Foa_Content_of_CDC-RFA-DP-24-0025.pdf

Division of Population Health/Healthy Tribes

Notice of Funding Opportunity

Application due June 28, 2024

A Cultural Approach to Good Health and Wellness in Indian Country (GHWIC) Opportunity number: CDC-RFA-DP-24-0025

Contents Before you begin 3

Step 1: Review the Opportunity 4

Basic information 5

Eligibility 9

Program description 11

Step 2: Get Ready to Apply 42

Get registered 43

Attend the informational webinar 44

Step 3: Prepare Your Application 45

Application contents and format 46

Step 4: Learn About Review and Award 52

Application review 53

Award notices 64

Step 5: Submit Your Application 65

Application submission and deadlines 66

Application checklist 68

Step 6: Learn What Happens After Award 69

Post-award requirements and administration 70

Contacts and Support 74

Appendix 77

Endnotes 79

Contents 2

Before you begin If you believe you are a good candidate for this funding opportunity, secure your SAM.gov and Grants.gov registrations now. If you are already registered, make sure your registration is active and up-to-date.

SAM.gov registration (this can take several weeks) You must have an active account with SAM.gov. This includes having a Unique Entity Identifier (UEI).

See Step 2: Get Ready to Apply

Grants.gov registration (this can take several days) You must have an active Grants.gov registration. Doing so requires a Login.gov registration as well.

See Step 2: Get Ready to Apply

Apply by June 28, 2024 Applications are due by 11:59 p.m. Eastern Time on June 28, 2024.

To help you find what you need, this NOFO uses internal links. In Adobe Reader, you can go back to where you were by pressing Alt + Left Arrow (Windows) or Command + Left Arrow (Mac) on your keyboard.

Before you begin 3 https://sam.gov/ https://grants.gov/

Jump to a step

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1:

Review the Opportunity

In this step

Basic information 5

Eligibility 9

Program description 11

Basic information Centers for Disease Control and Prevention (CDC)

National Center for Chronic Disease Prevention and Health Promotion

(NCCDPHP)

Division of Population Health/Healthy Tribes

Building a culture-first approach to chronic disease prevention, management, and control.

Have questions?

See Contacts and Support.

Key facts

Opportunity name:

A Cultural Approach to Good Health and Wellness in Indian Country (GHWIC)

Opportunity number:

CDC-RFA-DP-24-0025

Federal Assistance Listing:

93.479

Statutory authority number:

Sections 301(a) and 317 of the Public Health Service Act, 42 U.S.C.

241(a) and 247b

Key dates

Application deadline:

June 28, 2024, 11:59 p.m. ET

Informational webinar:

May 7, 2024, 3 to 4:30 p.m. ET

Expected award date:

August 30, 2024

Expected start date:

September 30, 2024

Summary The Healthy Tribes Program at the Centers for Disease Control and Prevention (CDC) provides funding to reduce health disparities and increase health equity among American Indians and Alaska Natives (AI/AN).

Collectively, we want to improve the health of AI/AN people by reducing the:

• Rates of death and disability from chronic diseases.

• Prevalence of commercial tobacco use, prediabetes and diabetes, high blood pressure, obesity, oral disease, and other chronic disease risk factors and conditions.

This notice of funding opportunity (NOFO) has three separate, competitive components:

• Component 1 (C1) will fund federally recognized Tribes, including Alaska Native Villages (Tribes/Villages), and Urban Indian Organizations (UIOs) to implement chronic disease prevention, management, and control strategies and activities within their community.

• Component 2 (C2) will fund tribal organizations.

◦ Tribal organizations will apply to serve either of the following:

▪ All Tribes/Villages/UIOs and other tribal entities in their Indian Health Service (IHS) Area (Area).

▪ All 41 UIOs funded by the Indian Health Service (IHS).

◦ Component 2 recipients will carry out the following two activities:

▪ Use at least 50% of their annual funding to offer subawards to at least two Tribes/Villages/UIOs, and other tribal entities within their award area, not funded under C1, to implement C1 strategies and activities.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 5 https://www.govinfo.gov/content/pkg/USCODE-2021-title42/html/USCODE-2021-title42-chap6A-subchapII-partA-sec241.htm https://www.govinfo.gov/content/pkg/USCODE-2021-title42/html/USCODE-2021-title42-chap6A-subchapII-partB.htm

▪ Provide training, technical assistance (TA), and support to all Tribes/Villages/UIOs, and other tribal entities in their award area on:

▪ C1 strategies and activities.

▪ Policies, systems, and environmental (PSE) changes that promote health and prevent chronic diseases and their risk factors.

• Component 3 (C3) will establish a Tribal Coordinating Center to help all Good Health and Wellness in Indian Country (GHWIC) recipients collaborate and share knowledge. It focuses on peer learning, sharing best practices, and coordinating a national evaluation that uses Indigenous and Western methods.

You must state which component you are applying for in your application’s project abstract summary.

Funding details Type: Cooperative agreement

Expected total program funding over the performance period: $103,550,330

Expected total program funding per budget period: $20,710,060

Expected awards: 30

Funding range per applicant per budget period:

• Component 1: $300,000 to $400,000

• Component 2: $500,000 to $1,450,000

• Component 3: $600,000

Expected average award amount per budget period:

• Component 1: $400,000

• Component 2: $1,130,586

• Component 3: $600,000

We plan to award projects for five 12-month budget periods for a five-year period of performance.

