MCHB HRSA-24-041 NCCT and 042 DPs_ MODIFIED 3.11.2023 (2).pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2024

Maternal and Child Health Bureau

Division of Services for Children with Special Health Needs

Transition for Youth with Autism and/or Epilepsy Demonstration Projects

Funding Opportunity Number: HRSA-24-042

Funding Opportunity Type(s): New

Assistance Listings Number: 93.110, 93.877

National Coordinating Center on Transition

Funding Opportunity Number: HRSA-24-041

Funding Opportunity Type(s): New

Assistance Listings Number: 93.110, 93.877

Application Due Date: March 13, 2024 Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

We will not approve deadline extensions for lack of registration.

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

Issuance Date: November 1, 2023

Modified on 3/11 – Deadline for HRSA-24-042 has been extended to 3/13

Modified on February 23, 2024, if you encounter a “Bad Request” or any other error while applying to one or more funding opportunities, please contact Grants.gov Applicant Support at 1-800-518-4726 or support@grants.gov.

Modified on November 8, 2023, to update the technical assistance webinar date on page iv and clarify eligible applicants on pages ii, 8, and 9.

Donna Johnson, MHS mailto:support@grants.gov?subject=GRANTS.GOV%20Support%20Center

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 2

Public Health Analyst, Division of Services for Children with Special Health Needs Phone: (240) 475-8092 Email: DJohnson@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act) and 42 U.S.C. 280i-1 (Public Health Service Act, § 399BB) mailto:DJohnson@hrsa.gov

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) i

508 COMPLIANCE DISCLAIMER

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.

SUMMARY

Funding Opportunity Title: Transition for Youth with Autism and/or Epilepsy Demonstration Projects

National Coordinating Center on Transition

Funding Opportunity Number: HRSA-24-042

HRSA-24-041

Assistance Listing Number: 93.110, 93.877

Due Date for Applications: March 11, 2024

Purpose: The purpose of this program is to advance national, state, and community-level frameworks that support successful transition from child to adult serving systems for youth with autism and/or epilepsy who have complex health and social needs and require a higher level of family support and coordination (YAES).1 This announcement includes instructions for two separate award competitions leading to two distinct sets of awards.

HRSA-24-042: Transition for Youth with Autism and/or Epilepsy Demonstration Projects (DPs) will implement and evaluate innovative, sustainable, and scalable strategies that support and improve outcomes for YAES and their families/caregivers transitioning from child to adult serving systems.

HRSA-24-041: National Coordinating Center on Transition (NCCT) will support HRSA-24-042 (DP) recipients in meeting their program objectives, and to provide national leadership to

1 The acronym “YAES” refers to youth with autism and/or epilepsy who require a higher level of support.

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) ii improve transition outcomes for YAES and their families/caregivers through training, technical assistance, evaluation, and the development and dissemination of resources to transition stakeholders.

Program Objective(s): HRSA-24-042 (DP) Objectives:

1) By August 2029, increase by 50% the percentage of YAES successfully transitioning to adult serving systems.

2) By August 2029, adopt a framework, for ongoing partnership, collaboration, and consultation between agencies to support the transition process.

3) By August 2029, increase by 75% the percentage of all families/caregivers reporting improved self-efficacy with the transition process.

HRSA-24-041 (NCCT) Objectives:

1) By August 2029, increase by 50% the percentage HRSA-24-042 recipient-identified YAES successfully transitioning to adult serving systems.

2) By August 2029, increase to 100% the HRSA-24-042 recipients' knowledge of sustainable and scalable transition strategies as a result of the technical assistance provided by the NCCT.

3) By August 2029, increase to 100% key stakeholders' knowledge of transition-related issues as a result of the technical assistance provided by the NCCT.

Eligible Applicants: You can apply if your organization is in the United States and is:

• Public or private

• Community-based Organizations

• Institutions of Higher Education

• Tribal (governments, organizations)2

2 For awards authorized by 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act), see also 42 CFR § 51a.3(a).

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) iii

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

Anticipated FY 2024 Total Available Funding:

HRSA-24-042 (DPs): $4,950,000

HRSA-24-041 (NCCT): $735,000

We’re issuing this notice to ensure that, should funds become available for this purpose, we can process applications and award funds appropriately. You should note that we may cancel this program notice before award if funds are not appropriated.

