Model Continuums of Care Initiative (MCCI) to Advance Health Equity and End Health Disparities Among Women and Girls in Racial/Ethnic Minority and Other Underserved Communities (Planning Phase)

Model Continuums of Care Initiative (MCCI) to Advance Health Equity and End Health Disparities Among Women and Girls in Racial/Ethnic Minority and Other Underserved Communities (Planning Phase) is sponsored by National Institutes of Health (NIH). This funding opportunity supports the planning phase of an initiative to advance health equity and end health disparities in racial/ethnic minority women and girls of reproductive age.

Expired RFA-AA-24-012: Model Continuums of Care Initiative (MCCI) to Advance Health Equity and End Health Disparities Among Women and Girls in Racial/Ethnic Minority and Other Underserved Communities (U34 Clinical Trials Required) This notice has expired. For NIH, in limited situations, applications may be accepted on a case-by-case basis for a short period after expiration to accommodate NIH late or continuous submission policies .

Contact the eRA Service Desk for any submission issues. Check the NIH Guide for active opportunities and notices. Department of Health and Human Services Part 1.

Overview Information Participating Organization(s) National Institutes of Health ( NIH ) Components of Participating Organizations National Institute on Alcohol Abuse and Alcoholism ( NIAAA ) National Institute of Nursing Research ( NINR ) National Institute on Minority Health and Health Disparities ( NIMHD ) National Center for Complementary and Integrative Health ( NCCIH ) Funding Opportunity Title Model Continuums of Care Initiative (MCCI) to Advance Health Equity and End Health Disparities Among Women and Girls in Racial/Ethnic Minority and Other Underserved Communities (U34 Clinical Trials Required) U34 Planning Cooperative Agreement April 4, 2024 - Overview of Grant Application and Review Changes for Due Dates on or after January 25, 2025.

See Notice NOT-OD-24-084 . August 31, 2022 - Implementation Changes for Genomic Data Sharing Plans Included with Applications Due on or after January 25, 2023. See Notice NOT-OD-22-198 .

August 5, 2022 - Implementation Details for the NIH Data Management and Sharing Policy. See Notice NOT-OD-22-189 . Funding Opportunity Number (FON) Companion Funding Opportunity See Section III.

3. Additional Information on Eligibility . Assistance Listing Number(s) 93.

273, 93. 213, 93. 307, 93.

361 Funding Opportunity Purpose The purpose of this NOFO is to support the planning phase of the Model Continuums of Care Initiative (MCCI) to Advance Health Equity and End Health Disparities Among Women and Girls in Racial/Ethnic Minority Communities. MCCI is a multi-ICO dissemination and implementation science initiative to advance racial equity and end health disparities in racial/ethnic minority women and girls of reproductive age.

Specifically, the Model Continuums of Care Initiative will apply the latest dissemination and implementation science approaches to significantly reduce the prevalence and impact of multi-morbidity among racial/ethnic minority women and girls of reproductive age at risk and living with mental health disorders, substance use disorders, chronic stress, cardiopulmonary diseases, common metabolic disorders (e.g., diabetes), cancer, and HIV/AIDS.

This concept proposes a continuum of care approach that integrates preventive health services, primary care, behavioral health, integrative care, and cardiopulmonary and endocrine specialties to fully address health care needs in each of these domains, and to have maximum impact on the overall health and well-being of racial and ethnic minority and other underserved women and girls.

While MCCI is not a maternal health initiative, women and girls ages 15-44 yrs. are centered because it is during the early reproductive period, i.e., adolescence, that multimorbidity typically begins and rapidly progresses, setting the stage for multiple chronic debilitating conditions in later life.

Special emphasis will be placed on using stakeholder partnerships, provider training, and infrastructure changes to improve access for subgroups of racial/ethnic minority women and girls who currently have the least access to high quality health care (e.g., racial/ethnic minority women and girls living in low resource settings).

