Foa_Content_of_CDC-RFA-DP-24-0049.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

Partner Promotion of Strategies to Advance Oral Health

CDC-RFA-DP-24-0049

06/03/2024

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA-DP- 24-0049. 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:

Partner Promotion of Strategies to Advance Oral Health

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)).

Type1

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP-24-0049

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:

93.446

F. Dates:

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

05/01/2024

2. Due Date for Applications:

06/03/2024 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

Wednesday, April 24, 2024

Time: 1:30 pm – 2:30pm

Conference Call Number: +1 646 828 7666 US

Webinar ID: 161 707 2141

Passcode: 50131416

Webinar link:

https://cdc.zoomgov.com/j/1617072141?pwd=Vm9xUXJCK21IYzdRMThuTWZUeVRtdz09 Passcode: j75=E8F6

Email address: PartnerOHE0049@cdc.gov

G. Executive Summary:

1. Summary Paragraph This three-year cooperative agreement supports the goals of the companion NOFO, CDC-RFA- DP24-0048: State Promotion of Strategies to Advance Oral Health. Up to three applicants will provide technical assistance (TA) and resources to CDC-RFA-DP-24-0048 recipients.

This NOFO has 3 components. Applicants must apply for each component separately.

Component 1 focuses on increasing the ability of CDC-RFA-DP-24-0048 recipients to implement activities that increase access to community water fluoridation (CWF) and evidence-based preventive dental services (EBPDS), such as dental sealants and fluoride varnish, as well as to develop and maintain supportive partnerships. Component 2 focuses on increasing adherence to Infection Prevention and Control (IPC) Standard Precautions and leveraging IPC partnerships. Component 3 focuses on increasing the ability of CDC-RFA-DP-24-0048 recipients to analyze, interpret, and disseminate secondary data about 1) medical-dental integration, as it relates to the oral health of people with diabetes, their overall health, as well as their use and access to medical and dental care, and 2) data about EBPDS use and access.

Component 3 also focuses on evaluating CDC-RFA-DP-24-0048 programs and partnerships.

https://www.grants.gov/ mailto:PartnerOHE0049@cdc.gov

a. Funding Instrument Type:

CA (Cooperative Agreement)

b. Approximate Number of Awards

c. Total Period of Performance Funding:

$1,800,000

d. Average One Year Award Amount:

$200,000 Average amount per award:

$200,000 for years 1-3 for Component 1

$150,000 for years 1-3 for Component 2

$250,000 for years 1-3 for Component 3

e. Total Period of Performance Length:

3 year(s)

f. Estimated Award Date:

July 31, 2024

g. 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.

Examples include complementary funding from other organizations, other U.S. government funding sources, including programs supported by the Department of Health and Human Services, and other agencies such as the Department of Education, Centers for Medicare and Medicaid Services, the Health Resources and Services Administration, the Department of Agriculture, and other funding sources. Applicants must coordinate with multiple sectors, such as public health, education, infection control programs, drinking water associations, health care delivery, community health centers (e.g., FQHCs), faith-based organizations, state HAI/AR programs, and other community-level resources.

Part II. Full Text

A. Funding Opportunity Description

1. Background

a. Overview Cavities (also known as tooth decay or caries) are a common chronic disease that can cause pain or suffering and diminish quality of life. Cavities can affect essential aspects of daily living, eating, and speaking. In 2008, 92.4 million school and work hours were lost among school children and adults due to urgent dental care needs, with children losing over 34 million hours of school. Data show that 57% of adolescents in the United States ages 12–19 years have https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772383/ https://doi.org/10.14485/HBPR.5.2.7 https://doi.org/10.14485/HBPR.5.2.7 https://www.cdc.gov/oralhealth/publications/OHSR-2019-dental-caries-permanent-teeth.html%22%20/t%20%22_blank experienced cavities and 17% need treatment on at least one decayed tooth. Among adolescents stratified by race/ethnicity (R/E), the prevalence of untreated cavities for non-Hispanic Blacks and Mexican Americans is about 30% higher than for non-Hispanic White adolescents. CDC’s 2019 Oral Health Surveillance Report highlights that sealant prevalence among adolescents aged 12–19 years increased from 38% during 1999–2004 to 48% during 2011–2016. Increases were observed across all socio-demographic characteristics, such as R/E and income. Evidence-based preventive dental services (EBPDS) include dental sealants and fluoride varnish. EBPDS are delivered in schools, dental offices, and other settings. EBPDS can prevent cavities, save money, and improve quality of life across the lifespan.

Community water fluoridation (CWF) is also an opportunity to improve oral health. It is the most efficient and cost-effective way to deliver fluoride to everyone in a community. Drinking fluoridated water keeps teeth strong and reduces cavities by up to 25% in children and adults.

