oppHRSA-18-112-cfda93.732-cidHRSA-18-112-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce

Division of Nursing and Public Health

Behavioral Health Workforce Education and Training (BHWET) Program –

Supplemental Funding

Funding Opportunity Number: HRSA-18-112 Funding Opportunity Type: Competing Supplement

Catalog of Federal Domestic Assistance (CFDA) Number 93.732

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2018

Application Due Date: July 6, 2018

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

HRSA will not approve deadline extensions for lack of registration.

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

Issuance Date: May 24, 2018

Patsy Cunningham, MA, NCC, LCPC Social Scientist, Behavioral and Public Health Branch, Division of Nursing and Public Health Email: PCunningham@hrsa.gov Fax: (301) 443-0791

Authority: Section 755 of the Public Health Service (PHS) Act, and section 756 of the PHS Act, as amended (42 U.S.C. § 294e and e–1)

HRSA-18-112

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2018 for a competitive supplement to the Behavioral Health Workforce Education and Training (BHWET) Program.

The purpose of this Notice of Funding Opportunity (NOFO) is to provide two-year competitive supplement awards to improve access to quality opioid use disorder (OUD)1 and other substance use disorder (SUD)2 treatment. The program will increase the number of professionals and paraprofessionals trained to deliver behavioral health and primary care services as a part of an integrated, interprofessional team in a HRSA supported health center,3 also referred to in this NOFO as “health center,”4 located in high-need and high demand areas.5 Trainees will address the full scope of a patient’s addiction, including the comprehensive services necessary to successfully treat OUD and other SUD using medication-assisted treatment (MAT).6

The FY 2018 BHWET Competitive Supplement is limited to the HRSA-17-070 award recipients. HRSA will utilize its pre-existing investments in BHWET funded programs and partnering health centers to build and strengthen the nation’s behavioral health workforce through the development of a supportive team-based learning collaborative.

To ensure quality community-based training in high need and high demand areas, BHWET supplement award recipients must develop or substantially expand partnerships with health centers that will provide experiential training to BHWET students.

HRSA will award up to 20 recipients through this NOFO for up to $400,000 for a two-year period of performance. In addition, HRSA may award a total of $10 million through a subsequent Health Center Program supplemental funding announcement to approximately 50 health centers partnering with BHWET supplement awardees.

HRSA has a number of investments targeting OUD and SUD across its bureaus and offices that applicants may be able to leverage. For information on HRSA-supported resources, technical assistance, and training, visit here: https://www.hrsa.gov/opioids.

1 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders Fifth Edition DSM-5. Washington, DC and London, England: American Psychiatric Publishing.

2 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders Fifth Edition DSM-5. Washington, DC and London, England: American Psychiatric Publishing.

3 For the purposes of this funding opportunity announcement, HRSA-supported health centers is used interchangeably with health centers.

4 For the purposes of this funding opportunity announcement, the term “health center” means organizations funded under Section

330(e), (g), (h), and/or (i) of the Public Health Service Act, as amended (Health Center Program award recipients).

5 For purposes of this NOFO high need and high demand areas are identified as sites with a Mental Health Automatic Facility

Health Professional Shortage Areas with a score of 16 or above, that have a County overdose rate that is higher than the national average of 19.8 per 100,000 population (2016 CDC).

6 https://www.samhsa.gov/medication-assisted-treatment https://www.hrsa.gov/opioids

Funding Opportunity Title: Behavioral Health Workforce Education and Training (BHWET) Program

Funding Opportunity Number: HRSA-18-112 Due Date for Applications: July 6, 2018

Anticipated Total Available FY 2018 Funding:

$8,000,000

Estimated Number and Type of Award(s): Up to 20 Competitive Supplements Estimated Award Amount: $400,000 (fully funded at the outset for use over the period of performance) Cost Sharing/Match Required: Cost sharing is required for doctoral programs only if the stipend exceeds $28,352

Period of Performance: September 1, 2018 through August 31, 2020 (2 years)

Eligible Applicants: Eligible applicants are limited to the current 136 Behavioral Health Workforce Education and Training grant recipients funded under HRSA-17-070.

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

Application Guide You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where 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 schedule the following technical assistance webinar to help you understand, prepare, and submit an application for this NOFO. The webinar is scheduled for:

Webinar

Thursday, May 31, 2018 Time: 3:30 – 5 p.m.

