MCHB HRSA-23-085 (UK3) MMHSUD_Final.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

Maternal and Child Health Bureau

Division of Healthy Start and Perinatal Services

Screening and Treatment for Maternal Mental Health and Substance Use Disorders

Funding Opportunity Number: HRSA-23-085 Funding Opportunity Type(s): New

Assistance Listings Number: 93.110

Application Due Date: June 2, 2023 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: April 3, 2023

M. Sonsy Fermin, MSW, LICSW Senior Public Health Analyst Division of Healthy Start and Perinatal Services Phone: (301) 443-1504 Email: wellwomancare@hrsa.gov See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 247b-13a (Title III, § 317L-1 of the Public Health Service Act) mailto:wellwomancare@hrsa.gov https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fuscode.house.gov%2Fview.xhtml%3Freq%3D(title%3A42%2520section%3A247b-13a%2520edition%3Aprelim)%2520OR%2520(granuleid%3AUSC-prelim-title42-section247b-13a)%26f%3Dtreesort%26edition%3Dprelim%26num%3D0%26jumpTo%3Dtrue&data=05%7C01%7CMBelizaire%40hrsa.gov%7Ce06e19337d434122a3e808da9101b7e9%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C637981733803433796%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=5z4U3LvMMiD22lOe5oL8z7rMu8QClAU%2F0eOjss7xmsQ%3D&reserved=0

HRSA-23-085 MMHSUD i

508 COMPLIANCE DISCLAIMER

Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, 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) 2023 Screening and Treatment for Maternal Mental Health and Substance Use Disorders (MMHSUD) program. The purpose of this program is to expand health care providers’ capacity to screen, assess, treat, and refer pregnant and postpartum people for maternal mental health and substance use disorders.

Funding Opportunity Title: Screening and Treatment for Maternal Mental Health and Substance Use Disorders

Funding Opportunity Number: HRSA-23-085

Due Date for Applications: June 2, 2023

Anticipated FY 2023 Total Available Funding:

$8,750,000

Estimated Number and Type of Award(s): Up to 14 cooperative agreement(s)

Estimated Annual Award Amount:

Up to $750,000 per award (see the Summary of Funding)

Cost Sharing/Match Required: Yes; not less than 10% in non-federal matching funds in each year from Year 1 to Year 5

Period of Performance: September 30, 2023 through September 29, 2028 (5 years)

Eligible Applicants: Eligible applicants include States, Indian Tribes and Tribal organizations. See Section III.1 of this notice of funding http://www.hrsa.gov/

HRSA-23-085 MMHSUD ii opportunity (NOFO) for complete eligibility information.

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA’s SF-424 Application Guide. Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

HRSA has scheduled the following webinar:

Tuesday, April 18, 2023 2 – 4 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1604267347?pwd=RTNTdURRT1JBNGtoRmFzL3hDOG9Zdz09

Attendees without computer access or computer audio can use the dial-in information below.

Call-In Number: 1-833-568-8864 Meeting ID: 160 426 7347 Passcode: 99834191

MCHB will provide an overview of the NOFO and an opportunity to ask questions.

HRSA will record the webinar and make it available at:

https://mchb.hrsa.gov/fundingopportunities/default.aspx.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/j/1604267347?pwd=RTNTdURRT1JBNGtoRmFzL3hDOG9Zdz09 https://hrsa-gov.zoomgov.com/j/1604267347?pwd=RTNTdURRT1JBNGtoRmFzL3hDOG9Zdz09 https://mchb.hrsa.gov/fundingopportunities/default.aspx

HRSA-23-085 MMHSUD iii

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. Attachments

3. 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

APPENDIX A: PAGE LIMIT WORKSHEET

APPENDIX B: ADDITIONAL RESOURCES FOR APPLICANTS

HRSA-23-085 MMHSUD 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the FY 2023 Screening and Treatment for Maternal Mental Health and Substance Use Disorders (MMHSUD) program. The purpose of this program is to expand health care providers’ capacity to screen, assess, treat, and refer pregnant and postpartum people for maternal mental health and substance use disorders. This will be accomplished by establishing, improving, and/or maintaining statewide or regional1 networks that provide real-time psychiatric consultation, care coordination support services, and culturally and linguistically appropriate training to maternity care providers and clinical practices. This program is also intended to help reduce maternal health inequities. For more details, see Program Requirements and Expectations.

