Foa_Content_of_CDC-RFA-DP-23-0058 Revised.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

Addressing Conditions To Improve Population Health (ACTion)

CDC-RFA-DP-23-0058

06/30/2023

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview

Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA-DP- 23-0058. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Addressing Conditions To Improve Population Health (ACTion) C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For purposes of this NOFO, research is defined as set forth in 45 CFR 75.2 and, for further clarity, as set forth in 42 CFR 52.2 (see eCFR :: 45 CFR 75.2 -- Definitions and https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR- 2007-title42-vol1-sec52-2.pdf. In addition, for purposes of research involving human subjects and available exceptions for public health activities, please see 45 CFR 46.102(l) (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section- 46.102#p-46.102(l)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP-23-0058

https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l) https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-46/subpart-A/section-46.102#p-46.102(l)

E. Assistance Listings Number:

93.945 F. Dates:

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

06/07/2023

2. Due Date for Applications:

06/30/2023 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

Date: May 11, 2023 Time: 2:00p.m - 3:30pm Eastern Standard Time (EST) Topic: Addressing Conditions to Improve Population Health (ACTion) Informational Call

Register in advance for this webinar:

https://cdc.zoomgov.com/webinar/register/WN_yqFKIGElTcyJ1IlckX9jEA

Or an H.323/SIP room system:

H.323: 161.199.138.10 (US West) or 161.199.136.10 (US East) Meeting ID: 161 610 1857 Passcode: 24447318 SIP: 1616101857@sip.zoomgov.com Passcode: 24447318

After registering, you will receive a confirmation email containing information about joining the webinar. Please visit the ACTion NOFO website at https://www.cdc.gov/populationhealth/sdoh/funding/action/ACTion-NOFO.htm for more information.

G. Executive Summary:

1. Summary Paragraph This NOFO will fund ACTion (Addressing Conditions To improve population health) projects that will reduce chronic disease related disparities, risk factors, and inequities that are experienced by populations disadvantaged by their social or economic status, geographical location or environment including those enrolled in Medicaid hereafter known as Medicaid beneficiaries. Required strategies and activities to address health disparities include (1) engaging in multisectoral partnerships; (2) implementing a minimum of 1 Policy, System, or Environmental Change intervention (PSE) in 1 or more of the following NCCDPHP Social Determinants of Health (SDOH) domains (i.e., Built Environment, Community-Clinical Linkages, Food and Nutrition Security, and Social Connectedness); (3) developing a plan to evaluate the ACTion project(s); and (4) evaluating the ACTion project(s). Applicants must have implementation ready plans to carry out ACTion projects. Example PSEs for each SDOH domain are described in Table 1. Project outcomes include policy changes (i.e., increases in the adoption of new policies and strengthening of existing policies), systems changes (i.e., increases https://www.grants.gov/ https://cdc.zoomgov.com/webinar/register/WN_yqFKIGElTcyJ1IlckX9jEA https://www.cdc.gov/populationhealth/sdoh/funding/action/ACTion-NOFO.htm in organizational behaviors and norms that promote healthy behaviors, reduce health risks, and improve access to health care and community services), and environmental changes (i.e., increases in the improvement of community level systems and structures that address the root causes of health inequities).

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards

d. Total Period of Performance Funding:

$7,500,000

e. Average One Year Award Amount:

$500,000

f. Total Period of Performance Length:

3 year(s)

g. Estimated Award Date:

August 31, 2023

h. Cost Sharing and / or Matching Requirements:

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

Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. Achieving health equity also requires addressing social determinants of health and health disparities (CDC). Social determinants of health are nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age and the wider set of forces and systems shaping the conditions of daily life. These challenges exacerbate health disparities and inequities among populations such as Medicaid beneficiaries which can drive health care utilization and cost and result in worse health outcomes. Current research indicates that some social interventions that prioritize Medicaid beneficiaries can result in improved health outcomes and significant savings to the health care sector.

Differences in SDOH contribute to the stark and persistent chronic disease disparities in the United States among priority populations that are disproportionately affected including racial, https://www.cdc.gov/chronicdisease/healthequity/index.htm#:~:text=NCCDPHP%20is%20advancing%20health%20equity%20by%20addressing%20social,to%20engage%20communities%2C%20and%20focus%20on%20workforce%20improvement.

https://www.cdc.gov/chronicdisease/healthequity/sdoh-and-chronic-disease/nccdphps-approach-to-social-determinants-of-health.html https://www.cdc.gov/chronicdisease/index.htm https://www.cdc.gov/nchhstp/healthequity/index.html ethnic, and socioeconomic groups, those who are medically underserved or who reside in rural/sparsely populated areas to live healthier lives. Public health crises and economic uncertainty may increase attention on disparities. However, health inequities have persisted across generations because of structural policies and practices that have systematically limited health access and opportunities. By addressing SDOH, we advance progress towards health equity. As the health care system begins to assess social needs and work more closely with human services, public health has a significant role to play in the broader population health and social determinant landscape. Maximizing public health impact, policy, systems, environmental, programmatic, and infrastructure strategies and activities that address SDOH have the potential to narrow disparities in many chronic diseases by removing barriers to practicing healthy behaviors.

