CDC-RFA-DD21-2102.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES

Improving Health of Americans with Intellectual and Developmental Disabilities Through Evidence-Based Health Promotion Programs

CDC-RFA-DD21-2102

Application Due Date: June 1, 2021

A

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- DD21-2102. 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:

Improving Health of Americans with Intellectual and Developmental Disabilities Through Evidence-Based Health Promotion Programs 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-DD21-2102

E. Assistance Listings Number:

93.184 F. Dates:

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

NA

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

2. Due Date for Applications:

06/01/2021 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

N/A

G. Executive Summary:

1. Summary Paragraph Special Olympics, Inc., has received federal funding from CDC since FY 2002 to develop, implement, evaluate, and disseminate health promotion activities such as the Healthy Athletes® program. This comprehensive health promotion platform serves the following core functions:

1) Expand capacity for health screening of people with intellectual and developmental disabilities (IDD) to assess risk for chronic disease and mental health conditions; assess need for follow-up care; provide education about chronic disease prevention and healthy lifestyle behaviors; and provide person-centered referral and facilitate linkage to appropriate prevention, wellness, and healthcare resources and services.

2) Adapt, implement, disseminate, and evaluate educational programs and resources to promote healthy lifestyle behaviors, improve knowledge and awareness of health risk factors, and increase utilization of routine health care among people with IDD.

3) Deliver educational programs and resources on the unique health needs of people with IDD to select audiences such as health professionals; medical, dental, and allied health students;

caregivers; health advocates; decision makers; and the public, in an effort to expand referral networks of providers to deliver health promotion services to people with IDD.

CDC-RFA-DD21-2102 is a 5-year funding opportunity to build on these decades of work and continue to improve the mental and physical health and wellness of Americans with IDD across the lifespan. The proposed activities funded under this Cooperative Agreement will be restricted to public health practice, with translation of evidence-based health promotion programs adapted to the unique needs of individuals with IDD.

a. Eligible Applicants:

Single

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards

d. Total Period of Performance Funding:

$ 68,412,125 This amount includes direct and indirect costs.

e. Average One Year Award Amount:

$ 13,682,425

f. Total Period of Performance Length:

g. Estimated Award Date:

https://www.grants.gov/

July 01, 2021

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 This NOFO addresses health disparities among children and adults with intellectual and developmental disabilities (IDD). In addition, this NOFO focuses on health promotion and wellness among this population.

The term ‘‘developmental disability’’ (DD) describes a severe, chronic disability of an individual that is attributable to a mental and/or physical impairment, is manifested before the individual attains age 22, and results in substantial functional limitations in multiple areas of major life activity.1 Intellectual disability (ID) is a specific type of developmental disability characterized by limitations in intellectual functioning and adaptive behavior that originates before 18 years.2 Intellectual disability is estimated to affect 1% to 3% of the population,3 whereas recent prevalence estimates for developmental disability can reach 2-6 times that number depending on how the condition is defined.4,5

A growing body of data indicate that individuals with disabilities, as a group, experience health disparities in routine public health arenas such as engagement in positive health behaviors, access to clinical preventive services, and are at higher risk for chronic disease and mental health conditions.6,7 Compared to individuals without disabilities, individuals with disabilities are:

More likely to engage in unhealthy behaviors that put their health at risk, such as cigarette smoking and poor diet;

Less likely to engage in positive health behaviors such as physical activity;

Less likely to have access to appropriate healthcare providers and receive recommended preventive healthcare services, such as routine dental care and cancer screenings;

At a higher risk for health conditions such as asthma, cardiovascular disease, diabetes, hypertension, hyperlipidemia, and stroke;6 and More likely to have behavioral health conditions such as depression and anxiety.7

To address these and other health determinants, the following World Health Organization (WHO) principles of action8 are recommended to achieve health equity among individuals with disabilities:9

1. Improve the conditions of daily life - the circumstances in which people are born, grow, live, work, and age - by encouraging communities to be accessible so all can live in, move through, and interact with their environment;

2. Tackle the inequitable distribution of resources - the structural drivers of those conditions of daily life - by increasing appropriate healthcare for individuals with disabilities, social participation, and access to needed technologies and assistive supports; and

3. Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.

For two decades, the eligible applicant has been working with CDC's National Center on Birth Defects and Developmental Disabilities (NCBDDD) on large-scale disability efforts, in particular the Special Olympics Healthy Athletes® program. Since 2002, trained volunteers have delivered over 2 million free health screenings (in eight disciplines) and trained more than 280,000 health professionals and students on the unique health needs of people with IDD. During 2019 alone, community volunteers conducted nearly 50,000 health screenings at Healthy Athletes® events, typically held in conjunction with Special Olympics regional games. Federal funding has also enabled the applicant to deploy multiple on-line platforms for management of patient screening data, training of volunteers and community health professionals, and offering a wide variety of accessible fitness programs for people with IDD, including fitness programs with self-screening components.