Applications that include a partnership between Research Centers in Minority Institutions and other institutions with extensive programs in women's health research are strongly encouraged. Funding Opportunity Goal(s) To develop a sound fundamental knowledge base which can be applied to the development of improved methods of treatment and more effective strategies for preventing alcoholism and alcohol-related problems.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) supports research in a broad range of disciplines and subject areas related to biomedical and genetic factors, psychological and environmental factors, alcohol-related problems and medical disorders, health services research, and prevention and treatment research.

Open Date (Earliest Submission Date) Letter of Intent Due Date(s) Renewal / Resubmission / Revision (as allowed) AIDS - New/Renewal/Resubmission/Revision, as allowed All applications are due by 5:00 PM local time of applicant organization. Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.

Required Application Instructions It is critical that applicants follow the instructions in the Research (R) Instructions in the How to Apply - Application Guide , except where instructed to do otherwise (in this NOFO or in a Notice from NIH Guide for Grants and Contracts ). Conformance to all requirements (both in the Application Guide and the NOFO) is required and strictly enforced.

Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV. When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions. Applications that do not comply with these instructions may be delayed or not accepted for review.

Part 1. Overview Information Part 2. Full Text of Announcement Section I.

Notice of Funding Opportunity Description Section II. Award Information Section III. Eligibility Information Section IV.

Application and Submission Information Section V. Application Review Information Section VI. Award Administration Information Section VII.

Agency Contacts Section VIII. Other Information Part 2. Full Text of Announcement Section I.

Notice of Funding Opportunity Description The purpose of this NOFO is to support the planning phase of the Model Continuums of Care Initiative (MCCI) to Advance Health Equity and End Health Disparities Among Women and Girls in Racial/Ethnic Minority and Other Underserved Communities (MCCI).

MCCI is a multi-ICO dissemination and implementation science initiative to advance health equity and end health disparities in racial and ethnic minority and other underserved women and girls of reproductive age living in the United States, with special emphasis on those with intersecting identities that increase their risk for health disparities; i.e., NIH-designated populations with health disparities, defined as racial and ethnic minority groups ( African Americans, Latinos/Hispanics, American Indians and Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders), people with lower socioeconomic status, underserved rural communities, sexual and gender minority (SGM) groups, and people with disabilities in the U.S. and its territories: See https://www.

nimhd. nih. gov/about/overview/ .

Specifically, MCCI will apply the latest dissemination and implementation science approaches to significantly reduce the prevalence and impact of multi-morbidity among racial/ethnic minority and other underserved women and girls of reproductive age at risk and living with mental health disorders, substance use disorders, chronic stress, cardiopulmonary diseases, common metabolic disorders (e.g., obesity, diabetes), cancer, and HIV/AIDS.

This concept proposes a continuum of care approach that integrates preventive health services, primary care, behavioral health, integrative care, and specialty care (e.g., cardiopulmonary, endocrine, cancer, and HIV/AIDS specialties) to fully address health care needs in each of these domains, and to have maximum impact on the overall health and well-being of racial and ethnic minority and other underserved women and girls.

Women and girls ages 15-44 yrs. are centered because it is during the early reproductive period, i.e., adolescence, that multimorbidity typically begins and rapidly progresses, setting the stage for multiple chronic debilitating conditions in later life.

This focus contrasts with maternal health initiatives, specifically, in that it does not focus solely on the perinatal period but instead considers the overall health of women between adolescence and menopause. MCCI will enhance the efforts of initiatives specific to maternal health, as the health of individuals years well before initial pregnancy is critical to maternal health.

In addition to the groups highlighted above, priority populations for this research initiative include populations of women and girls who have a substance use disorder and/or serious mental illness or other mental health disorder associated with functional impairments, and women and girls with intellectual or developmental disorders and/or other disabilities.

Girls in or transitioning from social service systems (e.g., foster care, group homes, etc.), girls involved in the juvenile justice system, and women involved with the criminal justice system are also a high priority.

In this trans-NIH, trans-HHS effort to improve the quality of health care available to racial and ethnic minority and other underserved women and girls of reproductive age, special emphasis will be placed on using stakeholder partnerships, provider training, and infrastructure changes to improve access for subgroups of women who experience significant impediments to high quality health care.