Estimated Number and Type of Award(s):

HRSA-24-042 (DP):

Up to four (4) new grants focused on autism Up to seven (7) new grants focused on epilepsy

HRSA-24-041(NCCT):

One (1) new cooperative agreement

Estimated Annual Award Amount:

HRSA-24-042 (DP): Up to $450,000 per award, subject to the availability of appropriated funds

HRSA-24-041 (NCCT): Up to $735,000, subject to the availability of appropriated funds

Cost Sharing or Matching Required:

No

Period of Performance: September 1,2024 through August 31, 2029 (5 years)

Agency Contacts: Business, administrative, or fiscal issues:

Denise Boyer Grants Management Specialist Division of Grants Management Operations, OFAM Email: dboyer@hrsa.gov

Program issues or technical assistance:

Donna Johnson, MHS Public Health Analyst, Division of Services for Children with Special Health Needs Phone: (240) 475-8092 Email: DJohnson@hrsa.gov mailto:dboyer@hrsa.gov mailto:DJohnson@hrsa.gov

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) iv

Application Guide

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

Technical Assistance

We have scheduled the following webinar:

Thursday, November 30, 2023

2:00 – 3:00 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1603360767?pwd=ODRxYWhhbC8raDIwaXhpaXh2Q0hyZz09

Attendees without computer access or computer audio can use the following dial-in information:

Call-In Number: 1-833-568-8864 Meeting ID: 160 336 0767

We will record the webinar.

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/1603360767?pwd=ODRxYWhhbC8raDIwaXhpaXh2Q0hyZz09 https://hrsa-gov.zoomgov.com/j/1603360767?pwd=ODRxYWhhbC8raDIwaXhpaXh2Q0hyZz09

HRSA-24-041(NCCT) and HRSA-24-042 (DPs) v

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 OR 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: GLOSSARY OF KEY TERMS AND PHRASES

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Transition3 for Youth with Autism and/or Epilepsy program, which includes the Transition for Youth with Autism and/or Epilepsy Demonstration Projects (DPs) (HRSA-24-042) and the National Coordinating Center on Transition (NCCT) (HRSA-24-041). The purpose of this program is to develop and advance national, state, and local/community-level frameworks that support successful transition from child to adult serving systems4 for youth with autism and/or epilepsy who have complex health and social needs and require a higher level of family support and coordination (YAES).5 This announcement includes instructions for applying to two separate awards. You may only apply for HRSA-24-042 (DPs) or HRSA-24-041 (NCCT), but not both projects. HRSA will not consider funding applicants who apply to more than one funding opportunity number or focus areas.

Program Goal

The goal of this program is to improve outcomes including quality of life and well-being for YAES and their families/caregivers transitioning from child to adult systems. These systems include but are not limited to post-secondary education, inclusive post-secondary education, employment, community, independent/daily living, and healthcare.6 The target population for this program is characterized as YAES between the ages of 13 and 26 who have co-occurring conditions, intellectual disabilities, experience challenges in social cognition, communication, interpersonal skills, and/or behaviors7 8 9 and require a higher level of family support and coordination.

HRSA-24-042 (DPs): Will be funded to implement and evaluate innovative, sustainable, and scalable strategies that support YAES and their families/caregivers in successfully transitioning from child to adult serving systems. There will be up to four (4) autism and seven (7) epilepsy grants.10 Applicants for HRSA-24-042 (DPs) shall propose a catchment area as well as the methodology and data source for identifying the target population of YAES. For the purpose of this program, catchment areas include but are not limited to school districts, states, local health districts, counties, regional health

3 See Appendix B for description of transition.

4 See Appendix B for additional details and examples of child and adult serving systems.

5 The acronym “YAES” refers to youth with autism and/or epilepsy who require a higher level of support.

6 See Appendix B for additional details for listed terms.

7 Maenner MJ, Shaw KA, Bakian AV, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Surveill Summ 2021;70(No. SS-11):1–16. DOI: http://dx.doi.org/10.15585/mmwr.ss7011a1 .

8 Steiger, B. K., & Jokeit, H. (2017). Why epilepsy challenges social life. Seizure, 44, 194-198.

9 Beghi, E. (2019). Social functions and socioeconomic vulnerability in epilepsy. Epilepsy & Behavior, 100, 106363.

10 HRSA acknowledges the co-occurrence of autism in epilepsy in children and youth. A project focused on autism can include youth with autism who have a co-occuring epilepsy diagnosis as part of their target population. A project focused on epilepsy can include youth with epilepsy who have a co-occuring autism diagnosis as part of their target population.

http://dx.doi.org/10.15585/mmwr.ss7011a1

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 2 districts, etc. Catchment areas proposed by organizations such as health care systems and family-based organizations cannot be limited to the youth served exclusively by the applicant organization.

HRSA-24-041 (NCCT): One NCCT will be funded to support the HRSA-24-042 (DP) recipients in meeting their program objectives, and to provide national leadership to improve transition outcomes for YAES and their families/caregivers through training, technical assistance, evaluation, and the development and dissemination of resources to transition stakeholders,11 including Title V programs.

Program Objectives

Both HRSA-24-042 (DPs) and HRSA-24-041 (NCCT) will be responsible for collecting data and reporting annually on the following objectives for the purposes of monitoring and evaluating the overall effectiveness of the program. Baseline data will be collected and reported by each recipient by August 31, 2025.

