oppHRSA-18-075-cfda93.877-cidHRSA-18-075-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Maternal and Child Health Bureau Division of Maternal and Child Health Workforce Development

Developmental-Behavioral Pediatrics Training Program

Funding Opportunity Number: HRSA-18-075

Funding Opportunity Type(s): New, Competing Continuation Catalog of Federal Domestic Assistance (CFDA) Number: 93.877

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2018

Application Due Date: February 20, 2018

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

Deadline extensions are not granted for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: December 21, 2017

Rita Maldonado, MPH Project Officer, Division of MCH Workforce Development E-mail: rmaldonado@hrsa.gov Telephone: (301) 443-3622 Fax: (301) 443-4842

Authority: Section 399BB(e)(1) of the Public Health Service Act (42 U.S.C. § 280i-1(e)(1)), as amended by the Autism CARES Act of 2014 (Pub. L. 113-157) mailto:rmaldonado@hrsa.gov

HRSA-18-075 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) is accepting applications for the fiscal year (FY) 2018 Developmental- Behavioral Pediatrics (DBP) Training Program. The purpose of this program is to enhance the behavioral, psychosocial, and developmental components of pediatric care by supporting DBP fellowship programs to prepare DBP fellows for leadership roles as teachers, investigators, and clinicians and to provide pediatric practitioners, residents, and medical students, with essential biopsychosocial knowledge and clinical expertise.

This will result in advancing the field by training health care professionals to use valid and reliable screening and diagnostic tools, in addition to providing evidence-based interventions for children with autism spectrum disorder (ASD) and other developmental disabilities (DD).

The FY 2018 President’s Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner. You should note that this program may be cancelled prior to award recommendations.

Funding Opportunity Title: Developmental-Behavioral Pediatrics

Training Program Funding Opportunity Number: HRSA-18-075 Due Date for Applications: February 20, 2018 Anticipated Total Annual Available FY18 Funding:

$1,906,150 (includes $35,000 for grantee meeting to be determined after award)

Estimated Number and Type of Award(s): Up to 10 grants Estimated Award Amount: Up to $187,115 per year Cost Sharing/Match Required: No Project Period/Period of Performance: July 1, 2018 through June 30, 2023

(5 years) Eligible Applicants: Per § 399BB(e)(1)(A) of the Public Health

Service Act, public or nonprofit agencies, including institutions of higher education, are eligible to apply.

See Section III-1 of this notice of funding opportunity (NOFO), formerly known as the funding opportunity announcement (FOA), for complete eligibility information.

Application Guide

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

HRSA-18-075 ii instructed in this NOFO to do otherwise. A short video explaining the Application Guide is available at http://www.hrsa.gov/grants/apply/applicationguide/.

Technical Assistance

HRSA has scheduled the following technical assistance webinar:

Webinar

Day and Date: Monday, January 8, 2018 Time: 2 p.m. – 3 p.m. ET Call-In Number: 1-888-946-3803 Participant Code: 1492777 Weblink: https://hrsa.connectsolutions.com/dbp_training/ Playback Number: 1-866-410-5848 Passcode: 3622 http://www.hrsa.gov/grants/apply/applicationguide/ https://hrsa.connectsolutions.com/dbp_training/

HRSA-18-075 iii

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Program-Specific Forms

vi. Attachments

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

SYSTEM FOR AWARD MANAGEMENT

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 AND OTHER PRE-AWARD ACTIVITIES

4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

IX. TIPS FOR WRITING A STRONG APPLICATION

APPENDIX A: APPLICABLE STANDARDS FOR USING GRANT FUNDS TO SUPPORT

TRAINEES/FELLOWS

APPENDIX B: DBP TRAINING PROGRAM LOGIC MODEL

APPENDIX C: KEY ELEMENTS OF COLLABORATIVE OFFICE ROUNDS

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I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for the Developmental-Behavioral Pediatrics (DBP) Training Program. The purpose of the DBP Training Program is to enhance the behavioral, psychosocial, and developmental components of pediatric care by supporting DBP fellowship programs to train health care professionals to use valid and reliable screening and diagnostic tools, in addition to providing evidence-based interventions for children with autism spectrum disorder (ASD) and other developmental disabilities (DD).

