HRSA-22-109.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Health and Public Safety Workforce Resiliency Training Program

Funding Opportunity Number: HRSA-22-109

Funding Opportunity Type(s): New Assistance Listings (CFDA) Number: 93.732

NOTICE OF FUNDING OPPORTUNITY

Fiscal year 2022

Application Due Date: August 30, 2021

SAM.gov and Grants.gov administrative flexibilities have been implemented.

Please see Section IV.3 for more information.

Issuance Date: July 16, 2021

Andrea L. Knox, MS Public Health Analyst, DNPH Telephone: (301) 443-4170 Email: HPSWRTP@hrsa.gov

Authority: Section 765 of the Public Health Service Act (42 U.S. Code § 295) and Section 2703 of the American Rescue Plan Act of 2021 (P.L.117-2).

mailto:HPSWRTP@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Health and Public Safety Workforce Resiliency Training Program (HPSWRTP). The purpose of this program is to plan, develop, operate or participate in health professions and nursing training activities using evidence-based or evidence-informed strategies, to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency among health care professionals, including health care students, residents, professionals, paraprofessionals, trainees, public safety officers,1 and employers of such individuals, collectively known as the “Health Workforce,” in rural and medically underserved communities.

HPSWRTP supports the HRSA Bureau of Health Workforce’s (BHW) priority on behavioral health by improving the quality of training and increasing access to care through partnerships and linkages to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency among health care professionals.

Funding Opportunity Title: Health and Public Safety Workforce

Resiliency Training Program Funding Opportunity Number: HRSA-22-109 Due Date for Applications: August 30, 2021 Anticipated Total Annual Available FY 2022 Funding:

$68,420,000 for 3 year period of performance (decremental funding):

$32,380,000 in year 1;

$21,270,000 in year 2; and $14,770,000 in year 3)

Estimated Number and Type of Award(s): Up to 30 cooperative agreements Estimated Award Amount: Up to $1,079,333 in year 1

Up to $709,000 in year 2 Up to $492,333 in year 3

Cost Sharing/Match Required: No

1 The broad term of public safety officer may refer to various professions related to public safety, such as firefighters, law enforcement officers, rescue squad members, or ambulance crew. A public safety officer is responsible for keeping the peace in public areas, such as university campuses or state facilities.

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Period of Performance: December 1, 2021 through November 30, 2024 (3 years)

• December 1, 2021 – November 30, 2022 year 1

• December 1, 2022 – November 30, 2023 year 2

• December 1, 2023 – November 30, Eligible Applicants: Health professions schools, academic health centers, state or local governments, Indian tribes and tribal organizations, or other appropriate public or private nonprofit entities (or consortia of such entities, including entities promoting multidisciplinary approaches.

The definition and example of a consortia can be found in Section VIII).

See Section III.1 of this notice of funding opportunity (NOFO) for complete eligibility information.

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance

HRSA will hold a pre-application technical assistance (TA) webinar(s) for applicants seeking funding through this opportunity. The webinar(s) will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions.

Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://bhw.hrsa.gov/fundingopportunities/default.aspx to learn more about the resources available for this funding opportunity.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://bhw.hrsa.gov/fundingopportunities/default.aspx

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

vi. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER TRANSITION

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

HRSA-22-109 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Health and Public Safety Workforce Resiliency Training Program (HPSWRTP).

Program Purpose The purpose of this program is to plan, develop, operate or participate in health professions and nursing training activities using evidence-based or evidence-informed strategies, to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency among health care students, residents, professionals, paraprofessionals, trainees, public safety officers, and employers of such individuals, collectively known as the “Health Workforce,” in rural and underserved communities.

Program Goal The goal of HPSWRTP is to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency among health care students, residents, professionals, paraprofessionals, trainees, public safety officers, and employers of such individuals, particularly in rural and medically underserved communities.

