CDC-RFA-DD21-2103 27 Apr 2021.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES

Improving the Health of People with Mobility Limitations and Intellectual/Developmental Disabilities through State-based Public Health Programs

CDC-RFA-DD21-2103

05/11/2021

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- DD21-2103. 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 the Health of People with Mobility Limitations and Intellectual/Developmental Disabilities through State-based Public Health 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-DD21-2103

E. Assistance Listings Number:

93.184 F. Dates:

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

03/26/2021 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:

05/11/2021 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

The program will host an informational conference call on Wednesday, March 31, 2021 (2:00 pm to 3:00 pm Eastern Time). The informational conference call can be accessed on the following link at Join Skype Meeting and/or by calling (770) 488-3600 and entering passcode 8019483#.

G. Executive Summary:

1. Summary Paragraph This Notice of Funding Opportunity (NOFO) supports a new five-year, non-research cooperative agreement to address statewide or jurisdictional needs related to reducing health disparities among adults with intellectual disabilities and other developmental disabilities (IDD), and adults with mobility limitations (ML) in the United States. In support of the overarching goal, this NOFO will provide funding to agencies, organizations, and institutions within states and jurisdictions to: (1) establish, expand, and enhance partnerships with organizations that serve adults with disabilities; (2) conduct community needs assessments within states and jurisdictions to identify gaps in resources and tools, and identify action steps to fill those gaps; (3) administer and evaluate a training for providers on accessible preventive health care; (4) implement and evaluate a demonstration project to link adults with IDD to preventive health care and health promotion programs in their community; (5) implement and evaluate evidence-based health promotion interventions, as well as policy, system and environmental (PSE) changes, and develop resources and tools to address health disparities among adults with IDD and ML; and (6) disseminate key findings and lessons learned. Long-term outcomes among the target populations include improvements in (1) number of providers that can offer accessible preventive health care,

(2) fewer unmet preventive health care needs, including mental health; (3) health behaviors and wellness; (4) chronic conditions and risk factors.

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards

d. Total Period of Performance Funding:

$ 28,625,000

e. Average One Year Award Amount:

$ 572,500

f. Total Period of Performance Length:

g. Estimated Award Date:

July 01, 2021

h. Cost Sharing and / or Matching Requirements:

https://www.grants.gov/ https://webconf.cdc.gov/lvs4/3FKH4K9M

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 adults with disabilities. Compared to the general population, adults with disabilities experience health disparities in physical and mental health (e.g., physical inactivity, smoking, insufficient sleep, mental distress, poor nutritional intake etc.)

(DHDS, 2016). Adults with disabilities are less likely to receive preventive healthcare, which can lead to preventable conditions (e.g., influenza, dental issues, diabetes etc.), delayed diagnosis, and lack of management for several other conditions (e.g., cancers, hypertension, and vision, hearing and mental health problems) (Williamson et al., 2017; Krahn & Fox, 2013; U.S. Surgeon General’s Office, 2005). For people with disabilities, health disparities are also associated with existing policy, system and environmental (PSE) barriers, (e.g., lack of inclusion in health promotion programs and venues and inaccessible healthcare) (Pharr, 2014; McDoom et al., 2012;

Kirschner et al., 2007; Rimmer et al, 2005).

Projected NOFO outcomes include improvements in (1) access to recommended preventive health care and other health services; (2) receipt of recommended healthcare, including mental health; (3) health behaviors and wellness; and (4) chronic conditions and risk factors. To achieve these outcomes and in alignment with the RE-AIM planning and evaluation framework, the updated Ten Essential Public Health Services, and Frieden’s pyramid, this NOFO uses a combination of public health approaches. As outlined in the provided NOFO logic model, award recipients will (1) establish, expand, and enhance partnerships with organizations that serve adults with disabilities; (2) conduct community need assessments within states and jurisdictions to identify gaps in resources and tools, and identify action steps to fill those gaps; (3) administer and evaluate a training for healthcare providers on accessible preventive health care; (4) implement and evaluate a demonstration project to link adults with IDD to preventive health care and health promotion programs in their community; (5) implement and evaluate evidence-based health promotion interventions, as well as PSE changes, and develop resources and tools to address health disparities among adults with IDD, and adults with ML; and (6) disseminate key findings and lessons learned.

