PKG00250374-instructions.pdf

Centers for Disease Control

Agency for Toxic Substances and Disease Registry

Pediatric Environmental Health Specialty Units (PEHSU)

CDC-RFA-TS19-1901

Application Due Date: 06/26/2019

Pediatric Environmental Health Specialty Units (PEHSU)

CDC-RFA-TS19-1901

TABLE OF CONTENTS

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

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

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-TS19-1901. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Pediatric Environmental Health Specialty Units (PEHSU) C. Announcement Type: New - Type 1 This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https ://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf.

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

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-TS19-1901

E. Assistance Listings (CFDA) Number:

93.161 F. Dates:

1. Due Date for Letter of Intent (LOI): 05/26/2019 Is a LOI: Recommended but not Required

2. Due Date for Applications: 06/26/2019, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

3. Date for Informational Conference Call: N/A

G. Executive Summary:

1. Summary Paragraph:

The Agency for Toxic Substances and Disease Registry (ATSDR) has a mandate to prevent or reduce illness and negative environmental health risks associated with exposure to hazardous substances in the environment. This can best be accomplished by preventing environmental contamination and the potential for exposures. Therefore, educating communities about environmental risk and how to reduce those risks will help to lower negative health outcomes.

Further, preparing primary care clinicians to recognize environmental exposure risks, provide risk reduction screening and/or counseling, and deliver patient care to those at risk of or harm from acute or chronic exposures to hazardous substances in the environment supports ATSDR’s mandate. It will also build health care capacity to assess patient and family environmental exposure risks and reinforce community risk reduction education, and, if needed, aid clinicians https://www.grants.gov https://www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.grants.gov to intervene on illness resulting from exposure to hazardous substances in the environment.

a. Eligible Applicants: Open Competition

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 1

d. Total Period of Performance Funding: $12,500,000

e. Average One Year Award Amount: $2,500,000

f. Number of Years of Award: 5

g. Estimated Award Date: 09/01/2019

h. Cost Sharing and / or Matching Requirements: N Cost sharing or matching funds are not required for this program

Agency for Toxic Substances and Disease Registry (ATSDR) in collaboration with the US Environmental Protection Agency (EPA) has maintained a long-standing relationship in the development and advancement of the Pediatric Environmental Health Specialty Unit (PEHSU) Program, through ongoing cooperative agreements initiated by ATSDR. The PEHSU serves health professionals, community organizations, governmental officials, federal staff, child-care providers, parents, and others having interest in environmental conditions that influence reproductive and pediatric health. Primary focuses of the PEHSU are to: (1) Build the capacity of primary care clinicians to recognize environmental exposure risks, provide risk reduction counseling, and deliver patient care to those at risk of or harm from acute or chronic exposures to hazardous substances in the environment. (2) Integrate environmental health content, placing emphasis on hazardous substances in the environment and related health effects, into pre-service clinical (i.e., medical, nursing, and allied health) course work; and primary care residency programs (i.e., clinicians in pediatrics, family medicine, and obstetrics and gynecology). (3) Increase patient and population awareness of environmental exposure risks and ways to reduce those risks. (4) Provide education and consultative services to community members, clinicians, state and local health departments, appropriate federal programs, and others involved in protecting children and couples of reproductive age from environmental threats. (5) Provide educational and consultative assistance in communities where ATSDR and/or Environmental Protection Agency (EPA) are addressing environmental contamination.

Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview ATSDR, through its Environmental Medicine Program (EMP), purposes to maintain and strengthen the PEHSU network in its role as a leading national source of medical information and consultative advice on environmental conditions that influence human health throughout the vulnerable stages of reproduction and pediatric development. Five interrelated strategies may be beneficial in achieving the short and intermediate outcomes expected from the PEHSU Program.

These strategies are (1) Resources and Tools Development: Build environmental exposure history tools, risk assessment and risk reduction guidance, and clinical information on specific environmental hazardous exposures. (2) Clinical Workforce Development: Determine environmental medicine competencies. Develop content to meet environmental medicine competencies, increase clinician awareness of environmental exposures and risk reduction practices, integrate content into appropriate clinical course work and assess competency attainment. (3) Health Promotion and Education: Identify target populations at risk, provide information, develop and promote actionable skills to undertake risk reduction efforts within the population. (4) Technical Consultative Services: Establish an expert network to provide consultation and technical support, deliver consultative services, develop communication channels with community and clinician audiences, assist in proper use of all related tools. (5) System Change Approaches: Identify process changes needed to integrate and adopt new tools and new clinical practices within clinical settings, recognize and reward tool and practice adoption, evaluate and communicate the benefits accrued from adoption of tools and practices.