The number of awards is subject to available funds and program priorities.

Step 1: Review the Opportunity 6

Funding strategy We will award up to 30 recipients for the three NOFO components.

Component 1 We will fund up to 16 recipients, including:

• Up to 12 federally recognized Tribes/Villages (up to two in each of the 12 IHS Administrative Areas).

• Up to 4 Urban Indian Organizations (UIOs) as defined in the glossary.

Component 1 applicants may apply for up to $400,000. Component 1 applicants may not apply for Component 2 or Component 3.

Component 2 We will fund up to 13 tribal organizations (see glossary), including:

• Up to one tribal organization in each IHS Area (12 IHS Administrative Areas).

• Up to one tribal organization with the ability to support all 41 UIOs funded by IHS.

The amount that tribal organizations can apply for to support all 41 UIOs is $1,250,000.

The amount that tribal organizations can apply for to support Area Tribes/ Villages/UIOs depends on their Area.

• IHS Areas with one to nine federally recognized Tribes/Villages: up to $500,000

◦ This includes the following IHS Area: Navajo

• IHS Areas with 10 to 25 federally recognized Tribes/Villages: up to $950,000

◦ This includes the following IHS Areas: Billings, Great Plains, Tucson/ Phoenix

• IHS Areas with 26 to 49 federally recognized Tribes/Villages: up to $1,250,000

◦ This includes the following IHS Areas: Albuquerque, Bemidji, Nashville, Portland, Southern Plains

• IHS Areas with 50 or more federally recognized Tribes/Villages: up to $1,450,000

◦ This includes the following IHS Areas: Alaska, California

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 7 https://www.federalregister.gov/documents/2024/01/08/2024-00109/indian-entities-recognized-by-and-eligible-to-receive-services-from-the-united-states-bureau-of https://www.ihs.gov/locations/ https://www.ihs.gov/locations/ https://www.ihs.gov/urban/nationalprograms/ https://www.ihs.gov/locations/ https://www.ihs.gov/locations/

Component 3 We will fund one tribal organization.

Component 3 applicants may apply for up to $600,000.

Note: Tribal organizations can apply for Component 2 and Component 3 and may be awarded under both components. A separate, complete application is required for each component.

Step 1: Review the Opportunity 8

Eligibility Who can apply

• Native American tribal governments (federally recognized), as defined by 25 U.S.C. 1603(14)

• Native American tribal organizations, as defined by 25 U.S.C. 1603(26) and Section 4 of the Indian Self Determination and Education Assistance Act (25 U.S.C. 5304(l)), other than federally recognized tribal governments

• Urban Indian Organizations, as defined by 25 U.S.C. 1603(29)

Other required qualifying factors GHWIC will support the following:

• Component 1:

◦ Native American tribal governments (federally recognized Tribes/ Villages), as defined by 25 U.S.C. 1603(14)

◦ Urban Indian Organizations (UIOs), as defined by 25 U.S.C. 1603(29)

• Component 2 and Component 3:

◦ Tribal organizations as defined by US Code 25 USC § 1603(26) that support all American Indian Tribes, Alaska Native Villages, and UIOs (Tribes/Villages/UIOS) in their Area (12 IHS Administrative Areas)

◦ Tribal organizations as defined by US Code 25 USC § 1603(26) with the ability to support all 41 UIOs funded by IHS

See glossary for definitions of tribal organizations and UIOs.

The following qualifying information applies to tribal organization applicants only:

• Tribal organizations will be funded to provide services that benefit all Tribes/Villages/UIOs in their award area.

• In your application, you must provide official documents that identify the Tribes, Villages, or UIOs your organization serves. This might include your organization’s charter, resolution, bylaws, or letters on official letterhead.

Include the official document in your attachments.

◦ If you do not provide this official documentation in your application, it will be considered nonresponsive. This means your application will not move forward in the application review process and your organization will not receive funding under this NOFO.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 9 https://www.federalregister.gov/documents/2024/01/08/2024-00109/indian-entities-recognized-by-and-eligible-to-receive-services-from-the-united-states-bureau-of https://www.federalregister.gov/documents/2024/01/08/2024-00109/indian-entities-recognized-by-and-eligible-to-receive-services-from-the-united-states-bureau-of https://www.ihs.gov/urban/urban-indian-organizations/regional-national-tribal/ https://www.ihs.gov/urban/urban-indian-organizations/regional-national-tribal/

For this NOFO, “award area” means either one of the 12 IHS Administrative Areas or the urban centers represented by the 41 UIOs funded by IHS. See glossary for definitions.

Note: Based on Congressional intent, CDC/ATSDR’s Tribal Advisory Committee counsels, and previous GHWIC NOFOs, Tribes/Villages/UIOs and tribal organizations are best situated to support the goals of the cooperative agreement to expand reach and implement effective, culturally appropriate activities to significantly impact individual and community health in AI/AN communities. This funding aligns with the intent of the establishment of the Good Health and Wellness in Indian Country appropriations line and the direction given in House Report 114-699 in FY17 and subsequently reaffirmed and funded in the FY18-FY24 Appropriation reports.