This approach is consistent with The Guide to Clinical Preventive Services, and practice models for linking adults with IDD to needed preventive health care (Ruiz et al, 2020; Williamson et al., 2017; Bower et al, 2017; Hwang et al., 2009; Mastal et al., 2007; Palsbo et al., 2006). Among adults with IDD, improved access and engagement with quality health care can help with the following: adopting and maintaining healthy behaviors earlier in life; receiving recommended preventive care; identifying and addressing barriers to care; and obtaining supports to maintain health, prevent, delay or effectively manage health conditions (Cyrus et al, 2019; Courtney-Long et al, 2017). In addition, over half of adults with IDD live in a home with a family member who may serve as their informal caregiver. The health, well-being, health education, and involvement https://dhds.cdc.gov/ https://pubmed.ncbi.nlm.nih.gov/28703641 https://www.readcube.com/articles/10.1111/jar.12067?locale=en https://www.ncbi.nlm.nih.gov/books/NBK44667/pdf/Bookshelf_NBK44667.pdf https://www.ncbi.nlm.nih.gov/books/NBK44667/pdf/Bookshelf_NBK44667.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825235/ https://journals.sagepub.com/doi/full/10.1177/1044207312469829 https://jamanetwork.com/journals/jama/article-abstract/205970 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449478/ https://www.cdc.gov/pcd/issues/2018/17_0271.htm https://www.debeaumont.org/10-essential-services/ https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.185652 https://www.ahrq.gov/prevention/guidelines/index.html https://journals.sagepub.com/doi/full/10.1177/1044207319835195 https://pubmed.ncbi.nlm.nih.gov/28703641/ https://pubmed.ncbi.nlm.nih.gov/28703641/ https://www.tandfonline.com/doi/full/10.1080/09638288.2016.1219773 https://journals.sagepub.com/doi/abs/10.1177/1044207308315564 https://journals.lww.com/professionalcasemanagementjournal/Abstract/2007/01000/Innovations_in_Disability_Care_Coordination.7.aspx https://pubmed.ncbi.nlm.nih.gov/17013056/ https://meridian.allenpress.com/ajidd/article-abstract/124/3/248/364892 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268742/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268742/ of informal caregivers can be an essential component of interventions addressing the needs of adults with IDD (Wilhite et al., 2012). Aligned with specified criteria for implementing interventions among adults with IDD and ML (Drum et al, 2016), health promotion intervention studies have demonstrated improvements in health behaviors (e.g., fitness), biologic indicators (e.g., body weight), and physical functioning, self-rated health, depression, fatigue, and pain (Ma & Ginis, 2018; White et al, 2011). The CDC, Guide for Community Preventive Services and Disability Inclusion, summarizes strategies and interventions that are applicable to adults with disabilities. In addition, there is an evidence base for providing disability competency training to healthcare providers, and using Healthcare Facility Assessments to help create accessible healthcare settings.

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 the Healthy People 2030, Disability and Health and Access to Health Services topic areas.

d. Other National Public Health Priorities and Strategies 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) Guidelines on Accessible, Durable Medical Equipment (Access Board, 2019) Barrier-Free Healthcare Initiative (2012) The Guide to Clinical Preventive Services (AHRQ) The Community Guide (CDC)

e. Relevant Work This NOFO builds on the previous CDC-RFA-DD16-1603, which provided awards to state-based health departments or their bona fide agents to implement accessible and inclusive health behavior interventions; provider and student training; and policy, system, and environmental changes.

2. CDC Project Description

a. Approach Bold indicates period of performance outcome.

https://search.proquest.com/docview/1282273737?pq-origsite=gscholar&fromopenview=true https://journals.sagepub.com/doi/abs/10.4278/ajhp.090303-CIT-94 https://www.sciencedirect.com/science/article/abs/pii/S1469029217304624 https://www.sciencedirect.com/science/article/abs/pii/S1469029217304624 https://www.sciencedirect.com/science/article/pii/S1936657410000361 file:///Z:/10.%20D&H%20Branch/DPIP/Manuscripts/Hinton%20et%20al%202017%20Community%20Guide.pdf.g6yjn1k.partial file:///Z:/10.%20D&H%20Branch/DPIP/Manuscripts/Hinton%20et%20al%202017%20Community%20Guide.pdf.g6yjn1k.partial https://nisonger.osu.edu/education-training/ohio-disability-health-program/odhp-training/ https://www.nchpad.org/1261/6287/Community~Health~Inclusion~Assessment~Tools http://health.gov/healthypeople/objectives-and-data/browse-objectives/people-disabilities https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality 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 https://www.access-board.gov/guidelines-and-standards/health-care https://www.ada.gov/usao-agreements.htm http://www.ahrq.gov/prevention/guidelines/index.html https://www.thecommunityguide.org/about/programs-and-services https://www.grants.gov/web/grants/search-grants.html?keywords=CDC-RFA-DD16-163

CDC-RFA- DD21-2103 LOGIC MODEL: Improving the Health of People with Mobility Limitations and Intellectual/Developmental Disabilities through State-based Public Health Programs

Strategies and Activities

Short-term Outcomes

Intermediate Outcomes

Long-Term Outcomes

1. Establish, expand, and enhance partnerships statewide or jurisdictional.

1.1 Stronger

engagement and coordination between recipients and key partners.

