MCHB HRSA-22-089_102 MIECHV Innovation Awards (UH4_U4G)_Final.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Maternal and Child Health Bureau Division of Home Visiting and Early Childhood Systems

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Innovation Award – General Data/Technology Innovations (Track One)

Funding Opportunity Number: HRSA-22-089 Funding Opportunity Type(s): New

ARP Act Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Innovation

Award – COVID-19 Related Data/Technology Innovations (Track Two) Funding Opportunity Number: HRSA-22-102

Funding Opportunity Type(s): New

Assistance Listings (CFDA) Number: 93.870

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2022

Application Due Date: November 26, 2021

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems, may take up to 1 month to complete.

Issuance Date: September 3, 2021

Rachel Herzfeldt-Kamprath, Policy Analyst Division of Home Visiting and Early Childhood Systems Maternal and Child Health Bureau Telephone: (301) 443-2534 Email: RHerzfeldt-Kamprath@hrsa.gov

Authority: 42 U.S.C. § 711(c) (Title V, § 511(c) of the Social Security Act) and 42 U.S.C.

711A(c) (Title V, § 511A(c) of the Social Security Act, as added by § 9101 of the American Rescue Plan Act of 2021 (P.L. 117-2))) mailto:RHerzfeldt-Kamprath@hrsa.gov

HRSA-22-089 and HRSA-22-102 i

508 COMPLIANCE DISCLAIMER

Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, please email or call one of the HRSA staff listed in Section VII.

Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 HRSA-22-089: MIECHV Innovation Awards - General Data/Technology Innovations (Track One) and HRSA-22-102: ARP Act MIECHV Innovation Awards - COVID-19 Related Data/Technology Innovations (Track Two). The purpose of these awards is to fund the development, implementation, and evaluation of innovations that leverage data- and technology-driven strategies to enhance home visiting service delivery through in-person and virtual home visits by state and territory Maternal, Infant, and Early Childhood Home Visiting (MIECHV) recipients. By improving service delivery, home visiting programs will promote safe, nurturing caregiver-child relationships and family well-being essential to the healthy development of young children. The MIECHV Program is administered by HRSA in partnership with the Administration for Children and Families (ACF).

These funding opportunities will support competitive awards to current MIECHV recipients to enhance service delivery through technology and data-driven innovations that improve home visits or virtual visits and to widely disseminate the results of these innovations.

This announcement includes instructions for two (2) separate funding opportunities:

HRSA-22-089: MIECHV Innovation Award - General Data/Technology Innovations (Track One), will fund the development, implementation, and evaluation of innovations that aim to leverage data- and technology-driven strategies to enhance home visiting service delivery. Innovations will target program priority areas described in Section 1.

HRSA-22-102: American Rescue Plan Act of 2021 (ARP), MIECHV Innovation Award - COVID-19-Related Data/Technology Innovations (Track Two), will fund the development, implementation, and evaluation of innovations that aim to leverage data and technology-driven strategies to enhance home visiting service delivery or virtual service delivery with specific reference to the impacts of the COVID-19 public health emergency. Innovations will target program priority areas described in Section 1 in alignment with the required uses of funds specified in the American Rescue Plan Act of

2021 (ARP).

HRSA-22-089 and HRSA-22-102 ii

Funding Opportunity Titles | Numbers: MIECHV Innovation Award – General Data/Technology Innovations (Track One)

| HRSA-22-089

ARP Act MIECHV Innovation Award – COVID-19-Related Data/Technology Innovations (Track Two) | HRSA-22-102

Due Date for Applications: November 26, 2021

Anticipated Total Available Funding: Track One | HRSA-22-089:Approximately $10,000,000 (subject to the availability of funds, additional funding may be awarded)

Track Two | HRSA-22-102: Approximately $12,000,000 (subject to the availability of funds, additional funding may be awarded)

Estimated Number and Type of Award(s): Track One | HRSA-22-089: Up to five (5) cooperative agreements for Track One (subject to the availability of funds, HRSA may release additional awards)

Track Two | HRSA-22-102: Up to six (6) cooperative agreements for Track Two (subject to the availability of funds, HRSA may release additional awards)

Estimated Award Amount: Track One | HRSA-22-089: Up to $2,000,000; or up to $4,000,000 if proposed as a collaboration—See Section III

Track Two | HRSA-22-102: Up to $2,000,000; or up to $4,000,000 if proposed as a collaboration—See Section III

Cost Sharing/Match Required: No

Period of Performance: March 1, 2022 through September 30, 2024

Eligible Applicants: Track One | HRSA-22-089: Eligible applicants include all states and six territories and jurisdictions serving the

HRSA-22-089 and HRSA-22-102 iii

District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, the Commonwealth of the Northern Mariana Islands, and American Samoa. Nonprofit organizations currently funded in FY 2021 under the MIECHV Program are also eligible to apply if the state for which they were funded to provide MIECHV services in FY 2021 does not apply.