Program Objectives

1. To plan, develop, operate or participate in health professions and nursing training activities using evidence-based or evidence-informed strategies, to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency among health care students, residents, professionals, paraprofessionals, trainees, public safety officers, and employers of such individuals, and rapidly deploy those evidence-based or evidence-informed strategies;

2. To create and advance protocols and system-wide approaches within eligible entities to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency;

3. To develop innovative sustainability practices/models (i.e., curriculum development) to promote provider resiliency and prevent or reduce clinician burnout;

4. To reduce financial barriers to health care students, residents, professionals, paraprofessionals, trainees, public safety officers, and employers of such individuals by paying for the cost of training for those who participate in training specifically designed to reduce and address burnout, suicide, mental health conditions and substance use disorders, or promote resiliency; and

5. To address the disproportionate burden of burnout, suicide, mental health conditions and substance use disorders among these professionals in rural and medically underserved communities.

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2. Background

The HPSWRTP is authorized by Section 765 of the Public Health Service Act (42 U.S.

Code § 295) and Section 2703 of the American Rescue Plan Act of 2021 (P.L.117-2)).

and builds upon HRSA’s mental and behavioral health programs.

The existing HRSA health workforce programs offer education, training, and practice opportunities for professionals and paraprofessionals who either will, or currently do, provide direct care services on integrated, interprofessional teams. Providing direct care services, specifically during the Coronavirus Disease 2019 (COVID-19) emergency, has contributed to increased rates of provider burnout, increased suicide rates among providers, and other negative behavioral health outcomes.2 Burnout commonly affects individuals involved in the direct care of others, including mental health practitioners.

Burnout consists of three components: emotional exhaustion, depersonalization of clients, and feelings of ineffectiveness or lack of personal accomplishment. Emotional exhaustion may include feeling overextended, being unable to feel compassion for clients, and feeling unable to meet workplace demands. Depersonalization is the process by which providers distance themselves from clients to prevent emotional fatigue. Finally, feelings of ineffectiveness and lack of personal accomplishment occur when practitioners feel a negative sense of personal and/or career worth.3

Burnout has increased among United States health care professionals, with over one-half of physicians and one-third of nurses experiencing symptoms. The burnout is detrimental to patient care and may exacerbate the impending physician shortage.4 Burnout has had a negative impact on varies communities. Primary care physicians (PCP) experience high rates of professional burnout. These symptoms may be magnified in underserved populations.5 Burnout has been associated with an intent to leave practice location. This is especially concerning in many rural areas, which already have physician shortages.6

Bureau of Health Workforce (BHW) places an emphasis on increasing access to quality care in its existing health workforce programs. Physician burnout is associated with a reduced efficiency of health care systems to deliver high-quality, safe care to patients.

Preventable adverse events cost several billions of dollars to health care systems every

2 Sharifi, M., Asadi-Pooya, A., & Mousavi-Roknabadi, R. (2020, December 10). Burnout among healthcare providers Of COVID-19; a systematic review of epidemiology and recommendations.

Retrieved April 13, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812159/ 3 Staff, P. (n.d.). Research roundup: Burnout in mental health providers. Retrieved April 13, 2021, from https://www.apaservices.org/practice/update/2018/01-25/mental-health-providers#:~:text=Burnout%20commonly%20affects%20individuals%20involved,Jackson%20%26%20Lie ter%2C%201997 4 Reith, T. P. (2018). Burnout in United States Healthcare Professionals: A Narrative Review. Cureus, 10(12), e3681. https://doi.org/10.7759/cureus.3681.https://doi.org/10.7759/cureus.3681.

5 Olayiwola, J. Nwando, et al. "Higher Perceived Clinic Capacity to Address Patients' Social Needs Associated with Lower Burnout in Primary Care Providers." Journal of Health Care for the Poor and Underserved, vol. 29 no. 1, 2018, p. 415-429. Project MUSE, doi:10.1353/hpu.2018.0028.

