oppHRSA-19-049-cfda93.926-cidHRSA-19-049-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Maternal and Child Health Bureau Division of Healthy Start and Perinatal Services

Healthy Start Initiative: Eliminating Disparities in Perinatal Health

Funding Opportunity Number: HRSA-19-049

Funding Opportunity Type(s): Competing Continuation and New Catalog of Federal Domestic Assistance (CFDA) Number: 93.926

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date: November 27, 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: September 28, 2018

Benita Baker, MS Chief, West Branch, Division of Healthy Start and Perinatal Services Telephone: (301) 443-0543 Email: MCHBHealthyStart@hrsa.gov

Authority: Public Health Service Act, Title III, Part D, § 330H (42 U.S.C. 254c-8).

mailto:MCHBHealthyStart@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2019 Healthy Start Initiative: Eliminating Disparities in Perinatal Health.

The purpose of this Healthy Start (HS) program is to improve health outcomes before, during, and after pregnancy, and reduce racial/ethnic differences in rates of infant death and adverse perinatal outcomes.

Funding Opportunity Title: Healthy Start Initiative: Eliminating

Disparities in Perinatal Health Funding Opportunity Number: HRSA-19-049 Due Date for Applications: November 27, 2018 Anticipated Total Annual Available FY 2019 Funding:

$95,000,000

Estimated Number and Type of Award(s): Approximately 100 Grants Estimated Award Amount: Up to:

Year 1: $892,500 Years 2-5: $950,000 per year

Funding amounts are subject to the availability of appropriated funds.

Cost Sharing/Match Required: No Period of Performance: April 1, 2019 through March 30, 2024

(5 years) Eligible Applicants: Eligible applicants include any domestic public or private entity. Domestic faith-based and community-based organizations, tribes, and tribal organizations are also eligible to apply.

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 Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf, except where instructed in this NOFO to do otherwise.

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

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Technical Assistance

TA call information will be provided as soon as possible, with at least 1 week advance notice. The TA call information will be provided in a modification to this NOFO and on HRSA’s Healthy Start website https://mchb.hrsa.gov/maternal-child-health-initiatives/healthy-start.

https://mchb.hrsa.gov/maternal-child-health-initiatives/healthy-start https://mchb.hrsa.gov/maternal-child-health-initiatives/healthy-start

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

3. TYPE OF APPLICATION AND AWARD

4. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. 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

APPENDIX A: GLOSSARY OF TERMS

APPENDIX B: RESOURCE LIST

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Healthy Start Initiative: Eliminating Disparities in Perinatal Health program. The purpose of this Healthy Start (HS) program is to improve health outcomes before, during, and after pregnancy, and reduce racial/ethnic differences in rates of infant death and adverse perinatal outcomes.

The HS program provides grants to high-risk communities with infant mortality rates at least 1.5 times the U.S. national average and high rates of other adverse perinatal outcomes (e.g., low birthweight, preterm birth, maternal morbidity and mortality). HS works to reduce the disparity in health status between the general population and individuals who are members of racial or ethnic minority groups.

Beginning in FY 2019, the HS program will serve infants and families for the first 18 months after birth. This is a change from the current program design, which includes support for infants and families up to 2 years after birth. Since the HS program emphasis is on infant mortality/women’s health/perinatal health, this change allows the program to focus resources on these key purposes and associated milestones (e.g., provision of interconception care), while ensuring support for children through critical milestones (e.g., immunization milestones established by American Academy of Pediatrics (AAP)). This change also reflects feedback from current recipients in the field to increase program capacity to serve more pregnant women within the project period and promote healthy pregnancy outcomes. HRSA will continue to ensure collaboration with other programs supporting early childhood (including the HRSA-funded Title V and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programs) to ensure continued support and healthy development for children born to HS participants.

The HS program aims to address its purpose by:

improving access to quality health care and services for women, infants, children, and families through outreach, care coordination, health education, and linkage to health insurance;

strengthening the health workforce, specifically those individuals responsible for providing direct services;

building healthy communities and ensuring ongoing, coordinated, comprehensive services are provided in the most efficient manner through effective service delivery; and promoting and improving health equity by connecting with appropriate organizations.

