5814 final~1.pdf

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REQUEST FOR GRANT APPLICATION (RFGA)

OregonBuys Number S-44300-00011096

OHA-RFGA-5814

Hospital-based Violence Intervention Program Expansion – Learning Community

The Oregon Health Authority (OHA) requests Grant Applications from qualified individuals or organizations hereinafter “Applicants,” to participate in a learning community about hospital-based violence intervention programming.

Date of Issuance: 7/25/2024 Applications accepted through: See Section 10 Issuing Office: Oregon Health Authority

Office of Contracts and Procurement 635 Capitol Street NE, Suite 350 Salem, OR 97301

Sole Point of Contact: Oregon Health Authority Office of Contracts and Procurement Paul Yakis Email: paul.yakis@odhsoha.oregon.gov mailto:dhs-oha.publicationrequest@state.or.us

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 2 of 17

1. Introduction and Purpose

a. Introduction.

2022 Oregon House Bill 4045 defines community violence as an intentional act of interpersonal violence committed in public by someone who is not the victim’s family member or intimate partner. The bill allocated funds to the Oregon Health Authority (OHA) to provide grants for planning, provider training and certification and general capacity to hospitals and community-based organizations (CBOs) to develop hospital-based violence intervention programs in communities of need other than in Multnomah County to reduce and interrupt the chronic cycle of community violence. The vision of HB 4045 is to expand availability of hospital-based violence intervention programs (HVIPs) within Oregon using the model known as Healing Hurt People (HHP). HHP is currently only delivered in the Portland area via a collaboration between Portland Opportunities Industrialization Center (POIC) and three hospitals: Legacy Emanuel, OHSU, and Adventist. The HHP program was developed based on research and practice at Drexel University and similar programs are currently implemented in cities across the country including Hartford, CT and Philadelphia, PA, via collaborations between CBOs and Level 1 Trauma Centers.

This funding opportunity will support development of HVIPs outside of Multnomah County, and outside the geographic catchment areas of the hospitals noted above, via seed grants to establish partnerships between CBOs and health systems that provide emergency room and/or urgent care services. This opportunity represents an initial round of funding to establish a learning community in Oregon made up of CBOs and health systems committed to exploring partnerships and planning for future HVIP implementation. Applicants awarded funding under this opportunity that successfully develop CBO-health system partnerships committed to HVIP implementation will be eligible to apply for future rounds of funding to support program implementation.

The grant funding may be used to support staffing, planning, training, and certification of credible peer messengers with lived experience to provide HVIP services, and organizational capacity building to support future HVIP program implementation and expansion.

HB 4045 also required OHA to request approval from the US Centers for Medicaid and Medicare Services (CMS) to allow billing for services provided under HVIP. Federal approval was granted in May 2023 and organizations applying for this funding opportunity will be provided training and technical assistance from the Oregon Medicaid Program to enable them to bill for HVIP services.

OHA has approximately $1,000,000 available under this grant opportunity and may award additional funds if they become available or may not award all the funds depending on applications received. CBOs and health systems applying individually may apply for up to $125,000 or more depending on budget justification of funding through this RFGA to participate in the HVIP Learning Community from July 1, 2024 through June 30, 2025. OHA anticipates making 3-8 grant awards depending on availability of funds. CBOs and health systems that apply singly will receive support in developing partnerships via the HVIP Learning Community.

CBOs and health systems with overlapping geographical catchment areas are strongly encouraged to submit proposals indicating interest in developing formal partnership to serve their shared community or communities. CBOs and health systems that can provide evidence of significant progress in developing partnership agreements (for example, executed contracts or

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 3 of 17 memoranda of understanding) by the end date of this funding opportunity will be eligible to receive additional funding should it become available.

Additional info about HB4045 can be found at the following website:

https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/SAFELIVING/Pages/hb4045.aspx

b. Purpose.

OHA acknowledges that racism, settler colonialism and historic and contemporary injustices have created policies and programs that have led to unfair and unjust health inequities over time, including those related to community violence. To center community strengths and wisdom, OHA supports development of partnerships between CBOs and hospital systems that provide emergency and urgent care services to establish HVIPs as a means of addressing the immediate emotional and social trauma of community violence, ending cycles of retaliatory violence, and supporting the long-term wellbeing of affected individuals and communities. OHA also aims to use this grant opportunity to support a professional path for peer violence intervention professionals and development of sustainable infrastructure for HVIPs, including acquiring diverse and ongoing funding streams.

