BHW HRSA-22-110 PRMHW_FINAL_MODIFIED.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Medicine and Dentistry

Promoting Resilience and Mental Health Among Health Professional Workforce

(PRMHW)

Funding Opportunity Number: HRSA-22-110 Funding Opportunity Type(s): New

Assistance Listings (CFDA) Number: 93.732

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

MODIFIED on August 20, 2021: Cover, Executive Summary, Section IV.4 and Section VI.3 Changed the Application Due Date, period of performance and period of reporting

Application Due Date: September 20, 2021

SAM.gov and Grants.gov administrative flexibilities have been implemented.

Please see Section IV.3 for more information

Issuance Date: July 16, 2021

Nancy V. Douglas-Kersellius, MSN Lead Public Health Analyst, Bureau of Health Workforce Fax: (301) 443-0162 Telephone: (301) 443-0907 Email: ndouglas@hrsa.gov

Authority: Section 765 of the Public Health Service Act (42 U.S. Code § 295) and Section

2705 of the American Rescue Plan Act of 2021 (P.L. 117-2).

mailto:ndouglas@hrsa.gov

HRSA-22-110 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Promoting Resilience and Mental Health Among Health Professional Workforce (PRMHW). The purpose of this program is to provide support to entities providing health care, health care providers associations, and Federally Qualified Health Centers (FQHCs), taking into consideration the needs of rural and medically underserved communities, to establish, enhance, or expand evidence informed or evidenced-based programs or protocols to promote resilience, mental health, and wellness among their providers, other personnel, and members, collectively known as the “Health Workforce.”

Funding Opportunity Title: Promoting Resilience and Mental Health

Among Health Professional Workforce

(PRMHW)

Funding Opportunity Number: HRSA-22-110 Due Date for Applications: September 20, 2021 Anticipated Total Available FY 2022 – FY 2024 Funding:

$29,560,000 for 3 year period of performance:

Year 1: $14,250,000 Year 2: $8,970,000 Year 3: $6,340,000

Estimated Number and Type of Award(s): Approximately 10 cooperative agreement(s)

Estimated Award Amount: Up to $1,425,000 for budget year 1 Up to $897,000 for budget year 2 Up to $634,000 for budget year 3

Cost Sharing/Match Required: No Period of Performance: January 1, 2022 through December 31, 2024

(3 years) Eligible Applicants: Eligible applicants are entities providing health care, including health care providers associations and Federally Qualified Health Centers (FQHCs).

See Section III.1 of this notice of funding opportunity (NOFO) for complete eligibility information.

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf except where instructed in this NOFO to do otherwise, except where instructed in this NOFO to do otherwise.

Technical Assistance

HRSA will hold a pre-application technical assistance (TA) webinar(s) for applicants seeking funding through this opportunity. The webinar(s) will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions.

Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://bhw.hrsa.gov/fundingopportunities/default.aspx to learn more about the resources available for this funding opportunity.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://bhw.hrsa.gov/fundingopportunities/default.aspx

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER TRANSITION

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

HRSA-22-110 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Promoting Resilience and Mental Health Among Health Professional Workforce (PRMHW).

Program Purpose The purpose of this program is to provide support to entities providing health care, health care providers associations, and Federally Qualified Health Centers (FQHCs), taking into consideration the needs of rural and medically underserved communities, to establish, enhance, or expand evidence informed or evidenced-based programs or protocols to promote resilience, mental health, and wellness among their providers, other personnel, and members, collectively known as the “Health Workforce.”

Program Goals The goal of the PRMHW program is for health care organizations to adopt, promote, implement, and demonstrate an organizational culture of wellness that includes resilience and mental health for their health professional workforce.

Program Objectives

1. Establish, enhance, expand, and integrate resilience, mental health, and wellness evidence-informed or evidence-based programs/protocols within their organization’s values, expectations, policies, and procedures to provide their health professional workforce with the knowledge, skills, services, and resources to become resilient and manage workplace stressors.