Success in these aims should lead to reduced infant mortality, improved birth outcomes, improved maternal/family health, improved child health, and reduced disparities in maternal, infant and child health in HS communities.

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HS Program Activities

Applicants shall propose projects that include the following core elements, which reflect input from the field and HRSA’s experience with current and previous HS recipients.

These core elements maintain the HS services that are currently being provided, but clarify the program’s focus on improving infant mortality through a lifecourse approach emphasizing women’s health, family health, and community/population health.

Improve Women’s Health: Activities to improve coverage, access to care, and health promotion and prevention, and health for women before, during, and after pregnancy.

Improve Family Health and Wellness: Activities to improve infant health and development using a two-generation approach. Acknowledging the health of families are interrelated, applicants shall support the parental and community factors that promote family health and wellness, including system coordination/integration, health promotion and prevention, and social support services that protect and advance parental and infant/child health and wellbeing.

Promote Systems Change: Activities to maximize opportunities for community action to address social determinants of health (SDOH), including systems coordination and integration among health and social services, other providers, and key leaders in the community and their states. Applicants shall provide regional and national leadership within the greater HS community and field of maternal and child health (MCH).

Assure Impact and Effectiveness: Activities to conduct ongoing HS workforce development, data collection, Quality Improvement, performance monitoring, and evaluation activities in order to identify best practices, demonstrate implementation of evidence-based practices, and report on results.

Every HS project funded under this notice should serve no less than: 300 pregnant women; 300 infants/children up to 18 months, preconception women, and interconception women (combined); and 100 fathers/male partners affiliated with HS women/infants/children, for a total of at least 700 program participants per calendar year. These targets are based on a review of performance data regarding numbers served by HS recipients with the greatest success in achieving program outcomes.

Targets may be adjusted to reflect available funding.

Failure to meet service numbers may result in restriction of funding, or drawdowns.

2. Background

This program is authorized by the Public Health Service Act, Title III, Part D, § 330H (42 U.S.C. 254c-8).

HS is a community-based program dedicated to reducing disparities in maternal and infant health. Created as a demonstration project in 1991, the program has grown from

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15 pilot sites to a network of 100 HS programs in 37 states and the District of Columbia.

Over its first 25 years, HS evolved from a program focused primarily on improving pregnant women’s access to prenatal care to a program seeking to improve women’s and children’s health from preconception to early childhood, creating the foundation for optimal infant and young child health and development.1 Current HS programs serve women of reproductive age, pregnant women, mothers who have just given birth, and infants and families from birth to the child’s second birthday.2 HS also involves fathers/male partners and supports couples with reproductive life planning.

Approximately four million women give birth each year in the United States.3 While most women have a safe pregnancy and deliver a healthy infant, that is not the experience for all women. Major and persistent racial and ethnic disparities exist for pregnancy-related maternal morbidity and mortality, infant mortality, and other adverse outcomes such as low birthweight and preterm birth.

II. Award Information

1. Type of Application and Award

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

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $95,000,000 to be available annually to fund approximately 100 recipients. You may apply for a ceiling amount of up to: $892,500 for Year 1 and up to $950,000 for each out year, Years 2-5 (includes both direct and indirect, facilities and administrative costs). The actual amount available will not be determined until enactment of the final FY 2019 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 period of performance is April 1, 2019 through March 31, 2024 (5 years). Funding beyond the first year is subject to the availability of appropriated funds for Healthy Start Initiative: Eliminating Disparities in Perinatal Health in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

HRSA plans to award up to 25 grants for projects serving rural communities (as defined below under eligible project area) in an effort to address unique needs and challenges, such as access to care and changing population characteristics. Fewer grants may be funded depending on the number of applications received and the outcome of the

1 https://www.hrsa.gov/advisorycommittees/mchbadvisory/InfantMortality/Meetings/20120710/reflectionsinitiative.ppt 2 Through March 2019. Grants beginning in FY19 will serve children though 18 months of age.

