CDC-RFA-DP18-1810.pdf

Centers for Disease Control

National Center for Chronic Disease Prevention and Health Promotion

State Actions to Improve Oral Health Outcomes

CDC-RFA-DP18-1810

Application Due Date: 05/04/2018

State Actions to Improve Oral Health Outcomes

CDC-RFA-DP18-1810

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-DP18-1810. 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:

State Actions to Improve Oral Health Outcomes 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-DP18-1810

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

93.366 F. Dates:

1. Due Date for Letter of Intent (LOI): 03/22/2018

2. Due Date for Applications: 05/04/2018, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

A Letter of Intent (LOI) is encouraged but not required for this NOFO. The purpose of the LOI is to allow CDC program staff to estimate the number of and plan for the review process of submitted applications.

The LOI should include the following:

o Descriptive title of proposed project.

o Name, address, telephone number, and an email address of the Principal

Investigator, Project Director, or both.

o Name, address, telephone number, and an email address of the primary contact for writing and submitting this application.

o Number and title of this NOFO.

o Whether the applicant will be applying for: a) Sealants, Community Water

Fluoridation, and Oral Health Surveillance, or b) Sealants, Community Water Fluoridation, Oral Health Surveillance and Medical-Dental Integration.

The LOI must be emailed or postmarked by 03/22/2018 11:59pm, U.S. Eastern Standard Time.

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.grants.gov

Send LOIs via email or U.S. express mail to:

Marcia Parker Department of Health and Human Services Centers for Disease Control and Prevention 4770 Buford Hwy, NE, MS F-80 Atlanta, Georgia 30341 Telephone: 770-488-6054 Email: 1810State@cdc.gov

3. Date for Informational Conference Call:

Date for Pre-application Information Conference Call: 03/08/2018

March 8, 2018 at 3:00 p.m. to 5:00 p.m. U.S. Eastern Standard Time. This pre-application informational conference call can be accessed by calling 1-866-852-7877.

The leader for this call is Mr. Casey Hannan and the passcode is 49956528.

Technical Assistance Opportunities for Potential Applicants:

Potential applicants may participate in a conference call for information about the Notice of Funding Opportunity (NOFO). The National Center for Chronic Disease Prevention and Health Promotion’s Division of Oral Health will host this call. Listed above is the Pre-application Conference Call information.

Frequently Asked Questions:

Information about this initiative is available at https://www.cdc.gov/oralhealth/funding/nofo1 810states.htm. This website will also provide answers to frequently asked questions and an email address for potential applicants to make inquiries and submit questions. Information about all CDC oral health programs, including recipients, is available at www.cdc.gov/oralhealth.

G. Executive Summary:

1. Summary Paragraph:

The “State Actions to Improve Oral Health Outcomes” program is a five-year competitive renewal to continue CDC investment in and support for oral health promotion and disease prevention programs. The purpose is to assist states in decreasing dental caries, oral health disparities, and other co-morbid chronic diseases associated with poor oral health. Recipients under this program will accomplish these outcomes through implementing priority strategies such as school sealant programs (including promoting adherence to infection prevention guidelines), supporting and increasing community water fluoridation, conducting oral health surveillance, and optionally integrating oral health with other chronic disease programs (i.e., medical-dental integration). The proposed program will replace FOA 13-1307 [FY 2013-FY 2018]. It will also incorporate important programmatic strategies currently implemented in FOA 16-1609 [FY 2016-FY 2017], Models of Collaboration among Chronic Diseases and Oral mailto:1810State@cdc.gov https://www.cdc.gov/oralhealth/funding/nofo1810states.htm https://www.cdc.gov/oralhealth/funding/nofo1810states.htm http://www.cdc.gov/oralhealth

Health Programs, to support enhanced medical-dental integration and provide improved quality of care. Successful implementation of the NOFO strategies will result in decreases in dental caries, oral health disparities, and other co-morbid chronic diseases.

a. Eligible Applicants: Limited

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 18 18 (18 awards for Sealants, CWF, and Oral Health Surveillance; 5 of these recipients will be awarded additional funding for Medical-Dental Integration).

d. Total Period of Performance Funding: $38,300,000

e. Average One Year Award Amount: $425,556 $370,000 for 13 recipients funded for Sealants, CWF, and Oral Health Surveillance; $570,000 for 5 recipients awarded additional funding for Medical-Dental Integration. (Overall average of $7,660,000/18 total recipients = $425,556). CDC recommends allocating 40% of budget for personnel costs and 60% for program implementation.

f. Total Period of Performance Length: 5

g. Estimated Award Date: 09/01/2018

h. Cost Sharing and / or Matching Requirements: N Cost sharing or matching funds are not required for this program. Although there are no statutory match requirements for this NOFO, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Examples include complementary private foundation funding, other U.S. government funding sources, including programs supported by the Department of Health and Human Services and other agencies such as the Department of Agriculture, the Department of Education, the Environmental Protection Agency, or other funding sources. Applicants should coordinate with multiple sectors, such as public health, education, health care delivery (Federally Qualified Health Centers, Community Health Centers, and Faith-based Organizations), drinking water associations, and other community-level resources.

