[Federal Register Volume 59, Number 167 (Tuesday, August 30, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-21290]


[[Page Unknown]]

[Federal Register: August 30, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration

 

Community Support Program: Cooperative Agreements for Employment 
Intervention Demonstration Program

AGENCY: Center for Mental Health Services, Substance Abuse and Mental 
Health Services Administration (SAMHSA), HHS.

ACTION: Notice of availability of funds and request for applications.

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    *It is important to note that applications are invited based on 
the funding levels proposed in the President's budget for fiscal 
year 1995. However, this RFA is being announced prior to an 
appropriation of funds in order to allow applicants sufficient time 
to establish collaboration and coordination and prepare 
applications. Solicitation of applications in advance of an 
appropriation will also enable the award of appropriated grant funds 
in the most expeditious manner and allow prompt implementation and 
evaluation of promising employment intervention programs for adults 
with severe mental illnesses. All applicants should understand, 
however, that final appropriation action will be necessary in order 
for CMHS to fund any applications. Questions regarding the status of 
the appropriation of funds should be directed to the program 
official listed under Contacts for Additional Information in this 
notice.

SUMMARY: The Center for Mental Health Services (CMHS) announces the 
availability of demonstration grants to document the effectiveness of 
programs designed to enhance competitive employment for adults with 
severe mental illnesses. Funds will be awarded through the Community 
Support Program (CSP) of the Division of Demonstration Programs of 
CMHS. This request for applications (RFA) solicits applications for two 
types of awards:

Demonstration Sites and a Coordinating Center.

    This demonstration program addresses a priority mental health need: 
the enhancement of competitive employment for adults with severe mental 
illnesses. A collaborative, multisite approach is essential to test the 
effectiveness of different employment interventions and synthesize the 
intervention results. Because of the complexity of the program, 
requiring substantial programmatic involvement of CMHS staff to 
facilitate communication and coordination across projects, the 
cooperative agreement mechanism is being used.
    This notice consists of three parts:
    Part I covers information on the legislative authority and the 
applicable regulations and policies related to the Community Support 
Program: Cooperative Agreements for Employment Intervention 
Demonstration Program.
    Part II describes the target population, the issue, and the 
programmatic goal and discusses eligibility, availability of funds, 
period of support and the receipt date for applications.
    Part III describes special requirements of the program, the 
application process, the review and award criteria and lists contacts 
for additional information.

Part I--Legislative Authority and Other Applicable Regulations and 
Policies

    Cooperative agreements awarded under this RFA are authorized under 
Section 520A of the Public Health Service Act, as amended (42 U.S.C. 
290bb-32).
    Federal regulations at Title 45 CFR Parts 74 and 92, generic 
requirements concerning the administration of grants, are applicable to 
these awards.
    Grants must be administered in accordance with the PHS Grants 
Policy Statement dated April 1, 1994 (DHHS Publication No. (OASH) 94-
50,000 (Rev)). This policy statement is effective for all grants with 
budget periods beginning on or after April 1, 1994. It also reflects 
policies with earlier effective dates. This document supersedes the PHS 
Grants Policy Statement dated October 1, 1990, as updated September 1, 
1991.
    The Catalog of Federal Domestic Assistance (CFDA) number for this 
program is 93.125.
    Reporting Requirements: Interim and final progress reports and 
financial status reports will be required and specified to awardees in 
accord with PHS Grants Policy requirements.
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of Healthy People 
20001, a PHS-led national activity for setting priority areas. 
This RFA, ``Employment Intervention Demonstration Program,'' is related 
to the objectives set forth in Chapter 6, Mental Health and Mental 
Disorders, in Healthy People 2000: National Health Promotion and 
Disease Prevention Objectives.
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    \1\Potential applicants may obtain a copy of Healthy People 2000 
(Full Report: Stock No. 017-001-00474-0; or Summary Report: Stock 
No. 017-001-00473-1) through the Superintendent of Documents, 
Government Printing Office, Washington, D.C. 20402-9325 (Telephone: 
202-783-3238).
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Part II--Target Population, Issue and the Programmatic Goal and Project 
Requirements and Activities, Eligibility and Application Receipt Date