3 National Center for Health Statistics. Retrieved from: https://www.cdc.gov/nchs/fastats/births.htm https://www.hrsa.gov/advisorycommittees/mchbadvisory/InfantMortality/Meetings/20120710/reflectionsinitiative.ppt https://www.cdc.gov/nchs/fastats/births.htm

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Objective Review Committee’s scoring of applications. In addition, HRSA will award no more than six (6) grants per state, and only one (1) project will be funded per project area. Only one (1) application per organization will be accepted under this NOFO.

These factors will allow HRSA to increase the geographic distribution of the HS program and will be taken into consideration in making funding decisions. Additional information about how HRSA will make funding decisions is provided under Section V. 2. (Review and Selection Process) of this NOFO.

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

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include any domestic public or private entity. Domestic faith-based and community-based organizations, tribes, and tribal organizations are also eligible to apply.

You must define both your project area and target population using the criteria below.

Eligible Project Area

You must identify your organization as serving an urban, rural, or other project area. A project area is defined as a geographic community in which the proposed services are to be implemented. A project area must represent a reasonable and logical catchment area, but the defined areas do not have to be contiguous. A map of the proposed project area and a list of zip codes must be included in the application.

Urban – Territory, population, and housing units located within an urbanized area (UA) or an urban cluster (UC), which has: a population density of at least 1,000 people per square mile; and surrounding census blocks with an overall density of at least 500 people per square mile.

Rural – To determine whether the Census tract or County for your proposed project area is defined as a rural area , visit the webpage Rural Health Grants Eligibility Analyzer and enter the project area address. Link:

http://datawarehouse.hrsa.gov/RuralAdvisor/ruralhealthadvisor.aspx?ruralByAddr=1

Other – A project area that does not fit either the urban or rural definitions above, and meets the other criteria provided.

Eligible Target Population

The target population is the population that you will serve within your geographic project area and will determine your eligibility. Your application must clearly identify the project area for which you are applying and the proposed target population within that project area to confirm eligibility. The target population should be the population with the http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 http://datawarehouse.hrsa.gov/RuralAdvisor/ruralhealthadvisor.aspx?ruralByAddr=1

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highest infant mortality rate (IMR) within the project area. The majority of the HS program services and resources should be focused on the target population.

Eligibility Factors Demonstrating Need

HRSA must be able to verify submitted data with the appropriate state/local government agency responsible for vital statistics. In all instances, the IMR (and number of infant deaths) must be the primary statistic used to indicate eligibility, if the data are available.

“Other” area applicants that cannot provide this verifiable data may use the other indicators specified in the second section below. Your application must include data for the eligibility factors in the application’s transmittal letter (Attachment 1) and in the needs assessment section of the submitted application. You should describe the existing racial/ethnic disparities or other perinatal indicators in the needs assessment section of the application.

Applications that do not provide this information, in the manner described within this NOFO, will be considered ineligible and the application will not proceed to the Objective Review Committee.

Your target population within your proposed project area must meet the following criteria using the smallest geographical area with verifiable data—not to be any larger than a combination of counties.

Urban and Rural Communities

Using verifiable 3-year average data for calendar years 2013 through 2015, the proposed project area for communities which meet the urban or rural area definition must meet the following indicators from the list below.

i. The 2013 through 2015 combined 3-year infant mortality rate (IMR, infant deaths per 1,000 live births over 3 years) must be equal to or more than 8.8 deaths per 1,000 live births (1.5 times the national average4) AND there must be 20 or more infant deaths in the target population during the 3-year period, 2013 through 2015.

ii. If the combined 2013 through 2015 number of infant deaths are less than (<)20, then to be eligible the following must be met:

a. The 2013 through 2015 3-year low birthweight (LBW) rate is equal to or more than 12.1 percent (1.5 times the national average5) AND there must be 100 or more LBW births in the target population during the 3-year period, 2013 through 2015.