1.2 Broader

reach among the target populations.

2. Conduct a statewide or jurisdictional need assessment, and develop resources and tools.

2.1 Recipients

gain knowledge about state and jurisdictional needs, and a repository of resources and tools to meet those needs.

2.2 States or

jurisdictions use resources and tools to improve the health of adults with IDD and adults with

ML.

3. Administer and evaluate a training for healthcare providers on accessible preventive health care.

3.1 Providers gain

disability and health competency.

3.2 Providers im prove efforts to deliver accessible preventive health care.

4. Implement and evaluate a demonstration project to link adults with IDD with unmet needs to preventive health care and health promotion programs in their

4.1 Participants

gain knowledge about recommended preventive health care and healthy lifestyle behaviors.

4.2 Participants

gain knowledge about addressing barriers to preventive health

4.3 Participants are appropriately linked to preventive health care, mental health care and health promotion activities.

Communities have increased number of providers that can offer accessible preventive health care

Adults with IDD have fewer unmet needs for preventive health care, including mental health

Adults with IDD and adults with ML have healthier behaviors

Adults with IDD and adults with ML have reduced prevalence of chronic diseases and their risk factors, including better emotional and mental health

i. Purpose This NOFO addresses health disparities among adults with IDD and adults with ML. This NOFO aims to (1) establish, expand, and enhance partnerships; (2) conduct community needs assessments and identify action steps to fill the gaps; (3) administer and evaluate a training for healthcare providers on accessible preventive health care; (4) implement and evaluate a demonstration project to link adults with IDD to preventive health care and health promotion programs in their community;

(5) implement and evaluate evidence-based health promotion interventions and PSE changes, and develop needed resources and tools; and (6) disseminate key findings and lessons learned.

ii. Outcomes As briefly outlined in the logic model, recipients are expected to achieve the short-term and intermediate outcomes during the five-year period of performance. Although recipients may achieve the long-term outcomes during the period of performance, it is not a requirement as long-term outcomes represent the ultimate impact to which the strategies and activities will contribute.

Strategy 1 Establish, expand, and enhance partnerships.

The overarching outcomes include strengthened engagement between recipients and with key partners, and broader reach among the target populations. These outcomes are detailed as follows:

community. care.

5. Implement and evaluate evidence-based health promotion interventions, policy, system and environmental (PSE) changes

5.1 Participants

enroll in evidence-based health promotion interventions.

5.2 Participants adopt healthy behaviors.

5.3 States or

jurisdictions experience notable PSE changes.

6. Disseminate key findings and lessons learned

6.1 Recipients

learn best practices and lessons learned.

6.2 Health

professionals and policymakers gain knowledge about ways to promote health among adults with disabilities.

Outcome 1.1 Strengthened engagement, planning and coordination between recipients, community-based organizations and complementary programs (e.g., health departments) within the state or jurisdiction to improve accessible preventive health care and health promotion activities among adults with IDD and adults with ML.

Outcome 1.2: Increased engagement between recipients and the CDC-funded National Centers on Disability (i.e., The National Center on Health, Physical Activity and Disability; and Special Olympics) to access and use their training, technical assistance, and resources.

Strategy 2 Conduct a need assessment, statewide or jurisdictional, to identify gaps in information, resources (e.g., accessible healthcare providers, programs, policies, services), and barriers to engagement with preventive healthcare services and health promotion programs among adults with IDD and adults with ML, and identify action steps to fill those gaps.

The overarching outcomes include increased knowledge about state and jurisdictional needs; a repository of resources and tools to meet those needs; and increased use of resources and tools to improve health among adults with IDD and adults with ML.

These outcomes are detailed as follows:

Outcome 2.1 Improved capability of award recipients to plan and implement activities to improve engagement with accessible preventive health care and health promotion programs among adults with IDD and adults with ML.

Strategy 3 Administer and evaluate a training for healthcare providers on accessible preventive health care.

The overarching outcome is improved disability and health competency. This outcome is detailed as follows:

Outcome 3.1 Increased awareness, knowledge, skill, and competency of healthcare providers to deliver accessible preventive health care to adults with IDD and adults with ML.