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview Oral diseases, which span cavities to gum disease to oral cancer cause pain and disability for millions of Americans, costing taxpayers billions of dollars each year.[1] Cavities (also called tooth decay) are one of the most common chronic conditions in the United States. More than 40% of adults report having felt pain in their mouth in the last year. In 2015, the nation spent $117.5 billion on costs related to dental care. More than $6 billion in productivity is lost each year because people miss work to get dental care. [2] Oral health strategies, school sealant programs and community water fluoridation are proven to prevent cavities and save money. [3],[4] Recent surveillance reports show improvements in oral health; for example, data from the National Health and Nutrition Exam Survey (NHANES) from 1999–2004 to 2011– 2014 show overall prevalence of dental sealants among 6-11 year olds increased from 31.1% to 43.6%.[5] From 2004–2014, more than 30 million people gained access to fluoridated water. Over 211 million individuals (74.4% of those served by community water systems) now have access to optimally fluoridated water. [6] Linkages exist between oral diseases and other chronic diseases like diabetes, cardiovascular disease, and obesity.[7],[8]This linkage also includes risk behaviors such as tobacco use and consuming foods and beverages with high levels of added sugar.[9] However, few public health programs across the United States integrate oral health and chronic disease programs. The Division of Oral Health's Models of Collaboration (also called "Medical-Dental Integration" strategy) provides a unique opportunity for oral health promotion, disease prevention, and chronic disease programs to work together to ensure care coordination that leads to improved chronic disease outcomes.

1. Seirawan H, Sundaresan S, Mulligan R. Oral health-related quality of life and perceived dental needs in the United States; Am Journal of Public Health Dentistry. 2011; (71):194-

2. Centers for Disease Control and Prevention (CDC). 2015, October 8. Oral Health: Oral Health Basic. https://www.cdc.gov/oralhealth/basics/index.html, November 11, 2017

3. Centers for Disease Control and Prevention (2016, November 7) Community Water Fluoridation. https://www.cdc.gov/fluoridation/statistics/fsgrowth.htm, September 11,

4. Griffin SO, Naavaal S, Scherrer CR, Patel M, Chattopadhyay S. Evaluation of school-based dental sealant programs: an updated Community Guide systematic economic review. Am J Prev Med. In press 2016.

5. Griffin SO, Wei L, Gooch B, Weno K, Espinoza L. Changes in dental sealant and untreated tooth decay prevalence and the estimated impact of increasing school-based sealant program coverage. MMWR. 2016; 65.

6. Centers for Disease Control and Prevention (2016, November 7) Community Water Fluoridation. https://www.cdc.gov/fluoridation/statistics/fsgrowth.htm, August 25, 2017

7. Sheiham, A., & Watt, R.G. (2000). The common risk factor approach: a rational basis for promoting oral health. Community dentistry and oral epidemiology, 28(6), 399-406

8. Preshaw, P. et al. (2016) Periodontitis and Diabetes: A Two-Way Relationship.

Diabetologia. 55(1): 21-31. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228943/

9. Sheiham, A., & Watt, R.G. (2000). The common risk factor approach: a rational basis for promoting oral health. Community dentistry and oral epidemiology, 28(6), 399-

b. Statutory Authorities The State Actions to Improve Oral Health Outcomes is authorized under the Public Health Act, Title 42, Section 243, 247(b)(k)(2) and 247(b-14).

c. Healthy People 2020 NOFO strategies that address the HP 2020 objectives: Reduce the proportion of youth with dental caries (OH-1.1-3); Reduce the proportion of youth with untreated dental decay (OH-2.1-3);

Increase the number of children with dental sealants on permanent molars (OH-12.2-3); Increase the proportion of the population on public water systems with fluoridated water (OH-1.3);

Increase the number of state health departments with an oral health surveillance system (OH-16);

Increase the proportion of persons with diabetes who have an annual dental examination (D-8);

Increase tobacco screening in dental care settings (TU-9.3) and; Increase tobacco cessation counseling in dental care settings (TU-10.3).

d. Other National Public Health Priorities and Strategies Oral health is one of 12 Healthy People Leading Health Indicators for the Nation. This program supports strategies to increase and improve the quality of oral health outcomes, community-clinical linkages, and preventive services in the following national plans and guidelines:

The Guide to Community Preventive Services - http://www.thecommunityguide.org/ The National Partnership for Action to End Health Disparities -https://minorityhealth.hhs.gov/npa/ Health Resources and Services Administration - http://www.hrsa.gov/index.html Centers for Medicare and Medicaid Services - http://www.cms.gov National Prevention Strategy - http://www.surgeongeneral.gov/priorities/prevention/strategy/