NCBDDD's Division of Human Development and Disability (DHDD) proposes a Notice of Funding Opportunity to continue this established collaboration with CDC. The applicant will propose strategies and activities for improving the health of individuals with IDD across the lifespan while addressing the WHO principles of action.

b. Statutory Authorities The program is authorized under the Public Health Service Act, Section 317C (42 U.S.C. 247b- 4, as amended).

c. Healthy People 2030 This NOFO primarily addresses Healthy People 2030 topic areas for Disability and Health; and Access to Health Services.

d. Other National Public Health Priorities and Strategies Additionally, this NOFO aligns with the following national agendas and strategies:

The Current State of Healthcare for People with Disabilities (National Council on Disability, 2009)

The Future of Disability in America (Institute of Medicine, 2007) U.S. Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities (DHHS, 2005) Disability and Public Health Competencies (Association of University Centers on

Disability, 2018) Core Competencies on Disability for Healthcare Education (Nisonger, 2019) The Guide to Clinical Preventive Services (AHRQ) The Community Guide (CDC) Division of Human Development and Disability Strategic Plan FY 2021-2025 (CDC)

e. Relevant Work https://health.gov/healthypeople/about/workgroups/disability-and-health-workgroup https://health.gov/healthypeople/about/workgroups/access-health-services-workgroup https://ncd.gov/publications/2009/Sept302009#:~:text=NCD%20undertook%20%22The%20Current%20State%20of%20Health%20Care,and%20disability%20research%20community%2C%20and%20people%20with%20disabilities.

https://ncd.gov/publications/2009/Sept302009#:~:text=NCD%20undertook%20%22The%20Current%20State%20of%20Health%20Care,and%20disability%20research%20community%2C%20and%20people%20with%20disabilities.

https://www.ncbi.nlm.nih.gov/books/NBK11434/pdf/Bookshelf_NBK11434.pdf https://www.ncbi.nlm.nih.gov/books/NBK44667/pdf/Bookshelf_NBK44667.pdf https://disabilityinpublichealth.org/ https://disabilityinpublichealth.org/ https://nisonger.osu.edu/wp-content/uploads/2019/08/post-consensus-Core-Competencies-on-Disability_8.5.19.pdf http://www.ahrq.gov/prevention/guidelines/index.html https://www.thecommunityguide.org/about/programs-and-services https://www.cdc.gov/ncbddd/humandevelopment/strategic-plan.html

This NOFO builds on the previous CDC-RFA-DD16-1602, which funded organizations of national scope to develop, implement, evaluate, and disseminate non-research activities aimed at reducing health disparities and improving the health of people with mobility limitations or intellectual disabilities across the lifespan.

References Cited in Overview Section:

1. Developmental Disabilities Assistance and Bill of Rights Act of 2000. https://acl.gov/sites/default/files/about-acl/2016-12/dd_act_2000.pdf.

2. American association on intellectual and developmental disabilities. https://aaidd.org/intellectual-disability/definition.

3. Patrick ME, Shaw KA, Dietz PM, Baio J, Yeargin-Allsopp M, Bilder DA, Kirby RS, Hall- Lande JA, Harrington RA, Lee LC, Lopez MLC, Daniels J, Maenner MJ. Prevalence of intellectual disability among eight-year-old children from selected communities in the United States, 2014. Disabil Health J. 2020.

4. Zablotsky B, Black LI, Blumberg SJ. Estimated Prevalence of Children With Diagnosed Developmental Disabilities in the United States, 2014-2016. NCHS Data Brief. 2017 Nov;(291):1-8. PMID: 29235982.

5. Zablotsky B, Black LI, Maenner MJ, Schieve LA, Danielson ML, Bitsko RH, Blumberg SJ, Kogan MD, Boyle CA. Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009-2017. Pediatrics. 2019.

6. Reichard A, Stolzle H, Fox MH. Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. Disabil Health J. 2011; 4:59-67.

7. Okoro CA, McKnight-Eily LR, Strine TW, Crews JE, Holt JB, Balluz LS. State and local area estimates of depression and anxiety among adults with disabilities in 2006. Disabil Health J 2011;4(2):78-90.

8. World Health Organization, Commission on Determinants of Health. Closing the gap in a generation: Health equity through action on the determinants of health. Final report. Geneva, Switzerland: WHO; 2008.

9. Solar O, Irwin A. A conceptual framework for action on the social determinants of health.

Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva, World Health Organization, 2010.

2. CDC Project Description

a. Approach Bold indicates period of performance outcome.