2. Implement evidence-informed or evidence-based practices within the organizations’ culture to support the rapid deployment of strategies and training that addresses health care professional workforce burnout, resilience, mental health, and wellness to achieve a culture of wellness in organizations and health care systems.

3. Increase the capacity of organizations to transform their organizational culture, values, and expectations to provide needed community-based and culturally competent services and resources to their health professional workforce(s) to enable them to manage workplace stressors.

2. Background

This program is authorized by Section 765 of the Public Health Service Act (42 U.S.

Code § 295) and Section 2705 of the American Rescue Plan Act of 2021 (P.L. 117-2).

Funding For Grants for Health Care Providers to Promote Mental Health Among Their Health Professional Workforce.

Mental Health is important throughout every stage of life. It influences emotional, psychological and social well-being, and affects how one thinks, feels and acts.1 Mental

1 Mentalhealth.gov/basics/what-is-mental-health. Mentalhealth.gov/basics/what-is-mental-health.

https://www.mentalhealth.gov/basics/what-is-mental-health

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health is the result of dynamic interactions between genes and environment, and encompasses a full spectrum from wellbeing, to burnout, to clinical conditions and suicide risk.”2 The COVID-19 pandemic “has had a profound negative effect on the mental health of the nation, especially among those who are faced with combatting the virus.”3

The health professional workforce faces many challenges that can bring about mental health issues or problems that are related to home (marital discord, death of a loved one, isolation) and work (heavy workloads, long hours, toxic work environment, isolation, and rapidly changing health care systems) stressors that result in depression, anxiety, addictions, burnout, and suicide. “Burnout consists of three components:

emotional exhaustion, depersonalization of clients and felling of ineffectiveness or lack of personal accomplishments. Emotional exhaustion of feeling overextended, being to feel compassion for clients, and feeling unable to meet workplace demands.

Depersonalization is the process by which providers distance themselves from clients to prevent emotional fatigue. Finally, feelings of ineffectiveness and lack of personal accomplishment occur when practitioners feel negative sense of personal and/or career worth”.4

Burnout in health care professionals is widespread and growing; recent studies indicate elevated levels of burnout, along with related conditions of depression and emotional exhaustion.5 Health care professionals experiencing burnout include physicians, advanced practice registered nurses, registered nurses, dentists, physician assistants, and other health professions. Approximately one in three physicians and one in eight dentists experience burnout at any given time.6,7

Compassion fatigue (stress related to constant exposure to high acuity and high patient volumes), long work hours, and unrealistic administrative responsibilities are just some of the risk factors for burnout.8 Depression, a symptom of burnout, is reported by approximately 40 percent of physicians and 18 percent of registered nurses. Two-thirds

2 Moutier, Christine. Physician Mental Health: An Evidence-Based Approach to Change. Journal of Medical Regulation, 104 (2). Retrieved May 4, 2021 from 1578321966_moutier-physician-mental-health-and-sp-jmr-2018.pdf.

3 Mental Health America. The Mental Health of Healthcare Workers in COVID-19. Retrieved May 4, 2021 from https://mhanational.org/mental-health-healthcare-workers-covid-19 4 https://www.apaservices.org/practice/update/2018/01-25/mental-health-providers#:~:text=Burnout%20commonly%20affects%20individuals%20involved,Jackson%20%26%20Lieter%2C%20 1997 .

5 Advisory Committee on Training in Primary Care Medicine and Dentistry, 15th Report, Improving Well-Being Among Primary Care Trainees, Faculty and Clinicians: Optimizing Systems to Mitigate Burnout, Promote Resilience and Drive Quality of Care. Retrieved March 11, 2021 from https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.htm l.

6 Gopalkumar Rakesh, M.D., Katherine Pier, M.D., Theresa L. Costales, M.D., A Call for Action: Cultivating Resilience in Healthcare Providers, The American Journal of Psychiatry Residents’ Journal. Retrieved March 11, 2021 from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2017.120402 7 Advisory Committee on Training in Primary Care Medicine and Dentistry, 15th Report, Improving Well-Being Among Primary Care Trainees, Faculty and Clinicians: Optimizing Systems to Mitigate Burnout, Promote Resilience and Drive Quality of Care. Retrieved March 11, 2021 from https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.htm l.

