CDC-RFA-TS-24-0005.pdf

Centers for Disease Control and Prevention

AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY

Pediatric Environmental Health Specialty Units (PEHSU)

CDC-RFA-TS-24-0005

05/07/2024

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA-TS- 24-0005. 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:

Pediatric Environmental Health Specialty Units (PEHSU)

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 purposes of this NOFO, research is defined as set forth in 45 CFR 75.2 and, for further clarity, as set forth in 42 CFR 52.2 (see eCFR :: 45 CFR 75.2 -- Definitions and https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR- 2007-title42-vol1-sec52-2.pdf. In addition, for purposes of research involving human subjects and available exceptions for public health activities, please see 45 CFR 46.102(l) (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section- 46.102#p-46.102(l)).

New

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-TS-24-0005

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.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l)

E. Assistance Listings Number:

93.161

F. Dates:

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

The LOI date will generate once the Synopsis is published if Days or a Date are entered.

2. Due Date for Applications:

05/07/2024 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

To Be Determined

G. Executive Summary:

1. Summary Paragraph The Agency for Toxic Substances and Disease Registry (ATSDR)’s mission is to protect communities from harmful health effects related to hazardous environmental exposures.

Environmental exposures during preconception and critical developmental stages in fetal, childhood, and adolescent development can have lifelong adverse consequences, and it is especially important that outreach and education efforts address these vulnerable life periods.

Providing outreach and education to communities on health risks associated with exposures to harmful environmental substances contaminants and ways to reduce such exposures can help prevent adverse health outcomes. Building capacity of primary care clinicians to recognize environmental exposures, and to provide appropriate management and counseling to patients with environmental exposures can further mitigate these risks. Partnering with other health professionals and organizations can increase community awareness of exposure reduction behaviors. These activities comprise a key part of ATSDR’s efforts in meeting its goal of reducing morbidity and mortality from environmental exposures.

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards

d. Total Period of Performance Funding:

$14,000,000

e. Average One Year Award Amount:

https://www.grants.gov/

$3,000,000 Between $2,500,0000-$3,5000,000. Varies based on funding for special projects.

f. Total Period of Performance Length:

3 year(s)

g. Estimated Award Date:

August 02, 2024

h. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview CDC/ATSDR aims to prevent health effects from hazardous environmental substances by translating science into actionable tools for health professionals, individuals, communities, and organizations. Since 1998, CDC/ATSDR has supported the Pediatric Environmental Health Specialty Units (PEHSU) in their work to prevent or mitigate hazardous environmental exposures during fetal childhood, and adolescent development as well as during the preconception period. Exposure to environmental substances during these critical stages of development may lead to lifelong adverse health effects, and under-resourced communities may face a disproportionate risk of exposure to hazardous substances in the environment. The specific outcome targeted by this NOFO is the continued support and enhancement of the PEHSU.

The approach undertaken by PEHSU involves the integration of environmental health into clinical care and public health. They routinely work in under-resourced communities, advancing equity in reproductive and children’s environmental health. PEHSU collaborate with various stakeholders, including health professionals; community organizations; federal, state, and local and tribal officials; families; schools; and others interested in children’s environmental health.

As a national network, PEHSU provide services to health professionals and communities including outreach, environmental health education, consultations, and referrals.

PEHSU's track record includes educating almost 600,000 health professionals and over 400,000 community members. With over 20,000 consultations and the publication of over 1300 works on children's environmental health, PEHSU has become a trusted source of scientific information on the prevention, diagnosis, and management of environmental health issues that affect reproductive and children’s health. This NOFO seeks to build on this foundation by evaluating the reach, impact, and effectiveness of PEHSU's outreach, educational, and consultative activities. The NOFO also seeks to effectively communicate its return on investments, improve financial processes, obtain additional funding and partners, and maximize internal collaboration.