Call-in Number: 877-616-0071 Participant Passcode: 953016 Web link:

https://hrsa.connectsolutions.com/bhw_workforce_education_training_opioid_nofo/ Playback Number: 888-203-1112 Passcode: 4942828 http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/ https://hrsa.connectsolutions.com/bhw_workforce_education_training_opioid_nofo/

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. 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

I. Program Funding Opportunity Description

1. Purpose

This Notice of Funding Opportunity (NOFO) solicits applications for Fiscal Year (FY) 2018 competitive supplements to the Behavioral Health Workforce Education and Training (BHWET) Program recipients.

The purpose of this Notice of Funding Opportunity (NOFO) is to provide two-year competitive supplement awards to improve access to quality opioid use disorder (OUD)1 and other substance use disorder (SUD)2 treatment. The program will increase the number of professionals and paraprofessionals trained to deliver behavioral health and primary care services as a part of an integrated, interprofessional team in a HRSA-supported health center3, also referred to in this NOFO as “health center4,” located in high-need and high demand areas5. Trainees will address the full scope of a patient’s addiction, including the comprehensive services necessary to successfully treat OUD and other SUD using medication-assisted treatment (MAT)6.

For purposes of this NOFO, high need and high demand areas are identified by two defined sources:

o County overdose rate where the health center is located is equal to or higher than the national average of 19.8 per 100,000 population7,8 o Mental Health Automatic Facility Health Professional Shortage Areas (HPSA) with a score of 16 or above9

FY 2018 BHWET Competitive Supplement awardees must develop or substantially expand partnerships with health centers4 that will train BHWET students. You may identify potential health center partners at https://findahealthcenter.hrsa.gov/?display=map&zip=.

https://bphc.hrsa.gov/programopportunities/fundingopportunities/behavioral-health-workforce.

Your proposal will address the need for trained behavioral health professionals and paraprofessionals, specifically those that deliver and/or support the treatment of OUD and other SUD including the comprehensive services necessary for successful MAT. Your proposal will also support training in communities demonstrating a high-need and high demand for OUD and other SUD treatment by enhancing partnerships with health centers that will provide experiential training in a behavioral health and primary care integrated, interprofessional team.

HRSA may also award additional supplemental grants to health centers partnering with BHWET supplement awardees. The purpose of the health center supplemental awards is to support the delivery of evidence-based care to health center patients through activities that will also enhance the experiential training offered by health centers in integrated, interprofessional behavioral health and primary care services, and community-based mental health, OUD and other SUD treatment services, including MAT. Health centers will use supplemental funds to improve access to needed mental health and SUD services by enhancing their education infrastructures, delivering quality experiential training, and improving their own integrated, interprofessional behavioral health and primary care teams. The health center supplemental

7 https://www.cdc.gov/nchs/products/databriefs/db294.htm 8 https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates 9 https://datawarehouse.hrsa.gov/tools/analyzers/hpsafind.aspx https://findahealthcenter.hrsa.gov/?display=map&zip https://bphc.hrsa.gov/programopportunities/fundingopportunities/behavioral-health-workforce awards will enhance the health centers’ education infrastructure through such activities as clinical educator training, and hiring or contracting with education specialists and coordinators to develop, organize, and evaluate experiential training curricula. In coordination with the BHWET supplemental awards, the health center supplemental awards will also support the development of didactic curricula, trainee and curricula evaluations, and appropriate supervision. Experiential training will demonstrate integrated, interprofessional, behavioral health and primary care service models through participation in patient visits, health care team meetings, and professional consultations. Ultimately, the health center supplemental awards will help establish and maintain a workforce that effectively addresses pressing behavioral health needs in the health center’s service area.

BHWET and partnering health centers will improve the preparation of behavioral health professionals and paraprofessionals, as well as the effectiveness of faculty, staff, and field supervisors in implementing and teaching the delivery of mental health, OUD and other SUD treatment services. Partnering health centers are expected to experience greater recruitment success and decreased time for new hires to achieve clinical proficiency when hiring BHWET students who trained in health centers or similar organizations. Health centers will benefit from the BHWET awardees’ expertise in promoting health care quality and innovations that support patient-centered medical home principles. Additionally, introducing new behavioral health professionals and paraprofessionals to health center teams may increase access to evidence-based behavioral health services, including MAT for OUD and other SUD. Advancing health centers’ integrated behavioral health-primary care teams will strengthen their business and operations models, which can help retain providers and staff, and ultimately improve their patient outcomes.

