Foa_Content_of_CDC-RFA-DP-23-0010 Revised.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

BOLD Public Health Programs to Address Alzheimer’s Disease and Related Dementias

CDC-RFA-DP-23-0010

03/27/2023

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Required Registrations

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

NOFO -Specific Glossary and Acronyms

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-DP- 23-0010. 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) B. Notice of Funding Opportunity (NOFO) Title:

BOLD Public Health Programs to Address Alzheimer’s Disease and Related Dementias C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52- 2.pdf. Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr- 46/index.html (See section 45 CFR 46.102(d)).

New Type 1

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP-23-0010

E. Assistance Listings Number:

https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html

93.334 F. Dates:

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

02/19/2023 Recommended but not Required

2. Due Date for Applications:

03/27/2023 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call

Time: 12:30 U.S Eastern Time (US and Canada) Topic: DP23-0010 Informational Conference Call

1. Zoom Meeting ID 161 494 8218, Passcode: BOLD2023! or at this invite link:

https://cdc.zoomgov.com/j/1614948218?pwd=WWpCRlZQMEtUcXMyZHJwdVRwU3l

QQT09

After 1/25/2023, the Informational Conference Call recording and transcript will be added to the DP23-0010 Information Webpage BOLD Public Health Programs |CDC-RFA-DP23-0010 |

CDC.

F. Executive Summary:

Summary Paragraph This NOFO supports actions from the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act PL115-406. It will fund public health departments to build infrastructure in the field of Alzheimer’s disease and related dementias (ADRD). This 5-year NOFO will fund recipients in two different components. Component 1 will be funded for 2 Capacity-Building years and 3 Implementation years. Component 2 will be funded for 5 Implementation years.

Recipients will use a public health approach to ADRD using CDC’s Healthy Brain Initiative State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map, the Road Map for Indian Country (RM Series), as well as future updates of both, as guides to expand and improve the response to ADRD in their jurisdictions. Recipients will increase awareness and understanding among the general public (including populations of high burden), providers, and other professionals of ADRD topics corresponding to primary, secondary, and tertiary prevention (see Glossary). Recipients will address the social determinants of health (SDOH) to achieve health equity goals including but not limited to the improvement of community-clinical linkages among health care systems and existing services, public health agencies, and community-based organizations.

a. Eligible Applicants:

Open Competition

b. NOFO Type:

CA (Cooperative Agreement) https://www.grants.gov/ https://cdc.zoomgov.com/j/1614948218?pwd=WWpCRlZQMEtUcXMyZHJwdVRwU3lQQT09 https://cdc.zoomgov.com/j/1614948218?pwd=WWpCRlZQMEtUcXMyZHJwdVRwU3lQQT09 https://www.cdc.gov/aging/funding/php/2023.html https://www.cdc.gov/aging/funding/php/2023.html https://www.congress.gov/115/plaws/publ406/PLAW-115publ406.pdf https://www.congress.gov/115/plaws/publ406/PLAW-115publ406.pdf https://www.cdc.gov/aging/healthybrain/roadmap.htm https://www.cdc.gov/aging/healthybrain/roadmap.htm https://www.cdc.gov/aging/healthybrain/roadmap.htm

c. Approximate Number of Awards The program will fund Component 1 and Component 2 awards in approximately equal amounts. Final numbers of programs funded in each Component will be decided after Phase II and Phase III review.

d. Total Period of Performance Funding:

$70,000,000

e. Average One Year Award Amount:

$450,000 Component 1 = years 1-2 = $250,000 Years 3-5 = $450,000;

Component 2 = $450,000

f. Total Period of Performance Length:

5 year(s)

g. Estimated Award Date:

September 30, 2023

h. Cost Sharing and / or Matching Requirements:

Yes "MATCHING REQUIREMENT.—Each health department that is awarded a cooperative agreement under this award shall provide, from non-Federal sources, an amount equal to 30 percent of the amount provided under such agreement (which may be provided in cash or in-kind) to carry out the activities supported by the cooperative agreement."

WAIVER AUTHORITY.—The Secretary of Health and Human Services may waive all or part of the matching requirement described here for any fiscal year for a health department of a State, political subdivision of a State, or Indian tribe or tribal organization (including those located in a rural area or frontier area), if the Secretary determines that applying such matching requirement would result in serious hardship or an inability to carry out the purposes of the cooperative agreement awarded to such health department of a State, political subdivision of a State, or Indian tribe and tribal organization."

Match Waivers may be considered. If your agency determines that applying such matching requirement would result in serious hardship or an inability to carry out the purposes of the cooperative agreement, you may submit a match waiver request. To submit a match waiver request, submit a letter, no more than 2 pages in length, 12 pt font on your agency’s letterhead with Office of Budget and Program Leadership signatures, with your application.

Match waiver requests will be determined on a case-by-case basis for the period of performance of this award. A match waiver may be approved, as described here, for the period of performance of this award unless circumstances change for any awardee that would then enable the awardee to meet the match requirement.