Specific aims of the program are to support DBP fellowship programs to prepare fellows for leadership roles as teachers, investigators, and clinicians, and provide other trainees—including pediatric practitioners, residents, and medical students—with biopsychosocial knowledge and clinical expertise, including with ASD/DD. Awardees should ensure trainees in this program:

1. Receive an appropriate balance of academic, clinical, and community opportunities;

2. Demonstrate a capacity to evaluate, diagnose or rule out, develop, and provide evidence-based interventions to individuals with ASD/DD;

3. Demonstrate an ability to use a family-centered approach;

4. Are culturally competent; and

5. Are ethnically diverse.1

“Fellowships” refer to non-degree-related training and “traineeships” refer to degree-related training. As used elsewhere the term "trainee" is generic. Appendix A:

Applicable Standards for Using Grant Funds to Support Trainees/Fellows defines trainees and fellows and provides guidelines for support. To be considered a long-term trainee, the trainee must complete 300 or more hours of DBP leadership, clinical, and didactic training.

2. Background

This training program is authorized by Section 399BB(e)(1) of the Public Health Service Act (42 U.S.C. § 280i-1(e)(1)), as amended by the Autism CARES Act of 2014 (Pub. L.

113-157). The “Purpose” section of this statute authorizes HRSA to increase awareness, reduce barriers to screening and diagnosis, promote evidence-based interventions and train professionals to utilize valid and reliable screening tools to diagnose or rule out and provide evidence based interventions for children with ASD/DD. See section 399BB(a) of the Public Health Service Act (42 U.S.C. § 280i-1(a).

1 For the purposes of this notice of funding opportunity, grantees will meet the objective of ethnic diversity through recruitment of racially and ethnically diverse trainees. See Project Narrative, Methodology, Trainee Recruitment and Retention for additional information.

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Need for the DBP Training Program

Children’s developmental-behavioral health

Nationally, 26 percent of children are at moderate or high risk of developmental or behavioral problems and one in 68 children aged 8 has been diagnosed with ASD.2,3 However, there is an unmet need for developmental pediatric evaluations for diagnosis and treatment due to a shortage of trained providers.4 As of 2016, only 775 pediatricians were ever certified by the American Board of Pediatrics as DBPs, resulting in a national average of 109,427 children per DBP. Furthermore, there are significant geographic disparities in DBP with a range of one DBP per 23,307 children in one state to one per 456,248 in another and three states lacking even one DBP.5

Between 2001 and 2011 there was a 21 percent increase in neurodevelopmental or mental health conditions among children under 18 years old.6 The shortage of trained subspecialty providers and insufficient training in DBP of general pediatricians results in an unmet need for developmental pediatric evaluations for diagnosis and treatment.7,8 This likely contributes to the average age of ASD diagnosis of greater than age 4, even though children can be diagnosed as early as age 2.4

Addressing mental health conditions in childhood can play a key role in preventing risky health behaviors and chronic conditions in adulthood. This is particularly true for children with ASD who experience more adverse childhood experiences (ACES) than children without ASD, particularly among lower income families,9 as well as high rates of mental and behavioral health comorbidities, such as ADHD.10

2 Child and Adolescent Health Measurement Initiative (2013). “Risk of Developmental or Behavioral Problems State Ranking Map.” Available at www.childhealthdata.org. Accessed 9/15/17.

3 Christensen DL, Baio J, Braun KV, et al. (2016) Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. MMWR Surveill Summ. 65(No. SS-3):1–23.

4 Autism Spectrum Disorder: Data and Statistics. https://www.cdc.gov/ncbddd/autism/data.html. Accessed 9/15/17.

5 American Board of Pediatrics Inc., 2016-2017. Pediatric Physicians Workforce Data Book.

https://www.abp.org/sites/abp/files/pdf/pediatricphysiciansworkforcebook2016-2017.pdf

6 Houtrow AJ, Larson K, Olson LM, Newacheck PW, Halfon N. (2016) Changing Trends of Childhood Disability, 2001 – 2011. Pediatrics 134: 530-8.

7 Jimenez ME, et. al. (2017) Access to Developmental Pediatrics Evaluations for At-Risk Children. J Dev Behav Pediatr. 1-7.