As part of the Centers for Disease Control and Prevention’s (CDC) commitment to achieving health equity, the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has developed a Framework for Addressing SDOH with significant potential to impact health outcomes related to chronic disease. This NOFO addresses SDOH through Policy, Systems, and Environmental changes (PSEs) (Refer to Table 1) that improve health equity.

Recipients will implement a minimum of 1 PSE change intervention that addresses at least one of the NCCDPHP Framework SDOH domains (i.e., Built Environment, Community-Clinical Linkages, Food and Nutrition Security, and Social Connectedness).

b. Statutory Authorities This program is generally authorized under Sec 317(k)(2) of the Public Health Service Act, as amended (42 USC 247b(k)(2)). In addition, this program is authorized by the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2023, House Report 117-403 page 82, which directed CDC to award competitive grants to state, tribal, local, and territorial (STLT) jurisdictions to support the development of Social Determinants of Health Accelerator Plans, the implementation of those plans, and to improve the health of Medicaid beneficiaries.

c. Healthy People 2030 This funding opportunity supports Healthy People 2030 objectives in the topic area of Social Determinants of Health. Healthy People 2030 categorizes SDOH into five domains: 1) Economic Stability; 2) Education Access and Quality; 3) Health Care Access and Quality; 4) Neighborhood and Built Environment; and 5) Social and Community Context.

d. Other National Public Health Priorities and Strategies The Guide to Community Preventive Services The National Partnership for Action to End Health Disparities: Toolkit for Community Action Thriving Together: A Springboard for Equitable Recovery and Resilience in Communities Across America - Community Commons COVID-19 Health Equity Strategy National Stakeholder Strategy for Achieving Health Equity Active People, Healthy Nation Surgeon General Priority: Community Health and Economic Prosperity Agency for Health care Research and Quality Social Determinants of Health and Practice Improvement Centers for Medicare & Medicaid Services Innovation Center Strategic Objectives https://www.cdc.gov/chronicdisease/programs-impact/sdoh.htm https://www.congress.gov/117/crpt/hrpt403/CRPT-117hrpt403.pdf https://health.gov/healthypeople/priority-areas/social-determinants-health https://health.gov/healthypeople/priority-areas/social-determinants-health https://health.gov/healthypeople/objectives-and-data/browse-objectives/economic-stability https://health.gov/healthypeople/objectives-and-data/browse-objectives/economic-stability https://health.gov/healthypeople/objectives-and-data/browse-objectives/education-access-and-quality https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality https://health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-environment https://health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-environment https://health.gov/healthypeople/objectives-and-data/browse-objectives/social-and-community-context https://www.thecommunityguide.org/ https://lucascountyhealth.com/wp-content/uploads/2016/07/NPA_Toolkit-for-Community-Action.pdf https://www.communitycommons.org/entities/fb33981e-616a-43aa-a0d7-28c14566ebbd#:~:text=Well%20Being%20Trust-,Thriving%20Together%3A%20A%20Springboard%20for%20Equitable%20Recovery%20and%20Resilience%20in,tangled%20threats%20to%20our%20nation.

https://www.communitycommons.org/entities/fb33981e-616a-43aa-a0d7-28c14566ebbd#:~:text=Well%20Being%20Trust-,Thriving%20Together%3A%20A%20Springboard%20for%20Equitable%20Recovery%20and%20Resilience%20in,tangled%20threats%20to%20our%20nation.

https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/cdc-strategy.html https://www.phdmc.org/program-documents/healthy-lifestyles/dche/64-achieving-health-equity/file https://www.cdc.gov/physicalactivity/activepeoplehealthynation/index.html https://www.hhs.gov/surgeongeneral/priorities/community-health-economic-prosperity/index.html https://www.ahrq.gov/sdoh/practice-improvement.html https://www.ahrq.gov/sdoh/practice-improvement.html https://innovation.cms.gov/strategic-direction

e. Relevant Work NCCDPHP prioritizes health equity to prevent chronic diseases, identify markers of health disparities, and address root causes of health inequities.