CDC-RFA-DD21-2102 Logic Model: Improving Health of Americans with Intellectual and Developmental Disabilities Through Evidence-Based Health Promotion Programs

Strategies Short-term Outcomes Long-term Outcomes

Strategy 1:

Health Screening, Among people with IDD:

- Increased health screening

Reduced prevalence of chronic disease among https://acl.gov/sites/default/files/about-acl/2016-12/dd_act_2000.pdf https://aaidd.org/intellectual-disability/definition

Referral, and Data-Based Monitoring

Strategy 2:

Health Promotion Programs

Strategy 3:

Capacity Building

- Increased person-centered referral and linkage to services

- Increased health check-ups

- Increased management and control of health conditions

- Increased knowledge of healthy lifestyle behaviors

- Increased participation in health promotion programs

- Increased knowledge of personal risk factors

- Increased adoption of healthy lifestyle behaviors

- Improved life satisfaction and perceived social-emotional support

- Increased utilization of and satisfaction with telehealth technology

Increased opportunities for professionals and volunteers to engage people with IDD in health-related screening

Improved data collection methods and increased availability and quality of data for continuous program improvement

Increased capacity to compare health indicators collected through health screenings with health indicators for people with IDD in national health surveys

Expanded application of telehealth technology in health promotion and wellness programs

Increased awareness about the effectiveness of health promotion and wellness programs for people with IDD

Improved quality of health promotion programs and services for people with IDD and their caregivers

Increased knowledge and awareness of the unique health needs of people with IDD people with IDD

Reduced prevalence of mental health conditions among people with IDD

Improved physical, mental, and emotional wellness among people with IDD

Reduced prevalence of acute secondary conditions among people with IDD

Reduced utilization of emergency medical care and emergency dental procedures among people with IDD

Reduced prevalence of vaccine-preventable illness among people with IDD

Improved sustainability of inclusive health promotion programs, policies, systems, and environments

Increased number of providers committed to delivering prevention and healthcare services to people with IDD

Increased frequency and reach of disseminated communications

Completion of at least two assessments to identify needs among local, state, and territorial health agencies for training, technical assistance, and resources to improve the health of people with IDD

Increased availability of community models, tools and resources to inform inclusive health promotion programs, policies, systems, and environments

Increased use of community models, tools, and resources to improve the health of people with IDD

Increased knowledge, skill, and competency of staff at local, state, and territorial health agencies

Strengthened capacity of local, state, and territorial health agencies to sustain health promotion programs for people with IDD

Strengthened capacity of communities to provide accessible, high-quality healthcare and related services to people with IDD

Increased delivery of high-quality health promotion programs and services to people with IDD

Increased number and quality of strategic partnerships with local, state, and territorial health agencies

i. Purpose To maximize health, prevent chronic disease, improve social and environmental living conditions, and promote full community participation, choice, health equity, and quality of life among Americans with intellectual and developmental disabilities, the applicant will propose strategies and activities to:

1) Expand capacity for health screening of people with IDD and analyze health screening data to inform health and wellness programs;

2) Adapt, implement, disseminate, and evaluate educational programs and resources that promote healthy lifestyle behaviors; and

3) Deliver educational programs and resources on the unique health needs of people with IDD.

ii. Outcomes Short-term and intermediate outcomes resulting from the activities funded under this NOFO include:

Health Screening, Referral, and Data-Based Monitoring

1.1.1 Among people with IDD, increased health screening to assess risk for chronic disease and mental health conditions (including, but not limited to: diabetes, obesity, heart disease, hypertension, depression, and anxiety disorders) to assess need for follow-up care of acute conditions and to provide education about chronic disease prevention, healthy lifestyle behaviors, vaccinations, and routine dental care and health check-ups with primary care and well-woman providers

1.1.2 Among people with IDD, increased person-centered referral and linkage to appropriate prevention and healthcare resources and services

1.1.3 Among people with IDD, increased receipt of routine health check-ups with primary care and well-woman providers, including recommended vaccinations and screening for mental health conditions, as well as increased receipt of routine dental care

1.1.4 Among people with IDD, increased adoption of healthy lifestyle behaviors such as physical activity, healthy eating, stress management and coping strategies, social connectedness, reduced tobacco use and exposure, and healthy sleep habits

1.1.5 Among people with IDD, increased management and control of chronic disease and mental health conditions

1.1.6 Among people with IDD, improved life satisfaction and perceived social-emotional support

1.2.1 Improved data collection methods and increased availability and quality of data for continuous program improvement

Health Promotion Programs

2.1.1 Among people with IDD, increased knowledge and awareness of healthy lifestyle behaviors

2.1.2 Among people with IDD, increased participation in evidence-based, innovative risk-reduction and health promotion programs

2.1.3 Among people with IDD, increased knowledge and awareness of personal risk factors for chronic disease and/or mental health conditions; among those at risk, increased awareness of the need for follow-up care