The program’s long-term goals are to:

• Increase routine behavioral health screening for pregnant and postpartum persons;

• Increase routine detection, assessment, brief intervention, treatment, and referral of maternal mental health conditions through the use of evidence-based practices; and,

• Increase access to treatment and recovery support services for pregnant and postpartum persons that are culturally and linguistically appropriate (e.g., translation of materials), community-based, that may be provided in-person or via telehealth.

The program objectives to be accomplished during the period of performance to support program goals, are included below. Recipients will collect and report baseline data by the end of Year 1, and subsequently achieve by the conclusion of the performance period in 2028, the following objectives:

• Increase the number of providers using the program for real-time psychiatric consultations and/or care coordination support services (including referrals).

• Increase the number of providers trained on maternal mental health and substance use disorders, including screening, assessment, treatment, and follow-up recovery support services.

• Increase the number of provider trainings that incorporate equity and respectful, culturally responsive, and congruent care.

• Increase the number of community-based mental health, substance use disorder treatment, and recovery support service providers in the project’s referral database.

1 Regional MMHSUD teams are defined as MMHSUD care teams within regions of a state, jurisdiction, or Tribal area.

HRSA-23-085 MMHSUD 2

For additional details on the program requirements and expectations to support and monitor the program goals and objectives, see Program Requirements and Expectations. Additional information about program measures and data can be found in the Reporting section.

2. Background

Authority

The Screening and Treatment for Maternal Mental Health and Substance Use Disorders Program is authorized by 42 U.S.C. § 247b-13a; (Title III, § 317L-1 of the Public Health Service Act).

Maternal Mental Health and Well-Being The U.S. suffers from one of the highest maternal death rates in the developed world, especially when compared to other developed countries.2 The leading underlying cause of pregnancy-related deaths from 2017 to 2019 was mental health conditions according to data from Maternal Mortality Review Committees (MMRCs) in 36 states. These included deaths due to suicide and overdose/poisoning related to substance use disorder.3 Additionally, depression during pregnancy and up to 12 months after delivery is one of the most common medical complications of pregnancy and childbirth.

Approximately one in eight pregnant individuals experience symptoms of depression after pregnancy,4 but maternal mental health conditions, like anxiety, depression, or substance use, can occur during or after pregnancy. Some studies have reported higher rates of postpartum depression in Black and Hispanic women compared to White women.5 An analysis conducted by the Centers for Disease Control and Prevention indicated that American Indian/Alaska Native women report the highest rates of depressive symptoms during the postpartum period.6 Stressors of the COVID–19 pandemic have exacerbated symptoms of depression, anxiety, post-traumatic stress, and loneliness reported among pregnant and postpartum women.7,8 Undetected and

2 The Commonwealth Fund. Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countries.

3 Trost SL, Beauregard J, Njie F, et al. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022.

4 Bauman BL, Ko JY, Cox S, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018. MMWR Morb Mortal Wkly Rep 2020; 69:575–581.

DOI: http://dx.doi.org/10.15585/mmwr.mm6919a2 5 Cannon C, Nasrallah HA: A focus on postpartum depression among African American women: A literature review. Ann Clin Psychiatry. 2019;31:138-143.

6 Bauman BL, Ko JY, Cox S, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018. MMWR Morb Mortal Wkly Rep 2020;69:575–581. DOI: http://dx.doi.org/10.15585/mmwr.mm6919a2. Retrieved 10/2020.

7 Liu, CH et al. “Risk Factors for Depression, Anxiety, and PTSD Symptoms in Perinatal Women during the COVID-19 Pandemic” Psychiatry Review DOI: 10.1016/j.psychres.2020.113552 8 Basu A, Kim HH, Basaldua R, Choi KW, Charron L, Kelsall N, et al. (2021) A cross-national study of factors associated with women’s perinatal mental health and wellbeing during the COVID-19 pandemic.

