Attachment_A_-_Statement_of_Work.pdf

HRSA COE for Behavioral Health Technical Assistance RFP No: 19-250-SOL-00045

Source Selection Sensitive

Attachment A – Statement of Work

HRSA Center of Excellence for Behavioral Health Technical Assistance

I. Background Information

As the federal agency with the mission to provide health care services in underserved communities, the availability of behavioral health services for patients seen at HRSA-funded organizations is critical.

Approximately 50% of all behavioral health disorders are treated in primary care, and when patients are referred to an outpatient behavioral health clinic, upwards of 50% do not make the first appointment.1 With over 5,000 Mental Health Shortage Areas across the nation, access to a range of behavioral health services in primary care settings is needed.2 Recent

HRSA National Center for Workforce Analysis projections indicate that for many behavioral health disciplines there will be deficits in the workforce by 2030.3

The opioid epidemic continues to take a heavy toll across the nation. With opioid overdose deaths five times higher in 2016 than 19994, there has been a great increase in the level of effort in primary care settings to address this epidemic. Research findings indicate a 650% increase in the number of buprenorphine prescriptions filled by primary care providers in

2014 compared to ten years earlier.5

The benefits of integrated care are clear. 80% of people with a behavioral health disorder will visit a primary care provider at least once during the year.6 One study found that the use of health care services decreased by 16% for those receiving behavioral health treatment in primary care settings, while it increased by 12% for patients who were not treated for their behavioral health care needs when seen regularly by a primary care organization. 7 Cost can be impacted as well – patients living with diabetes and receiving treatment for depression in primary care had $896 lower total healthcare costs over 24 months than similar patients not receiving needed behavioral health services in primary care. 8

The term “behavioral health” in this document includes activities to support the promotion of emotional health; the prevention of mental illnesses, e.g. depression and anxiety, substance use disorders (SUDs) including Opioid Use Disorder (OUD), psychological distress and suicide; and treatments and services for mental and/or substance use disorders; and recovery supports.

1 www.pcpcc.org/content/benefits-integration-behavioral-health 2 https://data.hrsa.gov/tools/shortage-area/hpsa-find 3 https://bhw.hrsa.gov/health-workforce-analysis/research/projections/behavioral-health-workforce-projections 4 www.cdc.gov/drugoverdose/data/statedeaths.html 5 Health Affairs, Vol. 38, No. 1, Wen, Borders and Cummings 6 https://www.pcpcc.org/content/benefits-integration-behavioral-health 7 https://www.pcpcc.org/content/benefits-integration-behavioral-health 8 https://www.pcpcc.org/content/benefits-integration-behavioral-health http://www.pcpcc.org/content/benefits-integration-behavioral-health https://data.hrsa.gov/tools/shortage-area/hpsa-find https://bhw.hrsa.gov/health-workforce-analysis/research/projections/behavioral-health-workforce-projections http://www.cdc.gov/drugoverdose/data/statedeaths.html https://www.pcpcc.org/content/benefits-integration-behavioral-health https://www.pcpcc.org/content/benefits-integration-behavioral-health https://www.pcpcc.org/content/benefits-integration-behavioral-health

Integrated behavioral health: “combines medical and behavioral health services in a collaborative way to address problems identified during primary care visits. Primary care providers and behavioral health specialists work together with patients and families to address mental health, substance abuse, and behaviors that affect physical health”.9

The purpose of this contract is to provide training and technical assistance to HRSA grantees and stakeholders (e.g., states, territories, federally recognized tribes and community-based organizations), to support the integration of evidence-based, culturally and linguistically competent behavioral health services in primary care settings.

The Health Resources and Services Administration (HRSA)

The United States Department of Health and Human Services (HHS), Health Resources and

Services Administration (HRSA), is the primary federal agency for improving health care to people across the lifespan who are geographically isolated, economically or medically vulnerable.

HRSA supports a “no wrong-door approach” to behavioral health services, emphasizing the availability of a highly skilled, professionally diverse and trusted workforce. The health care team provides screening, direct services and referrals in systems of care designed to address behavioral health concerns. HRSA-funded primary care safety net providers utilize a wide range of models to achieve behavioral health integration, including: primary care provider/behavioral health clinician brief interventions, care manager models, and those that support fully integrated collaborative behavioral and primary care staffing. Patients receive high-quality primary care with behavioral health services to help them cope with issues such as stress, depression, SUDs, and problems resulting from living with a chronic physical health condition.

Target populations include, but are not limited to: older adults, infants, children, children with special health care needs, adolescents, and transition-age young adults, pregnant women, rural populations, migrant workers, tribal populations, dually diagnosed persons, minorities, low-income families, incarcerated individuals transitioning to community care, and families affected by SUDs and/or OUD. Specific HRSA-funded programs that support the integration of behavioral health with primary care are described in Appendix B.