The lessons learned from prior PEHSU initiatives will be thoroughly examined and incorporated into the ongoing efforts outlined in this NOFO.

b. Statutory Authorities This program is authorized under section 104(i)(14) of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980, as amended by the Superfund Amendments and Reauthorization Act (SARA) of 1986; [42 U.S.C. §9604(i)(14)]

c. Healthy People 2030 This NOFO supports Healthy People 2030 topic areas including Environmental Health (EH 01, 04, 05, 07, 08, 09, 10, and D01); Health Care Access and Quality (C-R02); and Schools (ECBP- D09, 10, and 11) https://health.gov/healthypeople/objectives-and-data/browse-objectives

d. Other National Public Health Priorities and Strategies This NOFO supports the following National Public Health Priorities and Strategies:

• Summary of Executive Order 13045 - Protection of Children From Environmental Health Risks and Safety Risks | US EPA (https://www.epa.gov/laws-regulations/summary-executive-order-13045-protection-children-environmental-health-risks-and)

• President’s Task Force on Environmental Health Risks and Safety Risks to Children (https://ptfcehs.niehs.nih.gov/)

• Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts (https://www.epa.gov/sites/default/files/2018- 12/documents/fedactionplan_lead_final.pdf)

• Federal Government’s Justice 40 Goal (https://www.whitehouse.gov/environmentaljustice/justice40/)

• CDC - National Health Initiatives, Strategies, and Action Plans - STLT Gateway (https://www.cdc.gov/publichealthgateway/strategy/index.html)

• ATSDR Mission, Vision, Impact, and Core Values (https://www.atsdr.cdc.gov/about/mission_vision_goals.html)

• NCEH/ATSDR Strategic Plan and Priorities | National Center for Environmental Health | CDC (https://www.cdc.gov/nceh/information/mission_vision_goals.htm)

e. Relevant Work ATSDR supports PEHSU with an interagency agreement with U.S. Environmental Protection Agency (EPA) and a cooperative agreement through this NOFO with a National Program Office that manages PEHSU program activities. PEHSU activities align with and support ATSDR activities around translation of science for health professionals and communities. Further details are here:

Core Funding:

CDC-RFA-TS19-1901

• Pediatric Environmental Health Specialty Units (PEHSU)

• https://www.grants.gov/web/grants/view-opportunity.html?oppId=315179 https://health.gov/healthypeople/objectives-and-data/browse-objectives https://www.epa.gov/laws-regulations/summary-executive-order-13045-protection-children-environmental-health-risks-and https://www.epa.gov/laws-regulations/summary-executive-order-13045-protection-children-environmental-health-risks-and https://ptfcehs.niehs.nih.gov/ https://www.epa.gov/sites/default/files/2018-12/documents/fedactionplan_lead_final.pdf https://www.epa.gov/sites/default/files/2018-12/documents/fedactionplan_lead_final.pdf https://www.whitehouse.gov/environmentaljustice/justice40/ https://www.cdc.gov/publichealthgateway/strategy/index.html https://www.atsdr.cdc.gov/about/mission_vision_goals.html https://www.cdc.gov/nceh/information/mission_vision_goals.htm https://www.cdc.gov/nceh/information/mission_vision_goals.htm https://www.grants.gov/web/grants/view-opportunity.html?oppId=315179

CDC-RFA-TS14-1402

• Pediatric Environmental Health Specialty Unit (PEHSU) Program

• https://www.grants.gov/web/grants/view-opportunity.html?oppId=252294

CDC-RFA-TS09-901

• Pediatric Environmental Health Specialty Unit (PEHSU) Program

• https://www.grants.gov/web/grants/view-opportunity.html?oppId=47704

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA-TS-24-0005 Logic Model: Pediatric Environmental Health Specialty Units (PEHSU)

Bold indicates period of performance outcome

Strategies and Activities Short-term Outcomes Intermediate Outcomes Long-term Outcomes

Education of health professionals

Provide pre-service and in-service clinical education

Mentor health professionals on environmental health practices

Provide clinical and scientific information on specific environmental hazardous exposures

Provide robust web presence with national resources for health professionals

Develop tools translating and

Increased integration of environmental health content within clinical curriculum

Increased opportunities for health professionals to develop and enhance their knowledge on hazardous environmental exposures

Increased primary care awareness of medicine practices

Increased recognition by healthcare professionals of the importance of and competency in taking

Increased recognition of individuals impacted by

Improved clinical care for patients impacted by hazardous

Improved delivery of appropriate exposure reduction counseling

Increased incorporation of environmental medicine into routine primary clinical care

Increased community awareness of

Increased early exposure detection and mitigation

Reduced risk of geographic and age-specific environmental exposures within children and persons of reproductive potential

More timely prevention or mitigation of hazardous environmental exposures during critical developmental stages in fetal, childhood, and adolescent development https://www.grants.gov/web/grants/view-opportunity.html?oppId=252294 https://www.grants.gov/web/grants/view-opportunity.html?oppId=47704 communicating research into clinical practice

