BHW HRSA-22-124 (BH1) CHWTP_MODIFIED.pdf

U.S. Department of Health and Human Services

Bureau of Health Workforce

Division of Nursing and Public Health

Community Health Worker Training Program (CHWTP)

Funding Opportunity Number: HRSA-22-124

Funding Opportunity Type: New

Assistance Listings (AL) Number: 93.516

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: June 14, 2022 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems may take up to 1 month to complete.

Issuance Date: April 14, 2022

MODIFIED May 5, 2022: No Duplication of Funding and Efforts - Eligibility Section III.3 Other;

Attachment 10; and Review and Selection Section V.2

Marian Smithey, MS, RN Nurse Consultant/Project Officer, DNPH Telephone: (301) 443-3831 Email: MSmithey@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 295 (Section 765 of the Public Health Service Act) and Section 2501 of the American Rescue Plan Act of 2021(Public Law 117-2).

mailto:MSmithey@hrsa.gov

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508 COMPLIANCE DISCLAIMER

Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, please email or call one of the HRSA staff listed in Section VII.

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the Fiscal Year (FY) 2022 Community Health Worker and Health Support Worker Training Program (CHWTP). The purpose of this program is to expand the public health workforce through the training of new Community Health Workers (CHWs) and health support workers and to extend the knowledge and skills of current CHWs and other health support workers. Through this program, HRSA plans to train 13,000 new and current CHWs and other health support workers to support essential public health services and to focus on experiential training and employment through registered apprenticeships and job placements. The CHWTP aims to increase access to care, improve public health emergency response, and address the public health needs of underserved communities.

Individuals trained through the program will acquire knowledge, skills, and expertise to respond to public health needs and public health emergencies, such as the COVID-19 pandemic, in underserved communities through a network of partnerships.

Funding Opportunity Title: Community Health Worker Training

Program (CHWTP)

Funding Opportunity Number: HRSA-22-124

Due Date for Applications: June 14, 2022

Anticipated Total Amount Available: Approximately: $226,500,000

Estimated Number and Type of Award(s): Approximately 75 grants

Estimated Award Amount Up to $3,000,000 (Fully-funded at the time of award for use over the three-year period of performance)

Cost Sharing/Match Required: No

Period of Performance:

September 15, 2022, through September 14, 2025 (3 years)

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Eligible Applicants (A) Health professions schools, including accredited schools or programs of public health, health administration, preventive medicine, or dental public health or schools providing health management programs;

(B) Academic health centers;

(C) State or local governments including state, local and territorial public health departments; or

(D) Any other appropriate public or private non-profit entity such as, but not limited to: community colleges, community health centers, Federally Qualified Health Centers (FQHCs), and community-based organizations, and tribal entities that train public and allied health workers.

See Section III.1 of this Notice of Funding Opportunity (NOFO) for complete eligibility information.

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.

Technical Assistance

HRSA will hold a pre-application technical assistance (TA) webinar for applicants seeking funding through this opportunity. The webinar 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

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. Standardized Work Plan (SWP Form)

vi. Attachments

3. 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

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Community Health Worker and Health Support Worker Training Program (CHWTP).

The purpose of the CHWTP is to support projects that will increase the number of Community Health Workers (CHWs) and Health Support Workers and equip them with the skillsets needed to provide effective community outreach build trust with communities, support connections to and retention in care and support services, and other strategies to increase access to care and to assist individuals in prevention services, and recovery from the COVID-19 pandemic and other public health emergencies in underserved communities. These combined efforts are intended to advance public health, strengthen the public health workforce, reduce health disparities, and help underserved populations achieve health equity.

Program Goals

• Expand the public health workforce by training new and existing CHWs and health support workers with specialized training and financial support to offset expenses that would impede success in training. The Program’s goal is to provide training so that 75% of participants become newly credentialed CHWs and health support workers.

• Extend and upskill the public health workforce by developing new or enhancing existing curriculums to increase the skills and competencies of existing CHWs and health support workers.

• Increase CHW and health support worker employment readiness through field placements and apprenticeships developed in collaboration with a network of partnerships that will enable trainees to respond to and support essential public health services and provide them with employment opportunities.