Track Two | HRSA-22-102: As specified in the American Rescue Plan Act of 2021 (P.L. 117-2) (ARP), only current MIECHV recipients as of the time of ARP’s enactment (March 11, 2021) are eligible to receive funds for this award.

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 Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance

HRSA has scheduled the following technical assistance for anyone applying to MIECHV Innovation Award - General Data/Technology Innovations (Track One) | HRSA-22-089:

OR ARP Act MIECHV Innovation Award - COVID-19-Related Data/Technology Innovations (Track Two) | HRSA-22-102:

Webinar

Day and Date: Thursday, September 16, 2021 Time: 3 – 4:30 p.m. ET Call-in number and registration for this webinar will be available here:

https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting/program-implementation-and-fiscal-management-resources.

HRSA will record the webinar and archive the recording on the same webpage.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting/program-implementation-and-fiscal-management-resources https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting/program-implementation-and-fiscal-management-resources

HRSA-22-089 and HRSA-22-102 iv

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 Narrative

v. Program-Specific Forms

vi. Attachments

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

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

4. SUBMISSION DATES AND TIM ES

5. INTERGOV ERNM ENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSM ENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIV E AND NATIONAL POLICY REQUIREM ENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: PROGRAM EXPECTATIONS (SELECTED LIST APPLICABLE TO THIS

NOFO)

APPENDIX B: EXPECTATIONS FOR RESEARCH AND EVALUATION ACTIVITIES

APPENDIX C: GLOSSARY OF SELECTED TERMS

HRSA-22-089 and HRSA-22-102 1

I. Program Funding Opportunity Description

1. Purpose

This announcement solicits applications for two (2) separate funding opportunities, MIECHV Innovation Award – General Data/Technology Innovations (Track One) | HRSA-22-089 and ARP Act MIECHV Innovation Award – COVID-19-Related Data/Technology Innovations (Track Two) | HRSA-22-102. The purpose of these awards is to fund the development, implementation, and evaluation of innovations by MIECHV recipients that leverage new technology and/or data collection and sharing strategies to improve MIECHV service delivery, and extend the impact of MIECHV-funded voluntary early childhood home visiting services. Such innovations must be consistent with the service delivery model(s) being implemented by the awardee. The MIECHV Innovation Awards aim to address HRSA and HHS goals of achieving health equity and advancing population health. Innovations may also respond to the evolving and long-term impact of the COVID-19 public health emergency, or foster a workforce capable of addressing current and emerging needs of communities that historically face structural racisim and discrimination resulting in barriers to accessing resources they need to thrive.

Track One aims to leverage data- and technology-driven innovations in the key priority areas identified below to improve MIECHV service delivery consistent with the service delivery model(s) being implemented by the awardee.

Track Two aims to leverage data- and technology-driven innovations in the key priority areas identified below to improve MIECHV service delivery, including virtual service delivery, in order to address the impacts of the COVID-19 public health emergency, consistent with the service delivery model(s) being implemented by the awardee.

For the purpose of this NOFO, an innovation is defined as a process, product, strategy, or practice that improves (or is expected based on evidence of promise or strong theory1 to improve) upon the outcomes reached with current or status quo service delivery implementation and that can ultimately reach widespread effective usage. You are strongly encouraged to propose only one innovation, which may consist of multiple strategies and activities (see below for examples of potential innovations).

You may propose to improve, expand, or advance innovations that are currently being developed or implemented through MIECHV programs. MIECHV recipients are already considering how data and technology can advance their programs, and the COVID-19 public health emergency has required recipients to pivot quickly towards new modes of service delivery. These awards aim to build on these advances and innovative strategies.

1 See Appendix C for definitions of evidence of promise and strong theory.

HRSA-22-089 and HRSA-22-102 2

Program Objectives Innovations aim to build on a growing body of research and work to better understand how new technology2, measurement frameworks3,4, and data sharing strategies5,6 can improve and streamline home visiting service delivery, and better meet the emerging needs of families. The objectives of both awards are to:

1. Develop and implement innovations that introduce new or scale up technology and/or data sharing, data exchange, and interoperability strategies that are expected to improve the effectiveness of MIECHV-funded voluntary early childhood home visiting services.

2. Develop and implement innovations that are designed to address one or more of the following MIECHV home visiting program priority areas7:

Priority 1. Integrate administrative data measuring social and structural determinants of health (SSDOH) into home visiting data to better assess existing disparities and measure progress toward advancing health equity;

Priority 2. Create or enhance early childhood integrated data systems through data interoperability or other data sharing strategies;

Priority 3. Develop data- and technology-driven recruitment and retention strategies, such as centralized intake, to identify and reach families who are historically unserved by home visiting or who face disproportionate barriers to accessing or participating in services; and/or

Priority 4. Advance professional and workforce development by identifying, introducing, and evaluating the use of new technologies.

