dp12-1205 foa amendment ii final 02.17.12.doc

Amendment II made 2.17.12 to the following sections:

· Changes made to PART 2. FULL TEXT; I. FUNDING OPPORTUNITY DESCRIPTION; Program Implementation for Component 3: Health Systems Change and Quality Clinical Preventive Services in the National Breast Cervical Cancer Early Detection Program; Recipient Activities, under 4. Screening, Diagnostic and Patient Navigation Services; b. Screening Provision; fifth (5th) bullet.

· Change made to section II. AWARD INFORMATION; for Component 3: Health Systems Change and Quality Clinical Preventive Services in the National Breast and Cervical Cancer Early Detection Program; fourth (4th) bullet.

· Change made to section IV. Application and Submission Information; Content and Form of Application Submission; Project Narrative section for Component 2: Policy and Environment Approaches and Community-Clinical Linkages in the National Comprehensive Cancer Control to revise the page limit.

· Changes were made to include, as Addendum III an Action plan (work plan) template for Component 2: Policy and Environment Approaches and Community-Clinical Linkages in the National Comprehensive Cancer Control. The Template is also included for quick access to recipients applying to this Component.

· Changes are made to include the NCCCP Priorities as Addendum IV, as mentioned under Program Implementation; Recipient Activities; Program Management for Component 2: Policy and Environment Approaches and Community-Clinical Linkages in the National Comprehensive Cancer Control.

Amendment I made 1.27.12 to the following sections:

· Changes made in the Technical Assistance Opportunities for Potential Applicants to include a third call for applicants from the Pacific Island Jurisdictions on January 31 at 7:30 p.m. – 9:30 p.m. Eastern Daylight Savings Time. Access information for the call will be provided to eligible applicants via electronic mail.

· Changes made to Section III Eligibility Information to correct eligible applicants that may apply for Component 1 of the FOA.

RFA Number: DP12-1205 Title of Funding Opportunity Announcement (FOA): Cancer Prevention and Control Program for State, Territorial and Tribal Organizations Table of Contents

Part 1. Overview Information Part 2. Full Text of the Announcement Section I. Funding Opportunity Description Section II. Award Information Section III. Eligibility Information Section IV. Application and Submission Information Section V. Application Review Information Section VI. Award Administration Information Section VII. Agency Contacts Section VIII. Other Information

PART 1. OVERVIEW INFORMATION

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Federal Agency Name: Federal Centers for Disease Control and Prevention (CDC)

Funding Opportunity Title: Cancer Prevention and Control Programs for State, Territorial and Tribal Organizations

Announcement Type:

· New – Type 1

Agency Funding Opportunity Number: CDC-RFA-DP12-1205 Catalog of Federal Domestic Assistance Number:

93.283 for the National Comprehensive Cancer Control Program and the National Program for Cancer Registries; 93.919 for the National Breast and Cervical Cancer Early Detection Program Key Dates:

Application Deadline Date: March 26, 2012, 11:59pm U.S. Eastern Standard Time Potential applicants must participate in one of two conference calls for information on this Funding Opportunity Announcement (FOA). The conference calls will be conducted by the Division of Cancer Prevention and Control. The calls will be held:

· January 31, 2012 at 10:00 a.m. to 12:00 p.m. Eastern Daylight Savings Time For eligible applicants in the Atlantic, Eastern, and Central time zones. This conference call can be accessed by calling 1-888-282-4154. The leader for this call is Tanya Hicks and the passcode is 69711323.

· January 31, 2012 at 3:30 p.m. to 5:30 p.m. Eastern Daylight Savings Time – For eligible applicants in the Mountain and Western time zones. This conference call can be accessed by calling 1-888-282-4154. The leader for this call is Tanya Hicks and the passcode is 69711323.

· January 31, 2012 at 7:30 p.m. to 9:30 p.m. Eastern Daylight Savings Time --

For eligible applicants in the Pacific Island Jurisdictions. Access information for the conference call will be distributed to eligible applicants via electronic mail. The leader for this call will be Tanya Hicks.

Executive Summary The Centers for Disease Control and Prevention (CDC) announces the availability of Fiscal Year (FY) 2012 funds for a cooperative agreement program for state, territorial, and tribal health departments/organizations or their bona fide agent. The purpose of this funding opportunity announcement (FOA) is to implement cancer prevention and control programs to reduce morbidity, mortality, and related health disparities. In accordance with the Healthy People 2020 Goals for the nation, this FOA focuses on addressing the national cancer burden by conducting cancer surveillance, increasing access to screening, improving health outcomes for people living with cancer, and providing the evidence for and evaluation of policy and environmental approaches. This new FOA creates a new platform for the coordination and integration of long-standing cancer activities at the state, tribal and territorial levels. This is achieved by constructing 5 components in the new FOA which includes 3 previously funded programs and 2 new components to achieve coordination and integration of cancer activities and to introduce innovation to long-standing programs. The five components are as follows: Program Management, Leadership and Coordination (Component 1), which enables grantees to provide leadership, management and oversight to the other funded components in this FOA; Policy and Environmental Approaches and Community-Clinical Linkages (Component 2), which represents the previously established program of the National Comprehensive Cancer Control Program (NCCCP); Health Systems Change and Quality Preventive Services (Component 3), which corresponds to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP); Surveillance Activities (Component 4), which represents the National Program of Cancer Registries (NPCR); and a new Innovative Demonstration Projects to Advance Population-Based Cancer Screening (Component 5), which supports the implementation of large-scale, innovative demonstration projects that contribute to building organized cancer screening efforts that impact population-level cancer screening rates.

