CDC-RFA-DD21-2104.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES

Improving Health of Americans with Mobility Limitations Through Evidence-Based Health Promotion Programs

CDC-RFA-DD21-2104

Application Due Date: 06/01/2021

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- DD21-2104. 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 Mobility Limitations 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-DD21-2104

E. Assistance Listings Number:

93.184 F. Dates:

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

N/A 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:

NA

G. Executive Summary:

1. Summary Paragraph The National Center on Health, Physical Activity and Disability (NCHPAD) plays an important role in encouraging healthier lifestyles for people with disabilities by mobilizing national networks to provide technical assistance, training community leaders and organizations on health promotion strategies, and disseminating effective tools for disability service providers. For over 15 years this organization has worked with the National Center on Birth Defects and Developmental Disabilities (NCBDDD) on large-scale disability and health efforts. Core organizational capabilities include extensive technical and administrative infrastructure delivering services to diverse organizations serving people with mobility limitations (ML) and a unique relationship with (and access to) the Lakeshore training facility. 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 ML in community settings. This NOFO is intended to support the development, implementation, evaluation, and dissemination of non-research activities aimed at: 1) raising awareness of the health needs of people with ML; 2) developing and disseminating health promotion models, strategies, tools, and health promotion materials; 3) providing training and education to health care professionals and others who provide support and/or services to people with ML; and 4) promoting the adoption of healthy behaviors aimed at reducing health disparities for people with ML.

a. Eligible Applicants:

Single

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards

d. Total Period of Performance Funding:

$ 25,462,145

e. Average One Year Award Amount:

$ 5,092,429

f. Total Period of Performance Length:

g. Estimated Award Date:

July 01, 2021

h. Cost Sharing and / or Matching Requirements:

No https://www.grants.gov/

Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview This NOFO addresses health disparities among children and adults with mobility limitations (ML). In addition, this NOFO focuses on health promotion and wellness among this population.

Mobility, including the ability to walk and/or climb stairs, is a general expectation in human functioning and participation in daily living within most contexts.1 Restricted mobility can greatly affect quality of life, and is associated with negative health outcomes.2 Mobility limitations are estimated to affect over 13% of the U.S. population, and 30% of older adults.2,3

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.4,5 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 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,4 and More likely to have behavioral health conditions such as depression and anxiety.5

To address these and other health determinants, the following World Health Organization (WHO) principles of action6 are recommended to achieve health equity among individuals with disabilities:7

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.

The eligible applicant, through appropriations from Congress, has received federal funding from CDC over the past decade to develop a comprehensive program of non-research health promotion activities aimed at reducing health disparities and improving the health of people with mobility limitations. NCBDDD's Division of Human Development and Disability (DHDD) proposes this NOFO for NCHPAD to continue this established collaboration with CDC. The applicant will propose strategies and activities for improving the health of individuals with ML 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 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

1. Härkänen T, Sainio P, Stenholm S, et al. Projecting long-term trends in mobility limitations: impact of excess weight, smoking and physical inactivity. J Epidemiol Community Health 2019;73:443-450..

2. Musich S, Wang SS, Ruiz J, Hawkins K, Wicker E. The impact of mobility limitations on health outcomes among older adults. Geriatric Nursing 2018; 39:162-169.

3. Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults - United States, 2016. MMWR 2018;

67:882-887.

4. 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.

5. 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.

6. 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.

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

7. 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-DD21-2104 Logic Model: Improving Health of Americans with Mobility Limitations Through Evidence-Based Health Promotion Programs

Strategies Short-term Outcomes Long-term Outcomes

Strategy 1:

Health Screening, Referral, and Data-Based Monitoring

Strategy 2:

Health Promotion Programs

Strategy 3:

Capacity Building

Among people with ML:

- Increased health screening

- 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 ML 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 ML in national health surveys

Reduced prevalence of chronic disease among people with ML

Reduced prevalence of mental health conditions among people with ML

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

Reduced prevalence of acute secondary conditions among people with ML

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

Reduced prevalence of vaccine-preventable illness among people with ML

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

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 ML

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

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

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

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 ML

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 ML

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 ML

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

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

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 people with mobility limitations, the applicant will propose strategies and activities to:

1) Expand capacity for health screening of people with ML 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 ML.

