oppCDC-RFA-DD18-1802-cfda93.073-cidCDC-RFA-DD18-1802-instructions.pdf

Centers for Disease Control

National Center on Birth Defects and Developmental Disabilities

Implementing Alcohol Screening and Brief Intervention in Healthcare Systems Providing

Women's Health Services

CDC-RFA-DD18-1802

Application Due Date: 05/16/2018

Implementing Alcohol Screening and Brief Intervention in Healthcare Systems Providing

Women's Health Services

CDC-RFA-DD18-1802

TABLE OF CONTENTS

Part I. Overview Information A. Federal Agency Name B. Funding Opportunity Title C. Announcement Type D. Agency Funding Opportunity Number E. Catalog of Federal Domestic Assistance (CFDA) Number F. Dates G. Executive Summary

Part II. Full Text A. Funding Opportunity Description B. Award Information C. Eligibility Information D. Application and Submission Information E. Review and Selection Process F. Award Administration Information G. Agency Contacts H. Other Information I. Glossary

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-DD18-1802. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Implementing Alcohol Screening and Brief Intervention in Healthcare Systems Providing Women's Health Services C. Announcement Type: New - Type 1 This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https ://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.

Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DD18-1802

E. Catalog of Federal Domestic Assistance (CFDA) Number:

93.073 F. Dates:

1. Due Date for Letter of Intent (LOI): 03/30/2018

2. Due Date for Applications: 05/16/2018, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

3. Date for Informational Conference Call:

An informational call for potential applicants will take place March 29, 2018 at 2:00 p.m. U.S.

Eastern Time, Toll-Free: 855-644-0229, Conference ID: 4434827.

G. Executive Summary:

1. Summary Paragraph:

The purpose of this Notice of Funding Opportunity (NOFO) is to reduce risky alcohol use among women of childbearing age through system-level implementation of alcohol screening and brief intervention (SBI) in health systems providing women’s health services. Risky alcohol use can result in a variety of negative health and social consequences, such as motor vehicle crashes, intimate partner violence, and fetal alcohol spectrum disorders. It is costly, results in over 88,000 deaths annually, and can affect serious medical conditions, such as hypertension, liver disease and certain types of cancer. Health professionals are uniquely positioned to intervene with patients with acute and chronic health conditions caused or exacerbated by risky alcohol use. Alcohol SBI implementation efforts within health systems will focus on https://www.grants.gov https://www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.grants.gov development and implementation of: a training and technical assistance plan; alcohol SBI protocols in primary care clinics; system-level approaches that facilitate uptake (e.g., electronic health record integration and performance metrics); an evaluation plan assessing feasibility and impact of system-level implementation; a dissemination plan on promising models and lessons learned; and a sustainability plan. Expected performance outcomes include documenting provider/clinic readiness to conduct alcohol SBI, documenting implementation barriers and proposed solutions, tracking clinic-level data on alcohol SBI, and assessing the use of system-level strategies.

a. Eligible Applicants: Open Competition

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 3

d. Total Period of Performance Funding: $4,800,000

e. Average One Year Award Amount: $400,000

f. Total Period of Performance Length: 4

g. Estimated Award Date: 08/30/2018

h. Cost Sharing and / or Matching Requirements: N Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview Risky alcohol use can result in a wide range of negative health and social consequences, including motor vehicle crashes, intimate partner violence, and fetal alcohol spectrum disorders (FASDs). Over time, it can result in serious medical conditions, such as hypertension, liver disease and certain types of cancer. Risky alcohol use accounts for over 88,000 deaths and costs the US economy $249 billion annually. Nearly 14 million U.S. women binge drink about 3 times a month averaging 6 drinks per binge. A recent study reports that risky alcohol use among women continues to increase, placing women at greater risk for multiple adverse health outcomes. In addition, prenatal alcohol use can cause miscarriage, stillbirth, and a range of lifelong physical, behavioral, and intellectual disabilities known as FASDs. Recent data show that 10.2% of pregnant women report alcohol use and 3.1% of pregnant women report binge drinking in the past 30 days.

Healthcare professionals in primary care settings are in a unique position to intervene with patients experiencing both acute and chronic health conditions caused or exacerbated by risky alcohol use. Thus, it is critical for healthcare professionals to understand how risky alcohol use affects their patients’ health, how to discuss risky alcohol use and its related harms with patients, and how to guide patients in reducing or stopping their risky use. Alcohol screening and brief intervention (SBI) identifies and helps patients who might be drinking too much. It involves a validated set of screening questions to identify patients’ drinking patterns. If a patient screens positive, a short conversation about their alcohol use and the health risks associated with that use follows. A referral to specialized treatment may be needed for those few patients with severe risk.