Previously funded components under DP07-703, including NCCCP, NBCCEDP and NPCR will continue the same cancer-related activities. What is new in the FOA is the inclusion of Components 1 and 5 to better integrate efforts across all funded components and to encourage innovation to achieve greater outcomes.

Measurable outcomes of the program will be in alignment with one or more of the following performance goals for the National Center for Chronic Disease Prevention and Health Promotion:

· Reduce the age-adjusted annual rate of cancer mortality per 100,000 population (HP-C1).

· Increase the proportion of women who receive a breast cancer screening based on the most recent guidelines (C17).

· Increase the proportion of women who receive a cervical cancer screening based on the most recent guidelines (HP-C15).

· Increase the number of central, population-based registries from the 50 States and the District of Columbia that capture case information on at least 95 percent of the expected number of reportable cancers (Healthy People-C12).

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be reviewed. For the definition of research, please see the CDC Web site at the following Internet address:

http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf.

PART 2. FULL TEXT

I. FUNDING OPPORTUNITY DESCRIPTION

Statutory Authority: The National Comprehensive Cancer Control Program (NCCCP) is authorized under sections 317(k)(2) and (e) of the Public Health Service Act, [42 U.S.C. section247b (e) and (k)(2)], as amended. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is authorized under sections 1501-1510 [42 U.S.C. 300k, 42 U.S.C. 300l, 42 U.S.C. 3001-1, 42 U.S.C. 300m, 42 U.S.C. 300n, 42 U.S.C. 300 n-1, 42 U.S.C. 300 n-2, 42 U.S.C. 300 n-3, 42 U.S.C. 300 n-4, 42 U.S.C. 300 n-5] of the Public Health Service Act, as amended. The National Program of Cancer Registries (NPCR) is authorized under the Public Health Service Act, (42 USC 280e-280e-4; Public Law 102-515), as amended.

Background

Cancer is the second leading cause of death among men and women in the United States (Heron, 2009). As of 2007, there were 11.7 million cancer survivors, and these numbers are expected to rise (Centers for Disease Control and Prevention, 2007). Additionally, the economic costs of cancer are a burden on communities and the health care system. Over the past 20 years, the medical costs of cancer have nearly doubled (Tangka et al., 2010).

Breast, cervical, and colorectal cancers are highly treatable when detected early using cost effective screening tests; and in the case of cervical and colorectal cancers, altogether preventable when precancerous changes are detected and treated early (Whitlock, Lin, and Beil, 2008; Nelson, Tyne, Bougatsos, and Humphrey, 2009; Hartman, Hall, Nanda, Boggess, and Zoulnoun, 2002). Access to cancer screening is highly dependent on access to medical care that is affordable, convenient, and trusted. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was established in 1990 in response to the need to provide these cancer screening services to low-income, uninsured women. Grantees of the NBCCEDP have had a direct role in the health care delivery system by providing payment for screening services to uninsured women. This collaboration between public health and health care providers provides a framework to improve the scope and quality of screening services available to the U.S. public.

In the past, outreach efforts in the NBCCEDP have been constrained by grantees’ limited capacity to pay for screening services. Current provisions in the Affordable Care Act (ACA) would make screening services more widely available. However, research demonstrates that access to health insurance and medical care are not the only factors that influence participation in screening (Centers for Disease Control and Prevention, 2010). The NBCCEDP is positioned to assess the impact of expanded coverage and address non-cost-related screening barriers by implementing population-based strategies.

Surveillance is the cornerstone of cancer prevention and control efforts and a Strategic Priority for the Centers for Disease Control and Prevention (CDC). Vital information about cancer cases is necessary for monitoring trends, planning for and evaluating the impact of cancer control programs, allocating health resources, responding to reports of suspected increases in occurrence, and developing research hypotheses. Expanding the application of cancer registries to prevention and screening can enhance the utility of the NPCR.