This NOFO builds on these programs:

A Strategic Approach to Advancing Health Equity for Priority Populations with or at Risk for Diabetes

Closing the Gap with Social Determinants of Health Accelerator Plans Healthy Tribes High Obesity Program Improving Social Determinants of Health – Getting Further Faster Initiative Racial and Ethnic Approaches to Community Health (REACH) State Physical Activity and Nutrition (SPAN) Program

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA-DP-23-0058 Logic Model: Addressing Conditions to Improve Population Health (ACTion)

Strategies and Activities

Short-term Outcomes Intermediate Outcomes

Long-Term Outcomes

Engage in multisectoral partnerships to implement a minimum of 1 PSE in 1 or more

NCCDPHP SDOH

domains

(i.e., Built Environment, Community Clinical Linkages, Food and Nutrition Security, and Social Connectedness)

Policy changes

Increased strengthening of existing policies

Increased adoption of new policies

Systems changes

Increased organizational behavior and norms that promote health practices

Increased organizational behavior and norms

Increased health equity

Decreased health risk behaviors

Increased health promoting behaviors inequities disparities

Improved population health https://www.cdc.gov/chronicdisease/healthequity/social-determinants-of-health-and-chronic-disease.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fchronicdisease%2Fprograms-impact%2Fsdoh.htm https://www.cdc.gov/diabetes/funding-opportunity/NOFO-CDC-RFA-DP23-0020.html https://www.cdc.gov/diabetes/funding-opportunity/NOFO-CDC-RFA-DP23-0020.html https://www.cdc.gov/populationhealth/sdoh/index.htm https://www.cdc.gov/healthytribes/index.htm https://www.cdc.gov/nccdphp/dnpao/state-local-programs/hop-1809/high-obesity-program-1809.html https://www.cdc.gov/chronicdisease/healthequity/sdoh-and-chronic-disease/nccdphps-programs-to-address-social-determinants-of-health/getting-further-faster.htm https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm https://www.cdc.gov/nccdphp/dnpao/state-local-programs/span-1807/index.html

Develop an ACTion evaluation plan

Evaluate the ACTion project that reduce health risks

Increased availability of health care and community services

Increased accessibility to health care and community services

Environmental changes

Increased improvements in community design

Increased accessibility to community infrastructure

Increased utilization of health care and community services

i. Purpose This NOFO will fund STLT health jurisdictions to implement PSEs (refer to Table 1) that address SDOH to reduce chronic disease related disparities, risk factors, and inequities among priority populations. Priority populations are defined as those who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion;

socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability;

sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

ii. Outcomes The recipient is expected to complete activities that will impact the bolded short-term outcomes that are expected by the end of this period of performance.

Short-Term Outcomes

Policy changes o Increased strengthening of existing policies o Increased adoption of new policies

Systems changes o Increased organizational behavior and norms that promote healthy practices o Increased organizational behaviors and norms that reduce health risks o Increased availability of health care and community services o Increased accessibility of health care and community services

Environmental changes o Increased improvements in community design o Increased accessibility to community infrastructure

Examples of short-term outcomes by NCCDPHP Domains (Built Environment, Community Clinical Linkages, Food and Nutrition Security, and Social Connectedness) are included in Appendix B.

iii. Strategies and Activities Strategy 1: Engage in multisectoral partnerships to implement a minimum of 1 PSE in 1 or more NCCDPHP SDOH Domains The applicant is required to upload an implementation ready plan to www.grants.gov that will be utilized to carry out the ACTion project and the plan must describe at least 1 PSE that will be implemented that addresses at least 1 NCCDPHP Domain (Example PSEs for each SDOH domain are listed in Table 1). The applicant will name the file “ACTion_ Project_Plan.” This award may NOT be used to develop new plans. Recipients must engage in multisectoral partnerships to implement a minimum of 1 Policy System and Environmental Change intervention (PSE) in 1 or more of the following NCCDPHP SDOH domains (i.e., Built Environment, Community-Clinical Linkages, Food and Nutrition Security, and Social Connectedness). Applicants will identify the PSE change(s) the intervention is intended to achieve, associated short-term outcomes in the logic model, and the primary NCCDPHP SDOH domain being addressed (NOTE: Additional domains may be impacted by the PSE intervention).

The applicant’s ACTion project plan should include the following components outlined below:

A. The community of interest and potential Medicaid beneficiary population disproportionately affected by disparities or inequities related to chronic disease.

Identify the tribe, community, or catchment area for the ACTion project and describe the following:

o Results from a community health needs assessment (CHA) and/or state health needs assessment (SHA) that provide specific information about the community and population(s). The assessment should have been completed within the last five (5) years. Using the CHA and/or SHA and other data sources, the applicant should describe the following:

Demographic characteristics Health status Catchment area in which at least 50 percent of the total /jurisdiction are considered priority populations including Medicaid beneficiaries. Priority populations are defined as those who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion;

socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion).