Your letter requesting a match waiver should include the following elements:

Your agency and your proposed project budget

A brief statement of the hardship circumstances. (e.g., pandemic response, budget shortfall, emergency situation or other extenuating circumstances)

Documentation indicating that not receiving a match waiver may cause a serious hardship or an inability to carry out the purposes of the cooperative agreement

Signed by your state agency budget office authorized representative and the Principal Investigator

Name this file "XX Matching Waiver Request" as a PDF and upload with your application to www.grants.gov.

Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview Alzheimer’s disease is the most common form of dementia and the 5th leading cause of death for people aged ≥ 65 years in the United States. By 2060, approximately 14 million people are expected to have Alzheimer’s disease, a nearly three-fold increase, with minority populations disproportionately affected.

This NOFO will fund public health departments to build infrastructure and increase capacity in the field of Alzheimer’s disease and related dementias (ADRD). Recipients will expand and improve the response to ADRD in their jurisdictions. To do so, they will use a public health approach to ADRD with an emphasis on addressing the social determinants of health to achieve health equity goals and using CDC’s Healthy Brain Initiative State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map, the Road Map for Indian Country (RM Series), as well as future updates of both, as guides. The need for a well-coordinated public health approach is essential given advancements in knowledge about risk factors (see below in this section) related to cognitive decline, and the growing awareness of the role of SDOH. A public health approach can build coordinated systems that binds together jurisdiction efforts for ADRD and caregiving for persons with dementia. These coordinated systems, such as community-clinical linkages, are crucial for improving equitable outcomes for ADRD. The Secretary of the Department of Health and Human Services added a new goal to accelerate action to promote healthy aging and reduce risk factors for ADRD in the 2021 National Alzheimer’s Disease Plan. This goal focuses on reducing prevalence of 10 key risk factors, including: depression, diabetes, hearing loss, mid-life hypertension, physical inactivity, poor diet quality and obesity, poor sleep quality and sleep disorders, tobacco use, traumatic brain injury, and alcohol use.

This NOFO is authorized by the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act; PL115-406 that amends the Public Health Service Act (Section 398A; 42 U.S.C. 280c-3-4.). This act authorizes funding for “health departments of states, political subdivisions of states, and Indian [American Indian/Alaska Native] tribes and tribal organizations” to develop a strong and uniform dementia infrastructure. This NOFO supports recipients to use a public health approach to ADRD promoting SDOH to achieve healthy equity and encouraging data driven decision-making and action along with strategies that correspond to https://www.cdc.gov/aging/pdf/2018-2023-Road-Map-508.pdf https://www.cdc.gov/aging/pdf/2018-2023-Road-Map-508.pdf https://www.cdc.gov/aging/healthybrain/pdf/HBI-Road-Map-for-Indian-Country-508.pdf https://www.cdc.gov/aging/healthybrain/pdf/HBI-Road-Map-for-Indian-Country-508.pdf https://www.cdc.gov/socialdeterminants/index.htm https://aspe.hhs.gov/collaborations-committees-advisory-groups/napa#:~:text=The%20National%20Alzheimer%27s%20Project%20Act%20%28NAPA%29%20creates%20an,trajectory%20of%20Alzheimer%27s%20disease%20and%20related%20dementias%20%28AD%2FADRD%29.

https://aspe.hhs.gov/collaborations-committees-advisory-groups/napa#:~:text=The%20National%20Alzheimer%27s%20Project%20Act%20%28NAPA%29%20creates%20an,trajectory%20of%20Alzheimer%27s%20disease%20and%20related%20dementias%20%28AD%2FADRD%29.

https://www.congress.gov/115/plaws/publ406/PLAW-115publ406.pdf https://www.congress.gov/115/plaws/publ406/PLAW-115publ406.pdf https://www.cdc.gov/socialdeterminants/about.html primary (e.g., dementia risk reduction), secondary (e.g., early detection and diagnosis, linkages to treatment, care, and services), and tertiary (e.g., prevention and management of comorbidities leading to preventable hospitalizations and poor health outcomes, and caregiving for persons with dementia) prevention (see glossary). This 5-year NOFO will fund recipients in two different components. Component 1: “Capacity Building and Implementation” will be funded for 2 years as Capacity-Building and 3 years as Implementation. Component 2: “Implementation” will be funded for 5 Implementation years.

b. Statutory Authorities Section 398A of the Public Health Service Act, 42 U.S.C. 280c-4.

c. Healthy People 2030

Dementias (DIA):

DIA-1: Increase the proportion of older adults with dementia, or their caregivers, who know they have it DIA-2: Reduce the proportion of preventable hospitalizations in older adults with dementia DIA-3: Increase the proportion of older adults with subjective cognitive decline who have discussed their symptoms with a provider

Older Adults (OA):

OA-1: Increase the proportion of older adults with physical or cognitive health problems who get physical activity OA-2: Reduce the proportion of older adults who use inappropriate medications

Health Care Access and Quality (AHS):

AHS-8: Increase the proportion of adults who get recommended evidence-based preventive health care

d. Other National Public Health Priorities and Strategies

National Alzheimer’s Project Act (NAPA; PL 111-375) defined “Alzheimer's” as Alzheimer's disease and related dementias (ADRD) and directs the Department of Health and Human Services (HHS) to develop an Annual Alzheimer's Plan.

Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act; PL115-406 authorizes funding for “health departments of states, political subdivisions of states, and Indian [American Indian/Alaska Native] tribes and tribal organizations” to develop a strong and uniform dementia infrastructure.

Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act ( PL No: 115-

119) directs HHS to develop a national caregiving strategy.

https://health.gov/healthypeople/objectives-and-data/browse-objectives/dementias https://health.gov/healthypeople/objectives-and-data/browse-objectives/dementias/increase-proportion-older-adults-dementia-or-their-caregivers-who-know-they-have-it-dia-01 https://health.gov/healthypeople/objectives-and-data/browse-objectives/dementias/reduce-proportion-preventable-hospitalizations-older-adults-dementia-dia-02 https://health.gov/healthypeople/objectives-and-data/browse-objectives/dementias/increase-proportion-adults-subjective-cognitive-decline-who-have-discussed-their-symptoms-provider-dia-03 https://health.gov/healthypeople/objectives-and-data/browse-objectives/older-adults https://health.gov/healthypeople/objectives-and-data/browse-objectives/older-adults/increase-proportion-older-adults-physical-or-cognitive-health-problems-who-get-physical-activity-oa-01 https://health.gov/healthypeople/objectives-and-data/browse-objectives/older-adults/reduce-proportion-older-adults-who-use-inappropriate-medications-oa-02 https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality/increase-proportion-adults-who-get-recommended-evidence-based-preventive-health-care-ahs-08 https://aspe.hhs.gov/collaborations-committees-advisory-groups/napa https://aspe.hhs.gov/collaborations-committees-advisory-groups/napa/napa-documents/napa-national-plans https://www.congress.gov/115/plaws/publ406/PLAW-115publ406.pdf https://acl.gov/sites/default/files/about-acl/2018-10/PLAW-115publ119%20-%20RAISE.pdf#:~:text=Public%20Law%20115%E2%80%93119%20115th%20Congress%20An%20Act%20To,the%20United%20States%20of%20America%20in%20Congress%20assembled%2C https://acl.gov/sites/default/files/about-acl/2018-10/PLAW-115publ119%20-%20RAISE.pdf#:~:text=Public%20Law%20115%E2%80%93119%20115th%20Congress%20An%20Act%20To,the%20United%20States%20of%20America%20in%20Congress%20assembled%2C

e. Relevant Work

BOLD Public Health Programs to Address Alzheimer’s Disease and Related Dementias (CDC-

RFA-DP20-2004)

BOLD Public Health Centers of Excellence to Address Alzheimer’s Disease and Related Dementias (CDC-RFA-DP20-2005)

National Healthy Brain Initiative (CDC-RFA-DP20-2003)

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

FUNDED

STRATEGIES AND

ACTIVITIES

SHORT-TERM

OUTCOMES (1-2 Years)

INTERMEDIATE

OUTCOMES (3-5

Years)

IMPACTS/LONG-

TERM OUTCOMES

Strategy 1:Create, maintain or enhance a jurisdiction ADRD coalition. (Component 1 and Component 2)

Strategy 2: Educate coalition members/partners on ADRD topics.

(Component 1 and Component 2)

Strategy 3: Create or update a jurisdiction ADRD Strategic Plan using the Road Map Series as guides.

(Component 1 only)

Strategy 4: Lead the coalition to develop and track an Implementation Plan to aid implementation of the jurisdiction

Increased number and variety of coalition members/partners collaborating on jurisdiction dementia projects or initiatives.

Improved quality and comprehensiveness of jurisdiction ADRD goals across public health domains, ADRD topics, and prevention levels.

Increased availability of information, tools, resources, and training on ADRD topics.

Increased availability and use of data to inform, Increased number of coalition members/partners implementing actions of jurisdiction ADRD Strategic Plan.

Improved implementation of jurisdiction ADRD goals that are comprehensive across public health domains, ADRD topics, and prevention levels.

Increased awareness and understanding of ADRD topics among the general public, providers, and other professionals.

Accelerated action to reduce risk factors for ADRD (NAPA Goal 6).

Increased emphasis of integrating the caregiver into processes and systems from which they have been traditionally excluded.

(RAISE Family Caregiver Act Goal).

Increased proportion of older adults with dementia, or their caregivers, who are aware of the diagnosis.* (HP2030 –

DIA-1)

Increased proportion of https://www.cdc.gov/aging/awardees/index.html https://www.cdc.gov/aging/awardees/index.html https://www.cdc.gov/aging/funding/phc/index.html https://www.cdc.gov/aging/funding/phc/index.html https://www.cdc.gov/aging/funding/hbi/index.html https://aspe.hhs.gov/reports/national-plan-2021-update https://aspe.hhs.gov/reports/national-plan-2021-update https://acl.gov/RAISE/report https://acl.gov/RAISE/report https://health.gov/healthypeople/objectives-and-data/browse-objectives/dementias/increase-proportion-older-adults-dementia-or-their-caregivers-who-know-they-have-it-dia-01 https://health.gov/healthypeople/objectives-and-data/browse-objectives/dementias/increase-proportion-older-adults-dementia-or-their-caregivers-who-know-they-have-it-dia-01

ADRD Strategic Plan.

