FY15 Tier1Brevised.pdf

U.S. Department of Health and Human Services Office of the Assistant Secretary for Health

Office of Adolescent Health

Funding Opportunity Announcement And

Application Instructions

Application Due Date: April 1, 2015

Replicating Evidence-Based Teen Pregnancy Prevention Programs to

Scale in Communities with the Greatest Need (Tier 1B)

Announcement Type: New

Announcement Number: AH-TP1-15-002

Catalog of Federal Domestic Assistance (CFDA) No. 93.297

U.S. Department of Health and Human Services Office of the Assistant Secretary for Health

Office of Adolescent Health

Replicating Evidence-Based Teen Pregnancy Prevention Programs to Scale in Communities with the Greatest Need (Tier 1B)

Announcement Type: New

Announcement Number: AH-TP1-15-002

Catalog of Federal Domestic Assistance (CFDA) No. 93.297

Funding Opportunity Announcement And

Application Instructions

Application Due Date: April 1, 2015

Table of Contents

Executive Summary……………….……………..…………….……………………………….. 3 Purpose……………………………………………………………………………………………4 Background………………………………………………………………………………………6 Expectations of Funded Applicants……………………………………………………………13 Target Population and Need….…………………………………………………………..13 Program Approach……………….…………………………...………………………….15

Performance Measures and Evaluation ………………………………….…...………….30 Capacity and Experience of the Applicant Organization ………………………….…….33 Partnerships and Collaboration…...……………………………………………………...36 Project Management……………………………………..………………………………37 Cooperative Agreement Substantial Programmatic Involvement…………………………..38 Authority………………………………………………………………………………………...38 Award Information……………………………………………………………………………..39 Eligibility Information………………………………………………………………………….40 Application Responsiveness and Screening Criteria………………………………………...41 Application Submission Information………………………………………………………….42

1. Information to Request Application Package…………………………………….42

2. Content and Form of Application Submission……………………………………42

a. Important Grants.gov Information………………………………………..46

b. Application Content………………………………………………………...47

i. Project Narrative…………………………………………………...47

1. Target Population and Need...…………………...…………...48

2. Program Approach …………………..….…………………...50

3. Performance Measures and Evaluation.....…………………...55

4. Capacity and Experience of the Applicant Organization…….56

5. Partnerships and Collaboration……………..………...……...61

6. Project Management…………………………..……………..63

ii. Budget Narrative……………………………………………………64

iii. Appendices…………………………………………………………..67

c. Submission Dates and Times………………………………………………68

d. Intergovernmental Review…………………………………………………69

e. Funding Restrictions………………………………………………………..69 Application Review Information………………………………………………………………71 Criteria…………………………………………………………………………………..71

Review and Selection Process………………………………………………………….76 Award Administration Information…………………………………………………………..78 Agency Contacts……………………………………………………………….………………..84 Appendices………………………………………………………………………………………85

Table of Contents

Executive Summary. 3 Purpose 4 Background 6 Expectations of Funded Applicants 13

Target Population and Need 13 Program Approach 15 Performance Measures and Evaluation 30 Capacity and Experience of the Applicant Organization 33 Partnerships and Collaboration 36 Project Management 37

Cooperative Agreement Substantial Programmatic Involvement 38 Authority 38 Award Information 39 Eligibility Information 40 Application Responsiveness and Screening Criteria 41 Application Submission Information 42

1. Information to Request Application Package 42

2. Content and Form of Application Submission 42

a. Important Grants.gov Information 46

b. Application Content 47

i. Project Narrative 47

1. Target Population and Need 48

2. Program Approach 50

3. Performance Measures and Evaluation 55

4. Capacity and Experience of the Applicant Organization 56

5. Partnerships and Collaboration 61

6. Project Management 63

ii. Budget Narrative 64

iii. Appendices 67

c. Submission Dates and Times 68

d. Intergovernmental Review 69

e. Funding Restrictions 69

Application Review Information 71 Criteria 71 Review and Selection Process 76

Award Administration Information 78 Agency Contacts 84 Appendices 85

DEPARTMENT OF HEALTH AND HUMAN SERVICES

AGENCY: Office of the Secretary, Office of the Assistant Secretary for Health, Office of

Adolescent Health

FUNDING OPPORTUNITY TITLE: Announcement of Availability of Funds for

Replicating Evidence-Based Teen Pregnancy Prevention Programs to Scale in

Communities with the Greatest Need (Tier 1B)

ACTION: Notice

ANNOUNCEMENT TYPE: INITIAL COMPETITIVE COOPERATIVE AGREEMENT

FUNDING OPPORTUNITY NUMBER: AH-TP1-15-002

CFDA NUMBER: 93.297

CFDA PROGRAM: Teenage Pregnancy Prevention Program

DATES: Non-binding letters of intent are due February 1, 2015

Applications are due April 1, 2015 by 5 p.m. ET. To receive consideration, applications must be received electronically via Grants.gov by the HHS Office of the Assistant Secretary for Health

(HHS/OASH), Office of Grants Management (OGM) no later than this due date. Applications which do not meet the specified deadlines will be returned to the applicant unread. All applicants must submit electronically via Grants.gov unless they obtain a written exemption from this requirement 2 business days in advance of the deadline by the Director, HHS/OASH Office of Grants Management. To obtain an exemption, applicants must request one via email from the

HHS/OASH Office of Grants Management, and provide details as to why they are technologically unable to submit electronically through the Grants.gov portal. Requests should