Applications that include a partnership between Research Centers in Minority Institutions and other institutions with extensive programs in women's health research are strongly encouraged. Rising rates of anxiety and depression among U.S. women and girls are acting as important drivers of sharp increases in harmful alcohol and substance use.

Rates of alcohol-related emergency department visits have escalated rapidly over the past two decades, with the rate among women outpacing the rate among men in every age group. From 2019 to 2020 alcohol-related deaths increased by 27% for women and by 25% for men, continuing a trend in alcohol-related deaths that also has been observed for the past two decades.

This has been associated with a 400% increase in overdose-related deaths among women of reproductive age (i.e., ages 15 – 44 yrs. as defined by the CDC) over the same time period. Furthermore, the opioid crisis has disproportionately affected women from racial and ethnic minority communities.

There is a bidirectional, positive relationship between mental health conditions coupled with harmful substance use and increased risk for a range of physical conditions. For example, both major depressive disorder (MDD) and harmful use of substances, including alcohol, nicotine, and psychostimulants, independently increase the risk for cardiovascular disease (CVD) and other cardiopulmonary diseases (CPD).

Conversely, CVD increases the risk for MDD and cognitive impairment. People living with Diabetes Mellitus Type 1 or Type 2 (DM) are at greater risk for MDD, and there is mounting evidence that people living with MDD may be at greater risk for developing Type 2 diabetes. Alcohol and tobacco use increase cancer risk, and racial/ethnic minority women have higher rates of certain cancers and/or higher risk of dying from certain cancers.

For example, despite having similar rates of breast cancer, Black/African-American women are more likely than White women to die of the disease.

Key goals of MCCI include increasing awareness of the role of substance use in increasing cancer risk (e.g., the role of alcohol in increasing breast CA risk), implementing preventive interventions that reduce substance use-related risk, and advancing integrative care for mental health disorders and harmful substance use during cancer treatment.

The intersection of these disorders and processes may impact the health of women and girls across the lifespan, underscoring the need to prevent and treat multi-morbidity early in the life course, ideally prior to first pregnancy; i.e., early adolescence .

Research has found multiple factors contributing to disparities in multi-morbidity among women and girls, such as variability in access to high quality healthcare, underlying chronic conditions, implicit bias, overt discrimination, and chronic stress.

Among these factors, chronic stress is uniquely addressable using evidence-based, stress management methods that have been shown to reduce sympathetic overactivity, blood pressure, oxidative stress, and systemic inflammation, as well as improve sleep and glucose metabolism.

Thus, integrating stress management techniques into the health care of racial and ethnic minority and other underserved women and girls presents an opportunity to impact many aspects of mental and physical health and to prevent or reverse multiple inter-related chronic conditions.

This trans-NIH initiative will address gaps in the continuum of health care for racial and ethnic minority (REM) and other underserved women and girls by bringing evidence-based, integrative interventions for mental health and substance use disorders and common co-occurring physical conditions (e.g., hypertension, asthma obesity, diabetes, cancer, HIV/AIDS) to population scale across the entire continuum of women and girls’ health care and by optimizing coordination of care.

Specifically, MCCI proposes a continuum of care approach that integrates preventive health services, primary care, behavioral health, integrative care, and specialty care (e.g., cardiopulmonary, endocrine, cancer, and HIV/AIDS specialties) to fully address health care needs in each of these domains, and to have maximum impact on the overall health and well-being of racial and ethnic minority and other underserved women and girls.

By accelerating the scale-up of evidence-based interventions (EBIs) for common co-occurring conditions across multiple components of existing women’s health care continuums at the same time, MCCI is expected to have a transformative impact on women’s health care, significantly reducing longstanding inequities in the delivery of state-of-the-art prevention, diagnostic, and treatment services across racial and ethnic minority and other underserved communities.

MCCI is not a maternal health initiative. Instead, MCCI aims to redress longstanding health inequities affecting racial and ethnic minority and other underserved women and girls of reproductive age, in recognition of their intrinsic dignity and value apart from their role as current or potential mothers.