OR

4 Data Source: United States Department of Health and Human Services (US DHHS), Centers of Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics (DVS). Linked Birth / Infant Death Records 2007-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program, on CDC WONDER On-line Database. Accessed at http://wonder.cdc.gov/lbd-current.html 5 Data Source: United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics, Natality public-use data 2007-2016, on CDC WONDER Online Database, February 2018. Accessed at:

http://wonder.cdc.gov/natality-current.html http://wonder.cdc.gov/lbd-current.html http://wonder.cdc.gov/natality-current.html

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b. The 2013 through 2015 preterm birth (PTB) rate is equal to or more than

14.4 percent (1.5 times the national average) AND there must be 100 or more PTB births in the target population during the 3-year period, 2013 through 2015.

Applicants submitting proposals under other criteria

Using verifiable 3-year average data for 2013 through 2015, the proposed target population for project areas, which meet the “other” area definition, must have at least 1,000 births for the 3-year period AND meet at least three indicators from the list below.

If vital statistics are not available from state/local government agencies, other area applicants can use other verifiable data.

1. Percentage of pregnant women with diabetes is 10.2 percent or more;

2. Percentage of pregnant women who are obese is 39.2 percent or more;

3. Percentage of pregnant women entering prenatal care in the first trimester is less than 38.6 percent;

4. Percentage of births to women who had no prenatal care is 2.4 percent or more; and

5. Percentage of births to women who used tobacco during pregnancy is 10.8 percent or more.

Transmittal Letter Your required transmittal letter, which accompanies your application as Attachment 1, must clearly indicate:

The project area for which you are applying and the proposed target population within that project area confirms eligibility. The target population is the population you will serve and will determine your eligibility. The recipient must direct the majority of their services towards the target population that makes their application eligible.

That the indicator for IMR, LBW, or PTB for the target population is at least 1.5 times the national rate AND meets the number of deaths or births for the period 2013 through 2015 as indicated in the eligibility criteria. No other combination of years, and only a 3-year average, will be accepted to confirm eligibility – any deviation from this will result in an ineligible application.. (You must submit the statement of eligibility as Attachment 1).

Examples of verifiable and acceptable data sources:

1) Centers for Disease Control and Prevention (CDC):

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortalit y.htm

2) Your state’s public health/vital statistics office.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm

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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. HRSA encourages you to apply through Grants.gov using the SF-424 workspace application package associated with this NOFO following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

If you are reading this notice of funding opportunity (NOFO) (also known as “Instructions” on Grants.gov) and reviewing or preparing the workspace application package, you will automatically be notified 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 For Applicants page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the 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 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 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, https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html

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attachments, and letters of commitment and support required in the Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. 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 12: Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 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 Application Guide (including the budget, budget narrative, 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 Application Guide.

You must also identify as serving an urban, rural, or other community project area.

ii. Project Narrative This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, 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) You should briefly describe the purpose of your proposed project. Your application should include a discussion that exhibits a complete expert understanding of the issues related to improving perinatal outcomes, promoting women’s, infant and http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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family health, and the purpose of the program. As an applicant for this notice, you must also state whether you are serving an urban, rural, or other community project area.

NEEDS ASSESSMENT – Corresponds to Section V’s Review Criterion 1 (Need) This section outlines the needs of your community and/or organization. Your target population and its unmet health needs must be described and documented in this section. You should use and cite demographic data whenever possible to support the information provided. While your program cannot deny services to any eligible member of the community, your HS project under this competition may focus its efforts and interventions on a particular subpopulation of your community that exhibits disparities in infant, perinatal or interconception health. Your narrative in this section should help reviewers understand the community that your proposed project will serve.

Your application should provide a clear description of the current status, capacity and needs of your proposed geographic project area and the current perinatal system serving that area. Include demographic and health statistics to demonstrate current prevalent disparities. For comparison to other applications, your application must present data minimally from 2013 through 2015 (3-year average). If data that are more current are available, e.g., 2014 – 2016, you may also include it.

Describe (by race/ethnic origin) the perinatal health indicators including, 3-year averages (2013 through 2015) for live births, infant deaths (under 1 year of age), neonatal and post neonatal mortality rates, as well as the incidence of low birth weight, sudden unexpected infant death (SUID) births to teenagers 18 years and younger, trimester of initiation of prenatal care and adequacy of prenatal care.