Evaluate effectiveness of environmental health training

Identify and close knowledge gaps in training or tools

Coordinate communication between the program office and PEHSUs

Provide support and assistance to regional PEHSU to deliver training and education to health professionals

Educate healthcare professionals on the importance and practice of taking exposure histories in clinical care

Promote and evaluate the integration of exposure assessment and exposure reduction guidance into clinical delivery systems (e.g., Bright Futures, e-health records and clinical support systems) an environmental history as part of clinical care

Increase in access to knowledge about exposure risks and mitigation strategies among community members

Improved access to experts who understand

Better coordination with state and local health departments

Better recognition of PEHSU’s role and what resources they offer environmental risk reduction behaviors

Decreased risk among communities that are disproportionately affected by hazardous

Increased capacity of health professionals to provide timely and appropriate mitigation strategies to individuals impacted by hazardous

Increased rapport between communities and PEHSU

Education of and outreach to communities

Conduct community outreach and education on hazardous substances in the environment and prioritize those communities disproportionately affected by exposures

Promote actionable skills within populations to reduce risks to environmental hazards

Use available resources to identify priority environmental justice communities

Establish outreach plans for priority communities disproportionately affected by exposure to hazardous substances

Develop and tailor outreach materials and training for lay community audiences

PEHSU to deliver to communities

Consultations

Provide consultations to health professionals and communities on

Provide guidance on environmental hazard mitigation/reduction strategies to health professionals and

Develop communication and outreach channels with health professional and community audiences

Provide support to streamline responses to inquiries (e.g., develop and maintain library of responses to common inquiries; support partnerships with poison control centers)

Connect community members to local resources

Referrals

Provide specialty clinical and nonclinical resources to community

Provide resources to health professionals

Partnerships

Identify and develop partnerships that promote and support the PEHSU mission

Manage and support partnerships between PEHSU and other organizations to help better achieve the

Partner with communities to expand reach of regional

PEHSU

Build rapport and trust with communities

i. Purpose The purpose of the PEHSU is to lead the way in enhancing reproductive and children's health by incorporating environmental health into clinical care and public health, while also supporting communities. This funding opportunity will support initiatives aimed at educating health professionals, conducting outreach and education to communities, providing consultative services, offering referral resources, and collaborating with stakeholders to prevent or minimize hazardous environmental exposures during fetal, childhood, and adolescent development as well as the preconception period.

ii. Outcomes Outcomes to achieve by the end of the period of performance:

Short-term

1. Increased integration of environmental health content within clinical curriculum

2. Increased opportunities for practicing health professionals to develop and enhance their knowledge on hazardous environmental exposures

3. Increased primary care awareness of environmental medicine practices

4. Increased recognition by healthcare professionals of the importance of and competency in taking an environmental history as part of clinical care

5. Increase in access to knowledge about exposure risks and mitigation among community

6. Better recognition of PEHSU’s role and what resources they offer

Intermediate

7. Increased recognition of individuals impacted by environmental exposures

8. Increased community awareness of environmental risk reduction behaviors

9. Increased capacity of health professionals to provide timely and appropriate mitigation strategies to individuals impacted by hazardous environmental exposures

iii. Strategies and Activities Recipient activities and expectations for the PEHSU program are consistent with the logic model.

The work of the recipient is to serve as the PEHSU National Program Office (NPO). The recipient/NPO is encouraged to apply principles of “servant leadership” in the operations and relationship the NPO builds with regional PEHSU personnel. These collaborative efforts should ensure efficient delivery of services and effective representation of PEHSU performance within each PEHSU region and across the PEHSU network, including NPO activities that support national and regional PEHSU operations.

Education of health professionals

• Provide pre-service and in-service clinical education

• Mentor health professionals on environmental health practices

• Provide clinical and scientific information on specific environmental hazardous exposures

• Provide robust web presence with national resources for health professionals

• Develop tools translating and communicating environmental health research into clinical practice

• Evaluate effectiveness of environmental health training

• Identify and close knowledge gaps in training or tools

• Coordinate communication between the program office and PEHSU

• Provide support and assistance to regional PEHSU to deliver training and education to health professionals

• Educate healthcare professionals on the importance and practice of taking exposure histories in clinical care

• Promote and evaluate the integration of exposure assessment and risk reduction guidance into clinical delivery systems (e.g., Bright Futures, e-health records and clinical support systems)

Education of and outreach to communities

• Conduct community outreach and education on hazardous substances in the environment and prioritize those communities disproportionately affected by exposures