HRSA-24-042 – DPs

1) By August 2029, increase by 50% from baseline the percentage of all YAES in the catchment area that successfully transition to adult serving systems.

2) By August 2029, adopt a framework for ongoing partnership, collaboration,12 and consultation between agencies13 to support YAES and their families/caregivers in successfully transitioning from child to adult serving systems.

3) By August 2029, increase by 75% from baseline the percentage of all families/caregivers of YAES in the catchment area that report improved self-efficacy14 with the transition process.

HRSA-24-041 – NCCT

1) By August 2029, increase by 50% from baseline the percentage of all YAES within the catchment areas of the HRSA-24-042 (DP) recipients that successfully transition to adult serving systems.

2) By August 2029, increase to 100% from baseline the awareness/knowledge of HRSA-24-042 (DP) recipients in developing, implementing, and evaluating sustainable and scalable transition strategies as a result of the technical assistance, training, education, peer-to-peer learning, and resources provided by the NCCT.

11 See Appendix B for examples of stakeholders.

12 See Appendix B for definition of partnership and collaboration.

13 See Appendix B for examples of relevant agencies.

14 For the purposes of this funding opportunity, self-efficacy refers to an individual's belief in his or her capacity to execute behaviors necessary to produce specific performance attainments (Bandura, 1977, 1986, 1997). Self-efficacy reflects confidence in the ability to exert control over one's own motivation, behavior, and social environment. https://www.apa.org/pi/aids/resources/education/self-efficacy#:~:text=Self%2Defficacy%20refers%20to%20an,%2C%20behavior%2C%20and%20social%20environment.

https://www.apa.org/pi/aids/resources/education/self-efficacy#:%7E:text=Self%2Defficacy%20refers%20to%20an,%2C%20behavior%2C%20and%20social%20environment https://www.apa.org/pi/aids/resources/education/self-efficacy#:%7E:text=Self%2Defficacy%20refers%20to%20an,%2C%20behavior%2C%20and%20social%20environment

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 3

3) By August 2029, increase to 100% from baseline the awareness/knowledge of key stakeholders of transition issues related to the target population as a result of the technical assistance, training, education, and resources provided by the

NCCT.

For more details, see Program Requirements and Expectations.

2. Background

Authority

The Transition for Youth with Autism and/or Epilepsy program is authorized by 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act), which authorize Special Projects of Regional and National Significance (SPRANS), and 42 U.S.C. 280i- 1 (Public Health Service Act, § 399BB), as amended by the Autism Collaboration, Accountability, Research, Education, and Support (CARES) Act of 2019 (Pub. L. 116- 60).

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 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

To learn more about MCHB and the bureau’s strategic plan, visit Mission, Vision, and Work | MCHBhttps://mchb.hrsa.gov/about-us/mission-vision-work.

Equity

Equity is “the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons;

persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.”15

15 Executive Order 13985 on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, 86 FR 7009, at § 2(a) (Jan. 20, 2021), https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01753.pdf.

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 https://mchb.hrsa.gov/about-us/mission-vision-work https://www.govinfo.gov/content/pkg/FR-2021-01-25/pdf/2021-01753.pdf

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 4

Children and Youth with Special Health Care Needs Blueprint for Change

The Blueprint for Change: A National Framework for a System of Services for Children and Youth with Special Health Care Needs establishes a national agenda to ensure that every child gets the services he/she needs to play, go to school, and grow up to become a healthy adult. The Blueprint for Change outlines strategies in four critical areas that will strengthen the systems serving children and youth with special health care needs (CYSHCN): health equity; quality of life and well-being for CYSHCN and their families; access to services; and financing of services. All objectives and program requirements described in this NOFO align with principles and strategies presented in the Blueprint for Change. Learn more by reading the Blueprint for Change Pediatric Supplement.

Program Background

According to the 2020-2021 National Survey of Children’s Health, more than 14 million US children, or approximately 1 in 5, have a special health care need.16 Eighty-six percent of CYSHCN17 do not receive services in a well-functioning system of services.18 This program focuses on youth with autism and/or epilepsy who are a sub-population of CYSHCN. Autism is a developmental disability that may impact a person’s social, communication skills, and behaviors.19 The Centers for Disease Control and Prevention (CDC) indicates that 1 in 36 children aged 8 are diagnosed with autism.20 Epilepsy is a disorder of the brain that results in a person experiencing repeated unprovoked seizures;21 it is the most common childhood brain disorder in the United States.

Approximately 470,000 children and youth aged 0 to 17 years are diagnosed with active epilepsy.22

It is estimated that between 2011 and 2017, 4.5 million youth with special health care needs (YSHCN) ages 12–18 transitioned from child to adult serving systems.23 The

16 Child and Adolescent Health Measurement Initiative. 2020-2021 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved 05/22/23 from https://www.childhealthdata.org/browse/survey/results?q=9314&r=1.