The CDC’s early public health efforts in cancer prevention and control focused on tobacco, surveillance, and the prevention and early detection of breast and cervical cancers. In 1998, the agency established the National Comprehensive Cancer Control Program to address the breadth of cancer prevention and control issues across multiple diseases and levels of intervention. Grantees convene stakeholders, assess epidemiologic data, and prepare and implement formal plans to reduce the incidence and burden of cancer in their state and local areas. This highly organized system provides a powerful national constituency of professional, political, advocacy, and lay members to set the agenda for cancer prevention and control. A future focus on policy and environmental approaches will help implement this ambitious agenda.

Over the last two decades, the CDC has collaborated with state, tribal, and territorial health departments/organizations to create a public health system for cancer prevention and control that has successfully built a comprehensive national census of cancer cases and a nationwide program to provide cancer screening.

Purpose

The purpose of this FOA is to transition this highly-functional public health infrastructure for cancer prevention and control into new roles and functions to anticipate the nation’s needs over the next decade. The goals are to (1) seek efficiencies across the management and operations of cancer prevention and control programs, (2) focus on high-burden cancers with evidence-based, scalable interventions that already exist and can be broadly implemented, (3) develop organized screening programs that are more effective and efficient than current opportunistic approaches, and (4) maintain high-quality cancer registries and expand their application in prevention and screening. Toward this end, this Announcement will fund five components and continue to support and promote the enhancement of NCCCP, NBCCEDP and NPCR.

Component 1 of this FOA enables applicants to coordinate and collaborate across FOA components and with other chronic disease programs to gain efficiency and enhance effectiveness of cancer prevention and control activities.

The FOA will continue to support the National Comprehensive Cancer Control Program through Component 2 of this FOA which was established to address the breadth of cancer prevention and control issues across multiple diseases and levels of intervention. By convening stakeholders, assessing epidemiologic data, and implementing formal plans to reduce the incidence and burden of cancer, grantees are able to have impact in their state and local areas. The focus on policy and environmental approaches will help grantees improve health outcomes.

The FOA also provides for the enhancement of systems for breast and cervical cancer screening promotion and screening provision, follow-up, and support services for the entire population through Component 3 of this FOA. Special emphasis is placed on reaching low-income women, rural and frontier populations, and those experiencing health disparities within the following population subgroups: the uninsured or under-insured, geographically or culturally isolated, medically under-served, racial, ethnic, and/or cultural minorities, including African Americans, Alaska Natives, American Indians, Asian Americans, Hispanics, Pacific Islanders, lesbians, and women with disabilities. Applicants are encouraged to enhance existing organized system of policies, quality benchmarks, and delivery systems unique to the NBCCEDP. This FOA provides opportunities to develop organized screening systems expand targeted outreach efforts and use the extensive geographic infrastructure of state and local health departments to monitor and promote evidence-based screening practices.

In addition, this FOA will also support the operations and enhancement of state, tribal, and territorial health departments/organizations population-based central cancer registries and promote the use of registry data through Component 4 of this FOA. Applicants are encouraged to expand applied uses of cancer registry data to monitor preventable and screening-amenable cancer occurrence and outcomes in the United States; evaluate the impact of cancer prevention and early detection programs; and identify subpopulations where evidence-based interventions should be targeted to reduce the cancer burden.

Finally, though optional, competitive funding in Component 5, the FOA will support the implementation of large-scale, innovative demonstration projects that contribute to building organized cancer screening efforts that impact population-level cancer screening rates. Proposed projects must address breast, cervical, and colorectal cancer screening. Projects should incorporate systems or policy-level approaches that have the potential to be generalizable, replicable, and scalable in other states.

All applicants are strongly encouraged to apply for Component 1, leadership and coordination activities. Applicants are also eligible to apply for Components 2-4 and MAY apply for more than one specific component. Applicants for Component 5 may only submit 1 innovative demonstration project per state.

Measurable outcomes of the Cancer Prevention and Control Program for States, Territories, and Tribal Organizations will be in alignment with the following performance goals for the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) and Healthy People 2020:

· Increase the number of central, population-based registries from the 50 States and the District of Columbia that capture case information on at least 95 percent of the expected number of reportable cancers (Healthy People-C12).

· Reduce the female breast cancer death rate (Healthy People C-3).

· Reduce the death rate from cancer of the uterine cervix (Healthy People C-4).

· Reduce invasive uterine cervical cancer (Healthy People C-10).

· Increase the percentage of reporting sources (facilities) that submit data electronically to the central registry to 60%.

· Increase age-appropriate screening prevalence for breast and cervical cancer to 84%, 90% respectively.

· Decrease incidence rates of late-stage breast and cervical cancer diagnosis (1% breast and cervical).

· Implement three or more planned policy, systems, and environmental interventions per cancer program per year.

Program Implementation

Component 1: Program Management, Leadership, and Coordination in the Cancer Prevention and Control Program Recipient Activities

Coordinate and collaborate across FOA components and with other chronic disease programs to gain efficiency and enhance effectiveness of cancer prevention and control activities. Recipients are required to collaborate with other funded Cancer Programs.