    Purpose: The goal of this RFA is the generation of knowledge about 
effective approaches for enhancing competitive employment for adults 
with severe mental illnesses through support for the implementation and 
evaluation of promising employment intervention programs. Applications 
are being solicited for Demonstration Sites to conduct a multisite, 
cooperative study of employment interventions to enhance competitive 
employment. Applications are also being sought for a Coordinating 
Center to provide overall coordination and data management and to carry 
out the common protocol which will be developed.
    Target Population: The population of concern for CSP grants 
includes individuals 18 years and older with severe mental illnesses 
(including, but not limited to, schizophrenia, schizoaffective 
disorders, mood disorders, and severe personality disorders) that 
substantially interfere with a person's ability to carry out such 
primary aspects of daily living as self-care, household management, 
interpersonal relationships, and work or school.
    Statement of Issue: Rehabilitation is an essential component of 
care for adults with severe mental illnesses. In order to enhance 
independent living as fully as possible, rehabilitation services need 
to include appropriate vocational rehabilitation, which may include: 
assessment of potential for employment, training, job placement, 
continuing support, and reasonable accommodations at the work site. In 
addition to providing remuneration and social contacts, employment may 
promote improvements in self esteem, independence, community 
integration, and self-management of illness. People with psychiatric 
disabilities are the second largest group of applicants for vocational 
rehabilitation services and have the lowest rate of success. Even with 
high client motivation and the support of families, rates of employment 
for this population are very low, ranging from 10 percent to 25 
percent.
    Special attention should be focused on persons from ethnic minority 
communities who are over-represented in the adult severe mental illness 
population. With involvement of these community members at each stage 
of design, implementation and evaluation, culturally competent 
interventions can be successful.
    Program Goal: This demonstration program addresses a priority 
mental health need: competitive employment in integrated settings for 
adults with severe mental illnesses. Competitive employment is defined 
as a paid position which is open to anyone and pays at least minimum 
wages. Employment may include positions in a mental health system as 
long as the positions are not restricted to adults with diagnoses of 
severe mental illnesses. On-site and/or off-site long-term supports may 
be utilized. Because there is a need for systematically bringing 
together information concerning employment intervention programs, CMHS 
is initiating this program to determine the effectiveness of 
interventions. Findings concerning the most effective approaches and 
the associated direct costs are needed by policy makers and program 
planners.
    This program of study is focussed on employment interventions which 
will lead to competitive employment. The goal of the intervention, 
which may include vocational training and environmental accommodations, 
must be competitive employment in mainstream (not sheltered) work 
environments. Outcome measures may include, but are not limited to, 
days of paid employment within a specified time interval, level of 
social and occupational functioning, and consumer and employer 
satisfaction.2 Effective employment interventions are an integral 
part of a community support system and, therefore, are expected to be 
integrated with other services as appropriate.
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    \2\Technical assistance, provided upon request, will include a 
review of instruments prepared by Cook, J., Bond, G., Hoffschmidt, 
S., et al., Assessing Vocational Performance Among Persons with 
Severe Mental Illness, published by Thresholds National Research and 
Training Center, Chicago, IL: 1992.
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    The goals of this program address the themes of the Secretary of 
HHS: fostering independence through empowering people served; 
preventing future problems; and improving services to customers through 
modern management approaches.
    Demonstration Site applicants will develop, implement, and evaluate 
an intervention with the goal of improving competitive employment. This 
multisite, cooperative agreement will also develop a common study 
protocol. After grantees are selected for funding, grantees and CMHS 
staff will identify issues and study questions which can be examined by 
utilizing the data elements in common across the Demonstration Sites. 
The utilization of agreed-upon measures which are in common across 
Demonstration Sites provides the opportunity to compare intervention 
effects for different populations in different geographic locations, 
thereby enhancing the generalizability of results, and allows for 
statistical analyses that assess the effects of multiple factors on 
employment status outcomes.
    Progress in employment is often characterized by episodes of 
productive employment followed by unemployment. Therefore, a long-term 
perspective is needed to appropriately assess outcomes of an 
intervention. Successful applicants for this program of study will 
include data collection over a period of at least 2 years, and a longer 
time interval for data collection is encouraged.
    The primary goal of this RFA is the determination of the 
effectiveness of interventions. However, information on costs will be 
valuable in informing policy decisions for resource allocations. 
Effectiveness is defined as the improvement of positive outcomes and 
the reduction of adverse outcomes, regardless of costs. An important 
component in studying the value of an intervention is the determination 
of the costs of the intervention. Because this is an initial 
exploration of costs, the focus will be limited to actual direct 
expenditures for employment intervention programs and employment site 
activities. Costs unique to the evaluation component will not be 
included in the analyses. Cost information from this demonstration 
program may provide the basis for future studies of cost effectiveness 
that would likely be expanded to incorporate financial costs, indirect 
costs, and lost-opportunity costs.
    Structure and Phases of the MultiSite Program: The study will 
involve the cooperation of personnel from (1) a Coordinating Center, 
(2) the Demonstration Sites, and (3) the CMHS staff.
    Awards will be made for a project period of up to 5 years. For 
planning and budgeting purposes, the study can be envisioned as 
proceeding in the following three phases.