8 Boat TF, et al. (2016) Workforce Development to Enhance the Cognitive, Affective, and Behavioral Health of Children and Youth: Opportunities and Barriers in Child Health Care Training. Discussion Paper, National Academy of Medicine, Washington DC. https://nam.edu/wp-content/uploads/2016/11/Workforce-Development-to-Enhance-the-Cognitive-Affective-and-Behavioral- Health-of-Children-and-Youth.pdf

9 Kerns CM, Newschaffer CJ, Berkowitz S, Lee BK. (2017) Brief Report: Examining the Association of Autism and Adverse Childhood Experiences in the National Survey of Children’s Health: The Important Role of Income and Co-occurring Mental Health Conditions. J Autism Dev Discord 47:2275-81.

10 Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G. (2008). Psychiatric Disorders in Children with Autism Spectrum Disorders: Prevalence, Comorbidity, and Associated Factors in a Population-derived Sample. J of the American Academy of Child and Adolescent Psychiatry, 47: 921– 29.

https://www.cdc.gov/ncbddd/autism/data.html https://www.abp.org/sites/abp/files/pdf/pediatricphysiciansworkforcebook2016-2017.pdf https://nam.edu/wp-content/uploads/2016/11/Workforce-Development-to-Enhance-the-Cognitive-Affective-and-Behavioral-Health-of-Children-and-Youth.pdf https://nam.edu/wp-content/uploads/2016/11/Workforce-Development-to-Enhance-the-Cognitive-Affective-and-Behavioral-Health-of-Children-and-Youth.pdf https://nam.edu/wp-content/uploads/2016/11/Workforce-Development-to-Enhance-the-Cognitive-Affective-and-Behavioral-Health-of-Children-and-Youth.pdf

HRSA-18-075 3

Access to care for underserved

A lack of trained providers reduces access to care for children and youth with complex disabilities like ASD/DD and their families. Access to adequate health care is a significant problem for children with special health care needs, but is even more pronounced for those with ASD.11 Caregivers of children with ASD report issues accessing services, such as inadequate insurance coverage, difficulty using services, lack of a usual source of care, as well as lower quality of care such as lack of shared decision making and lack of care coordination.12 Further disparities in access to care can be found when looking by race and ethnicity, gender, language, and geography.13

Prevalence of ASD among non-Hispanic white children (15.5 per 1,000) is significantly higher than children who are non-Hispanic black (13.2 per 1,000), Asian/Pacific Islander (11.3 per 1,000), and Hispanic (10.1 per 1,000).3 A later age of first evaluation for non- Hispanic black and Hispanic children also points to disparities by race and ethnicity.

These disparities may be due to barriers in accessing services, such as services not available in the family’s primary language, limited cultural and linguistic competence among providers and health systems, lack of awareness, and stigma.

According to one study, wait-time for developmental pediatric evaluations at US children’s hospitals was nearly 6 months. This same study also found that many hospitals were unable to respond to a request for an appointment when the caller was speaking Spanish, indicating additional access issues for non-English speakers.7

Gender differences in the diagnosis of ASD with boys, being 4.5 times more likely to be diagnosed with ASD than girls, indicates a need for increased and earlier identification of ASD among girls. Furthermore, girls who are diagnosed with ASD have higher rates of co-occurring intellectual disability, suggesting that many girls with ASD go undiagnosed.3

Geography also impacts the access to care for both diagnostic and treatment services.

This is evident by the variability in age of identification of ASD by state.14 Rural communities also face disparities due to various factors such as distance to subspecialists and a lack of available services.15

11 Kogan et al, (2008) A National Profile of the Healthcare Experiences and Family Impact of Autism

Spectrum Disorder among Children in the United States, 2005 – 2006. Pediatrics 122(6):e1149-58.

12 Vohra R, Madhavan S, Sambamoorthi U, St. Peter C. (2014) Access to Services, Quality of Care, and

Family Impact for Children with Autism, Other Developmental Disabilities, and Other Mental Health Conditions. Autism 18(7): 815-826.

13 Liptak et al. (2008) Disparities in Diagnosis and Access to Health Services for Children with Autism:

Data from the National Survey of Children's Health Journal of Developmental and Behavioral Pediatrics 29(3):152-60.

14 Shattuck PT. (2009). The Timing of Identification among Children with an Autism Spectrum Disorder:

Findings from a Population-Based Surveillance Study. Am Acad Child Adolesc Psychiatry. 48(5): 474– 483.

15 Antezana L, Scarpa A, Valdespino A, Albright J, Richey JA. (2017) Rural Trends in Diagnosis and Services for Autism Spectrum Disorder. Frontiers in Psychology. 8:1-5.