This contract will align with the HHS 5-point strategy to combat the opioid crisis, which includes the following priorities:

1) Access: Better Prevention, Treatment, and Recovery Services

2) Data: Better Data on the Epidemic

3) Pain: Better Pain Management

4) Overdoses: Better Targeting of Overdose-Reversing Drugs

5) Research: Better Research on Pain and Addiction

TA needs of HRSA safety net provider and training education programs regarding behavioral health integration include integrated treatment models, workforce, clinical workflow and

9 https://integrationacademy.ahrq.gov/sites/default/files/AHRQ_Lexicon_Collateral_Terms.pdf) https://www.hhs.gov/opioids/about-the-epidemic/hhs-response/index.html https://integrationacademy.ahrq.gov/sites/default/files/AHRQ_Lexicon_Collateral_Terms.pdf informatics, service to system coordination, and financial sustainability. For more examples of

TA needs see Appendix A.

The audience for this TA Center will be HRSA Grantees funded by these bureaus and offices, with a particular focus on:

Bureau of Primary Health Care (BPHC) – HRSA-supported health centers.

Bureau of Health Workforce (BHW) – OUD and SUD-focused behavioral health workforce development programs and their communities of practice. Current programs include BHWET, BHWET Opioid Supplement, OWEP-Paraprofessionals, OWEP-

Professionals, and GPE.

Federal Office of Rural Health Policy (FORHP) - Rural Consortiums funded by HRSA;

prospective awardees; and other rural stakeholders.

HIV/AIDS Bureau (HAB) – HRSA-funded HIV provider organizations, including State or local government or other public or private nonprofit or for-profit entities.

Maternal and Child Health Bureau (MCHB) – MCH-serving workforce in HRSA-funded settings, including: Home Visitors; Community Health Workers; Primary Care Clinicians

(e.g., Pediatricians; OB/GYNs; Family Physicians; Nurse Practitioners; Physician

Assistants); Academics; Specialists (e.g., Social Workers; Psychologists; Counselors;

Psychiatrists; Developmental Behavioral Pediatricians); and interdisciplinary trainees.

The key functions of the COE include the following:

Supporting integrated behavioral health services in HRSA-funded primary care settings.

Supporting grantees who seek to initiate and sustain medication assisted treatment

(MAT) programs for substance use disorders.

Workforce training and knowledge enhancement.

Building systems of care and the financial sustainability of grantees that provide integrated behavioral health/primary care.

Implementing cloud web hosting, cloud webinar/virtual meetings, and a cloud eLearning

Management System (LMS) (optional) for the Center of Excellence for Behavioral

Health.

Specifically, the COE will establish a centralized training and technical assistance (T/TA) program with regional and topical presence (that addresses geographic disparities), to provide tailored T/TA to HRSA’s programs and stakeholders, including:

Delivering evidence-based T/TA services to HRSA-supported safety net providers for the primary care integration of behavioral health and SUD services through a Learning

Health System (LHS).10

Addressing the needs of behavioral health workforce development programs, focusing on the delivery of workforce training related to the provision of OUD and other SUD prevention, treatment, and recovery support services.

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America http://www.nationalacademies.org/hmd/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health- Care-in-America.aspx http://www.nationalacademies.org/hmd/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx http://www.nationalacademies.org/hmd/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx

Supporting rural communities in SUD/OUD prevention, diagnosis, treatment, and recovery.

Delivering evidence-based training and technical assistance services to HRSA-supported

HIV service providers for the integration of primary care and behavioral health and

OUD/SUD services.

Meeting workforce needs to tailor services to women, children, adolescents and transition-age young adults who receive care in HRSA-funded settings.

The purpose and identification of need for each T/TA modality will be based on the available evidence, including, at times, targeting grantees who can benefit the most from the T/TA.

Specific tasks will include clearly articulated plans informed by data (for example, Health

Profession Shortage Area [HPSA] designation and grantees with below average performance on depression screening or Screening, Brief Intervention, Referral to Treatment [SBIRT] visits). T/TA will also be informed by the models of care specific to the grantee community.

For example, the Contractor should understand the profile and working environment of health centers, HIV provider organizations, maternal and child health providers, rural providers, and academic training institutions.

The Contractor/COE will actively engage and collaborate with HRSA-funded TA centers and clearinghouses, such as: the HIV/AIDS Bureau-funded Behavioral Health Workforce, and the National Organization of State and TargetHIV Center, the Home Visiting Improvement

Action Center (HV-ImpACT), the Healthy Start EPIC Center, the National Association of

Community Health Centers, National Health Care for the Homeless Council, the Rural

Health Information Hub (RHIhub), and the University of Michigan Behavioral Health

Workforce Research Center. The T/TA Contractor shall use these collaborations to co-brand

T/TA deliverables where appropriate, align efforts, and disseminate information on available

T/TA. The Contractor shall leverage the COE to share findings from T/TA activities with

HRSA stakeholders via appropriate communication channels.

Strategic Partnerships: The COE will collaborate with key partners to develop T/TA activities and support recruitment of HRSA grantees in these activities. These key partners will be included as part of the Learning Health System and the COE will ensure that there is no duplication, but rather strategic coordination, of T/TA activities among key HRSA partners, such as:

Health Centers: Primary Care Associations (PCAs), HRSA/BPHC National

Cooperative Agreement (NCA) partners, Health Center Controlled Networks

(HCCNs)

Health Professions: HRSA Workforce Research Centers, American Psychological

Association (APA), American Psychiatric Association (APA) National Association of

Social Workers (NASW), National Board of Certified Counselors (NBCC), American

Counseling Association (ACA), American Dental Association (ADA), American

Medical Association(AMA), American Association of Nurse Practitioners (AANP), National Association for Addiction Professionals(NAAP), American Psychiatric

Nurses Association (APNA), American Occupational Therapy Association (AOTA), International Nurses Society on Addictions, American Academy of Pediatrics (AAP), and the American College of Obstetricians and Gynecologists (ACOG).

http://www.ruralhealthinfo.org/ http://www.ruralhealthinfo.org/

HIV/AIDS: AIDS Education and Training Centers (AETC), National State and

Territories AIDS Directors, (NASTAD).