Refer to the CDC National Center for Chronic Disease Prevention and Health Promotion’s Health Equity Guiding Principles for Inclusive Communication for guidance on addressing all people inclusively and respectfully.

http://www.grants.gov/ https://data.medicaid.gov/datasets?theme%5B0%5D=Enrollment https://www.cdc.gov/healthcommunication/Health_Equity.html https://www.cdc.gov/healthcommunication/Health_Equity.html

Community profile Chronic disease burden Available health care systems o High prevalence of behavioral-related factors, such as the following:

Physical inactivity Poor nutrition Alcohol use

Evidence of disproportionate vulnerability to adverse health outcomes by poverty rate and CDC Social Vulnerability Index (SVI) score.

Identify the population(s) disproportionately affected by disparities or inequities related to chronic disease and related risk factors (e.g., particularly those who have been affected by poverty, lack economic resources including communities with high rates of income inequity or low employment opportunities, etc.). Use cited data sources to define and describe the population(s). Include information about the Medicaid beneficiary population that will benefit from the ACTion project. Examples of data sources include the following:

o Transformed Medicaid Statistical Information System (T-MSIS) o Medicaid Participation (census.gov) o Medicaid Data Sources - General Information | CMS o Data.Medicaid.gov o County Health Rankings o City Health Dashboard o PLACES o Census o American Community Survey o Community Commons o CARES HQ – Center for Applied Research and Engagement Systems o Behavioral Risk Factor Surveillance Systems (BRFSS) o Youth Risk Behavior Surveillance System (YRBSS) o Nutrition, Physical Activity, and Obesity: Data, Trends and Maps o Pregnancy Risk Assessment Monitoring System

Describe at least 1 PSE intervention(s) that will be implemented in 1 or more NCCDPHP SDOH domains (i.e., Built Environment, Community-Clinical Linkages, Food and Nutrition Security, and Social Connectedness) that is (are) outlined in the ACTion project plan that will be implemented and evaluated during the 3-year period of performance.

Example PSEs for each NCCDPHP SDOH domain are included in Table 1. Applicants are strongly encouraged to select interventions that are ready to be implemented upon award of funding and are most likely to achieve short-term outcomes identified in the logic model in the 3-year period of performance. Applicants should describe the following:

o Why the PSE intervention(s) were selected including any available evidence of effectiveness.

o The specific PSE change(s) the intervention(s) is (are) intended to achieve.

https://www.atsdr.cdc.gov/placeandhealth/svi/index.html https://www.medicaid.gov/medicaid/data-systems/macbis/transformed-medicaid-statistical-information-system-t-msis/index.html https://www.census.gov/programs-surveys/sahie/technical-documentation/model-input-data/medicaid.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/MedicaidDataSourcesGenInfo https://data.medicaid.gov/ https://www.countyhealthrankings.org/ https://www.cityhealthdashboard.com/ https://www.cdc.gov/places/index.html https://data.census.gov/ https://www.census.gov/programs-surveys/acs https://www.communitycommons.org/ https://careshq.org/ https://www.cdc.gov/brfss/ https://www.cdc.gov/healthyyouth/data/yrbs/ https://www.cdc.gov/nccdphp/dnpao/data-trends-maps/index.html https://www.cdc.gov/prams/index.htm o Identify the short-term logic model outcomes aligned to the intended PSE change(s) that will be evaluated.

o Identify the primary NCCDPHP SDOH Domain that will be impacted because of successful implementation of the PSE intervention(s).

Table 1. Example PSE Interventions by NCCDPHP SDOH Domains

SDOH Domains Impact on Public Health Example PSE Interventions

Built Environment A healthy built environment facilitates access to transportation and physical resources that enhance quality of life, minimizes exposures to environmental contaminants, and supports physical activity, safe and accessible recreation, and other protective factors that improve chronic disease outcomes.

• Policies and activities that guide the physical development of a community including land use and zoning policies and plans;

jurisdiction-relevant pedestrian, bicycle, and parks and recreation plans; and housing, conservation, or economic development plans that include equitable and inclusive access to physical activity.

Community-Clinical Linkages

Effective community-clinical linkages improve chronic disease outcomes by increasing access to and utilization of preventive services in local communities.

• Policies and activities that increase access to programs (e.g., Diabetes Self- Management Education and Support) that are a covered benefit for Medicaid beneficiaries.

• Policies and systems to increase uptake and completion of Centers for Medicare & Medicaid Services (CMS) referrals for Medicaid beneficiaries.

• Policies and activities to increase access to health care screening and referral programs in communities that leverage the housing and transportation sectors.