A number of other efforts are underway in the United States to improve oral health. For example, the Centers for Medicare & Medicaid Services is working with state partners, the dental and medical provider communities, and other stakeholders to continue to assess and monitor quality of care, and improve access to dental care (http://www.cms.gov/). The Health Resources and Services Administration has made oral health a primary goal and is working on increasing and further developing the oral health workforce through training (http://www.hrsa.gov/index.html).

e. Relevant Work This NOFO builds upon past programmatic efforts to build state oral health program capacity to promote oral health and implement oral health prevention programs as outlined in CDC-RFA- DP13-1307. In addition, this NOFO supports or enhances the integration of medical and dental services that result in improved quality of care as outlined in CDC-RFA-DP16-1609.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

i. Purpose The purpose of this non-research NOFO is to assist States to decrease dental caries, oral health disparities, and other chronic diseases co-morbid with poor oral health. To accomplish this, recipients will implement school sealant programs (including promoting adherence to infection prevention guidelines), support and increase access to community water fluoridation, conduct oral health surveillance, and optionally integrate oral health with other chronic disease programs (medical-dental integration).

ii. Outcomes All applicants need to address the outcomes bolded in the logic model for each strategy in Component 1: School Sealant Programs, Community Water Fluoridation, and Oral Health Surveillance. In addition, applicants that apply for the optional fourth strategy under Component 2: Medical-Dental Integration will need to address the bolded outcome there. Besides the short and mid-term outcomes that are bolded, all applicants are expected to address the bolded long-term outcome related to dental caries prevalence.

Component 1 Strategies:

For the required School Sealant Programs (SSP) strategy, the relevant outcome in the logic model is expand school sealant program enrollment.

For the required Community Water Fluoridation (CWF) strategy, the relevant outcome in the logic model is increase proportion of people served by community water systems who receive optimally fluoridated water.

For the required Oral Health Surveillance (OHS) strategy, the relevant outcome in the logic model is disseminate oral health surveillance data on oral disease, risk factors, and use of preventive oral health services.

Component 2 Strategies:

For the optional Medical-Dental Integration strategy, the relevant outcome in the logic model is integrate oral health with other chronic disease programs.

School sealant programs and community water fluoridation result in measurable population-level health impact and economic savings. Conducting oral health surveillance will ensure programs are able to document burden, identify groups or geographic areas affected disproportionately by poor oral health outcomes, and monitor trends. Through medical-dental integration of oral health and chronic disease programs, staff will identify effective public health strategies to address mutually beneficial outcomes.

The School Sealant Program and Community Water Fluoridation performance measures in this NOFO directly support reaching and exceeding corresponding national oral health objectives (expanding school sealant programs and reaching at least 50% of high risk schools, and reaching or exceeding 79.6% of the population on public water systems having access to optimally fluoridated water) Healthy People 2020. The Oral Health Surveillance performance measure is to develop or maintain an oral health reporting system that enables oral health promotion and disease prevention programs to monitor effectively the burden of disease and report trends. The Medical-Dental Integration performance measure outcome is to establish and ensure care coordination to improve co-morbid outcomes of oral health and chronic disease programs.

SCHOOL SEALANT PROGRAM:

Recipients will promote, coordinate, implement, and evaluate dental sealant programs within elementary and middle schools in which at least 50% of students qualify for the federal or state free and reduced meal program. In addition, recipients will promote the adherence to the CDC’s infection prevention guidelines in school sealant programs, including the Guidelines for Infection Control in Dental Health-Care Settings – 2003, and the Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care.

SCHOOL SEALANT PROGRAM PERFORMANCE MEASURES FOR RECIPIENTS:

Performance Measure: Number of eligible schools* with dental sealant programs within each CDC-funded state.

Target: A minimum of a 5% increase in the number of eligible schools* with dental sealant programs within each CDC-funded state.

Data sources: Annual State Synopsis (funded by National Partner Cooperative Agreement); CDC Annual State Progress Report; National Center for Education Statistics (NCES)(http://nces.ed.gov/)**and CDC SEALS application (administered by DOH) or approved sealant data collection system.

*The term eligible schools is defined as schools with 50% or more of students eligible for free and reduced meals program (FARMs).

**CDC will provide recipients with guidance on how to collect NCES state-specific data within the first 45 days of award.

COMMUNITY WATER FLUORIDATION:

Recipients will monitor and report water fluoridation activities including documentation of public water systems that adjust fluoride and proportion of people served. Recipients will provide education on the benefits, safety, and effectiveness of maintaining recommended fluoride levels for community water fluoridation. They will also maintain an awareness of policy changes and actions that support and promote quality control and management of fluoridated water systems.

COMMUNITY WATER FLUORIDATION PERFORMANCE MEASURES FOR

RECIPIENTS:

Performance Measure: Number of population served by optimally fluoridated community water systems.

Target: Increase proportion of population served by community water systems who receive optimally fluoridated water.