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Training

Increased developmental and behavioral health training is necessary at multiple levels, including in undergraduate medical education, residency programs, and subspecialty fellowships. While a 1-month—or 200-hour—experience in DBP is required by the American Board of Pediatrics during the pediatric residency,16 surveys of practicing pediatricians indicate that they feel underprepared in these areas.17,18

Additional training in DBP is available for those interested in pursuing a 3-year subspecialty fellowship resulting in board certification. Increases in certified DBPs able to diagnose ASD/DD and provide effective treatment and interventions is a real need given the wait-time and access to care issues described. DBPs also work with the wider population as consultants to the systems of care, such as state Title V and other MCH agencies, and as researchers. Finally, because each pediatric residency program is required to have at least one faculty member who is certified in DBP, they also serve as faculty for medical schools.16

The DBP Training Program aims to increase the number of certified DBPs and support training in DBP for current and future pediatric practitioners. In FY 2015, the DBP Training Program prepared 50 long-term trainees, 441 medium-term trainees, and 2,454 short-term trainees to serve children with developmental and behavioral needs. Of the long-term trainees, over 22 percent were from underrepresented racial groups and 12 percent were Hispanic. These programs are supported by 136 DBP faculty members, representing 19 disciplines, to mentor fellows using innovative clinical and didactic curricula. They also reached 29,015 practicing providers through 519 continuing education events. All ten programs reported collaborating with state Title V (MCH) agencies or other MCH-related programs on over 177 activities in areas of service, training, continuing education, technical assistance, product development, and research. Illustrating their broad influence on the field, faculty, staff, and fellows successfully published 238 peer reviewed journal articles and 623 other documents and presentations.

16 Accreditation council on Graduate Medical Education. (2017) ACGME Program Requirements for

Graduate Medical Education in Pediatrics.

http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/320_pediatrics_2017-07- 01.pdf?ver=2017-06-30-083432-507. Accessed September 15, 2017.

17 Horwitz SM, et al. (2015) Barriers to the Identification and Management of Psychosocial Problems:

Changes from 2004 to 2013. Academic Pediatrics 2015:613-20.

18 McMillan JA, Land M, Leslie LK. (2017) Pediatric Residency Education and the Behavioral and Mental Health Crisis: A Call to Action. Pediatrics. 139(1).

http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/320_pediatrics_2017-07-01.pdf?ver=2017-06-30-083432-507 http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/320_pediatrics_2017-07-01.pdf?ver=2017-06-30-083432-507

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II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New, Competing Continuation

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $1,906,150 (includes $35,000 for grantee meeting to be determined after award) to be available annually to fund 10 recipients. You may apply for a ceiling amount of up to $187,115 total cost (includes both direct and indirect, facilities and administrative costs) per year. The FY 2018 President’s Budget does not request funding for this program. The actual amount available will not be determined until enactment of the final FY 2018 federal appropriation. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner. The project period is July 1, 2018 through June 30, 2023 (5 years). Funding beyond the first year is dependent on the availability of appropriated funds for the DBP Training Program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the federal government.

Five recipients awarded funds under this competition will be required to plan to develop and convene the DBP Training Program national grantee meeting during one of the years of the project period in the amount of $35,000, pending availability of funds.

HRSA will provide funds on a rotating basis to one recipient each year to host this meeting. While only five grantees will host the meeting, all applicants should include a brief plan for fulfilling this responsibility along with the statement of willingness and capability. Internal planning for the annual meeting must remain consistent with a budget of $35,000, applicants must not include these annual meeting costs in the overall budget request. The budget must not exceed $187,115 per year, as annual meeting supplemental funding will not be finalized until post-award.

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

The indirect cost rate for all MCH training programs is capped at 8 percent of modified total direct costs (MTDC) exclusive of tuition and related fees, direct expenditures for equipment, and subawards in excess of $25,000 (45 CFR § 75.414 Indirect (F&A) costs).

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

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III. Eligibility Information

1. Eligible Applicants

Per § 399BB(e)(1)(A) of the Public Health Service Act, public or nonprofit agencies, including institutions of higher education are eligible to apply.

For the purposes of this NOFO, an “institution of higher education" is defined as any college or university accredited by a regionalized body or bodies approved for such purpose by the Secretary of Education, and any teaching hospital which has higher learning among its purposes and functions and which has a formal affiliation with an accredited school of medicine and a full-time academic medical staff holding faculty status in such school of medicine.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA will consider any application that exceeds the ceiling amount non-responsive and will not consider it for funding under this notice.