(Component 1 Phase II, and Component 2)

Strategy 5 & 6:

Educate the general public, providers, and other professionals about ADRD topics.

(Component 1 Phase II, and Component 2)

Strategy 7: Increase the availability and use of data to improve knowledge, assess, plan and implement priorities.

(Component 1 Phase II, and Component 2)

Strategy 8: Improve sustainability of ADRD efforts.

(Component 1 and Component 2)

Strategy 9: Develop community-clinical linkages among health care systems and existing services, public health agencies, and community-based organizations.

(Component 1 Phase II, and Component 2) monitor or improve ADRD goal implementation and other supporting activities

Increased implementation of goals and activities that lead to sustainable jurisdiction ADRD program activities.

Increased number of community-clinical linkages among health care systems and existing services, public health agencies, and community-based organizations.

Increased use among the general public, providers, and other professionals of information, tools, resources and training on ADRD topics.

Increased number of jurisdiction ADRD projects and initiatives that are created and influenced by available data.

Increased sustainability of program activities.

Increased coordination across among health care systems and existing services, public health agencies, and community-based organizations.

older adults with subjective cognitive decline who have discussed their symptoms with a provider.* (HP2030 –

DIA-3)

Reduced proportion of preventable hospitalizations in older adults with dementia.* (HP2030-

DIA2)

Sustained ADRD program activities.

Development of a robust national data system that accurately reflects ADRD.

(BOLD Legislation)

i. Purpose This NOFO will fund state, local, and tribal public health departments to build infrastructure and increase capacity in the field of Alzheimer’s disease and related dementias (ADRD). Recipients will expand the response to ADRD in their jurisdictions. To do so, they will use a public health approach with an emphasis on SDOH to promote health equity and using CDC’s Healthy Brain Initiative State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map, the Road Map for Indian Country (RM Series), as well as future updates of both, as guides.

https://health.gov/healthypeople/objectives-and-data/browse-objectives/dementias/increase-proportion-adults-subjective-cognitive-decline-who-have-discussed-their-symptoms-provider-dia-03 https://health.gov/healthypeople/objectives-and-data/browse-objectives/dementias/increase-proportion-adults-subjective-cognitive-decline-who-have-discussed-their-symptoms-provider-dia-03 https://health.gov/healthypeople/objectives-and-data/browse-objectives/dementias/reduce-proportion-preventable-hospitalizations-older-adults-dementia-dia-02 https://health.gov/healthypeople/objectives-and-data/browse-objectives/dementias/reduce-proportion-preventable-hospitalizations-older-adults-dementia-dia-02

ii. Outcomes For all recipients, it is expected, at a minimum, that progress towards the bolded outcomes presented in the logic model above will be achieved during the period of performance. These are listed below.

Improved implementation of jurisdiction ADRD goals that are comprehensive across public health domains, ADRD topics, and prevention levels.

Increased awareness and understanding of ADRD topics among the general public, providers, and other professionals.

Increased number of community-clinical linkages among health care systems and existing services, public health agencies, and community-based organizations.

iii. Strategies and Activities This 5-year NOFO will fund recipients in two different components.

Component 1: “Capacity Building and Implementation” will be funded for 2 Capacity-Building years (Phase I) and 3 Implementation years (Phase II). This component is intended for applicants without a current jurisdiction dementia strategic plan or full active coalition.

Applicants previously funded under CDC-RFA-DP20-2004 are not eligible for Component 1 awards.

Component 2: “Implementation” will be funded for 5 Implementation years. This component is intended for applicants that already have an active dementia coalition and dementia strategic plan in place.

Component 1 — Capacity Building and Implementation

Component 1 Phase I -- Capacity Building (Years 1-2)

Strategy 1: Create or expand an existing jurisdiction Alzheimer’s Disease and Related Disease Coalition.

The required output for this activity is a jurisdiction coalition that addresses the criteria below.

1. The recipient is required to create, maintain, or expand a jurisdiction coalition (state, local or tribal). For the purposes of this program, a jurisdiction coalition is defined as a formal arrangement for cooperation and collaboration among a diverse cross-section of groups or sectors across the entire jurisdiction. Each group retains its identity and agrees to work together toward a common goal(s).

2. The jurisdiction coalition proposed by the applicant, at a minimum, should include representatives of the identified organizations. If the applicant's current coalition does not have representatives from the organizations listed below, they should work to include these organizations on their coalitions. Tribes and Tribal organizations should include members from their equivalent organizations.

Jurisdiction public health department representatives (the applicant) Jurisdiction aging services department representative

Jurisdiction public health department representatives from identified risk reduction areas (e.g., heart disease, diabetes)

National non-profit organization whose primary mission is Alzheimer’s disease (state or local chapter, as appropriate)

Persons with a lived experience (e.g., persons living with dementia (PLWD) or caregiver for person with ADRD)

3. Letters of support are required from the organizations serving on the jurisdiction coalition for the application from the aging services and a national non-profit organization whose primary mission is Alzheimer’s disease (state or local chapter, as appropriate). This letter must include a specific description of their unique role in support of the proposed work. Please see the "Collaborations" section for additional detail. 4. Applicants should name this file “XX Letters of Support” (where XX is the applicant name) and upload all letters of support in one PDF file to www.grants.gov.