OHA recognizes that CBOs, including advocacy groups, and faith-based organizations are central to the success of this plan to integrate methods, tactics and strategies that are most responsive to the needs of the communities in Oregon affected by community violence.

2. Authority OHA issues this RFGA under the authority of Oregon Revised Statute (ORS) 413.033.

3. Minimum Requirements To apply and to be eligible for award of a Grant Agreement, an Applicant must meet the following Minimum Requirements:

a. Any 501(c)(3) organization registered with the Oregon Secretary of State and located in Oregon that provides culturally responsive services to communities in Oregon that are impacted by community violence occurring outside of Multnomah County. Organizations with 501(c)(3) fiscal sponsors are eligible to apply. Organizations must hold commercial general liability insurance covering bodily injury and property damage of not less than $1,000,000 per occurrence and annual aggregate limit not less than $2,000,000 at the time of Grant award, if awarded. If the organization does not have the required level of insurance at the time of proposal, grant funds may be used to pay for expansion of existing insurance to the required level.

b. Any partnership or coalition of organizations working together, where the fiscal agent is a 501(c)(3) organization.

c. Health systems that include at least one emergency department or urgent care facility located in an Oregon county other than Multnomah, which serve people with injuries caused by community violence.

d. All applicants must agree to work toward development of CBO/hospital partnerships to develop hospital-based violence intervention programs. CBO applicants must agree to develop a partnership with a health system that provides emergency and/or urgent care services for community members injured during incidents of community violence, with a primary patient catchment area outside of Multnomah County, Oregon. Health system applicants must agree to https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/SAFELIVING/Pages/hb4045.aspx

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 4 of 17 develop a partnership with a CBO serving people within the geographic catchment area of the health system.

e. Apart from health systems as defined above, for-profit organizations are not eligible.

f. All grantees must demonstrate a commitment to learning about and implementing national best practices and standards of care for HVIPs, as well as a commitment to explore partnerships and feasibility of implementing the hospital-based violence intervention model, the role of trusted community messengers and a plan to certify violence prevention professionals.

g. All grantees must abide by OHA’s nondiscrimination policy, and state and federal civil rights laws, unless otherwise exempted by federal or state law. Specifically, people participating in OHA-sponsored activities or programs may not be treated unfairly because of age, color, disability, gender identity, marital status, national origin, race, religion, sex or sexual orientation.

4. Scope of Work (Grant Program Activities)

a. Geographic Considerations: Unless otherwise specified, there are no restrictions on proposing to work within a county vs. a region of the state. Please propose activities that meet the needs of your organization’s structure and/or service area.

b. Training and technical assistance: Community-based organizations and hospitals working toward partnerships to support HVIPs will need to build their staff capacity for certain skills or content area expertise. They will also need to develop organizational capacity to deliver HVIPs.

Training and technical assistance will be provided via Community of Practice meetings from organizations with local and national perspective on HVIP implementation.

c. Program Description:

(1) Eligible activities: Funding is available for staffing, planning, provider training and certification, technical assistance, and capacity building activities in support of development of HVIPs outside Multnomah County. Activities include, but are not limited to, those listed below.

(a) Planning activities

i. Regular attendance at, and active participation in, the HVIP Expansion Community of Practice. This group will meet monthly from July 2024 through June 2025 to build supportive connections between organizations interested in HVIP development/implementation and to provide training and technical assistance related to HVIP partnership development, planning, and eventual implementation.

NOTE: THIS ACTIVITY IS REQUIRED FOR ALL AWARDEES

ii. Convening meetings to explore and develop HVIP partnerships between community-based organizations and health systems with emergency department/urgent care facilities.

iii. Strategic planning for HVIP program development.

iv. Hosting community meetings to gather input on needs and concerns related to

HVIP program implementation.

v. Reviewing data from multiple sources to identify: the community or communities to be served by the HVIP, current annual number of community members receiving emergency room or urgent care for incidents of community violence, types of injuries to be included in the program (firearm, assault, stabbing, etc.), estimated

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 5 of 17 number of community members to be served per year, and other metrics that awardees determine will support the implementation of HVIPs.

vi. Identifying inclusion criteria and a community of focus

vii. Facilitating agreement between program partners about background check requirements for peers

viii. Identifying existing related services available in the community and remotely.