Cost sharing and matching funds This program has no cost-sharing or matching funds requirements.

If you choose to include cost-sharing funds as a contribution to the award, we won’t consider it during review of your application. If you receive an award, voluntary cost-sharing funds will be a requirement of your award and you will need to report on them.

Step 1: Review the Opportunity 10

Program description Background Overview This NOFO is the third funding opportunity for GHWIC. This GHWIC builds on previous and current GHWIC, Tribal Epidemiology Centers Public Health Infrastructure (TECPHI), and Tribal Practices for Wellness in Indian Country (TPWIC) programs.

Lessons learned From those programs, we learned that:

• A holistic approach that engages the entire family and community in cultural activities provides a foundation for chronic disease prevention.

• Subawards are an effective way to expand the reach and impact of chronic disease prevention efforts.

• Social and cultural connectedness can lead to healthy lifestyle changes that promote health and wellness.

The facts about health disparities AI/AN adults have:

• Higher rates of some chronic diseases than other ethnic groups in the United States.

• The highest prevalence of diabetes of any US racial or ethnic group.

• Prevalence of heart disease over 12%. It is the leading cause of death among AI/AN people.[1]

• A higher likelihood of smoking commercial cigarettes than any other racial or ethnic group, with 27.1% of AI/AN adults reporting current smoking.

• A 23% higher likelihood of reporting obesity than non-Hispanic whites.[2]

• A greater burden of severe periodontal disease, missing teeth, and untreated decay.[3]

• Poor oral health and oral pain compared to the general US adult population.[4]

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 11 https://www.grants.gov/search-results-detail/313595 https://www.grants.gov/search-results-detail/335074 https://www.grants.gov/search-results-detail/335074 https://www.grants.gov/search-results-detail/334873

Connection, language, and culture

• Recent studies have found that cultural connectedness is essential to health and wellness within AI/AN communities.[5]

• Health inequities are rooted in centuries of colonization efforts that led to a loss of culture and reduced health and wellness in AI/AN communities.[6]

• The cumulative evidence suggests that higher levels of social connectedness lead to better community outcomes. The outcomes may include population health, resilience, and community safety.[7]

• The evidence suggests that centering culture, language, and traditions in public health initiatives:

◦ Brings new partnerships into the community.

◦ Provides community engagement activities.

◦ Increases community participation in public health events.[8]

A Cultural Approach to Good Health and Wellness in Indian Country is designed to continue building evidence for a culturally responsive, community-driven approach to preventing, managing, and controlling chronic disease in AI/AN communities.

Related work

• A Strategic Approach to Advancing Health Equity for Priority Populations with or at Risk for Diabetes – Recipients | State, Local, and National Partner Diabetes Programs

• Good Health and Wellness in Indian Country

• High Obesity Program 2023-2028

• National and State Tobacco Control Program

• Racial and Ethnic Approaches to Community Health (REACH) 2023-2028

• State Actions to Improve Oral Health Outcomes — Funded Oral Health Programs

• State Physical Activity and Nutrition (SPAN) Program, 2023 - 2028

• The National Cardiovascular Health Program

• Tribal Practices for Wellness in Indian Country

• Tribal Epidemiology Centers Public Health Infrastructure

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 12 https://www.cdc.gov/diabetes/funding-opportunity/cdc-rfa-dp-23-0020-recipients.html https://www.cdc.gov/diabetes/funding-opportunity/cdc-rfa-dp-23-0020-recipients.html https://www.cdc.gov/diabetes/funding-opportunity/cdc-rfa-dp-23-0020-recipients.html https://www.cdc.gov/diabetes/funding-opportunity/cdc-rfa-dp-23-0020-recipients.html https://www.cdc.gov/healthytribes/ghwic.htm https://www.cdc.gov/nccdphp/dnpao/state-local-programs/hop/high-obesity-program-2023-2028.html https://www.cdc.gov/tobacco/stateandcommunity/tobacco-control/ https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/reach-2023-2028.html https://www.cdc.gov/oralhealth/funded_programs/nofo/state-promotion-of-strategies-to-advance-oral-health-cdc-rfa-dp24-0048.html https://www.cdc.gov/oralhealth/funded_programs/nofo/state-promotion-of-strategies-to-advance-oral-health-cdc-rfa-dp24-0048.html https://www.cdc.gov/oralhealth/funded_programs/nofo/state-promotion-of-strategies-to-advance-oral-health-cdc-rfa-dp24-0048.html https://www.cdc.gov/nccdphp/dnpao/state-local-programs/span/span-2023.html https://www.cdc.gov/dhdsp/funding-opps/national-dp-23-0004.htm https://www.cdc.gov/healthytribes/tribalpractices.htm https://www.cdc.gov/healthytribes/tecphi.htm

Other CDC resources

• Disability and Health Promotion

• Heart Disease and Stroke Best Practices Clearinghouse

• National Diabetes Prevention Program Customer Service Center

• The Community Guide

• The Public Health Professionals Gateway

Component 1 approach Our goal in this NOFO is to create community engagement through shared cultural experiences. These experiences will lay the foundation for a more comprehensive, holistic approach to health and wellbeing that will help prevent, manage, and control chronic diseases.

