CDC-RFA-DP17-1704PPHF17.pdf

Centers for Disease Control

National Center for Chronic Disease Prevention and Health Promotion

PPHF-2017-Building Public Health Infrastructure in Tribal Communities to Accelerate Disease

Prevention and Health Promotion in Indian Country

CDC-RFA-DP17-1704PPHF17

Application Due Date: 08/07/2017

PPHF-2017-Building Public Health Infrastructure in Tribal Communities to Accelerate Disease

Prevention and Health Promotion in Indian Country

CDC-RFA-DP17-1704PPHF17

TABLE OF CONTENTS

Part I. Overview Information A. Federal Agency Name B. Funding Opportunity Title C. Announcement Type D. Agency Funding Opportunity Number E. Catalog of Federal Domestic Assistance (CFDA) Number F. Dates G. Executive Summary

Part II. Full Text 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 Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-DP17-1704PPHF17. 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:

PPHF-2017-Building Public Health Infrastructure in Tribal Communities to Accelerate Disease Prevention and Health Promotion in Indian Country 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 http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-healt h-research-nonresearch.pdf.

New-Type 1 Cooperative Agreement

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP17-1704PPHF17

E. Catalog of Federal Domestic Assistance (CFDA) Number:

93.762 F. Dates:

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

2. Due Date for Applications: 08/07/2017, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

Due date is an estimate and may change based on when FOA is published.

3. Date for Informational Conference Call:

July 14, 2107 at 1:00pm Eastern Time Conference: 866-709-6010 Passcode: 37005261

G. Executive Summary:

1. Summary Paragraph:

This five-year funding opportunity (five year project period, one year budget period) offers support to tribal entities to increase public health capacity and infrastructure for chronic disease prevention, health promotion, and prevention and control of priority public health problems, by strengthening core public health functions of Tribal Epidemiology Centers. Awardees will provide public health leadership, surveillance and epidemiology, public health program design, implementation and evaluation, technical support and training to address a wide range of public 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 http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf https://www.grants.gov https://www.cdc.gov/nphpsp/essentialservices.html health needs and accelerate improvements in health outcomes for American Indian and Alaska Native populations across their Indian Health Service (IHS) Administrative Area. This project will fund approximately thirteen (13) applicants, including a network coordinating center, to strengthen public health capacity and infrastructure and provide a culturally informed, evidence-based and holistic approach to disease prevention and promotion of population health and wellness.

a. Eligible Applicants: Limited

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 13

This FOA will fund Tribal Epidemiology Centers (TECs) that have been established to serve each Indian Health Service Area. CDC expects to fund up to 12 Component A awards so as to include all IHS Areas, e.g., geographic region served by a TEC. See https://tribalepicenters.org.

These areas served by TECs are: Alaska Area, Albuquerque Area, Bemidji Area, Billings Area, California Area, Great Plains Area, Nashville Area, Navajo Area, Oklahoma City Area, Portland Area, Phoenix/ Tucson Area and Urban Area serving Urban Indian Health Centers. This FOA will also fund up to one Component B award: Network Coordinating Center.

If applying for both Component A and Component B, applicants must submit separate applications for Component A and Component B awards. Applicants may submit an application for only a Component A award or only a Component B award. The Component B awardee may or may not also receive a Component A award.

d. Total Project Period Funding: $42,500,000

e. Average One Year Award Amount: $658,000 Average one year award amount for Component A Awardees: $658,000 (range: $230,000 to $850,000) Average one year award amount for Component B (Network Coordinating Center) Awardee:

$500,000 (range: $400,000 to $600,000)

f. Total Project Period Length: 5

g. Estimated Award Date: 09/29/2017

h. Cost Sharing and / or Matching Requirements: N Cost sharing or matching funds are not required for this program. Although there is not a match requirement for this FOA, obtaining other resources and aligning ongoing efforts to promote sustainability is strongly encouraged. Examples include: complementary foundation funding and other US government funding sources. These may include programs supported by the Department of Health and Human Services, and Departments of Agriculture, Education, Interior, Housing and Urban Development, Transportation, and others. Applicants may coordinate with multiple sectors, such as public health, transportation, education, health care https://tribalepicenters.org delivery, agriculture and others, in order to build and strengthen public health capacity and infrastructure and implement the work of the FOA.