Data sources: CDC Annual Progress Report; Annual State Synopsis (funded by National Partner Cooperative Agreement); and CDC Water Fluoridation Reporting System

(WFRS)

ORAL HEALTH SURVEILLANCE:

Recipients will develop and maintain an oral health surveillance system. In addition, recipients will monitor the burden of oral diseases and access to preventive services (for example, dental sealants and community water fluoridation) and disseminate findings to inform program and policy decisions.

ORAL HEALTH SURVEILLANCE PERFORMANCE MEASURES FOR RECIPIENTS:

Performance Measure: Prevalence of dental caries experience, untreated decay and dental sealants among 3rd grade children.*

Target: A minimum of 5% reduction in dental caries experience and untreated decay among 3rd grade children. A minimum of 5% increase in dental sealants among 3rd grade children.

*Specific performance measures are defined under the Minimum Reportable Elements for Data Collection Activities of the Strategies and Activities.

Data sources: CDC Annual Progress Report and past and current Basic Screening Survey (BSS)

MEDICAL-DENTAL INTEGRATION:

A small number of recipients will receive additional funds for medical-dental integration.

These recipients will work closely with their chronic disease program partners, where appropriate, to implement a bi-directional referral system that results in a project that addresses oral diseases or conditions of those populations affected by or at risk of one of the following:

obesity, diabetes, cardiovascular disease, tobacco use or consumption of sugar-sweetened beverages. Expected outcomes include the integration of oral health and chronic disease program strategies that will lead to improvement on mutually agreed upon health outcomes.

Recipients will need to work at the program, clinical practice, and health systems levels to increase communication, coordination, and collaboration between the oral health and chronic disease programs to achieve expected outcomes.

MEDICAL-DENTAL INTEGRATION PERFORMANCE MEASURES FOR

RECIPIENTS:

Performance Measure: Percentage of adults screened for the chronic disease or risk factor selected.

Target: A minimum of 5% increase in the percentage of adults screened for the chronic disease or risk factor selected.

Data source: CDC Annual Progress Report

iii. Strategies and Activities

SCHOOL SEALANT PROGRAM STRATEGIES AND ACTIVITIES:

1: Partnerships and Collaborations-develop, coordinate, and implement diverse partnerships with a focus on the target population. Collaborate and integrate with disease prevention programs:

Develop, coordinate, implement, and evaluate jurisdiction-wide school sealant programs.

Provide training and technical assistance to local sealant programs, partners, and providers on topics such as evidenced-based strategies and data collection methods, and promote adherence through training on CDC’s infection prevention and control guidelines in dental settings.

Foster and sustain relationships with public and private organizations whose missions align with improving child health or oral health outcomes, including developing partnerships with community, non-traditional, and national partners that may assist with reaching priority populations. Examples include academia, community-based organizations, faith-based organizations, local dental associations, Medicaid, Managed Care Organizations, and Federally Qualified Health Centers.

Convene a sealant work group of key partners to develop strategies for improving sealant program operations, enhancing quality control efforts, expanding program reach, and establishing sustainability of school sealant programs. The work group is required to develop a sustainability plan for its school sealant program during the first project year that outlines strategies for leveraging other resource opportunities to reduce reliance on federal funds.

2: Communication and Policy-implement communications that promote the reach and impact of school sealant programs:

Develop a communication plan within the first project year to guide efforts for promoting the benefits and effectiveness of school sealant programs and for promoting increased participation by schools or children. The plan should identify the target audiences (parents or caregivers, medical and dental providers, school personnel, and decision-makers), key messages for each, and proposed communication channels. This plan should also identify a dissemination timeline and each partner’s role.

Over the five-year NOFO project period, the recipient is required to develop in plain language at least three publicly available documents for dissemination that describe the target audience and unmet need; the program’s purpose, reach, and impact; and improvement efforts. These documents may be fact sheets, success stories, data briefings or burden reports.

3: Data Collection and Reporting-collect and report sealant program data to track program efficiency and reach:

Monitor and track progress toward reaching or exceeding the Healthy People 2020 target

(HP OH 12.2).

Annually complete and submit requested sealant program information in State Synopsis questionnaire (survey administered by National Partner Cooperative Agreement Recipient).

Collect, analyze, and report school sealant programs’ cost of resources, quality assurance (sealant retention rate) and program impact using CDC’s SEALS web application or equivalent instrument. ***

Complete a dental sealant needs assessment to describe priority populations and assess the jurisdiction’s facilitators and barriers in advancing expansion of school sealant programs. The needs assessment should identify the target population and help to develop program priorities and plans. Recipients must submit the needs assessment within the first year of funding.

***Recipients must obtain CDC/DOH approval for use of an “equivalent instrument” within 90 days of the funding start date.

Below is additional guidance about the sealant program, data collection and reporting:

CDC/DOH will provide recipients with the Minimum Reportable Data Elements for data collection activities within 45 days of the award.

CDC/DOH allows recipients to pay for and collect data from non-state coordinated sealant programs.