2.1.4 Among people with IDD, increased adoption of healthy lifestyle behaviors such as physical activity, healthy eating, stress management and coping strategies, social connectedness, reduced tobacco use and exposure, and healthy sleep habits

2.1.5 Among people with IDD, increased management and control of chronic disease and mental health conditions

2.1.6 Among people with IDD, improved life satisfaction and perceived social-emotional support.

2.2.1 Among people with IDD, increased utilization of and satisfaction with telehealth technology

2.2.2 Expanded application of telehealth technology in health promotion and wellness programs

2.3.1 Improved data collection methods and increased availability and quality of data for continuous program improvement

2.3.2 Increased awareness about the effectiveness of health promotion and wellness programs for people with IDD

2.3.3 Improved quality of health promotion programs and services for people with IDD and their caregivers

Capacity Building

3.1.1 Increased knowledge and awareness of the unique health needs of people with IDD among healthcare and allied health professionals; medical, dental, and allied health students; caregivers;

health advocates; decision makers; and the public

3.2.1 Increased number of providers committed to delivering prevention and healthcare services to people with IDD

3.3.1 Increased frequency and reach of disseminated communications that include up-to-date directories of healthcare providers and health promotion services committed to serving people with IDD

3.4.1 Completion of at least two assessments, conducted through collaboration between organizations funded under CDC-RFA-DD21-2102, CDC-RFA-DD21-2103, and CDC-RFA- DD21-2104, to identify needs among local, state, and territorial health agencies for training, technical assistance, and resources to improve the health of people with IDD

3.5.1 Increased availability of community models, tools and resources to inform inclusive health promotion programs, policies, systems, and environments

3.5.2 Increased use of community models, tools, and resources to improve the health of people with IDD

3.6.1 Increased knowledge, skill, and competency of staff at local, state, and territorial health agencies and their partners to deliver health promotion programs and services to people with IDD and their caregivers

3.6.2 Strengthened capacity of local, state, and territorial health agencies to plan, integrate, implement, and sustain health promotion programs for people with IDD and their caregivers

3.7.1 Strengthened capacity of local, state, and territorial health agencies to provide accessible, high-quality healthcare and related services to people with IDD

3.7.2 Increased delivery of high-quality health promotion programs and services to people with IDD and their caregivers by local, state, and territorial health agencies and their partners

3.7.3 Increased capacity of local communities to provide accessible, high-quality healthcare and related services to people with IDD

3.8.1 Increased number and quality of strategic partnerships with local, state, and territorial health agencies, established and enhanced through collaboration between organizations funded under FY2021 NOFOs CDC-RFA-DD21-2102, CDC-RFA-DD21-2103, and CDC-RFA-DD21- 2104, to address health disparities experienced by people with IDD and associated disabilities

Long-term outcomes resulting from the activities funded under this NOFO include:

Reduced prevalence of chronic physical health conditions (including, but not limited to:

diabetes, obesity, heart disease, and hypertension) among people with IDD

Reduced prevalence of mental health conditions (including, but not limited to: depression and anxiety disorders) among people with IDD

Improved physical, mental, and emotional wellness among people with IDD

Reduced prevalence of acute secondary conditions (including, but not limited to: pain, pressure sores, dental problems, sleep disorders, and adjustment disorders) among people with IDD

Reduced utilization of emergency medical care and emergency dental procedures among people with IDD

Reduced prevalence of vaccine-preventable illness among people with IDD

Improved sustainability of inclusive health promotion programs, policies, systems, and environments

iii. Strategies and Activities The applicant is expected to propose strategies and activities under the following framework:

Strategy 1: Health Screening and Referral

Activity 1.1 Expand capacity for health screening of people with IDD to (1) assess risk for chronic disease and mental health conditions; (2) assess need for follow-up care to address acute conditions; (3) provide education about chronic disease prevention, healthy lifestyle behaviors, vaccinations, and routine dental care and health check-ups with primary care and well-woman providers; and (4) provide person-centered referral and facilitate linkage to appropriate prevention, wellness, and healthcare resources and services

Activity 1.2 Collect data from health screenings and follow-up contacts, and analyze data on an ongoing basis to better support individual clients and improve the program overall

Strategy 2: Health Promotion Programs

Activity 2.1 Adapt, implement, disseminate, and evaluate educational programs and resources that (1) promote healthy lifestyle behaviors, (2) improve knowledge and awareness of health risk factors, and (3) increase utilization of routine health care among people with IDD and persons in their support networks

Activity 2.2 Use and enhance telehealth technology in evidence-based health promotion and wellness programs that have been adapted for people with IDD

Activity 2.3 Collect data from health promotion and wellness programs, and analyze data on an ongoing basis to better support individual needs and improve the program overall