Program Requirements for Professional and Paraprofessional Tracks:

1. Train behavioral health professional and paraprofessional trainees to deliver evidence-based behavioral health and primary care services for patients with OUD and other SUD in collaboration with two or more health disciplines as a part of an integrated, interprofessional team in a health center located in high-need and high demand area.

2. Partner with at least one health center that meets the Health Center Requirements listed below and provides experiential training to BHWET students in support of the FY 2018 BHWET Competitive Supplement.

3. Build or leverage partnerships with technical assistance providers with expertise in integrated, interprofessional behavioral health and primary care services, mental health, OUD and other SUD treatment, including MAT, and experiential training.

4. Participate in train the trainer-model exercises that focus on improving the teaching skills of field supervisors and faculty; developing, implementing, and evaluating clinical training curricula; and sustaining clinical training opportunities.

5. Participate in a learning collaborative with other BHWET supplement recipients regularly during the project period, including progress updates and evaluations during and upon completion of the project period ending in August 31, 2020.

Partnering Health Center Requirements You must collaborate with at least one health center to accomplish the following requirements, as documented through a signed Memorandum of Understanding/Agreement (MOU/A) submitted as Attachment 2. For the health center to be eligible, the MOU/A must state that the health center:

1. Provides mental health and SUD services either directly or through formal or written agreement for which the health center pays at the time of application and will throughout the two-year funding period.

2. Has physicians, certified nurse practitioners, and/or physician assistants, on-site or with whom the health center has contracts, who have obtained a Drug Addiction Treatment Act (DATA)10 of 2000 waiver to treat OUD with medications specifically approved by the U.S. Food and Drug Administration (FDA) for that indication.

3. Has patients who received MAT for OUD from a physician, certified nurse practitioner, or physician assistant with a DATA 2000 waiver working on behalf of the heath center in 2017, and will in 2018 and 2019.

4. Will develop, host in academic years 2018-2019 and 2019-2020, and evaluate at least annually experiential rotations for individuals preparing to become social workers, psychologists, counselors, addiction counselors, paraprofessionals, or community workers, and that will teach integrated behavioral health and primary care services, and OUD and other SUD treatment, including MAT.

HRSA will assess the partnering health center’s eligibility by verifying the information provided in the memorandum using Health Center Program operational grant information (e.g., Form 5A11) and Uniform Data System (UDS) report data12. Additional information and technical assistance regarding partnering health centers are available at https://bphc.hrsa.gov/programopportunities/fundingopportunities/behavioral-health-workforce .

2. Background

The BHWET Program is authorized by Sections 755 of the Public Health Service (PHS) Act, and section 756 of the PHS Act, as amended (42 U.S.C. § 294e and e–1).

Opioid misuse and overdose deaths have impacted the lives of individuals and families, crippled communities, and depleted limited resources.13 Emergency departments treat over 1,000 people each day for misusing prescription opioids.14 Over the past seven years, the number of opioid deaths have increased 137 percent, including a 200 percent increase in the rate of overdose deaths involving opioids pain relievers and heroin.15 The effect is especially

10 https://www.samhsa.gov/programs-campaigns/medication-assisted-treatment/legislation-regulations-guidelines#DATA- 11 https://bphc.hrsa.gov/archive/about/requirements/scope/form5aservicedescriptors.pdf.

12 https://bphc.hrsa.gov/datareporting/index.html 13 https://www.jhsph.edu/events/2017/americas-opioid-epidemic/report/2017-JohnsHopkins-Opioid-digital.pdf.

14 Substance Abuse and Mental Health Services Administration. Highlights of the 2011 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. The DAWN Report. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2013.http://www.samhsa.gov/data/2k13/DAWN127/sr127-DAWN-highlights.htm.