8 Joint Commission, Division of Healthcare Improvement. Developing resilience to combat nurse burnout. Quality Safety, issue 50, July 2019. Retrieved March 11, 2021 from https://www.jointcommission.org//media/tjc/newsletters/quick_safety_nurse_resilience_final_7_19_19pdf.pdf .

https://mhanational.org/mental-health-healthcare-workers-covid-19 https://www.apaservices.org/practice/update/2018/01-25/mental-health-providers#:%7E:text=Burnout%20commonly%20affects%20individuals%20involved,Jackson%20%26%20Lieter%2C%201997 https://www.apaservices.org/practice/update/2018/01-25/mental-health-providers#:%7E:text=Burnout%20commonly%20affects%20individuals%20involved,Jackson%20%26%20Lieter%2C%201997 https://www.apaservices.org/practice/update/2018/01-25/mental-health-providers#:%7E:text=Burnout%20commonly%20affects%20individuals%20involved,Jackson%20%26%20Lieter%2C%201997 https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.htm https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.htm https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2017.120402 https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.htm https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.htm https://www.jointcommission.org/media/tjc/newsletters/quick_safety_nurse_resilience_final_7_19_19pdf.pdf

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of rural physician assistants (PAs) report moderate to high emotional exhaustion, and 34 percent of dentists’ report feeling physical and emotional exhaustion.9

Efforts to address burnout are usually focused on the individual. However, it is a twofold problem that exists in the work environment as well as the individual. Lack of control of schedule and working hours, heavy workload, non-supportive work environment, unrealistic expectations of provider and patients, lack of pay, and lack of acknowledgment are just some of the factors the health workforce are faced with in the work environment. To adequately decrease the incidence of burnout of their health care workforce, organizations need to promote a culture that supports resilience, mental health, and wellness.

Resilience is the ability to bounce back from stressful situations, endure hardships, and repair your own well-being, while creating a positive adaptation in the face of disruptive changes.10 The ability to be resilient may be innate, however, research shows that it could be learned.11

During the COVID-19 pandemic, Mental Health America conducted a survey of 1,119 health care workers and reported an increase in the number of health care professionals who experienced anxiety, depression, loneliness and other mental health concerns since the pandemic began.12 The report indicated that 93% of health care workers experience stress, 86% anxiety and 75% were overwhelmed. They also surveyed health care workers regarding emotional and physical exhaustion, 68% reported physical exhaustion, 52% compassion fatigue, and 70% had trouble sleeping.13

The impact of the COVID-19 response on the emotional and physical health of the U.S.

public health workforce have been well described.14 The “Coping with COVID” study found that nursing assistants, medical assistants, housekeeping and social workers from minority groups had somewhat higher levels of stress and burnout.15 Further contributing to the impact on provider burnout are the challenges faced in rural communities. Data shows that “African American, Latinx and Native American communities make up 22% of the rural population and are also at higher risk for underlying health conditions that are known risk factors for severe COVID-19

9 Advisory Committee on Training in Primary Care Medicine and Dentistry, 15th Report, Improving Well-Being Among Primary Care Trainees, Faculty and Clinicians: Optimizing Systems to Mitigate Burnout, Promote Resilience and Drive Quality of Care. Retrieved March 11, 2021 from https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.htmlCT .

10 Ibid.

11 Gopalkumar Rakesh, M.D., Katherine Pier, M.D., Theresa L. Costales, M.D., A Call for Action: Cultivating Resilience in Healthcare Providers, The American Journal of Psychiatry Residents’ Journal. Retrieved March 11, 2021 from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2017.120402 12 Mental Health America. The Mental Health of Healthcare Workers in COVID-19. Retrieved May 4, 2021 from https://mhanational.org/mental-health-healthcare-workers-covid-19 .