Diabetes affects over 28.7 million people and is the seventh leading cause of death in the United States (US). Among adults who self-report that they have diabetes, 60% have some form of periodontitis which can lead to tooth loss. Treating periodontal disease significantly improves blood sugar level among people with diabetes compared to no treatment or routine care. Dental visits are an important part of diabetes self-care management. Yet, about 60% of US adults with diabetes had a medical visit in the past year but no dental visit. Information is needed to understand medical services used by persons with diabetes and the opportunities missed for persons with diabetes to have both medical and dental visits within the past year.

This NOFO supports efforts of CDC-RFA-DP-24-0048 recipients to increase access to oral health services and reduce cavities. This NOFO continues dental sealant program, CWF, and medical-dental integration (MDI) technical assistance work of CDC-RFA-DP18-1811. MDI activities will focus on providing technical assistance to CDC-RFA-DP-24-0048 for analyzing associations between access to oral health services, medical services, and diabetes status. The COVID-19 pandemic highlighted a need to improve awareness of infection prevention control (IPC) in dental settings and develop related partnerships. This NOFO will support that need through technical assistance and partnership support.

This NOFO has three components. Applicants applying for more than one component must apply for each component separately. Component 1 funds technical assistance to expand the reach of and partnerships for EPBDS and CWF. Component 2 funds technical assistance and partnership support for IPC activities conducted by CDC-RFA-DP-24-0048 recipients. Component 3 funds technical assistance for a) analyzing and distributing the analysis of secondary oral health data, especially data about relationships between oral health and diabetes, and b) evaluating CDC- RFA-DP-24-0048 and CDC-RFA-DP-24-0049 activities.

b. Statutory Authorities Supported by statutory language of the Public Health Service Act, 42 U.S.C. §§ 247b(k)(2) and 247b-14 (Public Health Service Act sections 317(k)(2) and 317M, respectively).

c. Healthy People 2030 NOFO strategies address the following Healthy People 2030 topics:

https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html https://www.cdc.gov/oralhealth/publications/OHSR-2019-index.html https://www.thecommunityguide.org/pages/task-force-findings-oral-health.html https://www.thecommunityguide.org/pages/task-force-findings-oral-health.html https://www.thecommunityguide.org/pages/task-force-findings-oral-health.html https://health.gov/healthypeople/objectives-and-data/browse-objectives/oral-conditions

• Oral Conditions — General

• Adolescents

• Health Care Access and Quality

• Health Policy

• Nutrition and Healthy Eating

• Older Adults

• Preventive Care

• Public Health Infrastructure

d. Other National Public Health Priorities and Strategies This program supports strategies to increase and improve the quality of oral health outcomes, community-clinical linkages, and preventive services, which align with the following national plans, frameworks, and reports:

• The Guide to Community Preventive Services

• Health and Human Services - Equity Action Plan

• Health and Human Services - Strategic Plan FY 2022-2026

• Health Resources and Services Administration - Strategic Plan FY 2024

• Centers for Medicare and Medicaid Services - Framework for Health Equity 2022-2032

• National Institutes of Health - Oral Health in America: Advances and Challenges

• Public Health Accreditation Board

e. Relevant Work This NOFO incorporates lessons from CDC-RFA-DP18-1811 and CDC-RFA-DP18-1810. It also supports the promotion of CDC infection prevention and control guidelines and analyzing secondary data to inform the future integration of medical and dental services for individuals with diabetes.

This NOFO is associated with a companion NOFO: State Promotion of Strategies to Advance Oral Health (CDC-RFA-DP-24-0048)

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA-DP- 24-0049 Logic Model: Partner Promotion of Strategies to Advance Oral Health

Component 1: Community Water Fluoridation (CWF) and Evidence-Based Preventive Dental Services (EBPDS) Support

Strategy Short-Term Outcome

Intermediate Outcome Long-Term Outcome https://www.thecommunityguide.org/ https://www.hhs.gov/sites/default/files/hhs-equity-action-plan.pdf https://www.hhs.gov/about/strategic-plan/2022-2026/overview/index.html https://www.hrsa.gov/about/strategic-plan https://www.cms.gov/files/document/cms-framework-health-equity-2022.pdf https://www.nidcr.nih.gov/research/oralhealthinamerica https://phaboard.org/ https://www.grants.gov/search-results-detail/300295 https://www.grants.gov/search-results-detail/301195 https://grants.gov/search-results-detail/349661

Provide TA and resources related to EBPDS* implementation

Support partnerships for EBPDS programs

Provide TA and resources related to CWF program implementation

Support partnerships for CWF programs

*EBPDS: include sealants and fluoride varnish

Increased availability of TA and resources to address oral health disparities through EBPDS programs