We designed the strategies and activities to meet you where you are. We want you to build on what’s already in place or establish new systems and programs over the course of the five-year period of performance.

To prepare your application, consider the following:

• How cultural and traditional activities will provide the foundation for chronic disease prevention, management, and control, and increase community members’ sense of cultural connectedness.

• The systems and practices you use now for screening and testing community members for chronic diseases and their risk factors.

• How community members with chronic diseases or their risk factors are referred to clinicians, social service organizations, and community and tribal organizations.

• What policies and programs exist or need to be put in place to promote health and prevent chronic diseases and their risk factors.

Based on your assessment, you will plan to continue existing systems and establish new ones that:

• Are consistent with the strategies and activities of this NOFO.

• Will allow you to achieve the outcomes of this NOFO.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 13 https://www.cdc.gov/ncbddd/disabilityandhealth/partners-and-programs.html https://hdsbpc.cdc.gov/s/ https://nationaldppcsc.cdc.gov/s/about-the-customer-service-center https://www.thecommunityguide.org/ https://www.cdc.gov/publichealthgateway/index.html

In your application, describe the following:

• The work you propose to do in Year 1. Be specific and provide details.

• How the strategies and activities will build upon the community’s existing priorities and infrastructure.

• How your proposed cultural and traditional activities will provide the foundation for chronic disease prevention, management, and control, and increase community members’ sense of cultural connectedness.

• How your staff will participate in and support the Community of Practice, routine GHWIC videoconferences, and other collaborative efforts.

• A high-level overview of the work you will do in Years 2 through 5.

Component 1 logic model The logic model shows the required program strategies and the expected outcomes. We will require you to report on the asterisked (*) outcomes.

Outcomes are the results you intend to achieve and usually show the intended direction of change, such as increase or decrease. You will use these outcomes as a guide for finalizing your performance measures.

Strategy Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1. Provide a foundation for chronic disease prevention by implementing community-chosen, traditional AI/AN practices that build resilience and strengthen connections to family, culture, and community.

• Increased community member participation in family-centered cultural activities.

• Increased sense of identity.

• Increased sense of belonging to Tribe, Village, and community.

• Increased cultural connectedness among community members.*

• Increased sense of social connectedness.

• Increased resilience and use of cultural practices to prevent and manage chronic diseases.

• Increased sense of mental, emotional, physical, and spiritual wellbeing among community members.

• Reduced morbidity/ mortality due to chronic diseases and their risk factors.

Step 1: Review the Opportunity 14

Strategy Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 2. Establish and enhance systems that connect community members to community, clinical, and social services and programs to prevent, manage, and control chronic diseases and their risk factors.

• Increased partnerships with one or more clinical and social service providers, and community-based programs and resources to prevent, manage, and control chronic diseases.*

• Increased screening and testing of community members for chronic diseases and their risk factors.*

• Increased referrals for community members to clinical, social, and community service providers and programs who completed a visit.*

• Increased participation in prevention, management, and control programs, including self-management and self-monitoring, for commercial tobacco use, diabetes (including prediabetes), high blood pressure, obesity (physical activity and nutrition), and oral health.*

• Increased participation in traditional and contemporary wellness activities that prevent commercial tobacco use, diabetes (including prediabetes), high blood pressure, obesity, and oral diseases.*

• Increased effective chronic disease self-management.

• Reduced morbidity/ mortality due to chronic diseases and their risk factors.

• Increased sense of mental, emotional, and physical wellbeing among community members.

Step 1: Review the Opportunity 15

Strategy 3. Promote the implementation of multi-disciplinary team-based care to prevent, manage, and control chronic diseases and to connect patients to community and social service providers to address health-related social and economic needs.

• Increased use of multidisciplinary care teams implementing team-based care to prevent, manage, and control chronic diseases.

• Increased use of multidisciplinary care teams that provide patient care using evidence-based practices and guidelines to prevent and manage chronic diseases and risk factors.*

• Increased use of services for patients from multidisciplinary care teams.*

• Increased use of clinical and community-based services to prevent, manage, and control chronic diseases.

• Increased quality of care delivered by multidisciplinary care teams.

• Reduced morbidity/ mortality due to chronic diseases and their risk factors.

* Indicates outcomes you are required to report on.

Component 1 strategies and activities This section describes the required strategies and activities in the logic model and provides details about our expectations.

If you are funded, we will require you to implement the following strategies and activities over the five-year period of performance. If you already have any of the activities in place, we expect you to continue them over that period.

Strategy 1 Provide a foundation for chronic disease prevention by implementing community-chosen, traditional AI/AN practices that build resilience and strengthen connections to family, culture, and community.

Required activity

• Implement family-centered community activities that respect, support, teach, build upon, celebrate, and strengthen cultural practices and teachings. These might include Native language, seasonal cultural events, and intergenerational programs.

Step 1: Review the Opportunity 16

Strategy 2 Establish and enhance systems that connect community members to community, clinical, and social services and programs to prevent, manage, and control chronic diseases and their risk factors.