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 ML, 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, including well-woman providers

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

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

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

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

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

1.2.1 Improved data collection methods to increase quality, timeliness, completeness, and availability of data for continuous program improvement

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

Health Promotion Programs

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

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

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

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

2.2.1 Among people with ML, 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 to increase quality, timeliness, completeness, and availability of data for continuous program improvement

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

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

2.3.4 Increased capacity to compare health indicators collected through health promotion and wellness programs with health indicators for people with ML in national health surveys

Capacity Building

3.1.1 Increased knowledge and awareness of the unique health needs of people with ML 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 trained to deliver prevention and healthcare services to people with ML

3.2.2 Increased number of people with ML receiving prevention and healthcare services from providers with knowledge of the unique health needs of people with ML

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 ML

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 ML

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 ML

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 ML 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 ML 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 ML

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

3.8.1 Increased number and quantity 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 ML 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 ML

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

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

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

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

Reduced prevalence of vaccine-preventable illness among people with ML

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 ML 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, including 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 ML 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 ML

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 ML 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 ML

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-DD21-2102 and CDC- RFA-DD21-2103 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 ML

Activity 3.5 Disseminate and promote programmatic, policy, systems, and environmental community models, tools, and resources to increase and normalize inclusion of people with ML 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 ML 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-DD21-2102 and CDC- RFA-DD21-2103 to enhance and expand strategic partnerships with local, state, and territorial health agencies to address health disparities experienced by people with ML and associated disabilities (including, but not limited to intellectual and developmental 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 ML and associated disabilities (including, but not limited to intellectual and developmental 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 children and adults with ML and associated disabilities (e.g., Special Olympics, Inc.; 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)

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 mobility limitations. Mobility limitations are estimated to affect over 13% of the U.S. population, and 30% of older adults. Restricted mobility can greatly affect quality of life, and is associated with negative health outcomes.

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 ML, 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 ML 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 mobility limitations (ML) 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, including well-

Outcome 1.1.1:

Among people with ML, 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, including well-woman providers Outcome 1.1.2:

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

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

Among people with ML, increased receipt of routine health check-ups with primary care, including recommended vaccinations and screening for mental health conditions, as well as increased receipt of routine dental care Outcome 1.1.4:

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

Among people with ML, improved life satisfaction and perceived emotional support Outcome 1.1.7:

Increased opportunities for professionals and volunteers to engage people with ML through health-related screenings 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 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

Number of trained health professionals and volunteers engaging people with ML in health-related screening

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 1.2.2:

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

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 ML and people in their support networks

Outcome 2.1.1:

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

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

Among people with ML, 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 ML, increased adoption of healthy lifestyle behaviors such as physical activity, healthy

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 eating, stress management and coping strategies, social connectedness, reduced tobacco use and exposure, and healthy sleep habits Outcome 2.1.5:

Among people with ML, increased management and control of chronic disease and mental health conditions Outcome 2.1.6:

Among people with ML, improved life satisfaction and perceived social-emotional support 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:

Number of individuals from people with ML 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 ML

Outcome 2.2.1:

Among people with ML, 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

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

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 and improve the program overall programs for people with ML Outcome 2.3.3:

Improved quality of health promotion programs and services for people with ML and their caregivers Outcome 2.3.4:

Increased capacity to compare health indicators collected through health promotion and wellness programs with health indicators for people with ML in national health surveys

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 ML 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 ML 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

Outcome 3.2.1:

Increased number of providers trained to deliver prevention and healthcare services to

Process Measures:

Number of new local partners delivering prevention and

(including mental health professionals) to deliver follow-up prevention and healthcare services to people with ML people with ML Outcome 3.2.2:

Increased number of people with ML receiving prevention and healthcare services from providers with knowledge of the unique health needs of people with ML healthcare services to people with ML

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 ML

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 recipient funded under CDC-

RFA-DD21-2102

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 ML

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 ML

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 ML 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 ML

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 ML 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 ML and their caregivers

Activity 3.7:

Provide technical assistance to local, state, and territorial health agencies delivering health promotion

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

ML

Outcome 3.7.2:

Process Measures:

Number of presentations/trainings delivered to LHDs

Process Measures:

Number of wellness opportunities programs to people with ML and their caregivers, including enhanced technical assistance to agencies funded under CDC-

RFA-DD21-2103

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

Activity 3.8:

Collaborate with organizations funded under

CDC-RFA-

DD21-2102 and

CDC-RFA-

DD21-2103 to enhance and expand strategic partnerships with local, state, and territorial health agencies to address health disparities experienced by people with ML and associated disabilities (including, but not limited to intellectual and developmental disabilities)

Outcome 3.8.1:

Increased number and quantity 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 ML and associated disabilities

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 with ML and related 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

ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

How the applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement.

How key program partners will participate in the evaluation and performance measurement planning processes.

Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant)

Plans for updating the Data Management Plan (DMP) as new pertinent information becomes available. If applicable, throughout the lifecycle of the project.