3. Contribute to advances in knowledge about innovations that improve and/or expand home visiting services through:

a. Evaluation (in coordination with other successful recipients with support of an innovation technical assistance (TA) center);

b. Identification of further research needs, and;

c. Dissemination of knowledge to all MIECHV award recipients to scale up successful efforts as appropriate.

2 National Home Visiting Resource Center. Technology in Home Visiting: Strengthening Service Delivery and Professional Development Using Virtual Tools. November 2017. Available at https://w ww.jbassoc.com/w p-content/uploads/2018/03/Technology-Home-Visit ing.pdf 3 Braveman P, Acker J, Arkin E, Bussel J, Wehr K, and Proctor D. Early Childhood Is Critical to Health Equity.

Princeton, NJ: Robert Wood Johnson Foundation, 2018. Available at https://w ww.childfirst.org/sites/default/f iles/RWJF%20Health%20Equity%20Report%20May%202018.pdf 4 Healthy People 2020. Social Determinants of Health. Available at https://w ww.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health 5 Epstein Richards, Dale, King, Carlise. Lessons from the Early Care and Education Field for Home Visiting Data Integration. December 2018. Available at https://w ww.childtrends.org/blog/shining-a-light-lessons-from-the-early-care-and-education-f ield-for-home-visiting-data-integration 6 Off ice of Planning Research and Evaluation and Maternal and Child Health Bureau. Developing Data Exchange Standards for MIECHV Home Visiting Programs: Conceptual Brief. May 2019. Available at https://mchb.hrsa.gov/sites/default/f iles/mchb/MaternalChildHealthInitiat ives/HomeVisiting/data-exchange-standards-miechv.pdf 7 Note: You must ensure that proposed innovations under HRSA-22-102: MIECHV Innovation Aw ard - COVID-19 Related Data/Technology Innovations (Track Tw o) align w ith the required uses of funds specif ied in ARP. For more details about the required uses of funds, please see the COVID-19 Resources and FAQs for Home Visiting w ebpage.

https://www.jbassoc.com/wp-content/uploads/2018/03/Technology-Home-Visiting.pdf https://www.jbassoc.com/wp-content/uploads/2018/03/Technology-Home-Visiting.pdf https://www.childfirst.org/sites/default/files/RWJF%20Health%20Equity%20Report%20May%202018.pdf https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health https://www.childtrends.org/blog/shining-a-light-lessons-from-the-early-care-and-education-field-for-home-visiting-data-integration https://www.childtrends.org/blog/shining-a-light-lessons-from-the-early-care-and-education-field-for-home-visiting-data-integration https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/data-exchange-standards-miechv.pdf https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/data-exchange-standards-miechv.pdf https://mchb.hrsa.gov/Home-Visiting-Information-During-COVID-19

HRSA-22-089 and HRSA-22-102 3

MIECHV INNOVATION AWARD (TRACK ONE) | HRSA-22-089

Track One innovations must aim to achieve the objectives described above. Examples of innovations include (but are not limited to):

• Leveraging existing administrative data to measure and assess social and structural determinants of health contributing to disparities in access and/or outcomes for families enrolled in home visiting services (priority area 1);

• Integrating data or making data interoperable to better assess SSDOH in the context of home visiting programs (priority areas 1 and 2);

• Establishing early childhood data exchange, interoperability, and sharing strategies (priority area 2);

• Establishing or enhancing centralized or coordinated intake systems that share data to better identify and reach at-risk families historically unserved or facing greater challenges when accessing home visiting programs (priority areas 2 and 3);

• Integrating use of technology for conducting and evaluating high-quality supervision (priority area 4), and;

• Using technology or data-sharing strategies to assess the professional development needs of the home visiting workforce and/or offer professional development opportunities (priority area 4).

ARP ACT MIECHV INNOVATION AWARD (TRACK TWO) | HRSA-22-102

If you are applying for Track Two, you must propose a project that aims to achieve the objectives described above while specifically addressing how the use of technology and data strategies can support service delivery during or in response to the COVID-19 public health emergency. The purpose of section 9101 of the American Rescue Plan Act8 (ARP) is to provide MIECHV recipients with additional funds to provide home visiting services and engage in other activies to address the needs of expectant parents and families with young children during and in response to the COVID-19 public health emergency (see Section IV.6 for more information on ARP requirements).

ARP identifies seven categories of required uses of funding, including service delivery through home visits or virtual visits (“virtual home visiting”) that may be conducted by the use of electronic information and telecommunications technologies, in a service delivery model described in section 511(d)(3)(A) (i.e., through an evidence-based service delivery model or promising approach). Track Two innovations should leverage ARP funds to advance MIECHV service delivery, whether conducted in-person or virtually, through the use of new technology and data strategies.