Strategy 3: Capacity Building

Activity 3.1 Deliver educational programs and resources on the unique health needs of people with IDD to select audiences such as healthcare and allied health professionals; medical, dental, and allied health students; caregivers; health advocates; decision makers; and the public

Activity 3.2 Expand referral networks of providers (including mental health professionals) to deliver follow-up prevention and healthcare services to people with IDD

Activity 3.3 Disseminate up-to-date directories of healthcare providers and health promotion services in expanded communications to community partners, including state and local government agencies

Activity 3.4 Collaborate with organizations funded under CDC-RFA-DD21-2103 and CDC- RFA-DD21-2104 to conduct at least two assessments to identify needs among local, state, and territorial health agencies for training, technical assistance, and resources to improve the health of people with IDD

Activity 3.5 Disseminate and promote programmatic, policy, systems, and environmental community models, tools, and resources to increase and normalize inclusion of people with IDD in mainstream health care and health promotion services and activities

Activity 3.6 Develop and deliver training and resources to local, state, and territorial health agencies and provide technical assistance tailored to their specific needs, as identified through needs assessments

Activity 3.7 Provide technical assistance to local, state, and territorial health agencies delivering health promotion programs to people with IDD and their caregivers, including enhanced technical assistance to agencies funded under CDC-RFA-DD21-2103

Activity 3.8 Collaborate with organizations funded under CDC-RFA-DD21-2103 and CDC- RFA-DD21-2104 to enhance and expand strategic partnerships with local, state, and territorial health agencies to address health disparities experienced by people with IDD and associated disabilities

1. Collaborations

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

The funding recipient is expected to develop strategic partnerships to address health disparities experienced by people with IDD and associated disabilities, emphasizing those forged through collaboration between organizations funded under FY2021 NOFOs CDC-RFA-DD21-2102, CDC-RFA-DD21-2103, and CDC-RFA-DD21-2104. In addition, and where it is instrumental to this NOFO, partnerships are encouraged between the recipient and other CDC-funded national organizations providing services and training to improve the health of adults with IDD and associated disabilities (e.g., National Center on Health, Physical Activity and Disability;

National Association of County and City Health Officials; Association of State and Territorial Health Officials; Association of University Centers on Disabilities).

b. With organizations not funded by CDC:

The funding recipient is further encouraged to collaborate with organizations that may not be funded by CDC, including but not limited to:

National disability organizations (e.g., American Association on Health and Disability, TASH, United Cerebral Palsy, National Council on Independent Living, etc.);

Statewide or jurisdictional disability organizations (e.g., the Arc, Easter Seals, Centers for Independent Living, Developmental Disabilities Councils, etc.);

Community-based organizations (e.g., universities, hospitals, health departments, clinics [medical, dental, vision, hearing, veterinarian, etc.], tribes);

Support networks on future planning, especially for young adults with IDD transitioning from pediatric to adult health care services; and

Others (e.g., chronic disease programs, consortium, businesses, churches, parks and recreation etc.).

2. Target Populations This NOFO addresses health disparities among children and adults with intellectual and developmental disabilities (IDD). The term ‘‘developmental disability’’ (DD) describes a severe, chronic disability of an individual that is attributable to a mental and/or physical impairment, is manifested before the individual attains age 22, and results in substantial functional limitations in multiple areas of major life activity.1 Intellectual disability (ID) is a specific type of developmental disability characterized by limitations in intellectual functioning and adaptive behavior that originates before 18 years.2 Intellectual disability is estimated to affect 1% to 3% of the population,3 whereas recent prevalence estimates for developmental disability can reach 2-6 times that number depending on how the condition is defined.4,5

In addition, this NOFO involves partnerships with community-based organizations, disability service organizations, clinical practices, hospitals and universities. The success of this Cooperative Agreement hinges on the applicant having the ability to engage children and adults with IDD, their families and caregivers, and their healthcare providers through the strategies and activities funded under this award.

a. Health Disparities A growing body of data indicate that individuals with disabilities, as a group, experience health disparities in routine public health arenas such as engagement in positive health behaviors, access to clinical preventive services, and are at higher risk for chronic disease and mental health conditions. Compared to individuals without disabilities, individuals with disabilities are:

More likely to engage in unhealthy behaviors that put their health at risk, such as cigarette smoking and poor diet;

Less likely to engage in positive health behaviors such as physical activity;

Less likely to have access to appropriate healthcare providers and receive recommended preventive healthcare services, such as routine dental care and cancer screenings;

At a higher risk for health conditions such as asthma, cardiovascular disease, diabetes, hypertension, hyperlipidemia, and stroke; and More likely to have behavioral health conditions such as depression and anxiety.

