PKG00252837-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Maternal and Child Health Bureau Division of Services for Children with Special Health Needs

Early Hearing Detection and Intervention Program

Funding Opportunity Number: HRSA-20-047

Funding Opportunity Type(s): Competing Continuation, New Assistance Listings (CFDA) Number: 93.251

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2020

Application Due Date: November 8, 2019

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: July 10, 2019

Sandra Battiste, MPH Public Health Analyst Division of Services for Children with Special Health Needs Telephone: (301) 443-0223 Fax: (301) 443-2960 Email: SBattiste@hrsa.gov

Bethany Applebaum, MPH, MA

Division of Services for Children with Special Health Needs Telephone: (301) 443-6314

Email: BApplebaum@hrsa.gov

Authority: Public Health Service Act, Title III, § 399M(a) (42 U.S.C. 280g-1(a)).

mailto:sbattiste@hrsa.gov mailto:BApplebaum@hrsa.gov

HRSA-20-047 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2020 for the Early Hearing Detection and Intervention (EHDI) Program.

The purpose of this program is to support comprehensive and coordinated state and territory EHDI systems of care so families with newborns, infants, and young children up to 3 years of age who are deaf or hard-of-hearing (DHH) receive appropriate and timely services that include hearing screening, diagnosis, and early intervention (EI).

The FY 2020 President’s Budget does not request funding for this program. This notice is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner. You should note that this program may be cancelled prior to award.

Funding Opportunity Title: Early Hearing Detection and Intervention

Program Funding Opportunity Number: HRSA-20-047 Due Date for Applications: November 8, 2019 Anticipated Total Annual Available FY 2020 Funding:

$13,865,000

Estimated Number and Type of Award(s): Up to 59 grants Estimated Award Amount: Up to $235,000 per year subject to the availability of appropriated funds Cost Sharing/Match Required: No Period of Performance: April 1, 2020 through March 31, 2024

(4 years) Eligible Applicants: Any state, including the District of

Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, and the jurisdictions encompassing the former Trust Territory of the Pacific Islands; or any domestic public or private entity, including an Indian tribe or tribal organization (as those terms are defined at 25 U.S.C.

450(b)) is eligible to apply. Domestic faith-based and community-based organizations are also eligible to apply.

(45 CFR § 75.218).

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

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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.

Technical Assistance

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Wednesday, July 31, 2019 Time: 2 p.m. – 4 p.m.

Call-In Number: 1-888-889-2042 Participant Code: 1398484 Weblink: https://hrsa.connectsolutions.com/hrsa-20-047-ta/

HRSA will record the webinar and make it available at:

https://mchb.hrsa.gov/fundingopportunities/default.aspx.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://hrsa.connectsolutions.com/hrsa-20-047-ta/ https://mchb.hrsa.gov/fundingopportunities/default.aspx

HRSA-20-047 iii

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget 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

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Early Hearing Detection and Intervention (EHDI) Program. The purpose of this program is to support comprehensive and coordinated state and territory EHDI systems of care1 so families with newborns, infants, and young children up to 3 years of age2 who are deaf or hard-of-hearing (DHH)3 receive appropriate and timely services that include hearing screening4, diagnosis, and early intervention (EI).

In alignment with the Early Hearing Detection and Intervention Act of 2017, this funding opportunity will support EHDI systems of care within states and territories to:

• Lead efforts to engage all EHDI system stakeholders at the state/territory level to improve developmental outcomes of children who are DHH;

• Provide a coordinated infrastructure to:

o Ensure that newborns are screened by 1 month of age, diagnosed by 3 months of age, and enrolled in EI by 6 months of age (1-3-6 recommendations5); and o Reduce loss to follow-up/loss to documentation.

• Identify ways to expand state/territory capacity to support hearing screening in young children up to 3 years of age;

• Strengthen capacity to provide family support6 and engage families with children who are DHH and adults who are DHH throughout the EHDI system;

• Engage, educate, and train health professionals and service providers in the

EHDI system about the 1-3-6 recommendations; the need for hearing screening up to age 3, the benefits of a family-centered medical home and the importance of communicating accurate, comprehensive, up-to-date, evidence-based information to families to facilitate the decision-making process; and

• Facilitate improved coordination of care and services for children who are DHH and their families through the development of mechanisms for formal

1 For the purposes of this NOFO, the EHDI system of care refers to families, consumers, providers, services, and programs that work towards developing coordinated and comprehensive state and territory systems so that families with newborns, infants, and young children who are deaf or hard of hearing receive appropriate and timely services that include hearing screening, diagnosis, and intervention.

2 For the purposes of this funding opportunity, “children” are defined as all newborns, infants, and young children up to the age of 3.

3 For the purposes of this funding opportunity, “deaf” and “hard of hearing” or “DHH” are used in this document to represent the entire spectrum of children with varying hearing levels (from mild to profound) and laterality, and is intended to be inclusive of those who have other disabilities and/or conditions.