This NOFO seeks to address the problem of risky alcohol use through system-level implementation of alcohol SBI, an evidence-based, clinical preventive service to reduce risky alcohol use and its related harms. While alcohol SBI is recommended for all adults in primary care settings, this NOFO emphasizes integration of alcohol SBI within health systems providing women’s health services to assure that female patients are receiving accurate and appropriate messages from healthcare professionals about the harms related to risky alcohol use, including prenatal alcohol use.

Based on over thirty years of evidence, the U.S. Preventive Services Task Force and many other organizations have recommended that alcohol SBI be implemented for all adults in primary healthcare settings. Yet, alcohol SBI has not been widely implemented in medical practice.

Recent data indicate that only one of six U.S. adults reported ever discussing alcohol use with a health professional. CDC has experience working with primary care providers to advance the use of evidence-based practices, including alcohol SBI, to prevent alcohol-exposed pregnancy and risky alcohol use. However, large-scale implementation of alcohol SBI is needed to prevent risky alcohol use among all adults, including women of childbearing age. System-level strategies such as integration of alcohol SBI into electronic health records and adoption of relevant performance metrics could facilitate uptake. Working with health systems to provide alcohol SBI within their primary care settings can build capacity within these systems to address risky alcohol use, and to identify effective strategies that lead to sustainable, quality delivery of this clinical preventive service.

b. Statutory Authorities This program is authorized under sections 301 [42 USC 241] and 317C of the Public Health Service Act, [42 U.S.C. Section 247b-4].

c. Healthy People 2020 This program addresses the Healthy People 2020 focus area of Maternal, Infant, and Child Health . Relevant objectives include MICH-11.1, increase abstinence from alcohol among pregnant women from 89.4% to 98.3%; MICH-11.2, increase abstinence from binge drinking among pregnant women from 95% to 100%; MICH-16.4, increase the proportion of women delivering a live birth who did not drink alcohol prior to pregnancy from 51.3% to 56.4%; and MICH-25, reduce the occurrence of fetal alcohol syndrome (FAS).

d. Other National Public Health Priorities and Strategies This NOFO supports the National Prevention Strategy – Strategic Direction: Clinical and Community Preventive Services; Priority Area: Preventing Drug Abuse and Excessive Alcohol Use https://www.surgeongeneral.gov/priorities/prevention/strategy/index.html#The Strategic Directions https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives

e. Relevant Work This NOFO builds on previous alcohol SBI implementation pilot studies done through three of the CDC-funded FASD Regional Training Centers in 2012. These efforts explored small-scale alcohol SBI implementation documenting the training and implementation process, identifying facilitators and barriers to implementation, and evaluating uptake of alcohol SBI within the identified systems of care.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

Strategies and Activities Short-term Outcomes Long-Term Outcomes

Develop and implement a training and technical assistance plan to support implementation of alcohol SBI in a large system

Develop and implement alcohol SBI protocols in multiple primary care clinics within a health system

Adopt system-level strategies to increase uptake of alcohol SBI including integration of alcohol SBI in electronic health records (EHR) and use of performance metrics (e.g., alcohol HEDIS measure, other)

Develop and implement an evaluation approach to assess feasibility of systems-level alcohol SBI implementation within a large health system

Develop and implement a plan for disseminating promising implementation models and sharing lessons learned

Increased awareness of the importance of talking to patients about alcohol use among healthcare providers

Increased knowledge about risks of alcohol use and alcohol use during pregnancy among healthcare providers

Increased access to alcohol-related resources and technical support by healthcare providers

Increased understanding of healthcare team member roles in the alcohol SBI process within healthcare providers’ practice setting

Increased provider comfort and skills in discussing alcohol as part of routine care

Increased number of healthcare providers prepared to deliver alcohol SBI

Alcohol screening and brief intervention is a routine part of care

Decrease in risky alcohol use among women of reproductive age

Improved health outcomes, including health of women and their babies

Develop and implement a sustainability plan for long-term alcohol SBI integration or expansion

Integrated protocols to conduct alcohol SBI in practice settings within a health system

Increased uptake of alcohol SBI through system-level strategies (e.g. EHR integration, alcohol HEDIS measure, other)

i. Purpose The purpose of this NOFO is to implement alcohol SBI within health systems providing women’s health services to reduce risky alcohol use among women of childbearing age. This will be achieved by developing and implementing: a training and technical assistance plan; alcohol SBI protocols in primary care clinics within the system; system-level approaches (e.g., EHR integration and performance metrics); an evaluation plan assessing feasibility and impact of system-level implementation; a dissemination plan for sharing promising models and lessons learned; and a sustainability plan.