1. Program Leadership, Management, and Coordination

· Provide leadership and coordination across funded cancer program components 2 – 5 (the National Comprehensive Cancer Control Program (NCCCP), the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the National Program of Cancer Registries (NPCR), and the Innovative Demonstration Project) to manage the planning, implementation, and evaluation of each individual program component included in this overall cancer award. Describe how the individual cancer program components will be managed in a coordinated fashion, either in the current or in a new leadership and management structure. Where cancer activities are decentralized within a grantee's organization, deliberate efforts to cross-coordinate and collaborate is expected of each cancer program component.

· Describe efforts to share and leverage expertise, gain efficiencies and maximize effectiveness across all cancer program components.

· Describe efforts to collaborate with funded cancer grantees such as those under DP09-903, The Colorectal Cancer Control Program, DP10-1017, Demonstrating the Capacity of Comprehensive Cancer Control Programs to Implement Policy and Environmental Cancer Control Interventions, and DP09-9010301PPHF11, The Coordinated Chronic Disease Prevention and Health Promotion Program.

· Establish, enhance, and maintain a collaborative relationship with other chronic disease prevention programs within the health department.

· Continue to leverage and engage key partners and partner organizations in a coordinated fashion across cancer program components.

· Support crosscutting policy, communications, epidemiology, and evaluation activities among chronic disease programs.

Performance will be measured by:

· The establishment of strong, effective, and coordinated leadership across all federally-funded cancer programs.

· Within 90 days of the award, the grantee should develop a staffing and training plan that includes specific quarterly milestones that meet the annual objectives for the cancer programs and describes specific functions to support a coordinated and collaborative approach to cancer control and meets the specific program requirements in the areas described under Component 1 recipient activities.

2. Enhanced use of surveillance data

· Use program leadership to provide sufficient oversight for and increased use of central cancer registry data to guide decisions, assess needed changes in priority, inform health policy decision-making, and improve quality and efficiency of cancer prevention and treatment efforts across state/tribal/territorial organizations.

· Facilitate NPCR data exchange between cancer programs to support and guide cancer control interventions, measure success, and make mid-course corrections in program activities in all cancer programs, as described in the Cancer Control Plan.

· Facilitate routine data linkages between registries, screening data from NBCCEDP and CDC-RFA-DP 09-903, “The Colorectal Cancer Control Program” (if funded in the state/tribal/territorial organization), and vital records to provide staging and mortality data as key outcomes of cancer programs.

· Facilitate use of cancer registry data and other surveillance information through use of Statistical Analysis Software (SAS) Licensures for cancer program grantees. SAS licenses will be awarded as direct assistance (DA) to the grantees.

Performance will be measured by:

· Evidence of routine and increased use of cancer registry data to help inform public policy and influence the selection and measure the success of cancer control interventions.

3. Promotion of population-based cancer screening

· Provide management support and leadership to collaboratively promote population-based quality screening and appropriate follow-up for breast, cervical, and colorectal cancer using evidenced-based interventions including policy approaches, organized screening programs, health systems improvements, quality assurance and targeted communications and outreach.

Performance will be measured by:

· Increased population level screening prevalence for breast, cervical, and colorectal cancer.

· Evidence of formal agreements for collaborative efforts with prioritized health systems (e.g., state Medicaid programs, state Primary Health Care Association).

4. Coordination of Cancer Program Activities with Existing Cancer Coalition

· Provide management support and leadership to maintain an active and coordinated role with existing state, tribal or territorial Cancer Coalition.

· Ensure that a representative of the leadership from the health department cancer program or bona fide agent is a member of the coalition leadership team.

· Ensure that state-level health leaders (e.g., State Health Officer, Chronic Disease Directors) are actively engaged with the Cancer Coalition and that there is a formal mechanism to interface with other chronic disease coalitions within the Health Department.

Performance will be measured by:

· Evidence that the coalition is fully engaged, extending the reach of the cancer program and effective in educating stakeholders about effective policy and systems change approaches.

5. Alignment of Cancer Programs with Cancer Control Plan

· Provide management support and leadership to ensure that goals and intended outcomes of individual cancer programs are aligned with the state, tribal, or territorial-wide Cancer Control Plan.

Performance will be measured by:

· The extent to which the one-year and five-year goals of each of the cancer program components are reflected in and aligned with the state, tribal, or territorial-wide Cancer Control Plan.

Component 2: Policy and Environmental Approaches and Community-Clinical Linkages in the National Comprehensive Cancer Control Program Recipient Activities Facilitate community-clinical linkages to build support for interventions for people with, or at risk for, chronic conditions. Implement policy, systems and environmental approaches to prevent cancer and clinical-community linkages that reduce the cancer burden.