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview

American Indians and Alaska Natives experience health disparities in chronic diseases and underlying risk factors, as well as injuries and infectious diseases. American Indians and Alaska Natives have higher rates of chronic disease, injury, and premature death than other racial and ethnic groups in the U.S., including the highest prevalence of diabetes and higher heart disease and stroke death rates; they are more likely to be obese, to use commercial tobacco products, including smoking cigarettes, and less likely to quit smoking cigarettes. They are more likely to engage in alcohol impaired driving, die in a motor vehicle crash or commit suicide. They have higher rates of infectious disease mortality such as influenza, hepatitis C, tuberculosis, and invasive pneumococcus. American Indians and Alaska Natives have a number of inherent strengths, including unique tribal languages and cultures, and use of these resources to foster community and cultural connections, and to overcome challenges. Connection to place, history, culture, and spiritual strength all create opportunities for wellness that can be drawn upon to overcome challenges.

Tribal public health capacity and infrastructure are under-resourced and under-developed to address these disparities and improve health outcomes. This FOA is intended to contribute to reductions in chronic diseases and risk factors, reductions in disparities in health outcomes, and improvements in overall health by building public health capacity and infrastructure in Indian Country for disease surveillance, epidemiology, prevention and control of disease, injury, or disability, and program monitoring and evaluation, to assure intended outcomes are reached.

With this funding support, TECs will increase their capacity to deliver public health functions to and with the tribes/villages in their IHS Area (including the Urban Area). Strong public health capacity and infrastructure, and a culturally driven, evidence-based, and holistic approach to health promotion and disease prevention are needed to build on the inherent strengths of American Indian and Alaska Native people and address these challenges.

This 5-year funding opportunity includes 2 types of awards:

Component A: Up to 12 awards, one in each IHS Administrative Area, will increase capacity for and delivery of core public health functions, including development and delivery of public health support and services to Area tribes, tribal organizations, and urban Indian organizations, and increase their own capacity for core public health functions, including, collecting and monitoring data on health status objectives; evaluating delivery and data systems that impact Indian health; assisting tribes, tribal organizations and urban Indian organizations to determine health status objectives and services needed to meet those objectives; providing technical assistance to tribes, tribal organizations and urban Indian organizations to develop local health priorities and disease incidence and prevalence rates; and providing disease surveillance and promoting public health; among others.

Component B: Up to one award will be made to establish a Network Coordinating Center (NCC) for the purpose of collaboratively supporting and coordinating Component A work, including project organization, logistics, communication, and performance evaluation support for the Component A awardees to achieve health outcomes in their areas. The NCC will facilitate the formation of a Steering Committee consisting of the Principal Investigators from each Component A award. The Component B awardee may or may not also receive a Component A award.

b. Statutory Authorities Authority Public Health Service Act 42. U.S.C., section 241(a), and 247(b), and Title IV, Section 4002, Prevention and Public Health Fund, Affordable Healthcare Act.

c. Healthy People 2020

This program supports the Healthy People 2020 focus areas of Diabetes, Heart Disease and Stroke, Nutrition and Weight Status, Physical Activity, Adolescent Health, Early and Middle Childhood, and Maternal Infant Child Health; Creating social and physical environments that promote good health for all; and Public Health Infrastructure, with the goal of ensuring that Federal, State, Tribal, territorial, and local health agencies have the necessary infrastructure to effectively provide essential public health services. As federal agencies, CDC and ATSDR recognize their unique relationship with Indian tribes, and are committed to fulfilling their critical role in promoting their health and safety.

d. Other National Public Health Priorities and Strategies

This program supports strategies to improve multiple chronic diseases and the risk factors associated with the following public health priorities: uncontrolled hypertension; the prevention and control of diabetes; the prevention and management of obesity; increased physical activity and healthy eating in children and adults; commercial tobacco use cessation; and improving the management of chronic conditions of students and adults in the following national plans and guidelines:

The Guide to Community Preventive Services: http://www.thecommunityguide.org/index .html The National Prevention Strategy: http://www.healthcare.gov/prevention/nphpphc/strategy /report.pdf National Physical Activity Plan: http://www.physicalactivityplan.org Dietary Guidelines for Americans, 2015-2020: https://health.gov/dietaryguidelines/2015/ Million Hearts®: www.millionhearts.hhs.gov CDC-led National Diabetes Prevention Program: http://www.cdc.gov/diabetes/prevention http://www.healthypeople.gov https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health https://www.cdc.gov/nphpsp/essentialservices.html http://www.thecommunityguide.org/index.html http://www.thecommunityguide.org/index.html http://www.healthcare.gov/prevention/nphpphc/strategy/report.pdf http://www.healthcare.gov/prevention/nphpphc/strategy/report.pdf http://www.physicalactivityplan.org http://www.millionhearts.hhs.gov http://www.cdc.gov/diabetes/prevention/index.htm

/index.htm National Standards for Diabetes Self-Management Education and Support

e. Relevant Work These CDC programs have laid important ground work in chronic disease prevention efforts in Indian Country:

o (2002-2004) “Honoring Our Health” o (2005-2008) “Identifying Indicators of Environmental Adaptations to Address