6 Hogue, A.L., Huntington, M. (July 2019). Family Physician Burnout Rates in Rural versus Metropolitan Areas: A Pilot Study. South Dakota journal of medicine 72(7):306-309 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812159/ https://www.apaservices.org/practice/update/2018/01-25/mental-health-providers#:%7E:text=Burnout%20commonly%20affects%20individuals%20involved,Jackson%20%26%20Lieter%2C%201997 https://www.apaservices.org/practice/update/2018/01-25/mental-health-providers#:%7E:text=Burnout%20commonly%20affects%20individuals%20involved,Jackson%20%26%20Lieter%2C%201997 https://www.apaservices.org/practice/update/2018/01-25/mental-health-providers#:%7E:text=Burnout%20commonly%20affects%20individuals%20involved,Jackson%20%26%20Lieter%2C%201997 https://doi.org/10.7759/cureus.3681

HRSA-22-109 3

year. Physician burnout therefore is costly for health care organizations and undermines a fundamental societal need for safe care.7

The COVID-19 pandemic has resulted in an overall increase in new cases of depression and anxiety and an exacerbation of existing mental health issues, with a particular emotional and physical toll on health care workers. Limited resources, longer shifts, disruptions to sleep and to work-life balance, and occupational hazards associated with exposure to COVID-19 have contributed to physical and mental fatigue, stress and anxiety, and burnout. Research indicates that increases in emotional breakdowns among front-line health care providers is mainly due to the added pressure of having to choose between family responsibilities and an inner sense of duty toward patients.8

The impact of the COVID-19 response on the emotional and physical health of the U.S.

public health workforce have been well described.9 The “Coping with COVID” study found that nursing assistants, medical assistants, housekeeping and social workers from minority groups had somewhat higher levels of stress and burnout.10 Further contributing to the impact on provider burnout are the challenges faced in rural communities. Data shows that “African American, Latinx and Native American communities make up 22% of the rural population and are also at higher risk for underlying health conditions that are known risk factors for severe COVID-19 disease.”11 Rural health care systems face challenges in responding to the needs of rural populations such as fewer hospitals and providers who specialize in critical care.

Despite the support and resources offered, data still shows the rising prevalence of burnout among clinicians (over 50 percent in some studies), which has led to questions on how burnout affects access to care, patient safety, and care quality.12 With providers focusing on providing access to quality care despite their own needs, they sometimes subjugate their own health needs. An estimated 400 physicians died by suicide last year. The rate of suicide among doctors is twice that of the general population, and one

7 Rosenberg, Jaime. (2018). Physician Burnout Associated With Poorer Patient Outcomes.

https://www.ajmc.com/view/physician-burnout-associated-with-poorer-patient-outcomes 8 Farzan Sasangohar, PhD, SM, MASc, Stephen L. Jones, MD, MSHI, [...], and Bita A. Kash, PhD, MBA, FACHE. Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High- Volume Intensive Care Unit. Published online 2020 Apr 9. doi: 10.1213/ANE.0000000000004866.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173087/ 9 Stone, K.W., Kitziger,K. W., […] and Horney, J.A. Public Health Workforce Burnout in the COVID-19 Response in the U.S. International Journal of Environmental Research and Public Health. 2021 April;

18(8):4369 10 Kriti Prasada, Colleen McLoughlinc, Martin Stillmanb, Sara Poplaub, Elizabeth Goelzb, Sam Taylorc, Nancy Nankivilc, Roger Brownd, Mark Linzerb, Kyra Cappeluccic, Michael Barbouchee, Christine A.