DEPARTMENT OF HEALTH AND HUMAN SERVICES

AGENCY: Office of the Secretary, Office of the Assistant Secretary for Health, Office of

Adolescent Health

FUNDING OPPORTUNITY TITLE: Announcement of Availability of Funds for

Replicating Evidence-Based Teen Pregnancy Prevention Programs to Scale in

Communities with the Greatest Need (Tier 1B)

ACTION: Notice

ANNOUNCEMENT TYPE: INITIAL COMPETITIVE COOPERATIVE AGREEMENT

FUNDING OPPORTUNITY NUMBER: AH-TP1-15-002

CFDA NUMBER: 93.297

CFDA PROGRAM: Teenage Pregnancy Prevention Program

DATES: Non-binding letters of intent are due February 1, 2015

Applications are due April 1, 2015 by 5 p.m. ET. To receive consideration, applications must be received electronically via Grants.gov by the HHS Office of the Assistant Secretary for Health

(HHS/OASH), Office of Grants Management (0GM) no later than this due date. Applications which do not meet the specified deadlines will be returned to the applicant unread. All applicants must submit electronically via Grants.gov unless they obtain a written exemption from this requirement 2 business days in advance of the deadline by the Director, HHS/OASH Office of Grants Management. To obtain an exemption, applicants must request one via email from the

HHS/OASH Office of Grants Management, and provide details as to why they are technologically unable to submit electronically through the Grants.gov portal. Requests should be submitted at least 4 business days prior to the application deadline to ensure the request can be considered prior to 2 business days in advance of the deadline. If requesting an exemption, include the following in the e-mail request: the HHS/OASH announcement number; the organization's DUNS number; the name, address and telephone number of the organization; the name and telephone number of the Authorizing Official; the Grants.gov Tracking Number

(GRANTXXXX) assigned to the submission; and a copy of the "Rejected with Errors" notification from Grants.gov. Send the request with supporting documentation to ogm.oash@hhs.gov. Note: failure to have an active System for Account Management (SAM) registration will not be grounds for receiving an exemption to the electronic submission requirement.

The HHS/OASH Office of Grants Management will only accept applications via alternate methods (hardcopy paper via US mail or other provider or PDF via email) from applicants obtaining prior written approval. The application must still be submitted by the deadline. Only applications submitted through the Grants.gov portal or alternate format

(hardcopy paper via US mail or other service or PDF via email) with an approved written exemption will be accepted. See the heading "APPLICATION and SUBMISSION

INFORMATION" for information on application submission mechanisms.

To ensure adequate time to successfully submit the application, HHS/OASH recommends that applicants register as early as possible in Grants.gov since the registration process can take up to one month. For information on registering for Grants.gov, refer to http://www.grants.gov or contact the Grants.gov Contact Center 24 hours a day, 7 days a week

(excluding Federal holidays) at 1-800-518-4726 or support@grants.gov. Applicants are strongly encouraged to register multiple authorized organization representatives.

be submitted at least 4 business days prior to the application deadline to ensure the request can be considered prior to 2 business days in advance of the deadline. If requesting an exemption, include the following in the e-mail request: the HHS/OASH announcement number; the organization’s DUNS number; the name, address and telephone number of the organization; the name and telephone number of the Authorizing Official; the Grants.gov Tracking Number

(GRANTXXXX) assigned to the submission; and a copy of the ‘Rejected with Errors’ notification from Grants.gov. Send the request with supporting documentation to ogm.oash@hhs.gov. Note: failure to have an active System for Account Management (SAM) registration will not be grounds for receiving an exemption to the electronic submission requirement.

The HHS/OASH Office of Grants Management will only accept applications via alternate methods (hardcopy paper via US mail or other provider or PDF via email) from applicants obtaining prior written approval. The application must still be submitted by the deadline. Only applications submitted through the Grants.gov portal or alternate format

(hardcopy paper via US mail or other service or PDF via email) with an approved written exemption will be accepted. See the heading “APPLICATION and SUBMISSION

INFORMATION” for information on application submission mechanisms.

To ensure adequate time to successfully submit the application, HHS/OASH recommends that applicants register as early as possible in Grants.gov since the registration process can take up to one month. For information on registering for Grants .gov, refer to http://www.grants.gov or contact the Grants.gov Contact Center 24 hours a day, 7 days a week

(excluding Federal holidays) at 1-800-518-4726 or support@grants.gov. Applicants are strongly encouraged to register multiple authorized organization representatives.

mailto:ogm.oash@hhs.gov http://www.grants.gov/ mailto:support@grants.gov

Technical Assistance: A technical assistance webinar for potential applicants will be held on

Thursday, January 22nd from 3:00-5:00 pm ET (start time of 2:00 pm CT, 1:00 pm MT, 12:00 pm

PT). Potential applicants should call 1-888-566-5780, passcode 3899321, and log-on to https://www.mymeetings.com/nc/join.php?i=PW1052978&p=3899321&t=c.

EXECUTIVE SUMMARY: The HHS Office of Adolescent Health (OAH) announces the availability of funds for Fiscal Year (FY) 2015 cooperative agreement awards under the authority of Division H, Title II of the Consolidated Appropriations Act, 2014 (Public Law No.

113-76), and the Continuing Resolution thus far for FY 2015 (Public Law No. 113-164), for

Replicating Evidence-Based Teen Pregnancy Prevention Programs to Scale in

Communities with the Greatest Need (Tier 1B). OAH intends to make available approximately $60 million for an estimated 60 awards.