• Advance health equity and support for underserved communities by increasing the number of CHWs and health support workers that are employed as integral members of integrated care teams that use their expanded skills to reduce health disparities.

Program Objectives

1. Expansion:

• Establish educational training curriculums and recruit, train and enable new CHWs and health support workers candidates to acquire core competencies for CHWs and Public Health certifications that follow state, local, or entity guidelines and support essential public health services.

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• Reduce barriers to CHW and health support worker program enrollment and retention by providing eligible trainees with participant support (e.g., tuition/fees, stipends, health insurance, and child care).

2. Extension/Upskilling:

• Provide additional training for current CHWs and health support workers to include the core competencies for Public Health and Essential Public Health Services.

• Develop or enhance trainee curriculum around evidence-based core competencies for public health, including but not limited to emergency response education, prevention, treatment, and vaccine hesitancy research.

3. Employment:

• Implement hands-on CHW and health support worker integrated training through community-based partnerships that provide field placements in underserved communities.

• Provide job placement services and on-the-job experiential training to new CHWs and health support workers through Department of Labor or state/local registered apprenticeship programs.

4. Health Equity:

• Address critical gaps in public health and community needs that can be filled by CHWs health support workers in communities that are disproportionately burdened by COVID-19, health inequities, limited access to technology, and the Social Determinants of Health (SDOH).

• Increase the distribution and diversity of the CHW and health support workers workforce by recruiting, training, or employing, as applicable, individuals who will serve in underserved communities as integral members of integrated care teams.

Promoting equity is essential to the Department’s mission of protecting the health of Americans and providing essential human services. This view is reflected in Executive Order (E.O.) 13985, “Advancing Racial Equity and Support for Underserved Communities Through the Federal Government” (Jan. 20, 2021).

Recipients of Federal Financial Assistance (FFA) from HHS must administer their programs in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age and, in some circumstances, religion, conscience, and sex. This includes ensuring programs are accessible to persons with limited English proficiency and persons with disabilities. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. See HHS Provider Obligations, HHS Nondiscrimination Notice, and Section VIII. Other Information for further details.

https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html https://www.hhs.gov/civil-rights/for-providers/provider-obligations/index.html https://www.hhs.gov/civil-rights/for-individuals/nondiscrimination/index.html

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HRSA’s Bureau of Health Workforce is committed to increasing diversity in health professions programs and the health workforce across the Nation. This commitment extends to ensuring that the U.S. has the right clinicians, with the right skills, working where they are needed.

For more details, see Program Requirements and Expectations.

General Emergency Preparedness Statement

Eligible entities must be ready to continue programmatic activities in the event of a public health emergency – both expected and unexpected. A training-focused emergency preparedness plan is critical for HRSA-funded projects and helps ensure that grantees are able to continue programmatic activities, can coordinate effectively, and can implement recovery plans when emergencies disrupt project activities.

Applicants must develop and maintain a flexible training-focused emergency preparedness plan in case of public health emergencies to ensure continuation of programmatic and training activities, including but not limited to experiential training on the CHWTP.

2. Background

The CHWTP is authorized by Section 765 of the Public Health Service Act (42 U.S.C. §

295) and Section 2501 of the American Rescue Plan Act of 2021 (P.L. 117-2).

The current COVID-19 pandemic has widened health disparities for people that live in underserved communities that are often economically and medically under-resourced and/or geographically isolated. Underserved communities tend to have more people living with chronic health conditions which can predispose individuals to frequent or more severe bouts of illness1 and/or COVID-19-related morbidity and mortality.2 While the reasons for these poor health outcomes vary, a constant is that access to care and resources are limited while needs remain great.

The social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. They include economic stability, education access and quality, health care access and quality, neighborhood

1 HealthyPeople.gov, [online]. Available: October 20,2021 https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/poverty 2 MMWR / April 9, 2021 / Vol. 70 / No. 14, US Department of Health and Human Services/Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report.

https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7024a4-H.pdf https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/poverty https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/poverty https://www.cdc.gov/mmwr/volumes/70/wr/pdfs/mm7024a4-H.pdf

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and built environment, and social and community context.3 A number of recent studies have recognized that only about 20 percent of health outcomes are attributed to clinical care, while SDOH account for an estimated 80 percent of overall health outcomes.4 Therefore, addressing the SDOH can improve health equity and population health outcomes and, by virtue of their role, CHWs and health support workers are well-suited to address these factors that influence health outcomes.