Food and Nutrition Security

Enhancing durable access to and routine consumption of adequate, nutritious food

• Policies that establish or update food service or charitable food distribution in https://www.cdc.gov/diabetes/pdfs/managing/Managing-Diabetes_CMS-CDC_English-508.pdf https://www.cdc.gov/diabetes/pdfs/managing/Managing-Diabetes_CMS-CDC_English-508.pdf https://www.cdc.gov/diabetes/pdfs/managing/Managing-Diabetes_CMS-CDC_English-508.pdf

SDOH Domains Impact on Public Health Example PSE Interventions supports overall health, reduces morbidity and mortality associated with chronic disease, and decreases health care utilization.

community institutions, such as hospitals, government worksites, colleges and universities, food banks and pantries, or parks and recreation centers to align with the federal food service guidelines.

Social Connectedness Social connectedness is a significant determinant of mental, emotional, and physical health and serves as a key factor in protecting, improving, and maintaining individual and community well-being. A high degree of social connectedness can increase the likelihood of individuals engaging in positive health behaviors, ultimately improving chronic disease outcomes and increasing longevity. It can also moderate the negative health effects of psychological conditions such as stress, trauma, anxiety, and depression.

• Policies and activities that create environments that increase opportunities for safe gathering in community settings (e.g. parks, recreation centers, community centers).

• Policies and activities that increase support and access to organizations that offer programs that foster social connectedness and community-based activities.

• Policies and systems that increase screening for social factors that impact health, including social support.

B. Multisectoral partners engaged in implementing the ACTion project

Describe an established multisector Leadership Team that will guide the implementation of the ACTion project. Recipients will manage and convene the Leadership Team in person or virtually throughout the ACTion project. Refer to the required collaboration section below for required membership of the multisector leadership team.

Describe multisectoral partner roles, responsibilities, and goals.

Describe how the recipients will utilize a community-based participatory approach in engaging the Leadership team that includes shared decision making and builds upon the collective assets of the community.

Describe how recipient will collaborate with Medicaid offices at the state or county level (department of public social services) and/or Medicaid Managed Care organizations (MCOs)as appropriate to ensure ACTion projects improve the health of Medicaid beneficiaries in their community.

Describe method used to engage diverse and inclusive new and existing partners in implementation and evaluation efforts.

Strategy 2. Develop an ACTion Project Evaluation Plan CDC is funding an evaluation technical assistance partner (hereafter referred to as “Evaluation/TA Partner”) to support rapid evaluation of the 3-year ACTion projects and provide evaluation technical assistance to recipients. Recipients are required to collaborate with CDC and the Evaluation/TA Partner. Refer to Appendix A to review additional information about roles and responsibilities for evaluation.)

Applicants will propose “draft evaluation plans” in the NOFO application in the section below titled “Applicant Evaluation and Performance Measurement Plan.” CDC and the Evaluation/TA Partner will work with recipients to finalize the draft evaluation plans.

Recipients are required to submit the final ACTion Project Evaluation plans to CDC 6 months post-award.

Recipients are required to participate in technical assistance provided by CDC and the Evaluation/TA Partner to finalize the draft ACTion project evaluation Plan (i.e., NOFO section “Applicant Evaluation and Performance Measurement Plan”).

Strategy 3. Evaluate the ACTion Project Recipients will conduct process and outcome evaluation in collaboration with CDC and the Evaluation/TA Partner. Process evaluation will be conducted throughout the 3-year period of performance.

Monitor and track ACTion project implementation processes.

Collect and report data on implementation processes using performance measures reporting tools provided by the Evaluation/TA Partner and via other methods developed by the Evaluation/TA Partner (e.g., key informant interviews).

Develop a dissemination plan to ensure that findings and lessons learned are broadly shared to inform ongoing PSE strategies and support sustainability of efforts.

Dissemination plans will be due to CDC at the end of year two of the project period.

CDC-funded technical assistance partners will support recipients in their development of dissemination plans.

1. Collaborations

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

Required Collaborations:

Recipients are required to collaborate with CDC designated Evaluation/TA and SDOH Domain/TA providers that will support the implementation and evaluation of PSEs described in their ACTion project.

If CDC-funded state and/or local chronic disease prevention programs exist, applicants are required to collaborate with those programs (as appropriate) throughout the ACTion period of performance including but not limited to those listed below.

Applicants should submit at least one letter of support that describes how they will collaborate with the CDC-funded chronic disease prevention program(s) as appropriate.

The letter(s) must be signed by the applicant and the program director of the CDC-funded program. Applicants must name the file "CDC_Letter_of_Support_Required" and upload to www.grants.gov.

CDC-funded chronic disease and health promotion programs include the following.

