CDC-RFA-CE-23-0005_Full Announcement.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL

Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action

CDC-RFA-CE-23-0005

06/12/2023

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview

Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA-CE- 23-0005. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52- 2.pdf. Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr- 46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-CE-23-0005

E. Assistance Listings Number:

https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html

93.136 F. Dates:

1. Due Date for Letter of Intent (LOI):

05/09/2023

2. Due Date for Applications:

06/12/2023 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

Information will be provided for potential applicants on one informational conference call/webinar. This call will be for potential applicants on April 21, 2023, 1:00 pm-2:30 pm EST. To register and access the webinar, visit: Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action Informational Call. If you are having trouble registering for or accessing the webinar, please contact the Agency Contact for this NOFO, Khiya Mullins, kmarshall@cdc.gov;770-488-3911.

The purpose of this webinar is to help potential applicants understand the scope and intent of this cooperative agreement. Participation is not mandatory. A Frequently Asked Questions document will be made available following the call. Applicants who want to submit questions prior to the call, or should applicants find they have additional questions or need clarification after the call, please see the Agency Contact.

G. Executive Summary:

1. Summary Paragraph CDC will support recipients to 1) enhance a state-level surveillance infrastructure that ensures the capacity to collect, analyze, and use adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) data to inform prevention strategy implementation; 2) implement data-driven, comprehensive, evidence-based ACEs primary prevention strategies and approaches, particularly with a focus on health equity (e.g., with a specific intent to reach groups that have been economically or socially marginalized, or under-resourced communities); and 3) conduct data-to-action activities on an ongoing basis to inform changes or adaptations to existing prevention strategies or selection and implementation of additional prevention strategies.

Recipients are expected to leverage multi-sector partnerships and resources to improve ACEs and PCEs surveillance infrastructure and the coordination and implementation of ACEs prevention strategies across the state. As a result, there will be increased state capacity to develop and sustain a surveillance system that collects, uses, and disseminates data on ACEs and PCEs, including data used to identify and address health inequities; and increased implementation and reach of tailored ACEs prevention strategies that bolster PCEs and help to promote safe, stable, nurturing relationships and environments where children live, learn and play.

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement) https://www.grants.gov/ https://cdc.zoomgov.com/meeting/register/vJIsceGgqT0tHsIiF_Z__ghQJxB4l2vYvfo https://cdc.zoomgov.com/meeting/register/vJIsceGgqT0tHsIiF_Z__ghQJxB4l2vYvfo mailto:kmarshall@cdc.gov

c. Approximate Number of Awards

d. Total Period of Performance Funding:

$29,114,065

e. Average One Year Award Amount:

$400,000

f. Total Period of Performance Length:

5 year(s)

g. Estimated Award Date:

August 01, 2023

h. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that occur in childhood and adolescence (0-17 years) such as experiencing physical, emotional, or sexual abuse; witnessing violence in the home or having a family member attempt or die by suicide.

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with substance use, mental health problems, or instability due to parental separation, divorce, or incarceration of a parent, sibling, or other member of the household.1,2 As the number of ACEs experienced increases, so does the risk for negative health and life outcomes,3 including health risk behaviors, chronic health conditions, mental health challenges, limited educational and economic opportunity, and early death. Systemic racism, discrimination, multigenerational poverty, and socioeconomic conditions, such as living in under-resourced, racially segregated neighborhoods or experiencing food insecurity can exacerbate the effects of ACEs, particularly in certain populations.4 However, ACEs can be prevented. Preventing ACEs has the potential to reduce leading causes of death, mental health challenges, health risk behaviors such as substance use, verified reports of child abuse and neglect, increase productivity and educational attainment, and saves billions of dollars each year.3,5-7 By addressing the conditions that give rise to ACEs and simultaneously addressing the needs of children and parents, communities can take a multigenerational approach to prevent ACEs. Additionally, addressing inequities associated with the disproportionate burden of ACEs is paramount to prevention. Achieving health equity requires addressing the root causes (e.g., discrimination and biases in societal values, public policy) that inequitably disadvantage groups based on characteristics such as race, ethnicity, gender, and ability, often expressed as racism, sexism, and ableism.

Recipients are expected to leverage multisector partnerships and resources to improve and sustain ACEs and positive childhood experiences (PCEs) surveillance infrastructure that collects, uses, and disseminates data on ACEs and PCEs, including data that identify health inequities, to inform implementation of ACEs prevention strategies across the state. Recipients will advance health equity by implementing comprehensive strategies and approaches that create the context in which ACEs occur. This will result in increased state capacity to monitor and use data to understand the prevalence of ACEs and PCEs, risk and protective factors, and ACEs-related health outcomes critical to improving public health.