The American Public Health Association (APHA) defines CHWs as frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served.5 This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.6 Since the onset of the COVID-19 pandemic, CHWs have proven to be an essential element of the response to the disease by implementing vaccine outreach and through proactive community education and engagement.7 Because of their close community connections, CHWs are often able to succeed where clinicians might fail in connecting with hard-to-reach populations. Their outreach efforts can improve health equity for individuals in underserved areas by building on their community trust to encourage individuals to seek care and stay connected to treatment or adopting preventive health behaviors that result in better health outcomes.8 CHWs have the capacity to strengthen communities’ connections to health care providers and community trust in health care information, and potentially improve health outcomes by connecting at-risk individuals to local resources, social supports, care coordination, and home and community-based services.9,10

3 Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved December 10, 2021, from https://health.gov/healthypeople/objectives-and-data/social-determinants-health 4 Hood, C. M., K. P. Gennuso, G. R. Swain, and B. B. Catlin. 2016. County health rankings: Relationships between determinant factors and health outcomes. American Journal of Preventive Medicine 50(2):129-135.

https://doi.org/10.1016/j.amepre.2015.08.024 5 “Community Health Workers.” American Public Health Association. Downloaded October 17, 2021 https://www.apha.org/apha-communities/member-sections/community-health-workers

6 “Support for Community Health Worker Leadership in Determining Workforce Standards for Training and Credentialing.” American Public Health Association (APHA) Policy Statements and Advocacy, Nov 18, 2014, Downloaded December 10, 2021 from https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy- Statements/Policy-Database/2015/01/28/14/15/Support-for-Community-Health-Worker-Leadership 7 Peretz, Patricia J., et al. “Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond: NEJM.” New England Journal of Medicine, 10 Mar. 2021.

8 Kim, K., Choi, J. S., Choi, E., Nieman, C. L., Joo, J. H., Lin, F. R., Gitlin, L. N., & Han, H. R. (2016). Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review. American journal of public health, 106(4), e3–e28.

https://doi.org/10.2105/AJPH.2015.302987 9 Lee, L. K., Ruano, E., Fernández, P., Ortega, S., Lucas, C., & Joachim-Célestin, M. (2021). Workforce Readiness Training: A Comprehensive Training Model That Equips Community Health Workers to Work at the Top of Their Practice and Profession. Frontiers in public health, 9, 673208. https://doi.org/10.3389/fpubh.2021.673208 10 Bhatt, J., & Bathija, P. (2018). Ensuring Access to Quality Health Care in Vulnerable Communities. Academic medicine : journal of the Association of American Medical Colleges, 93(9), 1271–1275.

https://doi.org/10.1097/ACM.0000000000002254 https://health.gov/healthypeople/objectives-and-data/social-determinants-health https://health.gov/healthypeople/objectives-and-data/social-determinants-health https://doi.org/10.1016/j.amepre.2015.08.024 https://www.apha.org/apha-communities/member-sections/community-health-workers https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2015/01/28/14/15/Support-for-Community-Health-Worker-Leadership https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2015/01/28/14/15/Support-for-Community-Health-Worker-Leadership https://doi.org/10.2105/AJPH.2015.302987 https://doi.org/10.3389/fpubh.2021.673208 https://doi.org/10.1097/ACM.0000000000002254

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As members of integrated teams in primary care, public health departments, hospitals or community health centers, CHWs act as outreach workers or patient navigators who can facilitate individuals connection to care, facilitate patient follow-up, completing medical insurance applications, addressing food insecurity, transportation and housing issues, health literacy, and providing informal counseling and emotional support.11 In predominantly Hispanic communities where language barriers can be a significant impediment to care, CHWs are known as “promotores,” or “promotoras de salud,” often working with faith-based or community-based organizations to provide health education and connect communities to health resources, often speaking the language of the communities served and understanding the culture of the communities they serve.12 Research studies show that promotoras de salud programs are vital partners in improving the health of Hispanic families and their communities.13