15 American Journal of Transplantation, http://onlinelibrary.wiley.com/doi/10.1111/ajt.13776/full https://bphc.hrsa.gov/programopportunities/fundingopportunities/behavioral-health-workforce https://bphc.hrsa.gov/datareporting/index.html http://onlinelibrary.wiley.com/doi/10.1111/ajt.13776/full evident in geographical areas with large rural concentrations of the US, where nonmedical prescription opioid misuse remains a growing public problem.16

On October 26, 2017, the President declared the opioid epidemic a public health emergency.17 HRSA has a unique role in the response to the call for action. HRSA supported health centers provide comprehensive, affordable, quality primary health services in thousands of rural and underserved areas across the country. According to the most recent available data, in 2016, nearly 70 percent of health centers provided opioid and other substance use disorder (SUD) services, and nearly 90 percent provided mental health services.18 Additionally, more than 1,100 substance abuse service professional full time equivalents provided over 1.1 million visits for SUD treatment.18

HRSA training programs, such as the BHWET Program, work to address the growing need for this healthcare workforce by increasing the numbers of adequately prepared behavioral health professionals and paraprofessionals entering and capable of working with high need and high demand areas that treat OUD and other SUD.

Program Definitions A full listing of definitions of key terms relevant to this notice can be found in Section VIII Other Information.

II. Award Information

1. Type of Application and Award

Types of applications sought: Competitive Supplement

HRSA will provide funding in the form of a supplemental award.

2. Summary of Funding HRSA expects approximately $8,000,000 to be available to fund up to 20 awards for a two-year period of performance. Applicants may apply for a ceiling amount of up to $400,000 total cost (includes both direct and indirect, facilities, and administrative costs) for the Professional and Paraprofessional Tracks. The budget period and period of performance are a two-year co-extensive duration, from September 1, 2018 to August 31, 2020. Awards are fully funded at the outset for use over the period of performance.

Indirect costs under training grants to organizations other than federally recognized Native American or American Indian tribes, state, or local governments will be budgeted and reimbursed at eight percent of modified total direct costs rather than on the basis of a negotiated cost agreement, and are not subject to upward or downward adjustment. Direct cost amounts for equipment, tuition and fees, and sub-awards and contracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

16 American Journal of Public Health, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935688/ 17 https://www.whitehouse.gov/briefings-statements/president-donald-j-trump-taking-action-drug-addiction-opioid-crisis/.

18 2016 Uniform Data System Health Center Data available at https://bphc.hrsa.gov/uds/datacenter.aspx?q=tall&year=2016&state

Administration and Management of the Program Up to 50 percent of the supplemental award may be dedicated for the combination of activities to:

1. Engage in training through available technical assistance centers that use the “train the trainer” model focusing on training field supervisors in health centers and faculty from collaborating programs. The intent would be to create an infrastructure of skills, expertise, and support for a behavioral health team in the health center, including DATA waived MAT prescribers;

2. Develop or enhance didactic and experiential training activities in integrated, interprofessional team-based care focusing on treatment of patients with OUD and other SUD; and

3. Provide trainees/interns with participant support costs, including health insurance, travel, attendance at professional conferences, and preparation for licensing exams, licensees, and other support for reasonable allowable trainee-related costs.

Stipend Support Activity for Professional Track At least 50 percent of the award recipient’s overall requested budget for supplemental funds (direct and indirect costs) per year must be used for stipends to trainees in field placement or internships, according to the following guidelines:

• $10,000 per master’s-level trainees (including Advanced Standing); and

• $28,352 per doctoral-level psychiatry, psychology or school psychology, psychiatric nursing and behavioral pediatrics intern per year.

OR

Trainee Support Activity for Paraprofessional Certificate Track At least 50 percent of the award recipient’s overall requested budget for supplemental funds (direct and indirect costs) per year must be used for trainees’ tuition, fees, and supplies. You may request a maximum of $3,000 per trainee to cover support activities (tuition, fees and supplies) for the 12 month period for full-time trainees and for the 24 month period for part-time trainees. Stipends are not allowed for the Paraprofessional Certificate Track.

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

Except as noted throughout, the terms and conditions, funding restrictions, and requirements of the BHWET base award apply to applications and awards made under this competitive supplement.

To support the enhanced experiential training offered by health centers, HRSA will award approximately $10 million in both FY 2018 and FY 2019 to approximately 50 health centers partnering with BHWET supplement awardees. Eligible health centers will be notified via HRSA Electronic Handbooks (EHB) how to submit a complete project work plan, budget, and budget narrative to support the supplement to their Health Center Program operational grant awards (grant number H80CSXXXXX) with $200,000 a year for two years. Health centers may include up to $25,000 for equipment costs to support their educational roles for such items as telemedicine carts/cases, systems, and platforms. See /https://bphc.hrsa.gov/programopportunities/fundingopportunities/behavioral-health-workforce for more information.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants are limited to the current Behavioral Health Workforce Education and Training grant recipients awarded under HRSA-17-070.