Required activities

• Engage community members of all ages in traditional and contemporary wellness activities focused on chronic disease prevention. These might include community walking programs, healthy eating classes, or virtual wellness classes.

• Develop a new or expanded coordinated system for screening, testing, and making referrals for community members to community, clinical, and social services and programs for chronic disease prevention, management, and control.

• Identify or offer culturally appropriate programs for preventing and managing chronic diseases that you can refer community members to.

These might include the National Diabetes Prevention Program (National DPP), blood pressure (BP) monitoring, and family healthy weight programs.

• Recruit clinical and social service providers to participate in your community clinical linkages program.

• Implement systems for screening, testing, and making referrals to clinical, social, and community-based services and resources for chronic disease prevention, management, and control.

Required diabetes activities

• Diabetes screening

◦ Screen tribal members at risk for diabetes using the American Diabetes Association/CDC Prediabetes Risk Test. Refer those at risk to a health care provider for blood glucose testing and a type 2 diabetes prevention program. See options in the next required activity.

• Type 2 diabetes prevention. Pick one of the following based on your community’s needs:

◦ Establish a new (or maintain an existing) CDC-recognized, culturally relevant version of the National DPP lifestyle change program for adult tribal members with prediabetes using the PreventT2 curriculum.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 17 https://www.cdc.gov/prediabetes/takethetest/ https://www.cdc.gov/diabetes/prevention/resources/curriculum.html

◦ Establish a new (or maintain an existing) community-selected, evidence-informed type 2 diabetes prevention program using elements of the National DPP PreventT2 curriculum. This could include “Eat Well to Prevent T2,” “Commit to Change,” “Coping with Challenges,” “Support,” and other modules.

• Build partnerships to help the community address disparities related to chronic disease by:

◦ Training health care providers and social service organizations about preventing, managing, and controlling chronic diseases. Providers might include pharmacists, physicians, dentists, and community-based health care workers.

◦ Establishing and expanding two-way referral systems between clinical providers, social services, and community resources.

Strategy 3 Promote the implementation of multidisciplinary team-based care to prevent, manage, and control chronic diseases and to connect patients to community and social service providers to address health-related social and economic needs.

Required activities

• Promote the implementation of team-based care teams to include community, social, and clinical service providers. Examples of providers include community health workers (CHWs), community health representatives (CHRs), patient navigators, social workers, pharmacists, and dentists.

• Engage multidisciplinary teams to improve team-based care coordination and provide more comprehensive and holistic care.

• Facilitate referrals from health care settings to community and social services for patients reporting health and social economic needs.

For example activities, please refer to the GHWIC Implementation Guide.

Component 2 approach Plan to use at least 50% of your total award for at least two subawards to Tribes, Villages, UIOs, and other tribal entities within your award area.

Subrecipients will use this funding to implement C1 strategies and activities to expand the reach of GHWIC.

Subawards allow GHWIC resources and programs to reach additional Tribes, Villages, UIOs, and other tribal entities beyond directly funded C1 recipients.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 18 https://www.cdc.gov/healthytribes/pdf/GHWIC-CulturalApproach-ImplementationGuide-508.pdf

In your application, describe the following:

• The work you propose to do in Year 1. Be specific and provide details.

• How you will make subawards. Include the rationale for your approach.

You do not need to identify the subrecipients in your application, but you must describe how you will select them.

• How you will provide training, technical assistance, and resources to all Tribes, Villages, UIOs, and other tribal entities within your award area on Component 1 strategies and activities.

• How you will work with all Tribes, Villages, UIOs, and other tribal entities within your award area, including C1 recipients, to establish policy, systems, and environmental changes.

• How your staff will participate in and support the Community of Practice, routine GHWIC videoconferences, and other collaborative efforts.

• A high-level overview of the work you will do in Years 2 through 5.

Component 2 logic model The logic model shows the required program strategies and the expected outcomes. We will require you to report on the asterisked (*) outcomes.

Outcomes are the results you intend to achieve and usually show the intended direction of change, such as increase or decrease. You will use these outcomes as a guide for finalizing performance measures.

Strategy Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy 1. Provide funding, training, technical assistance, and evaluation support to all Tribes, Villages, UIOs, and other tribal entities within your award area to conduct activities across all Component 1 (C1) strategies.

• Increased partnerships/ collaborations with Tribes, Villages, UIOs, and other tribal entities within your award area to support activities across all C1 strategies.

• Increased reach of TA, training, and resources to all Tribes, Villages, UIOs, and other tribal entities

• Increased reach of

GHWIC C1

strategies and activities within your award area.*

• Increased capacity among all Tribes, Villages, UIOs, and other tribal entities within your award area to implement

GHWIC C1

strategies and activities.

• Increased resilience and use of cultural practices to prevent, manage, and control chronic diseases.

• Increased sense of mental, emotional, and physical wellbeing among community members.

Step 1: Review the Opportunity 19 within your award area across all C1 strategies and activities.*

• Increased reach of tailored messages to encourage healthier behaviors.

• Increased effective chronic disease self-management.

• Reduced morbidity/ mortality due to chronic diseases and their risk factors.