State Public Health Approaches to Addressing Arthritis National Breast and Cervical Cancer Early Detection Program National Comprehensive Cancer Control Program National Program of Cancer Registries Colorectal Cancer Control Program Cancer Genomics Program National Diabetes Prevention Program A Strategic Approach to Advancing Health Equity for Priority Populations with or at

Risk for Diabetes Good Health and Wellness in Indian Country Improving the Health of Americans through Prevention and Management of Diabetes and

Heart Disease and Stroke Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes, Heart Disease, and Stroke Wise Women Mississippi Delta Health Collaborative State Physical Activity and Nutrition (SPAN) High Obesity Program (HOP) Racial and Ethnic Approaches to Community Health (REACH) State Actions to Improve Oral Health Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Maternal and Child Health Epidemiology Program, (MCHEP) Pregnancy Risk Assessment Monitoring System (PRAMS) Sudden Unexpected Infant Death and Sudden Death in the Young Case Registry Improving School Health and Academic Achievement Through Nutrition, Physical

Activity and the Management of Chronic Conditions in School Community Health Workers for COVID Response and Resilient Communities (CCR)

Encouraged Collaborations:

If it is relevant to the SDOH domain selected, recipients are asked to collaborate with CDC-funded programs outside of chronic disease that focus on population health approaches to reduce health disparities and address the social determinants of health (e.g., injury prevention, mental health promotion, and sexually transmitted disease prevention). These collaborations are especially essential for implementing efforts that strengthen community resilience. This will ensure proposed activities are complementary with other CDC-funded programs operating in the same area and avoid duplication of efforts. Applicants are encouraged to submit a letter of support that describes how they will collaborate with the relevant non-chronic disease CDC-funded program(s) if appropriate. The letter must be signed by the applicant and the program director of the CDC-funded program. Applicants must name the file "CDC_Letter_of_Support" and upload the letter to www.grants.gov.

http://www.grants.gov/ https://www.cdc.gov/arthritis/funded/nofo/cdc-rfa-dp-23-0001.html https://www.cdc.gov/cancer/nbccedp/ https://www.cdc.gov/cancer/ncccp/ https://www.cdc.gov/cancer/npcr/ https://www.cdc.gov/cancer/crccp/ https://www.cdc.gov/cancer/genomics/ https://www.cdc.gov/diabetes/prevention/index.html https://www.cdc.gov/diabetes/funding-opportunity/NOFO-CDC-RFA-DP23-0020.html https://www.cdc.gov/diabetes/funding-opportunity/NOFO-CDC-RFA-DP23-0020.html https://www.cdc.gov/healthytribes/ghwic.htm https://www.cdc.gov/dhdsp/programs/spha/overview.htm https://www.cdc.gov/dhdsp/programs/spha/overview.htm https://www.cdc.gov/dhdsp/programs/spha/overview.htm https://www.cdc.gov/dhdsp/programs/spha/overview.htm https://www.cdc.gov/dhdsp/programs/spha/overview.htm https://www.cdc.gov/dhdsp/programs/spha/overview.htm https://www.cdc.gov/nccdphp/dnpao/state-local-programs/span-1807/index.html https://www.cdc.gov/nccdphp/dnpao/state-local-programs/hop-1809/high-obesity-program-1809.html https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm https://www.cdc.gov/oralhealth/funded_programs/cooperative_agreements/index.htm#:~:text=Under%20the%20State%20Actions%20to%20Improve%20Oral%20Health,states%20will%20implement%20a%20core%20set%20of%20activities%3A https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/index.html https://www.cdc.gov/reproductivehealth/mchepi/index.htm https://www.cdc.gov/prams/ https://www.cdc.gov/sids/case-registry.htm https://www.cdc.gov/healthyschools/fundedpartners.htm https://www.cdc.gov/healthyschools/fundedpartners.htm https://www.cdc.gov/covid-community-health-workers/index.html https://www.cdc.gov/injury/index.html https://www.cdc.gov/mentalhealth/ https://www.cdc.gov/mentalhealth/ https://www.cdc.gov/nchhstp/sexual-health-topics.htm http://www.grants.gov/

b. With organizations not funded by CDC:

Required Collaborations:

Recipients are required to strengthen existing multi sector partnerships, identify and collaborate with key partners who have existing community or social service delivery programs for population groups experiencing health disparities and inequities.

Applicants are required to collaborate with Medicaid offices at the state or county level (department of public social services) and/or Medicaid Managed Care Organization as appropriate to ensure ACTion projects improve the health of Medicaid beneficiaries in their community. Applicants are required to submit a letter of support that describes how they will collaborate with the Medicaid provider(s). The letter (s) must be signed by the applicant and the related Medicaid provider(s) leadership. Applicants must name the file “Medicaid Letter_of_Support” and upload it to www.grants.gov.

Applicants should describe how they will collaborate with additional state and local health care providers, in addition to required Medicaid providers (above), to ensure that ACTion project activities are coordinated and synergistic. Letter of support should describe how they will collaborate with other relevant the health care providers (as appropriate), i.e., Federal Qualified Health Centers, hospitals, insurance plans). The letter

(s) should be signed by the applicant and the related partner's organizational leader.