Rural Health: State Offices of Rural Health (SORHs), the National Organization of

State Offices of Rural Health (NOSORH), National Organization of State and Local

Officials (NOSLO), National Rural Health Association (NRHA), Rural Health

Research Centers (RHRCs), National Cooperative of Health Networks Association

(NCHN), Rural Health Information Hub (RHIhub), and the Rural Communities

Opioid Response Program Technical Assistance (RCORP-TA) provider.

Maternal and Child Health: American Academy of Pediatrics (AAP), American

Academy of Obstetricians and Gynecologists (ACOG), HRSA/BPHC NCA partners, state agencies including those that administer the MCH Title V Block Grant, HRSA

Workforce Research Centers.

II. Purpose

The purpose of this procurement is to provide technical assistance on evidence-based interventions and promising practices that support the integration of behavioral health in HRSA-funded safety net provider organizations and HRSA-funded training/education programs through a HRSA Center of Excellence (COE) for Behavioral Health Technical Assistance. The COE will address both mental health and substance use disorders (“behavioral health”), with an emphasis on the current opioid epidemic.

III. Period of Performance/Place of Performance

The period of performance is a base period of 12 months from the effective date of the contract

(EDOC) and two (2) 12-month option periods. The primary place of performance is off-site.

IV. Tasks

Task 1: Organizational Meetings and Quality Assurance

Task 1.1 Contract Meetings

This task describes the kick-off meetings, the purpose of which are to orient the Contractor to the project, introduce the Contractor to key government staff, and establish meeting schedules and other operating timelines and procedures.

Task 1.1.1: Kick-Off Meetings

The Contractor shall:

1.1.1.1 Conduct a half-day kick-off meeting with the COR and key HRSA staff within five (5) days of the EDOC, virtually or in person at HRSA Headquarters if locally-based within the DC-metropolitan area. The objectives of the kick-off meetings are to discuss the expectations of the contract including goals, objectives, processes, staffing, timelines, deliverables, proposed approaches to the contract tasks including the monthly progress report format (Task 1.2.2), the

Project Management Plan (PMP), and identify any potential problem areas.

1.1.1.2 Conduct five (5) kick-off meetings with the COR and key Bureau/Office HRSA staff virtually as follows: Health Centers (1/2 day), health professions (1/2 day), rural health (1.5 hours), HIV/AIDS (1.5 hours) and MCH (1.5 hours). If the Contractor is located within the DC-metropolitan area, the meetings shall be in-person at HRSA Headquarters.

1.1.1.3 Submit a draft meeting agenda and presentation materials to the COR for review/approval within three (3) days prior to the meetings. The COR will review and provide any edits/comments within two (2) days of receipt.

1.1.1.4 Submit to the COR brief and concise meeting minutes, including a summary of agreements reached (2 pages or less) within five (5) days after the meetings.

Task 1.1.2: Bi-Weekly Monitoring Meetings

1.1.2.1 Convene bi-weekly contract monitoring meetings beginning within ten (10) business days after the kick-off meetings. The purpose of these meetings are to discuss work performed to-date and activities projected, progress achieved towards meeting the contract goals and milestones, summaries of deliverables submitted with dates of delivery, challenges encountered and anticipated, and activities requiring input or approval.

1.1.2.2 Convene six (6) bi-weekly meetings, one (1) for the overall contract, as well as one (1) for each of the five (5) programs (e.g. health centers, health professions, HIV/AIDS, MCH, and rural health).

1.1.2.3 Submit a draft meeting agenda and presentation materials to the COR for approval two

(2) days prior to each meeting. The COR will review and provide any edits/comments within one

(1) day of receipt.

1.1.2.4 Submit to the COR, two (2) days after the meetings, brief and concise meeting minutes, including a summary of agreements reached (2 pages or less).

Task 1.2: Plans and Reports

Task 1.2.1: Revise and Maintain a Project Management Plan (PMP)

Based on the results of the kick-off meetings (Task 1.1.1), the Contractor shall:

1.2.1.1 Revise its PMP including goals and objectives, timelines, and outcome metrics (e.g., efficacy of training, scope of dissemination, utility of products developed in this contract, etc.).

The PMP must also describe how activities for each task shall be accomplished and include timelines, key personnel associated with each task, as well as the metrics proposed to evaluate efficacy at the completion of each COE task. The PMP shall be considered a living document and shall be updated and maintained over the life of the contract. PMP progress shall be tracked bi-weekly (see Task 1.1.2).

1.2.1.2 Submit a final PMP for the contract performance period five (5) days after the kick-off meetings, to the COR for approval.