This funding opportunity announcement (FOA) is one of a series of five (5) FOAs, each with a different focus, currently available from OAH’s Teen Pregnancy Prevention (TPP) Program.

Applicants may apply for more than one FOA. This FOA provides information for applying to Replicating Evidence-Based Teen Pregnancy Prevention Programs to Scale in

Communities with the Greatest Need (Tier 1B). Other available FOAs include:

Capacity Building to Support Replication of Evidence-Based TPP Programs (Tier 1A) Supporting and Enabling Early Innovation to Advance Adolescent Health and Prevent Teen Pregnancy (Tier 2A) Rigorous Evaluation of New or Innovative Approaches to Prevent Teen Pregnancy (Tier 2B) Effectiveness of TPP Programs Designed Specifically for Young Males (Tier 2C).

The goal of this FOA is to have a significant impact on reducing rates of teen pregnancy and existing disparities by replicating evidence-based TPP programs to scale in at least 3 settings in communities and with populations at greatest need. Applicants can propose to work in a single

Technical Assistance: A technical assistance webinar for potential applicants will be held on

Thursday, January 22’ from 3:00-5:00 pm ET (start time of 2:00pm CT, 1:00pm MT, 12:00 pm

PT). Potential applicants should call 1-888-566-5780, passcode 3899321, and log-on to https ://www.mymeetings .comlnc/ioin.php?i=PW 105297 8&p=3 899321&t=c.

EXECUTIVE SUMMARY: The HHS Office of Adolescent Health (OAH) announces the availability of funds for Fiscal Year (FY) 2015 cooperative agreement awards under the authority of Division H, Title II of the Consolidated Appropriations Act, 2014 (Public Law No.

113-76), and the Continuing Resolution thus far for FY 2015 (Public Law No. 113-164), for

Replicating Evidence-Based Teen Pregnancy Prevention Programs to Scale in

Communities with the Greatest Need (Tier 1B). OAH intends to make available approximately $60 million for an estimated 60 awards.

This funding opportunity announcement (FOA) is one of a series of five (5) FOAs, each with a different focus, currently available from OAH’s Teen Pregnancy Prevention (TPP) Program.

Applicants may apply for more than one FOA. This FOA provides information for applying to Replicating Evidence-Based Teen Pregnancy Prevention Programs to Scale in

Communities with the Greatest Need (Tier 1B). Other available FOAs include:

• Capacity Building to Support Replication of Evidence-Based TPP Programs (Tier 1A)

• Supporting and Enabling Early Innovation to Advance Adolescent Health and Prevent

Teen Pregnancy (Tier 2A)

• Rigorous Evaluation of New or Innovative Approaches to Prevent Teen Pregnancy (Tier

2B)

• Effectiveness of TPP Programs Designed Specifically for Young Males (Tier 2C).

The goal of this FOA is to have a significant impact on reducing rates of teen pregnancy and existing disparities by replicating evidence-based TPP programs to scale in at least 3 settings in communities and with populations at greatest need. Applicants can propose to work in a single https://www.mymeetings.com/nc/join.php?i=PW1052978&p=3899321&t=c community or in multiple communities. Each target community must be defined by clear geographic boundaries in order to assure that the number of youth served can be identified and teen pregnancy and/or teen birth rates can be monitored throughout the project.

The amount of funding an applicant may request on an annual basis is linked to the number of participants, on average that the applicant proposes to reach in years 2-5 with evidence-based

TPP programs. The award ranges are based on existing performance measure data from the FY

2010 – FY 2014 OAH TPP Program and are included below:

Annual Budget Annual Reach

$500,000 - $749,999 At least 700 per year

$750,000 - $999,999 At least 1,500 per year

$1,000,000 - $1,249,999 At least 3,000 per year

$1,250,000 - $1,499,999 At least 6,000 per year

$1,500,000 - $1,749,000 At least 10,000 per year

$1,750,000 - $2,000,000 At least 15,000 per year

I. FUNDING OPPORTUNITY DESCRIPTION:

PURPOSE

The purpose of this FOA is to have a significant impact on reducing rates of teen pregnancy and existing disparities (see pages 7-8) by replicating evidence-based TPP programs to scale in at least 3 settings in communities and with populations at greatest need. In each community served, grantees will be expected to:

Mobilize the community to develop and implement a plan to prevent teen pregnancy and promote positive youth development Engage in an up to 12-month planning, piloting, and readiness period Implement evidence-based TPP programs to scale with fidelity and quality in at least 3 settings Ensure that program materials are medically accurate, age appropriate, culturally and linguistically appropriate, and inclusive of Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) youth community or in multiple communities. Each target community must be defined by clear geographic boundaries in order to assure that the number of youth served can be identified and teen pregnancy and/or teen birth rates can be monitored throughout the project.