Increased availability of TA and resources to address oral health disparities through CWF programs

Increased opportunities for collaboration between CDC-

RFA-DP-24-0048

recipients and partners that support populations of focus

Increased implementation of activities, policies, and systems changes related to increasing use of and access to

EBPDS

implementation of activities, policies, systems, and environmental changes related to increasing access to optimally fluoridated water

Increased multi-sector partnerships that support CWF and EBPDS programs, particularly among partners that focus on reducing health disparities and addressing SDOH

Decrease in cavities, especially in communities with water systems serving 10,000 or fewer people and among populations who disproportionately lack access to optimally fluoridated water systems

Reduced disparities in EBPDS receipt across sociodemographic characteristics

Component 2: Oral Health Infection Prevention and Control Support

Strategy Short-Term Outcome

Intermediate Outcome

Long-Term Outcome

Provide TA and resources related to implementing IPC activities for populations of focus

Support collaborative partnerships for IPC activities

Increased availability of IPC guidance TA and resources availability of partnership engagement TA and resources

Increased ability to help oral health programs adhere to CDC IPC guidelines

Increased multi-sector partnerships that support IPC activities

Increased adherence to IPC Standard Precautions and other infection prevention recommendations in programs serving traditional and non-traditional dental settings

Component 3: Medical-Dental Integration and EBPDS Data and Program Evaluation Support

Strategy Short-Term Outcome

Intermediate Outcome

Long-Term Outcome

Provide TA and resources related to analyzing, interpreting, and disseminating secondary data about 1) medical-dental integration, specifically the oral health of people with diabetes, their overall health, as well as their use and access to medical and dental care, and 2) EBPDS use and access

Evaluate CWF, EBPDS, and IPC activities conducted and partnerships

Increased availability of TA and resources for analyzing secondary oral surveillance data and EBPDS data

Increased ability to collect evaluation data about the context and impact of CWF, EBPDS, and IPC activities and partnerships

Increased analysis, interpretation, and dissemination of data about 1) medical-dental integration, specifically, relationships between the oral health of people with diabetes, their overall health, as well as their use of and access to medical and dental care, and

2) EBPDS use and access

Increased availability and use of CWF, EBPDS, and IPC program and partnership evaluation data

Increased access to integrated medical and dental services among people with diabetes

Reduced disparities in receipt of EBPDS across sociodemographic characteristics

i. Purpose The purpose of this non-research NOFO is to provide TA and resources for CDC-RFA-DP-24- 0048 recipients to expand CWF and EBPDS activities among populations of focus (Component 1), support IPC partnerships and activities among populations of focus (Component 2), analyze secondary data to inform the future integration of medical and dental services for individuals with diabetes (Component 3), analyze EBPDS data to understand access and use among populations of focus (Component 3), and evaluate CWF, EBPDS, and IPC activities and partnerships of CDC-RFA-DP-24-0048 recipients (Component 3).

ii. Outcomes Applicants must apply for each component separately. All applicants must address the bolded outcomes in the logic model for each strategy under each component of interest. The bolded outcomes are associated with the performance measures.

COMPONENT 1 - CWF AND EBPDS SUPPORT

• Increased implementation of changes to water fluoridation and EBPDS activities, policies, systems, or environments due to use of TA and resources.

• Increased multi-sector partnerships that support CWF and EBPDS programs, particularly among partners that focus in reducing health disparities and addressing SDOH.

COMPONENT 2 - ORAL HEALTH IPC SUPPORT

• Increased multi-sector partnerships that support IPC activities, (particularly among partners with experience working with oral health providers, medical, behavioral, and dental healthcare programs, school programs, and facilities serving CDC-RFA-DP-24- 0048 populations of focus and other populations with a large burden of health disparities and who are disproportionally affected by SDOH.

COMPONENT 3 - MEDICAL DENTAL INTEGRATION AND EBPDS DATA AND

PROGRAM EVALUATION SUPPORT

• Increased analysis, interpretation, and dissemination of data about 1) medical-dental integration, specifically, relationships between the oral health of people with diabetes, their overall health, as well as their use of and access to medical and dental care, and 2) EBPDS use and access.

• Increased availability and use of program and partnership evaluation data.

Strategies involve expanding the capacity of oral health programs to reach their populations of focus. Long-term outcomes include decreases in cavities, untreated decay, and oral health disparities, as well as increased adherence to IPC Standard Precautions.

iii. Strategies and Activities the Applicants must propose specific, measurable, attainable, relevant, and time-based (SMART) objectives or strategies. Applicants are encouraged to focus SMART strategies on being inclusive and equitable (SMARTIE) and relevant to the applicant’s and DOH’s populations of focus (see Populations of Focus section below). For an example of SMARTIE, see this link.