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

NOTE: Multiple applications from an organization are not allowable.

If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates) an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov. You must use the SF- 424 Research and Related (R&R) application package associated with this NOFO following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

Effective December 31, 2017 - You must use the Grants.gov Workspace to complete the workspace forms and submit your application workspace package. After this date, you will no longer be able to use PDF Application Packages.

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

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HRSA recommends that you supply an email address to Grants.gov on the grant opportunity synopsis page when accessing the notice of funding opportunity (NOFO) (also known as “Instructions” on Grants.gov) or application package. This allows Grants.gov to email organizations that supply an email address in the event the NOFO is changed and/or republished on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note you are ultimately responsible for reviewing the Find Grant Opportunities page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

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

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

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 80 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO.

Standard OMB-approved forms that are included in the application package do not count in the page limitation. Biographical sketches do count in the page limitation.

Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

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

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) The prospective recipient certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

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

3) Where the prospective recipient is unable to attest to the statements in this certification, an explanation shall be included in Attachment 8: Other Relevant Documents.

http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html http://apply07.grants.gov/search/spoExit.jsp?p=search-grants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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

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

Section 201 of the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 (PAHPRA), Public Law 113-5 amends section 319 of the Public Health Service (PHS) Act to provide the Secretary of the Department of Health and Human Services (HHS) with discretion to authorize the temporary reassignment of state, tribal, and local personnel during a declared federal public health emergency upon request by a state or tribal organization. The temporary reassignment provision is applicable to state, tribal, and local public health department or agency personnel whose positions are funded, in full or part, under PHS programs and allows such personnel to immediately respond to the public health emergency in the affected jurisdiction. Funds provided under the award may be used to support personnel who are temporarily reassigned in accordance with section 319(e). This authority terminates September 30, 2018. Please reference detailed information available on the Assistant Secretary for Preparedness and Response (ASPR) website via http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx.

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

i. Project Abstract See Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

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

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

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

Briefly describe the purpose of the proposed project. State concisely the importance of the project by relating the specific objectives to the potential of the project to meet the purposes of the grant program described in Section I.1.

Purpose of this NOFO.

http://www.phe.gov/Preparedness/legal/pahpa/section201/Pages/default.aspx http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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

Outline the needs of the community and organization. Use and cite demographic data whenever possible to support the information provided.

• Document clearly the needs related to services and systems of care for individuals with neurodevelopmental and other related disabilities, including

ASD.

Describe and document the target population and its unmet health needs. This includes describing the social determinants of health and health disparities impacting the population or communities served. Consider disparities associated with a broad range of factors in assessing unmet health needs, including but not limited to race; ethnicity; gender identity; sexual orientation; religion; geography;

socioeconomic status; mental health; cognitive, sensory, or physical disability;

age; primary language; and health literacy; or other characteristics historically linked to discrimination or exclusion.

• Discuss any relevant barriers in the service area that the project seeks to overcome. This section will help reviewers understand the community and/or organization that you will serve with the proposed project.

• Evaluate critically the national, regional, state, and local demand for the training, and specifically identify issues the project will address and gaps that the project is intended to fill.

METHODOLOGY -- Corresponds to Section V’s Review Criterion(a) (2) Response

Respond to the provisions in Section 399BB of the Public Health Service Act (42 U.S.C. § 280i-1, as amended by the Autism CARES Act of 2014 (Pub. L. 113-157) (hereafter referred to as Autism CARES or the Autism CARES Act of 2014) to increase awareness of ASD/DD and reduce barriers to screening and diagnosis by training professionals to utilize appropriate tools and interventions.

Propose methods that you will use to address the stated needs and meet each of the program requirements and expectations described in this NOFO. Describe methods to recruit pediatricians to complete a 3-year DBP fellowship (long-term trainees). Describe efforts to increase the diversity of the trainees and, ultimately, the developmental-behavioral workforce. Describe plans to develop and/or update curriculum, as needed, and to include self-advocates and family members of children with ASD/DD as partners to enhance patient-centered and family-centered care principles into the DBPs’ training. All fellows must be instructed on ASD/DD systems of care and services with particular emphasis on how to diagnose or rule out ASD/DD.

Describe methods to train medium- and short-term trainees (including medical students, pediatric residents, and pediatric practitioners) to strengthen their ability to assess and address the developmental-behavioral needs of their patients.