13 Ibid.

14 Stone, K.W., Kitziger,K. W., […] and Horney, J.A. Public Health Workforce Burnout in the COVID-19 Response in the U.S. International Journal of Environmental Research and Public Health. 2021 April; 18(8):4369 15 Kriti Prasada, Colleen McLoughlinc, Martin Stillmanb, Sara Poplaub, Elizabeth Goelzb, Sam Taylorc, Nancy Nankivilc, Roger Brownd, Mark Linzerb, Kyra Cappeluccic, Michael Barbouchee, Christine A. Sinskyc. Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study. EClinical Medicine. Retrieved July 9, 2021 from https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00159-0/fulltext https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.htmlCT https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.htmlCT https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2017.120402 https://mhanational.org/mental-health-healthcare-workers-covid-19 https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00159-0/fulltext

HRSA-22-110 4

disease.”16 Rural health care systems face challenges in responding to the needs of rural populations such as fewer hospitals and providers who specialize in critical care.

The health professional workforce may hesitate seeking assistance for mental health issues or problems they are experiencing due to stigma associated with having a mental health issue or problem. The concern is that identifying a mental health issue or problem poses the potential for negative ramifications to their reputation, may influence licensure and hospital privileging, as well as other barriers such as lack of confidentiality, time constraints, and uncertainty about whether treatment would help.17

Organizations can help or mitigate health care professionals experiencing stressors and mental health issues or problems by implementing strategies that may include evidence-informed or evidence-based practices (for example: age friendly health systems/framework, motivational interviewing, cognitive behavioral therapy) and system changes such as development and enhancement of wellness and employee assistance programs. They should also provide education and stigma reduction efforts, enhance resiliency, institute policies and procedures to address mental health as one would a physical health condition and promote a culture of respect.18

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the Health Workforce Glossary.

In addition, the following definitions apply to the PRMHW Program for Fiscal Year 2022:

Age-Friendly Health System/Framework (AFHSF): For the purposes of this NOFO, the AFHSF is adapted to provide a comprehensive person-centric approach to mental health education, training, and health care, for individuals in the workplace, with a goal to improve their quality of life. This approach addresses four key elements that include

a) What Matters (to the individual); b) Medication; c) Mentation; and d) Mobility.

Community of Practice (CoP) are groups of people who share a concern or a passion for something they do and discover how to do it better as they interact regularly.19

Consortium (plural – consortia) means a group of people, companies, etc. that agree to work together.20

Culture of Wellness is defined for purposes of this NOFO as fostering a workplace that encourages and promotes the well-being of your employees by availing programs, services, and resources for employees that encourages a healthy or wellness oriented lifestyle and work environment.

16 Infectious Diseases Socieity of America. (2020). COVID-19 Policy Brief : Disparities Among Rural Communities in the United States. Retrieved from https://www.idsociety.org/globalassets/idsa/public-health/covid-19/covid19-health-disparities-in-rural-communities_leadership-review_final_ab_clean.pdf 17 Moutier, Christine. Physician Mental Health: An Evidence-Based Approach to Change. Journal of Medical Regulation, 104 (2). Retrieved May 4, 2021 from 1578321966_moutier-physician-mental-health-and-sp-jmr-2018.pdf.

18 Ibid.

19 Wenger-Trayner, E and B. Introduction to communities of practice: A brief overview of the concept and its uses.

Retrieved April 7, 2021 from https://wenger-trayner.com/introduction-to-communities-of-practice/ 20 Retrieved April 7, 2021 from https://www.merriam-webster.com/dictionary .

https://bhw.hrsa.gov/grants/resourcecenter/glossary https://www.idsociety.org/globalassets/idsa/public-health/covid-19/covid19-health-disparities-in-rural-communities_leadership-review_final_ab_clean.pdf https://www.idsociety.org/globalassets/idsa/public-health/covid-19/covid19-health-disparities-in-rural-communities_leadership-review_final_ab_clean.pdf https://wenger-trayner.com/introduction-to-communities-of-practice/ https://www.merriam-webster.com/dictionary

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Health Professional Workforce is defined for purposes of this NOFO as the full spectrum of health care workers. The health care team is inclusive of health care professionals (including public health), paraprofessionals, direct care workers, care givers and health care support personnel such as administrative, facilities (IT, security, linen, dietary, etc.), operations (bioengineering) and maintenance (janitorial, etc.).