Highlight current trends in morbidity, including such areas as birth defects, infant/child abuse and neglect, accidents, HIV, other communicable diseases and other prevalent factor(s) affecting your project area.

Briefly describe the size, demographic characteristics, prevalent norms, and health behaviors of your targeted population(s). You should also include data on poverty status, average education level, employment status, and major industries of employment for women of childbearing age as well as demographics of fathers/male partners.

List the population(s) your HS program will target for your activities to improve women’s health, and infant health and wellness (e.g., all pregnant and interconception women at risk for a poor perinatal outcome, at risk for developmental delay or special health care needs infants and toddlers, other women of reproductive age, fathers/male partners; etc.).

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

Your application should also include a description of any innovative methods that you will use to address the stated needs. As appropriate, include development of effective tools and strategies for ongoing staff training, outreach, collaborations, clear communication, and information sharing/dissemination with efforts to involve

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participants, families and communities. If applicable, include a plan to disseminate reports, products, and/or project outputs so key target audiences receive the project information.

You must also propose a plan for project sustainability after the period of federal funding ends. HRSA expects recipients to sustain key elements of their projects, e.g., strategies or services and interventions, which are effective in improving practices, and those that led to improved outcomes for the target population.

This section of your application should be organized by the following categories:

Improve Women’s Health, Improve Family Health and Wellness, and Promote Systems Change. The HS EPIC Center includes HS resources that may be useful for preparing your application (see Appendix B).

1. Improve Women’s Health

You are expected to use a lifecourse approach6 in delivering services and address the social determinants that impact health outcomes.7 It is critical that you target women who are at highest risk for adverse perinatal health outcomes within your community. Please respond using the corresponding outline numbers under each category (e.g., 1.i., 1.ii., 1.iii…):

a. Access to health insurance to improve women’s health

i. Describe how you will facilitate enrollment in Medicaid or other linkages with the financial supports needed to promote access to clinical health services.

ii. Provide details about how you will train your staff on state eligibility rules.

iii. Describe how your program will increase participant knowledge and awareness of Medicaid or other insurance/health care financing options.

iv. Provide details on the barriers/challenges your organization faces internally, as well as in the community at large, related to health insurance education, enrollment and referrals.

b. Access to health care services for women

a. Describe how your program will conduct and provide outreach and recruitment to women program participants.

b. Explain how your project will utilize community-based outreach to identify high-risk women for enrollment in HS who have such risk factors as prior poor birth outcomes and possess unhealthy behaviors, which can lead to adverse health outcomes.

c. Describe your project’s proposed intake and enrollment process for program participants, including who performs these activities.

i. Explain how your project will conduct comprehensive assessments using the HS standardized tools8.

6 https://mchb.hrsa.gov/training/lifecourse.asp 7 https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health 8 https://healthystartepic.org/healthy-start-implementation/screening-tools/ https://mchb.hrsa.gov/training/lifecourse.asp https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health https://healthystartepic.org/healthy-start-implementation/screening-tools/

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d. Explain how you will use HS assessment and case management information to improve care effectiveness and service coordination (e.g., communication and linkages with primary care providers).

e. Identify and describe any tools your program will use for care coordination/case management, planning and monitoring, in addition to the HS standardized tools.

f. Detail your care coordination/case management process.

g. Discuss how your program will determine differing levels of client risk and the type, timing, duration, and intensity of services matched to the risk levels. Detail the projected number of program participants in the prenatal and interconception periods, as well as each level of risk.

h. Provide details on your approach to promote service coordination and systems integration. Explain how your project will ensure a full range of services is available for women before, during, and after pregnancy.

i. Describe your process for ensuring your HS participants have a medical home.

j. Discuss how your approach will improve access to medical, social, developmental, behavioral, educational, and informal support services.

c. Preventive services and health promotion to improve women’s health

i. Describe how you will promote and track the use of women’s clinical preventive services, including prenatal care, preconception care, family planning, and well-woman visits.