Outcome 3.2 Increased capacity of local communities to provide accessible preventive health care to adults with IDD and adults with ML.

Outcome 3.3 Increased effort among healthcare providers to deliver accessible preventive health care to adults with IDD and adults with ML.

Strategy 4 Implement and evaluate a demonstration project to link adults with IDD to preventive health care and health promotion programs in their community.

The overarching outcomes include increased knowledge about recommended preventive health care and healthy lifestyle behaviors; ways to address barriers to preventive health care; and linkages to preventive health care, mental health care and health promotion activities. These outcomes are detailed as follows:

Outcome 4.1 Increased knowledge and awareness of the importance of recommended health check-ups with primary care and well-woman providers, mental health screenings and care;

recommended dental, vision, and hearing healthcare; vaccinations; and healthy lifestyle behaviors, among enrolled participants with unmet health care needs.

Outcome 4.2 Increased knowledge and awareness of (a) barriers to recommended health check-ups with primary care and well-woman providers; mental health screenings and care;

recommended dental, vision, and hearing healthcare; vaccinations, and healthy lifestyle behaviors and (b) how to address those barriers, among enrolled participants with unmet health https://www.nchpad.org/ https://www.specialolympics.org/about/our-mission care needs..

Outcome 4.3 Increased linkage, among enrolled participants with unmet health care needs, to accessible recommended preventive health care (e.g., check-ups with primary care, and well-woman providers, cancer screenings, vaccinations, as well as dental, vision, and hearing check-ups; and health promotion activities and services.

Outcome 4.4 Increased linkage to mental healthcare services, among enrolled participants who are at elevated risk for mental health conditions.

Strategy 5 Implement evidence-based health promotion interventions, as well as policy, system and environmental (PSE) changes; and resources and tools.

The overarching outcomes include enrollments in evidence-based health promotion interventions, adoption of healthy behaviors, and notable PSE changes. These outcomes are detailed as follows:

Outcome 5.1 Among adults with ML, and adults with IDD and their caregivers, increased participation in evidence-based health promotion interventions.

Outcome 5.2 Among adults with ML, and adults with IDD and their caregivers, increased adoption of healthy lifestyle behaviors among intervention participants.

Outcome 5.3 Increased and notable PSE changes within states or jurisdictions.

Outcome 5.4 Among adults with ML, adults with IDD and their caregivers, increased reach and use of resources and tools.

Outcome 5.5 Among communities, increased availability and use of directories for accessible

(a) healthcare facilities and providers, and (b) venues and programs that promote healthy lifestyle behaviors.

Strategy 6 Disseminate key findings and lessons learned to public health professionals and policymakers, statewide or jurisdictional.

The overarching outcomes include learning best practices and ways to promote health among adults with disabilities. The details of these outcomes are as follows:

Outcome 6.1 Increased sharing of best practices and lessons learned among award recipients.

Outcome 6.2 Increased knowledge and awareness among public health professionals and policymakers about ways to improve the health of adults with IDD and adults with ML (e.g., by increasing access to health care through training healthcare providers, linking adults with IDD with needed accessible preventive health care and health promotion programs, providing accessible health promotion programs for adults with IDD and adults with ML, and implementing sustainable PSE changes).

iii. Strategies and Activities Recipients of this award must implement several strategies and activities to achieve and measure the short-term and intermediate outcomes as indicated in the provided logic model. The strategies and activities are detailed below.

Strategy 1 Establish, expand, and enhance partnerships.

Activity 1.1 Establish a project advisory workgroup that includes adequate representation of adults with IDD and adults with ML, e.g., Best Practices Guide. The workgroup should also include representatives from the healthcare community, e.g., medical, nursing, dental, vision, women’s health, mental health etc. The recipient should manage the workgroup and should establish regular meetings, an agenda and tasks that the workgroup can undertake https://ncapps.acl.gov/docs/Participant%20Engagement%20Guide%20200904.pdf to facilitate approaches, connections and resources needed to complete the workplan and key activities each year.

Activity1.2 Establish, expand, enhance, and regularly assess partnerships with community partners across the state (e.g., local health departments, community-based organizations, disability service organizations, healthcare providers, universities, hospitals, in-home service providers, therapeutic and wellness service providers, etc.) to facilitate accessible preventive health care and health promotion programs among adults with IDD and adults with ML.

