMHC, or both. Conduct research in one or more of the following priority areas:Technology to improve health and function outcomes among people with SMHCs.Individual and environmental factors associated with improved health and function outcomes among people with SMHCs.Interventions that are designed to contribute to improved heath and function outcomes among people with SMHCs. Interventions may include any strategy, practice, program, policy, or tool that, when implemented as intended, contributes to improvements in health and function outcomes among people with SMHCs. Research on interventions may include longitudinal research that examines longer-term effectiveness of an intervention or interventions.Effects of government policies and programs on health and function outcomes among people with SMHCs.Practices and policies that contribute to improved health and function outcomes among children and adolescents with SMHC. Focus its research on a specific stage(s) of research. If the RRTC is to conduct research that can be categorized under more than one stage, including research that progresses from one stage to another, those stages must be clearly specified and justified. These stages -- exploration and discovery, intervention development, intervention efficacy, and scale-up evaluation -- are defined on ACL’s website. Applicants must justify the need and rationale for research at the proposed stage or stages and describe fully an appropriate methodology or methodologies for the proposed research.The RRTC must conduct at least one study in real-world settings at the intervention efficacy or scale-up evaluation stage. Demonstrate, in its original application, that people with SMHCs from racial and ethnic minority backgrounds will be included in study samples in sufficient numbers to generate knowledge and products that are relevant to the racial and ethnic diversity of the population of people with SMHCs being studied. The RRTC must describe and justify, in its original application, the planned racial and ethnic distribution of people with SMHCs who will participate in the proposed research activities. Serve as a national resource center related to the health and function of people with SMHCs by conducting knowledge translation activities that include but are not limited to:Providing research-based information and technical assistance to people with SMHCs and their representatives, service providers, and other key stakeholders.Providing training (including graduate, pre-service, and in-service training), to graduate students and postdoctoral fellows, rehabilitation service providers and other service providers, to identify and facilitate more effective delivery of services to people with SMHCs. This training may be provided through conferences, workshops, public education programs, in-service training programs, and similar activities.Disseminating research-based information and materials related to improving health and function outcomes among people with SMHCs to key stakeholders, including individuals with SMHCs. Demonstrate in its original application that people with SMHCs from the target population will be involved in planning and implementing all RRTC activities, and in evaluating the RRTC’s work. This involvement will help maximize the relevance and usability of the new knowledge generated by the RRTC. Ensure that all materials, websites and information technology tools and products that the RRTC develops or maintains are accessible, and that electronic materials are produced in full compliance with Section 508 of the Rehabilitation Act (29 U.S.C. 794d). For websites this compliance currently requires meeting Web Content Accessibility Guidelines (WCAG) 2.0/2.1 AA success criteria. Applications must demonstrate an ability to meet these requirements.