Health support workers are trained lay persons that work in tandem with licensed health care professionals to provide a mixture of basic health care patient services in settings such as hospitals, health clinics, schools, physician offices, nursing care facilities, and patient homes. In behavioral health settings, support workers can include peer support counselors/ mentors, outreach workers, social services aides, and substance use disorder recovery coaches. In these roles, individuals perform a variety of preventive health promotion activities, including health care education and helping patients access care and resources according to their individual needs. Behavioral/peer support specialists and CHWs continue to represent an under-utilized segment of the public health workforce14,15 and have also been increasingly recognized by federal agencies for their key role in mitigating provider shortages and increasing health care access to underserved minority populations.16,17 State regulations, which vary across the country, determine the types of health care services that individuals covered by this announcement can provide and determine the length and type of training that they must have.

11 Payne J, Razi S, Emery K, Quattrone W, Tardif-Douglin M. Integrating Community Health Workers (CHWs) into Health Care Organizations. J Community Health. 2017 Oct;42(5):983-990 12 Centers for Disease Control and Prevention. Promotores de Salud/Community Health Workers https://www.cdc.gov/minorityhealth/promotores/index.html 13 Johnson, C. M., Sharkey, J. R., Dean, W. R., St John, J. A., & Castillo, M. (2013). Promotoras as research partners to engage health disparity communities. Journal of the Academy of Nutrition and Dietetics, 113(5), 638–642.

https://doi.org/10.1016/j.jand.2012.11.014 14 Briggs, H.E., Miller, S.E, Briggs, A.C. Enhancing Behavioral Health Workforce in Youth Mental Health through Grand Challenges in Social Work. Journal of Child and Adolescent Behavior 2016; 4(1): 270. Available at:

https://www.omicsonline.org/open-access/enhancing-behavioral-health-workforce-in-youth-mental-health-throughgrand-challenges-in-social-work-2375-4494-1000270.php?aid=69568 15 Minore B, Jacklin K, Boone M, Cromarty H. Realistic expectations: the changing role of paraprofessional health workers in First Nation communities in Canada. Educ Health (Abingdon). 2009 Aug;22(2):298. Epub 2009 Aug 26.

PMID: 20029752.

16 The Annapolis Coalition on the Behavioral Health Workforce. An Action Plan for Behavioral Health Workforce Development. Cincinnati, OH: Annapolis Coalition 2007.

17 https://www.health.mil/Reference-Center/Congressional-Testimonies/2018/09/17/Improving-Access-to-Para- Health-Professional-Extenders https://www.cdc.gov/minorityhealth/promotores/index.html https://www.omicsonline.org/open-access/enhancing-behavioral-health-workforce-in-youth-mental-health-throughgrand-challenges-in-social-work-2375-4494-1000270.php?aid=69568 https://www.omicsonline.org/open-access/enhancing-behavioral-health-workforce-in-youth-mental-health-throughgrand-challenges-in-social-work-2375-4494-1000270.php?aid=69568 https://www.health.mil/Reference-Center/Congressional-Testimonies/2018/09/17/Improving-Access-to-Para-Health-Professional-Extenders https://www.health.mil/Reference-Center/Congressional-Testimonies/2018/09/17/Improving-Access-to-Para-Health-Professional-Extenders

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While the role of the CHW or health support workers is dependent upon the work setting, the integration of CHWs and health support workers into care teams can result in optimal contributions to health systems.18 CHWs and health support workers can bridge access to care gaps by helping patients obtain internet connected tools and devices by providing hands-on instruction in using this technology to access online resources, learn self-care, and participate in remote office visits as a cost-effective means of continuing follow-up care with their health care provider(s).

Racial and ethnic diversity in the health care workforce, an aspect of organizational cultural competence, can correlate to the delivery of quality care to minority populations. Frequently, CHWs and health support workers face some of the same barriers, such as financial, educational, language and other barriers, as the underserved populations and communities they serve, which can mean that pursuing training may be unaffordable, both due to the direct cost of training programs and the hours and costs associated with participating in training.19 Individuals from racial and ethnic minority communities continue to disproportionately experience negative health outcomes.