Sinskyc. Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study. EClinical Medicine. Retrieved July 9, 2021 from https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00159-0/fulltext 11 Infectious Diseases Socieity of America. (2020). COVID-19 Policy Brief : Disparities Among Rural Communities in the United States. Retrieved from https://www.idsociety.org/globalassets/idsa/public-health/covid-19/covid19-health-disparities-in-rural-communities_leadership-review_final_ab_clean.pdf 12 Physician Burnout. Content last reviewed July 2017. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html https://www.ajmc.com/view/physician-burnout-associated-with-poorer-patient-outcomes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173087/ https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00159-0/fulltext https://www.idsociety.org/globalassets/idsa/public-health/covid-19/covid19-health-disparities-in-rural-communities_leadership-review_final_ab_clean.pdf https://www.idsociety.org/globalassets/idsa/public-health/covid-19/covid19-health-disparities-in-rural-communities_leadership-review_final_ab_clean.pdf https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html

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of the highest among any profession. Stress, burnout, and trauma all contribute to this devastating toll.13

The HPSWRTP aims to reduce and address burnout, suicide, mental health conditions and substance use disorders by funding entities that train and employ the workforce in order to strengthen the existing health care system’s ability to support provider wellness.

Program Definitions A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the Health Workforce Glossary. Additional definitions specific to this NOFO can be found in Section VIII below.

II. Award Information

1. Type of Application and Award

Type of applications sought: New

HRSA will provide funding in the form of a cooperative agreement. A cooperative agreement is a financial assistance mechanism where HRSA anticipates substantial involvement with the recipient during performance of the contemplated project.

In addition to the usual monitoring and technical assistance provided under the cooperative agreement, HRSA program involvement will include:

• Providing ongoing input and review of activities and procedures to be established and implemented for accomplishing the goals of the cooperative agreement;

• Participating in the planning, development, and evaluation of all phases of the project;

• Participating, as appropriate, in meetings or site visits conducted during the period of the cooperative agreement;

• Assisting recipients and their partners in developing a national provider resiliency network to share resources, best practices, and lessons learned;

• Reviewing and giving feedback on project information prior to dissemination;

• Assisting with establishing collaborative relationships with federal, state agencies, other HRSA Health and Public Safety Workforce Resiliency Training Program recipients, and other entities relevant to the project mission;

• Providing programmatic input and consultation for the development and delivery of the resiliency training and interventions;

• Collaborating with recipients to develop and implement assessment and evaluation strategies;

13 Jay Bhatt, Jerry Reed. September 2019. Suicide prevention resources available to help physicians.

https://www.aha.org/news/insights-and-analysis/2019-09-17-suicide-prevention-resources-available-help-physicians https://bhw.hrsa.gov/grants/resourcecenter/glossary https://www.aha.org/news/insights-and-analysis/2019-09-17-suicide-prevention-resources-available-help-physicians https://www.aha.org/news/insights-and-analysis/2019-09-17-suicide-prevention-resources-available-help-physicians

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• Providing informational resources;

• Participating in the dissemination of written project activities through email and educational products such as toolkits, assessment tools, etc.

The cooperative agreement recipient’s responsibilities will include:

• Participating in ongoing conference calls and webinars with other HPSWRTP recipients and HRSA staff;

Carrying out all program activities in accordance with, section 2703 of the American Rescue Plan Act of 2021, specifically grant recipients must plan, develop, operate, or participate in health professions and nursing training activities for health care students, residents, professionals, paraprofessionals, trainees, and public safety officers, and employers of such individuals, in evidence-based or evidence-informed strategies for reducing and addressing suicide, burnout, and mental and behavioral health conditions (including substance use disorders) among health care professionals.

• Providing the HRSA project officer with an opportunity to review project information prior to dissemination;

• Establishing contacts relevant to the project’s mission such as with federal and non-federal partners, and other HRSA grant recipients;

• Coordinating activities with other HPSWRTP recipients;

• Collaborating with HRSA and other HPSWRTP recipients to develop and implement assessment and evaluation strategies.

2. Summary of Funding

HRSA estimates approximately $68,420,000 to be available to fund 30 recipients. You may apply for a ceiling amount of up to:

• $1,079,333 in year 1

• $709,000 in year 2, and

• $492,333 in year 3.