1. Program Management

· Establish or retain staff sufficient to manage and provide administrative support to the National Comprehensive Cancer Control Program (NCCCP). Establish or maintain staff, contractors, and/or consultants sufficient in number and expertise to conduct, communications (public relations, media relations, social media), surveillance, epidemiology and utilization of health data, health care system interventions, fiscal and resource management, professional development, strategic planning, and coalition and partnership development.

· Recommend that the applicant have at least .5 (1/2) full-time equivalent (FTE) as a subject matter expert in policy, system, and environmental (PSE) approaches, focusing on awareness of policy and environmental approaches and community–clinical linkages. Contractors and/or consultants can be used to compile 100% of an FTE if necessary. This person (or persons) will be responsible for educating stakeholders about evidence-based PSE practices, strategies, and interventions, that can be implemented to accomplish priorities identified in the Cancer Control Plan. This person will also assure that measurable outcomes have been identified to demonstrate impact of these policy interventions implemented throughout the project period.

· Recommend that the applicant have no less than one third (1/3) full-time equivalent (FTE) responsible for planning and implementing the evaluation of the program throughout the project period. This person will coordinate evaluation of all program components described in this FOA and ensure that progress is monitored throughout the project period.

· Submit complete, accurate, and timely interim and annual progress reports, Federal Financial Reports (SF-425), evaluation plans and reports, and other programmatic reports.

· Maintain current information including performance milestones in all sections of the CDC Management Information System (MIS).

· Participate in various CDC-sponsored meetings, trainings, conferences, webinars and workshops and other relevant meetings to facilitate exchange of information and skills development with peers, CDC, and other subject matter experts (See Addendum I).

· Provide technical assistance and training to constituents based on the competencies acquired through CDC-sponsored meetings (e.g., a train-the-trainer model with partners to enhance utilization of PSE approaches).

· Communicate routinely with coalition members, partners and staff from other CDC-funded cancer programs as well as chronic disease prevention and health promotion programs to present a clear and consistent vision of what needs to be accomplished to increase cancer prevention.

· Develop strategic communication opportunities to educate the public and decision makers about cancer burden, prevention and control, implemented interventions, and impact of the program.

Performance will be measured by:

· Successful identification of strong, effective leadership and staffing for the key positions (program management, evaluation, and policy) within 90 days, with competencies needed to accomplish the FOA objectives as supported by curricula vitae, training certificates, and other relevant documents.

· Inclusion of SMART (specific, measurable, achievable, realistic, and time-phased) annual and project period objectives in the action plan that align with the CDC/NCCCP priorities.

· Completion and submission of accurate and timely MIS reports; participation in CDC-sponsored meetings and other professional training opportunities as indicated in the budget, action plan, and attendance rosters (See Addendum I).

· Provision of training and technical assistance to partners, staff, and constituents on topics that support the accomplishment of objectives and activities noted in this FOA.

· Implementation and coordination of a communication plan with evidence that partners, staff, decision makers and constituents understand the cancer burden and the coordinated plan to implement cancer prevention and control interventions.

2. Fiscal Management

· Provide a detailed budget justification that reflects the following:

· No less than 30% of the total NCCCP funding should be allocated to implementation of cancer plan goals and objectives. This includes, but is not limited to, funded coalition workgroups and team activities with local implementation efforts and sub-awards to implement activities in rural areas or with local governmental or non-governmental organizations. These sub-awards ensure local participation, extend the reach of the program, extend the technical assistance and training impact, and support effective implementation and sustainability of the program.

· No less than 10% of the total “Cancer Prevention and Control Programs for Health Departments” funding should be allocated for program evaluation.

· Appropriate documentation is included for the recommended 10% cost sharing requirement. Leveraged funds (monetary funds) and in-kind funds (non-monetary contributions) can be used to meet this requirement. The source and amount of funds used for the cost share should be reported in the budget justification. These funds should also be documented in the relevant section of the MIS under the financial tab (i.e., leveraged funds or in-kind contributions).

· A collaborative process is described for working with fiscal management staff to develop and implement procedures to track and monitor expenditures.

· A reporting system should be used that meets the online reporting criteria and timelines as stated in the “Reporting Requirements” section of this FOA.

· All recipient activities described in the budget narrative, including sub-recipient activities, must support and align with the goals of the plan and chronic disease plan, when applicable.

Performance will be measured by:

· Evidence that the recipient and sub-recipients align program funding with the goals and objectives of the cancer plan and meet the funding percentage requirements.

· Establishment of appropriate contracts or memoranda of agreement with local entities (e.g., local health departments, community based organizations, universities).

· Establishment of procedures to track and report expenditures; preparation of required reports according to the designated schedule; and maintenance of appropriate spend rate.

3. Routinely Utilize Cancer Surveillance Data

· Develop a plan to utilize the population-based central cancer registry data, described in Component 4 of this FOA, to support the overall Cancer Control Plan implementation.