Increasing the diversity of the public health workforce is one strategy used at the community and organizational level to improve the quality of care and health outcomes among these populations.20

CHW core competencies support activities that can be applied throughout the continuum of care. CHWs help individuals navigate social and health care systems by linking them to appropriate services and by providing them with specific health information and culturally-sensitive education that gives people the tools to help make informed health choices. Through informal counseling, CHWs offer compassionate support, and as community advocates, they work with multiple local stakeholders to build community capacity.21,22

18 Hartzler AL, Tuzzio L, Hsu C, Wagner EH. Roles and Functions of Community Health Workers in Primary Care. Ann Fam Med. 2018;6(3):240-245. doi:10.1370/afm.2208Manage. 2020 Oct/Dec; 43(4):268-277.:

10.1097/JAC.0000000000000351. PMID: 32858726; PMCID: PMC7461725.

19 Albritton, E. July 2016, How States Can Fund Community Health Workers through Medicaid to Improve People’s Health, Decrease Costs, and Reduce Disparities Publication ID: HE-HST071116 Policy brief, FamiliesUSA.org https://www.google.com/search?rlz=1C1GCEA_enUS941US941&lei=Wj_0YcvED7PN1QGi2YLIC Q&q=community%20health%20worker%20scholarships&ved=2ahUKEwjL2bvdktX1AhWzZjUKHaKsAJkQsKwBKAJ6 BAhMEAM&biw=1366&bih=657&dpr=1 20Jackson, C. S., & Gracia, J. N. (2014). Addressing health and health-care disparities: the role of a diverse workforce and the social determinants of health. Public health reports (Washington, D.C.: 1974), 129 Suppl 2(Suppl 2), 57–61.

https://doi.org/10.1177/00333549141291S211 21 Brown O, Kangovi S, Wiggins N, Alvarado CS. Supervision Strategies and Community Health Worker Effectiveness in Health Care Settings. NAM Perspect. 2020 Mar 9; 2020:10.31478/202003c. doi: 10.31478/202003c.

PMID: 34532677; PMCID: PMC8406506.

22 Allen C G, Brownstein N, Satsangi A, Escoffery C (2016) Capacity Building and Training Needs for Community Health Workers Working in Health Care Organizations. J Community Med Health 6:403. doi:10.4172/2161- 0711.1000403 https://www.google.com/search?rlz=1C1GCEA_enUS941US941&lei=Wj_0YcvED7PN1QGi2YLICQ&q=community%20health%20worker%20scholarships&ved=2ahUKEwjL2bvdktX1AhWzZjUKHaKsAJkQsKwBKAJ6BAhMEAM&biw=1366&bih=657&dpr=1 https://www.google.com/search?rlz=1C1GCEA_enUS941US941&lei=Wj_0YcvED7PN1QGi2YLICQ&q=community%20health%20worker%20scholarships&ved=2ahUKEwjL2bvdktX1AhWzZjUKHaKsAJkQsKwBKAJ6BAhMEAM&biw=1366&bih=657&dpr=1 https://www.google.com/search?rlz=1C1GCEA_enUS941US941&lei=Wj_0YcvED7PN1QGi2YLICQ&q=community%20health%20worker%20scholarships&ved=2ahUKEwjL2bvdktX1AhWzZjUKHaKsAJkQsKwBKAJ6BAhMEAM&biw=1366&bih=657&dpr=1 https://doi.org/10.1177/00333549141291S211

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Program Definitions

A glossary containing general definitions for terms used throughout Bureau of Health Workforce NOFOs can be found in the Health Workforce Glossary. In addition, the following definitions apply to the CHWTP for Fiscal Year 2022:

Apprenticeship: The U.S. Department of Labor defines an apprenticeship as an industry-driven, high-quality career pathway where employers can develop and prepare their future workforce, and individuals can obtain paid work experience, classroom instruction, and a portable, nationally-recognized credential. Note: for the purposes of this grant, this includes state/locally-recognized credentials.