These services can include domestic violence resources, youth outreach, street outreach, tele-mental and tele-behavioral health, and others.

ix. Identifying culturally specific and culturally responsive service providers to receive referrals for HVIP clients to specific services. Examples include psychotherapy, substance abuse and alcohol misuse screening and treatment, legal and financial services, educational support, conflict resolution and socio-emotional learning, employment services, and housing support

x. Business planning to identify program expenses and revenue streams.

xi. Identifying program evaluation metrics

xii. Developing grant writing and other organizational capacity building skills to support sustainable funding for HVIPs

(b) Violence Prevention Professional training and certification

i. Development of position descriptions and hiring standards for peer HVIP providers

ii. Recruitment of trusted community messengers to become peer Certified Violence Prevention Professionals, sufficient to meet the standard of response following an incident of community violence

iii. Conducting background checks for potential Certified Violence Prevention Professionals with criminal history or history of incarceration

iv. Training peer Violence Prevention Professionals through the Health Alliance for Violence Intervention or other training providers approved by OHA (35 hours minimum). Training costs may include registration fees, travel costs and per diem

v. Developing and implementing standards for on-the-job training (orientation, shadowing)

vi. Continuing education for Certified Violence Prevention Professionals (at least six hours every two years)

(c) Building capacity to serve communities of need

i. Development of memoranda of agreement or other types of documentation outlining the roles and relationship between community-based organizations and hospitals leading HVIP planning and development. Please note: Such documentation will be required for awardees to be eligible for future rounds of funding under this opportunity.

ii. Development of contractual relationships with Certified Violence Prevention Professionals

iii. Development of referral agreements with culturally responsive service providers

iv. Holding trainings for hospital/urgent care administrative staff, medical and social service providers, security personnel and administrators to ensure smooth integration of HVIPs into system operations

v. Documentation and standards for program processes, including intake, risk assessment, services rendered, etc.

(d) Documenting and sharing program successes and challenges (required)

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i. Participating in program evaluation as requested by OHA, including preparing and submitting quarterly reports; participation in surveys, focus groups and key informant interviews and other means of collecting quantitative and qualitative information on grant activities.

5. Sole Point of Contact (SPC)

Oregon Health Authority Office of Contracts and Procurement Paul Yakis Email: paul.yakis@odhsoha.oregon.gov All communications concerning this RFGA document, and the Application process must be directed through OregonBuys to the SPC named above. Any oral communications will be considered unofficial and non-binding. Information received in writing from the SPC is also considered official.

When appropriate, the Office of Contracts and Procurement (OC&P) will issue revisions, substitutions, or clarifications as addenda to this RFGA. Changes/modifications to the RFGA shall be recognized only if in the form of written addenda issued by OC&P. OC&P will not automatically mail copies of any addenda or answers but will publish addenda and questions and answers on the OregonBuys website at https://oregonbuys.gov/bso/. OregonBuys will be used to distribute all information regarding this RFGA. To review complete RFGA documentation please go to the OregonBuys website at https://oregonbuys.gov/bso/.

6. Applicant Assurances By submitting an Application in response to this RFGA, Applicant certifies that the following statements are true:

a. Applicant does not discriminate in its employment practices with regard to race, creed, age, religious affiliation, sex, disability, sexual orientation or national origin, except as otherwise permitted by law. Further, Applicant has not and will not discriminate against a subcontractor in the awarding of a subcontract because the subcontractor is a minority, women or emerging small business enterprise certified under ORS 200.055 or a Disabled Veteran or a subcontractor that employs a Disabled Veteran, and

b. Information included in the Application shall remain valid for 90 days after the Application is submitted or until a contract is executed, whichever comes first, and

c. The statements contained in the Application are true and complete to the best of the Applicant’s knowledge and Applicant accepts as a condition of the RFGA, the obligation to comply with the applicable state and federal requirements, policies, standards, and regulations. The Applicant recognizes that this is a public document and open to public inspection, and

d. The Applicant acknowledges receipt of any addenda to the RFGA, and

e. If the Applicant is awarded a Grant Agreement as a result of this RFGA, the Applicant will be required to enter into, and will be bound by, all of the terms and conditions set forth in the sample Grant Agreement, Attachment #3. All grant funds must be expended by Grantee by June 30, 2025

7. Application Evaluation https://oregonbuys.gov/bso/ https://oregonbuys.gov/bso/

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 7 of 17

Applications must be complete at the time of submission and submitted through OregonBuys prior to closing of this opportunity. The OHA Evaluation team will review all Applications received by the close date as described in Section 10 to determine whether each Applicant meets the Minimum Requirements.

The Evaluation team will review each application for completeness of the required elements within the Application Form, work plan and budget alignment with scope of work and available funding, acuity of community violence populations served, geographic and language access reach.