17 See Appendix B for definition of children and youth with special health needs (CYSHCN).

18 Sarah E. McLellan, Marie Y. Mann, Joan A. Scott, Treeby W. Brown; A Blueprint for Change: Guiding Principles for a System of Services for Children and Youth With Special Health Care Needs and Their Families. Pediatrics June 2022; 149 (Supplement 7):

e2021056150C. 10.1542/peds.2021-056150C.

19 Maenner MJ, Warren Z, Williams AR, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ 2023;72(No. SS-2):1–14. DOI: http://dx.doi.org/10.15585/mmwr.ss7202a1.

20 Maenner MJ, Warren Z, Williams AR, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ 2023;72(No. SS-2):1–14. DOI: http://dx.doi.org/10.15585/mmwr.ss7202a1.

21 AAP National Coordinating Center for Epilepsy, Understanding Pediatric Epilepsy.

22 Centers for Disease Control and Prevention, 2020.

23 Research Protocol: Transitions of Care From Pediatric to Adult Services for Children With Special Healthcare Needs. Content last reviewed February 2022. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.

https://effectivehealthcare.ahrq.gov/products/transitions-care-pediatric-adult/protocol.

https://mchb.hrsa.gov/programs-impact/focus-areas/children-youth-special-health-care-needs-cyshcn/blueprint-change https://publications.aap.org/pediatrics/issue/149/Supplement%207?autologincheck=redirected https://publications.aap.org/pediatrics/issue/149/Supplement%207?autologincheck=redirected https://www.childhealthdata.org/browse/survey/results?q=9314&r=1 http://dx.doi.org/10.15585/mmwr.ss7202a1 http://dx.doi.org/10.15585/mmwr.ss7202a1 https://www.aap.org/en/patient-care/epilepsy/understanding-pediatric-epilepsy/ https://www.cdc.gov/epilepsy/about/fast-facts.htm#:%7E:text=According%20to%20the%20latest%20estimates,17%20years%20have%20active%20epilepsy.&text=Think%20of%20a%20school%20with,our%20Data%20and%20Statistics%20page.

https://effectivehealthcare.ahrq.gov/products/transitions-care-pediatric-adult/protocol

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 5 transition process for YAES is more complex and nuanced than the population of YSHCN.24 25 Although a variety of programs26 27 28 exist to support the transition to adulthood, lack of information and coordination between child and adult serving systems create gaps and barriers in planning, navigating, accessing, and integrating quality services across systems.29 30 Only 14% of young adults with autism and 31% of young adults with epilepsy have had a discussion with their pediatrician about transitioning to an adult provider before they turn 18.31 32

Youth with autism and/or epilepsy with complex health and social needs typically rely on their families/caregivers to provide a high-level of leadership and assistance in transitioning across systems.33 YAES and their families/caregivers may benefit from support in areas such as:

1) Navigating child and adult serving systems,34

2) Increasing YAES and family/caregiver self-efficacy in identifying and connecting to appropriate services and supports,

3) Engaging in shared and supported decision-making, and

4) Accessing services that support daily living skills and community living.

This program will build on and expand previous efforts by HRSA to improve transition outcomes for youth with autism and epilepsy by incorporating family/caregiver navigation and health care transition into frameworks, which includes the system of services and supports for successful transition from child to adult serving systems.

24 Sosnowy, C., Silverman, C., & Shattuck, P. (2018). Parents’ and young adults’ perspectives on transition outcomes for young adults with autism. Autism, 22(1), 29–39. https://doi.org/10.1177/1362361317699585.

25 Goselink, R. J., Olsson, I., Malmgren, K., & Reilly, C. (2022). Transition to adult care in epilepsy: A systematic review. Seizure.

26 PROMISE 5 Year Report.

27 The 2020 Federal Youth Transition Plan: A Federal Interagency Strategy.

28 Shogren, K. A., & Wittenburg, D. (2020). Improving Outcomes of Transition-Age Youth with Disabilities: A Life Course Perspective. Career Development and Transition for Exceptional Individuals, 43(1), 18–28.

https://doi.org/10.1177/2165143419887853.

29 Hughes, M. M., Shaw, K. A., Patrick, M. E., DiRienzo, M., Bakian, A. V., Bilder, D. A., ... & Maenner, M. J. (2023). Adolescents with autism spectrum disorder: diagnostic patterns, co-occurring conditions, and transition planning. Journal of Adolescent Health.

30 Hughes, M. M., Kirby, A. V., Davis, J., Bilder, D. A., Patrick, M., Lopez, M., ... & Maenner, M. J. (2023). Individualized Education Programs and Transition Planning for Adolescents With Autism. Pediatrics, e2022060199.

31 Baca CM, Barry F, Berg AT. The epilepsy transition care gap in young adults with childhood-onset epilepsy. Epilepsy Behav. 2018 Oct; 87:146-151. https://doi.org/10.1016/j.yebeh.2018.06.052. Epub 2018 Aug 25. PMID: 3015405.