Community Health Worker: A member of the community that is not licensed to practice as a fully-qualified health care professional, who works in association with the local health care system as a frontline agent of change, helping to reduce health disparities in underserved communities.

Core Competencies for Public Health: The Core Competencies for Public Health Professionals (Core Competencies) are a consensus set of knowledge and skills for the broad practice of public health, as defined by the 10 Essential Public Health Services (see definition below).

Disparity Impact Statement: A statement applicants are expected to develop using local data (e.g. the CDC Social Vulnerability Index (SVI)) to identify populations at highest risk for health disparities and low health literacy. The Disparity Impact Statement will provide the framework for ongoing monitoring and determining the impact of the CHWTP proposed project. See Section VIII. Other Information for further details.

Essential Public Health Services: Provide a framework for public health to protect and promote the health of all people in all communities. To achieve equity, the Essential Public Health Services actively promote policies, systems, and overall community conditions that enable optimal health for all and seek to remove systemic and structural barriers that have resulted in health inequities. See Section VIII. Other information for further details.

Health Equity: The consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, Indigenous and Native American persons, Asian Americans and Pacific Islanders, and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) https://bhw.hrsa.gov/grants/resourcecenter/glossary https://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_Professionals_2021October.pdf https://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_Professionals_2021October.pdf https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html

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persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.23

Health Support Worker: A person who provides various health promotion services which meet the needs of a particular recipient or community, to whom a particular aspect of a professional task is delegated but who is not licensed to practice as a fully-qualified health care professional. Health support workers include but not limited to patient navigators, health care aids, peer support specialists, health education specialists, doulas, and promotores de salud/promotoras.

Registered Apprenticeship Program: A proven model of apprenticeship that has been validated by the U.S. Department of Labor or a State Apprenticeship Agency. An apprenticeship is a proven approach for preparing workers for jobs while meeting the needs of business for a highly-skilled workforce. It is an employer-driven, “learn-while-you-earn” model that combines on-the-job training, provided by the employer that hires the apprentice, with job-related instruction in curricula tied to the attainment of national, state, or local skills standards. See Section VIII. Other Information for further details.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $226,500,000 to be available to fund an estimated 75 recipients. You may apply for up to a ceiling amount of up to $3,000,000 total cumulative costs, or up to a ceiling amount of $1,000,000 per year (includes both direct and indirect/facilities and administrative costs). The budget period and period of performance are from September 15, 2022 through September 14, 2025, three (3) years. Awards are fully funded at the outset for use over the period of performance. All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75.

Limitations on indirect cost rates

Indirect costs under training awards to organizations, other than state or local governments or federally recognized Indian tribes, will be budgeted and reimbursed at 8 percent of modified total direct costs rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost

23 Executive Office of the President. Executive order 13985: Advancing racial equity and support for underserved communities through the federal government. Washington, DC: The White House, January 20, 2021. Available in the Federal Register at 86 FR 7009.

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

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amounts for equipment, tuition and fees, as otherwise allowable, and subawards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include:

(A) health professions schools, including an accredited school or program of public health, health administration, preventive medicine, or dental public health or a school providing health management programs;

(B) academic health centers;

(C) State or local governments, including state, local and territorial public health departments; or

(D) any other appropriate public or private non-profit entity such as but not limited to:

community colleges, community health centers, Federally Qualified Health Centers (FQHCs), and community-based organizations, and tribal entities that train public health workers.

In addition to the 50 states, eligible applicants include the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. Tribes and Tribal organizations may apply for these funds, if otherwise eligible. Foreign entities and individuals are not eligible for this HRSA award.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA may not consider an application for funding if it contains any of the non-responsive criteria below:

• Any application that exceeds the ceiling amount of $3,000,000 (includes both direct and indirect costs) for the entire three-year project period or exceeds the $1,000,000 per year ceiling

• Fails to satisfy the deadline requirements referenced in Section IV.4

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Beneficiary Eligibility Requirements

Eligible trainees are individuals with a minimum of a high school diploma or GED certificate.

Trainees receiving support from grant funds must be a citizen of the United States or a foreign national having in his/her possession a visa permitting permanent residence in the United States.