· In addition to government reporting requirements, this registry should be used to routinely monitor cancer burden in jurisdiction populations to support and guide selected program interventions, measure success, and make mid-course corrections in program activities. Information obtained from the registry should be used to communicate disease burden and health behaviors to relevant stakeholders to ensure that programmatic efforts led by partners are based on current data and program successes are disseminated.

Performance will be measured by:

· Evaluation of the quality, accuracy, and representativeness of routine cancer burden reports; evidence that the burden report is routinely used to revise or update the cancer plan, action plan, or other program document; and use of cancer surveillance data and information to plan, implement, and evaluate the cancer plan.

4. Routinely Support, Collaborate and Coordinate with Existing Cancer Coalition

· Maintain an active and coordinated role with existing state, tribal or territorial Cancer Coalition to lead and/or collaborate with cancer plan revisions, implementation, and evaluation.

· Support and strengthen the capacity of the coalition to educate and inform key stakeholders about the impact of evidence-based policy and environmental approaches and community–clinical linkages.

· Ensure that coalition members represent organizations strategically positioned to effectively implement Cancer Control Plan activities.

· Ensure that the coalition includes members represent the following:

· Population sub-groups that experience health disparities;

· Other Cancer program components (i.e., the NBCCEDP, CDC-RFA-DP 09-903, “The Colorectal Cancer Control Program” (if funded in the state/tribal/territorial organization), and the Central Cancer Registry);

· Chronic disease and risk factor programs (e.g., tobacco control; nutrition, physical activity, and obesity; immunization).

· Members of non-health sectors as appropriate, to include other government agencies, professional associations/organizations, academic/medical institutions, business/industry, political leaders, and community-based organizations.

· Ensure that coalition and leadership team are linked or aligned with broader leadership efforts (e.g., Prevention and Public Health Fund Coordinated Chronic Disease Prevention and Health Promotion Program).

· In collaboration with coalition, periodically assess coalition membership and its effectiveness in the key components of the cancer plan.

· As appropriate, link coalition and its leadership team with other national, state, local, tribal and territorial efforts and foundation activities to advance and/or enhance the FOA activities. Ensure sustainability by linking with broader chronic disease efforts and identifying future resources from diverse sources to support key components of this FOA including the cancer plan.

Performance will be measured by:

· The extent to which the coalition leadership team ensures that the strategic direction of the coalition reflects program activities related to this FOA.

· The extent to which the coalition is comprised of population sub-groups that experience health disparities; representatives from other state-based cancer programs, chronic disease and risk factor programs, and members of non-health sectors.

· The extent to which the coalition is involved in the planning, implementation, and evaluation of the key activities of the FOA and cancer plan (i.e., member organizations lead and/or actively participate in activities).

· Completion of an annual assessment of membership composition, cancer plan activity assignments, and outcomes related to their implementation of the key components of the FOA and cancer plan.

5. Maintain, Implement, and Periodically Revise a Comprehensive Cancer Control Plan

· Maintain, implement, and periodically revise a state, tribal, or territorial-wide Cancer Control Plan based on cancer incidence, stage and mortality data and relevant behavioral and risk factor data, which includes concrete and achievable evidence- and practice-based methods for preventing and reducing the high-burden cancers, and reflects the NCCCP priorities.

· If the current plan was revised within the past 24 months, consider adding an amendment to the plan to address the plan components described in this FOA. If the current plan has not been revised within the past 24 months, consider revising the plan within the first 24 months of this award to reflect the plan components described in this FOA.

· The plan should reflect all available pertinent surveillance data including:

· cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology and End Results Program;

· cancer mortality data from the National Center of Health Statistics;

· cancer behavioral data from surveillance systems such as the Behavioral Risk Factor Surveillance System, Youth Risk Behavior Surveillance System, Youth Tobacco Survey, or National Health Interview Survey. Population subgroup analyses should be included where applicable.

· The plan should describe the populations experiencing health disparities, identify specific and appropriate strategies to reduce disparities, and ensure effective and equitable cancer prevention and control strategies in these populations living with disparities.

· The plan should focus efforts on the highest burden cancers, and those with available evidence or practice-based public health interventions.

· The plan should focus cancer control interventions in the following areas:

· Providing evidence for policy, systems and environmental approaches and interventions to sustain cancer control. The following steps should be conducted when developing PSE interventions:

Assess surveillance data

Conduct an environmental PSE scan

Establish or sustain a PSE task force

Support awareness of effective PSE approaches

Engage community

Develop a media or communications plan

Develop an evaluation plan Implement and evaluate the selected interventions

· Increasing awareness of effective PSE approaches that support and promote primary prevention of cancer (reducing exposure to cancer risk factors for high burden cancers and increasing the use of vaccines that prevent cancer). Approaches should propose to increase tobacco-free living, improve nutrition and physical activity in schools, worksites, and communities, and address sun safety, indoor tanning, and vaccination preventable cancers, with clear cancer outcomes linked to all proposed interventions.