This notice of funding opportunity intends to build upon established PEHSU capabilities and to reaffirm and strengthen collaboration between ATSDR, Environmental Protection Agency (EPA), and the PEHSU National Program Office (NPO) recipient that will lead and manage day-to-day operations of the national PEHSU network. The recipient will work collaboratively with each regional PEHSU to strengthen effectiveness of the PEHSU network, meet program goals, and achieve targeted health outcomes.

b. Statutory Authorities This program is authorized under sections 104(i)(14) of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980, as amended by the Superfund Amendments and Reauthorization Act (SARA) of 1986 [42 U.S.C.§9604(i)(14)]

c. Healthy People 2020 Healthy People 2020: This program addresses the “Healthy People 2020” focus area(s) of Educational and Community-Based Programs (ECBP 10.7, 12.4, 13.4, 14.4, 15.4, and 16.4), Environmental Health (EH -23), and Age-Related Life-Stage Objectives for children less than 18 years of age, including place related objectives like safe and healthy schools and healthy built environments. These objectives are available at:

https://www.healthypeople.gov/2020/topics-objectives/topic/environmental-health

d. Other National Public Health Priorities and Strategies This program will be in alignment with CDC priority area-3: Strengthen public health and health care collaboration -- increase the value of health investment by aligning, coordinating, and https://www.healthypeople.gov/2020/topics-objectives/topic/environmental-health integrating public health and health care.

ATSDR Performance Goal, Promoting environmental justice and reduce health disparities associated with environmental exposures.

Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts: The President’s Task Force on Environmental Health Risks and Safety Risks to Children. December 2018. Available at: https://ptfceh.niehs.nih.gov/resources/lead_action_plan_508.pdf

e. Relevant Work The ATSDR PEHSU Program supports PEHSU activities through a cooperative agreement with a national partner. The past funded partners have demonstrated their national outreach and linkage to the clinical community. Serving as the National PEHSU Program Office, these partners have managed funding agreements and lead coordinated efforts, through a network of regional PEHSU, to build clinical capacity within the U.S. primary care system. The focus is to enable primary care clinicians to prevent health effects from environmental exposures, recognize environmentally exposed patients, and provide appropriate patient care or patient referral to specialty services.

The existing regional PEHSU are located in academic medical centers situated in each of the 10 federal regions. The first PEHSU units, established in 1998, have demonstrated strong capability in providing information, education, and consultation services to both lay community individuals and clinical care providers. Over the years, these units have educated more than 460,000 clinicians and clinician trainees and educated nearly 350,000 community members on the health effects from exposure to a wide range of environmental hazards. Additionally, the PEHSU have provided over 12,000 consultations to health professionals, community leaders and community organizations, state and local officials, and both parents and expectant mothers. The PEHSU have addressed exposures arising from air, water and soil pollutants.

The success of the next National PEHSU Program Office will depend on the capabilities of the regional PEHSU. These regional PEHSU regularly teach and mentor the next generation of clinicians and public health professionals. Their expertise builds upon in-depth knowledge of well-studied environmental hazards and their ability to review and translate environmental research finding on emerging contaminants of concern into relevant clinician guidance.

Specifically, their literature assessment allows the PEHSU to translate research findings into useful reproductive and pediatric clinical practice advice as well as community guidance on contaminants of concern. The PEHSU are also skilled in message development and apply evidence-based risk communication skills in presenting information on health risks from environmental exposures. This is especially important in addressing concerns about emerging contaminants and the uncertainty of health impacts associated with early research on emerging contaminants. To achieve the expected outcomes of this NOFO, the combined capabilities of a strong National PEHSU Program Office and the regional network of PEHSU is essential.

2. CDC Project Description

a. Approach https://ptfceh.niehs.nih.gov/resources/lead_action_plan_508.pdf

Bold indicates period of performance outcome.