Applicants may also apply to implement optional enhanced activities. These activities consist of

(1) collecting ACEs data using syndromic surveillance approaches, (2) implementing ACEs primary prevention strategies at the local level; and/or (3) linking state and local data on the social determinants of health to youth-based ACEs data. Applicants applying for the enhanced activities must have core youth-based ACEs surveillance data (as defined by CDC) in a survey administered during or prior to 2023.

This NOFO builds on the findings and lessons learned in the previous NOFOs CE18-1803:

Childhood Essentials and CE20-2006: Preventing ACEs: Data to Action. As a result, this NOFO will continue to use data to inform the implementation of evidence-based strategies and approaches to ensure that all children have safe, stable, and nurturing relationships and environments.

b. Statutory Authorities This Notice of Funding Opportunity is authorized under Section 393 of the Public Health Service Act [42 U.S.C. 280b-1a] and Section 301(a) of the Public Health Service Act, 42 U.S.C. 241(a).

c. Healthy People 2030 This NOFO specifically addresses the proposed Healthy People 2030 focus areas of Injury and Violence Prevention.

d. Other National Public Health Priorities and Strategies This NOFO supports the following national public health priorities and strategies: CDC’s National Center for Injury Prevention and Control’s research priorities, Adverse Childhood Experiences Research Priorities, Adverse Childhood Experiences Prevention Strategy, CDC CORE Health Equity Science and Intervention Strategy, and the U.S. Surgeon General’s Advisory on Protecting Youth Mental Health.

e. Relevant Work This NOFO builds upon the work of several CDC efforts and their lessons learned:

CDC-RFA-CE13-1303 Implementation of Essentials for Childhood: Safe, Stable, Nurturing Relationships and Environments

CDC-RFA-CE18-1803 State Essentials for Childhood Initiative: Implementation of Strategies and Approaches to Child Abuse and Neglect Prevention

CDC-RFA-CE20-2006 Preventing Adverse Childhood Experiences: Data to Action Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and

Programmatic Activities Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence https://health.gov/healthypeople/about/workgroups/injury-and-violence-prevention-workgroup#:~:text=Members%20of%20the%20Injury%20and%20Violence%20Prevention%20Workgroup,self-harm%20related%20injuries%2C%20and%20child%20abuse%20and%20neglect%29.

https://health.gov/healthypeople/about/workgroups/injury-and-violence-prevention-workgroup#:~:text=Members%20of%20the%20Injury%20and%20Violence%20Prevention%20Workgroup,self-harm%20related%20injuries%2C%20and%20child%20abuse%20and%20neglect%29.

https://www.cdc.gov/injury/pdfs/researchpriorities/cdc-injury-research-priorities.pdf https://www.cdc.gov/injury/pdfs/researchpriorities/cdc-injury-research-priorities.pdf https://www.cdc.gov/injury/pdfs/researchpriorities/Research-Priorities_ACEs.pdf#page=1 https://www.cdc.gov/injury/pdfs/researchpriorities/Research-Priorities_ACEs.pdf#page=1 https://www.cdc.gov/injury/pdfs/priority/ACEs-Strategic-Plan_Final_508.pdf https://www.cdc.gov/healthequity/core/index.html https://www.cdc.gov/healthequity/core/index.html https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf https://www.grants.gov/web/grants/search-grants.html?keywords=preventing%20adverse%20childhood%20experiences https://www.grants.gov/web/grants/search-grants.html?keywords=preventing%20adverse%20childhood%20experiences https://www.grants.gov/web/grants/search-grants.html?keywords=preventing%20adverse%20childhood%20experiences https://www.grants.gov/web/grants/search-grants.html?keywords=preventing%20adverse%20childhood%20experiences https://www.grants.gov/web/grants/search-grants.html?keywords=preventing%20adverse%20childhood%20experiences https://www.cdc.gov/violenceprevention/pdf/CAN-Prevention-Technical-Package.pdf https://www.cdc.gov/violenceprevention/pdf/CAN-Prevention-Technical-Package.pdf https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf

CDC-RFA-CE21-2101 Core State Injury Prevention Program (Core SIPP)

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA-CE-23-0005 Logic Model: Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action *Additional activities and corresponding short-term and intermediate outcomes supported by enhanced funding

Strategies and Activities

Short-term Outcomes (1-3 years)

Intermediate Outcomes (3-5 years)

Long-Term Outcomes (5+ years)

Goal 1: Build or improve Surveillance Infrastructure and Capacity

Build or improve ACEs and PCEs surveillance infrastructure and data collection capacity

Collect or gather state-level youth-based data on ACEs, PCEs, and related risk and broader protective factors

Use (and link*) data on the social determinants of health

Synthesize and use ACEs and PCEs, and near-real time data, and related risk and protective factor data from across systems to inform prevention strategies

