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Treatments, Interventions or Related Information Concept Submission Form

The Concept Submission Program process is designed to collect information on evidence-based services, products, programs and research that support service members and their families and is available to the general public. The information that a collaborator shares about products or services must be related to psychological health and/or traumatic brain injury.

By completing the submission form, you are agreeing to have your submission reviewed by a representative of Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) who may wish to contact you for further information related to your submission.

DCoE does not award contracts, provide research grants or offer other forms of financial support.

DCoE does not purchase programs, services or products through the concept submission process.

If you are seeking funding please visit: http://www.usamraa.army.mil/pages/baa_forms/index.cfm

For grant announcements please visit: www.grants.gov

Treatments, Interventions or Related Information Concept Submission Form

Title of Treatment/Intervention:


 

This research was funded in whole or in part by:

 

If funded by "Other", please describe:

Referred by:

By whom?:

Contact Information:

Organization Name:

Lead Individual’s Name:


 

Street Address:


 

E-Mail:


   

Phone:


 
 

Website:
(If applicable)

Topic Areas:

(Check 4 most closely associated)






 

Other Topic Area:

Population who would benefit from treatment/intervention:

(Check 4 most closely associated)





Other Population:

What is the purpose of this submission? What do you hope to gain as a result of this concept submission? (e.g. "Request dissemination of this treatment/intervention throughout DoD" or "Request DCoE be aware of our treatment/intervention that shows improved outcomes for PTSD/TBI") (2000 word limit)

 

Focus of Treatment/Intervention (e.g. What does the treatment do? What were the results? What are the implications for populations of interest to DCoE?) (2000 word limit)

Treatment/Intervention components (e.g. What is used in the intervention, what is the treatment length (12 weeks/2 hours per week of group based treatment for Alcohol Abuse Aftercare), etc.) (2000 word limit)

Demographics (e.g. "This intervention assists active duty Service Members post-deployment" or "This treatment/intervention is for inpatient treatment of adolescent military family members ages 12-18 with mood disorders") (2000 word limit)

Current Populations already involved with treatment/intervention (e.g. has intervention been implemented? Where/When/Outcomes, contact information of location and/or points of contact?) (2000 word limit)

Contraindications for Treatment/Interventions (e.g. What populations are not recommended to use this treatment/intervention?) (2000 word limit)

Accreditations (e.g. Joint Commission) (list citations, short paragraph or Not Available)

Approvals for Third Party Reimbursement (i.e. insurers who have approved)

Future activities/plans (e.g. "We will be implementing this intervention at _____" or "We are refining/expanding our treatment to _____” or "We have applied for a grant with _______.”) (2000 word limit)

Additional information DCoE should know (2000 word limit)

Evidence to Support Intervention

Please list supporting empirical evidence for the treatment. If anecdotal evidence please list as such.

Randomized Controlled Studies: (citation or short paragraph for each or Not/Available)

Case Studies/Case Reports/Anecdotal Evidence: (Citation or short paragraph or N/A)

By completing the submission form, you are agreeing to have your submission reviewed by a representative of DCoE who may wish to contact you for further information related to your submission.

DCoE does not award contracts, provide research grants or offer other forms of financial support.

DCoE does not purchase programs, services or products through the concept submission process.

If you are seeking funding please visit: http://www.usamraa.army.mil/pages/baa_forms/index.cfm

For grant announcements please visit: www.grants.gov