CDC/DOH will provide specific guidance on the data collection for sealant needs assessment for school sealant programs within 45 days of the award.

Recipients may use CDC funding to purchase portable dental sealant delivery units for school sealant programs. If funding is used for portable sealant equipment, the recipient must report how the equipment is being used and maintained.

COMMUNITY WATER FLUORIDATION STRATEGIES AND ACTIVITIES:

1: Partnerships and Collaborations-promote and provide support for quality control and management of fluoridated water systems within the recipient’s jurisdiction:

Foster and sustain partnerships with community leaders, water treatment professionals, coalitions and others whose mission aligns with promoting and increasing community water fluoridation.

Encourage water treatment personnel to take the CDC Water Fluoridation Principles and Practice training course online or in-person.

Ensure water treatment personnel understand and implement current Engineering and Administrative Recommendations for Water Fluoridation [1] for maintaining optimal fluoridation levels.

Within the first two years of the award, conduct an assessment to identify and document community water systems with aging fluoridation equipment and document the expected equipment lifespan and capital replacement costs, describing the possible funding sources and replacement timeline.

Fund or leverage funds, where appropriate, through mini-grants to provide new or replacement fluoridation equipment to community water systems.*

*Applicants for equipment funds must provide a justification that includes specific plans for equipment maintenance, training on the use of the equipment, and number of persons served by this new equipment.

2: Communication and Policy-educate public, water treatment professionals, and decision makers on benefits of community water fluoridation:

Educate water treatment personnel on the importance of and rationale for recommended fluoridation levels.

Use key informant and opinion leader interviews or other data sources to determine levels of knowledge or public opinion on the benefits of community water fluoridation.

Develop and implement a communication plan that identifies goals, objectives, and strategies to increase decision maker and public knowledge of the benefits of community water fluoridation. The plan should include strategies to:

o Educate key decision makers on the scientific evidence of the effectiveness and safety of this intervention (decision makers may include local and public officials, drinking water program managers, water treatment professionals, leaders and staff of other chronic disease programs, members of coalitions, etc.).

o Educate the general public on the tooth decay-preventing benefits and safety of community water fluoridation through venues such as dental and public health professional networks; parent, student, and teacher organizations; local town hall or board members; letters to the editor or Op-eds for local newspapers, and other media outlets or social media sites.

3: Data Collection and Reporting-identify, promote, and implement policy changes to improve and increase the amount and quality of fluoridated water in the jurisdiction:

Collect, analyze, and report on the proportion of people served by optimally fluoridated community water systems.

Ensure that information on Public Water Systems (PWS) in the CDC Water Fluoridation Reporting System (WFRS) is current and accurate, and that all discrepancy reports provided by CDC on WFRS are addressed on a timely basis.

Track policy changes in the recipient’s jurisdiction that affect community water fluoridation; analyze the anticipated impact of these policy changes; and report them in the CDC Annual Progress Report.

Summarize and disseminate water fluoridation data. Report data annually to CDC, including any reporting discrepancies.

ORAL HEALTH SURVEILLANCE STRATEGIES AND ACTIVITIES:

Identify and leverage opportunities and resources to develop or maintain surveillance capacity. Opportunities might include (but are not limited to) collaborating with other programs to address oral health related priority issues or cost sharing to support qualified staff (such as an epidemiologist or evaluator) with other programs.

Develop and maintain an oral health surveillance system that includes all of the following elements: surveillance plan, surveillance indicators, and timely data dissemination to monitor burden of oral disease and inform program and policy decisions.

o Develop or update a surveillance plan for the project period and submit it to CDC in the first year annual progress report. The surveillance plan must include the following components: surveillance plan goals and objectives, logic model, identification of needs and priorities evidenced by current oral health status and trends in population(s). Include prioritized indicators and their definitions; target population(s); data sources, data collection and analysis methods and frequency;

strategy to ensure data security; including privacy and data confidentiality, storage, and release policies by Health Insurance Portability and Accountability Act of 1996 (HIPPA) Privacy and Security Rules; plan for data dissemination, use and evaluation; and list of resources required, including personnel and budget.

o Collect, analyze, interpret, and disseminate data from core set of surveillance indicators for inclusion in a state-based oral health surveillance system recommended by the Council of State and Territorial Epidemiologist (CSTE) http ://www.cste.org/resource/resmgr/Chronic/StateBasedOralHealthSurveill.pdf ?hhSearchTerms=%22oral+and+health+and+surveillance+and+pdf%22.

http://www.cste.org/resource/resmgr/Chronic/StateBasedOralHealthSurveill.pdf?hhSearchTerms=%22oral+and+health+and+surveillance+and+pdf%22 http://www.cste.org/resource/resmgr/Chronic/StateBasedOralHealthSurveill.pdf?hhSearchTerms=%22oral+and+health+and+surveillance+and+pdf%22 http://www.cste.org/resource/resmgr/Chronic/StateBasedOralHealthSurveill.pdf?hhSearchTerms=%22oral+and+health+and+surveillance+and+pdf%22 o The table below lists the required core set of surveillance indicators, data sources, and minimum data collection frequency. Details about these indicators' specific measures, revision of indicators, and data access are in the 2015 CSTE Position Statement on the revision to the National Oral Health Surveillance System (NOHSS) Indicators http://c.ymcdn.com/sites/www.cste.org/resource/resmgr /2015PS/2015PSFinal/15-CD-01-ALL.pdf.