4. Recipients are strongly encouraged to have representatives from the following groups or organizations on their coalitions. The list below is not an exhaustive list. Recipients are encouraged to expand their coalition membership according to the needs, priorities, and goals of the jurisdiction.

State administrators managing applicable programs (e.g., Medicaid, senior public health officials, public health chronic disease directors)

Subject-matter experts with expertise in dementia risk reduction, brain health and cognitive impairment, including ADRD care and service providers and caregiving for persons with dementia

Subject-matter experts with expertise in public health tools, strategies, and resources, including advanced knowledge of the public health systems at the national, state, tribal and local levels

Primary care practice representatives Healthcare organization representatives (who provide services for PLWD and their caregivers) Health systems representatives Local community-based organization representative where their work aligns with aging, ADRD, brain health.

Local public health departments Representatives of programs addressing SDOH (e.g., transportation, social connectedness). Further topics can be found at: CDC SDOH or NCCDPHP SDOH.

Representatives of communities of high ADRD risk or incidence Colleges and universities engaged in aging, dementia, and brain health work Long term care providers Policymakers Caregivers Organizations representing those populations at high risk including those with intellectual disabilities or others

5. The coalition proposed by the applicant should have the following capacities and/or characteristics:

https://www.cdc.gov/socialdeterminants/about.html https://www.cdc.gov/chronicdisease/programs-impact/sdoh.htm

Ability to leverage partnerships across settings and sectors to address key contributors to ADRD within their community.

Incorporate input from a diverse set of partners and community coalition members.

If an existing coalition, a detailed description of their history of success in working together with partners on issues relating to ADRD.

Include coalition members who will champion specific implementation plan steps as outlined in the coalition implementation plan.

6. Recipients are encouraged to engage their coalition to conduct the following types of activities. The list below is not an exhaustive list. Recipients are encouraged to expand their activities to reflect their coalition goals and priorities.

Use results of an existing needs assessment (if conducted in the past 3 years) or conduct a new needs assessment to establish jurisdiction ADRD priorities for either the ADRD strategic plan or implementation plan.

Convey the current state of the ADRD science and program to their larger community using health communication strategies.

Update or create a jurisdiction ADRD strategic plan that proposes recommendations for objectives or initiatives that are consistent with Road Map actions and that address jurisdiction priorities.

Build linkages to bridge science and implementation across their jurisdiction.

Participate in the development or revision of a balanced set of recommendations including primary (e.g., dementia risk reduction), secondary (e.g., early detection and diagnosis, linkages to treatment, care, and services), and tertiary (e.g., prevention and management of comorbidities leading to preventable hospitalizations and poor health outcomes, and caregiving for persons with dementia) prevention to be used to develop or revise the jurisdiction wide ADRD strategic plan and implementation plan.

7. CDC will review and approve the ADRD coalition membership (during continuation application time) before approving a move into Phase II (Implementation).

Strategy 2: Educate coalition members and partners to orient them to brain health and ADRD issues and the broad spectrum of actions needed to fully address ADRD across the jurisdiction.

Strategy 3: Create or update a jurisdiction ADRD Strategic Plan using actions from the CDC’s Healthy Brain Initiative RM Series, as well as future updates, as guides.

The required output for this activity is a jurisdiction ADRD Strategic Plan that addresses the key elements below:

1. Uses available data (e.g., BRFSS, health system data, registries, community listening sessions, needs assessments, and other available data sources) to assess, identify and set the goals and activities of the Strategic Plan to inform implementation in Strategy 4. This includes prioritizing populations and communities experiencing the greatest disparities in the prevalence of ADRD or ADRD-associated risk factors.

2. The ADRD strategic plan must ensure that a balanced approach to ADRD is proposed. A balanced approach includes the following:

Include goals that represent each of the prevention levels. The prevention levels are primary (e.g., dementia risk reduction), secondary (e.g., early detection and diagnosis; linkages to treatment, care, and services), and tertiary (e.g., prevention and management of comorbidities leading to preventable hospitalizations and poor health outcomes; caregiving for persons with dementia) prevention.

Include at least 4 Road Map actions. This includes a minimum of one (1) action from each of the Road Map domains (i.e., Educate and Empower (E), Develop Policies and Mobilize Partnerships (P), Assure a Competent Workforce (W), and Monitor and Evaluate (M)).

Prioritizes populations and communities experiencing the greatest disparities in the prevalence of ADRD or ADRD-associated risk factors and also have plans to address SDOH (e.g., transportation, social connectedness). Further topics can be found at:

CDC SDOH or NCCDPHP SDOH

3. CDC will review and approve the ADRD strategic plan (during continuation application time) before approving a move into Phase II (Implementation).