· Enhancement of efforts by existing programs to increase the use of cancer screening and other appropriate clinical preventive service programs, with a focus on Health Systems Change. Screening activities included in the plan should link to the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), CDC-RFA-DP 09-903, “The Colorectal Cancer Control Program” (if funded in the state/tribal/territorial organization), and other state-based screening activities. Approaches may include the use of the “Patient-Centered Medical Home” model to improve patient access, communication and decision support, health risk assessments, preventive health exams and screening history to prioritize adherence to cancer screening and other recommended clinical preventive services.

· Patient navigation to increase appropriate cancer screening and ensure receipt of appropriate cancer treatment and care.

· Establishment of community–clinical linkages to support cancer control self-management, via primary prevention and screening, among cancer survivors, in coordination with activities funded under CDC- RFA-DP10-1015- Cancer Survivorship Resource Center. Interventions may include:

· Chronic Disease Self-Management approaches to reduce risk of a second or recurrent cancer among cancer survivors.

· Activities related to developing evidenced-based information on cancer survivorship including guidelines on post-cancer diagnosis care for survivors.

· Activities to help bridge public health and clinical communities to enhance awareness of post-cancer clinical care for survivors and to define an appropriate medical home for cancer survivors following treatment of their cancer.

· Activities to enhance collaboration with federal and non-federal partners including American Indian/Alaska Native organizations, the National Cancer Institute (NCI), Health Resources and Services Administration (HRSA), and /or other national health organizations to implement cancer survivorship education and awareness activities.

· Support and dissemination of resources developed by the National Cancer Survivorship Resource Center as an effective method for increasing the health literacy and self-management for people who have been successfully treated for cancer but are increased risk for a second or recurrent cancer.

· The plan should describe how proposed activities will complement or enhance existing activities within the state/tribal/territorial organization including: the Chronic Disease Plan, Coordinated Chronic Disease Prevention and Health Promotion Program, Community Transformation Grants and Communities Putting Prevention to Work programs. Proposed activities should align with NCCCP priorities, as well as state and federal public health goals including Healthy People 2020.

Performance will be measured by:

· Implementation of a plan that contains specific strategies to support PSE approaches to prevent cancer and clinical-community linkages to reduce second or recurrent cancers among survivors; reflects all available pertinent surveillance data; defines concrete and achievable evidence- and practice-based methods; explicitly links to existing chronic disease plans in the jurisdiction and address populations experiencing health disparities; describes plans for sustainability; and includes specific and measurable outcomes, consistent with current guidelines and targets, for the content areas listed above.

6. Demonstrate Outcomes through Evaluation to Improve Program Performance

· Allocate resources for program evaluation and convene an evaluation planning team led by a program evaluator who will coordinate with the other specialized program components of this FOA.

· Develop an annual comprehensive evaluation plan that establishes specific, measurable and realistic short-term, intermediate, and long-term program objectives consistent with the purpose of this FOA. The evaluation plan should consider components identified in the CCCB Program Evaluation Toolkit.

· Monitor, track, analyze, and report program data in a Management Information System. Data elements will be used to demonstrate program effectiveness.

· Implement program-led evaluation plan and utilize findings for program improvement.

· Participate in nationally coordinated evaluation activities that measure clinical, cost, policy and other outcomes.

· Develop and disseminate an annual evaluation report that outlines the implementation of the evaluation plan, key findings, and recommendations for program improvement.

· Over the five-year period of the cooperative agreement, develop and distribute at least four (4) unique dissemination documents created for stakeholders based on performance monitoring data, health assessment data, and other program-related information, including results of pre- and post-intervention data collection efforts. These documents may be briefing updates, reports, or manuscripts, and will be used to disseminate best-practices from this effort. Develop and disseminate at least one peer-reviewed manuscript based on evaluation data.

Performance will be measured by:

· Identification of a lead evaluator within 90-days post-award who will convene an evaluation planning team and lead program evaluation efforts.

· In subsequent years, performance will be measured by the extent to which the evaluation workgroup sustains program evaluation efforts through the project period; evidence that program uses the chronic disease Management Information System in an effective and timely manner; evidence that the program participates in nationally coordinated evaluation activities; evidence that the program developed and disseminated four (4) unique evaluation documents, including one manuscript published in a peer-reviewed journal; evidence of an approved evaluation plan within 120 days post- award covering specific, measurable, and realistic short-term, intermediate, and long-term program objectives consistent with this FOA.

Component 3: Health Systems Change and Quality Clinical Preventive Services in the National Breast Cervical Cancer Early Detection Program Recipient Activities

Support high quality breast and cervical cancer screening promotion and provision activities through policy approaches, health systems change and outreach strategies related to improving delivery and the use of clinical and other preventive services.