32 Kuo, A. A., Crapnell, T., Lau, L., Anderson, K. A., & Shattuck, P. (2018). Stakeholder perspectives on research and practice in autism and transition. Pediatrics, 141(Supplement_4), S293-S299.

33 Reyes, C., Perzynski, A., Kralovic, S. et al. Factors Associated with Transition Planning in Autism and Other Developmental Disabilities. J Dev Phys Disability 34, 43–56 (2022). https://doi.org/10.1007/s10882-020-09785-3.

34 See Appendix B for additional details about child and adult serving systems.

https://doi.org/10.1177/1362361317699585 https://doi.org/10.1177/2165143419887853 https://doi.org/10.1016/j.yebeh.2018.06.052 https://doi.org/10.1007/s10882-020-09785-3

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 6

II. Award Information

1. Type of Application and Award

Application types

HRSA-24-042 (DPs): New

HRSA-24-041 (NCCT): New

We will fund you via a grant for the HRSA-24-042 (DPs).

We will fund you via a cooperative agreement for the HRSA-24-041 (NCCT).

A cooperative agreement is like a grant in that we award money, but we are substantially involved with program activities.

For the HRSA-24-041 (NCCT), aside from monitoring and technical assistance (TA), we also get involved in these ways:

• Participating in the planning and development of project activities during the period of performance.

• Reviewing policies and procedures, activities, emerging issues, data, measures, and tools designed and implemented during the period of performance.

• Reviewing and editing, as appropriate, written documents developed by the recipient prior to submission for publication or public dissemination. This includes any articles, presentations, website changes, or other resource documents.

• Participating with the recipient in the dissemination of project findings, best practices, and lessons learned, and in producing and jointly reviewing reports, articles, and/or presentations developed under this NOFO.

• Assisting in the establishment of partnerships, collaboration, and cooperation that may be necessary for carrying out the project, including with other federal agencies or other programs within HRSA or HHS.

• Providing input on the composition of the project advisory committee or other relevant groups.

For HRSA-24-041 (NCCT), you must follow all relevant federal regulations and public policy requirements. Your other responsibilities will include:

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

• Collaborating with HRSA personnel, the Autism Transitions Research Project (ATRP, HRSA-22-099), the National Center for a System of Services for

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 7

CYSHCN (HRSA-23-075), the Family Engagement and Leadership in Systems of Care (FELSC) program (HRSA-23-078), HRSA-24-042 (DP) recipients, and other stakeholders to develop the definition of “successful transition”, and identify associated activities, measures, and data.

• Collaborating with HRSA personnel in the planning, development, and implementation of project activities, identifying emerging issues; developing strategies and tools; and identifying topics for advisory committee meetings, learning collaboratives, and publications.

• Producing and disseminating project findings through publishing articles, reports and/or presentations (see Acknowledgement of Federal Funding in Section 2.2 of HRSA’s SF-424 Application Guide).

• Completing activities proposed in response to the project requirements and scope of work to meet the project goals and objectives.

• Analyzing evidence-informed data, impact and quality improvement data, and any relevant data trends.

• Participating in meetings and conference calls with HRSA during the period of performance to provide regular updates on progress in meeting goals and objectives.

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

• Collaborating with HRSA-24-042 (DP) recipients to meet the goals and objectives of the program.

• Tracking and reporting on activities and expenditures by topic area/funding streams/authority (Autism CARES Act Funding, $275,000; Special Projects of Regional and National Significance (SPRANS) Epilepsy Funding, $610,000).

2. Summary of Funding

HRSA-24-042 DPs

We estimate $1,800,000 from the Autism CARES Act funding/authority will be available each year to fund up to four (4) autism DP recipients. We estimate $3,150,000 from the SPRANS Epilepsy funding/authority will be available each year to fund up to seven (7) epilepsy DP recipients. You may apply for a ceiling amount of up to $450,000 annually (reflecting direct and indirect costs) for either the autism or epilepsy funding.

https://www.hrsa.gov/sites/default/files/hrsa/grants/sf424-application-guide.pdf#page=9 https://www.hrsa.gov/sites/default/files/hrsa/grants/sf424-application-guide.pdf#page=9

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 8

HRSA-24-041 NCCT

We estimate $735,000 to be available annually to fund one (1) recipient. This includes $275,000 from the Autism CARES Act funding/authority and $460,000 from the SPRANS Epilepsy funding/authority. You may apply for a ceiling amount of up to $735,000 annually (reflecting direct and indirect costs).

The period of performance is September 1, 2024, through August 31, 2029 (5 years).

This program notice depends on the appropriation of funds. If funds are appropriated for this purpose, we will proceed with the application and award process.