Applicants must name the file “Health_care_Sector_Letter_of_Support” and upload it to www.grants.gov.

Applicants should describe how they will integrate innovative or best practices for coordinating with diverse and inclusive multisectoral partners on their Leadership Team.

The applicant is required to submit at least four letters of support from Leadership Team members detailing the individuals’/represented organization’s commitment to the implementation of the ACTion project. The applicant will name the file "Leadership_Team_Letters_of_Support" and upload it to www.grants.gov.

Encouraged Collaborations:

As appropriate, recipients should describe their collaborations with other non-public health sectors such as, transportation, housing, to implement PSE interventions as appropriate that are not already on the Leadership Team. Additional partners may include:

o Governmental organizations focused on non-health services (e.g., Coordinating Council on Access and Mobility – Department of Transportation, Supportive housing for the elderly – Housing and Urban Development; Community Development Financial Institutions Fund - Department of the Treasury) o Social services providers and organizations, including those that address social determinants of health (e.g., community transportation; anti-discrimination organizations legal services; service providers for persons with disabilities) o Community health centers (e.g., federally qualified health centers, (FQHCs), Rural Health Clinics (RHCs)) o Community-based and civic organizations (e.g., community gardens, literacy organizations) o Tribes, tribal or native serving organizations and health systems, urban Indian organizations http://www.grants.gov http://www.grants.gov o Academic institutions, and universities (e.g., Historically Black Colleges and Universities (HBCUs), Hispanic Association of Colleges and Universities (HACUs), American Indian Higher Education Consortium (AIHEC), Tribal Colleges and Universities (TCUs) o Asian American, Native Hawaiian, and Pacific Islander Serving Institutions

(AAPI)

o Faith-based organizations o Public and private non-governmental organizations (e.g., Area Agencies on

Aging, Boys and Girls Club) o Correctional facilities and institutions o Local governmental agencies and community leaders (e.g., libraries, pools, parks) o Local businesses and business community networks and organizations, (e.g., employers, local chambers of commerce, small business community groups or associations) o Labor Unions and other employee organizations o Health care providers and related professionals (e.g., physicians, nurses, community health workers, pharmacists) o Health-related organizations, (e.g., pharmacies, testing centers) o State Offices of Rural Health (SORH) or equivalent, State Rural Health

Associations (SRHAs) o Health care facilities (e.g., Critical Access Hospitals (CAHs), children’s hospitals, urgent care clinics) o Community and Economic Development organizations

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

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

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

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

CDC recognizes that social and economic opportunities, health behavior, and the physical environment in which people live greatly impact health outcomes. Health disparities represent preventable differences in the burden of disease, disability, injury or violence, or in opportunities to achieve optimal health. Applicants must describe the population they intend to work in, including relevant health disparities, and how their ACTion project will improve health and reduce or eliminate one or more identified chronic disease health disparities.

iv. Funding Strategy N/A

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

CDC will work with the Evaluation/TA Partner and recipients to conduct rapid evaluation of the 3-year ACTion Project. This will involve providing technical assistance (including reporting templates) to recipients both individually and collectively to finalize evaluation plans by 6 months post-award.

Evaluation plan components are described below in the Applicant Evaluation and Performance Measurement Plan section of the NOFO. Evaluation will occur throughout the period of performance and focus on both process (i.e., implementation of the ACTion project) and outcomes (i.e., intervention success in achieving of project-specific short-term outcomes aligned to NOFO logic model outcomes).

Over the 3-year period of performance, data will be secured with limited access to authorized CDC program and evaluation staff. CDC will publish summative reports on individual and aggregate performance measurement data to internal and external stakeholders.

Throughout the 3-year period of performance, CDC will seek to answer the following overarching evaluation questions based on the program logic model, strategies, and activities:

To what extent were recipients successful in implementing their ACTion projects?

(process evaluation)

What obstacles and/or challenges did recipients encounter in conducting their ACTion project, developing an evaluation plan, and evaluating their ACTion project? (process evaluation)

What factors facilitated successful implementation of the ACTion project? (process evaluation)

To what extent did ACTion project PSE Interventions achieve intended PSE changes and short-term outcomes? (outcome evaluation)

Process Evaluation Process evaluation will focus on implementation of the ACTion project and will involve collecting standardized data across all recipients. The process evaluation plan will be developed by the Evaluation/TA Partner in collaboration with CDC. The contractor will provide orientation and training to recipients on the process evaluation plan, conduct the process evaluation, and provide ongoing technical assistance to recipients on their participation in the process evaluation (e.g., data collection and reporting). Recipients will be expected to participate in evaluation activities such as surveys, interviews, case studies, and other data collection efforts to ensure there is a robust evaluation of the ACTion project implementation process. CDC and the Evaluation/TA Partner will use findings from these evaluation efforts to refine technical assistance, compile lessons learned, and inform future CDC efforts to support and sustain implementation of plans to address SDOH.