Strategy 2. Provide training, technical assistance, and support to all Tribes, Villages, UIOs, and other tribal entities within your award area to establish policy, systems, and/ or environmental (PSE) changes that promote health and prevent chronic diseases and their risk factors.

• Increased support for PSE changes that promote wellness and prevent chronic diseases and their risk factors.

• Increased reach of TA, training, and resources to all Tribes, Villages, UIOs, and other tribal entities within your award area on evidence-based PSE changes that promote health and wellness and encourage healthier behaviors.*

• Increased adoption of PSE changes to promote health and prevent chronic diseases and their risk factors.*

• Increased reach of PSE changes that promote wellness and prevent chronic diseases and their risk factors.

• Increased implementation of PSE changes that promote health and wellness and prevent chronic diseases.

• Reduced morbidity/ mortality due to chronic diseases and their risk factors.

* Indicates outcomes you are required to report on.

Step 1: Review the Opportunity 20

Component 2 strategies and activities This section describes the required strategies and activities in the logic model and provides details about our expectations.

If you are funded, we will require you to complete the following strategies and activities over the course of the five-year period of performance within your award area.

Strategy 1 Provide funding, training, technical assistance, and evaluation support to all Tribes, Villages, UIOs, or other tribal entities within your award area to conduct activities across all Component 1 (C1) strategies.

Required activities

• Expand the implementation of C1 strategies and activities to reach at least two additional Tribes, Villages, UIOs, and other tribal entities not funded under C1.

• Provide technical assistance, training, and resources to all Tribes, Villages, UIOs, and other tribal entities to support developing, implementing, and evaluating activities across all C1 strategies.

• Help all Tribes, Villages, UIOs, and other tribal entities link clinical sectors to community resources to support C1 strategies and activities.

• Work with all Tribes, Villages, UIOs, and other tribal entities to develop and implement tailored health communication and messaging strategies.

Focus on increasing awareness and encouraging healthier behaviors in AI/AN populations at greatest risk for:

◦ Commercial tobacco use.

◦ Diabetes, including prediabetes.

◦ High blood pressure.

◦ Obesity, including from physical activity and nutrition.

◦ Oral disease.

Strategy 2 Provide training, technical assistance, and support to all Tribes, Villages, UIOs, and other tribal entities within your award area to establish policy, systems, and environmental (PSE) changes that promote health and prevent chronic diseases and their risk factors.

Step 1: Review the Opportunity 21

Required activities

• Assist all Tribes, Villages, UIOs, and other tribal entities in establishing policies that promote healthier behaviors, such as commercial smokefree air, worksite wellness, and public locations for physical activity.

• Provide technical assistance, training, and resources to all Tribes, Villages, UIOs, and other tribal entities on evidence-based PSE changes.

• Assist all Tribes, Villages, UIOs, and other tribal entities in increasing awareness among community members and leaders about how PSE changes promote health and encourage healthier behaviors.

• For example PSE change activities, refer to the GHWIC Implementation Guide.

Component 3 approach The Component 3 (C3) recipient will establish a Tribal Coordinating Center (TCC). The purpose of the TCC is to engage all GHWIC recipients and CDC in learning from each other and working together to achieve the NOFO outcomes. At a minimum, you will be required to establish a Community of Practice (COP) and host routine videoconferences with all GHWIC recipients and CDC.

In your application, describe the following:

• The work you propose to do in Year 1. Be specific and provide details.

• How you will engage all GHWIC recipients in the Community of Practice and routine videoconferences.

• How your staff will participate in and support the Community of Practice, routine GHWIC videoconferences, and other collaborative efforts.

• How you will work with recipients and CDC to improve the quality of evaluation data to make decisions about the program and document the impact of GHWIC.

• How you will work with CDC to develop and implement a national evaluation plan, including a national measurement framework, to inform national and community decision-making.

• A high-level overview of the work you will do in Years 2 through 5.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 22

Component 3 logic model The logic model shows the required program strategies and the expected outcomes. We will require you to report on the following asterisked (*) outcomes.

Outcomes are the results you intend to achieve and usually show the intended direction of change, such as increase or decrease. You will use these outcomes as a guide for finalizing your performance measures.

Strategy Short-term outcomes Intermediate outcomes Long-term outcomes

Strategy: Establish a Tribal Coordinating Center (TCC) to collaborate with all GHWIC recipients to foster peer-to-peer learning, share best or promising practices, and coordinate national and recipient evaluation efforts.

• Enhanced recipient engagement to identify, assess, and share program successes, promising practices, lessons, and outcomes.*

• Improved availability and quality of evaluation data to inform national and community decision-making.*

• Increased awareness of GHWIC as an integrated approach to chronic disease prevention in AI/ AN communities.

• Increased use of community assets and strengths to implement recipient strategies and activities.

• Increased number of recipients using their evaluation data to monitor progress and for program improvement.

• Strengthened evidence base for holistic and culturally led chronic disease prevention in AI/ AN communities.

* Indicates outcomes you are required to report on.

Component 3 strategies and activities This section describes the required strategies and activities described in the logic model and provides details on our expectations.

You must complete the following strategy and activities over the course of the five-year period of performance.