Phase I: Development of a collaborative study plan (common protocol); 
development, refinement, and pilot testing of common methodological 
procedures and instruments (baseline and outcome); training in the 
common field procedures; examination of validity of proposed 
instruments and development of a centralized database and coordinating 
structure, intervention start up (months 1-6);
Phase II: Full implementation of service programs, identification and 
enrollment of clients; ongoing data collection and evaluation 
activities; interim data analyses (months 6-30);
Phase III: Phase-down of intervention programs; end enrollment of 
clients in the study; complete follow-up data collection for enrolled 
clients; conduct data analyses and produce reports and publications 
(months 30-60).

    Role of Demonstration Sites: Each Demonstration Site grantee, in 
collaboration with the Federal staff and the Coordinating Center, will 
have responsibility at their own site for service program planning and 
implementation, client enrollment and follow up, data collection, 
preliminary and final data analysis and interpretation, quality 
control, and preparation of reports and publications. In addition, each 
Demonstration Site grantee will participate in the development and 
activities of the common protocol including providing data to the 
Coordinating Center.
    Role of the Coordinating Center: For the common protocol which will 
be developed in the planning phase, the Coordinating Center will 
provide overall study coordination, including data management and 
analysis, training in common procedures, distribution of common 
materials to all study sites, monitoring of data quality and analysis 
of cost data collected by the Demonstration Sites. The Coordinating 
Center will also coordinate the pilot testing of the common core 
instruments, as agreed upon in the planning phase. CMHS staff will work 
with and monitor the Coordinating Center. The Coordinating Center will 
develop and maintain a common data repository, containing those data 
elements collected by each Demonstration Site which will be used in the 
common protocol.
    Role of CMHS Staff: CMHS staff will be active participants in all 
aspects of the cooperative agreements and will serve as collaborators 
with project directors from the Demonstration Sites and the 
Coordinating Center. CMHS staff have overall responsibility for 
monitoring the conduct and progress of this program and will make 
recommendations regarding continuance of the program. CMHS staff will 
provide substantial input, in collaboration with the grantees, both in 
the planning and conduct of this program.
    Role of the Steering Committee: The Steering Committee will be 
composed of the project director of the Coordinating Center, the 
project directors from each of the Demonstration Sites, and CMHS staff. 
In addition, for Demonstration Sites where the State mental health 
authority is not the direct applicant, the State mental health 
authority will be invited to be a participant as a voting member of the 
committee.
    All participating grantees will agree to abide by the common 
protocol study design and policy recommendations developed by the 
Steering Committee and any required CMHS approvals set forth in the 
terms and conditions of this cooperative agreement.
    Eligibility: Eligible applicants include States, political 
subdivisions of states and nonprofit private agencies. Therefore, State 
mental health authorities, as well as one or more of public 
organizations in a State, such as units of State and local governments, 
and nonprofit organizations such as community-based organizations, 
universities, colleges and hospitals may be direct applicants.
    Entities may apply for either and/or both types of awards 
(Demonstration Site and/or Coordination Center).
    Availability of Funds: It is estimated that approximately $2.3 
million will be available to support approximately four to five awards 
to Demonstration Sites and a Coordinating Center under this RFA in FY 
95. For each of the 5 years, an average of approximately $300,000 per 
year will be available for the Coordinating Center and an average of 
$400,000 to $500,000 for each of the Demonstration Sites for each year. 
It is anticipated that in years one and five, funding of the 
Coordinating Center will be higher than in years two through four. 
Funding for Demonstration Sites will be lower in years one and five, 
and higher in years two through four. Actual funding levels will depend 
upon the availability of appropriated funds.