• Promote actionable skills within populations to reduce risks to environmental hazards

• Use available resources to identify priority environmental justice communities

• Establish outreach plans for priority communities disproportionately affected by exposure to hazardous substances

• Develop and tailor outreach materials and training for lay community audiences

• Provide support and assistance to regional PEHSU to deliver training and education to communities

Consultations

• Provide consultations to health professionals and communities on environmental exposures

• Provide guidance on environmental hazard mitigation/reduction strategies to health professionals and communities

• Develop communication and outreach channels with health professional and community audiences

• Provide support to streamline responses to inquiries (e.g., develop and maintain library of responses to common inquiries; support partnerships with poison control centers)

• Connect community members to non-clinical local resources

Referrals

• Provide specialty clinical and nonclinical referral resources to community members

• Provide specialty clinical and nonclinical referral resources to health professionals

Partnerships

• Identify and develop partnerships that promote and support the PEHSU mission

• Manage and support partnerships between PEHSU and other organizations to help better achieve the PEHSU mission

• Partner with communities to expand reach of regional PEHSU

• Build rapport and trust with communities

Specifically, recipient as NPO will:

• Support regional PEHSU (established in each of the 10 federal regions), through timely execution of contractual agreements (i.e., fully executed contracts within 60 days of the beginning of the project period) with each of the academic medical and nursing schools that sponsor PEHSU.

• Assure adequate time of critical staffing in the NPO, including a minimum of two full time employees (FTEs) for day to day program management and financial support with additional part or full time support for other needs including communications/promotions, contract management, cooperative agreement/grant support, and other needs.

https://www.atsdr.cdc.gov/dro/index.html

• Assure critical clinical expertise in reproductive and pediatric environmental medicine is maintained in each regional PEHSU. This expertise could be derived from a variety of disciplines including, but not limited to pediatrics or family medicine, maternal fetal medicine or obstetrics/gynecology, occupational and environmental medicine, or medical toxicology.

• Establish and maintain transparency through timely, clear, concise communication with funders and regional units. Communications should be responsive to needs, timely, and relevant for all operations including but not limited to contracts, performance across the network, best performance practices, performance challenges, status of NPO support activities, and important news and updates.

• Establish annually the performance targets that each regional PEHSU will contribute to achieve overall performance expectation and outcome measures. Workload distribution should consider different strengths among the regional PEHSU and their expected level of performance across all measures, taking into account that measures divided by 10 may not optimally leverage regional strengths.

• Identify needs/interest from unit(s) in expanding geographic reach through satellite units, with final decision on adding satellite unit and staffing of that unit made in collaboration with ATSDR. New regional satellite operations requests are submitted with the annual continuation application (due six [6] months after the start of each budget year). This request should cover proposed start date, satellite operational responsibilities, regional work plan linkages, proposed regional director management of satellite operations, work plan tangibles, and a detailed budget with justifications. If approved, the recipient’s annual continuation application funding will provide support for the new satellite operations.

• Facilitate and support identification of appropriate leadership for regional units when needed, with final decision on staffing made in collaboration with ATSDR.

• Prepare plans annually for development or updates of PEHSU resources and tools considering gaps in educational resources and current needs. These resources and tools should focus on exposure reduction activities that build capacity in health professionals to advise exposed individuals, empower communities with environmental health information, and connect health professionals and communities with environmental health resources for children and families. Efforts should be made to engage federal funders, regional PEHSU directors, and others as appropriate to identify resource needs and support collaborative work on these resources.

• Provide technical guidance associated with implementing program strategies and activities that improve reproductive and pediatric environmental health.

• Provide emergency response support and assist regional PEHSU in developing and/or delivering training and educational resources for communities to address natural or technological disasters. These disasters may include flooding, wildfires, hurricanes, earthquakes, and extreme heat events as well as hazardous substance spills or releases.

• Coordinate timely internal peer review of national PEHSU products.

• Facilitate technical reviews from subject-matter experts for PEHSU products and coordinate timely submission of continuing education packages for products.

• Maintain and expand a national learning management system and the course work available within it. Promote its use in clinical pre-service, residency, and in-service training and evaluate the impact of training provided.

• Support the steering committee monthly meetings for regional PEHSU directors as a forum for them to collectively:

o Provide input to the NPO and funders on challenges and successes o Give feedback on network operational processes and support needed from NPO and funders o Share best practices that advance program outcomes o Exchange important and relevant information between regions o Discuss strategic direction of the PEHSU network; and o Develop national initiatives to achieve outcomes of the PEHSU program, leveraging strengths of regional units.