Support beyond the first budget year will depend on:

• Appropriation

• Satisfactory progress in meeting the project’s objectives

• A decision that continued funding is in the government’s best interest

45 CFR part 75 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards applies to all HRSA awards.

If you’ve never received a negotiated indirect cost rate, you may elect to charge a de minimis rate of 10 percent of modified total direct costs (MTDC)*. You may use this for the life of the award. If you choose this method, you must use it for all federal awards until you choose to negotiate for a rate. You may apply to do so at any time. See Section 4.1.v. Budget Narrative in the Application Guide.

*Note: One exception is a governmental department or agency unit that receives more than $35 million in direct federal funding.

III. Eligibility Information

1. Eligible Applicants

You can apply for HRSA-24-042 (DPs) or HRSA-24-041 (NCCT) if your organization is in the United States, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau and is:

• Public or private

• Community-based Organizations

• Institutions of Higher Education https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75 https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 9

• Tribal (governments, organizations)35

For more information on eligible organizations, please see this link https://www.grants.gov/learn-grants/grant-eligibility

2. Cost Sharing or Matching

Cost sharing or matching is not required for HRSA-24-042 (DPs) nor HRSA-24-041

(NCCT).

3. Other

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

• Exceeds the funding ceiling amount

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

Multiple Applications

Applicants can only apply for funding under one funding opportunity number, either HRSA-24-042 (DPs) or HRSA-24-041 (NCCT). Applicants applying for the HRSA-24- 042 (DPs) may only apply for one focus area, autism or epilepsy, and must clearly state the focus area for which they are applying.7 HRSA will not consider funding applicants who apply to more than one funding opportunity number or focus area.

We will only review your last validated application before the Grants.gov due date.

Organizations can come together as a consortium to submit a joint application for a DP focus area (autism or epilepsy) or for the NCCT. Each consortium member must demonstrate substantial involvement in the project and contribute significantly to the goals of the project. The roles and responsibilities of each consortium member must be clearly defined in a proposed Memorandum of Understanding/Agreement (MOU/A). The proposed MOU/A must be supported in writing by all consortium members and submitted as Attachment 9.

IV. Application and Submission Information

1. Address to Request Application Package

We require you to apply online through Grants.gov. Use the SF-424 workspace application package associated with this notice of funding opportunity (NOFO). Follow

35 For awards authorized by 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act), see also 42 CFR § 51a.3(a).

https://www.grants.gov/learn-grants/grant-eligibility https://www.grants.gov/

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 10 these directions: How to Apply for Grants. If you choose to submit using an alternative online method, see Applicant System-to-System.

Note: Grants.gov calls the NOFO “Instructions.”

Select “Subscribe” and enter your email address for HRSA-24-042 (DPs) and/or HRSA- 24-041 (NCCT) to receive emails about changes, clarifications, or instances where we republish the NOFO. You will also be notified by email of documents we place in the RELATED DOCUMENTS tab that may affect the NOFO and your application. You’re responsible for reviewing all information that relates to this NOFO.

2. Content and Form of Application Submission

Application Format Requirements Submit your information as the Application Guide and this program-specific NOFO state. Do so in English and budget figures expressed in U.S. dollars. There’s an Application Completeness Checklist in the Application Guide to help you.

Application Page Limit The total number of pages that count toward the page limit shall be no more than 50 pages when we print them. We 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 do not 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”)

• Indirect Cost Rate Agreement

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

• Biographical Sketches of Key Personnel

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

If you use an OMB-approved form that is not in the HRSA-24-042 (DPs) or HRSA-24- 041 (NCCT) workspace application package, it may count toward the page limit.

Applications must be complete and validated by Grants.gov under HRSA-24-042 (DPs) or HRSA-24-041 (NCCT) before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification https://www.grants.gov/applicants/grant-applications/how-to-apply-for-grants https://www.grants.gov/system-to-system/applicant-system-to-system/

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 11

• When you submit your application, you certify that you and your principals36 (for example, program director, principal investigator) can participate in receiving award funds to carry out a proposed project. That is, no federal department or agency has debarred, suspended, proposed for debarment, claimed you ineligible, or you have voluntarily excluded yourself from participating.

• If you fail to make mandatory disclosures, we may take an action like those in 45 CFR § 75.371. This includes suspending or debarring you.37

• If you cannot certify this, you must include an explanation in Attachment 10-15:

Other Relevant Documents.

(See Section 4.1 viii “Certifications” of the Application Guide).

Program Requirements and Expectations HRSA-24-042 – DPs

Throughout the period of performance, successful recipients will be expected to complete the following activities:

• Implement and evaluate innovative, sustainable, and scalable strategies that support YAES and their families/caregivers in successfully transitioning from child to adult serving systems within the catchment areas defined in the recipients’ applications. Strategies should:

o Align with the principles and strategies from the Blueprint for Change38 with priority needs of the catchment area.

o Use life course39 40 41 and person/family-centered approaches and be coordinated, comprehensive, and culturally responsive to the needs of YAES and their families/caregivers.42 o Use implementation science43 to guide the development and implementation of transition strategies.