Activity 1.3 Establish, expand, and enhance partnerships with the CDC-funded National Centers on Disability (i.e., National Center on Health, Physical Activity and Disability; and Special Olympics) to improve the recipient’s access to their training, technical assistance, and resources that will enhance implementation of the proposed cooperative agreement activities. Award recipients are required to participate in quarterly meetings facilitated by the National Centers on Disability. In addition, and where it is instrumental to this NOFO, partnerships with other CDC-funded national organizations that serve adults with disabilities statewide or jurisdictional (e.g., National Association of County and City Health Officials) are encouraged.

Activity 1.4 Establish, expand, and enhance partnerships, where appropriate, with other established and ongoing chronic disease health promotion programs within the state to extend the implementation of chronic disease prevention and management programs among adults with IDD and adults with ML.

Strategy 2 Conduct need assessments, statewide or jurisdictional, to identify gaps in information and resources (e.g., accessible healthcare providers, programs, policies, services), and barriers to engagement with preventive healthcare services and health promotion programs among adults with IDD and adults with ML, and identify action steps to fill those gaps.

Activity 2.1 Use available data sources (e.g., National Health Interview Survey, the Disability and Health Data System (DHDS), National Core Indicators Survey, administrative claims data or reports (e.g., Medicaid, Residential Information Systems Project) to describe disparities for adults with IDD and adults with ML in the state or jurisdiction related to: (a) engagement with preventive health care, including but not limited to the receipt of recommended preventive health care (e.g., health check-ups with primary care, well-woman, dental, vision and hearing providers;

screenings for mental health conditions, chronic conditions and risk factors, and vaccinations); (b) practice of healthy lifestyle behaviors; (c) any reported barriers and gaps in information, resources, programs, policies and services within the state or jurisdiction.

Activity 2.2 Complete the need assessments in collaboration with the project advisory workgroup to identify gaps in information, resources, programs, policies, services, and barriers to engagement with accessible preventive health care and health promotion programs among adults with IDD and adults with ML. This information should be compiled and used to help inform the development of resources and tools, and the selection of evidence-based health promotion interventions and PSE changes.

Activity 2.3 Identify actions planned to address needs, and facilitate engagement with accessible preventive health care and health promotion programs among adults with IDD and adults with

ML.

Strategy 3 Administer and evaluate a training for healthcare providers on accessible preventive health care.

https://www.nchpad.org/ https://www.specialolympics.org/about/our-mission https://www.specialolympics.org/about/our-mission https://www.cdc.gov/nchs/nhis/index.htm https://www.cdc.gov/ncbddd/disabilityandhealth/dhds/overview.html https://www.nationalcoreindicators.org/upload/core-indicators/NCI_Flyer_Final_200211.pdf https://risp.umn.edu/

Activity 3.1 Collaborate with CDC, other award recipients, and disability and health training programs to assess and identify existing trainings for healthcare providers. Trainings that offer continuing education credits are encouraged [e.g., Continuing Medical Education (CME), Continuing Education (CE), Continuing Nursing Education (CNE), Maintenance of Certification (MOC)]. Include adults with disabilities in the training. Enhance and tailor an existing training to include:

(a) awareness of health disparities and unique health needs;

(b) communication barriers, including patient-provider interaction and etiquette;

(c) physical barriers, including accessible, medical diagnostic equipment and facility assessments using various instruments (e.g., Healthcare Facility Assessments, Craig Hospital Inventory of Environmental Factors, Community Health Environment Checklist, etc.); and

(d) the Americans with Disabilities Act (ADA) Activity 3.2 Recruit training sites and participants through healthcare settings (e.g., universities, hospitals, local health departments, private practices, veterinary, therapeutic and wellness services, contracted services), and media venues that target provider audiences (e.g., U.S.

journals that offer CEs).

Activity 3.3 Promote, schedule, and administer trainings to healthcare providers in communities.

Activity 3.4 Track training participation and collect post-training assessments mapped back to the learning objectives. Support the implementation of actions covered in the training, where appropriate. For online trainings, recipients should partner with host sites to track participation and assess feedback and post-training measurements.

Strategy 4 Implement and evaluate a demonstration project to link adults with IDD currently lacking recommended preventive health care with preventive health care and health promotion programs in their community.

Activity 4.1 In collaboration with the other recipients, develop a common protocol for implementing the demonstration project, and tools for gathering information about the linkage intervention sessions and participant recruitment, screening, enrollment, and retention.

This is expected to be done in the first 6 months of the award.

Activity 4.2 Recruit and train linkage coordinators to implement the demonstration project, e.g., how to communicate with participants and their caregivers, collect data, and provide follow up.

Develop a job description for this position and submit it with the application.