The amount of funding an applicant may request on an annual basis is linked to the number of participants, on average that the applicant proposes to reach in years 2-5 with evidence-based

TPP programs. The award ranges are based on existing performance measure data from the FY

2010 — FY 2014 OAH TPP Program and are included below:

Annual Budget Annual Reach $500,000 - $749,999 At least 700 per year $750,000 - $999,999 At least 1,500 per year $1,000,000 - $1,249,999 At least 3,000 per year $1,250,000 - $1,499,999 At least 6,000 per year $1,500,000 - $1,749,000 At least 10,000 per year $1,750,000 - $2,000,000 At least 15,000 per year

I. FUNDING OPPORTUNITY DESCRIPTION:

PURPOSE

The purpose of this FOA is to have a significant impact on reducing rates of teen pregnancy and existing disparities (see pages 7-8) by replicating evidence-based TPP programs to scale in at least 3 settings in communities and with populations at greatest need. In each community served, grantees will be expected to:

• Mobilize the community to develop and implement a plan to prevent teen pregnancy and promote positive youth development

• Engage in an up to 12-month planning, piloting, and readiness period

• Implement evidence-based TPP programs to scale with fidelity and quality in at least 3 settings

• Ensure that program materials are medically accurate, age appropriate, culturally and linguistically appropriate, and inclusive of Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) youth

Ensure that programs are implemented in a safe and supportive environment for youth and their families Establish and maintain linkages and referrals to youth-friendly health care services Engage in strategic dissemination and communication activities to raise awareness of the program with youth, their families, and key stakeholders Develop and implement a plan for sustainability to ensure continuation of program efforts beyond the grant Collect and use performance measure data to make continuous quality improvements Evaluate the implementation and outcomes of program activities.

Supporting HHS Strategic Goals, Healthy People 2020, and the National Prevention

Strategy

This FOA supports the HHS Strategic Goal to “Put Children and Youth on the Path for

Successful Futures.” Under this goal, HHS is committed to supporting both evidence-based programs and innovative approaches for children and youth in order to positively impact a range of important social and health outcomes such as child maltreatment, school readiness, teen pregnancy, youth violence, sexually transmitted infections (STIs), mental illness, substance abuse, and delinquency. HHS is investing in strategies that give children and youth a positive start in life and help ensure their future health and development. http://www.hhs.gov/strategic-plan/youth_futures.html

This FOA addresses the Healthy People 2020

(http://www.healthypeople.gov/2020/default.aspx) overarching goals to (1) achieve health equity, eliminate disparities, and improve the health of all groups and (2) promote quality of life, healthy development, and healthy behaviors across all life stages. The FOA addresses several

Healthy People 2020 goals and objectives, including Family Planning Objectives 7 through 13;

STD Objectives 1 and 6; HIV Objective 2; Adolescent Health Objectives 3 and 5; and the LGBT

Topic Area Goal.

• Ensure that programs are implemented in a safe and supportive environment for youth and their families

• Establish and maintain linkages and referrals to youth-friendly health care services

• Engage in strategic dissemination and communication activities to raise awareness of the program with youth, their families, and key stakeholders

• Develop and implement a plan for sustainability to ensure continuation of program efforts beyond the grant

• Collect and use performance measure data to make continuous quality improvements

• Evaluate the implementation and outcomes of program activities.

Supporting HHS Strategic Goals, Healthy People 2020, and the National Prevention

Strategy

This FOA supports the HHS Strategic Goal to “Put Children and Youth on the Path for

Successful Futures.” Under this goal, HHS is committed to supporting both evidence-based programs and innovative approaches for children and youth in order to positively impact a range of important social and health outcomes such as child maltreatment, school readiness, teen pregnancy, youth violence, sexually transmitted infections (STIs), mental illness, substance abuse, and delinquency. HHS is investing in strategies that give children and youth a positive start in life and help ensure their future health and development. http://www.hhs.gov/strategicplan/youth futures.html

This FOA addresses the Healthy People 2020

(http://www.healthypeople.gov/2020/default.aspx) overarching goals to (1) achieve health equity, eliminate disparities, and improve the health of all groups and (2) promote quality of life, healthy development, and healthy behaviors across all life stages. The FOA addresses several

Healthy People 2020 goals and objectives, including Family Planning Objectives 7 through 13;

STD Objectives 1 and 6; HIV Objective 2; Adolescent Health Objectives 3 and 5; and the LGBT

Topic Area Goal.

http://www.hhs.gov/strategic-plan/youth_futures.html http://www.hhs.gov/strategic-plan/youth_futures.html http://www.healthypeople.gov/2020/default.aspx

This FOA also supports the National Prevention Strategy’s

(http://www.surgeongeneral.gov/initiatives/prevention/strategy/#The Goal) overarching strategic direction to help people make healthy choices and eliminate health disparities. This FOA supports the recommendations in the reproductive and sexual health priority area to (1) provide effective sexual health education, especially for adolescents, and (2) enhance early detection of

HIV, viral hepatitis, and other STIs and improve linkages to care.

BACKGROUND

OAH’s Teen Pregnancy Prevention Program

OAH announces the availability of FY2015 funding to support the TPP Program, which was initiated in FY 2010 as one of six major evidence-based policy initiatives across the Federal government. OAH supports two types of grants through the TPP program: (1) projects that replicate evidence-based program models that have been shown to be effective through rigorous evaluation, referred to as “Tier 1” and (2) research and demonstration projects in order to develop and test additional models and innovative strategies to prevent teen pregnancy, referred to as “Tier 2.” Additional information about OAH and specifically about the TPP Program can be found on the OAH website ( http://www.hhs.gov/ash/oah/oah-initiatives/teen_pregnancy/).

Within this framework, OAH is announcing five separate FOAs, each with a different focus.

Available FOAs include:

Capacity Building to Support Replication of Evidence-Based TPP Programs (Tier 1A) Replicating Evidence-Based TPP Programs to Scale in Communities with the Greatest Need (Tier 1B) Supporting and Enabling Early Innovation to Advance Adolescent Health and Prevent Teen Pregnancy (Tier 2A) Rigorous Evaluation of New or Innovative Approaches to Prevent Teen (Tier 2B) Effectiveness of TPP Programs Designed Specifically for Young Males (Tier 2C)

This FOA also supports the National Prevention Strategy’s

(http :!!www. surgeongeneral.gov!initiatives!prevention!strategy!#The Goal) overarching strategic direction to help people make healthy choices and eliminate health disparities. This FOA supports the recommendations in the reproductive and sexual health priority area to (1) provide effective sexual health education, especially for adolescents, and (2) enhance early detection of

HIV, viral hepatitis, and other STIs and improve linkages to care.