COMPONENT 1

For CWF and EBPDS Support, the relevant logic model outcomes are 1) to increase CDC- RFA-DP-24-0048 recipients’ ability to implement CWF and EBPDS approaches and 2) support CWF and EBPDS partnerships.

Applicants must describe how they will:

Provide CDC-RFA-DP-24-0048 recipients with TA and resources related to CWF and EBPDS program implementation.

• Upon request, assist CDC-RFA-DP-24-0048 recipients in identifying, planning, and implementing CWF and EBPDS interventions that that lead to policy, system, and environmental changes. Assistance may be provided via one-on-one consultation, workshops, conference calls, webinars, or other forums. The CDC-RFA-DP24-0049 recipient must have the necessary media equipment (teleconference capability with https://www.cdc.gov/cancer/nbccedp/pdf/smartie-objectives-508.pdf sufficient number of phone lines) to accommodate all CDC-RFA-DP24-0048 recipients, their partners, DOH staff, and other national partners.

• Lead communities of practice that address barriers to CWF and EBPDS program implementation and increase reach to populations of focus. CoP must include best practices in:

o using and sharing CWF and EBPDS data.

o using secondary data to inform program planning and implementation.

o developing and maintaining multi-sector collaborations to increase EBPDS programs for populations of focus.

o additional peer learning opportunities.

• Review existing resources related to CWF and EBPDS program implementation, including resources from CDC-RFA-DP-24-0048 recipients, to identify and address any gaps in implementing programs, especially for populations of focus.

• Use, adapt, or develop resources (e.g., tool kits, factsheets, reference documents, environmental scans) that support CDC-RFA-DP-24-0048 outcomes, including providing program-specific TA (e.g., trainings) to:

o enhance or expand CWF and EBPDS program reach, particularly in populations of focus.

o facilitate learning and information sharing among CDC-RFA-DP-24-0048 recipients and their key partners.

Support collaborative partnerships for CWF and EBPDS activities.

• Provide TA and resources for CDC-RFA-DP-24-0048 recipients to:

o identify and engage partners with missions that align with reducing health disparities or who serve populations of focus.

o support development of specific objectives, activities, and roles/responsibilities for each collaboration.

o focus collaborations on activity, policy, and systems changes to support the goals of this NOFO.

• Provide TA to support new or existing multi-sector collaborative partnerships to increase participation of populations of focus in CDC-RFA-DP-24-0048 interventions.

Partnership TA and engagement consists of:

o developing and compiling resources to identify, expand, and sustain new or existing partners, in both private and public sectors.

o promoting best practices to programs to improve and expand program implementation and services to increase participation rates.

COMPONENT 2

For Oral Health Infection Prevention and Control support, the relevant outcome in the logic model is to increase multi-sector partnerships that support IPC activities outlined in CDC-

RFA-DP-24-0048.

Provide CDC-RFA-DP-24-0048 recipients with TA and resources related to implementing IPC activities for populations of focus.

• Provide TA and resources (e.g., communities of practice, tool kits, facilitation guides, reference documents, webinars) to assist CDC-RFA-DP-24-0048 recipients in promoting IPC training, guidelines, and other infection prevention control resources.

• Provide TA to CDC-RFA-DP-24-0048 recipients (including trainings) to expand the reach of IPC information in dental settings across CDC-RFA-DP-24-0048 recipients’ jurisdictions for the populations of focus.

• Lead a community of practice to address barriers to IPC program implementation and increase reach to populations of focus. CoP must include best practices in:

o using and sharing IPC data.

o using secondary data to inform program planning and implementation.

o developing and maintaining multi-sector collaborations to increase IPC programs for populations of focus.

o additional peer learning opportunities.

Support collaborative partnerships for IPC activities.

• Provide TA and resources to CDC-RFA-DP-24-0048 recipients to:

o identify specific partners who serve populations of focus.

o support strategies that increase awareness of, use of, and adherence to dental

IPC recommendations and resources among programs serving other populations with a large burden of health disparities and who are disproportionally affected by SDOH. (e.g., EBPDS programs in priority schools).

o promote best practices to IPC programs to improve, expand, and sustain collaborations to increase the reach of and adherence to IPC recommendations.

COMPONENT 3

For Medical Dental Integration and EBPDS Data and Program Evaluation Support, the first relevant outcome in the logic model is to increase the ability of CDC-RFA-DP-24-0048 recipients to analyze, interpret, and disseminate data about 1) medical-dental integration, specifically, relationships between the oral health of people with diabetes, their overall health, as well as their use and access to medical and dental care and 2) EBPDS use and access. The second relevant outcome is to evaluate CWF, EBPDS, and IPC activities and partnerships.