The funding for year one (1) is greater compared to years 2-3, as health professionals may have immediate mental health needs related to current issues with COVID-19, and by providing more substantial funds up front HRSA hopes to enable award recipients to immediately address those needs.

• The total cost (includes both direct and indirect, facilities and administrative costs) per year. The period of performance is December 1, 2021 through November 30, 2024 (3 years). Funding beyond the first year is subject to the availability of appropriated funds for the HPSWRTP in subsequent fiscal years, satisfactory recipient progress, and a decision that continued funding is in the best interest of the Federal Government.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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Limitations on indirect cost rates Indirect costs under training awards to organizations other than state, local or Indian tribal governments will be budgeted and reimbursed at 8 percent of modified total direct costs rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost amounts for equipment, tuition and fees, and subawards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include the following:

Health professions schools, academic health centers, state or local governments, Indian tribes and tribal organizations, or other appropriate public or private nonprofit entities (or consortia of such entities, including entities promoting multidisciplinary approaches).

Individuals are not eligible to apply under this NOFO.

In addition to the 50 states, eligible entities may be located in the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Accreditation/Approval Documentation Health professions schools and academic health center applicants must be accredited by a nationally recognized accrediting agency, and provide a copy of their active accreditation or active approval from state government as Attachment 6, as specified by the U.S. Department of Education, or must be approved by the state government.

HRSA may consider any application that fails to attach a copy of the required accreditation or related documentation as Attachment 6 to be non-responsive and may not consider it for funding under this notice. Applicants are required to maintain their accreditation or state approval status throughout the period of performance and notify HRSA of any change in status.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of up to $1,079,333 in year 1, $709,000 in year 2, and $492,333 in year 3 for the three-year period of performance non-responsive and will not consider it for funding under this notice.

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Page Limit HRSA will consider any application that exceeds the page limit referenced in Section_IV non-responsive and will not consider it for funding under this notice.

Deadline HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

Multiple Applications Multiple applications from an organization are not allowable.

An organization is an entity with its own unique DUNS number or Unique Entity Identifier (UEI).

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive.

Beneficiary Eligibility Health care students, residents, professionals, paraprofessionals, trainees, public safety officers, and employers of such individuals receiving support from grant funds must be citizens of the United States or a foreign national having in his/her possession a visa permitting permanent residence in the United States, or a non-citizen national.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 Research and Related (R&R) workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for each NOFO you are reviewing or preparing in the workspace application package in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this NOFO.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

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2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the SF-424 R&R Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files included in the page limit shall not exceed the equivalent of 70 pages when printed by HRSA. The page limit includes the project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO. Please note: Effective April 22, 2021, the abstract is no longer an attachment that counts in the page limit. The abstract is the standard form "Project Abstract Summary.” Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Biographical sketches do count in the page limitation. Note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-22-109, it may count against the page limit.

Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 70 pages will not be read, evaluated, or considered for funding.

Applications must be complete, within the maximum specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3321).

3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachment 9: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 R&R Application Guide for additional information on all certifications.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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Temporary Reassignment of State and Local Personnel during a Public Health Emergency

Section 319(e) of the Public Health Service (PHS) Act provides the Secretary of the Department of Health and Human Services (HHS) with discretion upon request by a state or tribal organization to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with § 319(e). Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness (ASPR) website via http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx.

Program-Specific Instructions

Program Requirements

1) Use grant funds to pay for short-term training (i.e. training lasting from a few weeks to a few months) to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency among health care students, residents, professional and paraprofessional trainees, public safety officers, and employers of such individuals;

2) Create a program that focuses on targeted population by both 1) demographic (i.e. minority, tribal, rural) and 2) role (i.e. doctor, nurse, public safety, etc.) in order to promote equity and effectiveness of delivery.