ii. Outcomes By the end of the project period, the recipients are expected to achieve the following short-term outcomes:

Increased awareness of the importance of talking to patients about alcohol use among healthcare providers

Increased knowledge about risks of alcohol use and alcohol use during pregnancy among healthcare providers

Increased access to alcohol-related resources and technical support by healthcare providers

Increased understanding of healthcare team member roles in the alcohol SBI process within health care providers’ practice setting

Increased provider comfort and skills in discussing alcohol as part of routine care Increased number of healthcare providers prepared to deliver alcohol SBI Integrated protocols to conduct alcohol SBI in practice settings within a health system Increased uptake of alcohol SBI through system-level strategies (e.g. EHR integration, alcohol HEDIS measure, other)

iii. Strategies and Activities All applicants for this NOFO must identify a specific health system that provides women’s health services. Refer to section, "Organizational Capacity of Recipients to Implement the Approach" for more information. Applicants should provide information on how the following strategies and activities will be implemented within the identified health system.

Strategy 1: Develop and implement a training and technical assistance plan to support implementation of alcohol SBI in a large system Activities:

Develop and carry out a training and technical assistance plan based on the needs of the identified health system to implement alcohol SBI broadly. At a minimum, this should address the development of competencies in alcohol SBI and its implementation among providers and office staff and should include three types of training needed to implement alcohol SBI:

o Introduction to Alcohol SBI – this level of training is for administration and staff to understand what the service is about, why it is necessary, and how its basic elements will be implemented into practice. It is intended for both clinical and administrative leadership of the practice in addition to anyone whose job will change under the new alcohol SBI program o Implementation Training – this involves guidance on creating and implementing alcohol SBI protocols appropriate to the unique realities of a clinical setting and includes administrative functions such as overseeing medical records and billing o Practitioner training – this includes clinical functions such as conducting the screening and delivering interventions

Use of existing CDC resources and training materials is encouraged and, if used, should be specified in the application. These include:

o Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices, available for download at:

https://www.cdc.gov/ncbddd/fasd/documents/AlcoholSBIImplementationGuide .pdf o CDC online training resources available on the CDC’s FAS website (www.cdc.gov/fasdtraining). Additional resources may need to be developed to meet specific needs of the identified health system.

Describe plans for ongoing technical assistance and support to clinic staff and refresher trainings at clinic and system levels.

Strategy 2: Develop and implement alcohol SBI protocols in multiple primary care clinics within a health system Activities:

Describe plans for how alcohol SBI protocols will be developed within the primary care clinics within the selected health system, including establishing procedures for implementation of screening, brief intervention, patient follow-up, and referral of patients with severe problems

Document the roles and responsibilities of medical and administrative staff in the implementation process and how ongoing improvements of the clinic protocols will be assessed https://www.cdc.gov/ncbddd/fasd/documents/AlcoholSBIImplementationGuide.pdf

Strategy 3: Adopt system-level strategies to increase uptake of alcohol SBI including integration of alcohol SBI in electronic health records (EHR) and use of performance metrics (e.g., alcohol HEDIS measure, other) Activities:

Describe specific systems-level approaches that will be a part of alcohol SBI implementation processes (e.g., EHR integration, HEDIS or other performance measure, other strategy)

Describe how information gathered from these approaches will be used to improve delivery of alcohol SBI

Strategy 4: Develop and implement an evaluation approach to assess feasibility of systems-level alcohol SBI implementation within a large health system Activities:

Collaborate with CDC to develop and implement an evaluation plan for the implementation of alcohol SBI within the identified health system. Evaluation activities should include:

o Documenting provider/clinic readiness to conduct alcohol SBI (e.g., awareness/knowledge about the topic, access to and use of resources, understanding of staff roles/responsibilities, provider comfort in delivering the intervention) o Documenting the implementation process, including real and perceived barriers, methods to overcome barriers, and solutions identified o Tracking implementation data including number of patients screened, number of patients who screen positive, number of patients who receive brief and or other interventions, number of patients referred to other sources of help, and number of patients who reduce their alcohol use o Tracking basic demographic descriptors of patients receiving alcohol SBI services (i.e., sex, race/ethnicity, age) o Documenting the use and impact of systems-level strategies such as EHR systems, performance measures, other strategies

Strategy 5: Develop and implement a plan for disseminating promising implementation models and sharing lessons learned Activities:

Outline how project progress will be reported to participating clinic staff and relevant system-level administrators and leaders.