STRATEGIES and

ACTIVITIES

SHORT-TERM

OUTCOMES

INTERMEDIATE-

TERM

OUTCOMES

LONG-TERM

OUTCOMES

Resources and tools development

Tools translating and communicating environmental health research into clinical practice

Exposure assessment and risk reduction guidelines on hazardous substances

Clinical workforce development

Pre-service clinical education

Residency education

In-service clinical education

Health promotion and education

Clinical and community outreach and education

Promote actionable skills

Clinician awareness:

Increased primary care awareness of environmental medicine practices

Clinical education:

Incorporate environmental health content and environmental medicine practices into:

Undergraduate clinical curriculums

Primary care residency programs

Primary care in-service programs

Clinician adoption of:

Environmental exposure history assessment

Reproductive and pediatric environmental exposures risk

Healthcare system:

Enhanced primary care clinician competency in environmental medicine

Increased primary care system capacity to apply and track environmental exposure assessment and risk reduction practice

Increased recognition and care delivery to patients impacted by environmental exposures

Increased patient awareness of environmental risk reduction behaviors

Routine primary care clinician (e.g., obstetricians, pediatricians, family medicine) delivery of:

Human environment:

Increased early exposure detection and mitigation

Reduced risk of geographic and age-specific environmental exposures within populations

Reduced environmental disease and disability from toxicant exposures within the population within populations to reduce risks to environmental hazards

Technical consultative services

Provide clinical and community consultations

System change approaches

Promote integration of exposure assessment and risk reduction guidelines into clinical delivery systems (e.g., Bright Futures, e-health records and clinical support systems) reduction counseling practices

Anticipatory risk reduction guidance to patients and communities at risk of environmental exposure

Clinical care for patients impacted by exposure to hazardous substances in the environment

i. Purpose The purpose of the PEHSU Program is to serve as a leading national source of medical information and consultative advice on environmental conditions, with emphasis on exposure to hazardous substances in the environment, that influence human health throughout the vulnerable stages of reproduction and pediatric development. The PEHSU serves health professionals, community organizations, governmental officials, federal staff, child-care providers, parents, and others having interest in environmental conditions that influence reproductive and pediatric health. Primary focuses of the PEHSU are to: (1) Build the capacity of primary care clinicians to recognize environmental exposure risks, provide risk reduction counseling, and deliver patient care to those at risk of or harm from acute or chronic exposures to hazardous substances in the environment. (2) Integrate environmental health content, placing emphasis on hazardous substances in the environment and related health effects, into pre-service clinical (i.e., medical, nursing, and allied health) course work; and primary care residency programs (i.e., clinicians in pediatrics, family medicine, and obstetrics and gynecology). (3) Increase patient and population awareness of environmental exposure risks and ways to reduce those risks. (4) Provide education and consultative services to community members, clinicians, state and local health departments, appropriate federal programs, and others involved in protecting children and couples of reproductive age from environmental threats. (5) Provide educational and consultative assistance in communities where ATSDR and/or Environmental Protection Agency (EPA) are addressing environmental contamination.

ii. Outcomes To achieve the short and intermediate outcomes specified in the logic model above and listed below, the NPO and the regional PEHSU network will undertake a series of anticipated activities to achieve the changes needed to reach those outcomes. The activities will be quantified by a set of outputs measures. The application of these activities will build awareness, increase education and knowledge competencies about environmental contaminants, and drive adoption of exposure assessment and risk reduction behaviors in communities and exposure assessment and risk reduction counseling within primary care clinical practice. All of the short and intermediate outcomes are important interim steps towards building a future national primary care health system where long-term outcomes are reached when clinical environmental medicine knowledge and practice competency are focused on exposure prevention and reduction, early exposure detection, and reduced disease and disability caused by environmental toxicant exposures within populations.

There are four short-term outcomes targeted for this 2019 NOFO:

1. Primary care awareness of environmental medicine practices

2. Incorporation of environmental health content within clinical undergraduate curriculum and coarse work

3. Adoption of environmental exposure history assessments

4. Adoption of reproductive pediatric environmental exposures risk reduction practices

There are three intermediate-term outcomes:

1. Enhanced primary care competencies in environmental medicine

2. Increased patient awareness of environmental risk reduction behaviors

3. Routine primary care clinician delivery, (e.g. obstetricians, pediatricians):

A. Anticipatory risk reduction guidance to patients and communities at risk of environmental exposure B. Clinical care for patients impacted by exposure to hazardous substances in the environment

iii. Strategies and Activities Five interrelated strategies may be beneficial in achieving the short and intermediate outcomes expected from the PEHSU Program. These strategies and activities are listed below.