ii. Describe how you will promote and monitor interconception health among high-risk women, including chronic disease management and reduction of reproductive health risks.

iii. Describe how you will provide health promotion and education to improve women’s health,

iv. Describe how you will promote and monitor reproductive life planning, including the tools and staffing approach you will use.

v. Describe how you will augment community-wide health education and promotion in the suggested areas for woman and their partners.

vi. Describe how you will increase provider awareness of best practices in preconception, prenatal care, birth, postpartum, interconception, well-woman care, and reproductive life planning.

vii. Identify evidence-based curricula your program intends to use.

viii. Identify and justify other evidence-based models and approaches proposed for use (e.g., Centering Pregnancy, MIECHV evidence-based home visiting models, Bright Futures guidelines for health supervision).

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d. Collaboration with local, state, and national initiatives that support women’s health

i. Describe how you will connect with local, state, and national MCH initiatives and stay abreast of current guidelines and activities focused on women’s health.

ii. If your program is located within a state that has enrolled in Alliance on Innovation Maternal Health (AIM), describe how you will collaborate with your State’s Perinatal Quality Collaborative and assist in the adoption of the Maternal Safety Bundle(s)9.

iii. Describe how your program will support the Women’s Preventive Services Initiative10 that provides recommendations to update the Women’s Preventive Services Guidelines11 and develop new recommendations.

iv. If your program is located within a state with the Infant Mortality Collaborative Improvement and Innovation Network (IM CoIIN)12, describe how you will support the team topic of reducing infant mortality by addressing SDOH, sudden unexpected infant death, early prenatal care, or preconception health.

v. Describe how your program will support the Ryan White HIV/AIDS Program Part D that provides funding to improve access to family-centered HIV medical care for low income, uninsured, underinsured, and medically underserved women (25 years and older) living with HIV and their infants (up to 2 years of age) exposed to or living with HIV.

See Section VI.3. Reporting for a list of performance measures associated with the Improve Women’s Health approach.

2. Improve Family Health and Wellness

Please respond using the corresponding outline numbers under each category (e.g., 1.i., 1.ii., 1.iii…):

a. Access to health care services for infants and children under 18 months

i. Describe the process for ensuring that infants and children under 18 months have a medical home. Discuss how your project will connect infants and children under 18 months13 to medical care by providing on-site primary health services, if applicable, or assuring linkages to a community provider to provide such services.

b. Prevention and health promotion

i. Describe how you will provide health education and promotion for women, infants, and families for the topics below

9 https://www.acog.org/About-ACOG/ACOG-Departments/Patient-Safety-and-Quality-Improvement/What-is-AIM 10 https://www.womenspreventivehealth.org/ 11 https://www.hrsa.gov/womens-guidelines/index.html 12 https://mchb.hrsa.gov/maternal-child-health-initiatives/collaborative-improvement-innovation-networks-coiins 13 This is a change from the previous period of performance. Beginning in FY19, HS programs will serve infants and children up to 18 months.

https://www.acog.org/About-ACOG/ACOG-Departments/Patient-Safety-and-Quality-Improvement/What-is-AIM https://www.womenspreventivehealth.org/ https://www.hrsa.gov/womens-guidelines/index.html https://mchb.hrsa.gov/maternal-child-health-initiatives/collaborative-improvement-innovation-networks-coiins

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1. Maternal Care – well-woman care; family planning; reproductive life planning; prenatal care; childbirth education; breastfeeding;

postpartum care; oral health; mental health promotion; perinatal depression and anxiety screening, referral, and follow-up;

prevention of substance-exposed pregnancies, including the prevention of fetal alcohol spectrum disorder.

2. Infant Care – well child visits; immunizations; oral health; infant growth and development; safe sleep; nutrition; car and home safety; lead poisoning, and the five domains of child development (physical/motor development, social-emotional development, approaches to learning, language development and cognition, and general knowledge), including the importance of reading to a child to promote early literacy.