Diabetes in AI/AN Communities.”

o (2002-2010) Diabetes EducationK-12 curriculum, Health is Life in Balance.

o (2011-2013) Case studies from 8 tribal communities using Eagle Books.

o (2008-2014) “Using Traditional Foods and Sustainable Ecological Approaches to

Promote Health and Prevent Diabetes in American Indian and Alaska Native Communities.”

o Universities Working with Communities to Prevent Type 2 Diabetes o (2014-2019) Good Health and Wellness in Indian Country

2. CDC Project Description

a. Approach

Bold indicates project period outcome.

Component A Logic Model

Strategies Short-term Outcomes Intermediate Outcomes Long-Term Outcomes

Strengthen Public Health Capacity and Infrastructure

Increased collaboration and training on surveillance, epidemiology and data collection among tribes, tribal organizations and urban Indian organizations.

Increased collaboration and training on the development or strengthening of culturally-relevant, evidence-based chronic disease prevention and other priority health programs among tribes, Improved monitoring of health status (e.g., improved surveillance, surveys, access to and use of public health data) Coordinated communication with public health, health care and other sectors of the community to address chronic diseases and other heath priorities (e.g., publication of reports, data summaries, issue briefs, program evaluation findings and other communication

Strengthened epidemiology and surveillance capacity of TECs to monitor health of tribes, tribal organizations and tribal members served by urban Indian organizations.

Data routinely collected, analyzed, and interpreted and http://www.cdc.gov/diabetes/prevention/index.htm https://professional.diabetes.org/sites/professional.diabetes.org/files/media/2017_national_standards_for_dsmes_public_comment.pdf tribal organizations and urban Indian organizations

Increased communication and partnerships among health and non-health sector partners on chronic disease prevention and other priority areas at the Area and/or tribal levels products). disseminated by TECs to routinely inform public health programs in Indian country Leadership of TECs for effective and sustained evidence-based and culturally-relevant chronic disease prevention and other priority health programs Chronic disease prevention and health promotion programs regularly and rigorously evaluated Systems of collaboration established at the Area level and across Indian country.

Implement Activities to Improve Effectiveness of Health Promotion and Disease Prevention

Increased understanding by tribes, tribal organizations and urban Indian organizations of the needs and resources in the Area related to chronic disease prevention and other priority health issues.

among tribes, tribal

Increased implementation of sustainable programs identified from local and Area-wide assessments Increased capacity among tribes, tribal organizations and urban Indian organizations to incorporate evaluation results into program plans Increased capacity for

Essential public health functions are supported by TECs across the Area Programs established or strengthened to address chronic disease and other leading causes of death and organizations and urban Indian organizations on planning, implementing and evaluating public health programs and activities chronic disease prevention and management by tribes, tribal organizations and urban Indian organizations across the Area.

disability Increased capacity of TECs and Area tribes for seeking financial support for public health programs and managing grants.

Engage in Sustainability Activities and training among tribes, tribal organizations and urban Indian organizations on identifying and securing funding and managing grants.

Increased numbers of grant writing trainings for tribes, tribal organizations and urban Indian organizations.

Increased numbers of grants applied for and received.

Increased financial support for chronic disease prevention and health promotion activities by tribes, tribal organizations and urban Indian organizations.

Increased access, supported by TECs, to chronic disease prevention and health promotion activities by tribes and urban Indian organizations.

Component B Logic Model

Strategies Short-term Outcomes Intermediate Outcomes Long-term Outcomes

Coordinate Collaborative Activities to Strengthen Public Health Capacity and Infrastructure

Increased collaboration and training on surveillance, epidemiology and data collection among Component A awardees.

Increased collaboration and training on the development of culturally-relevant, evidence-based chronic disease prevention and other priority health programs among

Improved monitoring of health status (e.g., improved surveillance, surveys, access to and use of public health and other related data) Coordinated communication with public health, health care, other sectors of the public to address chronic diseases and other heath priorities (e.g., publication of reports, data summaries, issue briefs, program evaluation findings and other

Strengthened epidemiology and surveillance capacity of TECs to monitor health in tribes, tribal organizations and urban Indian organizations.

Data routinely collected, analyzed, and

Component A awardees.

Increased communication and partnerships among Component A awardees, communication products).

interpreted and disseminated to inform public health programs in Indian country Leadership for effective sustained evidence-based and culturally-relevant chronic disease prevention and other priority health programs Chronic disease prevention and health promotion programs regularly and rigorously evaluated Systems of collaboration established across Indian country at Area level.