Examples of Track Two innovations that leverage data and technology to address the impact of the COVID-19 public health emergency could include (but are not limited to):

• Making administrative data interoperable to strengthen understanding of the health equity implications of COVID-19 for families enrolled in home visiting services (priority areas 1 and 2; aligned with ARP funding categories service delivery and/or staff costs);

• Using technology or data-sharing strategies to improve the recruitment and retention of families who have been adversely and disproportionally impacted by

8American Rescue Plan Act of 2021 (P.L. 117-2) (ARP) ), section 9101

HRSA-22-089 and HRSA-22-102 4 the COVID-19 public health emergency (priority areas 1 and 3; aligned with ARP funding categories service delivery and/or staff costs);

• Evaluating the use of technology to provide virtual home visiting services during the COVID-19 public health emergency (priority area 3; aligned with ARP funding category – service delivery and/or technology), and;

• Evaluating virtual strategies to implement and support high-quality supervision and professional development during the COVID-19 public health emergency (priority area 4; aligned with ARP funding categories – service delivery, technology, and/or staff costs).

2. Background

Statutory Authority The MIECHV Program is authorized by 42 U.S.C. § 711(c) (Title V, § 511(c) of the Social Security Act) to make grants to enable the provision of home visiting services to eligible families by states, nonprofit organizations serving states, and U.S. territories and jurisdictions. The Bipartisan Budget Act of 2018 (Pub. L. 115-123) (BBA),9 among other actions, extended appropriated funding for the MIECHV Program through FY 2022. The Consolidated Appropriations Act, 2021 (P.L. 116-260) (CAA),10 includes new authorities related to use of MIECHV grant funds during the declared COVID-19 public health emergency period. Additionally, the American Rescue Plan (ARP)11 Act appropriated $150 million in funding for the MIECHV Program and added new statutory authority under 511A of the Social Security Act to support continued response to the COVID-19 public health emergency. ARP specifies that only current MIECHV recipients, as of the time of enactment, are eligible to receive ARP funds, in addition to other eligibility requirements specified in the statute. ARP provides authority for MIECHV recipients to use funding to provide home visiting and virtual services and for other specified allowable activities, which are detailed in Section IV.6.

The MIECHV Program supports voluntary, evidence-based home visiting services for pregnant women and parents with young children up to kindergarten entry. The goals12 of the MIECHV Program are to: (1) strengthen and improve the programs and activities carried out under Title V of the Social Security Act; (2) improve coordination of services within at-risk communities; and (3) identify and provide comprehensive services to improve outcomes for eligible families13 living in at-risk communities. MIECHV statute also requires that programs demonstrate improvements for participating eligible families in each of the following benchmark areas: improved maternal and child health;

prevention of child injuries, child abuse, or maltreatment, and reduction of emergency department visits; improvement in school readiness and achievement; reduction in crime or domestic violence; improvements in family economic self-sufficiency; and

9 Bipartisan Budget Act of 2018 (P.L. 115-123) (BBA), sections 50601-50607.

10 Consolidated Appropriations Act, 2021 (P.L. 116-260) (CAA), Division X, section 10.

11 American Rescue Plan Act of 2021 (P.L. 117-2) (ARP), section 9101.

12 Social Security Act, Title V, § 511(a).

13 Under Social Security Act, Title V, § 511(k)(2), “[t] he term “eligible family” means— (A) a w oman w ho is pregnant, and the father of the child if the father is available; or (B) a parent or primary caregiver of a child, including grandparents or other relatives of the child, and foster parents, w ho are serving as the child’s primary caregiver from birth to kindergarten entry, and including a noncustodial parent w ho has an ongoing relationship w ith, and at times provides physical care for, the child.”

https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview

HRSA-22-089 and HRSA-22-102 5 improvements in the coordination and referrals for other community resources and supports.14

Need for Innovation Awards

In 2017 (through HRSA-16-025), HRSA funded 19 MIECHV state and territory recipients to establish and evaluate new home visiting program, practice, and system innovations to benefit families served by the MIECHV Program.15 Topics addressed included: family engagement, workforce development, service coordination, and continuous quality improvement. Evaluations of the funded innovations identified positive outcomes in increased home visitor skills, knowledge and abilities; increased referrals to other community services; and increased family retention in home visiting services.

To address needs in the home visiting field, this second cohort of innovation awards will introduce new technology and/or data-sharing, data exchange, and interoperability strategies that are expected to improve the effectiveness of MIECHV-funded voluntary early childhood home visiting services.

Data and technology serve a critical role in advancing and evaluating the impact of home visiting service delivery. Integrating new data and technology into home visiting systems also provides new tools to better assess how best to address historic and emerging challenges facing the populations served by MIECHV. Challenges such as siloed data systems and imprecise metrics often impede programs from answering critical questions and targeting services to families. These challenges can also increase data collection burden on families and home visitors. Additionally, the COVID-19 public health emergency has required MIECHV recipients to rethink how their programs use data and technology to continue to support families and assess the challenges facing communities. COVID-19 has also further exposed critical disparities and inequalities in access to services, population impacts, and health outcomes. Leveraging existing administrative data to measure and assess social and structural determinants of health contributing to disparities in access and outcomes for families enrolled in home visiting services will be critical in fully understanding how to address the health needs of those most affected.