Activity 4.3 In collaboration with the project advisory committee, develop up-to-date community directories of: (a) providers of accessible preventive health care, including but not limited to primary care, well-woman, dental, vision and hearing; screenings for mental health conditions;

and health promotion services; and (b) health promotion programs and accessible venues that support healthy lifestyle behaviors. This should be used for the demonstration project referrals, as well as dissemination through various avenues, e.g., website.

Activity 4.4 Screen and enroll adults with IDD, who are currently lacking recommended preventive health care, into the intervention. Complete initial and follow up sessions for a minimum cohort of 50 participants with IDD per year for a total of 200 across the 5-year period of performance. Participants screened and enrolled should represent the demographics of the target population in the state or jurisdiction, by race, sex and socioeconomic status. These sessions must be accessible for people with IDD.

Activity 4.5 Linkage coordinators should conduct initial linkage sessions with participants to: (a) assess baseline knowledge of recommended preventive health care (by age and sex) and healthy https://www.nchpad.org/1261/6287/Community~Health~Inclusion~Assessment~Tools http://www.tbims.org/combi/chief/ http://www.tbims.org/combi/chief/ https://www.ot.wustl.edu/about/resources/chec-m-393 behaviors (b) provide education about the importance of scheduling health check-ups with providers for primary care, well-woman, mental health, dental, vision, and hearing healthcare;

(c) screen for depression and anxiety; (d) identify barriers to engaging with recommended preventive health care and health promotion programs; and (e) provide referrals and facilitate linkage to preventive health care and health promotion programs in the community, and to essential services that support engagement with health services (e.g., financial assistance, healthcare benefits, caregiver support, food, housing, transportation, substance use treatment services, employment/vocational training, education, other social services).

Activity 4.6 Linkage coordinators should conduct a 3-month, post-referral, follow-up session with participants to: (a) assess increases in knowledge about recommended preventive health care and healthy behaviors; (b) determine whether participants received recommended services or adopted healthy behaviors (e.g., physical activity, healthy eating, smoking cessation etc.), and

(c) identify barriers to receiving recommended services and adopting healthy behaviors; and (d) address barriers (e.g., further facilitate linkages to appropriate services and resources). Retain at minimum, 50 participants in the 3-month, follow-up session.

Activity 4.7 Collect, manage, quality assure, and report participant-level data to CDC including:

(a) recruitment (i.e., initial interview, screening and enrollment outcomes) and (b) 3-month follow-up retention and linkage outcomes. These data will be used to support participants, improve the overall quality and reach of the project, and demonstrate and evaluate project effectiveness in reducing unmet healthcare and health promotion needs. Data collection software will be agreed upon in the first 6 months of the award.

Strategy 5 Implement evidence-based health promotion interventions, as well as policy, system and environmental (PSE) changes; and resources and tools designed or adapted for adults with IDD and adults with ML. Based, in part, on information derived from the needs assessment and the ongoing demonstration project (e.g., health disparities, health inequity, gaps in information and community resources, and unmet healthcare and health promotion needs), recipients will collectively identify one evidence-based health promotion intervention with intended outcomes to implement for adults with IDD, and one for adults with ML. This strategy is applicable to implementing Activities 5.1 through 5.3. If appropriate, award recipients can select one intervention (e.g., focused on healthy lifestyles) for the two target populations, but this must be agreed upon across all award recipients.

Activity 5.1 Identify, implement and evaluate the intended outcomes of evidence-based health promotion interventions (one for adults with ML, and one for adults with IDD and their caregivers) that are aligned with either: (a) engaging accessible preventive health care, including but not limited to, recommended health check-ups with primary care and well-woman providers;

mental health screenings and care; dental, vision, and hearing healthcare; and vaccinations, (b) adopting healthy lifestyle behaviors, or (c) managing chronic diseases and mental health conditions. Options for and approaches to implementing evidence-based health promotion interventions must be discussed with CDC and agreed upon collectively prior to implementation.

Activity 5.2 Identify, implement and evaluate policy, system and environmental (PSE) changes to facilitate (a) engagement with preventive healthcare providers, including but not limited to, providers of primary care, women’s health, mental health, dental, vision, and hearing healthcare,

(b) adoption of healthy lifestyle behaviors, and (c) management of chronic diseases and mental health conditions. A few examples of PSE changes are showcased by Healthy Communities. In addition, it will be important to use assessment tools to support environmental changes, e.g., https://ctb.ku.edu/en/best-change-processes/implementing-effective-interventions/overview https://www.cdc.gov/ncbddd/disabilityandhealth/reaching-people.html

Healthcare Facility Assessments. Award recipients will select one PSE change for adults with ML, and one for adults with IDD and their caregivers. These changes do not have to be the same across all award recipients as they are likely to be responsive to the prior needs assessment across the state or jurisdiction. Options for PSE changes must be discussed with CDC prior to implementation.