Implement Activities to Improve Collaboration among Component A Awardees to Support Effective Health Promotion and Disease Prevention

Increased understanding by tribes, tribal organizations and urban Indian organizations of the needs and resources in each Area and across all Areas related to chronic disease prevention and other priority health issues.

Increased collaboration among tribes, tribal organizations and urban Indian organizations on

Increased sustained implementation of programs identified from local and Area-wide assessments Increased capacity among tribes, tribal organizations and urban Indian organizations to incorporate evaluation results into program plans Increased capacity for chronic disease prevention and management by tribes, tribal organizations and urban Indian

Essential public health functions are provided across the Areas Programs established or strengthened to address leading causes of death and disability Increased capacity for seeking financial support for planning, implementing and evaluating public health programs and activities organizations across the Area. public health programs and managing grants.

Support Component A Awardees to Engage in Sustainability Activities

Increased collaboration and training among tribes, tribal organizations and urban Indian organizations on identifying and securing funding and managing grants.

Increased numbers of grant writing trainings for tribes, tribal organizations and urban Indian organizations.

Increased numbers of grants applied for and received.

Increased financial support for chronic disease prevention and health promotion activities by tribes, tribal organizations and urban Indian organizations.

Increased access to chronic disease prevention and health promotion activities by tribes, tribal organizations and urban Indian organizations.

Coordinate an evaluation approach with Component A awardees that monitors accomplishments in achieving FOA outcomes

Finalized evaluation plan in collaboration with CDC and Component A Awardees.

Set of performance measures finalized in collaboration with CDC and Component A Awardees.

Findings utilized to monitor accomplishments in achieving FOA outcomes and to inform program strategies.

Role of Tribal Epidemiology Centers in building capacity demonstrated.

i. Purpose This FOA is intended to contribute to reductions in chronic diseases and risk factors, reductions in disparities in health outcomes, and improvements in overall health by building public health capacity and infrastructure in Indian Country for disease surveillance, epidemiology, prevention and control of disease, injury, or disability, and program monitoring and evaluation. With this funding support, TECs will increase their capacity to deliver public health functions to and with the tribes/villages in their IHS Area (including the Urban Area).

ii. Outcomes As shown in the Logic Model, a series of short and intermediate-term outcomes to reduce chronic disease and related risk factors are expected to be achieved as a result of awardee efforts. With the long-term outcomes of 1. Improving surveillance, data collection and monitoring of health status; 2. Delivering effective chronic disease prevention and health promotion programs; and 3. Developing sustainable public health capacity and infrastructure, awardees will work with their tribes, tribal organizations and urban Indian organizations in their

IHS Area to accomplish the following short term outcomes from each strategy. Through their respective work, Component A awardees design and implement the work and increase their public health capacity, while the Component B awardee facilitates program implementation and accelerates progress toward program goals by coordinating a Community of Practice for sharing knowledge, collaborating on problem solving and engaging in quality improvement efforts with Component A awardees. Thus, both Components are working toward the same outcomes.

Strategy: Strengthen Public Health Capacity and Infrastructure Short term outcomes:

Increased collaboration and training on surveillance, epidemiology and data collection among tribes, tribal organizations and urban Indian organizations.

Enhanced collaboration and delivery of training on the development or strengthening of culturally-relevant, evidence-based processes to identify health status objectives and the programs needed to meet those objectives, related to disease prevention and health promotion programs to tribes, tribal organizations and urban Indian organizations

Increased communication and partnership among partners outside the health sector on chronic disease prevention and other priority areas at the Area and/or tribal levels

Strategy: Implement Activities to Improve Effectiveness of Health Promotion and Disease Prevention Short term outcomes:

Increased understanding by tribes, tribal organizations and urban Indian organizations of the needs and resources in the area related to chronic disease prevention and other priority health issues.

Increased collaboration among tribes, tribal organizations and urban Indian organizations on planning, implementing and evaluating public health programs and activities

Strategy: Engage in Sustainability Activities Short term outcomes:

Increased collaboration and training among tribes, tribal organizations and urban Indian organizations on identifying and securing funding and managing grants.

Increased numbers of grant writing trainings for tribes, tribal organizations and urban Indian organizations.

These short-term outcomes are intended to contribute to the accomplishment of the following intermediate-term outcomes, organized by the same strategies:

Strategy: Strengthen Public Health Capacity and Infrastructure Intermediate term outcomes:

Improved monitoring of health status (e.g., improved surveillance, surveys, access to and use of public health data)

Coordinated communication with public health workers, health care professionals, and the public about chronic diseases and other heath priorities (e.g., publication of reports, data summaries, issue briefs, program evaluation findings and other communication products).