Describe strategies for sharing lessons learned from alcohol SBI implementation processes and strategies used to increase uptake

Strategy 6: Develop and implement a sustainability plan for long-term alcohol SBI integration or expansion Activities:

Describe project’s approach to sustainability of alcohol SBI integration with the health system and/or possible expansion to other clinics or health systems. Issues described could include potential partnerships, funding streams, role of clinic and system leaders, and use of evaluation data.

1. Collaborations

a. With other CDC programs and CDC-funded organizations:

Recipients will collaborate with other CDC-funded FASD-related efforts including:

DD18-1801: Promoting Resources for Fetal Alcohol Spectrum Disorders Awareness and Prevention

DD18-1803: Reaching Healthcare Professionals in the Prevention of Fetal Alcohol Spectrum Disorders through National Professional Organizations

These collaborations are encouraged to promote information sharing across CDC-funded FASD-related efforts and to identify any potential opportunities for collaboration.

b. With organizations not funded by CDC:

The recipients are encouraged to collaborate with the following partners:

Primary care clinics within the system selected to participate in this effort; recipient should also have mechanisms in place to communicate with health system leadership and non-participating clinics to update them on progress of this effort

Local substance use agencies or other entities that provide training on alcohol SBI or are referral sources for alcohol treatment services

2. Target Populations The applicant should identify and define primary care providers within the identified health system that provides women’s health services. While alcohol SBI should be made available to all patients in selected clinics within the health system, strategies and activities should focus primarily on reaching women of reproductive age and their babies.

a. Health Disparities The applicant should provide information on how they plan to ensure that underserved populations (i.e., people with disabilities, rural populations, tribal populations, sexual and gender minorities, non-English speaking populations, and people with limited health literacy skills) will have access to alcohol screening and brief intervention services provided within the selected clinics in the identified health system.

iv. Funding Strategy

N/A

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy This evaluation and performance measurement strategy will be used to monitor recipient efforts to address the key strategies and activities outlined in this NOFO. The process and outcome measures outlined here will guide progress and improvements of the alcohol SBI implementation process in the selected primary care settings within the health system and help assess the utilization and impact of systems-level strategies to improve uptake of alcohol SBI in a sustainable way. Clinic-specific implementation data will be reported to CDC quarterly in an aggregate format without personal identifiers.

Develop and implement a training and technical assistance plan to support implementation of alcohol SBI in a large system

Example Process Measures:

o Number of system-level staff receiving training on alcohol SBI o Number of system-level staff receiving alcohol SBI resources and information on the risks of alcohol use during pregnancy o Number of clinic-level staff receiving training on alcohol SBI and how to implement it o Number of clinic-level staff receiving alcohol SBI resources and information on the risks of alcohol use during pregnancy o Number of technical assistance requests completed o Number of refresher trainings provided to system and clinic-level staff o Clinic-level readiness to deliver alcohol SBI

Related Short-term Outcomes:

o Increased awareness of the importance of talking to patients about alcohol use among healthcare providers o Increased knowledge about risks of alcohol use and alcohol use during pregnancy among healthcare providers o Increased access to alcohol-related resources and technical support by healthcare providers

Develop and implement alcohol SBI protocols in multiple primary care clinics within a health system

Example Process Measures:

o Number of alcohol SBI protocols developed for primary care clinics within the selected health system o Documentation of the implementation process:

Total number of patients within selected clinics Number of patients screened for alcohol use

Number of patients who screen positive for risky alcohol use Number of patients who receive brief and/or other follow-up care within 2 months of a positive screen Number of patients referred to other sources of help Number of patients who reduce their alcohol use o Documentation of the roles and responsibilities of medical and administrative staff in the implementation process o Documentation of barriers to implementation of alcohol SBI protocol and proposed solutions o Documentation on impact of alcohol SBI implementation within the health system Related Short-term Outcome Measures:

o Increased understanding of healthcare team member roles in the alcohol SBI process within healthcare providers’ practice setting o Increased provider comfort and skills in discussing alcohol as part of routine care o Increased number of healthcare providers prepared to deliver alcohol SBI o Integrated protocols to conduct alcohol SBI in practice setting o Increased uptake of alcohol SBI through system-level strategies (e.g., EHR integration, alcohol HEDIS measure, other)

Adopt system-level strategies to increase uptake of alcohol SBI including integration of alcohol SBI in electronic health records (EHR) and use of performance metrics (e.g., alcohol HEDIS measure, other)