Provide CDC-RFA-DP-24-0048 recipients with TA and resources related to analyzing, interpreting, and disseminating secondary oral health data about 1) medical-dental integration, specifically, relationships between the oral health of people with diabetes, their overall health, as well as their use and access to medical and dental care, and 2) EBPDS use and access.

• Assist funded recipients in analyzing, interpreting, and disseminating secondary oral health data about 1) medical-dental integration, specifically, relationships between the oral health of people with diabetes, their overall health, as well as their use and access to medical and dental care, and 2) EBPDS use and access.

• Facilitate a community of practice about analyzing, interpreting, and disseminating secondary oral health and EBPDS data analyses learning among CDC-RFA-DP-24- 0048 recipients.

• Use, adapt, or develop resources (e.g., tool kits, factsheets, reference documents) to provide program-specific TA to CDC-RFA-DP-24-0048 recipients. At a minimum, TA must include:

o providing assistance with using software and statistical methods to analyze oral health surveillance data and EBPDS data at community levels (e.g., Medicaid claims and other data, if complementary). EBPDS data analyses must identify

1) disparities in use and access (i.e., delivery in clinical and community programs) and 2) populations of focus.

o identifying data sources and indicators in oral health surveillance databases that can be used to describe oral health disparities and challenges to community-clinical linkages.

o disseminating secondary data analyses about 1) medical–dental integration, specifically, relationships between the oral health of people with diabetes, their overall health, as well as their use of and access to medical and dental care, and

2) EBPDS use and access.

Evaluate CWF, EBPDS, and IPC activities and associated collaborations.

• Develop and disseminate case studies that summarize the reach or impact of activities performed by CDC-RFA-DP-24-0048 recipients. Case studies must provide cost analyses, describe program successes, factors that increase program success, lessons learned, and information about how recipients addressed oral health disparities in CDC-RFA-DP-24-0048 strategy areas (CWF, EBPDS, and IPC).

• Evaluate processes used by CDC-RFA-DP-24-0048 recipients to obtain race/ethnicity/basic demographic data in school and FQHC settings for the purposes of oral health surveillance and program evaluation activities and prepare a best practice document to support increased analysis, interpretation, and dissemination of secondary oral health data.

• Use an analytical approach to track and evaluate partnerships supporting CDC-RFA- DP-24-0048 activities.

1. Collaborations

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

Collaborations with CDC projects and CDC-funded organizations are required to maximize resources, reach, impact, and sustainability of CDC-RFA-DP-24-0048 recipient NOFO outcomes.

Applicants for Components 1, 2, and 3 are required to describe how they will establish, enhance, and maintain multi-sector partnerships. Recipients must collaborate with other CDC projects or CDC-funded organizations that have a role in achieving the NOFO outcomes and must include a variety of public and private partners. Applicants must also collaborate with CDC-RFA-DP-24- 0048 recipients and any additional recipients of this NOFO. Collaborations must center on shared goals related to health disparities and addressing social determinants of health-related barriers impacting access to and participation in CDC-RFA-DP-24-0048 NOFO interventions.

Collaborations must leverage existing resources (e.g., frameworks, toolkits, guidance) to ensure the following:

• Engagement of CDC-RFA-DP-24-0048 recipients with their selected populations of focus.

• Training, TA, and subject matter expertise to address critical challenges of CDC-RFA- DP-24-0048 recipients to reach their outcomes.

• Sharing of data strategies for surveillance and evaluation.

• Providing education about the impact of policies on health outcomes.

• Including oral health strategies in existing or new policies to better-address oral health inequities (e.g., enabling school-based health center medical providers to implement oral health interventions).

• Other strategies as identified by the applicant, based on NOFOs CDC-RFA-DP-24-0048 and CDC-RFA-DP-24-0049.

Applicants must briefly describe experience and past examples of collaborations with key projects and organizations funded by CDC, highlighting any existing collaborations that can be leveraged to reduce health disparities among CDC-RFA-DP-24-0048 recipients’ jurisdictions and at a national level. Identified collaborations must enable CDC-RFA-DP-24-0048 recipients to reach their intended NOFO outcomes. When describing collaborations, applicants must also describe how collaborations with specific projects and organizations will meet the outcomes of this NOFO, including any allocation of funding provided to subrecipient partners or provided in-kind. Applicants must describe collaborations with individual consultants or contractors in the Organizational Capacity section below; individual people do not meet the criteria of partners.

Applicants must describe three examples of past collaborations with CDC projects or CDC-funded organizations demonstrating shared goals, strategies, or activities.

Applicants are required to provide a minimum of three letters of support, letters of collaboration, MOUs, MOAs, or other equivalent documentation clearly describing the levels and intended outcomes of collaborations with CDC projects or CDC-funded organizations to meet NOFO goals. Submitted documentation must:

• Clearly outline the NOFO goal(s), strategies, and activities that are enabled by the collaborations with CDC projects or CDC-funded organizations.