Strategy: Implement Activities to Improve Effectiveness of Health Promotion and Disease Prevention Intermediate term outcomes:

Increased sustained implementation of programs identified from local and Area-wide assessments

Increased capacity among tribes, tribal organizations and urban Indian organizations to incorporate evaluation results into program plans

Increased capacity for disease prevention and health promotion by tribes, tribal organizations and urban Indian organizations across the Area.

Strategy: Engage in Sustainability Activities Intermediate term outcomes:

Increased numbers of grants applied for and received Increased financial support for disease prevention and health promotion activities by tribes, tribal organizations and urban Indian organizations.

iii. Strategies and Activities The Strategies and Activities section builds on the Outcomes section outlined previously.

Awardees are expected to implement strategies outlined in the Logic Model, utilizing the activities below. As depicted in the Logic Model, awardees will engage in assessment and planning with tribes, tribal organizations and urban Indian organizations to identify the priorities/gaps related to the activities and outcomes supported under this FOA. Awardees will implement the following strategies and activities:

Strengthen Public Health Capacity and Infrastructure

Collect and monitor data on health status objectives of tribes, tribal organizations and urban Indian organizations.

Evaluate delivery and data systems that impact Indian health.

Assist tribes, tribal organizations and urban Indian organizations to determine health status objectives and services needed to meet those objectives.

Provide technical assistance to tribes, tribal organizations and urban Indian organizations to effectively apply surveillance data and epidemiology to determine local health priorities and to plan and monitor interventions to address them.

Provide technical assistance to tribes, tribal organizations and urban Indian organizations on chronic disease prevention and other health priority areas.

Cultivate multi-sector collaborations at Area tribe, state, and federal levels

Implement Activities to Improve Effectiveness of Health Promotion and Disease Prevention

Identify public health priorities by conducting community health assessments (CHA) or using previous CHAs or other available data.

Identify community strengths, resources, and needs Develop and support implementation of culturally-relevant evidence-based activities to address identified needs.

Evaluate Area and tribal efforts to address chronic diseases and other priority health conditions.

Engage in Sustainability Activities

Identify possible sources for financial support that align with program priorities Create a plan to sustain program efforts after grant period ends

1. Collaborations

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

Collaboration with programs funded by CDC is encouraged, particularly those that are working to mitigate risk factors associated with diabetes, heart disease, stroke, cancer and obesity.

National initiatives, guidelines, and policies have been identified from The Community Guide and CDC’s Division of Nutrition, Physical Activity, and Obesity; Division of Diabetes Translation; Division for Heart Disease and Stroke Prevention; Division of Cancer Prevention and Control and the Office on Smoking and Health that may complement and build on effective, culturally-grounded activities. In addition, CDC’s Center for Surveillance, Epidemiology, and Laboratory Services is a valuable resource for support for epidemiology, surveillance, health communication and public health training. Examples of CDC tribal programs that may provide collaboration opportunities to support achievement of FOA outcomes include Good Health and Wellness in Indian Country and the National Native Network for Tobacco Control.

b. With organizations not funded by CDC:

Awardees are expected to collaborate with organizations external to CDC, such as those listed below, that are necessary to achieve project outcomes or that can enhance and accelerate achievement of project outcomes. Relationships with other potential partners, such as local and state health departments and relevant non-profit and provider groups, are encouraged. Building and/or continuing strategic partnerships and collaborations with organizations that have a role in achieving the long-term outcomes of this FOA are encouraged.

Indian Health Service (Health Promotion Disease Prevention - https://www.ihs.gov/hpdp

Indian Health Service Special Diabetes Program for Indians - https://www.ihs.gov/sdpi/ https://www.ihs.gov/hpdp/ https://www.ihs.gov/hpdp/ https://www.ihs.gov/sdpi/

USDA (Rural Development grants: support housing, community facilities, and community and economic development projects in rural areas.: https://www.rd.usda.gov /programs-services/rural-community-development-initiative-grants ;

Land Grant University (LGU) system: https://nifa.usda.gov/land-grant-colleges-and-universities-partner-website-directory ; FDPIR nutrition education http://www.fns.usda .gov/fdpir/fdpir-nutrition-education-grant-awards)

National Park Service: https://www.nps.gov/thpo/ NIH (Multilevel Program and Policies to Reduce Chronic Disease for American Indians, Johns Hopkins Center for American Indian Health and NIH. Launched in 2015 and set to expire in 2020);

HHS (Child Care and Development Block Grant- reauthorization permitted healthy eating/exercise funding provisions. Funds also available to Tribes)