Note that the indicators bolded below ALSO serve as performance measures recipients will report to show progress on the bolded outcomes in the logic model. Details on these messages are below in the section "CDC Evaluation and Performance Measurement Strategy."

CORE SET OF

SURVEILLANCE

INDICATORS

DATA SOURCES FREQUENCY OF

DATA

COLLECTIONS

Prevalence of caries experience, untreated tooth decay, and dental sealants among third-grade students

Third-Grade Basic Screening Survey

(BSS)

Every 3-5 years

Permanent tooth loss among adults

Behavioral Risk Factor Surveillance System (BRFSS)

Every two years

Oral and pharyngeal cancer incidence mortality

Cancer Registries; National Program of Cancer Registries (NPCR); Surveillance Epidemiology; and National Cancer Institute (NCI)'s End Results (SEER); and Vital Statistics

Annually

Percent of Medicaid and CHIP enrolled children who received dental services (any dental services, preventive services, or dental sealants) in the past year

Centers for Medicare & Medicaid Services (CMS)'s CMS-416 Form http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/2015PS/2015PSFinal/15-CD-01-ALL.pdf

Percent of children who had a dental visit or preventive dental visit in the past year

National Survey of Children's Health

(NSCH)

Every 2-4 years

Percent of adults who had a dental visit in the past year

BRFSS

Percent of adults with a selected chronic disease(s)or risk factor(s) who had a dental visit in the past year

BRFSS adults with diabetes with a dental visit is a CDI Chronic Disease Indicator and posted on Chronic Disease data every 2 years. Adults with heart disease with a dental visit calculated from on-line BRFSS data.

Fluoridation status of community water systems

Water Fluoridation Reporting System

(WFRS)

Data on state oral health programs, workforce and infrastructure

State Synopsis o Collect, analyze, interpret, and disseminate data on at least one additional indicator twice during the 5 year period. It can be an indicator for the National Oral Health Surveillance System (NOHSS) (http://c.ymcdn.com/sites/www.cste.org/resource /resmgr/2015PS/2015PSFinal/15-CD-01-ALL.pdf) ;such as an indicator from BSS among older adults, or a new indicator based on state-added questions to BRFSS.

A new indicator collected through primary data collection rather than from existing data sources should include plans for sampling methodology; examiners, consents and approvals (including Office of Management and Budget or Institutional Review Board approval), data entry methods, quality assurance checks; and a Data Management Plan. Expand oral health surveillance beyond the core set of surveillance indicators to include one additional indicator consistent with the recipient's priorities and resources.

o Disseminate oral health surveillance data to inform public health programs and policy decisions. Evidence of data dissemination methods must include a burden document conducted once during the 5 year period. In addition, at least one of the core set of surveillance indicators and one additional indicator must be disseminated annually through publicly accessible media such as an oral health report, fact sheet, data brief, infographics, web-based content, or peer-reviewed publications.

*Minimum reportable elements for data collection activities:

Submit surveillance plan in the first year through CDC annual progress report. Former CDC/DOH recipients who have a 5 year oral health surveillance plan and who receive these NOFO funds must update their oral health surveillance plan if it is greater than 5 yeas old.

Complete at least a Third Grade Basic Screening Survey during the funding period and submit data for three indicators through the National Partner Cooperative Agreement Recipient(s). The data must meet the criteria outlined by the Association of State and Territorial Dental Directors (ASTDD)'s Children BSS Manual for submission to the National Oral Health Surveillance System (NOHSS).

The three BSS Indicators:

% of 3rd grade students with caries experience % of 3rd grade students with untreated tooth decay % of 3rd grade students with sealants

MEDICAL-DENTAL INTEGRATION STRATEGIES AND ACTIVITIES:

1: Partnerships and Collaborations–establish strategic partnerships with medical and dental programs and practices that serve the target population. Collaborate and integrate with disease prevention programs:

Develop and maintain an advisory panel of key chronic disease and oral health personnel to provide oversight throughout the five-year project period. Panel members should possess program, administrative, evaluation and clinical practice expertise, and must actively participate in advisory panel functions.

Convene a work group to develop a plan of action to improve medical-dental integration operations, including expanding program reach and establishing a sustainability effort. The work group should submit the plan of action within the first 90 days of receiving the award.

Develop and implement, where appropriate, a bidirectional referral system between oral health and chronic disease programs to ensure continuity of care.