To address these and other health determinants, the following World Health Organization (WHO) principles of action are recommended to achieve health equity among individuals with disabilities:

1. Improve the conditions of daily life - the circumstances in which people are born, grow, live, work, and age - by encouraging communities to be accessible so all can live in, move through, and interact with their environment;

2. Tackle the inequitable distribution of resources - the structural drivers of those conditions of daily life - by increasing appropriate healthcare for individuals with disabilities, social participation, and access to needed technologies and assistive supports; and

3. Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.

This Notice of Funding Opportunity includes strategies and activities for improving the health of individuals with IDD across the lifespan while addressing these WHO principles of action.

iv. Funding Strategy

NA

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

CDC and the funding recipient will work together to evaluate and measure the performance of this project.

CDC staff will monitor and evaluate:

1. progress (i.e., using process measures, benchmarks, adherence to NOFO requirements and use of funds, and outputs such as products and materials); and

2. the achievement of specified short-term and intermediate outcomes and targets (quantitative and qualitative measures).

The funding recipient will propose and implement performance evaluation strategies and measures for the activities described in this NOFO.

1. Performance measures proposed in the application will not be considered final. CDC staff and the funding recipients will have six months after the period of performance start date to finalize evaluation approaches and measurements for the activities described in this NOFO.

2. The recipient will be expected to submit aggregate data from evaluation measures to CDC. The timing and content of these submissions will be established once evaluation approaches and measures are finalized.

3. Guidance on collecting, reporting, and using data will be provided by CDC project staff throughout the period of performance. Such guidance might include recommendations for sharing aggregate data with CDC and other partners in public health.

4. CDC may use aggregate data from these performance measures to produce annual reports describing accomplishments related to this NOFO, fact sheets, and other monitoring and evaluation reports. Results may be shared at conferences, through publication in professional journals, and via online reports.

Performance measurement will involve collecting information to monitor, evaluate, and continuously improve program performance. The funding recipient should use multiple steps, such as collection, analysis, and interpretation of quantitative and qualitative data on program implementation and performance; tracking of expenditures and outcomes achieved by the program. The funding recipient may add evaluation sub-activities to conduct in-depth, detailed evaluations of selected program activities or elements, either individually or in collaboration with other local and national partners. These special evaluation activities might compare the effectiveness of different health promotion approaches or strategies under specific circumstances.

The funding recipient will be required to provide project information through an annual work plan, performance report, and financial report routine, as well as teleconference and email communications with CDC staff (See below, CDC Monitoring and Accountability Approach, section e.). CDC staff will routinely monitor these reports and communications to:

(a) identify strategies to continuously improve overall project quality and performance;

(b) assess the value of the NOFO (e.g., improved public health outcomes, effectiveness of key strategies and activities);

(c) demonstrate evidence for NOFO strategies and activities; and

(d) facilitate collaboration and information-sharing among national partners.

Expected Process and Outcome Measures Presented below is an initial outline of outcome and process measures. During the first six months of the period of performance, CDC and the funding recipient will discuss and finalize the measures presented in the CDC Evaluation and Performance Measurement section. For each of the Strategies, the proposed Work Plan (see below, section d) should first lay out the short-term and intermediate outcomes and their associated measures, followed by the project activities and their associated process measures based on the CDC Evaluation and Performance Measurement table included below.

Strategy 1: Health Screening and Referral

Activity 1.1:

Expand capacity for health screening of people with intellectual and developmental disabilities (IDD) to

(1) assess risk for chronic disease and mental health conditions; (2) assess need for follow-up care to address acute conditions; (3) provide education about chronic disease prevention, healthy lifestyle behaviors, vaccinations, and routine dental care and health check-ups with primary care and well-woman providers; and

(4) provide person-centered referral and facilitate linkage to appropriate prevention, wellness, and healthcare resources and services

Outcome 1.1.1:

Among people with IDD, increased health screening to assess risk for chronic disease and mental health conditions (including, but not limited to:

diabetes, obesity, heart disease, hypertension, depression, and anxiety disorders) to assess need for follow-up care of acute conditions and to provide education about chronic disease prevention, healthy lifestyle behaviors, vaccinations, and routine dental care and health check-ups with primary care and well-woman providers Outcome 1.1.2:

Among people with IDD, increased person-centered referral and linkage to appropriate prevention and healthcare resources and services Outcome 1.1.3:

Among people with IDD, increased receipt of routine health check-ups with primary care and well-woman providers, including recommended vaccinations and screening for mental

Outcome Measures:

Percentage of health screening participants who report receiving routine prevention and healthcare services (among those with follow-up data available)

Percentage of health screening participants who report following up with specialty healthcare providers, as recommended, to address elevated risk for chronic disease and/or mental health conditions (among those with follow-up data available)

Percentage of health screening participants who report receiving a health check-up within the past year

Percentage of female health screening participants who report receiving a well-woman health check-up within the past year