PLoS ONE 16(4): e0249780. https://doi.org/10.1371/journal.pone.0249780 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fuscode.house.gov%2Fview.xhtml%3Freq%3D(title%3A42%2520section%3A247b-13a%2520edition%3Aprelim)%2520OR%2520(granuleid%3AUSC-prelim-title42-section247b-13a)%26f%3Dtreesort%26edition%3Dprelim%26num%3D0%26jumpTo%3Dtrue&data=05%7C01%7CMBelizaire%40hrsa.gov%7Ce06e19337d434122a3e808da9101b7e9%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C637981733803433796%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=5z4U3LvMMiD22lOe5oL8z7rMu8QClAU%2F0eOjss7xmsQ%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.govinfo.gov%2Fcontent%2Fpkg%2FCOMPS-8773%2Fpdf%2FCOMPS-8773.pdf%23page%3D61&data=05%7C01%7CMBelizaire%40hrsa.gov%7Ce06e19337d434122a3e808da9101b7e9%7C14b77578977342d58507251ca2dc2b06%7C0%7C0%7C637981733803433796%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=4QXVmdA1%2F9eU%2FEk31%2BhBZP39q4OKHNBrQNXyGgjn5u4%3D&reserved=0 https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries http://dx.doi.org/10.15585/mmwr.mm6919a2 https://pubmed.ncbi.nlm.nih.gov/31046035/ https://pubmed.ncbi.nlm.nih.gov/31046035/ https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6919a2-H.pdf https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6919a2-H.pdf http://dx.doi.org/10.15585/mmwr.mm6919a2 https://www.sciencedirect.com/science/article/abs/pii/S0165178120332133 https://doi.org/10.1371/journal.pone.0249780

HRSA-23-085 MMHSUD 3

untreated, these conditions can increase the risk of poor outcomes for mothers and their children.

A nationwide shortage of psychiatrists compounds these issues.9 Women in rural and medically underserved areas are especially vulnerable to these shortages.10 The U.S.

Preventive Services Task Force and the American College of Obstetricians and Gynecologists recommend screening pregnant and postpartum women for mental and substance use disorders with a brief intervention where possible and referral when appropriate,11,12,13,14,15 but this has not yet been consistently achieved in practice. By training front-line clinical providers16 to identify and treat behavioral health conditions as part of their routine care,17 pregnant and postpartum people can receive screening, assessment, treatment, and referrals from providers with whom they may already have established relationships.

About MCHB and Strategic Plan The HRSA Maternal and Child Health Bureau (MCHB) administers programs with focus areas in maternal and women’s health, adolescent and young adult health, perinatal and infant health, child health, and children with special health care needs. To achieve its mission of improving the health and well-being of America’s mothers, children, and families, MCHB is implementing a strategic plan that includes the following four goals:

Goal 1: Assure access to high quality and equitable health services to optimize health and well-being for all maternal and child health (MCH) populations Goal 2: Achieve health equity for MCH populations Goal 3: Strengthen public health capacity and workforce for MCH Goal 4: Maximize impact through leadership, partnership, and stewardship

9 Weiner, S. (2018, February 12). Addressing the escalating psychiatrist shortage. AAMC. Retrieved December 20, 2021.

10 The American College of Obstetricians and Gynecologists. Committee Opinion No. 586: Health Disparities in Rural Women. February 2014, reaffirmed 2021. Retrieved 8/2021.

11 The U.S. Preventive Services Task Force, Final Recommendation Statement: Screening for Depression in Adults. January 26, 2016. Retrieved November 8, 2022.

12 The U.S. Preventive Services Task Force, Final Recommendation Statement: Unhealthy Drug Use:

Screening. June 09, 2020. Retrieved November 8, 2022.

13 The U.S. Preventive Services Task Force, Final Recommendation Statement: Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions. November 13, 2018.

Retrieved November 8, 2022.

14 The American College of Obstetricians and Gynecologists. Committee Opinion No.757: Screening for Perinatal Depression. November 2018. Retrieved November 2022.

15 The American College of Obstetricians and Gynecologists. Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy. August 2017. Retrieved November 2022.

16 Front-line clinical providers may include, but are not limited to, any health care providers (including nurse practitioners, nurse midwives, obstetrician-gynecologists, pediatricians, psychiatrists, mental health care providers, and adult primary care clinicians) that provide or receive real-time psychiatric consultation (in-person or remotely) to aid in the treatment of pregnant and postpartum people.