For individuals who wish to become pregnant, it aims to address their complex health and social needs prior to pregnancy and/or between pregnancies, consistent with data showing that the health trajectory of any single pregnancy is largely determined by conditions that exist prior to pregnancy.

While the focus of MCCI is on strengthening the continuum of women and girl’s health care external to clinical maternal health care, strategies to improve linkages between maternal health care and other components of the health care continuum must be a critical element of the partnering community’s broader plan to develop a model continuum of care.

For the purposes of this RFA, a model continuum of care for racial and ethnic minority women and girls is defined as one that includes various community partners (e.g., primary care facilities, hospitals, specialized care centers, community-based organizations, faith-based organizations, community advisory groups, etc.) and that, at a minimum, optimizes access to state-of-the art, evidence-based preventive, clinical, and rehabilitative health maintenance interventions for women and girls across the full continuum of health care.

These interventions should be culturally appropriate and congruent with the changing needs and preferences of women and girls living within a given community.

The overarching goals of MCCI are to: 1) strengthen state and community public health surveillance system infrastructure and capacity relevant to the health of REM and other underserved women and girls; 2) promote provider education/training in the implementation of EBPs to prevent/treat multimorbidity in REM and other underserved women and girls; 3) support the integration and coordination of primary healthcare, behavioral health systems, and community-based services to meet the health and social needs of racial/ethnic minority and other underserved women and girls of reproductive age; 4) accelerate the adoption and implementation of evidence-based screening and interventions for common comorbidities affecting REM and other underserved women and girls of reproductive age across the entire continuum of women’s health care; and 5) leverage existing federal, state and local resources and collaborations for aligning community and clinical services centering REM and other underserved women and girls.

MCCI Planning Phase (U34): This U34 NOFO supports the Planning Phase of MCCI.

During this phase, investigators will have 2 - 3 years to: 1) establish public-private scientific partnerships involving the public health leadership in selected communities and NIH and other Federal agencies; 2) identify and address facilitators of and barriers to the implementation of evidence-based mental health, substance use, cardiovascular, cardiometabolic, cancer, and HIV/AIDS interventions (EBI’s) focused on racial and ethnic minority and other underserved women, girls, and families living in communities at high risk for health disparities; 3) complete an assessment of local community surveillance, prevention and treatment needs; 4) identify a set of empirically-informed implementation research goals; 5) identify and develop plans to address essential policy, personnel, data, and other resource needs; and 6) complete a pilot implementation research project.

Awarded U34s that achieve the above milestones established for the planning phase will be eligible to apply for one or more Cooperative Agreement mechanisms during the Implementation Phase, during which awarded grantees will have up to 5 years to: 1) conduct large scale implementation studies to accelerate the translation to community practice of EBI’s to prevent and reduce multimorbidity in racial and ethnic minority and other underserved women and girls of reproductive age; and 2) disseminate and share findings and lessons learned through a data coordination center.

Given that MCCI aims to increase the adoption of an integrated set of EBPs delivered across the entire continuum of women’s health care, the Implementation Phase will involve conducting a suite of coordinated studies in multiple components of the health care continuum for women and girls, such as adolescent and adult prevention services; adolescent and adult primary care services; adolescent and adult mental and behavioral health services; adult cardiopulmonary care; adult endocrinology services; adult cancer care; adult HIV/AIDS services; and community-based wellness and health maintenance services.

Research to determine which strategies and interventions can be implemented in non-clinical community-based settings (e.g., faith-based institutions, schools, community service centers) is strongly encouraged. In the Implementation Phase, up to 7 studies per continuum are envisioned. Research Areas of Special Interest Research topics of special interest to participating NIH Institutes include, but are not limited to: 1.

Optimal strategies for assuring the sustainability of evidence-based practices (EBPs) for the prevention and treatment of common, co-occurring conditions in REM and other underserved women and girls. Specifically, research that illuminates the health infrastructure necessary to assure sustainability of data-driven, evidence-based systems of care, including but not limited to: a.