• Facilitate selection of PEHSU strategic director by steering committee members and meet monthly with strategic director and funders to discuss important network-wide issues, strategies for growth and development of the network, and other topics.

• Create steering committee meeting agendas with PEHSU strategic director and funders to be reflective of timely and relevant topics for the entire network. Make agenda for each meeting available for PEHSU directors and funders at least 24 hours before meeting.

Take meeting minutes and make these available to PEHSU directors and funders within 24 hours of each meeting.

• Using the logic model, collaborate with ATSDR to define outcome measures presented in the “PEHSU Performance Measures” section and identify sources of data needed for ongoing evaluation to monitor achievement of outcomes in the logic model.

• Develop a simplified data management system for data collection, data quality, data inquiry, and data integration (with secondary data sources). This system should inform program management of tracking output and outcome measures and allow analytical analysis and robust reporting on program achievements.

• Meet monthly with each region to review program data, including but not limited to progress toward achieving program measures and outcomes, spend down/finances, challenges to accomplishing work, and important achievements/impactful activities.

• Identify quality improvement opportunities and develop a continuous quality improvement plan with input from regional directors to guide program refinements.

• Provide quarterly reports to ATSDR program staff and grants management system electronically within 30 days of the end of each quarter that include:

o Information on progress by the network toward meeting performance measures and outcomes o Challenges and needs with recommendations on how to address them o Impact stories that demonstrate breadth and depth of PEHSU activities o Comprehensive financial tracking of spend down by NPO and units and other relevant financial information o Summary of collaborations with external partners (funded or non-funded); if funded include relevant details of financial tracking and spend down through the partnership(s) o Summary of assistance provided by the PEHSU for emergency preparedness and response for natural/technological disasters o Recommendations for improving effectiveness of PEHSU program

• Include with each quarterly report a snapshot of the information contained within not to exceed 2 pages that can be shared with other federal funders, partners, and agency leadership.

• Plan and host an annual meeting of the PEHSU network and funders for the purpose of strengthening collaborations and promoting professional and organizational development in pediatric and reproductive environmental medicine. If appropriate, hold annual PEHSU meeting in conjunction with other federal partner meetings when such collaboration can strengthen partnerships, expand the reach of the PEHSU program, and contribute to reaching program outcomes. Incorporate input from the PEHSU network in planning and executing this annual meeting.

• Collaborate with network and funders to identify possible funding options that build PEHSU performance capacity and improve its current and future financial sustainability.

• Maintain and continually improve the PEHSU website (https://www.pehsu.net/), incorporating best practices for website design; updating and refreshing content regularly;

incorporating social media; employing innovative design features, including from regional PEHSU sites; highlighting PEHSU events and products; and streamlining search capabilities.

• Establish and maintain a repository of PEHSU activities with links when appropriate, organized by topic and type of activity and readily accessible to funders and the network.

The contents of the repository should be determined in collaboration with the network and funders and include but not be limited to o Factsheets o Webinars, ECHO programs, other trainings o Videos, comics, booklets, other visual materials o Articles, book chapters, other published works o Media featuring PEHSU o List of federal, state, local, and nongovernmental organizations and committees with PEHSU participation

• Ensure that all materials developed under cooperative agreement funding will not be copyrighted and will remain in the public domain to encourage wider distribution.

• Build communication channels and routinely promote PEHSU products, services, and accomplishments among local, state, tribal, and national organizations serving healthcare professionals, environmental health organizations, community organizations and health centers, other health care providers (e.g., HMOs, health insurance providers, etc.), and public health agencies.

• Review annually a promotional communication plan with regional directors and federal partners, including plans to reach priority audiences. Review effectiveness of promotional plans annually, and in collaboration with federal partners and regional directors, identify steps to improve reach with these efforts.

• Establish and maintain a PEHSU speaker's bureau and facilitate involvement of speakers for media, environmental health organizations, schools, federal programs, and other organizations both proactively and in response to speaker requests.

• Facilitate development and promotion of academic training opportunities in reproductive and/or pediatric environmental medicine and nursing across the PEHSU network.

• Identify and explore opportunities to create a pediatric and reproductive environmental health specialty for physicians and nurses.

• Assess annually PEHSU satisfaction with NPO support and share results with ATSDR.