Health Equity is the absence of disparities or avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.21

Health Care Providers Associations, for purposes of this NOFO, means an organization formed for the benefit of a single discipline or multiple disciplines that sets standards or certifications or program approval. This includes, for example, the American Medical Association, Physician Assistant Education Association, American Association of Medical Colleges, Commission on Collegiate Nursing Education, and Council on Social Work Education.

Resilience is defined as the ability to bounce back from stressful situations, endure hardships, and repair your own well-being, while creating a positive adaptation in the face of disruptive changes.22

Rural is defined as having at least one rural partner or entity located in a rural area, or the beneficiary of the services lives in a rural area as indicated by the rural health analyzer https://data.hrsa.gov/tools/rural-health.

Wellness for purposes of this NOFO is multidimensional and holistic, encompassing lifestyle, physical, mental and emotional well-being, and the environment.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where HRSA anticipates substantial involvement with the recipient during performance of the contemplated project.

In addition to the usual monitoring and technical assistance provided under the cooperative agreement, HRSA program involvement will include:

• Participating in the planning, development, and evaluation of all phases of the project to accomplish the objectives of the cooperative agreement;

21 Health Resources and Services Administration Office of Health Equity.

https://www.hrsa.gov/about/organczation/bureaus/ohe/index.html.

22Advisory Committee on Training in Primary Care Medicine and Dentistry, 15th Report, Improving Well-Being Among Primary Care Trainees, Faculty and Clinicians: Optimizing Systems to Mitigate Burnout, Promote Resilience and Drive Quality of Care. Retrieved March 11, 2021 from https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.html .

https://data.hrsa.gov/tools/rural-health https://www.hrsa.gov/about/organczation/bureaus/ohe/index.html https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.html https://www.hrsa.gov/advisory-committees/primarycare-dentist/reports.html

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• Reviewing project training and education products such as videos, toolkits, assessment tools, on-line training, and manuscripts as they are being developed and prior to dissemination;

• Assisting recipients and their partners in developing a national network to share resources, best practices, and lessons learned;

• Assisting with establishing collaborative relationships with federal, state and local agencies, and other entities that may be relevant to the project’s mission;

• Providing programmatic input and consultation for development and delivery of mental health, resilience, and wellness education and training materials; and

• Collaborating with recipients and their partners to develop and implement assessment and evaluation strategies.

The cooperative agreement recipient’s responsibilities will include:

• Participating in monthly technical assistance calls with other PRMHW recipients and HRSA staff;

• Collaborating and communicating in a timely manner with the HRSA project officer;

• Providing the HRSA project officer with an opportunity to review project information and project training and education products such as videos, toolkits, assessment tools, on-line training and manuscripts as they are being developed and prior to dissemination;

• Establishing contacts and coordinating activities with federal, state, and local agencies, and other HRSA mental health projects;

• Collaborating with HRSA and other recipients under this NOFO to develop and implement assessment and evaluation strategies; and

• Participate in a Community of Practice (CoP) with HRSA-funded PRMHW grant recipients to share resources and characteristics of an organizational culture that promote resilience, mental health, and wellness for the health professional workforce.

2. Summary of Funding

HRSA estimates approximately $29,560,000 will be available over a three-year period of performance to fund approximately 10 recipients. The amount allocated will be available via decremental funding each year of the 3 year period of performance:

$14,250,000 in year one, $8,970,000 in year two, and $6,340,000 in year three. The funding for year one (1) is substantial compared to years 2 and 3, as awardees may have immediate needs for the development and implementation of mental health support for their workforce. The reason for the decremental funding is to allow for the start-up of the project and to reach as many participants as possible.

You may apply for the following ceiling amounts for each year (inclusive of both direct and indirect, facilities and administrative costs):

• Year one - up to $1,425,000

• Year two - up to $897,000

• Year three - up to $634,000.

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The period of performance is January 1, 2022 through December 31, 2024 (3 years).