1.2.1.3 Submit to the COR a draft PMP for the upcoming period of performance six (6) weeks before the end of the current period of performance. The COR will review and provide any edits/comments within two (2) weeks of receipt. One (1) week after receiving COR edits/comments, the Contractor shall submit a revised PMP, incorporating COR comments, and submit to the COR for review and approval.

Four (4) key elements of the PMP are:

1. Learning Health System Plan:

The Learning Health System (LHS) shall serve as the conceptual framework for the COE activities to ensure there is sharing and learning across all the tasks and the various programs.

The Contractor shall lead the LHS for this initiative and shall support and facilitate evidence-based training and technical assistance on the integration of mental health and substance use/opioid disorder services targeting HRSA programs. In addition, the Contractor shall build the

LHS by identifying and using promising and best practices across the various HRSA programs to inform LHS implementation.

The LHS plan shall include a narrative that shall discuss the Contractor’s approach to all of the tasks and the following elements:

A description and visual depiction of the LHS COE model (i.e. logic model) that shall be used to facilitate the expert T/TA training to HRSA grantees at the national level and across the 10 HHS Regions.11

Experiential learning and provider education opportunities.

A description of expert faculty/staff that shall facilitate the T/TA sessions and conduct the various COE activities.

A description of Years 1-3 T/TA strategies and activities that the COE shall develop and implement on a quarterly basis for HRSA-supported grantees; activities shall include:

o Primary Care Practice Transformation Coaching12 o Webinars on best and promising practices and lessons learned for primary care integration of mental health and substance use /opioid use disorder services o Clinical case conferencing or e-consultations o Telephone/teleconference technical assistance

Identification of the main goals and outcomes for each of the proposed T/TA activities.

A description of incentives, such as continuing education credits or certificates of completion, that shall support maximum grantee staff participation at COE T/TA activities.

11 https://www.hhs.gov/about/agencies/iea/regional-offices/index.html

12 https://archive.ahrq.gov/professionals/systems/primary-care/coachmnl/index.html https://www.hhs.gov/about/agencies/iea/regional-offices/index.html

A description of the key partners that the COE shall collaborate with to develop T/TA activities and support recruitment of grantee staff participation in these activities.

These key partners shall be included as part of the LHS and the COE shall ensure that there is no duplication, but strategic coordination of T/TA activities among key

HRSA funded partners, such as: Primary Care Associations (PCAs), HRSA/BPHC

NCA partners, state agencies, and HRSA Workforce Research Centers.

A description of resources and information on evidence-based practices and clinical strategies for the effective delivery of mental health and substance use disorder services in the primary care setting. In addition, the Contractor shall describe ways to promote networking abilities among HRSA grantees through the COE website where primary care teams can share/discuss increasing care complexity and the challenges they face with the goal of supporting each other and discovering opportunities to transform their practices based on strategies that work.

2. COE Communications Plan

The COE Communications plan shall include:

Branding the COE, including the development of a COE logo and templates for all task-related communications.

Communicating information about COE events through COE communication channel to COE stakeholders, as well as HRSA-funded technical assistance centers.

Communicating information about national T/TA events sponsored by outside sources that may be of interest to COE stakeholders.

3. Rapid Cycle Improvement (RCI) Plan

The purpose of the RCI process is to be responsive to emerging T/TA topical needs and to continuously improve the COE’s T/TA approaches in order to meet the changing needs of HRSA grantees for enhancing decision-making and care. The Contractor shall dedicate a portion of the

PMP to an RCI plan, which shall be implemented by the Contractor within 10 days of PMP approval by the COR.

The RCI plan shall include:

A logic model depicting the RCI process and how it relates to behavioral health outcomes across the programs (health centers, health professions, MCH, rural health, and HIV/AIDS) and how metrics and clinical quality measures from the Uniform

Data System data shall be used to examine impact of the health center T/TA activities.

An outline of the process for assessing clinician/staff knowledge, attitudes, and behavior change as a result of the T/TA activities conducted by the Contractor before, during, and after T/TA events.

A description of the RCI strategy that shall address the ongoing and continuous process for assessing and enhancing the T/TA activities for this initiative, including individual task assessments.

The development, implementation, and evaluation of a comprehensive approach to assessing the outcomes of the TA using rapid cycle improvement (RCI) methodologies.

Address how the assessments will include process measures, impact/outcome measures, and task assessments. Based on the assessment findings and feedback from the Contracting Officer Representative (COR), the plan shall address the development and implementation of improvement plans, with an emphasis on real-time enhancements to current performance, as well as improvements to processes for the following contract year.

4. COE Information Technology (IT) Systems Implementation and Support Plan

The Contractor shall prepare a COE IT Systems Implementation and Support Plan that addresses and describes the design, development, implementation, and maintenance for COE Cloud

Website, Program-Specific Cloud Websites, Cloud Webinar/Virtual Meetings, and Cloud eLearning Management Systems in the contract for Task 11. The COE IT Systems

Implementation and Support Plan shall include:

Architectural Approach o Functional requirements (e.g., data, workloads and accuracy, user interface, reliability, availability, security, and maintenance).

o Technical requirements (e.g., hardware, software, and telecommunications) o Customer Experience requirements (e.g. web page responsiveness, systems usage, response to overutilization of resources) o System architecture.

o Security architecture.

o Seamless integration between the Cloud Website, Cloud Program-Specific

Website, Cloud Webinars/Virtual Meetings, and Cloud eLearning Management

System (e.g. reuse of credentials).