As home visiting programs continue to evolve to meet the changing needs of families, new technology and data solutions can help streamline and improve coordination of services for families. By improving service delivery, home visiting programs will better promote safe, nurturing caregiver-child relationships and family well-being, which are essential to the healthy development of young children. HRSA intends for these innovations to collectively contribute to improved equity among home visiting participants, populations, and systems, and to move award recipients towards better improvements in MIECHV benchmark areas.

14 Social Security Act, Title V, Section 511(d)(1).

15 Health Resources and Services Administration. FY 2017 Home Visiting Innovation Aw ards. Available at https://mchb.hrsa.gov/home-visiting/innovationaw ards#:~:text=The%20MIECHV%20Innovation%20Aw ards%20w ere,MIECHV%2Dfunded%20ho me%20visiting%20services.

https://mchb.hrsa.gov/home-visiting/innovationawards#:%7E:text=The%20MIECHV%20Innovation%20Awards%20were,MIECHV%2Dfunded%20home%20visiting%20services https://mchb.hrsa.gov/home-visiting/innovationawards#:%7E:text=The%20MIECHV%20Innovation%20Awards%20were,MIECHV%2Dfunded%20home%20visiting%20services https://mchb.hrsa.gov/home-visiting/innovationawards#:%7E:text=The%20MIECHV%20Innovation%20Awards%20were,MIECHV%2Dfunded%20home%20visiting%20services

HRSA-22-089 and HRSA-22-102 6

MIECHV home visiting programs work to address new and emerging issues while continuing to address the enduring impacts of inequality on families served. Programs continue to support families that face poverty, family violence, poor family health outcomes, and inequitable access to resources. Now, home visiting programs seek to address the disparate impacts of the COVID-19 public health emergency that have further exacerbated poor and unequal family outcomes. Leveraging new and innovative technology and data strategies will allow programs to more accurately assess the disparate impacts these issues have on families, and identify new solutions to improve family outcomes, increase access to home visiting services, and facilitate engagement and retention. Thus, there is an additional need to develop and implement innovations to harness technology and data strategies within the context of evidence-based home visiting programs and generate and disseminate new knowledge and best practices in order to maximize the impact of MIECHV programs.

Program Priority Areas

HRSA has identified four program priority areas in which to implement technology and data-driven innovation and improvement. Innovations may also address additional priorities of the recipient that are not identified below as long as they also address at least one of the program priority areas and focus on leveraging new technology or data strategies. The four identified program priority areas include:

1. Integrate administrative data measuring social and structural determinants of health into home visiting data to better assess existing disparities and measure progress toward achieving health equity;

While ensuring a healthy start to life can establish a trajectory of lifelong well-being, not every family has equitable access to the resources they need to thrive. The root causes of inequity, including poverty, discrimination, and racism, facilitate conditions that lead to poor health outcomes by limiting access to housing, employment, economic security, and high-qualityeducation16. Additionally, the COVID-19 public health emergency has further exposed structural and systemic inequalities that harm racial and ethnic minority communities and low-income households. Addressing these social determinants is critical to achieving equity and population health. However, before these issues can be addressed, programs have to understand how they impact families, and approach implementation with a health equity lens. “A health equity lens directs attention to addressing the social determinants of health and the upstream causes of poor well-being and health, including stagnant economic mobility and increasing wealth inequality.”17 While home visiting is inherently an upstream approach to addressing SSDOH, implementation may benefit from integrating data that can recognize, measure, and evaluate peoples’ experiences with inequality and discrimination. By applying an equity lens, recipients may be able to produce findings that more accurately identify institutional and structural factors that perpetuate inequality, and provide decision

16 Woolf, S., Braveman, P. 2011. Where Health Disparities Begin: The Role of Social and Economic Determinants – And Why Current Policies May Make Matters Worse. Health Affairs 30(10). https://doi.org/10.1377/hlthaff.2011.0685 17 Zuckerman, D., V. Duncan, and K. Parker. 2016. Building a Culture of Health Equity at the Federal Level. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201603a.

https://doi.org/10.31478/201603a

HRSA-22-089 and HRSA-22-102 7 makers with information that can inform necessary change.18 Strategies that leverage administrative data to examine SSDOH help programs identify and more precisely address the true root causes, including structural racism and implicit bias, of health disparities. Examining home visiting performance and outcome data using health equity data frameworks or while integrating SSDOH data could allow programs to better evaluate the associations between health disparities and program outcomes, and identify leverage points for more effective home visiting interventions.19

2. Create or enhance early childhood integrated data systems through data interoperability, or other data sharing strategies;