Funding beyond the first year is subject to satisfactory recipient progress and a decision that continued funding is in the best interest of the Federal Government.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants are entities that provide health care, including health care providers associations, and FQHCs.

See FAQs on the Related Documents Tab in GRANTS.GOV HRSA-22-110 for more information.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount non-responsive and will not consider it for funding under this notice.

Deadline HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

Multiple Applications Multiple applications from an organization are not allowable. An organization can have multiple locations across the country that are separate but have the same name. In order to be eligible, applicant organizations with the same name must have a different DUNS numbers or a Unique Entity Identifier Number (EIN).

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://www.grants.gov/web/grants/search-grants.html

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IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 Research and Related (R&R) workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for each NOFO you are reviewing or preparing in the workspace application package in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing this NOFO.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the SF-424 R&R Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files included in the page limit may not exceed the equivalent of 80 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Biographical sketches do count in the page limitation. Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-22-110, it may count against the page limit. Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 80 pages will not be read, evaluated, or considered for funding.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3321).

3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachment 11: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 R&R Application Guide for additional information on all certifications.

Temporary Reassignment of State and Local Personnel during a Public Health Emergency

Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness (ASPR) website via http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx.

Program-Specific Instructions

Program Requirements

1. Establish, enhance, or expand evidence-informed or evidence-based programs or protocols that promote organizational capacity to support resilience, mental health, and wellness for the health professional workforce. Applicants must describe the activities they will use to establish the programs and/or protocols. Examples of activities may include, but are not limited to, addressing current health professional workforce issues via in-service training for employees that integrates wellness, and resilience practices, and creates a mutual open and supportive environment that encourages health care providers to accept assistance and services.

http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx

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2. Integrate resilience, mental health, and wellness evidence-informed or evidence-based programs or protocols within their organization’s values, expectations, policies, and procedures to provide their health professional workforce with the knowledge, skills, services, and resources to become resilient and manage workplace stressors.

3. Develop partnerships with organizations that have established and successful programs to provide resilience, mental health, and wellness training for their health professional workforce(s) taking into consideration:

a. the needs of rural and medically underserved communities,

b. health equity and health disparities (social and medical needs),

c. social determinants of health,

d. burnout, and

e. barriers to seeking mental health support for burnout in the workplace.

4. Conduct a survey within 45 days of award to identify local or regional organizations that provide evidence-informed or evidence-based programs/protocols that promote resilience, mental health, and wellness within the context of addressing social determinants of health needs; providing community-based and culturally-competent services, financial and social support; and resources to the health professional workforce.

5. Develop or enhance strategies and interventions for rapid deployment (call center, hotline, consultation, referral, support groups for employees, motivational interviewing and behavioral health coaching, etc.) to address burnout and other workplace stressors for the health professional workforce.

Applicants that do not meet all of the program requirements will be considered non-responsive and will not will not be considered for funding under this notice.

In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Application Guide (including the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

i. Project Abstract

See Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

The Abstract must include:

1. A brief overview of the project as a whole

2. Specific, measurable objectives that the project will accomplish

3. Which of the clinical priorities will be addressed by the project, if applicable; and

4. How the proposed project for which funding is requested will be accomplished, i.e., the "who, what, when, where, why and how" of a project.

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ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and well-organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

PURPOSE AND NEED -- Corresponds to Section V’s Review Criterion #1.

Briefly describe the purpose of the proposed project. Use and cite demographic data whenever possible to support the information provided. This section will help reviewers understand the organization that would receive funding

1. Provide evidence of having the working infrastructure for rapid deployment (call center, hotline, consultation, referral, support groups for employees, motivational interviewing and behavioral health coaching, etc.) to address burnout and other workplace stressors for the health professional workforce.

2. Describe your organization’s current values, expectations, policies, procedures, strategies, interventions, and evidence-informed or evidence-based programs/ protocols to provide resilience, mental health, and wellness support, training, services, and/or resources to the full spectrum of the health professional workforce and any identified gaps.

3. Provide data on the demographics, social determinants of health, health disparities and the resilience and wellness of the applicant organization’s providers, other personnel, and members, including those from rural and or medically underserved communities.