Example: expand efforts to promote the use of the Quitline and cessation services among populations with high tobacco use rates; or increase the number of dental providers who screen, counsel and refer patients for hypertension and diabetes.

Identify oral health program staff and partners to oversee and implement work plan activities that will result in program, clinical, or systems-level changes.

Assess the training needs of involved personnel and partners; identify effective methods to provide technical assistance.

Engage Federally Qualified Health Centers, community health centers, health center programs, and medical professionals to provide clinical consultation on the importance of maintaining good oral health while they manage selected chronic disease.

2: Communication and Policy–implement communication activities that encourage system changes that support oral health and medical integration:

Develop a communication plan within the first year to address the importance and benefits of coordinated approaches for oral health and other chronic diseases.

Identify target audiences and key messages to convey. The plan should identify the target audiences, key plain language messages for each, and proposed communication channels. This plan should also identify a dissemination timeline and each partner's role.

Develop a quality improvement process and plan within the first year to monitor program implementation, improve program performance, and identify how the program will achieve stated outcomes.

Develop a sustainability plan within the first year to ensure long-term viability of collaborative efforts. The plan should also outline strategies for leveraging other resource opportunities to reduce reliance on federal funds.

3: Data Collection and Reporting–collect and report medical and dental integration project data to track efficiency and reach:

Provide baseline data on the selected chronic disease and identified target population(s).

Report on progress towards identified project outcomes to chronic disease and oral health partners.

Report methods to establish or enhance program infrastructure and capacity to increase oral health and chronic disease screening and referral rates.

[1] Engineering and Administrative Recommendations for Water Fluoridation, 1995. MMWR, September 29, 1995;44(RR–13):1–40

1. Collaborations

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

To ensure program success and achieve NOFO outcomes, recipients must identify and leverage opportunities that enhance their work with other programs addressing chronic diseases or underlying risk factors within the relevant programs and organizations. Opportunities include cost sharing to support a shared position (for example, chronic disease epidemiologist, health https://www.cdc.gov/mmwr/preview/mmwrhtml/00039178.htm communication specialist, program evaluator, or policy analyst) to collaborate on activities across units or departments within the recipient organization. Other options include, but are not limited to, joint planning and leadership activities, joint funding of aligned program strategies, establishing or maintaining coalition alliances, joint health education efforts, communication activities, data acquisition, analysis and communication, and combined development and implementation of environmental, policy, systems, or community interventions and other cost-sharing activities that align program strategies and performance measures. Chronic diseases of mutual importance include cancer, diabetes, cardiovascular disease, and obesity. Risk factors include tobacco use or consumption of sugar-sweetened beverages.

Letters of agreement are required for collaborations between the recipient and the other CDC-funded state chronic disease program with which they are collaborating. Recipients must file letters of agreement as appropriate, name the file "Letter_of_Agreement", and upload it as PDF file at www.grants.gov. Memorandum of Understanding (MOUs) or Memorandum of Agreement (MOAs) are required for collaborations between the recipient and other CDC-funded non-state organizations with which they are collaborating. Recipients must file the MOU or MOA as appropriate, name the file, and upload it as a PDF file at www.grants.gov.

b. With organizations not funded by CDC:

Recipients are required to establish, enhance, or maintain collaborative relationships with external organizations that have a critical role in achieving the NOFO outcomes. Partners and agencies identified should serve the priority population or communities of interest.

Collaborative relationships may include:

Stakeholder groups (coalitions and strategic partnerships) that have a common mission of advancing oral health in the jurisdiction.

Representatives from Departments of Education or School Board

Associations; parent, teacher, student organizations; school nurses, and health coordinators.

Representatives from water departments or associations.

Persons or groups representing targeted populations.

State administrators managing Medicaid/Medicare programs and other relevant federally funded programs.

Health Resources and Services Administration or other applicable federally-funded programs, including programs receiving Title III, V and VII funding.

Representatives from the Dental Association, Primary Care Associations, Primary Care Office, Regional Extension Centers, managed care organizations, Indian Health Service clinics, American Indian or Alaska Native tribal governments or tribally designated organizations.

Representatives from Federally Qualified Health Centers, Community

Health Centers, safety-net clinics and School-based Health Centers (SBHCs).

Representatives from privately funded oral health programs, civic and business associations, State Aging Network, and the AARP.

Representatives from dental provider and insurer organizations.

Representative opinion leaders, including decision-makers.

Recipients are required to submit letters of support from collaborating organizations. Letters of support must be dated within 30 days of the application and should describe the organizations’ roles and how they will help the applicant achieve the goals of the NOFO. If awarded, MOUs or MOAs with these partner organizations must be submitted within 90 days of receiving the award.

2. Target Populations The target audience for each recipient is the residents of the jurisdiction they serve. More specific target populations are identified for each of the topical areas below:

Sealant Program The School Sealant Program targets schools with large proportions of children at high risk for cavities through school free and reduced meal programs. Eligible schools include public elementary or middle schools located in urban areas in which at least 50% of students qualify for the federal or state free and reduced meal program. Rural schools are also eligible if their school district has a median income that is at or below 235% of the federal poverty level, as defined in section 673(2) of the Community Services Block Grant Act (42 U.S. C. 9902(2). Applicants must know or have a plan to identify where the gaps exist in school sealant programs in their respective jurisdictions.