1.1. Increased

capacity to create, use, and disseminate data from a comprehensive ACEs and PCEs surveillance system

1.2. Increased state

level collection of ACEs and PCEs data through youth-based surveillance

1.3. Increased

capacity to collect data on the social determinants of health

1.4. Increased access

to ACEs and PCEs, risk and protective factor, and social determinants of health data to inform prevention strategies and identify inequities

1.5. Increased state-

level monitoring of trends in ACEs and PCEs over time, and use of data from youth populations

1.6. Increased use of

data on health inequities and the social determinants of health to contextualize risk factors for ACEs, and reduce inequities

1.7. Increased

sustainability of a comprehensive ACEs and PCEs surveillance system

Decreased rates of ACEs (including child abuse and neglect), and increased rates of PCEs in the population

Reductions in inequities in ACEs across subpopulations, and their inequitable burden related to the social determinants of health

Improved health and social outcomes that have been linked to ACEs

Increased safe, stable, nurturing relationships and environments for all children https://www.grants.gov/web/grants/search-grants.html?keywords=CDC-RFA-CE21-2101

Goal 2: Implement and Sustain ACEs Prevention Strategies

Enhance an existing state action plan to support implementation and sustainability of ACEs prevention strategies

Implement comprehensive ACEs prevention strategies at the state (and local*) level as outlined in the CDC’s ACEs Prevention Resource document

Leverage multi-sector partnerships and resources toward preventing ACEs among state (and local*) agencies and other sectors

2.1. Increased partner

awareness of existing state prevention strategies and approaches that address ACEs

2.2. Increased

coordination and collaboration between state (and local*) agencies and other sectors

2.3. Increased

capacity to implement comprehensive ACEs prevention strategies at the state (and local*) level

2.4. Increased

uptake and implementation of comprehensive ACEs prevention strategies at state (and local*) level

2.5. Increased reach

of prevention strategies, with a focus on communities with disproportionate needs due to social determinants of health

2.6. Increased

evidence for population-based approaches to prevent ACEs

Goal 3: Use ACEs/PCEs Data for Action

Conduct or update ACEs & PCEs capacity assessments for surveillance and current state-wide prevention strategies

Utilize surveillance and program evaluation findings to tailor and improve strategy implementation at the state (and local*) level, with a specific focus

3.1. Increased

understanding of state surveillance and prevention capacity related to ACEs and PCEs

3.2. Increased

capacity to use ACEs and PCEs surveillance and evaluation data to identify and tailor ACEs prevention strategies, improve health equity, and the social determinants of health

3.5. Increased use

and translation of surveillance and evaluation data to inform tailored prevention strategy implementation to reduce ACEs and improve health equity and social determinants of health

3.6. Increased

partner response to the burden of ACEs and PCEs in their state, and public awareness of societal on improving health equity

Develop and implement a data to action dissemination plan to translate state ACEs, PCEs, and associated risk and protective factor data

Conduct a process and outcome evaluation of program activities related to ACEs surveillance and prevention (using linked* data)

3.3. Increased data

dissemination on ACEs and PCEs to state (and local*) partners, policy-makers, and the public

3.4. Increased

knowledge about the effectiveness of ACEs prevention strategies to improve health and wellbeing, and reduce inequities factors that lead to safe, stable, and nurturing relationships and environments

i. Purpose This NOFO will support the implementation of data-driven, comprehensive, evidence-based ACEs primary prevention strategies and approaches, with a particular focus on health equity, to prevent ACEs and ensure safe, stable nurturing relationships and environments for all children.

Recipients will enhance a state-level surveillance infrastructure that ensures the capacity to collect, analyze, and use ACEs and PCEs data among youth; and conduct data-to-action activities to inform changes or adaptations to existing strategies or selection and implementation of additional prevention strategies.

ii. Outcomes Measurable outcomes are essential for determining the extent to which implemented strategies and activities achieve their objectives. With technical guidance and support from CDC, recipients will identify, measure, and monitor indicators aligned with the outcomes related to the strategies and activities specified in their logic model. For the purpose of this NOFO, indicators are defined as a measurable piece of information from a data source regarding some aspect of the program outcomes being evaluated, including outcomes related to the tracking and measurement of ACEs and PCEs. Recipients will use indicators to monitor outcomes and evaluate program implementation per the logic model, and track progress toward reducing ACEs and promoting PCEs. Measures of intermediate risk and protective factors, including those related to the social determinants of health with a focus on those related to economic stability (e.g., child in poverty rates; unemployment rates); ensuring a strong start for children (e.g., availability of child care centers and cost burden; school funding adequacy); and structural factors that contribute to instability for children and families (e.g., food insecurity and access; access to healthcare providers; high housing cost), are important for assessing the gradual impact of community and societal level prevention strategies that may not show immediate impacts on ACEs prevention outcomes. While recipients are only expected to achieve the short-term and intermediate outcomes during the period of performance, CDC will work with recipients to measure outcomes that most likely demonstrate long-term impact on ACEs and PCEs. The Evaluation and Performance Measurement section further describes the methods for evaluation and performance monitoring of this NOFO and provides examples of indicators and related measures for these outcomes.