Describe development of effective tools and strategies for ongoing staff training, outreach, collaborations, communication, and information sharing/dissemination

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with efforts to involve patients, families, and communities. Describe efforts to support strengthening the systems of care, such as in state Title V agencies.

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

HRSA expects recipients to sustain key elements of their projects, such as strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population.

1) Goals and Objectives

State the overall goal(s) of the project and list the specific objectives that respond to the stated need/purpose for this project. The objectives must be “SMART”:

specific, measurable, achievable, realistic and time-phased.19 These outcomes are the criteria for evaluation of the program.

The DBP Training Program recipients should offer fellows a balance of interdisciplinary learning experiences, including clinical, didactic, mentoring, community-based practicums, research, and peer leadership in addition to required oral and written presentation experiences.

2) Curriculum

The DBP Training Program is designed to support high quality education for health professionals who will advance the field of MCH and enhance systems of care for children (infants through adolescents) with or at-risk of ASD/DD. The educational curricula, in addition to promoting excellence in scholarship and leadership, should emphasize the integration of services supported by states, local agencies, organizations, private providers, and communities. Understanding the multiple influences on the health status of children such as their families, the environment, lifestyle and cultural values, economic, legal and political conditions, and technical advances is vital. By focusing on the importance of health promotion, disease prevention, and the benefits of coordinated health care, families and practitioners can utilize evidence-based interventions and develop creative approaches for reaching the highest quality of life for children and families, particularly among vulnerable groups whose needs are not currently being met.

The curriculum must clearly define how the proposed training program content and structure ensures an adequate base of knowledge and experience.

Programs must develop clear, measurable educational objectives for an interdisciplinary core curriculum, clinical and didactic, with a focus on ASD/DD and incorporate the acquisition of knowledge of:

• All aspects of DBP

• The social environment (e.g., family, community, school)

• Cultural competency

• Patient-centered services

• Family-centered services

19 Logic Model Tip Sheet https://www.acf.hhs.gov/sites/default/files/fysb/prep-logic-model-ts.pdf https://www.acf.hhs.gov/sites/default/files/fysb/prep-logic-model-ts.pdf

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• Medical home

• Life course and social determinants of health

• Interdisciplinary team skills

• Leadership skills (e.g., team-building, conflict resolution)

• Communication skills (e.g., verbal, written)

The curriculum must prepare graduates to assume leadership roles in the development, improvement and integration of systems of care, especially in programs providing maternal and child health services. Such services include those for children with special health care needs, with special emphasis on ASD/DD, in community-based, patient/family-centered settings. Attention to the needs of children living in underserved communities is vital to increasing access to services for those children and families.

The curriculum must include acquisition of in-depth knowledge of the following:

relevant psychosocial and biological sciences, growth and development, injury and disease prevention, and health promotion. The curriculum must include didactic content on the following: intellectual, social, and emotional functioning;

psychological implications of physical illness; the child's environments (including, home, family, school, and community); interviewing children and family members;

screening, assessment and treatment for all developmental domains; screening and treatment of physical, behavioral, and mental health comorbidities; public and private health resources; and formulating management and treatment plans.

The objective reviewers will evaluate projects on the strength of their 3-year fellowship program as described in clear educational objectives, the comprehensiveness of the curriculum, and productivity. The applicant institution must possess current accreditation for certification in DBP by the Accreditation Council for Graduate Medical Education (ACGME) (provide documentation in Attachment 6).

Include an outline of the curriculum, with descriptions of courses, workshops, seminars, and field experiences in Attachment 5. Identify the competencies expected of trainees and the required curriculum, including didactic and experiential components.

Additionally, the curriculum should address the elements of Healthy People 2020 National Health Promotion and Disease Prevention Objectives related to developmental and behavioral health.

a. Clinical Preparation

Training should be based on a comprehensive, exemplary, interdisciplinary clinical services model that is patient-centered, family-centered, and culturally and linguistically competent. Focus must be on prevention, early detection, assessment, care coordination, and treatment, including care at home and follow up, of children and youth with an emphasis on ASD/DD. Trainees should demonstrate a capacity to evaluate, diagnose or rule out, develop, and provide evidence-based interventions to individuals with ASD/DD. The intent is to

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increase the number of individuals who are able to provide information and education on ASD/DD and to increase public awareness of developmental milestones.