Example Process Measures:

o Number of system-level approaches implemented (e.g., EHR integration, HEDIS or other performance measure, other strategy) o Documentation of barriers to implementation of system-level strategies to increase uptake of alcohol SBI and proposed solutions o Documentation on impact of systems-level approaches on alcohol SBI implementation within the health system

Related Short-term Outcome Measures:

o Integrated protocols to conduct alcohol SBI in practice setting o Increased uptake of alcohol SBI through system-level strategies (e.g. EHR integration, alcohol HEDIS measure, other)

Develop and implement a plan for disseminating promising implementation models and sharing lessons learned

Example Process Measures:

o Number of meetings/conference presentations on lessons learned o Number of publications/products shared on lessons learned o Documentation of alcohol SBI implementation best practices

Related Short-term Outcome Measures:

o Integrated protocols to conduct alcohol SBI in practice setting o Increased uptake of alcohol SBI through system-level strategies (e.g. EHR integration, alcohol HEDIS measure, other)

Recipients will be required to submit a more detailed Evaluation and Performance Measurement Plan, including a Data Management Plan, within the first six months of award, as described in the Reporting Section of this NOFO.

ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

How applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement.

How key program partners will participate in the evaluation and performance measurement planning processes.

Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant)

Plans for updating the Data Management Plan (DMP), if applicable, for accuracy throughout the lifecycle of the project. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data; data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans. For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additionalrequirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, they should be directed to:

Describe the type of evaluations (i.e., process, outcome, or both).

Describe key evaluation questions to be addressed by these evaluations.

Describe other information (e.g., measures, data sources).

Recipients will be required to submit a more detailed Evaluation and Performance Measurement plan, including a DMP, within the first 6 months of award, as described in the Reporting Section of this NOFO.

c. Organizational Capacity of Recipients to Implement the Approach The applicant should demonstrate experience and capacity to carry out the strategies and https://www.cdc.gov/grants/additionalrequirements/ar-25.html activities described within the notice of funding opportunity announcement. Specifically, the applicant should demonstrate their ability to:

Conduct the activities of the cooperative agreement, including documentation of previous relevant experience, experience in the implementation of alcohol SBI or similar clinical intervention, and documentation of adequate management structure and organizational and clinical capacity

Identify and recruit qualified personnel, including credentials and appropriate experience to fill key positions and begin project activities in a timely fashion.

Describe all project staff, regardless of their funding source. Descriptions should include professional title, relevant qualifications and experience, percentage of time devoted to the project, as well as the portion of their salary to be paid by the cooperative agreement

Position descriptions for proposed project staff Identify adequate office space for the project and space required for delivery of the intervention Evaluate alcohol SBI implementation efforts and utilize data to monitor progress and identify areas for improvement. The applicant is required to identify and recruit an evaluator to manage the project evaluation plan (minimum: 25% time).

The applicant should demonstrate that the health system addresses the following criteria:

Description of system providing women's health services o The system must have multiple clinics (preferably more than 15 over the period of performance) and be managed by a single umbrella organization.

o The clinics implementing alcohol SBI must be primary care settings offering women’s health services such as family practice clinics, internal medicine clinics, or OB/GYN clinics.

o The primary care clinics implementing alcohol SBI must serve women of reproductive age (18 to 44 years) and this population should represent at least 30% of the clinic patient population served. However, all adult patients seen in the clinic—both males and females—should be provided alcohol SBI services.

System commitment and support o The application must include a signed letter of commitment from the identified health system responsible for carrying out the proposed strategies and activities.

o The system selected must agree to make a formal institutional commitment to implement alcohol SBI.

o The system selected should identify an employee who will authorize and support this activity—one with both institutional and leadership credibility within the system. For example, the employee has explicit authority within the organization to commit resources and to set direction and expectations.

o The system selected should also identify an employee who can coordinate the activity, that is, carry out these directions and expectations and operationalize the activity.

Implementation requirements o The system selected should agree to incorporate alcohol SBI prompts and reminders within the electronic records systems of selected clinics.

o The system selected is encouraged to promote, utilize, and monitor the newly approved HEDIS measure on unhealthy alcohol use and follow-up to assess performance.

o The system selected does not have to implement alcohol SBI in all of its clinical settings. For example, the system selected might include 40 different clinics, of which 20 are primary care clinics serving women of reproductive age (18 to 44 years) and this population should represent at least 30% of the clinic patient population served. However, alcohol SBI could be implemented in only 15 of those 20.

o The applicant should not target multiple systems or separate clinics that are part of different management systems.

o The system selected should not have previously fully and successfully implemented alcohol SBI. However, it can be a system that previously implemented alcohol SBI in some clinics and is now looking to expand to other clinics.