17 The American College of Obstetricians and Gynecologists. Screening for perinatal depression. ACOG Committee Opinion No. 757. Obstet Gynecol 2018;132:e208–12 https://www.aamc.org/news-insights/addressing-escalating-psychiatrist-shortage https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/02/health-disparities-in-rural-women https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/02/health-disparities-in-rural-women https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/depression-in-adults-screening#fullrecommendationstart https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/depression-in-adults-screening#fullrecommendationstart https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-interventions https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-interventions https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy

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This program addresses all of MCHB’s goals. Award recipients will address these goals by establishing new or enhancing existing statewide, tribal, or regional networks that expand health care provider capacity to assess, treat, and refer pregnant and postpartum people with behavioral health concerns, especially in rural and medically underserved areas. MCHB is committed to promoting equity in health programs for mothers, children, and families.

To learn more about MCHB and the bureau’s strategic plan, visit Mission, Vision, and Work | MCHB.

II. Award Information

1. Type of Application and Award

Type(s) 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 (TA) provided directly to award recipients, HRSA program involvement will include:

• Providing oversight and subject matter expertise in the planning and development of all phases of this cooperative agreement.

• Participating in appropriate meetings, committees, conference calls, and working groups related to the cooperative agreement and its projects.

• Reviewing the establishment and implementation of activities, procedures, measures, and tools for accomplishing the goals of the cooperative agreement on an ongoing basis.

• Assisting in the establishment and facilitation of effective collaborative relationships with federal and state contacts, HRSA-funded recipients, and other entities that may be relevant for the successful completion of tasks and activities identified in the approved scope of work.

• Participating with the award recipient in the dissemination of project findings, best practices, and lessons learned from the project.

In addition to adhering to all applicable federal regulations and public policy requirements, the cooperative agreement recipient’s responsibilities will include:

• Completing activities proposed in response to this NOFO.

• Meeting with the federal project officer to review the current strategies and to ensure the project and goals align with HRSA priorities for this activity.

https://mchb.hrsa.gov/about-us/mission-vision-work%22%EF%B7%9FHYPERLINK%20%22https:/mchb.hrsa.gov/about-us/mission-vision-work https://mchb.hrsa.gov/about-us/mission-vision-work%22%EF%B7%9FHYPERLINK%20%22https:/mchb.hrsa.gov/about-us/mission-vision-work

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• Providing ongoing, timely communication and collaboration with the federal project officer, including holding regular check-ins.

• Collaborating with HRSA on ongoing review of activities; procedures and budget items; information/publications prior to dissemination; contracts; and interagency agreements.

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

• Assuring that all recipient administrative data and performance measure reports, as designated by HRSA, will be completed, and submitted on time.

• Participating in HRSA’s TA activities for the MMHSUD program; to include data monitoring, evaluation, and capacity building assistance.

• Willingness to adapt as necessary to meet the required goals and objectives of the program.

2. Summary of Funding

HRSA estimates approximately $8,750,000 to be available annually to fund up to 14 recipients. You may apply for a ceiling amount of up to $750,000, annually (reflecting direct and indirect costs) per year.

Total Number of Women of Reproductive Age Within the

State or Tribal Area(s) 18

Annual Funding Amount

<200,000 Up to $500,000

>200,000 Up to $750,000

The period of performance is September 30, 2023 through September 29, 2028 (5 years). Funding beyond the first year is subject to the availability of appropriated funds for the MMHSUD Program in subsequent fiscal years, satisfactory 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.

18 Women of reproductive age is defined as women 15-44 years of age. 2020 population estimates from the US Census Bureau for women 15-44 years of age by state (and some counties) are available from CDC WONDER (CDC WONDER) or March of Dimes Peristats (https://www.marchofdimes.org/peristats/).

Population estimates for women 15-44 years of age for tribal areas can be calculated from US Census Bureau My Tribal Area (https://www.census.gov/tribal/).

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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III. Eligibility Information

1. Eligible Applicants

Eligible applicants are States, Indian Tribes, and Tribal organizations (as such terms are defined in section 4 of the Indian Self-Determination and Education Assistance Act) (25 U.S.C. § 5304)).

2. Cost Sharing/Matching

Cost sharing/matching is required for this program.

Under this NOFO, applicants need to show how they will provide matching funds that are no less than 10%. For example, the match could be $75,000 for an annual award in the amount of $750,000.

Possible sources to meet the 10% non-federal cost sharing/matching requirement may include, but are not limited to:

• Sponsoring organization (State, clinic, hospital, university, etc.) supports the project financially

• Local or national foundation

• Local business/corporate funding

• Community fundraising

• In-kind funds (i.e., space, rent, equipment, staff time, health provider time, volunteer time, etc.)