Department of Treasury - Community Development Financial Institutions Fund (CDFI Fund) https://www.cdfifund.gov/programs-training/Programs/Pages/default.aspx ; http ://ofn.org/cdfi-locator -- locator for CDFIs

National Council for Urban Indian Health (http://www.ncuih.org/index) Healthy Native Communities Partnership - http://www.hncpartners.org/

2. Target Populations Applicants are expected to design their activities to have an impact on public health capabilities of tribal epidemiology centers and the health outcomes of the American Indians and Alaska Natives they serve. Applicants must represent or serve at least 60,000 American Indians and Alaska Natives.

a. Health Disparities American Indians and Alaska Natives experience health disparities in chronic diseases (e.g.

diabetes, heart disease, stroke, cancer) and their underlying risk factors, as well as injuries and infectious diseases. Specifically, American Indians and Alaska Natives have higher rates of chronic disease, injury, and premature death than other racial and ethnic groups in the United States. Tribal public health capacity and infrastructure are correspondingly under-resourced and under-developed to address these disparities and improve health outcomes. This FOA is focused exclusively on American Indians and Alaska Natives and the tribes, tribal organizations and urban Indian organizations that serve them, in order to reduce disparities in chronic disease prevention and related risk factors, and public health capacity and infrastructure.

iv. Funding Strategy Component A award amounts are based in part on the number of federally recognized Indian tribes or villages (or urban Indian health centers) in the area the applicant serves. In the first year of this FOA, a base amount of about $230,000 (depending upon quality and scope of work, and government resources) will be provided to all Component A awardees, with an incremental increase for the number of tribes/villages (or centers, in the case of urban Indians) in the area and served by the program, and for the extent and reach of the proposed program.

Specifically, applicants serving one tribe may apply for up to $330,000; applicants serving at https://www.rd.usda.gov/programs-services/rural-community-development-initiative-grants https://www.rd.usda.gov/programs-services/rural-community-development-initiative-grants https://nifa.usda.gov/land-grant-colleges-and-universities-partner-website-directory https://nifa.usda.gov/land-grant-colleges-and-universities-partner-website-directory http://www.fns.usda.gov/fdpir/fdpir-nutrition-education-grant-awards http://www.fns.usda.gov/fdpir/fdpir-nutrition-education-grant-awards https://www.cdfifund.gov/programs-training/Programs/Pages/default.aspx http://ofn.org/cdfi-locator http://ofn.org/cdfi-locator http://www.ncuih.org/index http://www.hncpartners.org/ least two and up to 19 tribes may apply for up to $610,000; applicants serving at least 20 and up to 49 tribes may apply for up to $750,000; applicants serving 50 or more tribes may apply for up to $850,000. Up to one Component A award will be made in each IHS Area. The Component B applicant may apply for up to $600,000.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy Evaluation and Performance Measurement: 1) help demonstrate achievement of program outcomes; 2) build a stronger evidence base for specific program interventions; 3) clarify applicability of the evidence base to different populations, settings, and contexts; and 4) drive continuous program improvement. Evaluation and performance measurement can also determine whether program strategies are scalable and effective at reaching the target or intended populations.

CDC Evaluation and Performance Management Strategy Throughout the five year project period, CDC will work individually and collectively with awardees for components A and B to answer the following evaluation questions based on the program Logic Model and activities:

Component A awardees:

1. To what extent has the capacity of TECs to collect and monitor data on health status of tribes, tribal organizations and urban Indian organizations increased?

2. To what extent has the capacity of TECs to evaluate delivery and data systems that impact Indian health increased?

3. To what extent has technical assistance been delivered by TECs to tribes, tribal organizations and urban Indian organizations to develop local health priorities and disease incidence and prevalence rates, with a focus on surveillance and epidemiology, including data collection for planning and monitoring?

4. To what extent has technical assistance been provided by TECs to tribes, tribal organizations and urban Indian organizations on chronic disease prevention and other health priority areas?

5. To what extent have multi-sector collaborations at Area, state, and/or tribal levels been established and implemented effectively?

6. To what extent have additional sources for financial support that align with program priorities been identified and secured?

7. To what extent has the program effectively engaged in the Network Coordinating Center activities and community of practice?

8. Is there a plan to sustain program efforts after grant period ends?

Component B awardee (NCC):

1. Has the structure and management of an ongoing Network of Component A awardees been successfully established or strengthened and maintained?

2. To what extent has coordination of collaborative activities of the Network been accomplished?

3. Has a coordinated and collaborative Community of Practice to facilitate knowledge-sharing, problem-solving and communication across the Network been established; is it meeting monthly and is attended by a majority of Component A awardees; and is it demonstrating value to Component A awardees and CDC, as demonstrated by specific instances of additional collaborations, sharing of practices and joint problem-solving that result from participation in the Network?