1. Resources and Tools Development:

Build environmental exposure history tools Translate research and Establish risk assessment and risk reduction guidance Provide clinical information on specific environmental hazardous exposures

2. Clinical Workforce Development:

Determine or apply existing environmental medicine competencies Develop content to meet environmental medicine competencies Increase clinician awareness of environmental exposures and risk reduction practices Integrate content into appropriate clinical course work and assess competency attainment

3. Health Promotion and Education:

Identify target populations at risk Provide information on hazardous substances in the environment Develop and promote actionable skills populations can use to undertake environmental risk reduction actions

4. Technical Consultative Services:

Expand the reach of the expert PEHSU network to provide consultation and technical support

Develop communication and outreach channels with community and clinician audiences Assist in the proper use of all tools to reduce risks of exposure to hazardous substances in the environment

5. System Change Approaches:

Identify and develop process changes needed to integrate adoption of new tools and new clinical practices in environmental medicine

Recognize and reward adoption of new tool that support environmental exposure assessment and risk reduction practices

Evaluate and communicate the benefits accrued from adoption of the system-level practices

Other Activities Recipient activities and expectations for the PEHSU Program are consistent with the logic model.

The work of the recipient is to serve as the PEHSU National Program Office (NPO). The recipient as the NPO manager is encouraged to apply principles of “servant leadership” in the operations and relationship the NPO builds with regional PEHSU personnel.

The work plan should build upon the activities presented below for the NPO and regional PEHSU to undertake. Applicants preparing the work plan are encouraged to provide their contextual view of how they will perform each responsibility outlined including the synergy between NPO responsibilities. The work plan should provide sufficient detail for a reviewer to understand how the recipient organizational capacity (described in section C) and applicant will meet these expectations. If other major activities not specified in the NOFO are deemed as necessary to accomplish the below NOFO expectations.

1. Recipient as NPO Manager will:

Establish a regional PEHSU having expertise in environmental health and medicine in each federal region by creating contractual agreements with academic medical centers (including schools of nursing), to conduct NOFO activities and achieve the PEHSU Program’s intended outcomes (federal regional map: https://www.atsdr.cdc.gov/dro/index .html).

Assure adequate time of critical regional leadership, approximately 20 percent of an FTE, is dedicated by regional directors to the activities of their regional PEHSU.

Assure critical clinical expertise in reproductive and pediatric environmental medicine is available to each regional PEHSU (i.e., environmental medicine expertise within a mix of clinicians drawn from pediatrics or family medicine, maternal fetal medicine or obstetrics, and occupational environmental medicine or medical toxicology) which represents the needed critical expertise to deliver PEHSU services.

Establish (annually) the performance targets that each regional PEHSU will contribute to achieve overall performance expectation and outcome measures including new National Classroom resources (work load distribution should consider different strengths among the regional PEHSU and their expected level of performance across all measures).

Consider, in consultation with ATSDR, supporting regional satellite operations to expand geographic reach if the established regional PEHSU supports a satellite partner.

Establish and nurture collaboratively developed operational structures and related processes with regional PEHSU directors to ensure efficient delivery of services and effective representation of PEHSU performance within each PEHSU region and across the PEHSU network, including NPO activities that support national and regional PEHSU operations.

Prepare plans (annually) to develop new or update existing PEHSU resources and tools that enable the PEHSU and their partners within communities to undertake environmental exposure risk reduction activities, clinical and community education, outreach, and care for reproductive and pediatric patient at risk of harm from exposure to hazardous substances in the environment (during normal and emergency situations) by engaging ATSDR/EPA, regional PEHSU directors and others as appropriate in collaborative resource and tool development.

Facilitate consensus on the best clinical approaches and outreach messaging about environmental hazards of concern and provide guidance materials produced by the PEHSU network.

Coordinate internal peer review of national PEHSU products developed or updated.

Establish a forum for regional PEHSU directors to collectively provide input to the

NPO on network operational processes, NPO support activities, exchange of information between regions, strategic direction of the PEHSU network, and development of initiatives to achieve outcomes of the PEHSU Program.

Establish and maintain transparency in all PEHSU operations including contracts, performance across the network, best performance practices and performance challenges, status of NPO support activities, and feedback on NPO reports to ATSDR.

https://www.atsdr.cdc.gov/dro/index.html https://www.atsdr.cdc.gov/dro/index.html

Define outcome measures presented in the “PEHSU Performance Measures” section (i.e., performance targets 2.3 and 3.3) and identify sources of data needed to establish an ongoing evaluation system to monitor achievement of outcomes associated with the PEHSU logic model.