Trainees supported by CHWTP receiving financial support, must be enrolled full- or part-time in the school or program receiving the CHWTP grant funding.

Trainees/participants in the apprenticeship programs must have first completed CHW or health support worker training prior to enrollment.

Experiential Training Sites

You must submit agreements and/or contracts with the experiential training sites that meet these criteria specified as Attachment 3.

Registered Apprenticeship Site Partnerships

You must submit a memorandum of understanding/memorandum of agreement with the community-based partner and/or educational organization(s) you will be collaborating with for this project in your application as Attachment 3.

Accreditation/Approval Documentation

Health professions schools and academic health center applicants must be accredited by a nationally-recognized accrediting agency, and provide a copy of their active accreditation or active approval from state government as Attachment 8.

All other eligible entities must be accredited by a nationally recognized accrediting agency, and provide a copy of their active accreditation or active approval from state government as specified by the U.S. Department of Education, or must be approved by the state or local government to provide a CHW, or public health-related health support worker certificate training program. Provide a copy of this documentation submitted as Attachment 8.

If the applicant is already established as a registered apprenticeship site, you must submit official documentation (e.g., certificate of approved registration) from the Department of Labor as Attachment 8.

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HRSA may consider any application that fails to attach a copy of the required accreditation or related documentation to be non-responsive and may not consider it for funding under this notice. Applicants are required to maintain their accreditation or state approval status throughout the period of performance and notify HRSA of change in status.

Maintenance of Effort The recipient must agree to maintain non-federal funding for award activities at a level that is not less than expenditures for such activities maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives the award, as required by 42 U.S.C. § 295n-2 (section 797(b) of the Public Health Service (PHS) Act). Such federal funds are intended to supplement, not supplant, existing non-federal expenditures for such activities. Complete the Maintenance of Effort (MOE) information and submit as Attachment 6.

HRSA will enforce statutory MOE requirements through all available mechanisms.

NOTE: Multiple applications from an organization are not allowable. Separate organizations are those entities that have unique DUNS number or Unique Entity Identifier (UEI).

For eligible colleges and universities, only one application per campus will be accepted;

multiple applications from a single campus are not allowable. A campus is defined as a division of a university that has its own grounds, buildings and faculty. Where multiple programs from an institution are interested in applying under this funding notice, you may collaborate across programs to submit a single application.

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, before 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.

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 NOFO, following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

Form Alert: For the Project Abstract Summary, applicants using the SF-424 R&R Application Package are encountering a “Cross-Form Error” associated with the Project https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-information-kit/unique-entity-identifier-update https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/iae-information-kit/unique-entity-identifier-update https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html

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Summary/Abstract field in the “Research and Related Other Project Information” form, Box 7. To avoid the “Cross-Form Error,” you must attach a blank document in Box 7 of the “Research and Related Other Project Information” form, and use the Project Abstract Summary Form 2.0 in workspace to complete the Project Abstract Summary.

See Section IV.2.i Project Abstract for content information.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-22-124 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 the For Applicants page for all information relevant to this

NOFO.

2. Content and Form of Application Submission

Application Format Requirements Section 4 of HRSA’s SF-424 R&R Application Guide provides general instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the HRSA 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 HRSA SF-424 R&R Application Guide for the Application Completeness Checklist.

Application Page Limitation The total size of all uploaded files included in the page limit shall not exceed the equivalent of 70 pages when printed by HRSA. The page limit includes 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.

Please note: Effective April 22, 2021, the abstract is no longer an attachment that counts in the page limit. The abstract is the standard form (SF) "Project Abstract Summary.”

Standard OMB-approved forms that are included in the workspace application package, including the Standardized Work Plan (SWP) Form, do not count in the page limit.

Biographical sketches do count in the page limitation. Note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-22- 124, 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 https://www.grants.gov/web/grants/applicants.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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not count in the page limit. It is important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 70 pages will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under HRSA-22-124 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. § 3354).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 10: 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 PHS Act provides the HHS Secretary 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 and Response (ASPR) website.