4. Have virtual and in-person meetings for Component A awardees and CDC project officers and project leadership been routinely planned and conducted?

5. To what extent has an internal and external website as described in this FOA to serve as a key communication and Network hub for Component A awardees been established and demonstrated value to Component A awardees and CDC?

6. Has a plan for tracking and disseminating Network-related publications, presentations, products, and other materials been developed and implemented?

7. Has an evaluation plan to coordinate monitoring of Component A and Component B accomplishments in achieving the outcomes of the FOA been developed and implemented?

Though performance measures will be finalized in the first year of the program, a sample of proposed process and outcome measures for Components A and B are listed below:

Component A – Process Measures

Proportion of Area tribes, tribal organizations and urban Indian organizations that have received technical assistance on chronic disease prevention and other health priority areas

Number of tribes, tribal organizations, and urban Indian organizations being assisted by Component A awardee to evaluate efforts to address chronic diseases and other priority health conditions

Number of possible sources for financial support that align with program priorities identified in the Area.

Component A – Outcome Measures

Proportion of Area tribes whose health data are routinely collected, analyzed and utilized to monitor health status;

Proportion of Area tribes implementing culturally-relevant, evidence-based chronic disease prevention programs;

Number of funded and in-kind grants or collaborations in the Area that were achieved, at least in part, through Component A technical assistance.

Component B- Process Measures

Number of new collaborations among Component A awardees focused on improving data collection, surveillance and epidemiology among respective Area tribes;

Number of new collaborations among Component A awardees focused on implementation of culturally-relevant, evidence based chronic disease prevention programs;

Existence of final evaluation plan, including set of performance measures, available data sources and a preliminary analysis and dissemination plan.

Number of Component A funded organizations engaged in monthly NCC meetings.

Number of Component A awardees and other partners using Internal and external

NCC website.

Component B – Outcome Measures

Number of Component A awardees that collaborate regularly to identify and share resources for providing technical assistance on the strategies of the FOA;

Existence of an evaluation report that demonstrates Component A awardees’ collective achievement toward FOA outcomes.

ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the awardee 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 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), if applicable, for accuracy throughout the lifecycle of the project. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data; data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans.

For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additionalrequirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, they should be directed to:

Describe the type of evaluations (i.e., process, outcome, or both).

Describe key evaluation questions to be addressed by these evaluations.

Describe other information (e.g., measures, data sources).

Awardees will be required to submit a more detailed Evaluation and Performance Measurement plan, including a DMP, within the first 6 months of award, as described in the Reporting Section of this NOFO.

https://www.cdc.gov/grants/additionalrequirements/ar-25.html

Throughout the five year project period, CDC will work individually and collectively with awardees for components A and B to answer the preceding evaluation questions based on the program Logic Model and activities.

To answer these questions, CDC will use a three-pronged evaluation approach. Component A and Component B awardees will be required to: 1) report on outcome performance measures; 2) develop awardee-specific and Area-specific evaluation plans (that is, conduct evaluation on selected strategies and activities implemented with tribes and villages in the area, as applicable) and conduct the evaluation; and 3) participate as requested in national evaluation activities.

CDC will work with the Component B awardee as the Network Coordinating Center for evaluation to select performance measures, operationalize the performance measures, and assist with identification of available and feasible data sources for these measures. Both Components will be responsible for gathering and analyzing the data for the performance measures and their awardee- and Area-specific evaluations. With these measures, the awardees and CDC will track the implementation and the achievement of the intended outcomes. CDC, in collaboration with awardees, will develop annual awardee- and Area-specific performance measure reports.

Awardee- and Area-specific performance measure reports will be used for program monitoring and for targeting areas for program quality improvement. CDC will develop annual, aggregate performance measure reports to be disseminated by multiple methods to awardees and other key stakeholders, including federal partners, non-funded partners, and policy makers, as appropriate.

These aggregate findings may also be presented during site visits and awardee meetings.

As resources permit, CDC will also identify and collaborate with Component B awardee to coordinate additional national evaluation projects to evaluate program activities and outcomes.

CDC will collaborate with Component B in the design, data collection, analysis, and reporting for these national evaluation efforts in collaboration with all awardees.

Applicants must provide an overall evaluation and performance measurement plan that is consistent with the CDC evaluation and performance measurement strategy. The plan must:

Describe how key program partners will be engaged in the evaluation and performance measurement planning processes.

Describe the population(s) that will be the focus of the work.

Describe the type of evaluations to be conducted (i.e., process and/or outcome).

Describe examples of data collection instruments related to the intended populations and respective interventions planned.