    (Note: CMHS is required by the Public Health Service Act to make 
available 15 percent of the funds appropriated under Section 520A 
for projects in rural areas.)

    Period of Support: Support may be requested for a period of up to 5 
years. Annual awards will be made subject to continued availability of 
funds and progress achieved.
    Applications Receipt Date and Review Schedule: The schedule for 
receipt and review of applications under this announcement is as 
follows: 

------------------------------------------------------------------------
                                                         Earliest start 
  Receipt date        IRG review       Council review         date      
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Jan. 10, 1995....  March 1995.......  May 1995........  June 1995.      
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    Consequences of Late Submission: Applications received after the 
above receipt date will not be accepted and will be returned to the 
applicant without review.
    The DRG system requires that applications must be received by the 
published application receipt date(s). However, an application received 
after the deadline may be acceptable if it carries a legible proof-of-
mailing date assigned by the carrier and the proof-of-mailing date is 
not later than one week prior to the deadline date. Private metered 
postmarks are not accepted as proof of timely mailing. If the receipt 
date falls on a weekend, it will be extended to the following Monday; 
if the date falls on a national holiday, it will be extended to the 
following work day.

Part III--Special Requirements, Review/Award Criteria and Contacts for 
Additional Information

    Letter of Intent: Organizations planning to submit an application 
in response to this announcement are requested to submit a letter of 
intent at least 30 days prior to the receipt date. Such notification is 
used by the Center for Mental Health Services for purposes of review 
and program planning. This letter is voluntary and does not obligate 
the person/organization to submit an application. In addition, the 
letter should be no longer than one page and should succinctly 
indicate:

--The number and title of the RFA.
--The name of the potential applicant organization, city and state.
--The name and affiliation of the proposed project director, i.e., the 
individual who will be assigned to coordinate the development and 
conduct of the project.
--The overall scope of the proposed project, including a brief 
description of the likely goals and objectives.