• For-profit ventures

• Program income

• Private insurance payments

Programs cannot use other federal funds, including Medicaid and CHIP payments, as matching funds. The match requirement allows recipients to leverage federal funds as they develop programs, deliver services, and conduct evaluations to test program success. These non-federal resources are important because they increase the capacity of projects during the period of performance.

3. Other

HRSA may not consider an application for funding if it contains any of the non-responsive criteria below:

• Exceeds the funding ceiling amount

• Fails to satisfy the deadline requirements referenced in Section IV.4

Multiple Applications

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Multiple applications from an organization are not allowed. HRSA will only accept and review your last validated electronic submission before the Grants.gov application due date.

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 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at Grants.gov: HOW TO APPLY FOR GRANTS. If you use an alternative electronic submission, see Grants.gov:

APPLICANT SYSTEM-TO-SYSTEM.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-23-085 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.

2. Content and Form of Application Submission

Application Format Requirements Section 4 of HRSA’s SF-424 Application Guide provides general instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, and certifications. You must submit the information outlined in HRSA SF-424 Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in this NOFO and HRSA’s SF-424 Application Guide. You must submit the application in the English language and budget figures expressed in U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the HRSA SF-424 Application Guide for the Application Completeness Checklist to assist you in completing your application.

Application Page Limit The total number of pages that count toward the page limit shall be no more than 60 pages when we print them. HRSA will not review any pages that exceed the page limit.

Using the pages within the page limit, HRSA will determine eligibility using Section III.

Eligibility Information of the NOFO.

These items don’t count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package

• Abstract (standard form (SF) "Project_Abstract Summary”) https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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• Indirect Cost Rate Agreement

• Proof of non-profit status (if it applies)

If there are other items that don’t count toward the page limit, we’ll make this clear in Section IV.2.v Attachments.

If you use an OMB-approved form that isn’t in the HRSA-23-085 workspace application package, it may count toward the page limit. We recommend you only use Grants.gov workspace forms related with this NOFO to avoid going over the page limit.

Applications must be complete and validated by Grants.gov under HRSA-23-085 before 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. § 3354).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachment 10: Other Relevant Documents.

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

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), which sunsets / terminates on September 30, 2023. Please reference detailed information available on the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) website.

Program Requirements and Expectations Successful MMHSUD award recipients will be expected to:

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx

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1) Provide training, education, and information to front-line health care providers on maternal mental health and substance use disorders. This includes evidence-based, trauma-informed, and culturally and linguistically appropriate screening; brief intervention; treatment (as applicable for healthcare providers); referrals for treatment; follow-up support services; and linkages to community-based resources.

Trainings should:

a. Be conducted in-person and/or via webinar (to support distance learning);

b. Incorporate evidence-based, trauma-informed, and culturally and linguistically appropriate protocols, guidelines, services, and treatment algorithms that include respectful care; and,

c. Educate health care providers and their staff on how to use these behavioral screening tools and protocols in clinical practice.

2) Attract participants and promote the benefits of trainings to clinical providers, by conducting vigorous and personal outreach; using a variety of marketing approaches; and providing incentives (e.g., continuing medical education credits).

3) Provide real-time psychiatric consultation, either in person or via telehealth, and care coordination support to front-line maternal health care providers to aid in the screening, assessment, and treatment of pregnant and postpartum people.

4) Develop and implement a mechanism(s) that addresses the following program components:

a. Establish and maintain quality psychiatric consultation services (in-person or via telehealth);

b. Collect and report on data and evaluation activities; and,

c. Utilize innovative approaches, such as telehealth and teleconsultation services, to address the needs of rural and medically underserved areas.

5) Collaborate with other federally funded programs that support mental and behavioral health, including, but not limited to, the National Maternal Mental Health Hotline, Community Mental Health Centers Grant Program, Veterans Affairs mental health services, Family Violence Prevention and Services Program, and the Pediatric Mental Health Care Access (PMHCA) program.

6) Develop and/or enhance partnerships to expand treatment and recovery support service options and coordinate services and activities and achieve program goals.

This program activity will be completed by:

a. Developing partnerships across the state, tribe and/or region and then connecting these partners to a broad range of community-based mental health and substance use treatment and recovery support service providers.