Percentage of health screening participants who report receiving routine dental care within the past year

Percentage of health screening participants who report receiving mental health screening within the past year

Percentage of health screening participants who report receiving one or more recommended/age-appropriate health vaccinations within the past year

Percentage of health screening participants reporting a change in status from the prior year regarding access to physical and mental health screening, routine health conditions, as well as increased receipt of routine dental care Outcome 1.1.4:

Among people with IDD, increased adoption of healthy lifestyle behaviors such as physical activity, healthy eating, stress management and coping strategies, social connectedness, reduced tobacco use and exposure, and healthy sleep habits Outcome 1.1.5:

Among people with IDD, increased management and control of chronic disease and mental health conditions Outcome 1.1.6:

Among people with IDD, improved life satisfaction and perceived emotional support.

preventive care, and specialty dental and healthcare providers.

Percentage of health screening participants reporting improved life satisfaction and perceived social-emotional support (collected in a format consistent with national health surveys, to enable comparative analyses)

Process Measures:

Number of individuals receiving health screening Number of health screening participants referred to healthcare providers for routine prevention and healthcare services

Number of individuals referred to specialty healthcare providers to address elevated risk for chronic disease and/or mental health conditions

Activity 1.2:

Collect data from health screenings and follow-up contacts, and analyze data on an ongoing basis to better support individual clients and improve the program overall

Outcome 1.2.1:

Improved data collection methods and increased availability and quality of data for continuous program improvement

Outcome Measures:

Percentage of existing health screening and follow-up data collection tools and systems enhanced or expanded

Percentage of health screening participants for whom follow-up data are available

Process Measures:

Number of new health screening and follow-up data collection tools and systems created

Number of data analysis strategies implemented to inform health screening program improvement

Strategy 2: Health Promotion Programs

Activity 2.1:

Adapt, implement, disseminate, and evaluate educational programs and resources that (1) promote healthy lifestyle behaviors, (2) improve knowledge and awareness of health risk factors, and

(3) increase utilization of routine health care among people with IDD and people in their support networks

Outcome 2.1.1:

Among people with IDD, increased knowledge and awareness of healthy lifestyle behaviors Outcome 2.1.2:

Among people with IDD, increased participation in evidence-based, innovative risk-reduction and health promotion programs Outcome 2.1.3:

Among people with IDD, increased knowledge and awareness of personal risk factors for chronic disease and/or mental health conditions;

among those at risk, increased awareness of the need for follow-up care Outcome 2.1.4:

Among people with IDD, increased adoption of healthy lifestyle behaviors such as physical activity, healthy eating, stress management and coping strategies, social connectedness, reduced tobacco use and exposure, and healthy sleep habits

Outcome Measures:

Percentage of individuals demonstrating increased knowledge of healthy lifestyle behaviors after utilizing educational programs and resources

Percentage of individuals demonstrating increased knowledge of personal risk factors for chronic disease and/or mental health conditions after utilizing educational programs and resources

Percentage of health promotion program participants who report following up with specialty healthcare providers, as recommended, to address elevated risk for chronic disease and/or mental health conditions (among those with follow-up data available)

Percentage of individuals demonstrating increased adoption of healthy lifestyle behaviors after utilizing educational programs and resources

Percentage of health promotion program participants reporting improved life satisfaction and perceived social-emotional support (collected in a format consistent with national health surveys, to enable comparative analyses)

Process Measures:

Outcome 2.1.5:

Among people with IDD, increased management and control of chronic disease and mental health conditions

Number of individuals from people with IDD participating in risk-reduction and health promotion programs

Activity 2.2:

Use and enhance telehealth technology in evidence-based health promotion and wellness programs that have been adapted for people with IDD

Outcome 2.2.1:

Among people with IDD, increased utilization of and satisfaction with telehealth technology Outcome 2.2.2:

Expanded application of telehealth technology in health promotion and wellness programs

Outcome Measures:

Percentage of individuals reporting satisfaction with telehealth technology in health promotion and wellness programs

Process Measures:

Number of individuals utilizing telehealth technology in health promotion and wellness programs

Number of new health promotion and wellness programs using telehealth technology

Activity 2.3:

Collect data from health promotion and wellness programs, and analyze data on an ongoing basis to better support individual needs and improve the program overall

Outcome 2.3.1:

Improved data collection methods and increased availability and quality of data for continuous program improvement Outcome 2.3.2:

Increased awareness about the effectiveness of health promotion and wellness programs for people with IDD Outcome 2.3.4:

Improved quality of health promotion programs and services for people with IDD and their caregivers

Outcome Measures:

Qualitative documentation of the types of new health promotion program data collection tools and systems created, enhanced, or expanded

Percentage of health promotion program participants for whom follow-up data are available