• Describe the role of the CDC projects or CDC-funded organization.

• Be named, depending on the documentation type, "LetterofSupport/LetterofCollaboration/MOU/MOA/other documentation_PartnerName_RFA_0049_name of applicant" and upload as PDF files to Grants.gov.

b. With organizations not funded by CDC:

Applicants must describe how they will build their own and the ability of CDC-RFA-DP-24- 0048 recipients to maintain collaborations with:

• Federal agencies and federally funded organizations that have a role in implementing proposed activities and achieving the outcomes of this and CDC-RFA-DP-24-0048 NOFOs (e.g., Centers for Medicare and Medicaid Services, Health Resources and Services Administration, Indian Health Service, Housing and Urban Development).

• National organizations that have a role in implementing proposed activities and achieving the outcomes of this and CDC-RFA-DP-24-0048 NOFOs.

• Other state, local, Tribal, and Territorial organizations/partners/programs/coalitions including organizations working with specific populations of focus, intersectional population(s), faith-based organizations, health care providers and systems, non-governmental organizations, state and local funded programs, governmental officials, civil society organizations, community-based organizations, community safety programs, transportation services, education, and social services organizations.

Applicants must briefly describe experience and past examples of collaborations with key projects and organizations not funded by CDC, highlighting any existing collaborations that can be leveraged to reduce health disparities and address social determinants of health among CDC- RFA-DP-24-0048 recipients and at a national level. Identified collaborations must enable CDC- RFA-DP-24-0048 recipients to reach their intended NOFO goals. When describing collaborations, applicants must also describe how collaborations with specific partners will meet the goals of this NOFO, including any allocation of funding provided to subrecipient partners or provided in-kind.

Applicants are required to provide a minimum of three letters of support, letters of collaboration, MOUs, MOAs, or other equivalent documentation clearly describing the levels and intended outcomes of collaborations with organizations not funded by the CDC to meet the NOFO goals.

Submitted documentation must:

• Clearly outline the NOFO goal(s), strategies, and activities that are enabled by the collaborations with organizations not funded by CDC.

https://www.grants.gov/

• Describe the role of the organization not funded by CDC.

• Be named, depending on the documentation type, "LetterofSupport/LetterofCollaboration/MOU/MOA/other documentation_PartnerName_RFA_0049_name of applicant" and upload as PDF files to Grants.gov.

2. Population(s) of Focus Among populations who could benefit from this funding include people from some racial and ethnic groups, people with lower incomes, persons with disabilities, people who do not speak English, people with limited literacy, American Indian and Alaska Native communities, people who live in rural areas and other under-resourced communities, people who identify as LGBTQIA+, and other populations with a large burden of health inequities.

All applicants must describe how the strategies they implement will address oral health disparities and social determinants of health in populations of focus. All applicants must also describe relevant experience providing TA, training, and guidance to organizations to assist in overcoming social determinant of health-related barriers that negatively impact access to and successful participation in health programs, and their experience supporting national, regional, state, and community strategies to address health disparities and social determinants of health, including partner and community engagement experience. Applicants are encouraged to use CDC's Preferred Terms for Select Population Groups & Communities and NCCDPHP's Equitably Addressing Social Determinants of Health and Chronic Diseases. Disparities by race and ethnicity, geography, mobility limitations or intellectual/developmental disability, primary language, health literacy, income, gender identity, and other relevant dimensions must be considered.

Component 1, 2, and 3 applicants must describe approaches to:

• Selecting populations of focus or populations with a large burden of health disparities and who are disproportionally affected by social determinants of health, including processes and resources used (e.g., datasets, frameworks, methodologies).

• Working with populations of focus or other populations with a large burden of health disparities and who are disproportionally affected by social determinants of health.

• Collaborating with CDC-RFA-DP-24-0048 recipients, organizations representing CDC- RFA-DP-24-0048 populations of focus, and other partners with expertise in addressing health disparities to support the development and implementation of NOFO strategies and activities.

• Providing TA, training, and guidance to organizations to assist in overcoming social determinants of health-related barriers that negatively impact access to and successful participation in health and wellness programs/services.

• Supporting national, regional, state, and community strategies to address health disparities and social determinants of health, including partner and community engagement.

• Include populations of focus and other populations with a large burden of health disparities and who are disproportionally affected by social determinants of health in program planning and implementation.

https://www.grants.gov/ https://www.cdc.gov/healthcommunication/Preferred_Terms.html https://www.cdc.gov/chronicdisease/healthequity/social-determinants-of-health-and-chronic-disease.html https://www.cdc.gov/chronicdisease/healthequity/social-determinants-of-health-and-chronic-disease.html

• Describe how to identify data gaps for CWF, EBPDS, and IPC programs serving populations of focus.