Component I Phase II -- Implementation (years 3-5)

Strategy 4: Lead the coalition to develop and track an Implementation Plan to achieve the priorities, activities, and goals specified in the jurisdiction’s ADRD Strategic Plan:

The required output for this activity is an Implementation Plan (e.g., a detailed description of the specific strategies, objectives, actions, and champions that are needed to implement the jurisdiction ADRD Strategic Plan goals) for the coalition that addresses the below criteria:

1. Is a living, dynamic document that allows for adjustments that are informed by experience, science, data, and contextual influences.

2. Has objectives that are specific, measurable, attainable, relevant, time bound, inclusive, and equitable (SMARTIE).

3. Uses available data (e.g., BRFSS, health system data, registries, community listening sessions, needs assessments, and other available data sources) to create the Implementation plan and monitor its progress. Uses specific best practices to address ADRD topics.

4. Contains actions that address sustainability (e.g., continuation of effort beyond the conclusion of the period of performance).

5. Prioritizes populations and communities experiencing the greatest disparities in the prevalence of ADRD or ADRD-associated risk factors, including addressing SDOH and health equity.

6. Identifies champions and the role they will play in implementation of each action.

Strategy 5: Educate members of the general public (including populations of high burden) about ADRD topics, including but not limited to primary (e.g., dementia risk reduction), secondary (e.g., early detection and diagnosis; linkages to treatment, care, and services), and tertiary (e.g., prevention and management of comorbidities leading to preventable https://www.cdc.gov/socialdeterminants/index.htm https://www.cdc.gov/socialdeterminants/about.html https://www.cdc.gov/cancer/nbccedp/pdf/smartie-objectives-508.pdf hospitalizations and poor health outcomes; caregiving for persons with dementia) prevention.

Strategy 6: Educate providers and other professionals about ADRD topics, including but not limited to primary (e.g., dementia risk reduction), secondary (e.g., early detection and diagnosis;

linkages to treatment, care, and services), and tertiary (e.g., prevention and management of comorbidities leading to preventable hospitalizations and poor health outcomes; and caregiving for persons with dementia) prevention.

Strategy 7: Increase the availability and use of data (e.g., BRFSS, health system data, registries, community listening sessions, needs assessments, and other available data sources) to improve knowledge and inform data driven decision-making about ADRD goals and activities.

Such data may include, as appropriate, information on cognitive decline, caregiving, and health disparities experienced by disproportionately-affected populations and individuals with cognitive decline and their caregivers. State recipients should support the collection of data from the BRFSS caregiving and subjective cognitive decline modules.

Recipients will also be expected to use available data to:

1. Increase program visibility.

2. Attract partners.

3. Assist ready communication.

4. Understand community achievements and public health burden.

5. Facilitate evolution of initiatives and overall sustainability of activities over time.

Strategy 8: Improve sustainability of jurisdiction ADRD efforts. This includes adopting activities that address all the following items :

1. Enhance the ability to effectively implement evidence-based practices over time.

2. Increase scalability.

3. Considers the changing landscape of resource and partner availability.

4. Improve systems, environments, and policies to support dementia (e.g., organizational policies, academic curricula, professional associations, accreditation, certification entities).

5. Incorporate the best available science about brain health, cognitive impairment, and caregiving for persons with dementia into their policies and training.

Strategy 9: Increase the number of community-clinical linkages among health care systems and existing services, public health agencies, and community-based organizations to improve both coordination and dementia outcomes, which will also address a key social determinant of health. This will include, but is not limited to, increasing the number of people knowing how and where to seek care and support, establishing formal agreements between entities, and connecting health care systems and providers to community services and programs to increase referrals between those entities. Community-clinical linkages should be bi-directional, meaning organizations both provide and receive the information needed to support increased coordination among public health, health care, and community-based sectors. Community-based organizations includes existing community services and programs related to ADRD or its modifiable risk factors.

Component 2 — Implementation

Strategy 1: Maintain or expand an existing jurisdiction Alzheimer’s Disease and Related Disease Coalition.

The required output for this activity is a jurisdiction coalition that addresses the criteria below

1. The recipient is required to maintain, or expand a jurisdiction coalition (state, local or tribal). For the purposes of this program, a jurisdiction coalition is defined as a formal arrangement for cooperation and collaboration among a diverse cross-section of groups or sectors across the entire jurisdiction. Each group retains its identity and agrees to work together toward a common goal(s).

2. The jurisdiction coalition proposed by the applicant, at a minimum, should include representatives of the identified organizations. If the applicant's current coalition does not have representatives from the organizations listed below, they should work to include these organizations on their coalitions. Tribes and Tribal organizations should include members from their equivalent organizations.

Jurisdiction public health department representatives (the applicant) Jurisdiction aging services department representative Jurisdiction public health department representatives from identified risk reduction areas (e.g., heart disease, diabetes) National non-profit organization whose primary mission is Alzheimer’s disease (state or local chapter, as appropriate) Persons with a lived experience (e.g., persons living with dementia (PLWD) or caregiver for person with ADRD)

3. Letters of support are required from the organizations on their jurisdiction coalition for the application from the aging services and a national non-profit organization whose primary mission is Alzheimer's disease (state and local chapter as appropriate) and must include a specific description of their role in support of the proposed work. Please see the "Collaborations" section for additional detail. Applicants should name this file “XX Letters of Support” (where XX is the applicant name) and upload all letters of support in one PDF file to www.grants.gov.