2. Cost Sharing/Matching Cost sharing is required for doctoral trainees whose stipend exceeds the stipulated amount in this NOFO of $28,352.

3. Other

Accreditation Applicants must maintain their accreditation throughout the period of performance.

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of $400,000 for the co-extensive duration of the budget period and period of performance non-responsive and will not consider it for funding under this notice.

Deadline 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.

Experiential Training Sites All trainees must be placed at health centers that are aligned with this BHWET supplement, receive the Health Center Program supplemental funding, and meet the criteria of this NOFO.

You must submit as Attachment 4, a description of the health center site(s) where experiential training will occur, as depicted in diagram 1 in the Purpose and Needs section.

Applicants are reminded that receipt of BHWET funds does not, of itself, confer eligibility for the applicant organization, its staff, or school participants for Federal Tort Claims Act (FTCA) coverage under the FTCA Health Center Program or the FTCA Health Center Volunteer Health Professionals (VHP) Program. For more information on these programs, please see https://bphc.hrsa.gov/ftca/index.html.

Memorandum of Understanding/Agreement with Health Centers Eligible applicants must include in their application a MOU/A with at least one health center that will provide experiential training that addresses the purpose of this funding opportunity, should the applicant receive an FY 2018 BHWET supplement award. Applicants are allowed https://bphc.hrsa.gov/programopportunities/fundingopportunities/supplement/ https://bphc.hrsa.gov/programopportunities/fundingopportunities/supplement/ https://bphc.hrsa.gov/programopportunities/fundingopportunities/behavioral-health-workforce https://bphc.hrsa.gov/ftca/index.html to partner with more than one HRSA-supported health center. The memorandum must fully adhere to the instructions provided for Attachment 2.

Applications that present only one health center partner, which HRSA determines to be ineligible (i.e., did not fulfill all health center requirements), will be deemed ineligible for FY 2018 BHWET Competitive Supplement awards. You should confirm that proposed health center partners are current Health Center Program award recipients (grant number H80CSXXXXX), and are able to fulfill the partnering health center requirements. Health centers should provide SUD services, including MAT, directly or through contracts or agreements for which the health center pays. Applicants may identify potential health center partners at https://findahealthcenter.hrsa.gov/?display=map&zip=.

Health centers will be eligible for health center supplemental funding if they: 1) signed an MOU/A submitted through the application of a FY 2018 BHWET Supplement award recipient,

2) meet all of the partnering health center requirements, and 3) submit additional information requested by HRSA to support their supplemental award, to include a complete project work plan, budget, and budget narrative. HRSA will assess the partnering health center’s eligibility by verifying the information provided in the MOU/A using Health Center Program operational grant information (e.g., Form 5A) and UDS report data. Prior to award, HRSA will also assess the partnering health center’s award status. Health centers will not be eligible to receive the health center supplemental funding if they have one or more of the following characteristics at the time of award:

• Conditions related to five or more Health Center Program requirement areas that are in the 60-day phase of Progressive Action.

• Conditions related to one or more Health Center Program requirement area(s) that are in the 30-day phase of Progressive Action.

Multiple Applications Multiple applications are not allowed under this funding opportunity. Only HRSA-17-070 awardees are eligible to apply for this supplemental funding and may only submit one application to supplement your current grant.

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.

Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive.

https://findahealthcenter.hrsa.gov/?display=map&zip

IV. Application and Submission Information

1. Address to Request Application Package

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

HRSA recommends that you supply an email address to Grants.gov on the grant opportunity synopsis page when accessing this NOFO (also known as “instructions” on Grants.gov) or workspace application package. This allows Grants.gov to email organizations in the event HRSA changes and/or republishes the NOFO 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 Applicants 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 SF-424 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 applications in the English language and in 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 20 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (bio sketches), 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 workspace application package do NOT count in the page limitation.

Biographical Sketches do count in the page limitation. 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 https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-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 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 any of the statements in this certification, an explanation shall be included in Attachment 6 Other Relevant Documents.