3. Family Wellness – effective parenting practices; infant attachment; mental health promotion; healthy weight; smoking and e-cigarette cessation; perinatal transmission, screening, and referral; sickle cell disease screening and referral; sexually transmitted disease prevention(e.g., HIV), screening, and referral; domestic violence screening and follow up; and behavioral health screening, referral and follow up.

ii. Describe any additional health education topics you plan to address.

iii. Describe how your project will conduct social-emotional development screening for child participants. Specify the tool(s) your program will use, intervals for screening, and case management\care coordination approaches to assure completed service of referrals and follow up.

iv. Discuss your program materials, including evidence of effectiveness, cultural and linguistic appropriateness, and other characteristics.

v. Describe how you will augment community-wide health education and promotion for each woman, infant, and family (described above).

c. Behavioral health support and services

i. Describe how your project will conduct screening of female participants for depression and anxiety. Specify the screening tools, intervals for screening, and specific case management\care coordination approaches to assure completed service referrals and follow up.

ii. Describe how your project will conduct screening of female participants for substance use/misuse. Specify the screening tools, intervals for screening, and specific case management\care coordination approaches to assure completed service referrals and follow up.

iii. Describe how your project will use the evidence-based practice of screening, brief intervention, and referral to treatment when conducting standardized screening.

iv. Describe linkages and service coordination activities with mental and substance use disorder treatment behavioral health providers, and recovery support providers (e.g., peer support groups) who may

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improve access to such services. Provide details on proposed activities to increase the availability of these services, if local resources are unavailable.

v. Describe your efforts to integrate, co-locate behavioral health services, as well as facilitating linkages to any tele-behavioral health services in your state or region.

vi. Discuss how you intend to assess and document risks related to toxic stress as part of your case management\care coordination approach.

vii. Describe how you will augment community-wide knowledge, awareness, education, support, and services of toxic stress, adverse childhood experiences (ACEs), trauma-informed care, and parent-child interventions for two-generation impact.

viii. Discuss how you will use partnerships, linkages, and system coordination to increase access to trauma-informed care.

d. Father/partner involvement

i. Discuss how your program will engage and promote fathers/male partners involvement in HS education, activities, services, and events for at least 100 fathers/male partners affiliated with HS women and infants/children annually.

ii. Identify and describe the assessment tools and evidence-based curriculum your program will use with HS fathers/male partners (e.g., 24/7 Dad, Responsible Fatherhood, Family Spirit, Wise Guys, and Nurturing Fathers Program).

iii. Describe your specific activities intended to improve the health, mental health, and resilience of fathers/male partners by supporting healthy relationships between parents/partners, strengthening life skills, and supporting opportunities for self-sufficiency and economic stability of the family.

iv. Discuss how you intend to engage community partners in strategies to encourage paternal involvement in supporting the well-being of HS women and child participants.

v. Describe specific community-based activities intended to improve the health, behavioral health, and resilience of fathers/male partners.

vi. Describe how you intend to involve fathers/male partners across all perinatal phases – preconception, prenatal, postpartum and parenting.

e. Parent education

i. Describe how your program will deliver parenting education, including timing, standardized curricula, tools, staff, and materials proposed for use.

ii. Discuss how your program will promote protective factors such as nurturing and attachment, appropriate limit setting, knowledge of child development, parental resilience, social connections, and concrete support for parents.

iii. Identify and justify your program’s proposed evidence-based models and approaches.

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iv. Describe how your program will include partners of women participants who are co-parenting in parent education, activities and events.

v. Describe how you will collaborate and integrate with other community organizations providing parenting education (e.g., home visiting, Early Head Start, Strengthening Families).

f. Improve service coordination and systems integration for women, their infants and children under 18 months, and their families

i. Describe your approach to service coordination and systems integration.

ii. Describe how your program will ensure significant involvement with MCH activities in your community, in particular Community Health Centers (CHC), other HRSA, and federally-funded investments in your state14.

iii. Describe how you will ensure that your program supports, but does not duplicate MCH activities in the community.

iv. Describe how your program will support coordination and systems integration among health, social services, and other providers in the community to address social determinants, while supporting improved access to these services.