3) Provide in-service credit or Continuing Education Units (CEUs) to staff participating in the provider resiliency trainings;

4) Identify and implement Resiliency Train-the-Trainer models for health care students, residents, professionals, paraprofessionals, trainees, and public safety officers, and employers of such individuals to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency;

5) Develop and enhance: a) training interventions to health care students, residents, professionals, paraprofessionals, trainees, public safety officers, and employers of such individuals to increase well-being and satisfaction in key domains such as workload, control/flexibility, social supports, work-life balance, workflow and administration; b) efficiencies in organizational culture, which may include self-care interventions such as mindfulness, stress management, communication skills, and interprofessional collaborations.

6) Create and advance protocols and system-wide approaches to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency;

http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx

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7) Create and develop innovative sustainability practices/models i.e., curriculum development, to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency;

8) Collaborate with the HRSA’s Health and Public Safety Workforce Resiliency Technical Assistance Center (HRSA-22-111) to share resources, best practices, models, methods, and/or protocols related to health workforce burnout and resiliency in health care students, residents, professionals, paraprofessionals, trainees, public safety officers, and employers of such individuals.

In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Application Guide (including the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

i. Project Abstract Use the Standard OMB-approved Project Abstract Summary Form 2.0 that is included in the workspace application package. Do not upload the abstract as an attachment. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

The Abstract must include:

1. A brief overview of the project as a whole

2. Specific, measurable objectives that the project will accomplish

3. Which of the clinical priorities will be addressed by the project, if applicable;

and

4. How the proposed project for which funding is requested will be accomplished, i.e., the "who, what, when, where, why and how" of a project.

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and well-organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

PURPOSE AND NEED -- Corresponds to Section V’s Review Criterion #1

Briefly describe the purpose of the proposed project and outline the needs of the entity for which funding is being requested. Discuss the target population(s) receiving the resiliency training and the impact resiliency training will have on their ability to provide direct care services.

Discuss the impact burnout has had on the target population, as well as the current rates of burnout, suicide, mental health conditions and substance use disorders among healthcare students, residents, professional and

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paraprofessional trainees, public safety officers, and employers of such individuals, including but not limited to social determinants of health and health equity. Use and cite demographic data or survey results, whenever possible to support the information provided. This section will help reviewers understand the organization that would receive funding for training, as well as the needs of the communities that they would ultimately serve.

You must describe:

1. The current workforce burnout and resiliency treatment and prevention landscape, including best practices and culturally-competent approaches that are most effective in addressing burnout, suicide, mental health conditions and substance use disorders and promote resiliency;

2. The unmet need of provider resiliency trainings in rural and medically underserved communities and how your proposed activities will help improve access to provider resiliency activities to promote better health outcomes.

3. Your institution’s and/or organization’s current operations, including current services and gaps, technical assistance, and evaluation activities currently in place across the “Health Workforce” on effective workforce resiliency strategies for the target populations.

RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections

— (a) Work Plan; (b) Methodology/Approach; and (c) Resolution of Challenges—all of which correspond to Section V’s Review Criteria #2 (a), (b), and (c).

(a) WORK PLAN -- Corresponds to Section V’s Review Criterion #2 (a).

In this section, you must provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope; it must include concrete steps on how you plan to implement the proposed project in order to achieve the goals of the NOFO and successfully implement the proposed activities identified in the Methodology/Approach section. The work plan must drive and align with the methodology and include the following:

1. Description of the objectives of the proposed project, key partners, responsible staff, and timeframes during the three (3) year period of performance. Goals and objectives must be specific, measurable, achievable, realistic, and time framed (SMART) https://www.cdc.gov/phcommunities/resourcekit/evaluate/smart_objectives .html;

2. Explanation of how the work plan is appropriate for the program design and how the targets for key activities fit into the overall cooperative agreement implementation timeline;

3. Identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including development of the application and, further, the extent to which these contributors reflect the populations and communities served; and https://www.cdc.gov/phcommunities/resourcekit/evaluate/smart_objectives.html https://www.cdc.gov/phcommunities/resourcekit/evaluate/smart_objectives.html

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4. If funds will be sub-awarded or expended on contracts, provide a description of how your organization will ensure the funds are properly documented.