4. Describe the national, regional or local incidence and prevalence of the health professional workforce burnout, resiliency, mental health, workplace stressors, and job retention.

5. Provides a table of your organization and associated satellite locations that will benefit from the project, which includes the information contained in the following example. Using the table below, indicate if your organization or satellite(s) location is located in a rural or medically underserved community. Refer to the following links:

Rural: https://data.hrsa.gov/tools/rural-health Medically Underserved Community: https://data.hrsa.gov/tools/shortage-area https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/shortage-area

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Table 1:

Name of Organization

Address (include City, ST and Zip code)

County Rural Community as indicated by the rural health analyzer located at:

https://data.hrsa.gov/tools/rural-health

Medically Underserved Community as indicated by https://data.hrsa.gov/tools/shortage-area

RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections — (a) Work Plan; (b) Methodology/Approach; and (c) Resolution of Challenges—all of which correspond to Section V’s Review Criteria #2 (a), (b), and (c).

(a) WORK PLAN -- Corresponds to Section V’s Review Criterion #2 (a).

Provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope (a sample work plan can be found here:

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.)

1. Describe the objectives of the proposed project. They should be specific, measurable, achievable, realistic, and accomplished in a reasonable timeframe.

2. Describe the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance identified in the Methodology section.

3. Describe the timeframes, deliverables, and key partners required during the grant period of performance to address each of the needs described in the Purpose and Need section.

4. Explain how the work plan is appropriate for the program design and how the targets fit into the overall timeline of grant implementation.

5. Identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including development of the application and, further, the extent to which these contributors reflect the applicant organization’s providers, other personnel and members.

6. If funds will be sub-awarded or expended on contracts, describe how your organization will ensure the funds are properly documented.

(b) METHODOLOGY/APPROACH -- Corresponds to Section V’s Review Criterion #2 (b).

Describe your objectives and proposed activities, and provide evidence for how they link to the project purpose and stated needs. Propose methods that you will use to https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/rural-health https://data.hrsa.gov/tools/shortage-area http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

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address the stated needs and meet each of the previously described program requirements and expectations in this NOFO.

1. Describe a plan for how your organization will collaborate with other awardees and stakeholders to develop a framework that supports the rapid deployment of evidence-informed or evidence-based strategies to address clinician burnout, mental health issues, and provider resilience and wellness.

2. Describe your plans for conducting a survey within 45 days of award to identify local or regional organizations that provide evidence-informed or evidence-based programs/protocols that promote resilience, mental health, and wellness within the context of addressing social determinants of health needs; providing community-based and culturally-competent services, financial and social support;

and resources to the health professional workforce.

3. Describe your strategies for the establishment, enhancement, or expansion of evidence-informed or evidence-based programs or protocols that promote an institutional culture that supports resilience, mental health, and wellness for the health professional workforce.

4. Describe the modalities (in-person, virtual, or on-demand) to be used and the types of trainings or programs to be implemented that reduce burnout, and improve and promote resilience, mental health, and wellness.

5. Describe the organizations values, expectations, protocols, procedures, policies, and activities to create an environment for health professional workforce to freely access services and resources that address provider burnout and promote and sustain a culture of resilience, mental health, and wellness that ensures privacy and confidentiality.

6. Describe the strategies/methods to be used to address health equities, health disparities, the social determinants of health, and the financial and social needs of your health professional workforce taking into consideration the needs of rural and medically underserved communities.

7. Describe the methods you will use to assess your health professional workforce’s recommendations on your organizations values, expectations, policies, and procedure to transform your organization culture to one that promotes resilience, mental health, and wellness.