1. Program Management

Enhance program infrastructure and capacity to increase evidence-based screening promotion services at the population level and to provide screening provision services to priority population(s) over the length of the project period.

· Hire or retain adequate and qualified staff to manage the program. Essential staff includes a program director and a full-time data manager.

· Develop a Program Management Plan that describes organizational structure, staff capacity, and coordination and collaboration processes to facilitate the achievement of program goals, objectives, and resolution of problems.

· Develop and maintain a fiscal system that tracks and monitors program expenditures and ensures the accurate and timely reimbursement of services provided by the program.

· Participate in required CDC meetings to facilitate the accomplishment of proposed objectives (See Addendum I).

· Establish specific, measurable, and realistic short-term (one year) and long-term (five years) objectives to increase high-quality population based breast and cervical cancer screening.

· Develop a work plan that relates the proposed screening promotion and screening provision activities and desired outcomes of each of the eight NBCCEDP program components to short- and long-term objectives (https://www.nbccedp.org).

· Conduct needs assessments to identify programmatic gaps and increase capacity across all program components with an emphasis on screening promotion activities.

· Create an overarching program framework and component specific logic models. Grantees may adapt the NBCCEDP framework and logic model to meet their unique needs, as desired. (B & C Appendices A and B). Convene a medical advisory board (MAB) to oversee the quality of screening promotion and provision services delivered throughout the five-year funding period.

· Establish, monitor and manage contracts with medical providers to provide screening, diagnostic and treatment referral services.

Performance will be measured by:

· The successful hire and retention of, at the very minimum, essential staff (e.g. Program director and Data Manager), including a plan that describes processes to retain a management structure/staffing and to identify opportunities to leverage resources and increase efficiency.

· The development and maintenance of a fiscal management system that tracks and monitors program expenditures, budget balances and ensures timely reimbursement for services provided.

· The extent to which specific, measurable, and realistic objectives are established, including realistic annual screening goals.

· The development of a work plan that includes program activities, outcomes, objectives, and all additional fields of information found in the work plan template (template available at www.nbccedp.org).

· The execution of a needs assessment, and utilization of the findings to continuously modify and improve program development and delivery.

· The development of an overarching program framework and component specific logic models within the first year of the project period.

· The extent to which the program has convened and maintained a Medical Advisory Board.

· The extent to which the program has established contracts with medical providers for screening, diagnostic and treatment referral.

2. Partnerships, Coordination, and Collaboration

Coordinate and collaborate across cancer and other chronic disease programs including the CCC coalition, NPCR, and with key external organizations, such as Medicaid, that reach large population groups to extend the scope and impact of breast and cervical cancer screening activities and to increase population level screening.

a. Screening Promotion

· Collaborate and actively engage with the comprehensive cancer control program (CCC) and coalition to increase awareness of effective policy, systems and environmental (PSE) approaches that support cancer screening activities in the cancer plan.

· Develop a portfolio that includes the following priority partners, Medicaid, federally qualified health centers (FQHCs), Medicare, health care systems, health insurers, or large workplaces, as well as other key external organizations that reach large populations as applicable. Execute formal agreements with key external organizations that reach large populations to support policy and health systems improvements, efficient use of resources and increase high-quality cancer screening.

b. Screening Provision

· Develop and maintain collaborative partnerships with diverse agencies and organizations in the community that serve disparate populations and with clinical providers participating in the program to conduct targeted outreach to ensure patient support, improve quality, and enhance coordination across all program components.

· For states, develop and maintain collaborative partnerships with local health jurisdictions (e.g., county, district) and with American Indian/Alaska Native tribes and tribal organizations to increase the program’s geographic coverage and access to eligible populations (eligible populations available at www.nbccedp.org).

· Develop and maintain collaborative relationships and data sharing agreements with central cancer registries to link the program‘s clinical data with cancer registry data and utilize these data in program planning, implementation and evaluation.

Performance will be measured by:

· The extent to which there is coordination and collaboration across cancer programs, CCC, and chronic disease prevention programs.

· The achievement of measureable progress toward implementing evidence-based population-level screening promotion strategies and activities.

· The execution of formal agreements with priority partners and other key external partner organizations.

· The existence of a formal data sharing agreement with the cancer registries program.

3. Public Education and Targeted Outreach

Public education involves the design and delivery of clear and consistent messages about breast and cervical cancer screening. Targeted outreach relies upon tailored, population-specific strategies designed to reach and bring women from priority populations into clinical screening services. In-reach identifies eligible populations within provider practices for screening.

a. Screening Promotion

· Engage partners, including representatives from the priority population(s) and the CCC coalition, in assessing needs and developing plans, and in selecting and implementing evidence-based strategies for public education, outreach, and in-reach appropriate for the priority population.

· Where appropriate, leverage…