The populations of focus for this NOFO are:

• Populations identified by CDC-RFA-DP-24-0048 recipients (to be determined).

• Division of Oral Health’s populations of focus, listed below by component.

• Other populations with a large burden of health disparities and who are disproportionally affected by social determinants of health.

The Division of Oral Health’s populations of focus are:

Component 1: CWF and EBPDS Populations of Focus

• CWF: Residents in communities with water systems serving 10,000 or fewer people.

• EBPDS:

o School Sealant Program: Public elementary or middle schools located in urban areas in which at least 50% of students qualify for federal or state free and reduced meal programs.

o Fluoride Varnish: Communities with lower incomes and those with high rates of cavities among children.

Component 2: IPC Populations of Focus

• EBPDS school programs and other dental programs or facilities serving populations with a large burden of health disparities and who are disproportionally affected by social determinants of health.

Component 3: Medical Dental Integration and EBPDS Data and Program Evaluation Support Populations of Focus

• For oral health data support, individuals with diabetes, especially those with unmet oral health needs (e.g., periodontitis and tooth loss) and risk factors for negative health outcomes (e.g., smoking).

• For evaluation support, populations of focus include those impacted by CWF, EBPDS, and IPC activities implemented by CDC-RFA-DP-24-0048 recipients.

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.

This NOFO seeks to address oral health disparities. While oral diseases affect all segments of society, certain populations experience a disproportionate burden and risk or lack adequate access to prevention and treatment services. Some people or populations may not have equitable access to resources and opportunities due to unfair policies, practices, and conditions and differential treatment because of a variety of factors. These factors include but are not limited to race and ethnicity, sexual orientation, gender identity, age, physical abilities, geographic location, educational background, economic status, and the intersectionality of these and other factors.

This NOFO focuses on providing subject matter expertise, relevant resources, training, and TA to CDC-RFA-DP-24-0048 recipients to identify strategies that reduce the burden of oral diseases and promote access to preventive dental care.

iv. Funding Strategy Not applicable

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

CDC will collaborate with recipient(s) to assess if they are implementing strategies and activities as expected, and if they are achieving outcomes. Evaluation and performance measurement will support program improvement and document accomplishments. CDC will help recipient(s) finalize evaluation plans within 6 months post-award and determine Data Management Plan (DMP) requirements.

A Data Management Plan (DMP) is required for each activity that involves the collection or generation of public health data. ("Public health data" means digitally recorded factual material commonly accepted in the scientific community as a basis for public health findings, conclusions and implementation. Public health data includes those from research and non-research activities.)

If you are uncertain whether a DMP is applicable to your application, see https://www.cdc.gov/chronicdisease/pdf/nofo/extramural-guidance-DMP-508.pdf for clarification.

The required Data Management Plan template can be found on this page:

https://www.cdc.gov/chronicdisease/programs-impact/nofo/index.htm

Data Management Plans must include at the minimum the following:

• A description of the data to be collected or generated in the proposed project.

• The standards to be used for the collected or generated data.

https://www.cdc.gov/chronicdisease/pdf/nofo/extramural-guidance-DMP-508.pdf https://www.cdc.gov/chronicdisease/programs-impact/nofo/index.htm

• Mechanisms for, or limitations to, providing access to the data, including a description for the provisions for the protection of privacy, confidentiality, security, and intellectual property, or other rights.

• Statement of the use of data standards that ensure all documentation that describes the method of collection, what the data represent.

• Plans for archiving and long-term preservation of the data or explaining why long-term preservation and access are not justified.

• Other additional requirements based on the program.

During the 3-year period of performance, CDC will work with recipients to answer the following evaluation questions based on the program logic model and activities:

Outcome Evaluation Questions

1. To what extent did the national partner (s) increase CDC-RFA-DP-24-0048 recipients’ capacity to implement CWF and EBPDS programs among populations of focus?

2. To what extent did the national partner(s) impact practices, systems, or policies by providing CWF and EBPDS TA?

3. To what extent did the national partner(s) increase CWF, EBPDS, and IPC partnerships?

4. To what extent did the national partner(s) increase CDC-RFA-DP-24-0048 recipients’ capacity to analyze, interpret, and disseminate data about relationships between the oral health of people with diabetes, their overall health, as well as their use of and access to medical and dental care?

5. To what extent did the national partner(s) increase CDC-RFA-DP-24-0048 recipients’ capacity to analyze, interpret, and disseminate data about EBPDS use and access?

6. To what extent did the national partner(s) identify and describe factors associated with effectively delivering CWF, EBPDS, and IPC programming, and addressing oral health disparities?