*Applicants applying for optional enhanced activities will be required to do additional activities and assess the corresponding short-term outcomes and intermediate-term outcomes.

Recipients are expected to achieve the following short-term outcomes within the first three years of the period of performance:

1.1. Increased capacity to create, use, and disseminate data from a comprehensive ACEs and PCEs surveillance system

1.2. Increased state level collection of ACEs and PCEs data through youth-based surveillance

1.3. Increased capacity to collect data on the social determinants of health

1.4. Increased access to ACEs and PCEs, risk and protective factors, and social determinants of health data to inform prevention strategies and identify inequities

2.1. Increased partner awareness of existing state prevention strategies and approaches that address ACEs

2.2. Increased coordination and collaboration between state (and local agencies*) and other sectors

2.3. Increased capacity to implement comprehensive ACEs prevention strategies at the state (and local*) level

3.1. Increased understanding of state surveillance and prevention capacity related to

ACEs and PCEs

3.2. Increased capacity to use ACEs and PCEs surveillance and evaluation data to identify and tailor ACEs prevention strategies, improve health equity, and the social determinants of health

3.3. Increased data dissemination on ACEs and PCEs to state (and local*) partners, policy-makers, and the public

3.4. Increased knowledge about the effectiveness of ACEs prevention strategies to improve health and wellbeing, and reduce inequities

Recipients are expected to achieve the following intermediate outcomes within three to five years of the period of performance:

1.5. Increased state-level monitoring of trends in ACEs and PCEs over time, and use of data from youth populations

1.6. Increased use of data on health inequities and the social determinants of health to contextualize risk factors for ACEs, and reduce inequities

1.7. Increased sustainability of a comprehensive ACEs and PCEs surveillance system that informs tailored prevention strategies

2.4. Increased uptake and implementation of comprehensive ACEs prevention strategies at state (and local*) levels

2.5. Increased reach of prevention strategies, with a focus on communities with disproportionate needs due to social determinants of health

2.6. Increased evidence for population-based approaches to prevent ACEs

3.5. Increased use and translation of surveillance and evaluation data to inform tailored prevention strategy implementation to reduce ACEs and improve health equity and social determinants of health

3.6. Increased partner response to the burden of ACEs and PCEs in their state, and public awareness of societal factors that lead to safe, stable, and nurturing relationships and environments

iii. Strategies and Activities The strategies and activities outlined in the logic model center around three goal areas: 1) Build or improve surveillance infrastructure and capacity; 2) Implement and sustain ACEs prevention strategies; and 3) Utilize ACEs/PCEs data for action. At the start of this cooperative agreement, recipients will simultaneously build or improve an ACEs and PCEs surveillance infrastructure and implement ACEs primary prevention strategies and approaches. To most effectively tailor prevention efforts, surveillance and program evaluation information garnered throughout the period of performance should be used to continuously identify specific types of ACEs with high burden; PCEs with low prevalence; and geographically or demographically specific subpopulations of interest that have a disproportionate burden of ACEs that contribute to health inequities. For recipients with existing youth-based surveillance data of ACEs and PCEs, and other comprehensive surveillance strategies, the use of tailored implementation of prevention strategies and approaches may begin earlier in the period of performance. Applicants can apply for enhanced funding to conduct one or more of the additional activities: (1) collect ACEs data using syndromic surveillance approaches, (2) implement ACEs primary prevention strategies at the local level; and/or (3) link state and local data on the social determinants of health to youth-based ACEs data.

Goal 1. Build or improve surveillance infrastructure and capacity

This goal will include the following required activities:

Build or improve ACEs and PCEs surveillance infrastructure and data collection capacity. Recipients will:

o acquire, maintain, or add staff and/or contracted staff to support surveillance activities, and to obtain, analyze, and disseminate multiple forms of surveillance data, including data that contains complex survey features. These data and surveillance are in service of the implementation and adaptation of evidence-based strategies in the populations they serve.

o acquire diverse, multisector partners that can be leveraged to enhance capacity for data collection, use, and dissemination. This can be accomplished by partnering with other state- and local-level agencies or organizations (e.g., data managers, education and housing sector partners, local health departments and non-government organizations) to facilitate access to ACEs/PCEs data. CDC strongly encourages partnering with agencies and organizations that support populations experiencing economic or social burden and are disproportionately impacted by ACEs. Recipients should provide information about multisectoral collaborations that can be leveraged to interpret and disseminate ACEs and PCEs data and utilize these data to inform prevention strategy implementation with core prevention partners.

o improve or expand an existing infrastructure and data collection system (e.g., youth-based surveillance system) that can be leveraged to conduct ongoing surveillance of ACEs and PCEs.