Community Water Fluoridation Program The Community Water Fluoridation program targets populations and jurisdictions served by community water systems. Target populations might include vulnerable and underserved populations that have inadequate access to this effective oral health preventive intervention.

Identifying where the gaps exist in community water fluoridation is important to expanding reach.

Medical-Dental Integration Program The Medical-Dental Integration program targets men and women at risk for oral diseases and chronic diseases such as diabetes, cardiovascular disease, and obesity or risk factors such as tobacco use and consumption of sugar-sweetened beverages. Recipients should strive to improve the health status of identified groups and seek to reduce gaps in health outcomes or risk behaviors by targeting efforts on specific population groups disproportionately affected by the selected chronic disease or risk factor. Recipients must select and focus on one of the chronic disease areas mentioned above.

a. Health Disparities While oral diseases affect all segments of society, certain populations experience a disproportionate burden and risk or lack adequate access to prevention and treatment services.

Recipients should seek to achieve health equity by targeting populations disproportionately affected by oral diseases, using relevant data to identify populations and select culturally appropriate interventions for implementation.

Disproportionately burdened populations may be defined by sex, race, ethnicity, disability, sexual orientation, gender identity, geographic location, or socioeconomic status. Among populations that will benefit from this funding are residents of urban and rural areas; culturally isolated persons; medically underserved persons: minorities defined by race, religion, ethnicity, or culture; lesbian, gay, bisexual, or transgender (LGBT) persons, non-English speaking persons, or persons living with disabilities.

iv. Funding Strategy N/A

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy Recipients are required to report on CDC performance measures as specified in this NOFO, develop and implement an evaluation plan that addresses recipient efforts to implement strategies, make progress on the relevant outcomes from the logic model, and participate in national evaluation efforts. CDC will work with recipients to operationalize the required outcomes and performance measures (see Table 1. Evaluation Questions and Performance Measures) and assist with the identification of sound data collection approaches and the availability of existing data collection instruments. CDC will manage and synthesize the required outcome-performance measure data submitted by recipients.

Table 1. Evaluation Questions and Performance Measures

Program Element Relevant Outcome and Performance Measure

Strategy 1: School Sealant Programs

Expand School Sealant Program enrollment

Performance Measure: Number of eligible schools* with dental sealant programs within each CDC-funded jurisdiction.

*The term eligible schools is defined as schools with 50% or more of students eligible for free and reduced meals program (FARMs).

Data sources: CDC Annual Progress Report; National Center for Education Statistics (NCES)(http://nces.ed.gov/)**; and Annual State Synopsis (funded by National Partner Cooperative Agreement)

Strategy 2:

Community Water

Expand community water fluoridation within the jurisdiction.

http://nces.ed.gov/)

Fluoridation

Performance Measure: Number of people served by optimally fluoridated community water systems.

Data sources: CDC Annual Progress Report; Annual State Synopsis (funded by National Partner Cooperative Agreement);

and CDC WFRS

Strategy 3: Oral Health Surveillance

Disseminate oral health surveillance data on oral disease, risk factors, and use of preventive oral health services.

Performance Measure: Number of funded states that create and disseminate data products to program and policy decision makers.

Existence of an oral health surveillance plan that meets standards for quality surveillance plan

Performance Measure: Number of states that develop or update a state oral health surveillance plan in the first year of the project period.

Existence of an oral health surveillance system that meets standards for a quality surveillance system

Performance Measure: Number of funded states that have a oral health surveillance system.

Strategy 4: Medical- Dental Integration

Integrate oral health with other chronic disease programs

Performance Measure: Adults screened for the chronic disease or risk factor selected.

Data Source: CDC Annual Progress Report

Long Term Outcomes

Component 1:

Performance Measure: Prevalence of caries experience, untreated tooth decay, and dental sealants among third-grade students in the past 5 years.

Data Source: Third- Grade Basic Screening Survey (BSS)

Alternative Performance Measure for recipients whose latest Third-Grade BSS is more than 5 years old ago: Prevalence of caries experience, untreated tooth decay and dental sealants among third-grade students from at least one Third-Grade BSS conducted during the project period compared to prior Third- Grade BSS.

Data Source: Third-Grade BSS

Alternative Performance Measure for recipients with no prior Third-Grade BSS: Conduct at least one Third-Grade BSS and report data during the project period.

Data Source: Third-Grade BSS

Component 2:

Performance Measure: Prevalence of other co-morbid conditions.

Data Source: State chronic disease surveillance reports

CDC will use overall evaluation findings during the 5-year project period to establish key recommendations for partners on program impact, sustainability, and continued program improvement upon completion of…