Develop a simplified data management system for data collection, data quality, data inquiry, and data integration (with secondary data sources) that informs program management by tracking output and outcome measures, allows analytical analysis, and robust reporting on program achievements.

Assure data is readily available to the NPO, regional PESHU directors, and federal partners.

Assure the PEHSU Program promotes the highest level of transparency, collaboration, and responsiveness among the PEHSU network, federal partners, and NPO through continuous program assessment and collectively (NPO, regional directors, and federal partners) setting quality improvement objectives annually.

Provide ATSDR (and the EPA co-funder) quarterly reports that include both quantitative and qualitative information on performance targets and outcome accomplishments, recommendations for increasing the effectiveness of the PEHSU Program, and eliminating performance and operational issues.

Plan and host an annual meeting of the PEHSU network and its agency sponsors for the purpose of strengthening regional-national PEHSU interactions and building professional and organizational development in pediatric and reproductive environmental medicine.

If appropriate, hold annual PEHSU meeting in conjunction with other federal partners such as the NIEHS/EPA Children's Environmental Health and Disease Prevention Research Centers.

Develop partnerships that promote and support the PEHSU mission and the outcomes expected from the NOFO (e.g., Poison Control Centers and Community Health Centers, etc).

Undertake identification and development of funding options that build PEHSU performance capabilities and improves its current and future financial sustainability.

2. Services and Support Provided by the Recipient/NPO are:

Establish a national toll-free contact center capable of receiving voice and digital inquires and establish its operational protocol with input from regional PEHSU staff.

Manage operations of the national toll-free contact center and coordinate responses by providing an answer to each inquiry, referring the inquiry to a region with subject matter expertise or to a region that serves the geographic area where the inquirer originated.

Maintain and continually improve the www.PEHSU.net site, incorporating best innovative features from regional PEHSU sites, streamlining and clarifying search capacities keeping it current with best practices for web site design and operations including seamlessly incorporating social media.

Maintain and expand the National e-classroom and the course work available within it.

Promote its use in clinical pre-service, residency, and in-service training and evaluating the impact of training provided.

Build communication channels and routinely conduct outreach initiatives on PEHSU services and accomplishments among local, state, and national organizations serving http://www.pehsu.net/ primary care clinicians, environmental health organizations, community health centers, other health care provider (e.g., HMOs, health insurance providers, etc.), and public health agencies.

Establish (in collaboration with regional directors and federal partners) outreach plans annually for priority audiences, review effectiveness of outreach plans annually, and identify steps to improve outreach efforts for follow on outreach work.

Determine if a speaker's bureau is viable for inclusion in the PEHSU outreach plan.

Direct outreach to media outlets so PEHSU staff are the go-to source on reproductive and pediatric environmental health issues.

Facilitate development of academic training opportunities for post residency fellowships in reproductive and/or pediatric environmental medicine across the PEHSU network.

3. Clinical Academic Centers Serving as Regional PEHSU will:

Participate in PEHSU network forums to exchange regional experiences and information, contribute strategic insight to guide PEHSU work and NPO support activities, and give input on network operational processes and development of initiatives to achieve outcomes of the PEHSU Program.

Develop regionally oriented outreach materials using evidenced-based risk communication messaging, if needed, and conduct outreach activities for health care professionals and lay community audiences.

Prepare and present undergraduate and graduate clinical education on the health effects of hazardous substances in the environment along with risk reduction guidance to lower exposures risks to hazardous substances in the environment.

Provide technical and consultative assistance to primary care providers and public health officials responsible for delivering patient care and protecting populations from reproductive and pediatric exposures to environmental health hazard concerns.

Provide a setting for internships and clinical rotations to increase learning opportunities about reproductive and pediatric environmental health.

Prepare for and provide academic training opportunities for post residency fellowships in reproductive and/or pediatric environmental medicine.

Assemble the needed clinical disciplines to staff the regional PEHSU, support a post residency fellowships, and ensure delivery of PEHSU services.

Prepare for and provide opportunities for clinical trainees and residents to learn about reproductive and pediatric environmental health and engage in regional PEHSU education and consultation services.

Provide environmental health education and PEHSU guidance materials to communities to help reduce or prevent exposure to environmental health hazards.

Assure environmental exposure concerns of children and their families are appropriately addressed through consultation and educational services.