4. Recipients are strongly encouraged to have representatives from the following groups or organizations on their coalitions. The list below is not an exhaustive list. Recipients are encouraged to expand their coalition membership according to the needs, priorities, and goals of the jurisdiction.

State administrators managing applicable programs (e.g., Medicaid, senior public health officials, public health chronic disease directors)

Subject matter experts with expertise in dementia risk reduction, brain health and cognitive impairment, including ADRD care and service providers and caregiving for persons with dementia

Subject matter experts with expertise in public health tools, strategies, and resources, including advanced knowledge of the public health systems at the national, state, tribal and local levels

Primary care practice representatives Healthcare organization representatives (who provide services for PLWD and their caregivers) Health systems representatives Local community-based organization representative where their work aligns with aging, ADRD, brain health.

Local public health departments Representatives of programs addressing SDOH (e.g., transportation, social connectedness). Further topics can be found at: CDC SDOH or NCCDPHP SDOH.

Representatives of communities of high ADRD risk or incidence Colleges and universities engaged in aging, dementia, and brain health work Long term care providers Policymakers Caregivers Organizations representing those populations at high risk including those with intellectual disabilities or others

5. The coalition proposed by the applicant should have the following capacities and/or characteristics:

Ability to leverage partnerships across settings and sectors to address key contributors to ADRD within their community.

Incorporate input from a diverse set of partners and community coalition members.

If an existing coalition, as by demonstrated a detailed description of the history of success in working together with partners on issues relating to ADRD.

Include coalition members who will champion specific implementation plan steps as outlined in the coalition implementation plan.

6. Recipients are encouraged to engage their coalitions to conduct the following types of activities. The list below is not an exhaustive list. Recipients are encouraged to expand their activities to reflect their coalition goals and priorities.

Use results of an existing needs assessment (if conducted in the past 3 years) or conduct a new needs assessment to establish jurisdiction ADRD priorities for either the ADRD strategic plan or implementation plans.

Convey the current state of the ADRD science and program to their larger community using health communication strategies.

Build linkages to bridge science and implementation across their jurisdiction.

Develop a coalition implementation plan, based on their jurisdiction ADRD plan, that includes the use of specific best practices to address Alzheimer’s disease and related dementia that includes primary (e.g., dementia risk reduction), secondary (e.g., early detection and diagnosis; linkages to treatment, care, and services), and tertiary (e.g., prevention and management of comorbidities leading to preventable hospitalizations and poor health outcomes; caregiving for persons with dementia) prevention to be used to develop or revise the jurisdiction wide ADRD plan.

https://www.cdc.gov/socialdeterminants/about.html

Strategy 2: Educate coalition members and partners to orient them to brain health and ADRD issues and the broad spectrum of actions needed to fully address ADRD across the jurisdiction.

Strategy 3: Not required for Component 2

Strategy 4: Lead the coalition to develop and track an Implementation Plan to achieve the priorities, activities, and goals specified in the jurisdiction’s ADRD Strategic Plan The required output for this activity is an Implementation Plan (a comprehensive description of the specific strategies, objectives, actions, and champions that are needed to implement the jurisdiction ADRD Strategic Plan goals) for the coalition that addresses the below criteria:

1. Is a living, dynamic document that allows for adjustments that are informed by experience, science, data, and contextual influences.

2. Has objectives that are specific, measurable, attainable, relevant, time bound, inclusive, and equitable (SMARTIE).

3. Uses specific best practices to address ADRD topics

4. Contains actions that address sustainability (e.g., continuation of effort beyond the conclusion of the period of performance).

5. Prioritizes populations and communities experiencing the greatest disparities in the prevalence of ADRD or ADRD-associated risk factors, including addressing SDOH and health equity.

6. Identifies champions and the role they will play in implementation of each action.

Strategy 5: Educate members of the general public (including populations of high burden) about ADRD topics, including but not limited to primary (e.g., dementia risk reduction), secondary (e.g., early detection and diagnosis, linkages to treatment, care, and services), and tertiary (e.g., prevention and management of comorbidities leading to preventable hospitalizations and poor health outcomes, and caregiving for persons with dementia) prevention.

Strategy 6: Educate providers and other professionals about ADRD topics, including but not limited to primary (e.g., dementia risk reduction), secondary (e.g., early detection and diagnosis, linkages to treatment, care, and services), and tertiary (e.g., prevention and management of comorbidities leading to preventable hospitalizations and poor health outcomes, and caregiving for persons with dementia) prevention.

Strategy 7: Increase the availability and use of data (e.g., BRFSS, health system data, registries, community listening sessions, needs assessments, and other available data sources) to improve knowledge and inform data driven decision-making about ADRD goals and activities.

Such data may include, as appropriate, information on cognitive decline, caregiving, and health disparities experienced by disproportionately-affected populations and individuals with cognitive decline and their caregivers. State recipients should support the collection of data from the BRFSS caregiving and subjective cognitive decline modules.