Step 1: Review the Opportunity 23

Strategy 1 Establish a Tribal Coordinating Center (TCC) to collaborate with all GHWIC recipients to foster peer-to-peer learning, share best or promising practices, and coordinate national and recipient evaluation efforts.

Required activities

• Collaborate with CDC evaluators to develop and implement an evaluation plan for the national program. As part of this work, you will work with CDC to develop an evaluation measurement framework that includes performance measures for C1, C2, and C3 recipients.

• Develop and implement a coordinated, collaborative Community of Practice (COP). This COP will focus on chronic disease prevention (including oral health) to facilitate peer-to-peer learning, knowledge sharing, problem solving, and communication across the network using regular videoconferencing sessions.

Outcomes Outcomes are the intended effects, or changes in someone or something, that result from the activities of the NOFO.

You must report progress on and achieve certain outcomes within the five-year period of performance. Those outcomes are asterisked (*) in each component’s logic model:

• Component 1 logic model

• Component 2 logic model

• Component 3 logic model

Focus populations American Indians and Alaska Natives (AI/AN).

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

Step 1: Review the Opportunity 24

Health disparities The goal of health equity is for everyone to have a fair and just opportunity to attain their highest level of health. Health disparities are often caused by social determinants that influence which populations are most disproportionately affected by health conditions.

A health disparity is a difference in health burdens between groups of people with differing social determinants of health.

Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age. These determinants affect a wide range of health, functioning, and quality-of-life outcomes and risks.

This NOFO focuses on reducing health disparities in American Indians and Alaska Natives. AI/AN communities have innate strengths and resilience rooted in tribal culture and traditional ways of life. We emphasize culture and tradition as the foundation for all GHWIC efforts.

Organizational capacity You must describe your organization’s capacity, including experience, staff, and other resources, to:

• Implement the required strategies and activities successfully.

• Achieve the required outcomes and performance measures of this

NOFO.

Provide examples when appropriate.

In your attachments, include an organizational chart illustrating where this program is within the organization and include the program’s organizational structure.

All components Explain your organization’s ability and experience in handling program management needs. Make sure to describe your organization’s:

• Plan for staffing the GHWIC program. Include:

◦ Current staff, staff to be hired, or proposed contractors in a project management structure sufficient to achieve program outcomes.

◦ Roles and responsibilities of staff and how each will contribute to the outcomes.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 25 https://www.cdc.gov/about/sdoh/index.html

◦ Your organization’s hiring processes, with customary timeframes for completing the process.

◦ Staff experience in program management, performance monitoring, budget management, and administrative support.

◦ Evaluation expertise of your current staff, staff to be hired, or proposed contractors.

◦ Resumes for current staff and job descriptions for unfilled positions in your attachments.

• Financial management system.

◦ How your organization will ensure proper funds management, separate funds by program, and meet the requirements in 45 CFR 75.302.

◦ How your program and financial staff will track program expenditures.

◦ How you will ensure timely financial reporting and drawdowns.

Component 1 In addition to the requirements for all components, also describe your organization’s:

• Successful collaborations with partners to achieve program outcomes, or the ability to build collaborations between clinical, social service, and community organizations. Provide specific examples.

• Experience engaging American Indian/Alaska Native community members in cultural practices. Provide specific examples.

• Experience securing data from clinical and community partners, programs, and agencies. Provide specific examples.

Component 2 In addition to the requirements for all components, provide evidence that your organization serves all Tribes, Villages, UIOs, and other tribal entities in your award area. Also describe your organization’s:

• Experience, expertise, and capacity to provide technical assistance, training, and resources to all Tribes, Villages, UIOs, and other tribal entities within your award area. Provide specific examples.

• Capacity and experience for developing, awarding, and overseeing subawards. Provide specific examples.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 26 https://www.ecfr.gov/current/title-45/section-75.302 https://www.ecfr.gov/current/title-45/section-75.302

• Capacity and experience working with communities to develop and adopt policy, systems, or environmental changes. Provide specific examples.

• Experience working with Tribes, Villages, UIOs, and other tribal entities to collect data, including data from others, such as clinical or community partners. Provide specific examples.

Component 3 In addition to the requirements for all components, also describe your organization’s:

• Capacity to staff, establish, and maintain a Community of Practice for all GHWIC recipients and CDC. Provide specific examples.

• Capacity to engage all recipients in developing and implementing a national evaluation plan and measurement framework. Provide specific examples.

Collaborations

With CDC We encourage you to collaborate with other CDC-funded programs, especially programs designed to reduce risk factors associated with commercial tobacco use, diabetes (including prediabetes), high blood pressure, obesity, and oral health. Find possible CDC partners and best practices:

CDC divisions

• Division of Nutrition, Physical Activity, and Obesity

• Division of Diabetes Translation

• Division for Heart Disease and Stroke Prevention

• Division of Cancer Prevention and Control

• Division of Oral Health

• Office on Smoking and Health

CDC centers

• National Center for Chronic Disease Prevention and Health Promotion

• National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 27 https://www.cdc.gov/nccdphp/dnpao/state-local-programs/index.html https://www.cdc.gov/diabetes/programs/stateandlocal/index.html https://www.cdc.gov/dhdsp/programs/funded-programs.htm https://www.cdc.gov/cancer/dcpc/about/foa-dp22-2202/index.htm https://www.cdc.gov/oralhealth/funded_programs/index.htm https://www.cdc.gov/tobacco/stateandcommunity/tobacco-control/index.htm https://www.cdc.gov/chronicdisease/index.htm https://www.cdc.gov/infrastructure/index.html https://www.cdc.gov/infrastructure/index.html