The burden of data collection continues to emerge as a challenge facing the home visiting workforce and the families served. Recognizing that government agencies serve a common set of families and individuals, there are opportunities to improve agencies’ ability to share data across programs in order to improve service delivery and, ultimately, the outcomes for these families and individuals.20 Given the unique reporting needs of individual programs, privacy requirements, and data systems characteristics, sharing data across programs to support service delivery is not straightforward. Efforts to align and share data could reduce this burden and free up home visitor capacity to focus more on the immediate and long-term goals of the families they work with. Recent efforts across federal, state, and local governments have identified frameworks and strategies for ensuring data interoperability and exchange. One model is the National Information Exchange Model (NIEM). “The NIEM model defines agreed-upon terms, definitions, relationships, and formats—independent of how information is stored in individual systems—for data being exchanged.”21 Additionally, HRSA recently released a toolkit for MIECHV recipients - Developing Data Exchange Standards for MIECHV Home Visiting Programs - to bolster data exchange efforts and make data more interoperable. Leveraging these strategies to improve data sharing and interoperability has the potential to transform how home visiting programs understand their impact and answer critical policy questions. The health and economic impacts of the COVID-19 public health emergency have disproportionately affected minority and low-income families. Sharing data across providers to identify those most affected to target for home visiting services may be a critical first step in supporting families in recovering from this crisis. Enhanced data sharing strategies present an opportunity to improve services to children and families by providing more and better data to assess family outcomes, identify community and family needs, and connect families with the resources that will best serve them.

18 HRSA’s HV-ImpACT Webinar: Applying a Health Equity Lens to the MIECHV Needs Assessment Update (Transcript) June 2019. Available at https://mchb.hrsa.gov/sites/default/f iles/mchb/MaternalChildHealthInitiat ives/HomeVisiting/HV- ImpACT_Transcript_June2019.pdf 19 Karen A. Monsen, Joan K. Brandt, Bonnie L. Brueshoff, Chih-Lin Chi, Michelle A. Mathiason, Sadie M. Sw enson, Diane R. Thorson, Social Determinants and Health Disparities Associated With Outcomes of Women of Childbearing Age Who Receive Public Health Nurse Home Visiting Services, Journal of Obstetric, Gynecologic & Neonatal Nursing, Volume 46, Issue 2, 2017, Pages 292-303, ISSN 0884-2175, https://doi.org/10.1016/j.jogn.2016.10.004.

20 Off ice of Planning Research and Evaluation and Maternal and Child Health Bureau. Developing Data Exchange Standards for MIECHV Home Visiting Programs: Conceptual Brief. May 2019. Available at https://mchb.hrsa.gov/sites/default/f iles/mchb/MaternalChildHealthInitiat ives/HomeVisiting/data-exchange-standards-miechv.pdf 21 National Information Exchange Model. Available at https://w ww.niem.gov/about-niem/niem-model https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/data-exchange-standards-miechv.pdf https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/data-exchange-standards-miechv.pdf https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/HV-ImpACT_Transcript_June2019.pdf https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/HV-ImpACT_Transcript_June2019.pdf https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/data-exchange-standards-miechv.pdf https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/data-exchange-standards-miechv.pdf https://www.niem.gov/about-niem/niem-model

HRSA-22-089 and HRSA-22-102 8

3. Develop data- and technology-driven recruitment and retention strategies, such as centralized intake, to identify and reach families who are historically unserved by home visiting or who face disproptionate barriers to accessing or participating in services;

Recruitment, engagement, and retention of families is a major challenge home visiting programs face, as eligible families are often isolated and marginalized from services due to socio-environmental factors.22,23 While the families that participate in MIECHV-funded home visiting face many socioeconomic and health risk factors, engaging and retaining families who historically have not received services continues to be a challenge. The Mother and Infant Home Visiting Program Evaluation (MIHOPE) study found that, “families with relatively more challenges and barriers participated in home visiting programs for shorter periods compared with average families in the study.”24 Identifying and connecting these families with the resources they need to fully participate in and benefit from home visiting may support families to engage more fully.

Recruitment includes identification, outreach, and enrollment of eligible families for voluntary participation in home visiting services. Family engagement and retention include activities to meet targets for the frequency or number of home visits received, length of program enrollment, and the amount or type of services received relative to the intended amount of services prescribed by the home visiting model.25 Additionally, family engagement may also include a focus on engagement in the content of visit or increased engagement with the home visitor through activities such as family goal-setting, planning, and attainment as antecedents to family retention. Innovative strategies that aim to improve recruitment and retention through aligned data processes, such as coordinated intake and referral systems, have the potential to reduce duplication across social service programs, better identify appropriate services for families, and improve monitoring and measurement of family outcomes.26 Additionally, as households are identified for home visiting and other safety net services during the COVID-19 recovery, technology may help recipients to enroll participants in multiple safety net programs more efficiently. Moreover, these coordinated systems may reduce duplication and data collection burden across programs, better identify and refer eligible families, and improve monitoring and measurement of family outcomes.

4. Advance professional and workforce development by identifying, introducing, and evaluating the use of new technologies.