BACKGROUND

OAH’s Teen Pregnancy Prevention Program

OAH announces the availability of FY20 15 funding to support the TPP Program, which was initiated in FY 2010 as one of six major evidence-based policy initiatives across the Federal government. OAH supports two types of grants through the TPP program: (1) projects that replicate evidence-based program models that have been shown to be effective through rigorous evaluation, referred to as “Tier 1” and (2) research and demonstration projects in order to develop and test additional models and innovative strategies to prevent teen pregnancy, referred to as “Tier 2.” Additional information about OAH and specifically about the TPP Program can be found on the OAH website (http:!!www.hhs.gov!ash!oah!oah-initiatives!teen pregnancy!).

Within this framework, OAH is announcing five separate FOAs, each with a different focus.

Available FOAs include:

• Capacity Building to Support Replication of Evidence-Based TPP Programs (Tier 1A)

• Replicating Evidence-Based TPP Programs to Scale in Communities with the Greatest Need

(Tier 1B)

• Supporting and Enabling Early Innovation to Advance Adolescent Health and Prevent Teen

Pregnancy (Tier 2A)

• Rigorous Evaluation of New or Innovative Approaches to Prevent Teen (Tier 2B)

• Effectiveness of TPP Programs Designed Specifically for Young Males (Tier 2C) http://www.surgeongeneral.gov/initiatives/prevention/strategy/#The Goal http://www.hhs.gov/ash/oah/oah-initiatives/teen_pregnancy/

Status of Adolescent Sexual Risk Behaviors

Teen Pregnancy and Existing Disparities

Teen pregnancy and birth rates in the United States dropped to a record low since their peak in the early 1990’s. The teen birth rate declined ten percent in 2013 alone and declined 38 percent since 2007 (1). There have also been improvements in teens’ sexual behavior and use of contraceptives. In 2013, about half (47%) of all high school students reported having ever had sex. In that same year among high school students who were sexually active, 86% reported using some method of contraception the last time they had sex (2).

Despite the progress that has been made to reduce teen pregnancy and sexual risk taking, there were still approximately 614,000 pregnancies to women younger than age 20 in 2010 (3) and 25% of teens in the U.S. will become pregnant at least once by the age of 20 (4).

Furthermore, young people age 15 to 24 account for nearly one-half of all new cases of STDs although they only comprise one quarter of the sexually active population in the U.S. (5).

In addition, great disparities continue to exist – by age, race and ethnicity, geography, urbanicity, and among especially vulnerable populations.

Age - Birth rates are much higher among older teens (47.3 per 1,000) than younger teens

(12.3 per 1,000), with 2/3 of teen births to girls ages 18 to 19 and 1/3 to girls ages 17 and younger (6,7).

Race and Ethnicity - In 2010, the teen pregnancy rate among non-Hispanic Black and

Hispanic teen girls age 15-19 was more than twice as high as the teen pregnancy rate among non-Hispanic White teen girls age 15-19 (8). In 2012, the teen birth rate was 46

Status of Adolescent Sexual Risk Behaviors

Teen Pregnancy and Existing Disparities

Teen pregnancy and birth rates in the United States dropped to a record low since their peak in the early 1990’s. The teen birth rate declined ten percent in 2013 alone and declined 38 percent since 2007 (1). There have also been improvements in teens’ sexual behavior and use of contraceptives. In 2013, about half (47%) of all high school students reported having ever had sex. In that same year among high school students who were sexually active, 86% reported using some method of contraception the last time they had sex (2).

Despite the progress that has been made to reduce teen pregnancy and sexual risk taking, there were still approximately 614,000 pregnancies to women younger than age 20 in 2010 (3) and 25% of teens in the U.S. will become pregnant at least once by the age of 20 (4).

Furthermore, young people age 15 to 24 account for nearly one-half of all new cases of STDs although they only comprise one quarter of the sexually active population in the U.S. (5).

In addition, great disparities continue to exist — by age, race and ethnicity, geography, urbanicity, and among especially vulnerable populations.

• Age - Birth rates are much higher among older teens (47.3 per 1,000) than younger teens

(12.3 per 1,000), with 2/3 of teen births to girls ages 18 to 19 and 1/3 to girls ages 17 and younger (6,7).

• Race and Ethnicity - In 2010, the teen pregnancy rate among non-Hispanic Black and

Hispanic teen girls age 15-19 was more than twice as high as the teen pregnancy rate among non-Hispanic White teen girls age 15-19 (8). In 2012, the teen birth rate was 46 per 1,000 for Hispanic teens; 44 per 1,000 for Black, non-Hispanic teens; 35 per 1,000 for American Indian teens; 21 per 1,000 for White, non-Hispanic teens; and 10 per 1,000 for Asian/Pacific Islander teens (9).

Geography - Substantial geographic variation exists in adolescent childbearing across the United States with the lowest teen birth rates reported in the Northeast, and the highest rates reported across the southern part of the country (10).

Urbanicity - Teen birth rates are much higher in rural areas (43 per 1,000) compared to small-medium metro areas (36 per 1,000) and large urban cities (24 per 1,000) (11).