A sample work plan can be found here:

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.

(b) METHODOLOGY/APPROACH -- Corresponds to Section V’s Review Criterion #2

(b)

In this section, you must describe your objectives, proposed activities and strategies to institute a training program that focuses on promoting workforce resiliency, provide evidence for how they link to the project purpose, the stated needs, and meet each of the program requirements in this NOFO.

You must include the methodologies, strategies and approaches for the following:

1. Creating and delivering culturally-competent resiliency training in rural and medically underserved communities to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency among health care professionals;

2. Describing the mechanisms to be used and the types of trainings to be implemented to encourage provider and health workforce well-being and improve/develop resiliency to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency among health care professionals;

3. Measuring rates of burnout, etc. among target communities at the beginning and end of the program that is done in an aggregated format and is in a confidential manner;

4. Transforming the workforce environment to ensure health care students, residents, professionals, paraprofessionals, trainees, public safety officers, and employers of such individuals are well prepared to address burnout, suicide, mental health conditions and substance use disorders and promote resiliency;

5. Providing a work plan as Attachment 1 that drives and aligns with the methodology and incorporates the activities and strategies to institute a provider resiliency training program to reduce and address burnout, suicide, mental health conditions and substance use disorders and promote resiliency among health care professionals; and,

6. Providing a Logic Model for designing and managing the project as Attachment 7. You can find additional information on developing logic models at the following website:

https://www.cdc.gov/eval/tools/logic_models/index.html.

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx https://www.cdc.gov/eval/tools/logic_models/index.html

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Logic Model

Submit a logic model as Attachment 7 for designing and managing the project. A logic model is a one-page diagram that presents the conceptual framework for a proposed project and explains the links among program elements to achieve the relevant outcomes. While there are many versions of logic models, for the purposes of this notice the logic model should summarize the connections between the:

• Goals of the project (e.g., reasons for proposing the intervention, if applicable);

• Assumptions (e.g., beliefs about how the program will work and support resources. Base assumptions on research, best practices, and experience);

• Inputs (e.g., organizational profile, collaborative partners, key personnel, budget, other resources);

• Target population (e.g., the individuals to be served);

• Activities (e.g., approach, listing key intervention, if applicable);

• Outputs (i.e., the direct products or deliverables of program activities); and

• Outcomes (i.e., the results of a program, typically describing a change in people or systems).

Although there are similarities, a logic model is not a work plan. A work plan is an “action” guide with a time line used during program implementation; the work plan provides the “how to” steps. A logic model is a visual diagram that demonstrates an overview of the relationships between the 1) resources and inputs, 2) implementation strategies and activities, and 3) desired outputs and outcomes in a project. You can find additional information on developing logic models at the following website:

https://www.cdc.gov/eval/logicmodels/index.htm.

(c) RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion #2 (c)

In this section, you must discuss challenges that you anticipate you are likely to encounter based on prior provider resiliency program experience in designing and implementing the activities described in the work plan, and approaches to resolve such challenges. Provide a description of how the identified challenges will be resolved. This section must include:

1. Challenges related to program requirements, work plan, project implementation, and achievement of the proposed goals and objectives (e.g., performance measurement requirements).

2. Challenges and resolutions related to encouraging participation in the institutions’ programs of individuals and groups;

3. Obstacles and approaches to ensure trainings offer integrated, culturally-competent interprofessional behavioral health/provider resiliency services and trauma informed care;

https://www.cdc.gov/eval/logicmodels/index.htm

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4. Challenges and resolutions related to recruiting, supporting, and training supervisors in rural and medically underserved communities to ensure health care students, residents, professionals, paraprofessionals, trainees, public safety officers, and employers of such individuals receive adequate guidance.