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

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 Please use FY 2018 BHWET Competitive Supplement as the Project Title. See Section 4.1.ix of HRSA’s SF-424 R&R Application Guide. In addition to these requirements, you must include the following information in the abstract:

• Indicate your HRSA-17-070 grant number listed on your Notice of Award, discipline(s) and track(s) for which you are applying, and the name of your institution/organization or certificate program seeking the HRSA-18-112 supplement;

• The funding amount requested;

• How the proposed project for which funding is requested will be accomplished (i.e., the "who, what, when, where, why and how" of a project);

• Goals and specific measurable objectives of the proposed project; and

• Identify whether the partnering health center site(s) where training will occur is located in:

o County overdose rate where the health center is located is equal to or higher than the national average of 19.8 per 100,000 population o Mental Health Automatic Facility HPSA with a score of 16 or above

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. The Project Narrative should be succinct, self-explanatory and well organized so that reviewers can understand the proposed project. It must address the goals and purpose of the NOFO and the strategies to be used in attaining the goals and meeting the funding notice purpose.

PURPOSE AND NEED -- Corresponds to Section V’s Review Criterion #1

Describe the behavioral health needs of the health center community where the trainees will train in an integrated, interprofessional primary and behavioral health team in a HRSA-supported health center. Include the following information in diagram 1 as Attachment 4 the County overdose rate where the health center is located, and the Mental Health Automatic Facility HPSA score.

https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-rr-guide-v2.pdf

Diagram 1 Site Name Health Center

Address

(EXAMPLE: XX

Main Street, Town, State, Zip code)

Number of

BHWET

trainees trained at health center

Number of trainee hours or hours in rotation

County Overdose

Rate (Provide

Rate)

Mental Health Automatic

Facility HPSA score

Discuss any relevant gaps or barriers in the defined area, including unmet needs of the population and limitations of the current behavioral health system, and how the proposed project plans to ameliorate or overcome them. This section should help reviewers understand the health center community’s behavioral health needs and the health center’s ability to train future providers.

You must discuss:

• Your ability to place behavioral health trainees in the partnering health center(s);

• The behavioral health workforce needs in the local community, including those of the partnering health center(s), and a description of the expertise and training that the BHWET program will provide to health center(s) to address these needs; and

• The regional, state, and local health status indicators related to opioid and substance use, overdose rate, behavioral health including morbidity and mortality statistics, applicable to population served.

RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections — (a)

Work Plan; (b) Methodology/Approach; and (c) Resolution of Challenges—all of which correspond to Section V’s Review Criteria #2 (a), (b), and (c).

In this section, you must describe how you will train the behavioral health professionals and paraprofessionals in an integrated, interprofessional behavioral health and primary care setting specifically in OUD and other SUD treatment to support the effective delivery of MAT.

(a) WORK PLAN -- Corresponds to Section V’s Review Criterion #2 (a).

You must provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope (a sample work plan can be found here:

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.). The work plan must include:

• State goals and objectives that are specific, measurable, achievable, and realistic.

• Describe the activities, timeframes, deliverables, health center(s), and other key partners required to address the Program Requirements and achieve each of the goals and objectives within the period of performance.

• Explain how the work plan is appropriate for the FY 2018 BWHET Competitive Supplement, and how the objective outcomes fit into the two-year period of performance.

• Describe how the collaboration with partnering health center(s) will be used to achieve the objective outcomes.

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

• If funds will be sub-awarded or expended on contracts, describe how your organization will ensure the funds are properly documented.

• Describe how you will maintain appropriate oversight and authority over all contracts for substantive programmatic work.

(b) METHODOLOGY/APPROACH -- Corresponds to Section V’s Review Criterion #2 (b).

You must describe your objectives and proposed activities, and provide evidence for how they link to the project purpose and stated needs. Propose methods that you will use to address the stated needs and meet each of the previously described program requirements and expectations in this NOFO.

You must present a clear plan to address program requirements. Also include how you will:

• Identify the number of individuals who will be trained by partnering health center(s) in academic years 2018-2019 and 2019-2020;

• Recruit individuals who are interested in OUD and SUD training, and place them in partnering health center(s) to receive training in a community-based setting;

• Supervise trainees and support partnering health center(s) using faculty with the appropriate skills and expertise, including the delivery of OUD treatment and MAT services.