22 Anne Duggan, Ximena A. Portilla, Jill H. Filene, Sarah Shea Crow ne, Carolyn J. Hill, Helen Lee, and Virginia Knox.

(2018). Implementation of Evidence-Based Early Childhood Home Visiting: Results from the Mother and Infant Home Visiting Program Evaluation. OPRE Report 2018-76A. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Available at https://w ww.acf.hhs.gov/sites/default/f iles/documents/opre/mihope_implementation_report_2018_10_26_508b.pdf 23 Folger, A. T., Brentley, A. L., Goyal, N. K., Hall, E. S., Sa, T., Peugh, J. L., & Ammerman, R. T. (2015). Evaluation of a community-based approach to strengthen retention in early childhood home visiting. Prevention Science, 1-10.

24 Anne Duggan, Ximena A. Portilla, Jill H. Filene, Sarah Shea Crow ne, Carolyn J. Hill, Helen Lee, and Virginia Knox.

(2018). Implementation of Evidence-Based Early Childhood Home Visiting: Results from the Mother and Infant Home Visiting Program Evaluation. OPRE Report 2018-76A. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Available at https://w ww.acf.hhs.gov/sites/default/f iles/documents/opre/mihope_implementation_report_2018_10_26_508b.pdf 25 U.S. Department of Health and Human Services, Health Resources and Services Administration. (2015). MIECHV Issue Brief – Enrollment and Engagement.

26 New York City Department of Health and Mental Hygiene. Coordinated Intake and Referral for Home Visiting Services (Concept Paper). November 2019. Available at https://w ww1.nyc.gov/assets/doh/dow nloads/pdf/acco/2019/intake-referral-home-visiting-concept-paper.pdf https://www.acf.hhs.gov/sites/default/files/documents/opre/mihope_implementation_report_2018_10_26_508b.pdf https://www.acf.hhs.gov/sites/default/files/documents/opre/mihope_implementation_report_2018_10_26_508b.pdf https://www1.nyc.gov/assets/doh/downloads/pdf/acco/2019/intake-referral-home-visiting-concept-paper.pdf

HRSA-22-089 and HRSA-22-102 9

The benefits of home visiting are realized only if appropriate program staff are hired with required knowledge and skills and receive ongoing training and support.27 Unfortunately, frequent staff turnover occurs in many home visiting programs28, which can ultimately result in lower program quality and efficiency. As a result, many home visiting programs conduct activities to increase job satisfaction and retention of skilled home visitors.29 A recent study of the home visiting workforce found that while a range of training opportunities are available to home visitors, the costs and time associated with receiving training can be significant constraints.30 New technology-driven strategies have the potential to remove these barriers to effective workforce development. The COVID-19 emergency has also exposed the need to leverage technology to support staff supervision and training activities. Leveraging lessons learned from these efforts may increase the effectiveness and efficiency of workforce development activities in the future.

Program Outcomes

These awards aim to contribute to advances in knowledge about innovations that leverage new technology or data-sharing strategies that improve MIECHV early childhood home visiting services. To achieve this objective, recipients will evaluate their innovation projects, apply new knowledge gained through innovations to advance early childhood policy, and disseminate findings to other MIECHV recipients.

HRSA anticipates that innovations to introduce and integrate new technology and/or data sharing, data exchange, and interoperability strategies for the purposes of improving service delivery may result in changes to a number of metrics collected for MIECHV reporting (MIECHV metrics), including demographic measures or improvement in benchmark performance measures aligned with statutory benchmarks.31 For example, innovations that focus on data sharing and integration with other early childhood systems providers may improve coordination and referrals for other community resources and supports. Similarly, innovations aimed at recruitment and retention of families may result in changes in demographic program data collected from participants, or data reflecting program participation. Recipients may also see improved health outcome data given the focus on assessing and addressing SSDOH.

Given the breadth of possible innovations, your application has to identify at least two MIECHV metrics that your innovations are intended to improve. These metrics might include MIECHV performance indicators, systems outcome measures, participant demographics, service utilization, or clinical indicators. While you are expected to identify at least two MIECHV metrics in your application, HRSA acknowledges that

27 Wasik, B. H. (1993). Staff ing issues for home visiting programs. The Future of Children, 140-157.

28 Gill, S., Greenberg, M. T., Moon, C., & Margraf, P. (2007). Home visitor competence, burnout, support, and client engagement. Journal of Human Behavior in the Social Environment, 15(1), 23-44.

29 Peters, Rebecca, Sarah Benatar, and Heather Sandstrom. 2021. Professional Development Supports for Home Visitors and Supervisors: Strengthening the Home Visiting Workforce. OPRE Report #2021-01, Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S.

Department of Health and Human Services. Available at https://w ww.urban.org/sites/default/f iles/publication/103468/professional-development-supports-for-home-visitors-and-supervisors_0.pdf 30 Ibid.