Design, implementation, and operational milestones for COE IT capabilities for Task

11.

24 hours x 365 days Operational Support approach for Task 11.

IT customer support Monday – Friday 9am-8pm EST.

Full acceptance of the Contractor’s COE IT Systems Implementation and Support

Plan is required before implementation and contingent upon the review and approval of the COR for Task 11.

The COE IT Systems Implementation and Support Plan shall be reviewed with the

COR monthly, and updated as necessary if major modifications are made to the IT

System for Task 11.

The Contractor shall follow the Health and Human Services Enterprise Performance

Life Cycle (EPLC) policy for Task 11.

Task 1.2.2: Monthly Progress Reports

1.2.2.1 Starting in the second (2nd) month of the period of performance, by the third (3rd) day of each month, the Contractor shall submit to the COR, a monthly progress report covering the previous calendar month, which includes a summary of T/TA activities. The Contractor shall present a draft report template at the kick-off meeting (Task 1.1.2), which it shall refine with the

COR throughout the period of performance. The report shall be organized by task and programs

(health centers, health professions, MCH, rural health, and HIV/AIDS) and include the most updated data from the COE T/TA in a Microsoft Office Excel file.

1.2.2.2 The report shall describe:

Summary of budget status including burn rates by task/program;

Status of strategic partnerships, including those with technical assistance centers and experiential training sites;

Summary table of T/TA activities to include:

o Activity type o Activity program(s) o Activity date(s) o Activity duration o Activity location, including HHS region(s) o Activity requestor o Target audience(s) o Number of attendees by type (i.e. program, profession, etc.)

o Participant feedback

Status of progress accomplishing the goals and tasks of the T/TA tasks and initiatives;

including progress and milestones implementing all COE plans;

Issues or challenges the Contractor is encountering by task/program and proposed solutions;

Issues or challenges that grantee communities are encountering by task/program and strategies for addressing these issues;

Summary of timelines;

Proposed changes to PMP and pending HRSA approvals;

Summary of IT interface use (including click reports) and dissemination of T/TA (i.e.

tools, products, and events);

Rolling three (3) month list of upcoming COE task related activities.

1.2.2.3 The Contractor shall also submit an appendix in Microsoft Excel containing details of the data summarized (by program) in the monthly report’s summary table, as well as for each event taking place since the previous monthly report:

Grantee identification number and site name (where applicable);

Name of individual practice sites (where applicable);

Mailing Address of individual practice site (where applicable);

Name(s) of COE staff conducting training;

Date and name of training/educational activities;

Total number of participants for each session;

Attendee names, titles, professions or certifications, health care organization and session(s) attended.

Task 1.2.3: Monthly Financial Reports

1.2.3. 1 The Contractor shall submit electronically, a monthly financial status report to the COR by the 15th of each month. The monthly financial status report shall include the following:

A monthly reimbursement report detailing the status of completed and/or pending reimbursement.

A monthly expenditure tracking report, which shall include the amount of current and cumulative contract funds, obligated, invoiced, and paid and remaining contract funds. The Contractor shall document the number of labor hours and budget amounts used for each task during the month, the amounts on a cumulative basis and the remaining balance on the contract. The format should be such that invoices can clearly be associated with the tasks and costs described in the monthly progress report. See sample format below:

Task Activity

Staff/Labo r Category Rate

# of

Hours

(Month)

$ Amount

(Month)

# of

Hours to

Date

$ Amount to Date

Remaining

Hours

Remaining

$ Balance

Total s:

Task 1.3: Annual Reports

1.3.1 Submit a draft annual report to the COR for review 45 days prior to the end of each contract year. The annual report shall be organized by clear and concise headings and submitted as a Microsoft Word document. The Contractor shall include a table of contents.

1.3.2 10 days after receiving draft report feedback from the COR, submit a final annual report incorporating the COR’s feedback for COR approval. The annual report shall include descriptions of the following for the overall contract, as well as for each program (health centers, health professions, MCH, rural health, and HIV/AIDS):

Purpose/Goals/Significance: Summarize how the COE impacted primary care integration for mental health and SUD/OUD capacity building among targeted

HRSA-supported programs.

T/TA Summary: Provide a cumulative summary from baseline of T/TA activities supported during the contract year:

o Summarize the T/TA activities by task and program (See Task 1.2.2);

o Describe the various approaches, innovations in the field, effective strategies, lessons learned, and areas of improvements and opportunities across the programs;

o Summarize the RCI process and descriptive feedback obtained throughout the year for COE activities.

T/TA Impact and Recommendations: Describe how the COE activities impacted HRSA-supported programs for the integration of mental health, SUD, and OUD services into the primary care setting.

o Using the logic model contained in the PMP (Task 1.2.1) as a guide, describe the impact of the COE model and activities on enhancing and sustaining HRSA-funded grantee capacity;

o Summarize RCI activities and what changes were made to enhance the

T/TA provided by the COE;

o Based on the contract progress and impact, describe which recommendations the Contractor would make regarding the working COE model and the approaches needed to effectively meet the goals of this contract;

o Summarize the reach of the T/TA activities, including the number of providers and care team members trained (Task 1.2.2);

o Results of the needs assessment;

o Participant satisfaction;

o Participant knowledge assessment;

o Deployment of evidence-based interventions (time to spread or utilization/uptake. i.e. science-driven solutions);

o New projects launched or expanded from grantee’s promising practice (i.e.

solution driven science).