Applicants must supply a signed letter of commitment from the identified health system named as “Letter of Commitment” and upload it at www.grants.gov.

Applicants must supply CVs/resumes of staff and an overall organizational chart for their organization and other relevant organizations involved in the project. Applicants must name this file “CVs/Resumes” or “Organizational Charts” and upload it at www.grants.gov.

d. Work Plan The applicant should provide a detailed work plan for the first year of the project and a high-level work plan for subsequent years that align with the strategies and activities, outcomes, and evaluation measures described in the NOFO logic model and narrative. The work plan should also address the applicant's plans to do the following:

Develop and implement a training and technical assistance plan to support implementation of alcohol SBI in a large system

Develop and carry out a training and technical assistance plan based on the needs of the identified health system to implement alcohol SBI broadly. At a minimum, this should address the development of competencies in alcohol SBI and its implementation among clinic staff and should include three types of training needed to implement alcohol SBI:

o Introduction to alcohol SBI – this level of training is for administrative leadership and staff (at system and clinic levels) to understand what the service is about, why it is necessary, and how its basic elements will be implemented into practice.

o Implementation Training – this involves guidance on creating and implementing the alcohol SBI protocol appropriate to the unique realities of a clinical setting and includes administrative functions such as overseeing medical records and billing o Practitioner training – this includes clinical functions such as conducting the screening and delivering interventions http://www.grants.gov/ http://www.grants.gov/

Use of existing CDC resources and training materials is encouraged and, if used, should be specified in the application. These include:

o Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices, available for download at:

https://www.cdc.gov/ncbddd/fasd/documents/AlcoholSBIImplementationGuide .pdf o CDC online training resources available on the CDC’s FASD website (www.cdc.gov/fasdtraining). Additional resources may need to be developed to meet specific needs of the identified health system.

Describe plans for ongoing technical assistance and support to clinic staff and refresher trainings at clinic and system levels

Develop and implement alcohol SBI protocols in multiple primary care clinics within a health system

Describe how primary care clinics will be identified and recruited to participate in the project

Establish an ongoing communication approach for systems-level contacts and participating clinic staff (e.g., regular meetings/calls, email communication, etc.)

Describe plans for how alcohol SBI protocols will be developed within the primary care clinics within the selected health system, including establishing procedures for implementation of screening, brief intervention, patient follow-up, and referral of patients with severe problems

Document the roles and responsibilities of medical and administrative staff in the implementation process and how ongoing improvements of the clinic protocols will be assessed

Describe training and technical assistance approach to guiding development and ongoing monitoring of implementation of alcohol SBI protocols within selected primary care clinics

Adopt system-level strategies to increase uptake of alcohol SBI including integration of alcohol SBI in electronic health records (EHR) and use of performance metrics (e.g., alcohol HEDIS measure, other)

Describe the specific systems-level approaches that will be a part of alcohol SBI implementation processes (e.g., EHR integration, HEDIS or other performance measure, other strategy) and how these will be incorporated within the alcohol SBI protocols within the health system

Describe how system-level strategies will be used for ongoing monitoring and quality improvement

Develop and implement an evaluation approach to assess feasibility of systems-level alcohol SBI implementation within a large health system

Collaborate with CDC to develop and implement an evaluation plan for the implementation of alcohol SBI within the identified health system. The description of proposed evaluation activities should include:

o Documenting provider/clinic readiness to conduct alcohol SBI (e.g., awareness/knowledge about the topic, access to and use of resources, understanding of staff roles/responsibilities, provider comfort in delivering the intervention) o Documenting the implementation process, including real and perceived barriers, methods to overcome barriers, and solutions identified o Tracking implementation data including number of patients screened, number of patients who screen positive, number of patients who receive brief and or other interventions, number of patients referred to other sources of help, and number of patients who reduce their alcohol use o Tracking basic demographic descriptors of patients receiving alcohol SBI services (i.e., sex, race/ethnicity, age) o Documenting the use and impact of systems-level strategies such as EHR systems, performance measures, incentives (e.g., reimbursement for service), other strategy

Develop and implement a plan for disseminating promising implementation models and sharing lessons learned

Outline how project progress will be reported to participating clinic staff and relevant system-level administrators and leaders.

Describe strategies for sharing lessons learned from alcohol SBI implementation processes and strategies used to increase uptake

Develop and implement a sustainability plan for long-term alcohol SBI integration or expansion

Describe project’s approach to sustainability of alcohol SBI integration with the health system and/or possible expansion to other clinics or health systems. Issues described could include potential partnerships, funding streams, role of clinic and system leaders in sustainability efforts, and use of evaluation data.