31 Social Security Act, Title V, Section 511(d)(1) https://www.urban.org/sites/default/files/publication/103468/professional-development-supports-for-home-visitors-and-supervisors_0.pdf https://www.urban.org/sites/default/files/publication/103468/professional-development-supports-for-home-visitors-and-supervisors_0.pdf

HRSA-22-089 and HRSA-22-102 10 recipients will refine or expand on these metrics in their evaluation plans which will be further developed with support from an innovation TA center after award. Recipients will conduct rigorous evaluations of their innovations, which will be collaborative across recipient projects with the support of the innovation TA center, in order to maximize the comparability and applicability of evaluation results. Instructions on performance reporting and required evaluation is available in Appendix B. Recipients will also identify a dissemination strategy, with support from the innovation TA center, to ensure that knowledge gained from the innovation awards is shared broadly with other MIECHV recipients and stakeholders.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

FOR BOTH AWARDS:

HRSA will provide funding for Track One | HRSA-22-089 and Track Two | HRSA-22-102 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.

HRSA Program involvement will include:

• Making available the services of experienced MCHB personnel as requested by the recipient in all phases of the project.

• Participating in some aspects of the development, implementation, and evaluation of innovations, including but not limited to, planning for the project, reviewing activities for compliance with federal law and programmatic requirements as well as best practices, and coordinating technical assistance to support recipients.

• Reviewing activities, measures, and tools to be established and implemented to accomplish the goals of the project.

• Providing feedback on evaluation design and measurement strategies through collaboration with an innovation TA center and other recipients.

The cooperative agreement recipient’s responsibilities will include:

• As approved by HRSA, development, implementation, and evaluation of an innovation to strengthen and improve the delivery of coordinated and comprehensive high-quality voluntary early childhood home visiting services by leveraging new technology or data-sharing strategies, based on evidence of promise or strong theory, to demonstrate improvement in one or more of the program priority areas.

• Completion of activities proposed in response to application review criteria in compliance with all applicable federal law and programmatic requirements, including required status and performance reporting. (See Appendix A for Program Expectations, Section IV for funding restrictions, and Section VI for reporting requirements.)

HRSA-22-089 and HRSA-22-102 11

• Participation in meetings and conference calls with relevant HRSA representatives and HRSA-supported technical assistance providers conducted during the period of performance.

• Collaboration with relevant HRSA representatives and HRSA-supported technical assistance providers on ongoing review of activities, procedures and budget items, information/publication prior to dissemination, contracts and interagency agreements.

• Adherence to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds. See Acknowledgment of Federal Funding in Section 2.2 of HRSA’s SF-424 Application Guide.

2. Summary of Funding

For both Track One | HRSA-22-089 and Track Two | HRSA-22-102:

For Track One, HRSA estimates approximately $10,000,000 to be available annually to fund an estimated five (5) recipients. For Track Two, HRSA estimates approximately $12,000,000 to be available annually to fund up to six (6) recipients. Additional awards may be issued subject to availability of funds.

You may apply for a ceiling amount of up to $2,000,000 for total costs (includes both direct and indirect, and administrative costs) for a single eligible applicant to develop, implement, and evaluate innovation. However, if the proposal reflects a collaboration of two or more eligible entities (wherein one eligible entity, as the applicant, proposes to receive and expend grant funding for work performed, in whole or in part, through a subaward by contract with one or more other eligible entities to develop, implement, and evaluate an innovation applicable to all of the entities), you may apply for a ceiling amount of up to $4,000,000.

NOTE: For applicants proposing to collaborate, the entity authorizing the application is the lead entity responsible for the programmatic and fiscal oversight of the award. Additionally, applicants must ensure that the necessary relationships, legal agreements, and infrastructure are already in place across recipients to facilitate effective partnerships, if submitting a proposal reflecting a collaboration (see Attachment 7).

The period of performance for both Track One and Track Two is March 1, 2022 through September 30, 2024 (2 years and 7 months).

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

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

HRSA-22-089 and HRSA-22-102 12

III. Eligibility Information

1. Eligible Applicants

MIECHV Innovation Award (Track One) | HRSA-22-089 Eligible applicants include all states and six territories and jurisdictions serving the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, the Commonwealth of the Northern Mariana Islands, and American Samoa. Nonprofit organizations currently funded in FY 2021 under the MIECHV Program are also eligible to apply if the state for which they were funded to provide MIECHV services in FY 2020 does not apply.

Applicants must not submit an application with a budget request exceeding $2,000,000 for a single eligible applicant to develop, implement, and evaluate an innovation in accordance with the terms of this NOFO.

However, as noted above, if the proposal reflects a collaboration of two or more eligible entities (wherein one eligible entity, as the applicant and potential funding recipient, proposes to receive and expend grant funding for work performed, in whole or in part, through a subaward by contract with one or more other eligible entities to develop, implement, and evaluate innovation applicable to all of the entities, the applicant may submit an application with a budget request that does not exceed $4,000,000.

Applicants must ensure that the necessary relationships, legal agreements (including data rights), and infrastructure are already in place to facilitate…