Reducing the Duration of Untreated Psychosis in the United States (R34 Clinical Trial Required) | PAR 19 235

Opportunity Information: Apply for PAR 19 235

The National Institutes of Health funding opportunity "Reducing the Duration of Untreated Psychosis in the United States (R34 Clinical Trial Required)" focuses on a major gap in early psychosis care: the long delay between when psychotic symptoms begin and when a young person actually starts receiving evidence-based treatment for a first episode of psychosis (FEP). The announcement notes that roughly 100,000 adolescents and young adults in the U.S. experience an FEP each year, and that the period early in illness is widely viewed as a critical window where effective intervention can prevent or limit long-term disability. Despite that, multiple studies show treatment is often delayed by one to three years, which can allow symptoms, social and school functioning, and overall life stability to deteriorate. The World Health Organization has promoted a much more ambitious benchmark, arguing that the duration of untreated psychosis (DUP) should ideally be brought down to three months or less, underscoring how far typical U.S. timelines can be from best-practice goals.

The grant uses the R34 mechanism, meaning it is intended as a planning and early-stage development project rather than a full-scale effectiveness trial. In practical terms, NIH is looking for projects that can lay the groundwork for larger studies by clarifying what current DUP looks like in real-world U.S. settings and by testing strategies that could realistically shorten that time. A key emphasis is on Coordinated Specialty Care (CSC), which is the leading evidence-based service model for early psychosis in the U.S. The opportunity frames the pathway as a sequence that must work end-to-end: early identification of FEP, rapid referral into CSC, and successful engagement so the person actually receives sustained care. If any part of that chain breaks, DUP stays long and the advantages of early intervention are lost.

Applicants are expected to do four main things. First, they must establish a baseline DUP rate within a defined community or institutional context, essentially measuring how long it currently takes from symptom onset to the start of appropriate FEP care. Second, they must map the real referral pathways that people travel on their way to CSC, which can involve schools, primary care, emergency departments, inpatient units, community mental health clinics, the justice system, and family-driven help-seeking. Third, they must identify bottlenecks and gaps in those pathways, such as points where referrals stall, where symptoms are missed or misattributed, where insurance or eligibility rules slow entry to care, where families do not know where to go, or where stigma and lack of culturally responsive services reduce follow-through. Fourth, they must develop and pilot test feasible strategies designed to substantially reduce DUP for people experiencing FEP. Because this is an R34, the expectation is that the pilot work demonstrates practicality and signals promise, producing the data and operational know-how needed for a larger confirmatory study.

The opportunity is categorized as a discretionary NIH grant in the health funding area (CFDA 93.242). The award ceiling listed is $225,000. It is explicitly labeled "Clinical Trial Required," indicating NIH expects the project to include a clinical trial component consistent with how NIH defines a clinical trial, even if the study is focused on systems, referral processes, or service engagement strategies rather than testing a new medication. The core idea is to move beyond describing the problem and into testing implementable approaches that can speed identification, referral, and uptake of CSC in routine settings.

Eligibility is broad and includes many types of U.S.-based entities: state, county, and local governments; special districts; independent school districts; public and state-controlled institutions of higher education; private institutions of higher education; federally recognized tribal governments and other tribal organizations; public housing authorities; nonprofits with or without 501(c)(3) status; for-profit organizations (other than small businesses); and small businesses, among others. The announcement also highlights additional eligible applicant types such as faith-based and community-based organizations and multiple categories of minority-serving institutions, including Historically Black Colleges and Universities, Hispanic-serving institutions, Tribally Controlled Colleges and Universities, and Alaska Native and Native Hawaiian Serving Institutions, as well as Asian American, Native American, and Pacific Islander Serving Institutions. U.S. territories or possessions are also included. At the same time, fully non-U.S. (foreign) institutions and non-U.S. components of U.S. organizations are not eligible to apply, though certain foreign components as defined under NIH policy may be allowed, which typically means specific elements of a project may occur abroad if justified and permitted under NIH rules while the applicant organization remains U.S.-based.

Overall, the grant is aimed at making early psychosis care faster and more reliable by shining a light on how young people actually reach (or fail to reach) CSC, then using that information to test practical, scalable solutions that can cut delays dramatically. The long-term payoff NIH is targeting is better clinical and functional outcomes for young people with psychosis by treating earlier, when intervention has the greatest chance to change the course of illness.

• The National Institutes of Health in the health sector is offering a public funding opportunity titled "Reducing the Duration of Untreated Psychosis in the United States (R34 Clinical Trial Required)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.242.
• This funding opportunity was created on 2019-04-02.
• Applicants must submit their applications by 2022-05-07. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $225,000.00 in funding.
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501 (c) (3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501 (c) (3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For-profit organizations other than small businesses, Small businesses, Others.

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