IMPACT - This section includes two sub-sections— (a) Evaluation and Technical Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b).

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to Section V’s Review Criterion #3 (a)

You must describe how you will evaluate and document your project’s performance. You must demonstrate evidence that the evaluative measures selected will be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which these can be attributed to the project.

Describe your capacity to collect, validate, and report required data measures such as, but not limited to:

• Number and location of health center sites;

• Number and discipline of individuals trained in OUD and other SUD treatment, including trainees, faculty, and health center staff who completed the health center training component;

• Number of trainees graduated during period of performance;

• Number of trainees who graduated and pursued behavioral health careers serving persons with OUD and other SUD in high need and high demand areas;

• Employment settings of graduates;

• Number of clinical training hours spent on MAT, OUD and other SUD treatment in health centers and other community-based settings as part of the health center training component;

• Number of integrated, team-based care meetings; and

• Number of opioid trainings attended by trainees, field site supervisors and faculty facilitated by a technical assistance center.

(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion #3 (b) You must provide a clear plan for project sustainability after the period of federal funding ends. You are expected to sustain key elements of your grant projects, e.g., training methods or strategies, which have been effective in improving practices. You must, at a minimum:

• Identify other sources of income and/or future funding initiatives that you can use to continue activities begun through this funding, as well as a timetable for when new funding sources will be in place;

• Describe how you will sustain relationships with health centers that provided experiential training and technical assistance providers; and

• Forecast challenges that are likely to be encountered in sustaining the program, and propose solutions to addresses the challenges.

ORGANIZATIONAL INFORMATION, RESOURCES and CAPABILITIES -- Corresponds to Section V’s Review Criterion #4

Succinctly describe your program’s capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project. Provide information on the partnering health center’s mission and structure, scope of current activities, leadership and personnel, quality and availability of facilities, and an organizational chart. Describe how all of these meet the BHWET program requirements and program expectations. Describe how the unique needs of target populations of the health center communities served are routinely assessed and improved.

You must, at a minimum address:

• Partnering health center mission and its congruence with integrated primary care and behavioral health services with a focus on patients with OUD and other SUD;

• Partnering health center commitment to the promotion of a workforce that reflects the population served and provides evidence of recruitment, retention, and training efforts to that end;

• Evidence of the partnering health center’s capacity to provide didactic and experiential training and supervision to trainees;

• Evidence of an adequate staffing plan for the proposed project as Attachment 1;

and

• Evidence of institutional support, e.g., resources and letters of support (commitment to provide financial or in-kind resources, including institutional policy) provided in Attachment 6.

The updated staffing plan and job descriptions for key faculty/staff must be included in Attachment 1 (Staffing Plan and Job Descriptions for Key Personnel). However, the biographical sketches must be uploaded in the SF-424 RESEARCH & RELATED Senior/Key Person Profile form, which can be accessed in the Application Package under “Mandatory.”

Include biographical sketches for persons occupying the key positions, not to exceed TWO pages in length each. In the event that a biographical sketch is included for an identified individual who is not yet hired, please include a letter of commitment from that person with the biographical sketch. Please do not re-submit bio sketches for any individuals included in the base award.

NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, this table provides a crosswalk between the narrative language and where each section falls within the review criteria.

Narrative Section Review Criteria Purpose and Need (1) Purpose and Need

Response to Program Purpose:

(a) Work Plan

(b) Methodology/Approach

(2) Response to Program Purpose

(a) Work Plan

(b) Methodology/Approach

Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

(3) Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

Organizational Information, Resources and Capabilities

(4) Organizational Information, Resources and Capabilities

Budget and Budget Narrative (below)

(5) Support Requested – the budget section should include sufficient justification to allow reviewers to determine the reasonableness of the support requested.

iii. Budget

See Section 4.1.iv of HRSA’s SF-424 R&R Application Guide. Please note: the directions offered in the SF-424 R&R Application Guide may differ from those offered by Grants.gov.

Follow the instructions included in the R&R Application Guide and the additional budget instructions provided below. A budget that follows the R&R Application Guide will ensure that, if the application is selected for funding, you will have a well-organized plan, and by carefully following the approved plan can avoid audit issues during the implementation phase.