It is essential for the program to provide a broad range of clinical experiences with all pediatric age groups, in all socioeconomic strata, and in multiple settings (inpatient, outpatient, office-based, community-based and, especially, primary care continuity clinics) emphasizing integration of services. Services should include health promotion, disease prevention and care coordination, as well as diagnosis and treatment of conditions that range from simple to highly complex.

The curriculum must promote the medical home model.

Clinical preparation should be interdisciplinary and involve families, youth, and self-advocates, as appropriate. Programs must identify a mechanism to receive input from families who utilize health services, as well as involve them in the decision making process.

The curriculum must emphasize appropriate content relating to science-based judgment, evidenced-based practice and documentation of quality outcomes and performance within an established plan of care; expansion of the direct service roles to include consultation, collaboration, and supervision; and various service delivery models and approaches.

All fellows are expected to:

• work on the development of clinical communication and teaching skills.

• achieve communication and pedagogical skills appropriate for a variety of professional and community audiences.

• advance administrative and academic skills through assigned administrative/academic responsibility for at least one focused service or teaching activity.

b. Leadership

The curriculum must include content and experiences to foster development of leadership attributes. Leadership training prepares MCH health care professionals to move beyond excellent clinical or health administration to leading in the areas of practice, research, teaching, administration, and academia.

Leadership in the area of policy development relates to the process of translating research to policy and training, as measured in Performance Measure Training 5.

The goal of leadership training is to prepare trainees who have shown evidence of leadership attributes and who have the potential for further growth and development as public health leaders. In order to accomplish this goal, trainees must achieve and excel in a variety of areas outlined in the Maternal and Child Health Leadership Competencies. A complete description of the competencies, including definitions, knowledge areas, and basic and advanced skills for each competence is included at http://leadership.mchtraining.net. Describe clearly how you will incorporate all of the MCH Leadership Competencies into the training http://leadership.mchtraining.net/

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curriculum, including in didactic and experiential components, and how you will measure their attainment.

c. Interdisciplinary Training and Practice

Given the shortage of providers and the complexity of issues among the children seen by DBPs, interdisciplinary practice is vital for DBPs to expand their reach and deepen their care of patients. Interdisciplinary/interprofessional practice provides a supportive environment in which the skills and expertise of team members from different disciplines, including a variety of professionals, MCH populations, and community partners, are acknowledged and seen as essential and synergistic. Input from each team member is elicited and valued in making collaborative, outcome-driven decisions to address individual, community-, or systems-level problems. Promoting interdisciplinary care during training and in practice is vital to meet the various needs of children and their families.

Additionally, promoting a broad understanding of disability is necessary in preparing clinicians to work with this population as is involving individuals who have lived experience with ASD/DD, both personally (self-advocates) and as family members.

The training curriculum must use an interdisciplinary approach to promote strong collaborations with other health professionals during and after training.

Knowledge of interdisciplinary practice will enhance the individual skills needed to be a more successful team member, enhance the quality of care for children, and expand the limited reach of trained developmental and behavioral practitioners.

Interdisciplinary training and practice should include professionals such as nurses, psychologists, child and adolescent psychiatrists, nutritionists, social workers, child neurologists, speech and language pathologists, educators, physical therapists, occupational therapists, and public health professionals. Family members of people with disabilities and self-advocates can also play key roles in interdisciplinary teams through roles such as patient navigation and policy development as well as serving as cultural brokers, when appropriate. You must describe the content and process that will ensure the interdisciplinary training and practice requirement is satisfied.

d. Cultural and Linguistic Competence

Training must be structured on a broad range of exemplary, interdisciplinary, comprehensive services that provide patient-centered and family-centered, coordinated care responsive to the cultural, social, and linguistic diversity of the community. You must demonstrate how the proposed training program will advance the cultural competence of fellows and other trainees, such as through the inclusion of cultural competency training in the curriculum, efforts to advance linguistic competence, administrative procedures, and faculty and staff development. Training should include strategies for approaching differing social, cultural, and health practices of various groups, and the implications of these relative to health status and the provision of health care. Recruiting culturally, racially, and ethnically diverse faculty and trainees is a key component of promoting cultural competence. Instruction on models of disability apart from the

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medical model and the intersection of disability with other experiences, such as race/ethnicity, are an important way to increase cultural competence for professionals serving people with disabilities. Performance Measure Training 2 measures the extent cultural and linguistic competence is integrated into the grant’s policies, guidelines, and training.