The below scoring matrix will be used to help OHA determine the highest-ranking applicant(s).

OHA may award the apparent successful applicants through any process that OHA believes will result in the best outcome for successful completion of the Grant goals and activities.

APPLICATION QUESTION POINTS

AVAILABLE

Organization’s Proposal Response

20 points

Community Need

20 points

National Best Practices Adherence and Understanding of Hospital-Based Violence Intervention Model

10 points

Geographic Area Served

15 points

Plan To Certify Violence Prevention Professionals

Language Access Provided

Budget

15 points

Total available points

OHA’s goal is to minimize application barriers and ensure the funding reaches as broadly across the state as possible. External community-based organizations/community members will recuse themselves from reviewing Applications for their own organization or Applications of close partners or in cases where there is a perceived or potential conflict of interest.

During the review process, OHA reserves the right to obtain clarification from Applicants regarding their Application information. Only Applicants determined by OHA to be qualified to provide grant activities pursuant to this RFGA will be offered a Grant Agreement.

Applicants will be notified of the decision regarding their Application and, for successful Applicants, the timeline to be issued a Grant Agreement.

8. Public Information All Applications are public information after the Application has been opened. Any person may request copies of public information. However, except as required by the Oregon Public Records Law, copies of Applications will not be released until the evaluation process has been completed and notice of intent to award letters are sent to successful awardees. Requests for copies of public information must be submitted in writing. Requestors will be charged according to the current OHA policies and rates for public records requests in effect at the time OHA receives the written request for public information.

Fees, if applicable, must be received by OHA before the records will be delivered to the requestor.

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 8 of 17

OHA will host two public informational virtual meetings to clarify grant intention and eligibility and to answer questions from interested parties. Both meetings will be recorded; recordings and a written response to all questions from attendees and other parties will be available at:

Informational call #1:

Pacific Time Topic: RFGA Q&A Session: Hospital Based Violence Intervention Program Expansion- Learning Community Time: Aug 12, 2024 12:00 PM Pacific Time (US and Canada)

Join ZoomGov Meeting https://www.zoomgov.com/j/1611674303?pwd=YrbR2rcElCFJJR1bdEeAoLSLszCZcx.1

Meeting ID: 161 167 4303 Passcode: 880841

Informational call #2:

Pacific Time Topic: RFGA Q&A Session: Hospital Based Violence Intervention Program Expansion- Learning Community Time: Aug 16, 2024 01:00 PM Pacific Time (US and Canada) Join ZoomGov Meeting https://www.zoomgov.com/j/1611373916?pwd=bwzmQx6Rxne2MA4aPMb7tZhJ4ZTJqX.1 Meeting ID: 161 137 3916 Passcode: 406595

9. Cost of Applications

All costs incurred in preparing and submitting an application in response to this RFGA are the responsibility of the Applicant and will not be reimbursed by OHA.

10. Closing Date for Submittal of Applications Applications will be received on an open and ongoing basis through August 27, 2024, or once all funding has been granted, whichever occurs first. When OHA has determined that sufficient Applications have been received, or for any other reason that OHA determines, OHA will issue notice on the OregonBuys website specifying a date after which Applications will no longer be received.

Applications received after the date and time specified in that notice, shall be late and will not be evaluated.

APPLICATIONS MAY BE REVIEWED BY OHA AT ANY TIME AFTER RECEIPT.

Applicants are encouraged to submit Applications as soon as possible. Grant Agreements may be issued at any time throughout the open Application period and in accord with the limitations set forth in this Section 10.

11. Grant Agreement Document Terms and Conditions

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 9 of 17

The final Grant Agreement will be in substantially the same form as Agreement Form Attachment #3 to this RFGA and will include all exhibits and attachments identified in the Grant Agreement. The terms and conditions included in the Grant Agreement are subject to negotiation at the sole discretion of OHA.

12. Reservation of OHA Rights OHA reserves all rights regarding this procurement, including, without limitation, the right to:

a. Amend or cancel this RFGA without liability if it is in the best interest of OHA to do so;

b. Reject any and all Applications received by reason of this request upon finding that it is in the best interest of OHA to do so;

c. Waive any minor informality with the provisions or procedures of this procurement, and to seek clarification from the Applicant, if required;

d. Reject any Application that fails to substantially comply with all prescribed procedures and requirements;

e. Extend, amend or negotiate any Grant Agreements that are a result of this RFGA, in accordance with the terms and conditions of Attachment #3; and

f. Engage Applicant by selection or procurement for different or additional grants or services independent of this RFGA process or any Contract, Agreement or PA entered into pursuant hereto.