Activity 5.3 Assemble, disseminate and evaluate resources and tools that facilitate: (a) engagement with providers of primary care, women’s health, mental health, dental, vision, and hearing healthcare, (b) adoption of healthy lifestyle behaviors, and (c) management of chronic diseases and mental health conditions. This should include community directories.

Strategy 6 Disseminate key findings and lessons learned to public health professionals and policymakers, statewide or jurisdictional.

Activity 6.1 Produce and disseminate findings that describe: (a) results of efforts to link adults with IDD and adults with ML with either accessible preventive health care; healthy lifestyle programs; (b) any improvements in managing chronic diseases and mental health conditions; and

(c) what was done and what worked to address barriers.

Activity 6.2 Disseminate key findings and lessons learned from the Cooperative Agreement activities through multiple communication avenues, e.g., evaluation reports, manuscripts, conference presentations, social media, success stories, webinars and websites, (e.g., sharing data and materials developed with CDC cooperative agreement funds in a manner consistent with applicable grant regulations).

Activity 6.3 Participate in recipient meetings (in-person and virtual), including reverse site visits to CDC, to share best practices and lessons learned from the Cooperative Agreement activities.

1. Collaborations

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

Under this NOFO and where appropriate, award recipients will be expected to collaborate with each other and with CDC-funded National Centers on Disability (i.e., National Center on Health, Physical Activity and Disability; and Special Olympics). In addition, and where it is instrumental to this NOFO, partnerships are encouraged with other CDC health promotion programs and CDC-funded national organizations providing services, and training to improve the health of adults with mobility limitations and adults with intellectual and/or developmental disabilities (e.g., 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:

Award recipients are encouraged to collaborate with organizations that may not be funded by CDC, including but not limited to:

National disability organizations (e.g., Association of University Centers on Disabilities, American Association on Health and Disability, TASH, United Cerebral Palsy, Disabled American Veterans, National Centre for Independent Living etc.), Statewide or jurisdictional disability organizations (e.g., the Arc, Easter Seals, Centers for Independent Living, etc.), Community-based organizations (e.g., universities, hospitals, health departments, clinics (e.g., medical, dental, vision, hearing, veterinarian, etc.), tribes), and https://www.nchpad.org/1261/6287/Community~Health~Inclusion~Assessment~Tools https://www.nchpad.org/ https://www.nchpad.org/

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

If collaborations are proposed, a description of the nature of the collaboration, with clear lines of responsibility and communication, should be described in a memoranda of understanding/agreement (MOU/MOA) and included as an attachment in the appendix. Applicants should name them "MOU_MOAs” and upload the file as a PDF under "Other Attachment Forms" at www.grants.gov.

If contracts are proposed, a description of contracts should include the name/type of contractor, selection method (e.g., bided, negotiated, best value, equal opportunity, sole source), period of performance, work scope and deliverables, method of accountability, reporting, evaluation and budget items as an attachment in the appendix. Applicants should name any contracts proposed "Contracts Proposed" and upload the file as a PDF under Other Attachment Form" at www.grants.gov.

2. Target Populations The target populations for this Cooperative Agreement are adults with IDD, and adults with ML, their families, and caregivers. In addition, this NOFO partners 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 locate and engage adults with IDD and adults with ML, their families and caregivers across a given state or jurisdiction. It is expected that applicants will describe (1) the target populations in their state or jurisdiction, (2) statewide or jurisdictional disability service organizations, and (3) any state initiatives, policies and current plans to address unmet needs among those populations. The population terms are defined in the glossary.

a. Health Disparities This NOFO aims to reduce health disparities between adults with and without IDD and ML and improve social determinants of health among adults with IDD and adults with ML using strategies that are outlined in the logic model, e.g., PSE changes.

A key activity under this NOFO will be to locate and engage the target populations to participate in recommended preventive health care and evidenced-based health promotion interventions related to prominent health disparities identified and tracked in state-based data sources, e.g., Behavior Risk Factor Surveillance System. Where possible, state or jurisdictional disparities for the target population should be assessed relative to national disparities.

iv. Funding Strategy Funding is available to support up to 10 awards, with no more than one award in any given state or jurisdiction. Funding for this project will be the same for all approved award recipients to address the strategies, activities and scope of work outlined in this NOFO. For each project year, the range of funds to budget for the linkage demonstration project is estimated to be between $200,000 and $300,000.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

CDC and recipients 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). Recipients will be required to provide project information through a routine annual performance report, workplan, and financial report, as well as phone and email communications with CDC staff (See below, CDC Monitoring and Accountability Approach, section e.).