Recipient will also ensure clinical academic centers serving as regional PEHSU will:

• Dedicate 20 percent of an FTE by regional directors to the activities of their PEHSU. The regional director will participate in and contribute to monthly steering committee meetings (see details above). Regional directors cannot delegate authority to regional sub-units/satellites, or to a regional sub-contract.

• Commit a minimum of 60% effort to delivering regional and national services that reach health professional audiences and up to 40% effort to lay audiences.

• Maintain the necessary clinical disciplines to staff the regional PEHSU, support regional activities, and ensure delivery of PEHSU services.

• Submit quarterly reports electronically to the NPO that include:

o Information on progress toward meeting performance measures and outcomes o Challenges and needs with suggestions on how to address these o Impact stories that demonstrate breadth and depth of activities o Financial tracking of spend down and other relevant financial information o Summary of collaborations with external partners (funded or non-funded); if funded include relevant details of financial tracking of spend down through the partnership(s); and o Summary of assistance provided for emergency preparedness and response for natural/technological disasters.

• Participate in and contribute to annual PEHSU meeting.

• Identify opportunities for collaboration across the network, developing programs that leverage specific individual and regional technical expertise to meet program outcomes and foster professional development.

• Participate in monthly meetings with NPO to discuss progress toward achieving program measures and outcomes, spend down/finances, challenges to accomplishing work, and important achievements/impactful activities, as well as share timely updates from the region.

• Participate in workgroups as needed to advance national initiatives, development of educational resources, or support other program activities.

• Provide a setting for mentorship, rotations, internships, scholar programs, and other learning opportunities to increase awareness of reproductive and pediatric environmental health.

• Develop regionally and nationally oriented environmental health educational materials using evidenced-based risk communication messaging for health professionals and community audiences.

• Develop partnerships with state and local health departments and other federal agencies, schools, community organizations, tribal and other organizations interested in pediatric and reproductive health to plan and deliver relevant environmental health education and outreach. These efforts may include assistance to communities, families, and health care providers to address environmental health threats at sites where ATSDR and EPA have ongoing health risk evaluation and remediation activities.

• Provide technical and consultative assistance to health professionals responding to concerns about reproductive and pediatric exposures to environmental health hazards.

• Provide expert consultative advice to families and connect them to specialty clinical care as needed, as well as to other resources that can assist in mitigating reproductive and childhood environmental health risks.

• Provide expert pediatric and reproductive environmental medicine consultations and technical support for emergency preparedness and response actions. These actions may be needed during natural and/or technological disasters where families are threatened with exposure or illness from hazardous substance spills or releases during these events.

1. Collaborations

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

The PEHSU Program has a long history and expertise in addressing reproductive and children’s environmental health issues as well as collaborating on a variety of initiatives throughout the agency. In order to continue these efforts, the recipient (NPO) is encouraged to facilitate PEHSU collaborations with other CDC and ATSDR cooperative agreement and/or grant programs to identify common needs, promote resource and information sharing, and collaborate on educational efforts. These optional collaborative efforts should align with ATSDR goals and facilitate public health actions to improve the health of communities and support PEHSU efforts in implementing activities and achieving the NOFO period of performance outcomes.

The recipient (NPO) is encouraged to describe how existing or potential collaborations with other CDC-funded programs and organizations could assist with implementing activities and achieving the NOFO outcomes. These programs include, but are not limited to:

• ATSDR APPLETREE program (https://www.atsdr.cdc.gov/states/index.html) Support community and local health professional education on potential health effects related to site contamination

• Childhood Lead Poisoning Prevention Program | CDC (https://www.cdc.gov/nceh/lead/default.htm) Share resources and collaborate on educational efforts

• National Asthma Control Program | CDC (https://www.cdc.gov/asthma/nacp.htm) Share resources and collaborate on educational efforts

• ATSDR Environmental Justice Index (EJI) (https://www.atsdr.cdc.gov/placeandhealth/eji/index.html) Use tool to work with communities disproportionately affected by environmental contamination; promote dissemination of tool with other partners https://www.atsdr.cdc.gov/states/index.html https://www.cdc.gov/nceh/lead/default.htm https://www.cdc.gov/asthma/nacp.htm https://www.atsdr.cdc.gov/placeandhealth/eji/index.html

Memorandums of understanding, and/or memorandums of agreement (MOUs/MOAs) as well as letters of support are optional, and not required. If submitted, upload as a PDF file titled “MOUs/MOAs” and/or “Letters of Support” to www.grants.gov..

b. With organizations not funded by CDC:

The recipient (NPO) is encouraged to support PEHSU collaborations with organizations not funded by CDC. These optional collaborations with organizations could include but are not limited to nonprofits, schools, community organizations, government agencies, tribal organizations, and others that can support PEHSU efforts in implementing activities and achieving the NOFO period of performance outcomes.