Policy requirements (e.g., health care financing; data management) b. Data collection, integration, and harmonization requirements c. Community partnership requirements d.

Workforce development requirements 2. Current trends in the prevalence of mental health disorders, SUDs, cardiopulmonary, and metabolic disorders, cancer, and HIV/AIDS among REM and other underserved women and girls of reproductive age in selected high-risk communities. 3.

Best approaches to leveraging health information technology tools (e.g., electronic health records) and data science approaches to improve community surveillance for mental health and SUDs, cardiopulmonary disease, metabolic disorders, cancer, HIV/AIDS, and other common co-occurring conditions. 4. Effective community-specific strategies for: a .

Preventing commonly occurring diseases in REM girls and women. Promoting adoption of evidence-based approaches to preventing mental health disorders, harmful substance use, and common, co-occurring somatic conditions among REM and other underserved women and girls in the partnering community and bringing them to population scale. b.

Improving rates and quality of screening for depression, anxiety, alcohol and other SUDs, cardiopulmonary and metabolic diseases, cancer, and HIV/AIDS. Specifically, research examining whether cardiopulmonary and metabolic disease screening and treatment can be effectively combined with mental health and substance use screening in clinical and non-clinical settings (e.g., community-based, school-based, mobile, etc.). c.

Promoting adoption of evidence-based brief interventions for harmful alcohol and other substance use. d . Improving treatment engagement and retention for REM and other underserved women and girls with mental health and SUDs and common, co-occurring, somatic conditions.

Research to improve treatment outcomes by providing targeted, evidence-based services for comorbid conditions with high prevalence among women and girls who use alcohol and other substances at harmful levels (e.g., comorbid psychiatric conditions, including posttraumatic stress disorder; trauma history; chronic stress; chronic pain) is an area of special interest. 5.

Best approaches to implementing evidence-based telemedicine models and other EBIs (e.g., spiritually based interventions; mind/body approaches; complementary and integrative health care approaches, etc.) with potential to significantly reduce disparities in access to care. 6.

Evidence-based implementation strategies for stepped care to increase reach, uptake, and implementation of integrative, evidence-based, stepped care for common co-occurring conditions in racial and ethnic minority and other underserved women and girls (e.g., Practice Facilitation; Intervention Mapping). 7.

Best approaches to health maintenance in racial and ethnic minority and other underserved community settings , both before onset and after stabilization of disease is achieved (e.g., community health workers, evidence-based stress management, digital health monitoring devices, health-focused artificial intelligence).

Model Continuum Description : Beyond supporting research that will significantly increase access to state-of-the-art health care among racial and ethnic minority and other underserved women and girls of reproductive age, MCCI seeks to catalyze broader efforts within partnering communities to develop optimized systems of care that can serve as regional models replicable by communities with similar demographic, cultural, and structural characteristics.

Each model continuum will ideally be: 1) Sustainable. Strategies and interventions to be evaluated must be implementable beyond the anticipated period of involvement by the federal government.

Given that the overarching goal of MCCI is to have a transformative and lasting impact on the quality of health care available to racial and ethnic minority and other underserved women and girls, sustainability planning must begin as early as possible in the planning process and show evidence of substantial progress at the end of each reporting period. 2 ) Inclusive.

Recruiting and outreach efforts to encourage women from minority and other underserved groups to consider participating in the program's organization, such as applying for open organizational leadership or advisory/oversight positions. 3 ) Trustworthy . Comprising personnel, programs and interventions that are and are perceived as respectful, safe, and affirming of personal autonomy.

Model continuums develop, implement, and continuously evaluate and modify plans to destigmatize mental and behavioral health disorders. 4) Person-centered . Model continuums embrace care of the whole person, cura personalis , as a central value.

Embracing the principle of providing care for the whole person includes acknowledging the importance of a woman or girl’s spiritual and religious beliefs and practices and including these in the care plan. 5) Wellness, prevention, and recovery-centered .