Vulnerable Populations – Rates of teen pregnancy and teen births have been found to be higher among especially vulnerable youth, including youth in foster care, parenting teens, and LGBTQ youth. Teen girls who are in foster care are 2.5 times more likely than their counterparts who are not in foster care to get pregnant by age 19 (12). Teens who are already parents are also at increased risk of becoming pregnant again. Overall, 17% of all teen births are repeat teen births (13). Lesbian, Gay, Bisexual, and Transgender

(LGBT) youth are 2-3 times more likely to be involved in a pregnancy compared to non-

LGBT youth. Lesbian, Gay, and Bisexual (LGB) youth are more likely to initiate sex at a very young age, have multiple partners, use alcohol and other substances before engaging in sexual intercourse; and are less likely to use contraception compared to non-LGB youth (14).

Risky behaviors are often co-occurring. Teens who drink or use drugs are at increased risk of (1) being sexually active, (2) not using contraception when they have sex, (3) having sex at an earlier age, and (4) having multiple partners (15). Teen pregnancy is also linked with various per 1,000 for Hispanic teens; 44 per 1,000 for Black, non-Hispanic teens; 35 per 1,000 for American Indian teens; 21 per 1,000 for White, non-Hispanic teens; and 10 per 1,000 for Asian/Pacific Islander teens (9).

• Geography - Substantial geographic variation exists in adolescent childbearing across the United States with the lowest teen birth rates reported in the Northeast, and the highest rates reported across the southern part of the country (10).

• Urbanicity - Teen birth rates are much higher in rural areas (43 per 1,000) compared to small-medium metro areas (36 per 1,000) and large urban cities (24 per 1,000) (11).

• Vulnerable Populations — Rates of teen pregnancy and teen births have been found to be higher among especially vulnerable youth, including youth in foster care, parenting teens, and LGBTQ youth. Teen girls who are in foster care are 2.5 times more likely than their counterparts who are not in foster care to get pregnant by age 19 (12). Teens who are already parents are also at increased risk of becoming pregnant again. Overall, 17% of all teen births are repeat teen births (13). Lesbian, Gay, Bisexual, and Transgender

(LGBT) youth are 2-3 times more likely to be involved in a pregnancy compared to nonLGBT youth. Lesbian, Gay, and Bisexual (LGB) youth are more likely to initiate sex at a very young age, have multiple partners, use alcohol and other substances before engaging in sexual intercourse; and are less likely to use contraception compared to non-LGB youth (14).

Risky behaviors are often co-occurring. Teens who drink or use drugs are at increased risk of (1) being sexually active, (2) not using contraception when they have sex, (3) having sex at an earlier age, and (4) having multiple partners (15). Teen pregnancy is also linked with various types of violence including dating violence, intimate partner violence, domestic violence and sexual abuse. Girls in high school who reported experiencing dating violence were four to six times more likely to have ever been pregnant than peers who had not experienced dating violence. Adverse childhood experiences such as physical abuse, verbal abuse, and witnessing intimate partner violence are also linked with having sex at an early age. Approximately 50 to 60 percent of adolescents who become pregnant have a history of childhood sexual or physical abuse (16).

Sexual Risk and Protective Factors

There are several risk and protective factors that influence a teen’s decision to engage in sexual behavior. The majority of risk and protective factors fall into one of four categories: (1) biological factors such as age, physical maturity, and sex; (2) disadvantage, disorganization, and dysfunction in the lives of teens and their families, peers, and communities; (3) sexual values and norms expressed or modeled by teens themselves or by their families, romantic partners, peers, faith communities, schools, and communities; and (4) teens’ connection to groups or institutions that discourage risky sexual behavior, encourage responsible behavior, or both (17). It is important for organizations to understand the factors that influence teens’ sexual behavior to have the greatest impact on reducing sexual risk taking.

Trauma Informed Care

Organizations should be aware that the youth they will be working with may have experienced some form of trauma. Youth can be exposed directly or indirectly to trauma through child abuse, neglect, domestic violence and other forms of violence. Exposure to traumatic events can have social, behavioral and emotional impacts on youth and lead to poor outcomes.

types of violence including dating violence, intimate partner violence, domestic violence and sexual abuse. Girls in high school who reported experiencing dating violence were four to six times more likely to have ever been pregnant than peers who had not experienced dating violence. Adverse childhood experiences such as physical abuse, verbal abuse, and witnessing intimate partner violence are also linked with having sex at an early age. Approximately 50 to 60 percent of adolescents who become pregnant have a history of childhood sexual or physical abuse (16).

Sexual Risk and Protective Factors

There are several risk and protective factors that influence a teen’s decision to engage in sexual behavior. The majority of risk and protective factors fall into one of four categories: (1) biological factors such as age, physical maturity, and sex; (2) disadvantage, disorganization, and dysfunction in the lives of teens and their families, peers, and communities; (3) sexual values and norms expressed or modeled by teens themselves or by their families, romantic partners, peers, faith communities, schools, and communities; and (4) teens’ connection to groups or institutions that discourage risky sexual behavior, encourage responsible behavior, or both (17). It is important for organizations to understand the factors that influence teens’ sexual behavior to have the greatest impact on reducing sexual risk taking.

Trauma Informed Care

Organizations should be aware that the youth they will be working with may have experienced some form of trauma. Youth can be exposed directly or indirectly to trauma through child abuse, neglect, domestic violence and other forms of violence. Exposure to traumatic events can have social, behavioral and emotional impacts on youth and lead to poor outcomes.