Barriers/Limitations: Summarize lessons learned and opportunities for improvement, including the challenges and/or limitations of the COE model and implementation of key elements of the PMP. Describe how these barriers impacted the T/TA activities and the COE’s ability to build behavioral health capacity among targeted HRSA-grantees across the programs (health centers, health professions, rural health, MCH, and HIV/AIDS).

Documents: The Contractor shall also provide copies of all T/TA materials, tools/resources, and other products and publications produced during the contract year.

Task 1.4: End of Year Meeting

1.4.1 Within 30 days prior to the end of the contract year, provide a half-day oral briefing for the

COR, key HRSA staff, and other persons deemed appropriate by the COR to present the major findings from the year. In the briefing, the Contractor shall summarize progress, problems encountered and their resolution, activities and/or findings to date, preliminary recommendations, and activities planned for the coming contract year. The briefing shall focus on highlights and major findings across the programs. Standard reporting requirements apply

(See Task 1.2.2).

1.4.2 Local Contractor staff shall attend the meeting onsite at 5600 Fishers Lane. Non-local

Contractor staff shall attend the meeting virtually.

1.4.3 Two (2) weeks prior to the briefing, submit a tentative outline of topics to the COR for review/approval.

1.4.4 One (1) week prior to the briefing, submit a final outline, based on comments from the

COR.

1.4.5 Two (2) weeks following end of year briefing, submit to the COR a summary of the meeting (including agreements reached). This summary shall not exceed ten (10) pages.

Task 2: Annual In-Person/Virtual COE Stakeholder Meeting

This task describes the annual stakeholder meeting (onsite and virtual). The goal of the meeting is for the government and COE stakeholders to share best practices and lessons learned during the previous contract year(s). The face-to-face onsite gathering shall be accessible (e.g. live-streamed) on an interactive web-based platform for offsite participation. The meetings, both virtual and face-to-face, shall be open to all HRSA-identified programs and their communities of practice.

Task 2.1: Annual Meeting Project Plan (Base Period and Option Period 1)

2.1.1 Submit for review a final annual meeting project plan for the contract performance period to the COR, 15 days after the kick-off meeting. The annual meeting project plan shall address the following:

The annual meeting project plan shall describe how the COE shall host, organize, and implement an annual, in-person meeting, with virtual access availability during Option

Period 1 and Option Period 2 of the contract performance period that shall highlight and disseminate lessons learned, as well as successes and challenges, among stakeholders

(health centers and health professions programs) advancing the integration of behavioral health services in primary care settings.

Face to face meetings shall be held at HRSA’s Parklawn offices at 5600 Fishers Lane, Rockville, MD.

The virtual component of the meeting shall be open to all HRSA grantees with initial registration preference for Health Center and Health Professions grantees.

The annual meeting shall include two (2) days of programming with eight (8) hours of events per day to include presentations, panel discussions, roundtables, and live demonstrations.

The annual meeting shall include events that highlight the implementation of best practices and key partnerships across the 10 HHS regions for the primary care integration and training/education of mental health and substance use disorder services and providers, including opioid use disorder, as well as feature impactful T/TA activities and health center innovations that have been discovered as a result of this contract.

Highlights shall also include features of work to support special populations, e.g.

pregnant women, infants, children, adolescents, young adults, people living with HIV, and tele-behavioral health activities.

HRSA safety net providers and training/education programs, and COE experts shall be the primary speakers during the annual meeting.

A strategy for how the Contractor shall work with various HRSA bureau and office representatives, the COR, and HRSA Office of Communications staff to develop and distribute information concerning the meeting registration and the posting of any conference materials.

Develop registration on the COE website for annual meeting participants.

Coordination with the COR to identify titles of presentations, names of presenters and due dates/timeframes for presentation materials and pre-recording of specific presentations.

2.1.2 90 days prior to the end of contract Years 1 and 2, submit to the COR, the final plan for each meeting.

Task 2.2: Convene Annual In-Person/Virtual Meeting (Option Period 1 – 2 Only)

2.2.1 Implement the annual meeting project plan and conduct the annual meeting for 250 in-person and 8,000 virtual participants. The two (2) annual meetings shall occur by months 20 and

30 of the contract performance period.

2.2.2 Provide personnel to host the two (2) annual meetings. Hold the meetings at the Parklawn offices at 5600 Fishers Lane, Rockville, MD.

2.2.3 Advertise the annual meeting on HRSA social media, conference boards and curated listservs.

2.2.4 Send an invitation for registration of the annual meeting at least 180 days prior to the annual meeting to all HRSA grantees.

2.2.5 Provide HRSA with the number of registrants every 30 days for 180 days preceding the annual meeting.

2.2.6 Coordinate with grantees and their communities of practice, presentation materials including PowerPoints, review for 508 compliance and post on the COE website.