Logic Model

Submit a logic model as Attachment 8 for designing and managing the project. A logic model is a one-page diagram that presents the conceptual framework for a proposed project and explains the links among program elements to achieve the relevant outcomes. While there are many versions of logic models, for the purposes of this notice the logic model should summarize the connections between the:

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• Goals of the project (e.g., reasons for proposing the intervention, if applicable);

• Assumptions (e.g., beliefs about how the program will work and support resources. Base assumptions on research, best practices, and experience);

• Inputs (e.g., organizational profile, collaborative partners, key personnel, budget, other resources);

• Target population (e.g., the individuals to be served);

• Activities (e.g., approach, listing key intervention, if applicable);

• Outputs (i.e., the direct products or deliverables of program activities);

and

• Outcomes (i.e., the results of a program, typically describing a change in people or systems).

Although there are similarities, a logic model is not a work plan. A work plan is an “action” guide with a time line used during program implementation; the work plan provides the “how to” steps. A logic model is a visual diagram that demonstrates an overview of the relationships between the 1) resources and inputs, 2) implementation strategies and activities, and 3) desired outputs and outcomes in a project. You can find additional information on developing logic models at the following website:

https://www.acf.hhs.gov/sites/default/files/documents/prep-logic-model-ts_0.pdf

(c) RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion #2 (c).

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges.

1. Describe the challenges you may encounter in achieving the program specific requirements.

2. Describe challenges related to achievement of project objectives, carrying out the work plan according to the proposed timetable, and project implementation.

3. Describe proposed solutions to the challenges that are identified.

IMPACT -- This section includes two sub-sections— (a) Evaluation and Technical

Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b).

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to

Section V’s Review Criterion #3 (a).

1. Describe the plan for program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation must monitor ongoing processes and progress toward meeting goals and objectives of the project. Include descriptions of the inputs (e.g., key evaluation personnel https://www.acf.hhs.gov/sites/default/files/documents/prep-logic-model-ts_0.pdf

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and organizational support, collaborative partners, budget, and other resources);

key processes; variables to be measured; expected outcomes of the funded activities; and a description of how all key evaluative measures will be reported.

Demonstrate evidence that the evaluative measures selected will be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which these can be attributed to the project.

2. Describe a plan to demonstrate health system/organization culture change and evaluate the impact of the project and program activities on burnout, resilience, mental health, and wellness of health professional workforce organizations using screening and/or assessment tools, including providing a description of evidence based screening and/or assessment tools available to evaluate this impact.

3. Describe the systems and processes that will support your organization's collection of HRSA’s performance measurement requirements for this program.

At the following link, you will find examples of the required data forms for this program: http://bhw.hrsa.gov/grants/reporting/index.html.

4. Describe the data collection strategy and tools to accurately collect, manage, analyze, store, and track/report data (e.g., assigned skilled staff, data management software) to measure process and impact/outcomes, and explain how the data will be used to inform program development and training in a way that allows for accurate and timely reporting of performance outcomes.

5. Describe current experience, skills, and knowledge of individuals on staff, including materials published and previous work of a similar nature.

6. Evaluate the efficacy of the project in establishing, enhancing, or expanding evidence-informed or evidence-based programs/protocols that promote access to quality of care, services, and resources provided to health care professionals in reducing burnout and improving resilience, mental health, and wellness.

Submit a publishable report of the evaluation to HRSA at the end of the cooperative agreement period of performance.

7. Describe any potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles. The evaluation and reporting plan also should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

http://bhw.hrsa.gov/grants/reporting/index.html

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8. Include a plan for Rapid Cycle Quality Improvement (RCQI) for the continuous monitoring of ongoing project processes, outcomes of implemented activities, and progress toward meeting grant goals and objectives and the implementation of necessary adjustment to planned activities to effect course corrections. You may choose to require RCQI as part of an activity to be included under some or all program objectives and submitted as under the Work Plan. Additional information on RCQI is available at the following website:

https://www.healthworkforceta.org//wpcontent/uploads/2016/06/RCQI_Resource _Guide.pdf

Performance Reporting Plan:

HRSA requires that you collect the following preliminary list of data annually.

1. Number of trainings provided and the demography of training participants.

2. Number of and type of health care organizations and disciplines of health care workforce trained.

3. Number of in-services and/or programs implemented to improve resiliency, mental health, burnout and wellness.

4. Number of training, toolkits, and other resources (website, social media, and apps) developed and disseminated to…