CDC staff will review findings across all recipients to:

(a) identify common challenges encountered by recipients while implementing their programs,

(b) identify needed assistance,

(c) implement actions to continuously improve overall project quality and performance,

(d) compare methods and outcomes across recipients to identify promising practices for dissemination among recipients during the period of performance,

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

(f) contribute to the evidence base for NOFO strategies and activities.

The performance measures described are not final. After awards are made, recipients will have six months to work with CDC staff to finalize evaluation approaches and performance measurements for the activities described in this NOFO, including the demonstration project component. Guidance on collecting, reporting, and using performance data will be provided by CDC project staff throughout the period of performance. CDC may use evaluation data 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.

This NOFO requires recipients to implement and evaluate a linkage demonstration project that focuses on linking adults with IDD, who are currently lacking recommended preventive health care, to accessible providers and health promotion programs in their community. For this demonstration project, recipients will need to evaluate accessible clinics and health promotion sites available within the state or jurisdiction to develop referral resources. In addition, recipients will need to screen adults with IDD to identify those who have unmet preventive healthcare needs. Recipients will collect, manage, validate, and analyze data on screened and enrolled participants regarding their (a) initial knowledge and awareness of recommended preventive health care and lifestyle (b) initial unmet preventive health care/health promotion needs and (b) 3-month follow-up status of knowledge and awareness, and unmet needs (see the evaluation outcome measures for the linkage project). Recipients will be asked to provide an annual evaluation report to CDC (see project outputs). The data will be used to improve linkage processes including population reach, and demonstrate linkage outcomes and effectiveness. The possibility of publishing the linkage project evaluation should be discussed among the recipients and with CDC during the first six month of the award.

Key evaluation questions include, but are not limited to the following:

Q1. To what extent is participation in the linkage demonstration project associated with increased knowledge and awareness of the importance of recommended preventive health care and healthy lifestyle behaviors?

Q2. To what extent is participation in the linkage demonstration project associated with decreased unmet health care needs (i.e., receipt of recommended preventive health care and health promotion programs?

Q3. To what extent is participation in the linkage demonstration project associated with increased referrals and linkage to mental healthcare services among those who are at elevated risk for mental health conditions?

Recipients will evaluate overall NOFO performance in their state or jurisdiction and provide performance measurements. This will involve collecting data at the state or jurisdictional level to monitor, evaluate, and continuously improve program performance. Recipients 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. These data may also be used to identify promising practices that may inform other interventions or activities conducted, which may be shared with other recipients under this NOFO. As part of a state or jurisdictional evaluation and performance measurement plan, applicants may add state or jurisdictional sub-activities, short-term outcomes or outcome measures that will be useful to program managers for monitoring and improving their programs.

Recipients may also elect to conduct in-depth, detailed evaluations of selected program activities or elements, either individually or in collaboration with other recipients. These special evaluation activities might compare the effectiveness of different approaches or strategies the recipient uses to accomplish a project activity and may allow recipients to identify the most effective methods for accomplishing project activities in their specific context and circumstances. After awarded, recipients will have six months to finalize their state or jurisdictional evaluation and performance measurement plan.

Expected Process and Outcome Measures Presented below is an initial outline of outcome and process measures. During the first six months of the project, CDC and recipients 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, and then the project activities and their associated process measures based on the CDC Evaluation and Performance Measurement table included below.

Strategy 1 Establish, expand, and enhance partnerships Short-term and Intermediate Outcome(s) Outcome Measure(s) Outcome 1.1 Strengthened engagement, planning and coordination between recipients, community-based organizations, and complementary programs (e.g., health departments) within the state or jurisdiction to improve engagement in accessible preventive health care and health promotion activities among adults with IDD and adults with

ML.

-A document describing statewide or jurisdictional partnerships and coordinated efforts to facilitate accessible preventive healthcare visits and health promotion programs for adults with disabilities. The document should specify which statewide or jurisdictional organizational partnerships have been developed under Activity 1.2 and the role of each partner, e.g., transportation.

-Qualitative summary of which Cooperative Agreement activities have been enhanced through partnerships with complementary public health programs.

Outcome 1.2 Increased engagement between recipients and National Centers on Disability (i.e., National Center on Health, Physical…