2.2.7 Make available continuing education credits, certified medical education (CME), and /or completion certificates for all annual meeting participants.

2.2.8 Within 14 days of completion of the annual meeting, submit to the COR for review and approval, a draft event report that summarizes the results of the activities conducted during the performance of the event, including a budget versus actual accounting report, participant feedback, problems encountered and their solution, and proposed changes to the approach, and any documents.

2.2.9 Submit a final activity report to the COR within five (5) working days of approval of the draft activity report. The Contractor shall be responsible for collecting any papers presented at the meeting that were not made available prior to the event so that a full set of documents discussed are available electronically.

Task 3: Needs Assessment

Task 3.1 Program Needs Assessment

The needs assessments shall identify gaps in knowledge and skills related to priority issues, as well as inform the broader work plan and tasks. The needs assessment shall focus on specific

HRSA bureau programs as identified by the COR.

The COR shall have the opportunity to review and approve the list of organizations and individuals identified for engagement as part of the needs assessment.

3.1.1 Determine priority issues for HRSA-supported grantees regarding integration of behavioral health and primary care, including a focus on treatment for substance/opioid use disorders using medication-assisted therapy (MAT).

3.1.2 Identify the methodology used to implement the needs assessment regarding direct service grantees and HRSA-funded training education programs. The Contactor shall include the range of grantees within specified grant programs (for example: rural/urban, large grantee/small grantee).

3.1.3 Five (5) business days from the Kick-Off meeting, submit to the COR a revised needs assessment plan for each program which includes a description of the needs assessment approach, the range of grantees within specified grant programs (for example: rural/urban, large, grantee/small grantee) and where the results of this assessment will be used to inform the development of T/TA activities for the COE.

3.1.4 Implement the Needs Assessment plan within three (3) business days of the COR-approved work plan for this task.

Below are program areas that require needs assessment services:

Health Centers - (Base Year Only)

3.1.5 Conduct a needs assessment to identify state and regional T/TA needs for HRSA-supported health centers through key informant interviews (at max 9) with experts/leaders/health center providers across the respective HHS regions and settings (urban/rural) who can provide feedback on priority T/TA issues such as best/promising practices, tools/resources, curriculum topics for the various, health center-focused T/TA tasks, evidence-based interventions, and formats (e.g., virtual or in the clinic setting). Subject matter experts from HRSA/Bureau of Primary Health

Care-funded National Cooperative Agreements (NCAs) shall also be considered for interviews.13The health center needs assessment plan shall include a description of the needs assessment approach where the results of this assessment will be used to inform the development of strategic T/TA activities for the health center population of the COE.

Health Professions – (Base Year Only)

3.1.6 Conduct a needs assessment of identified Bureau of Health Workforce (BHW) Programs to identify regional training/technical assistance (T/TA) needs and training gaps for BHW supported programs through key informant interviews (max 9) with grantees and their respective communities of practice across the HRSA regions. The needs assessment shall include assessment of the following used for preparing behavioral health professionals and paraprofessionals to provide OUD and other SUD prevention, treatment, and recovery services:

Training curricula;

Didactic and experiential modes of training;

Promising and evidenced based practices;

Tools/resources; and

Core competencies.

3.1.7 Utilize the needs assessment and other information provided by the various programs to identify and address training gaps in the delivery of OUD and other SUD prevention, treatment, and recovery services.

Rural Health - (Base Year Only)

3.1.8 Conduct a needs assessment to identify factors relevant to assessing the readiness of states and rural areas within states to develop a rural behavioral health paraprofessional workforce, including peer recovery support specialists, addiction counselors, community health workers, and other certified professionals that provide counselling and clinical supervision to participants for SUD/OUD treatment. “Paraprofessionals” are defined as individuals with SUD personal experience and up a four (4) year degree from an accredited university. “Rural” is defined using

13 https://bphc.hrsa.gov/qualityimprovement/strategicpartnerships/ncapca/natlagreement.html the Rural-Urban Commuting Area (RUCA) codes (see https://www.hrsa.gov/rural-health/about-us/definition/index.html for more information).

3.1.9 Consider what resources are necessary to create a sustainable paraprofessional behavioral health workforce in rural areas, including, the supply of candidates, supervisors, and current professionals; educational institutions available for training (i.e. community colleges, universities); facilities/organizations available for internships; state certification and licensure requirements; reimbursement policies; and broadband capabilities.

3.1.10 Conduct an environmental scan that compiles and summarizes the current state of the rural behavioral health paraprofessional workforce including, gaps in behavioral health workforce in rural community-based health organizations (i.e. rural hospitals, health centers, and addiction treatment agencies); types of paraprofessionals such as addictions counselors, community health workers, peer recovery support specialists, etc.; the availability of the various types of providers in rural areas; the titles, certifications, and licensure requirements by state; and the range of payers and reimbursement methodologies. Sources for the scan may include, scientific and policy-relevant literature (peer-reviewed and grey), certification entities (i.e., The

National Association of Alcohol and Drug Abuse Counselors, International Certification &

Reciprocity Consortium, American Academy of Providers and Addictive Disorders), Medicaid policies and state plans, and secondary data sources (i.e. Behavioral Health Workforce Research

Center, Scopeofpracticepolicy.org); and

3.1.11 Conduct interviews with a representative sample of nine (9) Rural Health grantees focused on SUD/OUD at the state and community-based level to determine the opportunities and challenges to developing and sustaining a paraprofessional behavioral health workforce in rural areas. The grantees shall be selected by the COR.