Describe key evaluation questions to be answered.

Describe potentially available data sources.

Describe how evaluation findings will be used for continuous program and quality improvement.

Describe how collaboration across sectors will be evaluated.

Awardees will be required to submit a more detailed Evaluation and Performance Measurement plan (including the Data Management Plan elements) within the first 6 months of award, as described in the Reporting Section of this FOA.

Awardees are encouraged to budget up to 10% of the total funding award to evaluation activities.

c. Organizational Capacity of Awardees to Implement the Approach Applicants must describe their organizational capacity to carry out the activities, strategies, performance measures, and evaluation requirements as outlined in the FOA. CDC anticipates that all applicants will demonstrate capacity to carry out the activities and evaluation over the 5-year project period.

General Capacity: All applicants must describe their organizational capacity to carry out CDC program requirements and meet the project period outcomes. Day-to-day responsibilities for key tasks such as leadership of project, monitoring of the project’s ongoing progress, preparation of reports, program evaluation, communication with partners and CDC, and timely, effective expenditure of funding should be outlined.

Applicants must provide evidence of:

An adequate staffing plan to carry out the project (program coordinator dedicated to this program, experienced evaluator, other staff with expertise in the areas of work, as appropriate, including surveillance, epidemiology, training, program planning and implementation, as appropriate). An organizational chart and CV/resume for all project staff or position description (if position is vacant) should be provided.

Component B applicants should include staff necessary to establish and maintain a robust network of Component A awardees to collaborate on program implementation and evaluation, knowledge-sharing and problem-solving. Experience and expertise in program planning, performance management and monitoring.

Evaluation experience and expertise.

Ability to travel (using Cooperative Agreement funds) to grantee and Network meetings.

Full capacity to manage the required procurement efforts, including the ability to write and award subcontracts in accordance with 45.C.F.R. 75, as applicable.

Experience with financial reporting, budget management and administration systems and methods.

Personnel management experience (including developing staffing plans, developing and training workforce, managing Direct Assistance and developing a sustainability plan).

Roles and responsibilities of existing and/or proposed partnerships.

Successful collaboration with the community served, including, for Component A applicants, demonstration of representing or serving at least 60,000 American Indians and Alaska Natives.

Additionally, Component B applicants should demonstrate capacity to support videoconferencing for NCC participants, as well as develop and maintain the NCC website described below, or contract for such services.

d. Work Plan Work plans for all Component A and Component B applicants must include, at a minimum:

Identification of the Component for which the applicant is applying. If applying for both Component A and Component B, two separate applications must be submitted.

A detailed, descriptive year-one work plan, including intended outcomes, strategies and activities, and timelines to support the achievement of FOA outcomes. Strategies must be in alignment with the FOA Logic Model and should have appropriate milestones or outputs for accomplishing tasks. A high-level work plan for years two through five should address how progress will continue.

Target population served is the American Indian and Alaska Native population in the IHS Area served by the applicant. The Component A work plan should specify the tribes, tribal organizations or urban Indian organizations to be served and generally describe the American Indian and Alaska Native population to be served by the applicant, including anticipated number of tribes and tribal members (including urban Indians, as appropriate) reached by strategies and activities. The target population for the Component B applicant is the Component A awardees and the populations they serve.

Staff and administrative roles to support the implementation of the proposed activities.

Awardee should identify and assign staff, contractors, and/or consultants, sufficient in number and expertise, to carry out the activities of the FOA.

A description of administration and assessment processes to ensure successful and timely expenditure of funds, implementation of program activities and quality assurance to achieve outcomes.

The Component A and Component B applicants are required to provide a work plan consisting of a narrative for the five-year program and a detailed description of the first year of the award.

The work plan should not exceed 10 pages.

Component A: The Component A work plan must, at a minimum, include:

1. Narrative (description) of public health programs, including disease surveillance, epidemiology, prevention and control of disease, injury or disability, program monitoring and evaluation, leadership, training, and technical assistance, as appropriate, to be provided; include identification of the program strategies that will be addressed (public health capacity and infrastructure, programs to improve disease prevention and health promotion, sustainability activities).

2. Description of Area tribes, tribal organizations, urban Indian organizations and/or American Indian and Alaska Native populations to collaborate with in order to carry out Component A activities.

3. Intended outcomes for the first year of the project period, as presented in the Logic Model provided above under each of the three strategies.

4. Program strategies to be used during the first year of the project period, including subawards to Area tribes, tribal organizations or urban Indian organizations, if appropriate.

6. Activities for the first year of the project period (note: activities must be in alignment with chosen program strategies).

7. Description of how applicant will effectively participate in and support the Community of Practice established by the Network…