36 See definitions at eCFR :: 2 CFR 180.995 -- Principal. and eCFR :: 2 CFR 376.995 -- Principal (HHS supplement to government-wide definition at 2 CFR 180.995).

37 See also 2 CFR parts 180 and 376, 31 U.S.C. § 3354, and 45 CFR § 75.113.

38 McLellan SE, Mann MY, Scott JA, Brown TW. A Blueprint for Change: Guiding Principles for a System of Services for Children and Youth with Special Health Care Needs and Their Families. Pediatrics (2022) 149 (Supplement 7): e2021056150C.

39 Richards, J., Pickett, O., & Wilhite, B. (2011). Life Course and Social Determinants. MCH Evidence.

https://www.mchlibrary.org/professionals/lifecourse.php.

40 Shogren, K. A., & Wittenburg, D. (2020). Improving Outcomes of Transition-Age Youth with Disabilities: A Life Course Perspective. Career Development and Transition for Exceptional Individuals, 43(1), 18–28.

https://doi.org/10.1177/2165143419887853.

41 Reyes, C., Perzynski, A., Kralovic, S. et al. Factors Associated with Transition Planning in Autism and Other Developmental Disabilities. J Dev Phys Disability 34, 43–56 (2022). https://doi.org/10.1007/s10882-020-09785-3.

42 See Appendix B for relevant definitions.

43 See Appendix B for definition of implementation science.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371 https://mchb.hrsa.gov/programs-impact/focus-areas/children-youth-special-health-care-needs-cyshcn/blueprint-change https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180/subpart-I/section-180.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376/subpart-I/section-376.995 https://www.ecfr.gov/current/title-2/subtitle-A/chapter-I/part-180 https://www.ecfr.gov/current/title-2/subtitle-B/chapter-III/part-376 https://uscode.house.gov/view.xhtml?req=granuleid%3AUSC-prelim-title31-chapter33&edition=prelim https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-B/section-75.113 https://www.mchlibrary.org/professionals/lifecourse.php https://doi.org/10.1177/2165143419887853 https://doi.org/10.1007/s10882-020-09785-3

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 12 o Incorporate health care transition44 approaches to support positive health outcomes for YAES and their families/caregivers.

o Include family/caregiver navigation approaches to improve and increase family/caregiver self-efficacy in identifying and navigating child and adult systems, obtaining information/resources, and connecting with appropriate services and providers to support successful transition.

• Engage and include YAES and their families/caregivers, and other persons with lived experience45 in the planning, development, implementation, and evaluation of the transition strategies.

• Create an advisory council (AC) and facilitate routine meetings to inform, support, and collaborate on developing and/or strengthening a system of support for YAES and their families transitioning from child to adult serving systems. The AC should be comprised of transition age (13-26) YAES and their families/caregivers, representatives of child and adult serving agencies (for example, Title V, Family to Family Health Information Centers (F2F), state agencies, federally funded programs, community-based organizations, etc.) that provide services to support YAES and their families through each stage of the transition process.

• Convene a meeting of the AC and other stakeholders in the catchment area during years three (3) and five (5) of the period of performance to share strategies, resources, and best practices related to transition supports and services for YAES and their families/caregivers.

• Develop and implement a monitoring and evaluation plan to track progress towards achieving DP goals and objectives. The plan should include an objective related to health equity. Activities should be ongoing, and data should be shared in annual and final reports as described in the Reporting section of this NOFO.

• Participate in activities organized by the NCCT, including technical assistance sessions, learning collaboratives, and in-person meetings.

In addition to the above activities, successful recipients will be expected to implement activities specific to each phase.

Phase I – Planning

Phase I will take place in year one (1) of the period of performance. During Phase I, successful recipients will be expected to complete the following activities:

44 See Appendix B for definition of health care transition.

45 See Appendix B for definition of persons with lived experience.

https://mchb.hrsa.gov/programs-impact/title-v-maternal-child-health-mch-block-grant https://familyvoices.org/lfpp/f2fs/ https://sph.umich.edu/ncbon/about/whatis.html

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 13

Finalize the population and baseline number of YAES in the recipient’s catchment area.

Conduct a landscape analysis of services and supports for the transition process for YAES and their families/caregivers in the recipient’s catchment area.

Examples of services and supports include state, community, and federally funded child and adult serving agencies, community-based organizations, etc.

Identify barriers to and opportunities for successful outcomes at all stages of the transition process.46

• Identify and convene the AC with membership comprised of representatives from the system of services identified above and other stakeholders that support transition from child to adult serving systems for YAES and their families/caregivers.

• Develop and facilitate partnerships (for example, memoranda of understanding, data sharing agreements) to strengthen the systems of services for YAES and their families/caregivers and collaboration between child and adult serving programs.

• Participate in the development, data collection, and reporting of measures to evaluate project impact as led by the NCCT, including the development of a “successful transition” definition.