13. Contractual Obligation All Applicants who submit an Application in response to this RFGA understand and agree that OHA is not obligated thereby to enter into an Agreement with any Applicant and further, has absolutely no financial obligation to any Applicant.

14. Application Requirements

• Applications must be submitted using Attachment #1 Application Form attached to this RFGA.

• Applicant must submit a separate Application for each site that has a different Employer Identification Number (EIN).

• Applicants must be registered with the Oregon Secretary of State as a business or note on the Application that Applicant is a government entity.

• Applicant must also meet the minimum insurance requirements as outlined in Exhibit C of the Form PA (Attachment 2) or Applicant must meet those requirements prior to PA execution.

• Applications must be submitted to the SPC through OregonBuys and must be clearly marked

"APPLICATION FOR RFGA OREGONBUYS NUMBER S-44300-00011096/OHA-

RFGA-5814”.

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 10 of

Attachment #1

Applicants must meet the Minimum Requirements, as described in Request for Application (RFA):

OREGONBUYS NUMBER: S-44300-00011096

RFGA-OHA-5814

Applicants must comply with the RFGA and submit this completed Application Form to be considered for an Agreement.

Applicant info for Hospital Based Violence Intervention Program Learning Community

Individual/Organization Name Including DBA if applicable:

Fiscal Sponsor Organization Name if applicable:

Fax ID, EIN or FIN:

Mailing Address:

City: State: County: Zip Code:

Phone:

Facsimile:

Website Address:

Type of Organization

501(c)3 organization Health system including at least one emergency department and/or urgent care center serving people in Oregon and located in a county other than Multnomah

Responsible Proposer Requirements

Yes, Applicant is currently registered with the Oregon Secretary of State business registry.

No, Applicant is not currently registered with the Oregon Secretary of State business registry but will meet requirement prior to Agreement execution.

Applicant Insurance

Commercial General Liability Insurance

Yes, we currently meet the CGL insurance requirement.

Do not currently meet CGL insurance requirements and will meet requirement prior to Contract execution.

Professional Liability Insurance

Yes, we currently meet the PLI insurance requirement.

Do not currently meet PLI insurance requirements but will meet requirement prior to Contract execution.

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 11 of

Certification for Business Inclusion & Diversity (COBID) Registered Firm or owned/operated by a person with lived experiences (Yes/no):___________

Applicant Contract Administrator

Name and Title:

Phone:

Email:

Authorized Applicant/Application Signature:

Authorized Applicant email:

Applicant Information Part 1

Geographic area served. Please describe the geographic catchment area your organization serves (city, county, region, etc.)

Primary populations to be served. Please describe the populations served by your organization.

Language access provided by your organization. Please indicate your organization’s capacity to speak and/or write in languages other than English. Also indicate whether the language capacity comes from a native or non-native speaker.

Language 1: ______________ Spoken fluently by native speaker(s) Spoken fluently by nonnative speaker(s) Written by native speaker(s) Written by nonnative speaker(s) or access to translation service Language 2: ______________ Spoken fluently by native speaker(s) Spoken fluently by nonnative speaker(s) Written by native speaker(s) Written by nonnative speakers or access to translation service

Other language access offered by your organization not already listed above:

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 12 of

Applicant Information Part 2

Which of the following activities is your organization planning to undertake with funds from this opportunity?

Required Activities

� Regular attendance at, and active participation in, the HVIP Expansion Community of Practice. This group will meet at least monthly to build supportive connections between organizations interested in HVIP development/implementation and to receive training and technical assistance related to HVIP partnership development, planning, and eventual implementation.

� Participating in program evaluation as requested by OHA, including preparing and submitting brief quarterly reports using a template provided by OHA; participation in surveys, focus groups and key informant interviews and other means of collecting quantitative and qualitative information on grant activities.

� Development of memoranda of agreement or other types of documentation outlining the roles and relationship between community-based organizations and hospitals leading HVIP development. Note:

such documentation will be required for awardees to be eligible for future funding under this opportunity.

Optional planning activities

� Convening meetings to explore and develop HVIP partnerships between community-based organizations and health systems with emergency department/urgent care facilities.

� Strategic planning for HVIP program development.

� Hosting community meetings to gather input on needs and concerns related to HVIP program implementation.

� Reviewing data from multiple sources to identify the community or communities to be served by the

HVIP, current annual number of community members receiving emergency room or urgent care for incidents of community violence, types of injuries to be included in the program (firearm, assault, stabbing, etc.), estimated number of community members to be served per year, and other metrics.