Collect or gather state-level youth-based data on ACEs, PCEs, and related risk and broader protective factors. Recipients will:

o use state, territorial, or tribal Youth Risk Behavior Survey (YRBS) or equivalent state-level jurisdiction-wide survey of adolescents to collect ACEs and PCEs data.

Youth-based surveillance approaches collect data directly from children or adolescents. This approach allows for data collection most proximal to the time that ACEs and PCEs occur (in childhood and adolescence) and can facilitate effective monitoring and understanding of the current burden of ACEs, and presence of PCEs, in a state.

o have (or the ability to include and/or access) core ACEs data elements (defined in the table below), in routine youth-based surveillance data collection cycles throughout the period of performance, with initial data collection occurring no later than 2025. For the YRBS, this would include data collection in the 2025 and 2027 survey cycles. States or other jurisdictions that intend to use another equivalent survey should provide information about the surveys’ data collection cycle timing and plans to include the core ACEs (outlined in the table below) throughout data collection cycles during the period of performance. In addition, recipients will include at least one new PCEs data element during the period of performance

Table 1: Core ACEs and PCEs Data Elements

Core ACEs Data Elements PCEs Data Elements Lifetime prevalence of emotional abuse

Lifetime prevalence of feeling able to talk to adults about feelings

Lifetime prevalence of physical abuse

Lifetime prevalence of feeling supported by friends

Lifetime prevalence of sexual abuse Incidence of feeling a sense of belonging at school

Lifetime prevalence of physical neglect

Lifetime prevalence of witnessed intimate partner violence

Lifetime prevalence of household substance abuse

Lifetime prevalence of household mental illness

Lifetime prevalence of incarcerated parent or guardian commit to sharing state-level YRBS or other local equivalent survey data during the period of performance to facilitate CDC’s provision of technical assistance in support of recipients’ data to action efforts. Standard data suppression rules will be applied to any data dissemination to maintain privacy; details will be negotiated with recipients and determined in writing at the start of the period of performance. These data and surveillance are in service of the implementation and adaptation of evidence-based strategies in the populations they serve.

Use data on the social determinants of health. Recipients will:

o utilize data to more effectively monitor social and structural inequities related to the social determinants of health that serve as a risk factor for ACEs and inhibit PCEs. Recipients can utilize publicly available data from sources such as the County Health Rankings (https://www.countyhealthrankings.org/) or other data sources (e.g., social vulnerability index (SVI) data).

o select social determinants of health indicators relevant to their ACEs prevention and intervention strategy selection, with a focus on those related to economic stability (e.g., child in poverty rates; unemployment rates); ensuring a strong start for children (e.g., availability of child care centers and cost burden; school funding adequacy); and structural factors that contribute to instability for children and families (e.g., food insecurity and access; access to healthcare providers; high housing cost). Recipients will also use indicators that identify areas with high volume of disproportionately impacted populations.

o collaborate with CDC to determine relevant indicators that align with prevention strategies.

Synthesize and use ACEs, PCEs, near real-time data, and related risk and protective factor data, including from across systems to inform prevention strategies. Recipients will:

o utilize state level youth-based ACEs and PCEs surveillance infrastructure to inform selection, implementation, and delivery of prevention strategies.

Recipients will outline a strategy for collecting, analyzing, and disseminating their youth-based surveillance data to inform prevention strategy implementation (i.e., in specific subpopulations or geographies) and tailor prevention strategies.

o generate data, triangulate data, and utilize different forms of data to tailor prevention, intervention, and evaluation efforts. In addition to youth-based surveillance data, this may include data from the National Survey of Children’s Health, Behavioral Risk Factor Surveillance System, state or local systems, or administrative data.

o monitor indicators of ACEs using near-real time data (e.g., Hotline data or equivalent). Recipients will collaborate with CDC post award to determine the most appropriate near-real time data collection activity.

o use near-real time data to increase use of timely, geographically specific information about trends for selected ACEs indicators by state and local partners for prevention and intervention planning.

https://www.countyhealthrankings.org/

Additional Activities Supported by Enhanced Funding In addition to goal 1 activities above, applicants can apply for enhanced funding for the following additional activities. (Applicants applying for additional funding will be required to assess the corresponding short-term outcomes.)