Process Measures:

Number of new health promotion program data collection tools and systems created

Percentage of existing health promotion program data collection tools and systems enhanced or expanded

Number of data analysis strategies implemented to inform health promotion program improvement

Qualitative documentation of enhancements to health promotion and wellness programs, emphasizing those informed by project data collection tools and systems

Strategy 3: Capacity Building

Activity 3.1:

Deliver educational programs and resources on the unique health needs of people with IDD to select audiences such as healthcare and allied health professionals;

medical, dental, and allied health students;

caregivers; health advocates; decision makers; and the public

Outcome 3.1.1:

Increased knowledge and awareness of the unique health needs of people with IDD among healthcare and allied health professionals; medical, dental, and allied health students;

caregivers; health advocates; decision makers; and the public

Process Measures:

Number of universities with curriculum changes Number of professionals and students trained outside of healthy athlete events

Number of family members/caregivers educated

Activity 3.2:

Expand referral networks of providers (including mental health professionals) to deliver follow-up prevention and healthcare services to people with IDD

Outcome 3.2.1:

Increased number of providers committed to delivering prevention and healthcare services to people with IDD

Process Measures:

Number of new local partners delivering prevention and healthcare services to people with

IDD

Activity 3.3:

Disseminate up-to-date directories of healthcare providers and health promotion services in expanded communications to community partners, including state and local government agencies

Outcome 3.3.1:

Increased frequency and reach of disseminated communications that include up-to-date directories of healthcare providers and health promotion services committed to serving people with

IDD

Process Measures:

Number of healthy athletes/families reached in communications/newsletters

Number of updated provider/service directories posted

Number of downloads/views of newsletters, directories, etc.

Activity 3.4:

Collaborate with organizations funded under CDC-RFA- DD21-2103 and CDC- RFA-DD21-2104 to conduct at least two assessments to identify needs among local, state, and territorial health agencies for training, technical assistance, and resources to improve the health of people with IDD

Outcome 3.4.1:

Completion of at least two assessments, conducted through collaboration between organizations funded under CDC-RFA-

DD21-2102, CDC-

RFA-DD21-2103, and

CDC-RFA-DD21-

2104, to identify needs among local, state, and territorial health agencies for training, technical assistance, and resources to improve the health of people with IDD

Outcome Measures:

Quality of needs assessments completed

Process Measures:

Number of needs assessments completed

Activity 3.5:

Disseminate and promote programmatic, policy, systems, and environmental community models, tools, and resources to increase and normalize inclusion of people with IDD in mainstream health care and health promotion services and activities

Outcome 3.5.1:

Increased availability of community models, tools and resources to inform inclusive health promotion programs, policies, systems, and environments Outcome 3.5.2:

Increased use of community models, tools, and resources to improve the health of people with IDD

Process Measures:

Number of resources and recommendations posted

Number of downloads/views of resources and recommendations posted

Activity 3.6:

Develop and deliver training and resources to local, state, and territorial health agencies and provide technical assistance tailored to their specific needs, as identified through needs assessments

Outcome 3.6.1:

Increased knowledge, skill, and competency of staff at local, state, and territorial health agencies and their partners to deliver health promotion programs and services to people with IDD and their caregivers Outcome 3.6.2:

Strengthened capacity of local, state, and territorial health agencies to plan, integrate, implement, and sustain health promotion programs for people with IDD and their caregivers

Activity 3.7:

Provide technical assistance to local, state, and territorial health agencies delivering health promotion programs to people with IDD and their caregivers, including enhanced technical assistance to agencies funded under

CDC-RFA-DD21-

Outcome 3.7.1:

Strengthened capacity of local, state, and territorial health agencies to provide accessible, high-quality healthcare and related services to people with IDD Outcome 3.7.2:

Increased delivery of high-quality health promotion programs and services to people with IDD and their caregivers by local, state, and territorial health agencies and their partners Outcome 3.7.3:

Increased capacity of local communities to provide accessible, high-quality healthcare and related services to people with IDD

Process Measures:

Number of presentations/trainings delivered to LHDs

Process Measures:

Number of wellness opportunities

Activity 3.8:

Collaborate with organizations funded under CDC-RFA- DD21-2103 and CDC- RFA-DD21-2104 to enhance and expand strategic partnerships with local, state, and

Outcome 3.8.1:

Increased number and quality of strategic partnerships with local, state, and territorial health agencies, established and enhanced through collaboration between

Outcome Measures:

Reach of new partnerships

Process Measures:

Number of new partnerships Qualitative documentation of developments in strategic partnerships to address health disparities experienced by people territorial health agencies to address health disparities experienced by people with IDD and related disabilities organizations funded under FY2021 NOFOs

CDC-RFA-DD21-

2102, CDC-RFA-

DD21-2…