IMPACT -- This section includes two sub-sections— (a) Evaluation and Technical

Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b). Corresponds to Section V’s Review Criterion #3

(a)EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criterion #3 (a)

1. Describe the plan for program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation must monitor ongoing processes and progress toward meeting goals and objectives of the project. Include descriptions of the inputs (e.g., key evaluation personnel and organizational support, collaborative partners, budget, and other resources);

key processes; variables to be measured; expected outcomes of the funded activities; and a description of how all key evaluative measures will be reported.

2. Describe the systems and processes that will support your organization's collection of HRSA’s performance measurement requirements for this program.

At the following link, you will find the required data forms for this program:

http://bhw.hrsa.gov/grants/reporting/index.html.

3. Describe the data collection strategy to accurately collect, manage, analyze, store, and track/report data (e.g., assigned skilled staff, data management software) to measure process and impact/outcomes, and explain how the data will be used to inform program development and service delivery in a way that allows for accurate and timely reporting of performance outcomes.

4. Describe current experience, skills, and knowledge, including individuals on staff, materials published, and previous work of a similar nature.

5. Describe any potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles. The evaluation and reporting plan also should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

6. Include a plan for Rapid Cycle Quality Improvement (RCQI) for the continuous monitoring of ongoing project processes, outcomes of implemented activities, and progress toward meeting grant goals and objectives and the implementation of necessary adjustment to planned activities to effect course corrections.

Additional information on RCQI is available at the following website:

https://www.healthworkforceta.org/rapid-cycle-quality-improvement-resources/.

http://bhw.hrsa.gov/grants/reporting/index.html

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(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion

#3 (b)

1. Provide a clear plan for project sustainability after the period of federal funding ends, including a description of specific actions you will take to (a) highlight key elements of your grant projects, e.g., training methods or strategies, which have been effective in improving practices; (b) obtain future sources of potential funding; as well as (c) provide a timetable for becoming self-sufficient.

Recipients are expected to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population.

2. Discuss challenges that are likely to be encountered in sustaining the program and approaches that will be used to resolve such challenges.

ORGANIZATIONAL INFORMATION, RESOURCES, AND CAPABILITIES --

Corresponds to Section V’s Review Criterion #4

Succinctly describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project. Provide information on your organization’s current mission and structure, including an organizational chart, relevant experience, and scope of current activities, and describe how these elements all contribute to the organization’s ability to implement the program requirements and meet program expectations. (A project organizational chart is requested in Section IV.2.v., Attachment 4.) Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs so as to avoid audit findings. Describe how the unique needs of target populations of the communities served are routinely assessed and improved.

The staffing plan and job descriptions for key faculty/staff must be included in Attachment 2 (Staffing Plan and Job Descriptions for Key Personnel). However, the biographical sketches must be uploaded in the SF-424 RESEARCH & RELATED Senior/Key Person Profile (Expanded) form that can be accessed in the Application Package under “Mandatory.” Include biographical sketches for persons occupying the key positions, not to exceed TWO pages in length each. In the event that a biographical sketch is included for an identified individual who is not yet hired, please include a letter of commitment from that person with the biographical sketch. When applicable, biographical sketches should include training, language fluency, and experience working with diverse populations that are served by their programs.

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Biographical sketches, not exceeding two pages per person, should include the following information:

• Senior/key personnel name

• Position Title

• Education/Training - beginning with baccalaureate or other initial professional education, such as nursing, including postdoctoral training and residency training if applicable:

o Institution and location o Degree (if applicable) o Date of degree (MM/YY) o Field of study

• Section A (required) Personal Statement. Briefly describe why the individual’s experience and qualifications make him/her particularly well-suited for his/her role (e.g., PD/PI) in the project that is the subject of the award.

• Section B (required) Positions and Honors. List in chronological order previous positions, concluding with the present position. List any honors. Include present membership on any Federal Government public advisory committee.

• Section C (optional) Peer-reviewed publications or manuscripts in press (in chronological order). You are encouraged to limit the list of selected peer-reviewed publications or manuscripts in press to no more than 15.