� Identifying inclusion criteria and a community of focus.

� Reaching agreement between program partners about background check requirements for peers.

� Identifying existing related services available in the community and remotely. These can include domestic violence resources, youth outreach, street outreach, tele-mental and tele-behavioral health, and others.

� Identifying culturally specific and culturally responsive service providers to receive referrals for HVIP clients to specific services. Examples include psychotherapy, substance abuse and alcohol misuse screening and treatment, legal and financial services, educational support, conflict resolution and social-emotional learning, employment services, and housing support.

� Business planning to identify program expenses and revenue streams.

� Identifying program evaluation metrics.

Optional: Violence Prevention Professional training and certification

� Development of position descriptions and hiring standards for peer HVIP providers.

� Recruitment of trusted community messengers to become peer Certified Violence Prevention

Professionals, sufficient to meet the standard of response within four hours following an incident of community violence.

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 13 of

� Conducting background checks for potential Certified Violence Prevention Professionals, using standards that avoid unnecessary disqualification of peers with criminal history or history of incarceration.

� Training peer Violence Prevention Professionals through the Health Alliance for Violence Intervention or other training providers approved by OHA. Training costs may include registration fees, travel costs and per diem.

� Developing and implementing standards for on-the-job training (orientation, shadowing).

� Continuing education for Certified Violence Prevention Professionals (at least six hours every two years).

Optional: Building capacity to serve communities of need � Development of contractual relationships with Certified Violence Prevention Professionals.

� Development of referral agreements with culturally responsive service providers.

� Holding trainings for hospital/urgent care administrative staff, medical and social service providers, security personnel and administrators to ensure smooth integration of HVIPs into system operations � Documentation and standards for program processes, including intake, risk assessment, services rendered, etc.

� Developing grant writing and other organizational capacity building skills to support sustainable funding for HVIPs.

Would your organization like to be notified by OHA when funding becomes available in the future to support continuing or related violence intervention or prevention initiatives?

Yes No

Does your organization currently receive funding for any work related to violence prevention or intervention?

Local public health authority (please list county:) ______________________________ Oregon Department of Justice Portland Opportunities Industrialization Center Other source (please list): ______________________________

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 14 of

Applicant Information Part 3 Our intention is to make this application as easy as possible to complete.

Clear and concise answers are welcome. There are no maximum or minimum word or page counts; use the amount of space you need to describe your project and answer the questions.

1) Describe your organization’s experience related to violence prevention.

2) Does your organization have experience in community violence prevention? If so, please describe. For the purposes of this application, community violence is defined as an intentional act of interpersonal violence committed in public by someone who is not the victim’s family member or domestic/intimate partner.

3) Describe your community’s need for hospital-based violence intervention services. What type of violence is happening in your community, who is it affecting, and how? If known, describe the rate/frequency/number of community members affected (monthly/annually?) by community violence.

4) Describe the population(s) you intend to serve with future hospital-based violence prevention programming, how long you have worked with that population and your relationship with this community/communities.

5) Are any other organizations in your community working to reduce violence? If so, please briefly describe their work and your organization’s relationship to it, if applicable.

6) Describe any existing or potential organizational partner(s) for proposed activities and the role each will play. CBOs are encouraged to partner with hospitals and vice versa. Additional partners could include other community-based organizations, hospitals, city government, local public health authorities, or partners in other sectors. Please describe the nature of your organization’s current relationship with these partners.

7) What kind of support would your organization need to carry out proposed activities?

Applicant Information Part 4

Applicants must submit a line-item budget for the grant period (July 1, 2024 – June 30, 2025 and a high-level justification using the attached template Attachment #3.

As you complete the Proposed Budget, consider budget items and justifications such as staff time, funding for food, childcare for community conversations, contractor/facilitator, advertising for social media, gift cards for community members to participate in community conversations, etc. Also encourage payment of a living wage (at least $15.00 per hour).

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 15 of

Reporting

• Financial reports are due quarterly.

• Progress reports are due quarterly.

Everyone has a right to know about and use Oregon Health Authority (OHA) programs and services. OHA provides free help. Some examples of the free help OHA can provide are:

• Sign language and spoke language interpreters

• Written materials in other languages

• Braille

• Large print

• Audio and other formats

Attachment #2 Budget Template Form

OREGONBUYS NUMBER S-44300-00011096 /OHA-RFGA-5814 Page 17 of

Attachment #3 Grant Agreement Form