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and recipients, site visits, and recipient reporting (including work plans, performance, and financial reporting).

Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements:

Tracking recipient progress in achieving the desired outcomes.

Ensuring the adequacy of recipient systems that underlie and generate data reports.

Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities deemed necessary to monitor the award:

Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

Ensuring that recipients are performing at a sufficient level to achieve outcomes within stated timeframes.

Working with recipients on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets.

Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk recipients.

f. CDC Program Support to Recipients (THIS SECTION APPLIES ONLY TO

COOPERATIVE AGREEMENTS)

Beyond routine monitoring, CDC will provide ongoing technical assistance regarding implementation challenges or other project-specific issues as identified by recipients.

B. Award Information

1. Funding Instrument Type: Cooperative Agreement CDC's substantial involvement in this program appears in the CDC Program Support to Recipients Section.

2. Award Mechanism: U84

3. Fiscal Year: 2018

4. Approximate Total Fiscal Year Funding: $1,200,000

5. Approximate Period of Performance Funding: $4,800,000

This amount is subject to the availability of funds.

Estimated Total Funding: $4,800,000

6. Approximate Period of Performance Length: 4 year(s)

7. Expected Number of Awards: 3

8. Approximate Average Award: $400,000 Per Budget Period

9. Award Ceiling: $400,000 Per Budget Period

This amount is subject to the availability of funds.

10. Award Floor: $300,000 Per Budget Period

11. Estimated Award Date: 08/30/2018

12. Budget Period Length: 12 month(s)

Throughout the project period, CDC will continue the award based on the availability of funds, the evidence of satisfactory progress by the recipient (as documented in required reports), and the determination that continued funding is in the best interest of the federal government. The total number of years for which federal support has been approved (project period) will be shown in the “Notice of Award.” This information does not constitute a commitment by the federal government to fund the entire period. The total period of performance comprises the initial competitive segment and any subsequent non-competitive continuation award(s).

13. Direct Assistance Direct Assistance (DA) is not available through this FOA.

C. Eligibility Information

1. Eligible Applicants Eligibility Category: Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled "Additional Information on Eligibility"

Additional Eligibility Category:

2. Additional Information on Eligibility

The award ceiling for this NOFO is $400,000. CDC will consider any application requesting an award higher than this amount as non-responsive and it will receive no further review.

3. Justification for Less than Maximum Competition N/A

4. Cost Sharing or Matching Cost Sharing / Matching Requirement: No Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

5. Maintenance of Effort Maintenance of effort is not required for this program.

D. Application and Submission Information

1. Required Registrations An organization must be registered at the three following locations before it can submit an application for funding at www.grants.gov.

a. Data Universal Numbering System:

All applicant organizations must obtain a Data Universal Numbering System (DUNS) number.

A DUNS number is a unique nine-digit identification number provided by Dun & Bradstreet (D&B). It will be used as the Universal Identifier when applying for federal awards or cooperative agreements.

The applicant organization may request a DUNS number by telephone at 1-866-705-5711 (toll free) or internet at http:// fedgov.dnb. com/ webform/ displayHomePage.do. The DUNS number will be provided at no charge.

If funds are awarded to an applicant organization that includes sub-recipients, those sub-recipients must provide their DUNS numbers before accepting any funds.

b. System for Award Management (SAM):

The SAM is the primary registrant database for the federal government and the repository into which an entity must submit information required to conduct business as a recipient. All applicant organizations must register with SAM, and will be assigned a SAM number. All information relevant to the SAM number must be current at all times during which the applicant has an application under consideration for funding by CDC. If an award is made, the SAM information must be maintained until a final financial report is submitted or the final payment is received, whichever is later. The SAM registration process can require 10 or more business days, and registration must be renewed annually. Additional information about registration procedures may be found at www.SAM.gov.

c. Grants.gov:

The first step in submitting an application online is registering your organization at www.grants.gov, the official HHS E-grant Web site. Registration information is located at the “Get Registered” option at www.grants.gov.

All applicant organizations must register at www.grants.gov. The one-time registration process usually takes not more than five days to complete. Applicants should start the registration process as early as possible.