3. Promote Systems Change

Please respond using the corresponding outline numbers under each category (e.g., 1.i., 1.ii., 1.iii…):

a. Community Action Network

i. Provide details on how you will identify/select members of the community action network (CAN), including: type of partner organizations and community members, recruitment and retention plans, racial/ethnic breakdown of membership, management procedures, and participation in review of community assets.

ii. Provide a list of CAN members. For each CAN member include their name and agency or organization represented. Also indicate whether they are state or local government, program participant , community participant, community-based organizations CHCs, private agencies or organizations (not community-based), other service providers, or other partner.

iii. Describe how your program will collaboratively engage partners to develop a common goal and objectives with shared outcomes and facilitate community collaboration, information sharing, and advocacy among this network.

iv. Provide details on how your program will revise, update, and monitor activities, and develop/implement/evaluate the 5-year CAN action plan to address barriers to care and improve the local system of care and/or address SDOH.

14 https://datawarehouse.hrsa.gov/

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v. Describe how your program will convene and facilitate collaborative partnerships to fulfill the approaches of HS. Describe how your program will engage a diverse group of partners who can contribute to shared outcomes that address the environmental and social needs that promote service utilization, and promotes overall health of the target population and/or service area.

vi. Describe your role in other community coalitions, collaboratives, and activities intended to affect systems change with identified priority areas and yearly goals that should be based on a needs assessment.

Reporting on progress will occur annually, along with any revisions to the approved proposal.

vii. Describe how you will provide leadership for the CAN. Provide details on past performance that demonstrate your capacity to lead collaborative community initiatives.

The restrictions on lobbying apply, and none of the activities described in this NOFO should be related to lobbying.

b. Local, State, Regional, and National Leadership

As a HS recipient, you are required to attend regional and national meetings sponsored by the national HS program. These are forums wherein your program can share and learn from others’ HS-related successes, best practices, promising innovations, and lessons. You are also encouraged to share your findings through publications and/or presentations at regional and national MCH and/or public health meetings.

i. Describe the collaboration efforts with others in the community to educate, establish, maintain, and make available a comprehensive perinatal system of care while serving as a leader for state, regional, and/or national action in support of HS and other community/state/regional/national organizations working to improve perinatal outcomes.

ii. Describe how your program will coordinate and align with State Title V Maternal and Child Health Block Grant programs, connect and coordinate with other federally-supported MCH programs and initiatives, and establish linkages with key state and local services and resources.

iii. Discuss how your program will participate in at least one of the following activities: Fetal Infant Mortality Review (FIMR), Maternal Morbidity and Mortality Review (MMMR), or Periodic Periods of Risk

(PPOR).

FIMR: Specify whether your program will participate in an existing FIMR project or develop your own FIMR. Discuss your program’s role and involvement. Identify the community/geographic area of focus; identify community resources/assets; determine the type and number of cases to be reviewed; determine FIMR’s relationship to other types of review; identify and address legal and institutional issues related to the review; establish systems to maintain

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confidentiality and anonymity; establish a system to identify cases;

select data collection and processing methods; designate the appropriate staff; formalize policies and procedures; and build in opportunities for initial and ongoing training.

MMMR: Provide details on how your program will be involved in M M M R , i.e., participate in an existing MMMR project OR develop a new MMMR in your community. Discuss your program’s role, involvement, and the steps you will take to develop a new project, if applicable.

PPOR: Provide details on how your program will: assess community readiness; conduct analytic phases of PPOR; develop strategic actions for targeted population; strengthen existing and/or launch new prevention initiatives; and repeat annually.

iv. Discuss your program’s interest in participating in either the HS

Collaborative Innovation Network (HS COIN) and/or HS Mentoring Program in which recipients must apply through the HS Technical Assistance Center15 to join in these activities. Identify topics for the HS COIN to address.

WORK PLAN -- Corresponds to Section V’s Review Criterion 2 (Response)

Describe the activities or steps that your program will use to achieve each of the objectives proposed during the entire period of performance in the Methodology section. Use a time line that includes each activity and identifies your responsible staff. As appropriate, identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including developing the application.