Concept Submission Form - Treatments, Interventions or Related Information

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 the Psychological Health Center of Excellence (PHCoE) or the Defense and Veterans Brain Injury Center (DVBIC) who may wish to contact you for further information related to your submission. 

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

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

If you are seeking funding, please visit: http://www.usamraa.army.mil/PagesifundingOpp.aspx.  (link is external)

For grant announcements, please visit: www.grants.gov (link is external) (http://www.grants.gov/ (link is external)).

CAUTION: This is not a secure or protected message system. Please do not provide sensitive personal information such as your social security number or medical condition. 

*If you need a fully accessible version of the form, please download a 508 compliant version here.

Contact Information

If applicable.
Check 4 most closely associated
check 4 most closely associated
What do you hope to gain as a result of this concept submission? e.g. "Request dissemination of information about this program throughot DoD" or "Request DI-IA be aware of the development of our program that shows improved outcomes for PTSD"
e.g. What does the treatment do? What were the results? What are the implications for populations of interest to DHA.
e.g. What is used in the inervention? What is the program length? (e.g. 12 weeks/2 hours per week of group based treatment for Alcohol & Aftercare), etc.
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 disorder"
e.g. Has the intervention been implemented? Where/When/Outcomes, contact information of location and/or points of contact?
e.g. What populations are not recommended to use this treatment/intervention?
e.g. Joint Commission; list citations, short paragraph or Not Available.
i.e. insurers who have approved
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_____".

Evidence to Support Program

Please list supporting empirical evidence. If anecdotal evidence please list as such.
Citation or short paragraph for each or Not Available.
Citation or short paragraph or N/A
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