Program Requirements and Expectations

All applicants funded under this NOFO will be required to implement the following:

Expansion

1. Recruit and train new CHWs and health support workers with the use of core competencies for CHWs and Public Health focusing on health equity and SDOH;

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx

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2. Ensure that at least 75 percent of trainees are in the new CHW and other health support workers training program, and receive employment opportunity training through field placements. Of these, a minimum of 25 percent of the new trainees must be trained through a registered apprenticeship program;

3. Implement training curriculum that include core competencies for CHWs and Public Health and follow state, local, or entity guidelines, support essential public health services and provides a certificate or certification continuing education documentation to confirm completion of training new CHWs and;

4. Provide financial support consistent with grant guidelines (e.g., travel, supplies, tuition/fees, health insurance, etc.) depending on the level of training;

5. Increase the diversity and distribution of the public health workforce by recruiting individuals from the underserved communities they will serve;

6. Develop or enhance trainee curriculum around evidence-based core competences for public health, including emergency response education, prevention, treatment, and vaccine hesitancy research;

7. Establish a network of partnerships by creating new or leveraging existing relationships with entities such as community colleges, public health departments, health care provider sites, an community-based organizations to accomplish program activities; and

8. Provide training on the use of technology and education to increase digital literacy.

Extension/Upskilling

1. Ensure that no more than 25 percent of trainees are in the extension/upskilling CHW and other health support workers training program.

2. Develop and/or enhance trainee curriculum around evidence-based core competencies for public health to include, but not limited to, emergency response education, prevention, treatment, and vaccine hesitancy research, used for the upskilling of current CHWs and health support workers;

3. Provide certificate or continuing education documentation to confirm completion of training and upskilling of current CHWs and other health support worker trainees and;

4. Establish a network of partnerships by creating new or leveraging existing relationships with entities such as: community colleges, public health departments, health care provider sites, and community based organizations to accomplish program activities.

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Employment

1. Implement an apprenticeship program that must be registered by the U.S.

Department of Labor or a state/local organization;

2. Establish a training curriculum that must include CHW core competencies, and follow state, local, or entity guidelines;24

3. The apprenticeship program will provide didactic training related to health equity and SDOH among patients impacted by COVID-19 and other public health emergencies, and located in underserved communities; topic areas include community education, care coordination, and linkages to care and resources;

4. Implement career development and employment readiness training that will prepare trainees to learn skills and expertise from collaborating partner programs;

5. Provide wraparound support to help trainees overcome barriers to success, such as mentoring and financial support in the form of stipends;

6. Provide job placement services to assist trainees not enrolled in apprenticeship programs in obtaining employment; and

7. Implement strategies to support work environment practices (e.g. policies and procedures) that ensure the resiliency, safety, and well-being of trainees, practicing CHWs, and health support workers.

Data Collection Coordinator

• Each recipient must allocate an appropriate individual to serve as the project’s designated data collection coordinator. This individual will work with the Project Director to support and coordinate data collection efforts for the project and serve

24 Core competencies include:

• Patient advocacy skills, defined as assisting patients in obtaining the care they need, and in navigating health and social service systems; and bringing visibility to each patients’ needs

• community outreach and engagement;

• Communication skills;

• Promoting healthy lifestyles/Healthy Eating Active living (HEAL);

• Cultural competence and responsiveness;

• Service coordination skills;

• Individual and assessment skills;

• Health insurance basics;

• Teaching skills;

• Organizational skills;

• Community capacity-building;

• Professional conduct and interpersonal skills; and

• Public health

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as a liaison between the recipient and any grant sub-contract partners to ensure that the HRSA performance measures and other data collection efforts are captured accurately and in a timely manner for reporting purposes. The recipient shall decide the job qualifications and percentage of effort needed to effectively fulfill these duties.

Performance Measures:

Award recipients must monitor and collect the following performance metrics data for HRSA reporting purposes:

Expansion:

• Number of new CHWs and health support workers trained

• Trainee demographics (race, ethnicity, disadvantaged background)

• Number of CHWs and health support workers enrolled in registered apprenticeship programs

• Number of CHWs and health support workers that have completed the registered apprenticeship program

• Attrition of…