4. Emergency Response: The NPO may undertake and facilitate development of tools and information that anticipates reproductive and pediatric needs during emergency response and recovery activities associated with natural and technological disasters. These may include:

Providing expert pediatric and reproductive environmental medicine consultations and toxicological guidance for emergency preparedness and response actions needed during natural and/or technological disasters where people, and their families, are threatened with exposure or illness from hazardous substance spills or releases during these events.

Providing support and assisting regional PEHSU to deliver training and education to communities addressing natural or technological disasters, including flooding, wildfires, earthquakes and extreme heat events as well as hazardous substance spills or releases.

Providing specialty referral resource: engage, collaborate with state and local health departments and other federal agencies to plan and deliver relevant pediatric and reproductive environmental medicine consultations services to assist communities, families, and health care providers to address environmental health threats to persons at sites where ATSDR and the Environmental Protection Agency (EPA) have ongoing health risk evaluation and remediation activities. (Note: This bullets and the one above it may require compliance with AR-18: Cost Recovery – ATSDR (AR-18 link: http://www.cdc .gov/od/pgo/funding/grants/additional_req.shtm).

1. Collaborations

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

1. With CDC/ATSDR funded programs: The PEHSU Program has a long history and expertise in addressing health issues of lead exposed children. PEHSU also has a history of working with public health agencies to investigate sources of lead exposure of children.

For this reason, there is opportunity to find synergy between the PEHSU Program and the Centers for Disease Control and Prevention’s (CDC) Childhood Lead Poisoning Prevention Program. The PEHSU Program offers clinical expertise in caring for lead exposed children and can serve as a resource to the CDC Program when questions requiring clinical expertise arise. Additionally, PEHSU have a defined role in the Federal Action Plan to reduce childhood lead exposure and associated health impacts.

b. With organizations not funded by CDC:

1. With organizations external to ATSDR: For the PEHSU Program potential partners are those with the capability to support the PEHSU in:

Translating environmental health research into clinical and preventive environmental health services that reduce risks of environmentally related diseases.

Providing medical education on environmental health topics in clinical undergraduate or pre-service education courses, in residency training programs, and in continuing education in-service programs.

Providing clinical consultation on environmental health topics to clinicians and families.

Facilitating system-level integration of environmental exposure assessment and risk reduction counseling within course work of institutions that prepare primary care clinicians, develop clinical practice standards, and deliver and/or pay for health care http://www.cdc.gov/od/pgo/funding/grants/additional_req.shtm http://www.cdc.gov/od/pgo/funding/grants/additional_req.shtm services.

2. Target Populations

1. The PEHSU serves those engaged in professional, volunteer, and personal activities that protect pregnant women and children from environmental exposure risks. Therefore the PEHSU Program serves health professionals, clinicians, community members and organizations, governmental officials, Federal staff, child-care providers, parents, and others having interest in environmental conditions that influence reproductive and pediatric health. The PEHSU ultimately serves couples of reproductive age and children throughout their childhood. For the PEHSU Program, it defines the pediatric population as all children from their earliest developmental stages up to the age of 18 years. The earliest developmental periods, including both preconception and prenatal exposures that have potential to impact child health across the life-span.

a. Health Disparities

1. While the focus of the PEHSU is on all children, special attention must be paid to children who live in areas where exposure to toxic substances and/or environmental hazards are the greatest, including those living in lower social-economic status and sub-standard housing, those living near known contaminated sites, those in areas of higher air and/or water pollution, and those without access to quality medical care.

iv. Funding Strategy (for multi-component NOFOs only)

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

1. Evaluation and Performance Measures

ATSDR-PEHSU Evaluation and Performance Measures: This Notice of Funding Opportunity (NOFO) requires tracking of performance output and outcome associated with achieving PEHSU short-term and intermediate outcomes presented in the logic model for this NOFO. These measures will allow ATSDR to evaluate, at the regional and national levels, the effectiveness of services delivered in reaching lay audiences (up to 40 percent level of effort) and professional audiences (a minimum of 60 percent level of effort). This level of effort should be described and supported within the applicant work plan. The activities within the logic model and their associated performance measures (PM) listed below should be presented within the applicant’s work plan, including process and outcome evaluation strategies, quarterly summary reporting;

and ATSDR required annual reports identified in other sections of this announcement.