With other organizations We also expect you to collaborate with other organizations to achieve your project’s outcomes. You could work with:

• Local and state health departments

• Nonprofit and provider groups

• Indian Health Service — Health Promotion/Disease Prevention

• Indian Health Service — Special Diabetes Program for Indians

• Federally Recognized Tribes Extension Program

• Land Grant University system, including tribal colleges

• Food Distribution Program on Indian Reservations nutrition education grant program

• National Park Service

• Administration for Children & Families Tribal and Native American Affairs

• Department of Treasury — Community Development Financial Institutions Fund, Native Initiatives

• National Council of Urban Indian Health

• Healthy Native Communities Partnership

• Bureau of Indian Affairs

• National Indian Health Board

• National Association of Chronic Disease Directors

• Association of State and Territorial Dental Directors

• NB3, Notah Begay III Foundation

Data, monitoring, and evaluation CDC strategy Evaluation and performance measurement help to:

• Demonstrate achievement of program outcomes.

• Build a stronger evidence base for specific program interventions.

• Clarify how the evidence applies to different populations, settings, and contexts.

• Drive continuous program improvement.

• Determine if program strategies are scalable and effective at reaching the priority populations.

1. Review 2. Get Ready 3. Prepare 4. Learn 5. Submit 6. Award Contacts

Step 1: Review the Opportunity 28 https://www.ihs.gov/hpdp/ https://www.ihs.gov/sdpi/ https://www.nifa.usda.gov/grants/programs/nifa-tribal-programs/federally-recognized-tribes-extension-program https://www.nifa.usda.gov/land-grant-colleges-and-universities-partner-website-directory https://www.fns.usda.gov/fdpir/nutrition-education-grant https://www.nps.gov/index.htm https://www.acf.hhs.gov/tribal-affairs https://www.cdfifund.gov/programs-training/programs/native-initiatives https://www.cdfifund.gov/programs-training/programs/native-initiatives https://ncuih.org/ https://hncpartners.org/ https://www.bia.gov/ https://www.nihb.org/ https://chronicdisease.org/ https://www.astdd.org/ https://www.nb3foundation.org/

CDC recommends that all C1, C2, and C3 applicants allocate 10% of their annual budget to evaluation efforts.

Evaluation questions Throughout the five-year period of performance, we will work individually and collectively with you to answer the following evaluation questions based on the program logic model, activities, and performance measures.

To answer these questions, CDC will use a multifaceted evaluation approach.

We will require you to:

• Report on performance measures.

• Develop, implement, and report the findings of your specific evaluation plans.

As resources allow, we may also identify and conduct additional evaluation projects. These might include observation and national inquiry studies and case studies. We will lead the design, data collection, analysis, and reporting for these additional studies in collaboration with selected recipients.

Component 1

• How has cultural connectedness among community members been improved?

• How have partnerships among clinicians, social service providers, and community-based programs and resources to prevent, manage, and control chronic diseases been improved?

• How have screening, testing, and referrals to clinical, social, and community services improved among community members?

• How has participation in prevention, management, and control programs, including self-management and self-monitoring, for commercial tobacco use, diabetes and prediabetes, high blood pressure, obesity (physical activity and nutrition), and oral health been improved?

• How has participation in traditional and contemporary activities that promote health and wellness and prevent commercial tobacco use, diabetes (including prediabetes), high blood pressure, obesity (physical activity and nutrition), and oral diseases been improved?

Step 1: Review the Opportunity 29

Component 2

• How has the reach of GHWIC Component 1 strategies and activities increased?

• How has the adoption of policies, systems, and environmental changes that promote health and prevent chronic diseases and their risk factors increased?

Component 3

• How have recipients engaged in identifying, assessing, and sharing program successes, promising practices, lessons, and outcomes?

• How has the quality of evaluation data used for decision-making been improved?

Required performance measures by component Following are the draft performance measures you will need to report on after award. We will work with you to finalize your measures before you submit any data.

We will work with you to:

• Select performance measures from the following list that align with your chosen activities.

• Operationalize the performance measures.

• Identify available and feasible data sources for the measures.

• Track your achievement of the required outcomes.

We will require you to submit baseline and target performance measures for your proposed activities within the first six months of the award. We will work with you to finalize your measures, if needed.

You will be responsible for gathering and analyzing the data for the performance measures and any specific evaluations you choose to do. In collaboration with CDC evaluators, the C3 recipient will assist C1 and C2 recipients to develop evaluation and data management plans that describe how you will collect, manage, and report data for performance measures and your specific evaluations.

Step 1: Review the Opportunity 30

Table: Component 1 required performance measures

Strategy Required performance measure Outcome

Strategy 1 • Number of community members that report feeling a greater connection to their family, Tribe, or culture.

• Increased cultural connectedness among community members.

Strategy 2 •…