The PEHSU program potential partners are those with the capability to support the PEHSU in

• Translating environmental health research into public health intervention programs to improve reproductive and children’s environmental health

• Providing medical/nursing education on environmental health topics, and

• Providing education on environmental health topics to families/communities.

Memorandums of understanding, and/or memorandums of agreement (MOUs/MOAs) as well as letters of support are optional, and not required. If submitted, upload as a PDF file titled “MOUs/MOAs” and/or “Letters of Support” to www.grants.gov.

2. Population(s) of Focus The PEHSU Program serves health professionals, community members and organizations, schools, families, governmental and tribal officials and entities, and others having an interest in environmental exposures that influence reproductive and pediatric health. This could also include any public health entity, national organization, academic institution, medical system, or non-profit organization that aims to increase the capacity of state, local, tribal, or territorial health agencies in environmental health education and preventing harmful environmental exposures during critical developmental stages.

The regional structure of the PEHSU enables each unit to develop a thorough understanding of local concerns and tailor education and outreach to meet community needs. PEHSU employ available tools and resources (e.g., ATSDR Environmental Justice Index and EPA EJScreen) to help identify populations with disproportionate risks, where PEHSU services can increase health equity. Through partnerships with trusted community organizations, PEHSU increase capacity in communities to address environmental concerns and empower individuals to make choices to protect their families from environmental hazards. Education of health professionals, particularly in areas with environmental exposure concerns, increases their capacity to provide appropriate exposure risk mitigation strategies and develop programs that decrease environmental exposures during the critical stages of development.

This NOFO, including funding and eligibility, is not limited based on, and does not discriminate on the basis of race, color, national origin, disability, age, sex (including gender identity, sexual orientation, and pregnancy) or other constitutionally protected statuses.

a. Health Disparities The goal of health equity is for everyone to have a fair and just opportunity to attain their highest level of health. Achieving this requires focused and ongoing societal efforts to address historical http://www.grants.gov/ and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.

Broadly defined, social determinants of health are non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces (e.g., racism, climate) and systems include economic policies and systems, development agendas, social norms, social policies, and political systems. See content below and in other sections (e.g., Approach, Collaborations, Populations of Focus) for information on how this specific NOFO affects social determinants of health.

A health disparity is a preventable difference in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been socially, economically, geographically, and environmentally disadvantaged. Health disparities are inextricably linked to a complex blend of social determinants that influence which populations are most disproportionately affected by these diseases and conditions.

This NOFO supports efforts to improve the health of children disproportionately affected by harmful environmental exposures. In developing educational materials and conducting training and outreach activities, the recipient must ensure that under-served populations such as tribal nations, people with disabilities, rural populations, sexual and gender minorities, non-English speaking populations and those for whom English is a second language are considered. The recipient will ensure that data, indices, and geospatial tools (e.g., CDC’s Social Vulnerability Index or Environmental Justice Dashboard; ATSDR’s Environmental Justice Index; and EPA’s MyEnvironment and EJScreen) are used to better understand community characteristics.

Examples of considerations include access to quality health care, healthy food choices, and presence of significant environmental pollution sources in locations where children live, play, and attend school, as well as where people of reproductive potential live, work, and play. This information can help plan effective community outreach strategies, build or strengthen collaborations, and develop appropriate educational and counseling materials for populations which historically may have been overlooked.

iv. Funding Strategy N/A

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

The purpose of evaluation and performance measurement is to help ATSDR and the recipient monitor the extent to which activities planned were successfully completed, demonstrate how PEHSU activities contribute towards program outcomes and inform decisions about future programming that drive continuous program improvement for more efficient and effective program performance.

ATSDR will assess the degree to which strategies in the logic model have been implemented and outcomes have been achieved through submitted quantitative and qualitative reporting. The assessment will occur on an ongoing basis through the evaluation of submitted products, training, and technical assistance delivered. The recipient is expected to develop an evaluation plan, submit quarterly and annual progress reports, and an additional final project report at the conclusion of the period of performance summarizing achievements, challenges, lessons learned, and next steps. Optional templates may be provided to guide the evaluation and performance measurement plan development and the final project reporting.