Youth who have been exposed to violence are more likely to become teen parents, with those who have experienced physical and sexual abuse more likely to experience a repeat pregnancy

(18).

Exposure to adverse childhood experiences (ACEs) including abuse, neglect, violence, and other stressors can have a lifelong impact on one’s health. As the number of ACEs increase, the risk for health problems (e.g., heart disease, depression, smoking, intimate partner violence, risky sexual behavior, and alcohol or drug abuse) increases. Trauma-informed care is an approach that is welcoming and appropriate for trauma survivors (e.g., those with ACEs), including avoiding re-traumatization. A trauma-informed approach is one in which all parties involved recognize and respond to the impact of ACE, trauma, and toxic stress on children, caregivers, and service providers. Organizations should prepare to incorporate a trauma informed approach when providing sexual health education to youth, which includes taking into consideration ACEs and the influence that they have on sexual health and decision making (19, 20).

Positive Youth Development

Positive youth development is an intentional, pro-social approach that engages youth within their communities, schools, organizations, peer groups, and families in a manner that is productive and constructive; recognizes, uses, and enhances youths' strengths; and promotes positive outcomes for young people by providing opportunities, fostering positive relationships, and furnishing the support needed to build on their leadership strengths (21). According to research on positive youth development, youth may have fewer behavioral problems and may be better prepared for a successful transition to adulthood if they have a variety of opportunities to

Youth who have been exposed to violence are more likely to become teen parents, with those who have experienced physical and sexual abuse more likely to experience a repeat pregnancy

(18).

Exposure to adverse childhood experiences (ACEs) including abuse, neglect, violence, and other stressors can have a lifelong impact on one’s health. As the number of ACEs increase, the risk for health problems (e.g., heart disease, depression, smoking, intimate partner violence, risky sexual behavior, and alcohol or drug abuse) increases. Trauma-informed care is an approach that is welcoming and appropriate for trauma survivors (e.g., those with ACEs), including avoiding re-traumatization. A trauma-informed approach is one in which all parties involved recognize and respond to the impact of ACE, trauma, and toxic stress on children, caregivers, and service providers. Organizations should prepare to incorporate a trauma informed approach when providing sexual health education to youth, which includes taking into consideration ACEs and the influence that they have on sexual health and decision making (19, 20).

Positive Youth Development

Positive youth development is an intentional, pro-social approach that engages youth within their communities, schools, organizations, peer groups, and families in a manner that is productive and constructive; recognizes, uses, and enhances youths’ strengths; and promotes positive outcomes for young people by providing opportunities, fostering positive relationships, and furnishing the support needed to build on their leadership strengths (21). According to research on positive youth development, youth may have fewer behavioral problems and may be better prepared for a successful transition to adulthood if they have a variety of opportunities to learn and participate at home, at school, in community-based programs and in their neighborhoods. Organizations should work to incorporate key positive youth development practices into all interactions with and programs for youth (22).

Evidence-Based TPP Programs Eligible for Replication

The Department of Health and Human Services (HHS) conducts the HHS TPP Evidence

Review (http://tppevidencereview.aspe.hhs.gov/EvidencePrograms.aspx) which uses a systematic process for reviewing evaluation studies against a rigorous standard in order to identify programs shown to be effective at preventing teen pregnancies, sexually transmitted infections, and/or sexual risk behaviors. The evidence review, first conducted in 2009 and updated periodically, is led by the HHS Office of the Assistant Secretary for Planning and

Evaluation. The most recent update was released in August 2014. There are currently 37 evidence-based TPP program models identified by the HHS TPP Evidence Review. The 37 programs are diverse on a number of variables, including program approach, target population, implementation setting, length of program, program outcomes, duration of program outcomes, and study design quality rating.

Evidence-based TPP programs eligible for replication by the applicant under this FOA are those that meet the following criteria prior to the end of the grantee’s planning and readiness period:

1. Have been identified as having evidence of effectiveness by the HHS TPP Evidence

Review (http://tppevidencereview.aspe.hhs.gov/EvidencePrograms.aspx) and

2. Have been assessed by the HHS TPP Evidence Review as being implementation ready, meaning that the program has clearly defined curricula and components, learn and participate at home, at school, in community-based programs and in their neighborhoods. Organizations should work to incorporate key positive youth development practices into all interactions with and programs for youth (22).

Evidence-Based TPP Programs Eligible for Replication

The Department of Health and Human Services (HHS) conducts the HHS TPP Evidence

Review (http ://tppevidencereview .aspe.hhs .gov/EvidencePrograms .aspx) which uses a systematic process for reviewing evaluation studies against a rigorous standard in order to identify programs shown to be effective at preventing teen pregnancies, sexually transmitted infections, and/or sexual risk behaviors. The evidence review, first conducted in 2009 and updated periodically, is led by the HHS Office of the Assistant Secretary for Planning and

Evaluation. The most recent update was released in August 2014. There are currently 37 evidence-based TPP program models identified by the HHS TPP Evidence Review. The 37 programs are diverse on a number of variables, including program approach, target population, implementation setting, length of program, program outcomes, duration of program outcomes, and study design quality rating.