Draft process measures for the ACTion project include the following:

Number of multisector partners involved Type of multisector partners involved Role of multisector partners in implementing the PSE intervention % of population of focus which are Medicaid beneficiaries (Note: Additional process measures to be developed and shared with recipients by 6-months post-award as part of the final process evaluation plan.)

Process measures will be reported by all recipients to CDC and the Evaluation/TA partner throughout the 3-year period of performance. Specific reporting requirements and frequency for the process measures will be determined and will be shared with recipients within 6 months post-award. The Evaluation/TA partner will also manage and analyze the data to identify recipient program improvements, respond to broader technical assistance needs, and to report to stakeholders. CDC and the Evaluation/TA Partner will analyze recipient submitted performance measure data and develop aggregate performance measure reports to be disseminated to recipients and other key stakeholders, including federal partners, non-funded partners, and policy makers, as appropriate. These aggregate findings may also be presented during site visits and recipient meetings.

Outcome Evaluation Outcome evaluation will focus on ACTion project PSE intervention success in achieving short-term outcomes identified in the NOFO logic model. The short-term outcomes in the NOFO logic model are intentionally broad to encompass recipients’ project-specific outcomes to be achieved by their PSE interventions and associated performance measures for those outcomes. Applicants will propose project-specific outcomes (aligned to NOFO logic model short-term outcomes) and performance measures as part of their draft evaluation plan submitted with their application (see the Application Evaluation and Performance Measurement Plan section in this NOFO).

Recipients will conduct outcome evaluation according to their final evaluation plans and will receive technical assistance from CDC and the Evaluation/TA Partner throughout the 3-year period of performance.

Sample performance measures for this NOFO are provided in the table below. These performance measures correspond to the strategy categories and short-term outcomes described in the logic model. Recipients can select relevant performance measures from the table below or work collaboratively with CDC and the Evaluation/TA Partner within the first 6-months of award to develop project-specific performance measures. Recipient evaluation plans, including project-specific short-term outcomes and performance measures must be finalized 6-months post-award and approved by CDC prior to conducting evaluation. Performance measures will be reported by recipients annually in the Annual Project Report (APR). CDC and the Evaluation/TA Partner will work with recipients to finalize their evaluation plans, including a Data Management Plan (DMP), in accordance with CDC program guidance. Applicants must include a Data Management Plan (DMP) that includes, but is not limited to, the type of data that will be collected, procedures for collecting the data, how data will be stored, procedures for providing access to the data, provisions for maintaining data privacy, confidentiality, and data security. If all of these items cannot be addressed comprehensively, applicants should include a DMP that is as complete as possible.

Short-Term Outcomes Sample Performance Measures

Increased strengthening of existing policies number and type of existing policies strengthened to enhance chronic disease prevention and promotion

Increased adoption of new policies number and type of new policies that enhance chronic disease prevention and promotion number and % of jurisdictions that have adopted new policies

Increased organizational behavior and norms that promote healthy practices number and type of organizational behavior and norms changes that improve chronic disease prevention number and type of organizational behavior and norms changes that improve chronic disease management

Increased organizational behaviors and norms that reduce health risks number and type of health care and/or community services number and % of population utilizing health care and community services

Increased accessibility (e.g., screening, referrals) of health care and community services number and type of health care and/or community services made more accessible number and % of population linked to health care and community services proportion of Medicaid beneficiary population linked to health care services (# of Medicaid beneficiaries /total catchment area population) utilizing health care services) proportion of Medicaid beneficiary population linked community services (# of Medicaid beneficiaries /total catchment area population) utilizing community services)

Increased availability of health care and community services number and type of health care and/or community services made more available number and % of population utilizing health care and community services proportion of Medicaid beneficiary population utilizing health care services (# of Medicaid beneficiaries /total catchment area population) utilizing health care services) proportion of Medicaid beneficiary population utilizing community services (# of Medicaid beneficiaries /total catchment area population) utilizing community services)

Increased improvements in community design number and type of community design improvements made available number and % of population potentially impacted by community design improvements proportion of Medicaid beneficiary population (# of Medicaid beneficiaries /total catchment area population) with access to community design improvements

Increased accessibility to community infrastructure number and type of community infrastructure (e.g., pedestrian, bicycle, public transit) made accessible number and % of population with increased access to community infrastructure proportion of Medicaid beneficiary population (# of Medicaid beneficiaries /total catchment area population) increased access to community infrastructure

ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance

Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

How applicant will collect the performance measures, respond to the…