Synthesize and use syndromic surveillance (near-real time) data to track ACEs and PCEs, and related risk and protective factor data from across systems to inform prevention strategies.

o Recipients who reside in states, territories, or tribal lands that participate in CDC’s National Syndromic Surveillance Program (NSSP) BioSense Platform are encouraged to commit to leveraging emergency department (ED) syndromic surveillance data through this mechanism. Recipients in these jurisdictions will conduct surveillance of selected ACEs indicators using ED data submitted to this national platform. Recipients must commit to using standard CDC syndrome definitions to track selected ACEs indicators. ED visits related to ACEs indicators may include, but not be limited to, child abuse and neglect; childhood sexual violence; mental health; suicide ideation and attempts; nonfatal overdose or substance use; and intimate partner violence. CDC will provide more information and guidance around the use of standard syndrome definitions upon funding. For the purposes of providing effective technical assistance that can facilitate the use of syndromic surveillance data to inform prevention activities, if recipients choose to share their data with CDC, surveillance reports will be provided by CDC highlighting the burden of ACEs-related ED visits within their state. CDC will work with recipients post award on the processes for sharing data.

Link social determinants of health data with youth-based ACEs and PCEs data.

Recipients will:

o link social determinants of health and ACEs and PCEs surveillance data to inform prevention strategy selection, alteration, and effectiveness. Data will be used by the recipient and CDC to identify social and structural risk and protective factors for individual and cumulative types of ACEs and evaluate the effectiveness of prevention strategies in reducing health inequities.

o report on data linkage challenges and successes and ways that these linked data will be used to inform prevention strategies.

Goal 2. Implement and Sustain ACEs Prevention Strategies

This goal will include the following required activities:

Enhance an existing state action plan to support implementation and sustainability of ACEs prevention strategies.

o Recipients will enhance an existing state action plan to include specific guidance, planning and activities for the implementation and evaluation of prevention approaches related to ACEs. Enhancements to the plan should include:

Demonstrated use of the public health approach to planning the overall prevention efforts (based on data) and selection of ACEs prevention strategies (both to increase safe, stable, nurturing relationships and environments for children; as well as a specific focus on children at higher risk for ACEs).

A vision for the state regarding ACEs prevention.

Details about the strategies and approaches to be implemented including full description, timeline, responsible parties, and outcomes.

Details about how recipients will include partners involved in the prevention efforts and how partners will advance health equity.

Implement comprehensive ACEs prevention strategies at the state level as outlined in

CDC’s ACEs Prevention Resource document. Recipients will:

o implement data-driven, comprehensive, evidence-based ACEs primary prevention strategies and approaches, particularly with a focus on health equity. Recipients are required to select at least two strategies and two approaches from the table below, derived from the CDC’s Preventing Adverse Childhood Experiences:

Leveraging the Best Available Evidence. The five primary ACEs prevention strategies in this table focus on changing norms, environments, and behaviors. Each strategy contains several approaches, or ways to advance the strategy, with examples of evidence-based programs, policies and practices provided for each approach. Preventing Adverse Childhood Experiences:

Leveraging the Best Available Evidence, which focuses on mitigating the immediate and long-term physical, mental, and behavioral consequences of ACEs through approaches such as enhanced primary care, victim-centered services, and treatment. This is also known as secondary prevention. Because this NOFO focuses on primary prevention of ACEs, secondary prevention strategies and approaches will not be funded under this NOFO.

Table 2: ACEs Prevention Strategies and Approaches

Strategy Approach

1. Strengthen Economic Supports to

Families Strengthening household financial security Family-friendly work policies

2. Promote Social Norms that Protect Against Violence and Adversity

Public education campaigns Approaches to reduce parents' use of corporal punishment Bystander approaches Men and boys as allies in prevention

3. Ensure a Strong Start for Children Early childhood home visitation High-quality childcare Preschool enrichment with family engagement

4. Teach Skills Social-emotional learning Safe dating and healthy relationship skill programs https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf

Parenting skills and family relationship approaches

5. Connect Youth to Caring Adults and Activities

Mentoring programs After-school programs o begin implementation of at least one of their selected ACEs prevention strategies within the first six months of the period of performance. Implementation of two ACEs prevention strategies must be started no later than the end of the first year of the period of performance.

o Current Essentials for Childhood (CE18-1803) and Preventing ACEs: Data to Action (CE20-2006) recipients must demonstrate that they are 1) implementing new strategies that are not currently being funded by CDC CE18-1803 or CE20- 2006 funds; 2) implementing new approaches under the strategies they are already implementing, or 3) substantially expanding a strategy already being implemented under current funding (e.g., expanding reach within the state, implementing in different locales, and/or targeting a new population with high burden of ACEs).