Evidence-based TPP programs eligible for replication by the applicant under this FOA are those that meet the following criteria prior to the end of the grantee’s planning and readiness period:

1. Have been identified as having evidence of effectiveness by the HHS TPP Evidence

Review (http ://tppevidencereview .aspe.hhs .gov/EvidencePrograms. aspx) and

2. Have been assessed by the HHS TPP Evidence Review as being implementation ready, meaning that the program has clearly defined curricula and components, file:///C:/Users/Amy.Bianchi/Documents/OAH/Supplemental%20Proposals/Planning%20for%202014%20TPP%20FOA/HHS%20TPP http://tppevidencereview.aspe.hhs.gov/EvidencePrograms.aspx file:///C:/Users/Amy.Bianchi/Documents/OAH/Supplemental%20Proposals/Planning%20for%202014%20TPP%20FOA/HHS%20TPP http://tppevidencereview.aspe.hhs.gov/EvidencePrograms.aspx necessary staff supports and training, and specified guidelines and tools for monitoring fidelity.

OAH is especially interested in replicating evidence-based TPP programs with the strongest evidence and that have been found to be effective through evaluations in multiple sites, in different settings, and with different populations. As the HHS TPP Evidence Review continues to grow and mature, OAH anticipates that new evidence will be generated for program models that currently have evidence of effectiveness in the TPP Evidence Review and that new evidence-based program models will be identified. OAH anticipates that as the evidence in this field expands through rigorous evaluation of replications of evidence-based programs and evaluations of new and untested programs, the TPP Evidence Review may be able to make further distinctions about the strength of evidence behind each program model. OAH will work with grantees to continuously review and evaluate new evidence to determine its impact on grantee programs.

A list of evidence-based TPP programs that currently meet the stated criteria and are eligible for replication under this FOA is included in Appendix D. Additional evidence-based

TPP programs identified by the HHS TPP Evidence Review prior to the end of the grantee’s planning and readiness period will also be eligible for replication under this FOA as long as the meet the 2 criteria specified on pages 11-12.

Taking Evidence-Based TPP Programs to Scale in Communities with Greatest Need

Implementing evidence-based TPP programs to scale focuses on expanding the reach of programs with an emphasis on impact and achieving better outcomes. Scaling can be defined as

“deliberate efforts to increase the impact of service innovations successfully tested in pilot or necessary staff supports and training, and specified guidelines and tools for monitoring fidelity.

OAH is especially interested in replicating evidence-based TPP programs with the strongest evidence and that have been found to be effective through evaluations in multiple sites, in different settings, and with different populations. As the HHS TPP Evidence Review continues to grow and mature, OAH anticipates that new evidence will be generated for program models that currently have evidence of effectiveness in the TPP Evidence Review and that new evidence-based program models will be identified. OAH anticipates that as the evidence in this field expands through rigorous evaluation of replications of evidence-based programs and evaluations of new and untested programs, the TPP Evidence Review may be able to make further distinctions about the strength of evidence behind each program model. OAH will work with grantees to continuously review and evaluate new evidence to determine its impact on grantee programs.

A list of evidence-based TPP programs that currently meet the stated criteria and are eligible for replication under this FOA is included in Appendix D. Additional evidence-based

TPP programs identified by the HHS TPP Evidence Review prior to the end of the grantee’s planning and readiness period will also be eligible for replication under this FOA as long as the meet the 2 criteria specified on pages 11-12.

Taking Evidence-Based TPP Programs to Scale in Communities with Greatest Need

Implementing evidence-based TPP programs to scale focuses on expanding the reach of programs with an emphasis on impact and achieving better outcomes. Scaling can be defined as

“deliberate efforts to increase the impact of service innovations successfully tested in pilot or experimental projects so as to benefit more people” (23). For OAH, the goal of scaling evidence-based TPP programs is to prevent teen pregnancy, reduce existing disparities, and promote healthy adolescent development by expanding the number of youth and their families who receive evidence-based TPP programs. To have a lasting impact on reducing rates of teen pregnancy and disparities, youth should receive evidence-based TPP programs at multiple times over the course of their adolescence, and the information provided should be sequential, consistent, and reinforcing. Implementation of a single evidence-based TPP program at a single point in time is likely insufficient to prevent teen pregnancy, STIs, and HIV for the long-term.

Under this FOA, organizations are expected to implement evidence-based TPP programs to scale in at least 3 settings, reaching communities, and youth within those communities, with the greatest need.

EXPECTATIONS OF GRANTEES

Included below are OAH’s expectations of grantees throughout the five-year project period.

Failure of a grantee to meet major milestones as required/defined by OAH may result in the discontinuation of grant funding at any time during the project period.

TARGET POPULATION & NEED

The intent of this FOA is to target limited resources to serving communities with the greatest need for preventing teen pregnancy and reducing existing disparities (see pages 7-8). Applicants may propose serving a single community or multiple communities within a single application.

Multiple communities could include communities within the same state, communities across states, etc. Each community must be defined by clear geographic boundaries in order to ensure that the number of youth served can be identified and teen pregnancy and/or teen birth rates can experimental projects so as to benefit more people” (23). For OAH, the goal of scaling evidence-based TPP programs is to prevent teen pregnancy, reduce existing disparities, and promote healthy adolescent development by expanding the number of youth and their families who receive evidence-based TPP programs. To have a lasting impact on reducing rates of teen pregnancy and disparities, youth should receive evidence-based TPP programs at multiple times over the course of their adolescence, and the information provided should be sequential, consistent, and reinforcing. Implementation of a single evidence-based TPP program at a single point in time is likely insufficient to prevent teen pregnancy, STIs, and HIV for the long-term.

Under this FOA, organizations are expected to implement evidence-based TPP programs to scale in at least 3 settings, reaching communities, and youth within those communities, with the greatest need.

EXPECTATIONS OF GRANTEES

Included…