Partnerships should increase access to such services for pregnant and https://mchb.hrsa.gov/national-maternal-mental-health-hotline/materials https://www.mentalhealth.va.gov/index.asp?utm_source=google&utm_medium=cpc&utm_campaign=search-va&utm_content=mental-health&utm_term=va%20mental%20health%20services&gclid=Cj0KCQjwhsmaBhCvARIsAIbEbH7dJBDA_j4nd1MXMsRHGkxIOlldMmRBdRQtMJrojcTRvoA8lwoLC3EaAnAIEALw_wcB https://mchb.hrsa.gov/programs-impact/programs/pediatric-mental-health-care-access https://mchb.hrsa.gov/programs-impact/programs/pediatric-mental-health-care-access

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postpartum people and their families. Service providers may also include any organization that reduces barriers to housing, food insecurity/nutrition, employment, education, transportation, childcare, etc. for patients in the target population. Partnerships should be established, at a minimum, with entities that receive funding for other HRSA programs to facilitate referrals for comprehensive services for pregnant and postpartum people. These HRSA programs may include Title V Maternal and Child Health (MCH) Block Grant agencies, Community Health Centers, Healthy Start, and the Maternal, Infant and Early Childhood Home Visiting (MIECHV). Other partners may include:

i. Health care organizations;

ii. Health insurance providers (e.g., Medicaid, TRICARE, commercial);

iii. People/families with lived experience with a mental illness and/or substance use disorder (i.e., someone with their own personal experience with a mental illness and/or substance use disorder), particularly persons who are medically underserved;

iv. Patient support and advocacy organizations, including doula, perinatal bereavement, and community health worker organizations;

v. Tribes and tribal organizations, including Urban Indian Organizations;

vi. Primary health care providers; and

vii. State chapters of medical and professional associations.

b. Establishing linkages with and among community-based resources, including mental health resources, primary care resources, and patient support groups.

7) Participate in HRSA’s technical assistance (TA) activities to support the MMHSUD program. Participation may include joining an MMHSUD Community of Practice and other program-wide learning communities and presenting to MMHSUD colleagues on programmatic successes, challenges, and program outcomes. TA may be a one-time encounter or on-going activity depending on the needs of the recipient organization. TA may target the needs of several states, tribes, or a HRSA region.

8) Collect MMHSUD performance measure data.

9) Participate in HRSA’s MMHSUD program evaluation activities. Participation may include responding to surveys, participating in interviews, and providing other reports on evaluation activities.

10) Track, report, and share the MMHSUD program performance and outcomes with HRSA, HRSA’s program evaluator, other award recipients, and state/regional partners.

https://mchb.hrsa.gov/programs-impact/programs/title-v-maternal-child-health-mch-block-grant https://bphc.hrsa.gov/ https://mchb.hrsa.gov/programs-impact/programs/healthy-start https://mchb.hrsa.gov/programs-impact/programs/home-visiting https://mchb.hrsa.gov/programs-impact/programs/home-visiting

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

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

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, the table below provides a crosswalk between the narrative language and where each section falls within the review criteria. Any forms or attachments referenced in a narrative section may be considered during the objective review.

Narrative Section Review Criteria

Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response

Work Plan (2) Response and (4) Impact

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures and

(5) Resources/Capabilities

Organizational Information (5) Resources/Capabilities

Budget Narrative (6) Support Requested

ii. Project Narrative This section provides a comprehensive description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and organized in alignment with the sections and format below so that reviewers can understand the proposed project.

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

INTRODUCTION -- Corresponds to Section V’s Review Criterion #1 Need

1. Briefly describe the purpose of the proposed project that is consistent with

Section I: Purpose.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1 Need

1. Describe the need for you to establish, improve, or maintain a program that expands health care providers’ capacity to screen, assess, treat, and refer pregnant and postpartum people for maternal mental health and substance use disorders, ensuring accessibility to community-based resources that include services in person or via telehealth.