Recipients will also be expected to use available data to:

1. Increase program visibility.

https://www.cdc.gov/cancer/nbccedp/pdf/smartie-objectives-508.pdf

2. Attract partners.

3. Assist ready communication.

4. Understand community achievements and public health burden.

5. Facilitate evolution of initiatives and overall sustainability of activities over time.

Strategy 8: Improve sustainability of jurisdiction ADRD efforts. This includes adopting activities that address all of the following items below:

1. Enhance the ability to effectively implement evidence-based practices over time.

2. Increase scalability.

3. Considers the changing landscape of resource and partner availability.

4. Improve systems, environments, and policies to support dementia (e.g., organizational policies, academic curricula, professional associations, accreditation, certification entities).

5. Incorporate the best available science about brain health, cognitive impairment, and caregiving for persons with dementia into their policies and training.

Strategy 9: Increase the number of community-clinical linkages among health care systems and services, public health agencies, and community-based organizations to improve both coordination and dementia outcomes, which will also address a key social determinant of health.

This will include, but is not limited to, increasing the number of people knowing how and where to seek care and support, establishing formal agreements between entities, and connecting health care systems and providers to community treatment care and services and programs to increase referrals between those entities. Community-clinical linkages should be bi-directional, meaning organizations both provide and receive the information needed to support increased coordination among public health, health care, and community-based sectors. Community-based organizations includes community services and programs related to ADRD or its modifiable risk factors.

1. Collaborations

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

All recipients are expected to identify and leverage opportunities with other CDC-funded public health programs with common interests and objectives related to brain health and cognitive impairment including dementia risk reduction (primary prevention) by addressing modifiable risk factors for ADRD (e.g., high blood pressure, heart disease, diabetes, smoking, lack of physical activity etc.), early detection and diagnosis; linkages to treatment, care, and services (secondary prevention), and prevention and treatment of comorbidities and avoidable hospitalizations; caregiving for persons with dementia (tertiary prevention). These collaborations would include, but are not limited to, CDC programs funded by the National Center for Chronic Disease Prevention and Health Promotion related to brain health risk factors (e.g., CDC Heart Disease and Stroke Prevention, CDC National Diabetes Prevention Program, CDC's National Tobacco Control Program, CDC's Nutrition, Physical Activity and Obesity programs; Division of Population Health’s Good Health and Wellness in Indian Country Excessive Alcohol Use Prevention, and others). To avoid duplication of effort, recipients of this NOFO will use their coalitions as well as these partnerships to build linkages to bridge science and implementation https://www.cdc.gov/chronicdisease/resources/publications/aag/heart-disease-stroke.htm https://www.cdc.gov/chronicdisease/resources/publications/aag/heart-disease-stroke.htm https://www.cdc.gov/chronicdisease/resources/publications/aag/diabetes.htm https://www.cdc.gov/chronicdisease/resources/publications/aag/tobacco-use.htm https://www.cdc.gov/chronicdisease/resources/publications/aag/tobacco-use.htm https://www.cdc.gov/chronicdisease/resources/publications/aag/dnpao.htm https://www.cdc.gov/healthytribes/index.htm https://www.cdc.gov/alcohol/index.htm https://www.cdc.gov/alcohol/index.htm across their jurisdiction.

All recipients will be required to collaborate with other successful applicants funded through this NOFO, as well as organizations funded under CDC-RFA-DP20-2005 “BOLD Public Health Centers to Address Alzheimer’s Disease and Related Dementias”, and CDC-RFA-DP20-2003 “The National Healthy Brain Initiative” as well as relevant contracts and other projects. CDC will facilitate collaboration with these recipients. Applicants must indicate in their application that they will collaborate with these organizations. Applicants should name this file “XX Letters of Support” (where XX is the applicant name) and upload all letters of support in one PDF file to www.grants.gov.

b. With organizations not funded by CDC:

All recipients are strongly encouraged to identify and leverage opportunities to enhance their work with organizations across their jurisdiction in all levels of prevention activities. Recipients will build infrastructure to encourage linking together existing efforts by partners to avoid duplication of effort, enhance reach, consider SDOH, and bridge between science and implementation across their jurisdiction. Component 1-- Phase II and Component 2 recipients are expected to collaborate with and assist other organizations not funded by CDC in implementing the RM Series actions identified.

Collaborations, at a minimum, should include representatives of the identified organizations.

Tribes and Tribal applicant organizations should include members from their equivalent organizations.

a. Jurisdiction public health department representatives (the applicant)

b. Jurisdiction aging services department representative

c. Jurisdiction public health department representatives from identified risk reduction areas

(e.g., heart disease, diabetes)

d. National non-profit organization whose primary mission is Alzheimer’s disease (state or local chapter as appropriate)

e. Persons with a lived experience (e.g., PLWD or caregiver for person with ADRD)

All recipients are strongly encouraged to collaborate with groups and individuals, including but not limited to, the following:

a. State administrators managing applicable programs (e.g., Medicaid, senior public health officials, public health chronic disease directors)

b. Subject matter experts with expertise in dementia risk reduction, brain health and cognitive impairment, including ADRD care and service providers and caregiving for persons with dementia

c.…