Phase II – Implementation

Phase II will take place in years two (2) through five (5) of the periods of performance.

During Phase II, successful recipients will be expected to complete the following activities:

• Adopt and implement a framework for YAES and their families/caregivers in successfully transitioning from child to adult serving systems. The framework must include systems of services and supports, partnerships, collaborations, and consultation with child and adult serving agencies.

• Collect and report data to evaluate project impact, including data related to measures associated with “successful transition” as defined in Phase I.

• Develop a sustainability plan by August 31, 2028, based on project findings and lessons learned to date. The plan will be submitted to HRSA as part of the progress report described in the Reporting section of this NOFO.

• Disseminate relevant resources, project findings, and lessons learned through a variety of channels targeting a wide range of audiences in a culturally responsive

46 See Appendix B for additional details on the stages of the transition process.

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 14 manner. Examples of dissemination channels include peer-reviewed manuscripts, conference presentations, reports, infographics, one-pagers, PSAs, etc.

HRSA-24-041 – NCCT

The NCCT will be expected to support the HRSA-24-042 (DP) recipients in meeting their program objectives and will be expected to provide national leadership to improve transition outcomes for YAES and their families/caregivers through training, technical assistance, evaluation, and development and dissemination of resources to transition stakeholders.

Regarding policy/practice analysis and national leadership, the successful recipient will be expected to:

• Conduct a landscape analysis of federally funded programs (for example, programs funded by Department of Special Education, Department of Labor, Centers for Medicare and Medicaid, and Administration for Community Living) that provide transition services and supports by August 31, 2025.

• Identify barriers to and opportunities for successful outcomes at all stages of the transition process.

• Collaborate with recipients of HRSA-24-042 (DPs) and stakeholders to develop a definition of “successful transition”, identify associated activities, measures (including measures of quality of life and well-being), and best practices for YAES transitioning from child to adult serving systems by August 31, 2025.

• Identify, develop, and disseminate resources that highlight culturally responsive, best, and promising transition policies and practices.

• Design and maintain a standalone public-facing website to share transition-related resources, policies, and practices as well as relevant information about the program.

• Disseminate project findings and lessons learned through a variety of channels targeting a wide range of audiences (for example, peer-reviewed manuscripts, conference presentations, reports, infographics, one-pagers, PSAs, etc.).

• Provide training, technical assistance, and relevant resources to national transition stakeholders, including state Title V programs.

Regarding partnerships and collaboration, the successful recipient will be expected to:

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 15

• Engage and compensate47 YAES and their families/caregivers in all projects and activities associated with the NCCT including, but not limited to:

o Defining “successful transition” as well as identifying associated activities and appropriate measures.

o Advising on training and technical assistance provided to HRSA-24-042 (DPs) recipients and other stakeholders.

o Developing resources.

• Identify members and convene a National Transition Advisory Council (NTAC) to inform and support the work of the NCCT throughout the period of performance.

The NTAC should help the NCCT identify transition-related emerging issues, future trends, and assist with the development of resource materials. The NTAC should be comprised of transition age (13-26) YSHCN, including YAES;

families/caregivers; persons with lived experience; and representatives of child and adult serving agencies (for example, federal agencies, community-based organizations (CBOs), etc.) with established transition-related supports and services. Representatives from state Title V and F2F programs should be included.

• Build and maintain partnerships and collaborations among HRSA-24-042 (DP) recipients and with other transition system stakeholders.

Regarding training and technical assistance to HRSA-24-042 (DP) recipients, the successful recipient will be expected to:

• Provide support in analyzing the transition services and supports available in recipient identified catchment areas.

• Assist in finalizing the population of YAES in their catchment areas.

• Provide technical assistance in identifying appropriate strategies and tools (for example, memoranda of understanding, data sharing agreements, etc.) to promote and support cross-agency collaboration.

• Provide one-on-one intensive support, as needed.

• Host and facilitate routine individual technical assistance calls to support HRSA- 24-042 (DP) recipients in reaching project goals.

47 Resources that provide information about compensating families for their participation can be found in these resources:

Family Voices and Lucile Packard Foundation for Children’s Health (2018). Issue Brief: A Framework for Assessing Family Engagement in Systems Change. FamilyVoices_LPFCH_assessing_family_engagement_April2018.pdf.

Family Voices. (2019). Framework for Supporting & Ensuring Meaningful Family Engagement in Genetics Services. Model-for-Meaningful-Family-Engagement_May_2019.pdf (familyvoices.org).

https://familyvoices.org/wp-content/uploads/2018/10/FamilyVoices_LPFCH_assessing_family_engagement_April2018.pdf https://familyvoices.org/wp-content/uploads/2019/05/Model-for-Meaningful-Family-Engagement_May_2019.pdf

HRSA-24-041 (NCCT) and HRSA-24-042 (DPs) 16

• Convene…