2. Describe and document, using demographic and geographic data and trends over time whenever possible (e.g., official federal, local, or state surveys; Title V MCH Block Grant or other program needs assessments and reports; Maternal Mortality Review Committee (MMRC) or severe maternal morbidity reports; issue papers; study reports; annual reports from trade/professional organizations; etc.):

a. The geographic areas to be served (i.e., statewide, tribe or regional), the behavioral health care services available, in those areas, any unmet health needs, including in rural areas and medically underserved areas or populations;

b. The need of the target population(s) to be served, including which types of health care providers you will target for program outreach and engagement (e.g., nurse practitioners, nurse midwives, obstetricians/gynecologists, nurse midwives, pediatricians, psychiatrists and psychiatric providers, mental and other behavioral health care providers, adult primary care clinicians, etc.); and

3. Include social determinants of health and health disparities that impact the population(s) or communities to be served.

4. Identify and discuss relevant barriers that the project hopes to overcome in the service area and possible solutions.

a. Describe the challenges that affect behavioral health care in the service area (e.g., poverty, uninsured or underinsured, social determinants of health). Please describe how the proposed program will address the challenges and impact the geographic areas you plan to serve.

METHODOLOGY -- Corresponds to Section V’s Review Criterion #2 Response

1. Propose clear and feasible methods that you will use to address the stated needs and ensure the activities described in the Program Requirements and Expectations section are integrated into the proposal to include:

a. Establishment and maintenance of quality consultative services through psychiatric consultation to be provided via telehealth or in-person.

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b. Provision of outreach services to rural and medically underserved areas and populations.

c. Participation in HRSA’s MMHSUD TA activities.

2. Approaches should encompass all 5 years of the project and identify the outcomes you expect to achieve by the end of the period of performance.

3. Provide Specific, Measurable, Achievable, Realistic, Time-bound, Inclusive, and Equitable (SMARTIE) objectives for each proposed project goal.

4. Include your methods for development of effective strategies for ongoing staff training, partner and provider outreach, partner collaborations, clear communication, information sharing, and involving patients with lived experience with mental illness and/or substance use disorder (i.e., individuals with their own personal experience with a mental illness and/or substance use disorder), families, and communities.

5. Describe which evidence-based or evidenced-informed screening tools and protocols you will use and why they are appropriate for the population(s) you are serving.

6. Describe a plan for disseminating reports, products, and/or project outputs so project information is provided to key target audiences.

7. Describe a plan for project sustainability after the period of federal funding ends.

WORK PLAN -- Corresponds to Section V’s Review Criteria #2 Response and #4 Impact

1. Provide a work plan and a timeline as Attachment 1 that describe the activities or steps, including cultural competency efforts, you will use to achieve each of the proposed objectives included in the Methodology section.

The work plan and the timeline should cover the entire 5year period of performance and identify responsible staff.

2. Describe an effective plan for managing the project, including its personnel, resources, and activities that will support the necessary infrastructure to operate consultative services and provider trainings. If you will make sub-awards or expend funds on contracts, describe how you will maintain communication among any subrecipients and how they will ensure consistent and timely, high-quality work. Describe how your organization will ensure proper documentation of funds for subrecipients.

3. Identify meaningful support and collaboration with key stakeholders, which may include engagement with state, (e.g., State Title V MCH Block Grant, etc.), tribes and tribal organizations, regional, and local systems in planning, designing, and implementing all activities, including developing the application.

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4. Submit a logic model as Attachment 2 that presents the conceptual framework for the project and explains the links between the goals, activities, and outcomes. Include descriptions of the inputs (e.g., organizational profile, collaborative partners, key personnel, budget, and other resources), key processes, and expected outcomes of the funded activities. You can find information on developing logic models at the following website: ACF HHS:

Logic Model Tip Sheet.

RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion #2 Response

1. Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan and approaches that you will use to resolve such challenges.

2. Discuss how you will address the lack of behavioral health and recovery support providers available to serve women in rural and medically underserved areas, if applicable. Describe your strategies, such as the use of direct patient telehealth services (e.g., direct patient tele-psychotherapy, direct patient tele-psychiatry, virtual support groups, etc.), and other strategies to overcome these barriers.

a. Address how you intend to resolve any challenges related to the level of readiness of your organization and of your expected partners’ organizations to work together to achieve project goals and expectations. Describe your organization’s leadership support of this program.

EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criteria #3 Evaluative Measures and #5 Resources/Capabilities

Provide a performance measurement and evaluation plan that demonstrates how you will fulfill the expectations and requirements for performance measurement and evaluation described in the Program Requirements and Expectations section.

This plan should include the following:

1. Monitoring: how you will track project-related processes, activities, and milestones, and use data to identify actual or potential challenges to implementation. Provide an initial list of measures (indicators, metrics) you will use to monitor progress.