Cultural competence is a developmental process that occurs along a continuum and evolves over an extended period. It broadly represents knowledge and skills necessary to communicate and interact effectively with people regardless of differences, helping to ensure that the needs of all people and communities are met in a respectful and responsive way in an effort to decrease health disparities and lead to health equity. Health equity exists when challenges and barriers have been removed for those groups who experience greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender identity;

sexual orientation; age; mental health; cognitive, sensory, or physical disability;

geographic location; or other characteristics historically linked to discrimination or exclusion.

Linguistic competence is the capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities. Linguistic competency requires organizational and provider capacity to respond effectively to the health literacy needs of populations served. The organization must have policy, structures, practices, procedures, and dedicated resources to support this capacity.20

A culturally and linguistically competent program is characterized by:

• Written strategies for advancing cultural competence

• Culturally and linguistically competent policies and practices

• Provision of knowledge and skill building efforts on cultural and linguistic competence for trainees, faculty, and staff

• Research data on populations served according to cultural groupings and historically underserved groups—racial, ethnic, linguistic, disability, etc.

• Faculty and instructors represent diverse backgrounds

• Periodic assessment of trainee, faculty, and staff progress in developing cultural and linguistic competence

Besides teaching concepts of cultural and linguistic competence, the intent is to ensure that project interventions are responsive to the cultural and linguistic needs of special populations, that services are accessible to consumers, and that the broadest possible representation of historically underrepresented groups. In order to ensure access and cultural and linguistic competence, you must demonstrate how projects will involve individuals from populations to be served, 20 Health Resources and Services Administration, Maternal and Child Health Bureau. 2017. Discretionary Grant Performance Measures. https://perf-data.hrsa.gov/mchb/DgisApp/FormAssignmentList/Discretionary_Grant_Performance_Measures_Attachments_B_ _C__and_D.pdf https://perf-data.hrsa.gov/mchb/DgisApp/FormAssignmentList/Discretionary_Grant_Performance_Measures_Attachments_B__C__and_D.pdf https://perf-data.hrsa.gov/mchb/DgisApp/FormAssignmentList/Discretionary_Grant_Performance_Measures_Attachments_B__C__and_D.pdf https://perf-data.hrsa.gov/mchb/DgisApp/FormAssignmentList/Discretionary_Grant_Performance_Measures_Attachments_B__C__and_D.pdf

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including those from historically underrepresented groups, in the planning and implementation of the project.

For additional resources and information, you are encouraged to refer to:

• The National Center for Cultural Competence at https://nccc.georgetown.edu/

• Documenting the Implementation of Cultural and Linguistic Competence, https://mchb.hrsa.gov/training/cultural-competence.asp

• The Curricula Enhancement Module Series created by the National Center for Cultural Competence, please visit https://nccc.georgetown.edu/curricula/resources.html.

• For information on various models of disability, please see Including People with Disabilities Public Health Workforce Competencies, http://www.aucd.org/docs/Competencies%20Draft_VERSION%201.8_updated%20 3.3.16.pdf

Plans for reporting on cultural competency as required in Section VI. 3. Reporting should be described.

e. Family-Centered Care, Patient-Centered Care, and Medical Home

The curriculum must include content about the provision of care that ensures the health and well-being of children and their families through a respectful family-professional partnership. Based on this partnership, family-centered care recognizes the importance of cultural diversity and family traditions; embraces community-based services; promotes an individualized and developmental approach to working with children and families; and ensures all policies, practices, and systems have the family in mind. Family-centered care honors the strengths, expertise, experiences, cultures, and traditions that everyone brings to this relationship. Patient-centered care is “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”21 The American Academy of Pediatrics defines the pediatric medical home as being accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.22 Family-centered, patient-centered, and medical home concepts should be integral to the curriculum to facilitate care transitions and connection to community services, and ensure coordination amongst a wide range of disciplines in practice.

21 Institute of Medicine (IOM). 2001. Crossing the quality chasm: A new health system for the 21st century. Washington D.C.: National Academy Press, 22 National Center for Medical Home Implementation https://medicalhomeinfo.aap.org/Pages/default.aspx https://nccc.georgetown.edu/ https://mchb.hrsa.gov/training/cultural-competence.asp https://nccc.georgetown.edu/curricula/resources.html http://www.aucd.org/docs/Competencies%20Draft_VERSION%201.8_updated%203.3.16.pdf…