    Letters of intent should be directed to: Barbara Silver, PhD, 
Acting Director, Office of Extramural Policy and Review, Center for 
Mental Health Services, 5600 Fishers Lane, Room 18C-07, Rockville, 
Maryland 20857, Attn: RFA/Letter of Intent.
    Coordination with Other Federal/Non-Federal Programs: Applicants 
seeking support under this announcement are encouraged to coordinate 
with other programs. Program coordination helps to better serve the 
multiple needs of the patient/client population, maximize the impact of 
available resources, and eliminate duplication of services. Applicants 
should identify the coordinating organizations by name and address and 
describe the process to be used for coordinating efforts. Letters of 
commitment specifying the kind(s) and level of support from 
organizations (both Federal and non-Federal) which have agreed to work 
with the applicant must be attached to this application. CMHS will 
consider an applicant's proposed coordination with other Federal/non-
Federal programs in its award decision-making process. (Please see 
Award Criteria section.) A list of Federal programs that applicants may 
coordinate with is included in the Application kit.
    Single State Agency Coordination: Coordination with the Single 
State Agency (SSA) for mental health is encouraged to ensure 
communication, reduce duplication, and facilitate continuity. Therefore 
applicants who are not State mental health authorities must include a 
copy of a letter sent to the SSA briefly describing the grant 
application. A list of SSAs can be found in the grant application kit. 
If the target population falls within the jurisdiction of more than one 
State, all representative SSAs should be involved.
    Intergovernmental Review (E.O. 12372): Applications submitted in 
response to this announcement are subject to the intergovernmental 
review requirements of Executive Order 12372, as implemented through 
DHHS regulations at 45 CFR Part 100. E.O. 12372 sets up a system for 
State and local government review of applications for Federal financial 
assistance. Applicants (other than federally recognized Indian Tribal 
Authorities) should contact the State's Single Point of Contact (SPOC) 
as early as possible to alert them to the prospective application(s) 
and to receive any necessary instructions on the State process. For 
proposed projects serving more than one State, the applicant is advised 
to contact the SPOC of each affected State. A current listing of SPOCs 
is included in the application kit. The SPOC should send any State 
process recommendations to the following address: Barbara Silver, PhD, 
Acting Director, Office of Extramural Policy and Review, Center for 
Mental Health Services, 5600 Fishers Lane, Room 18C-07, Rockville, MD 
20857, Attn: SPOC.
    The due date for State process recommendations is no later than 60 
days after the deadline date for the receipt of applications. The 
Center for Mental Health Services does not guarantee to accommodate or 
explain SPOC comments that are received after the 60-day cut-off.
    Public Health System Reporting Requirements: This program is not 
subject to the Public Health System Reporting Requirements.
    Promoting Nonuse of Tobacco: Studies have clearly established that 
the use of tobacco products increases mortality and morbidity, not only 
for the primary users of these products but for those in close 
proximity to the user. Statistics published by the National Cancer 
Institute indicate that cigarette smoking and chewing of tobacco are 
responsible for as many as 1,500 deaths per day in the United States. 
Recent studies conducted by the Environmental Protection Agency 
indicate that prolonged exposure to second-hand smoke significantly 
increases the probability of developing heart and lung disease.
    Consistent with its mission to protect and advance the physical and 
mental health of the American people, it is the policy of PHS to 
strongly encourage all recipients of the PHS grants to provide a smoke-
free work place and promote the nonuse of tobacco products. It is also 
the policy of PHS to encourage those recipients which already have a 
smoke-free work place and promote the nonuse of tobacco products to 
continue such practices. Particular attention should be given to 
avoiding exposure to secondary smoke by pregnant women and children. 
Additionally, CMHS strongly encourages all cooperative agreement 
applicants to implement policies and activities that promote the nonuse 
of tobacco products by clients/patients as a goal of treatment.
    Application Procedures: Completely separate applications must be 
submitted for Demonstration Sites and for the Coordinating Center.
    All applicants must use application form PHS 5161-1 (Rev. 7/92), 
which contains Standard Form 424 (face page). Grant application kits 
(including form PHS 5161-1 with Standard Form 424, complete application 
procedures, and accompanying guidance materials for the narrative 
approved under OMB No. 0937-0189) may be obtained from: Community 
Support Program, Center for Mental Health Services, 5600 Fishers Lane, 
Room 11C-22, Rockville, MD 20857, 301/443-3653.
    Applicants must submit: (1) an original copy signed by the 
authorized official of the applicant organization, with the appropriate 
appendices; and (2) two additional, legible copies of the application 
and all appendices to the Division of Research Grants, NIH. Center for 
Mental Health Services Programs, Division of Research Grants, NIH, 
Westwood Building, Room 240, 5333 Westbard Avenue, Bethesda, Maryland 
20892*.
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    *If an overnight carrier or express mail is used, the Zip Code 
is 20816.
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    Review Process: Applications submitted in response to this RFA will 
be reviewed for technical merit in accordance with established PHS/
SAMHSA peer review procedures for grants.
    Applications that are accepted for review will be assigned to an 
Initial Review Group (IRG) composed primarily of non-Federal experts. 
Notification of the IRG's recommendation will be sent to the applicant 
upon completion of the initial review. In addition, the IRG 
recommendations on technical merit of applications will undergo a 
second level of review by the appropriate advisory council whose review 
may be based on policy considerations as well as technical merit. 
Applications may be considered for funding only if the advisory council 
concurs with the IRG's recommendation for approval.
    Review Criteria for Demonstration Site Applications: The points 
noted in the parentheses for each criterion indicate the maximum number 
of points the reviewers may assign to that criterion. These points will 
be used to calculate a raw score for each application. The raw score 
will be converted to the official priority score.
Significance of the Project (30)
     Potential significance of the proposed project for 
increasing the knowledge of effective employment interventions, 
including original approaches and documenting the effectiveness of 
established approaches.
     Appropriateness of the applicant's proposed project to the 
goals of this announcement.
     Consistency of the proposed project relative to the 
knowledge base of evaluating employment interventions.
Adequacy and Appropriateness of Project Plans (20)
     In terms of the applicant's stated goals and objectives.
     In terms of the project management plan, implementation 
plan, and proposed staffing and resources.
     In terms of cultural competency for all aspects of project 
plans, addressing factors such as gender, age, ethnicity, and other 
relevant characteristics.
Adequacy and Appropriateness of Evaluation Plans (35)
     In terms of the adequacy to determine the effectiveness of 
the intervention, including overall effectiveness, relative 
effectiveness of components, and cost effectiveness.
     In terms of the applicant's stated goals and objectives.
     In terms of the proposed staffing and resources, project 
management plan, and implementation plan.
     In terms of cultural competency for all aspects of 
evaluation plans, addressing factors such as gender, age, ethnicity, 
and other relevant characteristics.
     Appropriateness of Staffing, Project Organization, and 
Resources (15)
     Qualifications and experience of the project director and 
other key personnel, including representation of appropriate cultural 
groups in staff.
     Adequacy of available resources (e.g., facilities, 
equipment).
     Capability and experience of the applicant organization 
with multisite projects.
     Adequacy of support for the project from other relevant 
organizations.
     Appropriateness of the proposed budget for each of the 
requested years (the IRG may recommend either increases or decreases in 
the budget based on their review of the application or on the adequacy 
of the budget justification).