2. Performance Measurement: your plan for measuring and tracking program performance on the objectives outlined in the Purpose Section. The plan should include required and/or proposed measures outlined in the Program Requirements and Expectations Section, and plans for the timely collection and reporting of all measures. Include plans for establishing baseline data by the end of Year 1.

https://www.acf.hhs.gov/sites/default/files/documents/prep-logic-model-ts_0.pdf https://www.acf.hhs.gov/sites/default/files/documents/prep-logic-model-ts_0.pdf

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3. Program Evaluation: your program evaluation plans and methods for completing the activities outlined in the Program Requirements and Expectations Section. Plans should include a description of data to be collected and how those data relate to program objectives and performance measurement, data management and data submission plans, and expected deliverables.

4. Continuous Quality Improvement: your plans for using and incorporating information from performance measurement and evaluation to inform and improve processes and outcomes.

5. Capacity: your capacity to collect and manage data in a way that allows for accurate and timely monitoring, good data quality, performance measurement, evaluation, and continuous quality improvement. Include a description of the available resources (e.g., organizational profile, collaborative partners, staff skills and expertise, budget), systems, and key processes you will use for monitoring, performance measurement, and evaluation (e.g., data sources, data collection methods, frequency of collection, data management software).

Describe any potential obstacles for implementing your performance measurement and evaluation plan and your plan to address those obstacles.

ORGANIZATIONAL INFORMATION -- Corresponds to Section V’s Review Criterion #5 Resources/Capabilities

1. Succinctly describe your organization’s current mission, structure, and scope of current activities and how these elements all contribute to the organization’s ability to implement the program requirements and meet program expectations.

2. Discuss expertise of staff that will be assigned to this project as it relates to the scope of this project. Specifically describe your organization’s and proposed staffs’ roles. Include an organizational chart as Attachment 6.

3. Provide information on your organization’s ability, capacity, and relevant experience developing, implementing, and managing a statewide, tribal or regional provider psychiatric consultation, care coordination, and/or provider training program, if applicable. Provide evidence of success in prior initiatives, if applicable, as well as any lessons learned.

4. Provide information on your organization’s efforts to deliver culturally and linguistically appropriate training for the population to be served.

5. Describe relationships with any agencies or organizations, including subrecipients, with which you intend to partner, collaborate, coordinate efforts, or receive consultation from while conducting project activities. Include letters of agreement and/or descriptions of proposed/existing contracts (project specific) in Attachment 5.

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6. Discuss how your 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.

iii. Budget The directions offered in the SF-424 Application Guide may differ from those offered by Grants.gov. Follow the instructions in Section 4.1.iv of HRSA’s SF-424 Application Guide and the additional budget instructions provided below. A budget that follows the Application Guide will ensure that, if HRSA selects your application for funding, you will have a well-organized plan and, by carefully following the approved plan, may avoid audit issues during the implementation phase.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) you incur to carry out a HRSA-supported project or activity.

Total project or program costs include costs charged to the award and costs borne by you to satisfy the less than 10 percent matching or cost-sharing requirement.

As required by the Consolidated Appropriations Act, 2023 (P.L. 117-328), Division H, § 202, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II…” Effective January 2023, the salary rate limitation is $212,100. Note that these or other salary rate limitations may apply in the following fiscal years, as required by law.

iv. Budget Narrative See Section 4.1.v. of HRSA’s SF-424 Application Guide.

In addition, the MMHSUD program requires that the budget narrative clearly describes each cost element, and explains how it relates to the project’s objectives.

The budget justification narrative should clearly describe how the not less than 10 percent cost sharing/matching requirement will be met in each year of the 5-year period of performance.

v. Attachments Provide the following items in the order specified below to complete the content of the application. Unless otherwise noted, attachments count toward the application page limit. Your indirect cost rate agreement and proof of non-profit status (if applicable) will not count toward the page limit. Clearly label each attachment. You must upload attachments into the application. HRSA and the objective review committee will not open/review any hyperlinked attachments.

Attachment 1: Work Plan and Timeline Attach the work plan and timeline for the project that includes all information detailed in Section IV.2.ii. Project Narrative. If you will make subawards or expend funds on contracts, describe how your organization will ensure proper documentation of funds.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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