3.1.12 The needs assessment report shall include:

The types of behavioral health paraprofessionals that are currently engaged in rural integrated health care models and their demographic data (e.g., age, sex, race/ethnicity, etc.);

The current supply of these paraprofessionals within rural communities;

The supply and types of organizations hiring/using these paraprofessionals;

Availability of reimbursement (e.g. Medicaid and/or Medicare coverage);

Identification of the supply of training institutions in rural areas:

i. What types of institutions provide the classroom paraprofessional training? How accessible are these types of institutions to rural areas

(e.g. Are there sufficient institutions available to rural areas to provide the required training?)

ii. What are the practice/supervisory training requirements for paraprofessionals in this type of role? Are there challenges to meeting supervisory requirements and accessing those providers (e.g.

limitations on using telehealth to meet these requirements)?

Feedback from interviewees on the demand for integrating behavioral health and primary care in rural areas, including using paraprofessionals, as well as identification of opportunities and challenges to training, recruiting, and retaining providers (e.g. broadband access, supply of trained paraprofessionals, etc.); and

Recommendations for factors or criteria that could be used by Federal, state, or local entities to assess the readiness and sustainability of a paraprofessional behavioral health workforce in rural areas.

HIV/AIDS – (Base Year Only)

3.1.13 Develop a needs assessment to determine grantee ability and capacity to address People

Living with HIV (PLWH) with opioid use disorder (best practices) and identify gaps and challenges in the integration of behavioral health in Ryan White Clinics, including the treatment of PLWH with an opioid disorder.

3.1.14 Identify selection criteria for a representative sample of nine (9) Ryan White HIV/AIDS grant program recipients at the state, local and community based level to obtain input for the needs assessment.

Needs Assessment Report

3.1.15 Submit a needs assessment report to the COR for approval within five (5) business days after the completion of each needs assessment. The report shall be no longer than 10 pages per program (health centers, health professions, MCH, and HIV/AIDS), with the exception of the rural health program (which shall be no longer than 20 pages - 1.5 line spacing, 1-inch margins, and Times New Roman – 12-point font), provide a summary of each interview, key interview findings, and the recommendations for strategic T/TA activities targeting HRSA-supported grantees across the 10 HHS regions based on the identified needs.

Activity Report

3.1.16 Submit a draft report to the COR within five (5) business days of completion for each of the programs needs assessment for review and approval.

3.1.17 The report shall summarize the results of the activities conducted during the performance of the needs assessment, including a budget versus actual accounting report, participant

3.1.18 Submit a final activity report to the COR within five (5) working days of approval of the draft activity report.

Task 3.2 Health Professions Needs Assessment for Workforce Education – (Option Period

1 Only)

The Contractor shall:

3.2.1 Obtain needs assessment survey data from HRSA and review, clean, and analyze for each subject/site, including aggregation and analysis of the data obtained for agreed upon groupings of all pertinent respondents.

3.2.2 The Contractor shall coordinate with the COR to maximize the benefit of data collection and findings.

3.2.3 Submit a draft needs assessment report to the COR for review 45 days after obtaining needs assessment data from HRSA. The report shall include survey or other instrument used by HRSA to obtain data, methodology, findings, identified T/TA needs and T/TA plan. The main body of the report shall not exceed 20 pages, single-spaced. The report shall include:

A narrative analysis of findings related to health professions and service delivery in integrated primary care settings.

A description of the methods used to obtain data, the completeness of data, and any deficiencies in the data.

Portray data and findings through narrative, tables, and charts, as appropriate.

3.2.4 Submit a final needs assessment report to the COR, 15 days after receiving feedback from the COR.

3.2.5 Submit a summary of the survey findings and analyses 30 days after the data is collected or provided.

3.2.6 Identify and develop the T/TA tasks for specific health professions topics based on the outcome of the needs assessment. The needs assessment shall allow the Contractor to identify

T/TA needs and capacity building in order to enhance academic and community-based training for behavioral health integration, as well as OUD and other SUD prevention, treatment, and recovery services.

Task 4: Virtual Clinical Case Conferencing for Health Centers (This task shall utilize the technology identified in Tasks 11)

HRSA’s Bureau of Primary Health Care (BPHC) is seeking to enhance their support to health centers concerning integrated SUD, OUD and mental health services through virtual, clinical case conferencing. Virtual clinical case conferencing (“e-consulting”) includes information sharing among health center staff and expert faculty to better understand a patient’s needs and to effectively collaborate to achieve a patient’s goals. This e-consultation service shall allow health center staff to present patient cases in order to received clinical feedback and assistance on prevention and treatment strategies from expert faculty.

4.1 Submit a final virtual clinical case conferencing plan for the contract performance period within 20 business days after the kick-off meeting to the COR for approval.

4.2 Implement the Clinical Case Conferencing program within 10 days of the COR-approved project plan for this task.

4.3 Provide 100, 30-minute clinical e-consultation sessions to different…