Step System Requirements Duration Follow Up 1 Data

Universal Number System

(DUNS)

1. Click on http:// fedgov.dnb.com/ webform

2. Select Begin DUNS search/request process

3. Select your country or territory and follow the instructions to obtain your DUNS 9-digit #

1-2 Business Days

To confirm that you have been issued a new DUNS number check online at (http:// fedgov.dnb.com/ webform) or call https://www.grants.gov/ http://fedgov.dnb.com/webform/displayHomePage.do https://www.sam.gov/portal/public/SAM/ https://grants.gov/ https://www.grants.gov/ https://www.grants.gov/ https://www.grants.gov/ http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform

4. Request appropriate staff member(s) to obtain DUNS number, verify & update information under DUNS number

1-866-705-5711

2 System for Award Management

(SAM)

formerly Central Contractor Registration

(CCR)

1. Retrieve organizations DUNS number

2. Go to www.sam.gov and designate an E-Biz POC (note CCR username will not work in SAM and you will need to have an active SAM account before you can register on grants.gov)

3-5 Business Days but up to 2 weeks and must be renewed once a year

For SAM Customer Service Contact https://fsd.gov/ fsd-gov/ home.do Calls:

866-606-8220

3 Grants.gov 1. Set up an individual account in Grants.gov using organization new DUNS number to become an authorized organization representative (AOR)

2. Once the account is set up the E-BIZ POC will be notified via email

3. Log into grants.gov using the password the E- BIZ POC received and create new password

4. This authorizes the AOR to submit applications on behalf of the organization

Same day but can take 8 weeks to be fully registered and approved in the system (note, applicants

MUST

obtain a

DUNS

number and

SAM

account before applying on grants.gov)

Register early!

Log into grants.gov and check AOR status until it shows you have been approved

2. Request Application Package Applicants may access the application package at www.grants.gov.

3. Application Package Applicants must download the SF-424, Application for Federal Assistance, package associated with this notice of funding opportunity at www.grants.gov. If Internet access is not available, or if the online forms cannot be accessed, applicants may call the CDC OGS staff at 770-488- 2700 or e-mail OGS ogstims@cdc.gov for assistance. Persons with hearing loss may access CDC telecommunications at TTY 1-888-232-6348.

4. Submission Dates and Times http://www.sam.gov https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do https://www.grants.gov mailto:ogstims@cdc.gov

If the application is not submitted by the deadline published in the NOFO, it will not be processed. Office of Grants Services (OGS) personnel will notify the applicant that their application did not meet the deadline. The applicant must receive pre-approval to submit a paper application (see Other Submission Requirements section for additional details). If the applicant is authorized to submit a paper application, it must be received by the deadline provided by

OGS.

a. Letter of Intent Deadline (must be emailed or postmarked by) Due Date for Letter of Intent: 03/30/2018

b. Application Deadline Due Date for Applications: 05/16/2018 , 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov. If Grants.gov is inoperable and cannot receive applications, and circumstances preclude advance notification of an extension, then applications must be submitted by the first business day on which grants.gov operations resume.

Date for Information Conference Call An informational call for potential applicants will take place March 29, 2018 at 2:00 p.m. U.S.

Eastern Time, Toll-Free: 855-644-0229, Conference ID: 4434827.

5. CDC Assurances and Certifications All applicants are required to sign and submit “Assurances and Certifications” documents indicated at http://wwwn.cdc.gov/ grantassurances/ (S(mj444mxct51lnrv1hljjjmaa)) /Homepage.aspx.

Applicants may follow either of the following processes:

Complete the applicable assurances and certifications with each application submission, name the file “Assurances and Certifications” and upload it as a PDF file with at www.grants.gov

Complete the applicable assurances and certifications and submit them directly to CDC on an annual basis at http://wwwn.cdc.gov/ grantassurances/ (S(mj444mxct51lnrv1hljjjmaa))/ Homepage.aspx

Assurances and certifications submitted directly to CDC will be kept on file for one year and will apply to all applications submitted to CDC by the applicant within one year of the submission date.

Duplication of Efforts Applicants are responsible for reporting if this application will result in programmatic, budgetary, or commitment overlap with another application or award (i.e. grant, cooperative agreement, or contract) submitted to another funding source in the same fiscal year.

Programmatic overlap occurs when (1) substantially the same project is proposed in more than one application or is submitted to two or more funding sources for review and funding consideration or (2) a specific objective and the project design for accomplishing the objective https://www.grants.gov http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx https://www.grants.gov http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx are the same or closely related in two or more applications or awards, regardless of the funding source. Budgetary overlap occurs when duplicate or equivalent budgetary items (e.g., equipment, salaries) are requested in an application but already are provided by another source.

Commitment overlap occurs when an individual’s time commitment exceeds 100 percent, whether or not salary support is requested in the application.