PM-1 - Resources and Tools Development: Increase availability and use of authoritative pediatric and reproductive environmental health promotion resources for lay and health professional audiences. This includes authoritative content on environmental hazards and tools for environmental exposure assessment and risk reduction guidance. Educational content and guidance on environmental hazards and risk reduction should be developed using evidence-based content and educational design that includes learner objectives and knowledge or competency evaluation that documents mastery of the learning objectives.

o Performance Target –1: Prepare or update at least 200 resources annually that present authoritative educational content on pediatric and/or reproductive environmental hazards and tools that assess environmental exposure and provide risk reduction guidance. The following types of resources should contribute to reaching this performance target:

o “Presentations Developed or Revised”: Presentations on environmental health developed for use with community or health professional audiences should include instructor led face-to-face education as well as distance learning (e.g., grand rounds, webinars, and short e-learning modules.) All presentations must include specific learner objectives, content supporting each learning objective, and a method to assess knowledge competencies of the learners.

o “Short Informational Documents Prepared”: Short information documents are designed to deliver actionable information for a designated audience such as a lay person or health professional. The short informational document could be a fact sheet, newsletter article, blog, public service announcement, commentary or other short informational materials. These materials will contribute to outreach measures that may or may not have a feedback loop for assessing individual or population-level action encouraged by the informational document.

o “Articles and Book Chapters Prepared”: Articles or book chapters published within the popular media, professional peer-reviewed journals, and educational text books offer an alternative educational format for the learner. The use of articles and book chapters can contribute to either outreach numbers or the number educated. To contribute to the number of individuals educated, information would need to be gathered from a continuing education provider who awards educational credits for reading the material. If such a feedback loop is not available an outreach number could be determined by taking a percent of the journal’s circulation, such as 20%, or the number of books sold annually.

PM-2 - Workforce and Capacity Development/Health Promotion and Education: Increase the ability of communities and health professionals to prevent or mitigate the health effects of exposures to hazardous substances in the environment. Accomplished this by delivering pediatric and reproductive environmental health content and clinical guidance on environmental expose issues, exposure assessment, and risk reduction using resources developed within PM-1. Four annual performance targets are associated with this PM-2.

Note that these targets are presented with the expectation that at least 60% effort of the PEHSU network is directed to health professionals. The focus on health professionals is intended to prepare the health professional to meet the environmental health needs of patients and members of the communities where those health professionals work. The annual targets are:

o Performance Target – 2.1: “Health Professionals Educated”: For health professionals educated, the measure will count those learners participating in a planned educational event that provides content that addresses specific learner objectives. Additionally, there should be a strategy to assess knowledge competencies of the learner participating. The first-year target for health professionals educated is 26,000. For year-two and beyond, the target is 30,000, or more, annually. Accomplishing these targets is aided by use of the inherited educational materials existing in the online PEHSU National Classroom and the capacity of existing PEHSU regional units to provide health professional education in pre-service or in-service settings.

o Performance Target – 2.2: “Demonstrated Knowledge Competency”: End of course testing should occur with 50 percent or more of health professionals receiving PEHSU education. The 50 percent target related to the number educated in performance target 2.1. The learners must score 80 percent or greater on their post tests to demonstrate knowledge competency. (The competency level is set at 80 percent because post tests are generally a short set of three to ten questions related to the presentation’s learning objectives. This requires the learner to answer all but one or two post test questions correctly to demonstrate knowledge competency).

o Performance Target – 2.3: “Application of Education in Clinical Practice”:

Building on the knowledge competency measure (performance target 2.2) resulting from PEHSU educational activities, additional outcomes associated with PEHSU educational need to be identified. As an example, a clinician’s adoption and use of information/guidance within his or her clinical practice demonstrates an important short-term outcome. This adoption is essential to achieving interim and long-tern outcomes for PEHSU work. Along the outcome continuum, the next outcome to understand is how the health care provider’s clinical adoption of PEHSU guidance benefits patients. The expectation is that the clinical care or risk reduction counsel (provided by the clinician following the PEHSU education) results in improvement of the patient’s status. Applicants for this cooperative agreement are encouraged to collaborate with ATSDR and determine how to undertake assessing and reporting outcomes resulting from adoption of PEHSU environmental risk reduction guidance they provide or promote to clinicians (i.e., patient assessment, patient care and risk reduction counseling).

o Performance Target – 2.4: “Community Members Educated”: Community members educated, will be determined by the number of community members participating in a planned educational event that provides environmental health content addressing specific learning objectives. If the educational event allows, there should be a way to assess the knowledge and understanding the community member has at the close of the educational presentation.