While state-of-the-art care for acute disease is an integral part of any model continuum of care, maintenance of good health (i.e., preventing first episodes of disease and, when disease occurs, achieving and maintaining remission) will be the central organizing principle. Model continuums of care will employ evidence-based strategies to promote wellness and prevent disease, and to promote long-term recovery after acute illness.

6) Trauma-informed .

Trauma-informed systems of care will, at a minimum, consistently provide staff training to: a) increase awareness of the widespread impact of trauma; b) enhance skills necessary to recognize the signs and symptoms of trauma in patients, families, and staff; c) promote integration of knowledge about trauma into organizational and clinical policies, procedures, and practices; and d) actively avoid re-traumatization by implementing universal trauma precautions.

Adopting trauma-informed practices can facilitate women and girls’ experience of safety , and potentially improve treatment engagement, adherence, and health outcomes, as well as wellness. 7) Culturally Competent.

A model continuum of care is cognizant and affirming of both the culture of individual women and girls and of the local community, and able to effectively deliver health care services that meet their social, cultural, linguistic, and health literacy needs.

This requires continuous staff training on cultural competence and cross-cultural issues and developing policies that reduce administrative, linguistic, and health literacy barriers to care. A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities.

8) Empowering of individual women and girls, their families, and the communities where they reside. A continuum of care that empowers women will, at a minimum, have a patient bill of rights developed and continuously reviewed and modified in collaboration with participating patients.

This bill of rights seeks to give every woman and girl a right to care that is safe, respectful, and affirming of her autonomy (e.g., the right to choose among available treatment options for the ones that are a best fit with her lifestyle and life circumstances).

The bill of rights is intended to reinforce the role of care providers as consultants, as opposed to authority figures with control over a woman or girl’s healthcare options or choices. 9) Guided by principles of care-integration , featuring evidence-based, integrative treatments for multiple chronic conditions and delivery of care by multidisciplinary teams.

Integrating stress management techniques into the health care of women presents an opportunity to impact many aspects of mental and physical health and prevent or reverse multiple inter-related chronic conditions. 10) Well-coordinated and resourceful , with clear plans in place to help women successfully transition from one component of the care continuum to the next when necessary.

A plan to strengthen linkages between the continuum of care for women who are not pregnant and maternal health services is a critically important component of the broader plan to develop a model continuum of care. 11) Community-partnered and collaborative .

Partnerships with organizations that provide a wide range of social services and operate and oversee community infrastructure (e.g., hospitals; community-based health care provider organizations; churches; health policy agencies; public safety organizations; housing agencies; departments of transportation; nutrition support services; schools and education associations; family and other social service providers; Medicaid; community-based membership organizations are an essential feature of a model continuum of care that is able to provide care for the whole person (i.e., cura personalis ).

12) Evidence-based, flexible, and responsive to real time data. To the greatest extent possible, the choice of prevention and treatment options is informed by empirical evidence, and cognizant of the fact that the evidence is constantly changing. Model continuums of care are flexible and responsive to changing epidemiological, environmental, health systems, and clinical outcome data.

NIAAA will support meritorious applications proposing, as a primary theme, dissemination and implementation research on EBIs/strategies to prevent, intervene early, effectively treat, and support recovery from alcohol and co-occurring substance use and mental health disorders among racial and ethnic minority and other underserved women and girls.

While addressing alcohol and co-occurring substance use and mental health disorders among racial and ethnic minority and other underserved women and girls will be the primary focus of successful applications, during the Implementation Phase of the Initiative (i.e., after the 3-year planning phase supported by this NOFO), we will strongly encourage the inclusion of research on integrative prevention, screening, treatment, and recovery support strategies targeting other health conditions that commonly co-occur in these populations, including but not limited to hypertension and other cardiovascular diseases; asthma; obesity; diabetes; cancer; and HIV/AIDS.

Study budgets should provide appropriate levels of funding for community partners commensurate with the roles and level of effort of the community partners in research design and implementation, if applicable. Applicants are encouraged to discuss their specific aims with the NIAAA contact listed prior to submission.