Reminder: The Total Project or Program Costs are the total allowable costs (inclusive of direct and indirect costs) incurred by the recipient to carry out a HRSA-supported project or activity. Total project or program costs include costs charged to the award and costs borne by the recipient to satisfy a matching or cost-sharing requirement, as applicable.

Advance planning with health center partners is required to prevent overlap in proposed costs presented on the BHWET and Health Center Program supplement budgets.

The Consolidated Appropriations Act, 2018, Division H, § 202, (P.L. 115-141) states, “None of the funds appropriated in this title, through a grant or extramural mechanism, shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” Please see Section 4.1.iv Budget – Salary Limitation of HRSA’s SF-424 R&R Application Guide for additional information. Note that these or other salary limitations may apply in FY 2018, as required by law.

Indirect costs under training awards to organizations other than state, local or Indian tribal governments will be budgeted and reimbursed at 8 percent of modified total direct costs rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost amounts for equipment, tuition and fees, and sub-grants and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

iv. Budget Justification Narrative See Section 4.1.v. of HRSA’s SF-424 R&R Application Guide. In addition, the Behavioral Health Workforce Education and Training program requires the following:

Professional Track applicants are required to provide a budget with at least 50 percent of a recipient’s overall requested budget (direct and indirect costs) per year dedicated and distributed ONLY as stipends to trainees in internships/field placements, practicums and fellowships.

Paraprofessional Certificate Track applicants are required to provide a budget with at least 50 percent of a recipient’s overall requested budget (direct and indirect costs) per year dedicated and distributed ONLY as tuition, fees and supplies to trainees in a paraprofessional worker certificate program. These costs must be reflected under Section E, participant trainee support costs. Stipends are not allowed for the Paraprofessional Certificate Track.

Participant/Trainee Support Costs: Provide a detailed itemized cost breakdown that lists tuition/fees/health insurance, stipends, travel, subsistence, other, and the number of participants/trainees. Ensure that your budget breakdown separates these trainee costs, and includes a separate sub-total entitled “Total Participant/Trainee Support Costs” which includes the summation of all trainee costs. Trainee Travel costs must clearly describe the purpose for how the travel supports the participants training program. Refer to section 2, summary of funding for more information on program budgetary requirements.

Recipients are reminded that all costs incurred before the issuance of a Notice of Award (NOA), are at the recipient's risk (i.e., HRSA is under no obligation to reimburse such costs if for any reason the recipient does not receive an award or if the dollar amount of the award is less than anticipated and inadequate to cover such costs).

v. Attachments

Please provide the following items in the order specified below to complete the content of the application. Attachments will be counted in page limit. You must clearly label each attachment.

Attachment 1: Staffing Plan and Job Descriptions for Key Personnel (See Section 4.1.vi. of HRSA’s SF-424 R&R Application Guide).

Keep each job description to one page in length as much as is possible. Include the role, responsibilities, and qualifications of proposed project staff. Also, please include a description of your organization’s time keeping process to ensure that you will comply with the federal standards related to documenting personnel costs.

Attachment 2: Memoranda of Understanding with Partnering Health Center

Provide a MOU/A with at least one health center that will fulfill, at a minimum, the stated Partnering Health Center Requirements. MOU/As must:

• Include the health center’s Health Center Program operational grant number

(H80CSXXXXX);

• Be dated and signed by the health center Authorized Representative;

• Address each of the stated Partnering Health Center Requirements; and

• Provide any documents that describe working relationships with other partners.

Documents that confirm actual or pending contracts or other agreements should clearly describe the roles of the contractors and any deliverable.

Additional information concerning the required MOU/A will be provided during the technical assistance webinar.

Attachment 3: Work Plan

Attach the work plan for the project that includes all information detailed in Response to Program Purpose.

Attachment 4: Experiential Training Site/Field Placement Documentation: (Required)

Provide a document with a description of the health center site(s) as depicted in diagram 1 in the Purpose and Need section, the health center site name and address, number of hours per week/rotation that each trainee will participate, the County overdose rate where the health center site is located, and the Mental Health Automatic Facility HPSA score.

Attachment 5: Letters of Support (As Applicable) Provide a letter of support for each organization or department involved in your proposed project. Letters of support must be from someone who holds the authority to speak for the organization or department (CEO, Chair, etc.), must be dated, and must specifically indicate understanding of the project and a commitment to the project, including any resource commitments (in-kind services, dollars, staff, space, equipment, etc.