This section presents example measures that ATSDR will use to track the implementation of strategies and activities (process evaluation) and progress on achieving period-of-performance outcomes (outcome evaluation). The measures below are not comprehensive or final, and ATSDR will finalize evaluation and performance measures in collaboration with the recipient within six (6) months of the project start date. ATSDR will work with the recipient on cadence of reporting of each measure quarterly and/or annually. The recipient should include key partners in the evaluation and measures planning process and ensure that information collected will be limited to data that can be analyzed and used for program improvement.

Process Evaluation

Education of health professionals

• Environmental health topics covered in the development of educational resources and tools

• Types of health professional trainings offered

• Website engagement with educational materials by health professionals

Education of and outreach to communities

• How community educational outreach activities reach populations disproportionally affected by environmental exposures

• Types of technical support provided in federal responses for natural and technological disasters

• Website engagement with educational materials by communities

Consultations

• Monitoring most frequent consultation topics for health professionals and communities

Referrals

• Effective referrals for community members, health professionals, state, local, and/or tribal public health officials, and others

Partnerships

• How new/existing partnerships are supported

• How existing organizational structure is leveraged to enhance partnerships

• Degree of PEHSU satisfaction with NPO support

Outcome Evaluation

• How PEHSU are increasing integration of environmental health content in clinical curricula (Short-term Outcome 1, page 17)

• Number of educational resources and tools developed (Short-term Outcome 2, page 17)

• Average number of hours training provided per week (Short-term Outcome 2, page 17)

• Examples of trainings that were particularly impactful and why (Short-term Outcome 3, page 17)

• Percentage of new clinical training materials that emphasize importance of taking an exposure history as part of clinical care (Short-term Outcome 4, page 17)

• Expansion of collaboration with community health workers, promotoras, and other community partners (Short-term Outcome 5, page 17)

• Monitoring website engagement (Short-term Outcome 6, page 17)

• Promotion of PEHSU program by NPO (Short-term Outcome 6, page 17)

• Number of health professionals who were trained by PEHSU (Intermediate Outcome 7, page 17)

• Effective information dissemination to communities (Intermediate Outcome 8, page 17)

• Most frequent consultation topics each quarter, providing at least 3 and not more than 5 topics (Intermediate Outcome 9, page 17)

When evaluating a program or project, relying solely on performance measures has limitations.

Measures often fail to represent the true picture of how well or poorly a program/project or recipient is doing and may not be able to consider contextual factors. Therefore, it is important to have other ways of collecting program/project information, such as success stories, to fully demonstrate performance.

The recipient will be required to submit a detailed evaluation and performance measurement plan, including a Data Management and Access Plan within the first 6 months of award. Data collected is for ongoing monitoring of the award to evaluate its effectiveness, and for continuous program improvement.

Data Management Plan

An overall Data Management Plan (DMP) is required by the recipient and should address general data management practices regarding public health data across the cooperative agreement. A DMP is required if the NOFO involves the collection or generation of public health data. The goal of the policy is to ensure public access to federally funded public health data. This specifically requires the development of a DMP for PEHSU activities that includes collection of public health data. DMPs should be as complete as possible but ATSDR can work jointly with the recipient within the first six (6) months after award to finalize the plan.

DMPs can be updated as appropriate throughout the life cycle of the data and should include a brief description of the following:

• Data that will be collected, including type of data collected or created and how that data will be captured and stored

• Data standards, including file formats and contextual information that make the data more meaningful and useable

• Period of time that data will be retained before disseminating to wider audience, if applicable

• Data access, including when data will be available, who will have access, how will it be shared, what contextual information will be included with the data, and processes and permissions to gain access with description of how confidential data will be protected

• Plans for archival and long-term preservation of the data, or explanation of why long-term preservation and access cannot be provided

The DMP may be submitted as a checklist, paragraph, or other format, as currently, HHS/CDC does not have a standardized DMP template or checklist due to Paperwork Reduction Act requirements. ATSDR may also provide a template, if needed.

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

• How applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement, including, as applicable to the award, how findings will contribute to reducing or eliminating health disparities and inequities.

• 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).

• How evaluation findings will be disseminated to communities and populations of interest in a manner that is suitable to their needs.

• Plans for updating the Data Management Plan (DMP) as new pertinent information becomes available. If applicable, throughout the lifecycle of the project. Updates to DMP should be provided in annual progress reports. 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/additional-requirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, the applicant 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…