The National Institute of Nursing Research (NINR) supports research to solve pressing health challenges and inform practice and policy - optimizing health and advancing health equity into the future. NINR discovers solutions to health challenges through the lenses of health equity, social determinants of health, population and community health, prevention and health promotion, and systems and models of care.

Drawing on the strengths of nursing’s holistic, contextualized perspective, core values, and broad reach, NINR funds multilevel and cross-sectional research that examines the factors that impact health across the many settings in which nurses work, including homes, schools, workplaces, clinics, justice settings, and the community. Observational, intervention, and implementation research are of interest to NINR.

NIMHD Areas of Research Interest The mission of the National Institute of Minority Health and Health Disparities (NIMHD) is to lead scientific research to improve minority health and reduce health disparities. NIMHD considers race/ethnicity and socioeconomic status as the two pillars of health disparities science .

Thus, NIMHD prioritizes novel and innovative research that examines, addresses, and mitigates the underlying causes, pathways, risks, and inequities adversely impacting the health and well-being of women and girls, particularly among minority health populations (i.e., African Americans, Latinos/Hispanics, American Indians and Alaska Natives, Asian Americans, Native Hawaiians and Pacific Islanders) and socioeconomically disadvantaged populations.

NIMHD also supports research at the intersection of such populations along with other NIH-designated populations experiencing health disparities, (i.e., underserved rural populations, sexual and gender minorities (SGM), and people with disabilities) within the U.S. and its territories. See https://www. nimhd.

nih. gov/about/overview/ . While MCCI is an implementation and dissemination science initiative, NIMHD encourages studies that use multiple domains of influence (e.g., biological, behavioral, sociocultural, environmental, physical environment, health system) and multiple levels of influence (e.g., individual, interpersonal, family, peer group, community, societal) to understand and address health disparities.

See the NIMHD Research Framework: See https://www. nimhd. nih.

gov/about/overview/research-framework/nimhd-framework. html ).

To meet the intersectional aims of research, investigators are encouraged to collaborate with community leaders, community-based organizations, and other relevant stakeholders to support the study and incorporation of physical, social, behavioral, cultural, ethical, structural, environmental, historical and policy factors into research designs, implementation, and dissemination.

Community partnerships (e.g., tribal leadership, academic, private, safety-net health systems, community organizations, public health departments, state and local governments, health care professionals, faith-based organizations, and school or childcare settings) are strongly encouraged. Applicants proposing community-based research, should document existing collaboration with or support from community organizations.

In addition to the Research Areas of Interest delineated above, examples of research topics of special interest to the NIMHD include: Studies that include multidisciplinary, multi-level interventions with engagement of community members and collaborators Studies that address SDoH that impact access to care and health outcomes, such as structural barriers, medical insurance, racism, discrimination, stigma, and biases, e.g., on health outcomes.

Studies that address cultural humility, literacy, numeracy, misinformation, and family models on perceptions, barriers, and adherence to care Studies that involve group-based innovative models in special populations that include SGM adults and persons living with disabilities.

Studies that use novel technologies and mechanisms to address multiple and chronic conditions among racial and ethnic minority women and girls residing in underserved rural communities. Study budgets should provide appropriate levels of funding for community partners commensurate with the roles and level of effort of the community partners in research design and implementation, if applicable.

Applicants are encouraged to discuss their specific aims with the NIMHD contact listed prior to submission. Investigators are encouraged to review the NCCIH Clinical Research Toolbox to learn more about NCCIH's requirements, policies, guidelines, and required templates for clinical trials.

Applicants are strongly encouraged to discuss their proposed research interest with the designated NCCIH Scientific/Research Contact listed below to confirm its relevance to the NCCIH mission areas. NCCIH welcomes pilot studies to prepare for future larger trials. The link, https://www.

nccih. nih. gov/grants/mind-and-body-clinical-trials-funding-opportunities , provides more information about NCCIH funding for intervention refinement and optimization.

Areas of interest to NCCIH include but are not limited to: Trials