Leverage multi-sector partnerships and resources toward preventing ACEs among state agencies and other sectors. Recipients will:

o serve as a convener and coordinator of multi-sector partnerships focused on ACEs prevention. This can be accomplished by partnering with other state-level partners (e.g., data managers, education sector partners, tribal healthcare workers, non-governmental youth-serving and family-serving organizations, policymakers, healthcare providers, local health departments, statewide domestic violence coalitions, historically black colleges and universities [HBCUs], minority serving institutions [MSIs]) who already may be implementing or are poised to begin implementing these types of strategies.

o demonstrate how existing or expanded partnerships will reduce inequities in ACEs at the state level.

Additional Activities Supported by Enhanced Funding In addition to goal 2 activities above, applicants can apply for enhanced funding for the following additional activities. (Applicants applying for additional funding will be required to assess the corresponding short-term and intermediate term outcomes.)

Implement comprehensive ACEs prevention strategies at the local level as outlined in CDC’s ACEs Prevention Resource document.

o Recipients will select at least two strategies and approaches from CDC’s Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence resource tool to help states and communities take advantage of the best available evidence to prevent ACEs. The strategies and their corresponding approaches are listed in Table 2: ACEs Prevention Strategies and Approaches.

Recipients of enhanced funding may implement the same strategies and approaches at the state level for local level implementation or chose new https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf strategies and/or approaches based on data. Recipients are expected to begin implementation of at least one of their selected ACEs prevention strategies within the first year of the period of performance.

Leverage multi-sector partnerships and resources toward preventing ACEs among local agencies and other sectors. Recipients will:

o serve as a convener and coordinator of multi-sector partnerships focused on ACEs prevention. This can be accomplished by partnering with local-level partners (e.g., data managers, education sector partners, tribal healthcare workers, non-governmental youth-serving and family-serving organizations, policymakers, healthcare providers, local health departments, statewide domestic violence coalitions, historically black colleges and universities [HBCUs], minority serving institutions [MSIs]) who already may be implementing or are poised to begin implementing these types of strategies.

o demonstrate how existing or expanded partnerships will reduce inequities in ACEs at the local level.

Goal 3. Use ACEs/PCEs Data for Action

This goal will include the following required activities:

Recipients will conduct data to action activities on an ongoing basis to inform changes or adaptations to existing prevention strategies, or selection and implementation of additional prevention strategies, to more effectively target and prevent ACEs. At the start of this cooperative agreement, recipients will simultaneously build and improve a comprehensive ACEs and PCEs surveillance infrastructure and implement ACEs primary prevention strategies and approaches while conducting foundational activities to build data to action capacity (e.g., conducting or updating capacity assessments; developing recommendations to continue building integrated, comprehensive surveillance and evaluation infrastructure; developing or enhancing an evaluation plan). Surveillance and program evaluation data garnered throughout the period of performance should be used to continuously identify specific types of ACEs with high burden;

PCEs with low prevalence; and geographically and demographically-specific subpopulations of interest in the state that have a disproportionate burden of ACEs that contribute to health inequities. This information should be used to inform strategic selection or adjustment of prevention strategies or prevention strategy implementation efforts to implement activities for populations with disproportionate burden.

Recipients are strongly encouraged to participate in national opportunities for sharing information by compiling and disseminating evaluation results, including but not limited to lessons learned, successes, challenges, evaluation findings, and tools developed, via multiple mechanisms such as listservs, conference calls, recipient meetings, web conferences and regional and national conferences.

Conduct or update ACEs and PCEs capacity assessments for surveillance and current state-wide prevention strategies. Recipients will:

o conduct or update capacity assessments to develop recommendations for improvement within the first 6 months of the period of performance. CDC will provide templates that can be utilized by recipients to conduct each capacity assessment. Recipients will share the findings from the surveillance and state-wide prevention strategy capacity assessments with CDC to inform technical assistance planning.

o utilize information from the ACEs and PCEs surveillance capacity assessment to develop recommendations for building or enhancing an integrated, comprehensive ACEs and PCEs surveillance system. Recipients should include plans for youth-based surveillance approaches as well as include recommendations for utilizing these data to inform prevention strategy implementation, evaluation of program effectiveness, and data dissemination related to ACEs and PCEs to the public, partners, and policymakers. Recipients will be asked to complete this activity within the first year of the period of performance and share draft recommendations with CDC to ensure recommendations align with best practices for ACEs and PCEs surveillance, meet the goals and activities of the cooperative agreement, and ensure adequate technical assistance can be provided by CDC.

Utilize surveillance and program evaluation findings to tailor and improve strategy implementation at the state level, with a specific focus on improving health equity.

o Surveillance and program evaluation findings should be utilized on an ongoing basis, as data are obtained, to inform prevention strategy implementation.

Findings should continuously identify specific types of ACEs with high burden;

PCEs with low prevalence; and geographically or demographically specific subpopulations of interest in the state that have a disproportionate burden of ACEs that contribute to health inequities.

o Recipients will develop and implement a process and outcome evaluation plan for enhancing ACEs and PCEs surveillance and ACEs prevention strategies. The recipient must demonstrate how they plan to evaluate the progress on NOFO activities (process evaluation) and program efforts (outcome evaluation).