CDC’s evaluation approach will include:

1. Required recipient reporting of performance measures

2. Required recipient reporting with Project Performance Monitoring Reports (PPMR)

3. CDC-RFA-DP-24-0049 recipient led monitoring and evaluation efforts

4. CDC-RFA-DP-24-0048 recipient led evaluations

If resources allow, CDC may conduct additional monitoring and evaluation activities. Recipients and CDC will only collect data that will be analyzed and used. Evaluation findings will contribute to the evidence base, program improvement, and future CDC funding opportunities.

Where appropriate, Paperwork Reduction Act of 1995 (PRA) and Institutional Review Board processes must be followed.

CDC will:

• Collect, analyze, and synthesize required performance measure data.

• Provide monitoring and evaluation TA (webinars, office hours, meetings, written materials, etc.).

• Provide guidance on calculating and reporting performance measures.

• Collaborate with recipients to plan and implement activities when necessary.

• Use monitoring and evaluation results to make recommendations about program improvement, sustainability, and outcomes.

CDC may present evaluation results to relevant internal and external audiences.

Component 1, 2, and 3 applicants must describe the following:

• Any recipient planned evaluations.

• Plans to collect evaluation data.

Component 1, 2, and 3 recipients are required to:

• Maintain processes, policies, procedures, a workforce, and data systems to monitor program activities and report performance measures.

• Conduct monitoring and evaluation activities related to strategies in the logic model and report data to CDC annually, including, but not limited to, performance measures.

• Participate in monitoring and evaluation activities related to the strategies and outcomes outlined in the logic model. CDC or a national partner may lead activities that include interviews, surveys, and other forms of data collection.

• CDC will provide guidance on each performance measure before the first reporting period. Recipients are required to report performance measures through CDC’s Award Management Platform (AMP) and other CDC systems.

• Summarize evaluation findings for each evaluation question annually and report the summary to CDC.

• Report cumulative evaluation findings for the 3-year project period in a Final Performance Report.

Project Outcomes and Required Performance Measures

The table below shows the logic model’s strategies and outcomes and their related performance measures. Recipients will be required to track and report the performance measures. Given the three-year performance period, CDC does not expect recipients to achieve the long-term outcomes.

Outcome Performance Measure

Increased implementation of activities, policies, and systems changes related to increasing use of and access to EBPDS

Number of activities, policies, or systems changes that resulted from using TA or resources provided, and are focused on increasing use of and access to EBPDS

Increased implementation of activities, policies, systems, and environmental changes related to increasing access to optimally fluoridated water

Number of activities, policies, systems, or environmental changes that resulted from using TA or resources provided, and are focused on increasing access to optimally fluoridated water

Increased multi-sector partnerships that support CWF and EBPDS programs, particularly among partners that focus on reducing health disparities and addressing

SDOH

Number of memoranda of understanding (or equivalent documents) developed and signed that create partnerships for CWF or EBPDS activities (process)

Number of memoranda of understanding (or equivalent documents) with partner organizations that serve CDC-RFA-DP-24- 0048 populations of focus

Increased multi-sector partnerships that support IPC activities

Number of memoranda of understanding (or equivalent documents) developed and signed that create partnerships for IPC activities (process)

Number of EBPDS school program partners reached with information about IPC resources due to partnership organization efforts

Number of partners serving non-school based dental programs or facilities in communities with oral health disparities reached with information about IPC resources due to partnership organization efforts

Increased dissemination of data about 1) medical-dental integration, specifically, relationships between the oral health of people with diabetes, their overall health, as well as their use of and access to medical and dental care, and 2) EBPDS use and access

Number of partner organizations that receive analyses of data that inform approaches to integrating medical and dental services for people with diabetes.

Number of partner organizations that receive an analyses of EBPDS data that describes service use, access trends, and characteristics of community-clinical linkages.

Increased availability and use of evaluation data about CWF, EBPDS, and IPC programs and partnerships

Number of completed monitoring and/or evaluation efforts that summarize the reach of and provide a cost-analysis of community water fluoridation, evidence-based preventive dental services, and infection prevention and control activities (process)

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

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

• How key program partners will participate in the evaluation and performance measurement planning processes.

• Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant).

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

• Plans for updating the Data Management Plan (DMP) as new pertinent information becomes available. If applicable, throughout the lifecycle of the project. Updates to DMP should be provided in annual progress reports. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data;

data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans. For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additional-requirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, the applicant should be directed to:

• Describe the type of evaluations (i.e., process, outcome, or both).

https://www.cdc.gov/grants/additional-requirements/ar-25.html

• Describe key evaluation questions to be addressed by these evaluations.

• Describe other information (e.g., measures, data sources).

Recipients…