PM-3 – “Consultative Services Delivery”: The PEHSU Program receives and responds to requests from clinicians, state and federal officials, local organizations and officials, as well as parents and expectant mothers who need guidance requiring a clinical perspective on environmental health concerns. This service is largely responsive in nature and of great value to those needing specialized guidance on environmental medicine issues. The level of outreach undertaken by the PEHSU will influence the demand for consultation services and the achievement of targets below. Additionally, this measure focuses on the outcome of these consultations.

o Performance Target – 3.1: The number of “Consultations provided to health and health care professionals” is a count of initial consultations provided annually to health professional audiences on pediatric and reproductive environmental medicine concerns. The annual target, based on past PEHSU history, is 960 consultations delivered.

o Performance Target – 3.2: “The number of “Consultations provided Community Organizations and Individuals” is a count of initial consultations provided annually to lay /non-clinical audiences on pediatric and reproductive environmental medicine concerns. The annual target, based on past PEHSU history, is 640 consultations delivered.

o Performance Target – 3.3: “Application of Consultative Guidance”: Application of consultative guidance is an important short-term outcome measure. It should provide both insight on use of the PEHSU guidance and the result achieved when the guidance was acted upon by those receiving or benefiting from the guidance.

Using an example of a clinician receiving guidance on assessing and caring for a child exposed to elemental mercury, there are three types of outcomes that could result. First, the clinician follows the PEHSU guidance and the child’s health improves. Second, the clinician develops the ability to care for other elemental mercury exposures. Third, an organizational or systems level outcome occurs when, for example, elemental mercury exposure sources are identified and action taken to prevent future exposures. Some outcomes are observable and can be documented. Others may require follow up to identify what did or did not happen following the consultation. Applicants for this cooperative agreement are encouraged to collaborate with ATSDR and determine how to undertake assessing and reporting outcomes resulting from PEHSU consultations.

PM-4 – “Outreach”: Develop and maintain communication channels and outreach activities with local, state and national organizations that enhance the capacity of the PEHSU Program to build pediatric and reproductive environmental medicine guidance and reach audiences that need PEHSU services.

o Performance Target – 4.1: “Outreach to Health Professionals”: Outreach to health care professionals occurs through traditional media channels, professional membership organizations and events, professional journals, and social media platforms. The primary objectives of outreach within the PEHSU Program are to raise awareness, stimulate service utilization, and encourage actions among health professionals to learn more about addressing environmental health hazards in their work. The numbers reported under outreach must reflect quantifiable data sources (such as those found in On-line Analytics) drawn from the outreach channels used.

For social media this may include unique visitors, impressions, sessions, page views and downloads or subscription or syndication numbers. Traditional media delivery channels should have data on circulation, viewer-ship, or listeners reached during the time frame the outreach was delivered. It may be based on the weekday for the publication or day and time of a broadcast. Year one of the cooperative agreement will establish a media outreach baseline for the PEHSU

Program.

o Performance Target – 4.2: “Outreach to Communities”: Outreach to community members occurs through traditional media channels, community organizations and events, and social media platforms. The primary objectives of outreach within the PEHSU Program are to raise awareness, stimulate service utilization, and promote understanding of environmental health hazards so that communities and individuals are able to prevent or reduce environmental exposure risks. The numbers reported under media outreach must reflect quantifiable data sources (such as those found in On-line Analytics) drawn from the outreach channels used.

For social media this may include unique visitors, impressions, sessions, page views and downloads or subscription or syndication numbers. Traditional media delivery channels should have data on circulation, viewer-ship, or listeners reached during the time frame the outreach was delivered. It may be based on the weekday for the publication or day and time of a broadcast. Year one of the cooperative agreement will establish a media outreach baseline for the PEHSU Program.

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

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

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

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

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

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

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

Describe key evaluation questions to be addressed by these evaluations.

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

https://www.cdc.gov/grants/additionalrequirements/ar-25.html

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

c. Organizational Capacity of Recipients to Implement the Approach The recipient must have organizational authority and capacity to undertake management and implementation of relevant strategies and activities within the PEHSU logic model. Further, the recipient must demonstrate experience in managing a national environmental health education and consultation program. The recipient must also show experience in successfully addressing the educational and consultative needs of clinicians and the public in their understanding of human health effects arising from exposure to hazardous substances in the environment. These should be addressed within the work plan as the recipient will describe how it will address the listed work plan activities. Overall, experiences and capabilities the recipient organization needs to have in carrying out the PEHSU Program work are listed below:

Demonstrated organizational capacity to manage national programming activities:

o Multi-regional programmatic…