Recipients should use the NOFO logic model to identify NOFO activities and outcomes. Recipients can find more details in the Evaluation and Performance Measurement section of this NOFO.

Develop and implement a data to action dissemination plan to translate state ACEs, PCEs, and associated risk and protective factor data. Recipients will:

o develop and implement a data dissemination and data to action plan, which will also include specification of how frequently data will be synthesized and used to tailor, monitor, or evaluate the impact of prevention strategies.

o utilize effective data visualization and data storytelling tools, with technical assistance provided by CDC, to translate and disseminate data. Effective data translation and data to action programming uses health communication principles to tell stories and easily visualize trends or critical points related to ACEs and PCEs data. Data may be disseminated in multiple formats, including but not limited to data dashboards, infographics, tailored fact sheets, and other tools as identified by recipients to meet their needs. Resources and templates may be provided to help facilitate this work at the state, territorial, or tribal level for specific data sources and integrated surveillance reports on ACEs and PCEs.

o share draft data dissemination and data to action plans with CDC within the first year of the period of performance; all plans should be approved by CDC. Plans should be updated annually and provided to CDC as part of annual reporting.

Conduct a process and outcome evaluation of program activities related to ACEs surveillance and prevention.

o Recipients will utilize the identified social determinants of health data from youth-based ACEs and PCEs surveillance, to conduct an evaluation (process and outcome) of whether prevention strategy implementation is reaching subpopulations with disproportionate need due to the social determinants of health. Recipients should also consider whether prevention strategies have the potential to reduce health inequities and improve the social determinants of health. Recipients will be asked to collaborate with CDC on this activity.

Additional Activities Supported by Enhanced Funding In addition to goal 3 activities above, applicants can apply for enhanced funding for the following additional activities. (Applicants applying for additional funding will be required to assess the corresponding short-term outcomes.)

Utilize surveillance and program evaluation findings to tailor and improve strategy implementation at the local level, with a specific focus on improving health equity.

o Surveillance and program evaluation findings should be utilized on an ongoing basis, as data are obtained, to inform prevention strategy implementation.

Findings should continuously identify specific types of ACEs with high burden;

PCEs with low prevalence; and geographically or demographically specific subpopulations of interest in local communities that have a disproportionate burden of ACEs that contribute to health inequities.

o Recipients will include local level implementation efforts within the process and outcome evaluation plan for enhancing ACEs and PCEs surveillance and ACEs prevention strategies.

Conduct a process and outcome evaluation of program activities related to ACEs surveillance and prevention in communities with disproportionate need due to the social determinants of health using linked data.

o Recipients will utilize publicly available data from sources such as the County Health Rankings (https://www.countyhealthrankings.org/) or other data sources (e.g., social vulnerability index (SVI) data).

Recipients should utilize the linked data from youth-based ACEs and PCEs surveillance, to conduct an evaluation (process and outcome) of whether prevention strategy implementation is reaching subpopulations with disproportionate need due to the social determinants of health.

Recipients should also consider whether prevention strategies have the potential to reduce health inequities and improve the social determinants of health. Recipients will be asked to collaborate with CDC on this activity.

1. Collaborations

a. With other CDC projects and CDC-funded organizations:

https://www.countyhealthrankings.org/

Regardless of funding category, as part of this cooperative agreement, the recipient is required to collaborate with the CDC-funded entity that implements the state, territorial, or tribal Youth Risk Behavioral System (YRBS) as well as the CDC-funded entity that implements the syndromic surveillance program (if applying for enhanced activities). A Memorandum of Understanding (MOU) or Memorandum of Agreement (MOA) is required for each CDC-funded data source at the time of the application, even if the administrator of each data source is the same entity. If the recipient is the administrator, a letter of evidence should state this. If the recipient is a jurisdiction that does not utilize the YRBS, or if this is not the intended youth-based surveillance system that will monitor ACEs and PCEs, the recipient is required to provide a similar MOA/MOU for the state, territorial, or tribal entity that administers the youth-based surveillance system. Similarly, if the applicant is applying for the enhanced activities and is a jurisdiction that does not participate in the National Syndromic Surveillance Program (NSSP), a MOA/MOU from the state, tribal, or territorial entity that manages the emergency department discharge diagnosis/billing data is required at the time of the application. Applicants must file the MOU or MOA, as appropriate, name the file “MOUs/MOAs”, and upload it as a PDF file at www.grants.gov.

Collaboration with other CDC-funded programs, including those related to surveillance and injury prevention programming, is optional but strongly encouraged to leverage existing resources, infrastructure, and promote sustainability.