Review Criteria for Coordinating Center Applications:

Significance of the Project (20)
     Understanding the issues and advantages in using a 
multisite approach in the development of the common protocol, including 
the logistics of convening program meetings.
     Adequacy of plans for enhancing cooperation, and 
preventing or ameliorating problems in cooperation among grantees.
Adequacy and Appropriateness of Evaluation Plans (40)
     In terms of development of the common protocol, training, 
an appropriate data base structure, security measures and procedures 
for safeguarding of data.
     In terms of data analysis based on the common protocol.
     In terms of potential evaluation concerns unique to this 
population and this type of program.
Appropriateness of Staffing, Project Organization, and Resources (40)
     Qualifications and experience of the proposed staff in 
similar multisite efforts.
     Adequacy of the existing and proposed facilities and 
resources.
     Appropriateness of proposed budget for each of the 
requested years.
    Award Criteria: Applications recommended for approval by the 
Initial Review Group and the CMHS Advisory Council will be considered 
for funding on the basis of their overall technical merit as determined 
through the review process. Other award considerations may include:
     Availability of funds.
     Coordination with other Federal/non-Federal programs.
     For Demonstration Sites, complementarity of designs and 
interventions, including factors such as ethnic groups, geographic 
area, socioeconomic status, mental illness diagnosis.

    In accordance 520A of the Public Health Service Act, no more than 
10 percent of a grant may be expended for administrative expenses.
Contacts for Additional Information: Questions concerning program 
issues may be directed to: Martha Ann Carey, PhD, RN, Community Support 
Program, Center for Mental Health Services, 5600 Fishers Lane, room 
11C-22, Rockville, MD 20857, (301) 443-3653.
    Questions regarding grants management issues may be directed to: 
Ms. Carole Edison, Grants Management Office, Center for Mental Health 
Services, 5600 Fishers Lane, room 15C-05, Rockville, Maryland 20857, 
(301) 443-4456.

    Dated: August 24, 1994.
Richard Kopanda,
Acting Executive Officer, SAMHSA.
[FR Doc. 94-21290 Filed 8-29-94; 8:45 am]
BILLING CODE 4162-20-P