4 For the purposes of this funding opportunity, the term hearing screening refers to the process of initial screening, diagnosis, and enrollment into early intervention (EI) services.

5 Joint Committee on Infant Hearing, (2007) Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Pediatrics Oct 2007, 120 (4) 898-921; DOI:

10.1542/peds.2007–2333.

6 For the purposes of this funding opportunity, family support is defined as “the practices that ensure that the holistic nature of the process for families is sustained through the timelines, policies, and procedures by the varying entities that the family encounters through hearing screening, diagnosis, EI, and beyond.”

See the Background section of this NOFO for the full citation.

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communication, training, referrals, and/or data sharing between the state/territory EHDI Program and the Individuals with Disabilities Education Act (IDEA) Program for Infants and Toddlers with Disabilities (Part C) Program.7

Program Goal HRSA supports EHDI systems at the national, state/territory, and local levels through a coordinated portfolio of programs.8 The goal of this funding opportunity is to support the development of state/territory programs and systems of care to ensure that children who are DHH are identified through newborn, infant, and early childhood hearing screening and receive diagnosis and appropriate early intervention to optimize language, literacy, cognitive, social, and emotional development.

Program Objectives The recipient is funded to achieve, collect, and report on the following program objectives:

By March 2024:

Using the state/territory’s data from the 2017 CDC (Centers for Disease Control and Prevention) EHDI Hearing Screening and Follow-up Survey (HSFS) as baseline data:

• Increase by 1 percent from baseline per year, or achieve at least a 95 percent screening rate, whichever is less, the number of infants that completed a newborn hearing screen no later than 1 month of age.9

• Increase by 10 percent from baseline, or achieve a minimum rate of 85 percent, the number of infants that completed a diagnostic audiological evaluation no later than 3 months of age.10

• Increase by 15 percent from baseline, or achieve a minimum rate of 80 percent, the number of infants identified to be DHH that are enrolled in EI services no later than 6 months of age.11

Using data collected from year 1 as baseline data:

• Increase by 20 percent from baseline the number of families enrolled in family-to-family support services by no later than 6 months of age.

• Increase by 10 percent the number of families enrolled in DHH adult-to-family support services by no later than 9 months of age.

• Increase by 10 percent the number of health professionals and service providers trained on key aspects of the EHDI Program.

Program Description For a detailed description of the program, please see Section IV, page 9.

7 IDEA Part C assists states in operating a comprehensive statewide program of EI services for infants and toddlers with disabilities, including children who have been identified as DHH, from birth through 2 years of age, and their families. For more information, see http://ectacenter.org/partc/partc.asp.

8 For more information, see https://mchb.hrsa.gov/maternal-child-health-initiatives/early-hearing-detection-and-intervention.html.

9 Denominator is total live births for reporting year.

10 Denominator is total not pass most recent/final screen.

11 Denominator is total diagnosed with permanent hearing loss.

http://ectacenter.org/partc/partc.asp https://mchb.hrsa.gov/maternal-child-health-initiatives/early-hearing-detection-and-intervention.html https://mchb.hrsa.gov/maternal-child-health-initiatives/early-hearing-detection-and-intervention.html

HRSA-20-047 3

2. Background

This program is authorized by the Public Health Service Act, Title III, § 399M(a) (42 U.S.C. 280g-1(a))

Approximately 1.7 of every 1,00012 U.S. newborns are documented as being identified early as congenitally DHH. Children continue to be identified as DHH through early childhood and by kindergarten the prevalence of children identified as DHH is estimated to increase to 6 of every 1,00013 children. When children who are DHH are identified early and provided timely and appropriate intervention services, they demonstrate better outcomes than later-identified children in the areas of vocabulary development,14 receptive language,15,16,17,18 expressive language,19,20 and social-emotional development.21,22 To reduce risks for developmental delays in children who are DHH, experts recommend following the 1-3-6 recommendations: all infants have their hearing screened no later than 1 month of age; for those infants who do not pass the initial newborn hearing screen, a diagnostic audiological evaluation should be completed no later than 3 months of age; and infants confirmed to be DHH should be referred for enrollment in EI services no later than 6 months of age.23 To promote healthy child development pediatric health supervision guidelines call for hearing screening based on

12 Centers for Disease Control and Prevention (2018, September 10). Annual Data Early Hearing Detection and Intervention (EHDI) Program. Retrieved from:

https://www.cdc.gov/ncbddd/hearingloss/ehdi-data.html 13 Northern JL, Downs MP. Hearing in children. 5th Ed. Chapter 1, Hearing and hearing loss in children. Baltimore: Williams and Wilkins; 2002.

14 Mayne AM, Yoshinaga-Itano C, Sedey AL, Carey A. Expressive vocabulary development of infants and toddlers who are deaf or hard of hearing. Volta Rev. 1998;100(5):1-28.

15 Yoshinaga-Itano C, Baca RL, Sedey AL. Describing the trajectory of language development in the presence of severe-to-profound hearing loss: a closer look at children with cochlear implants versus hearing aids. Otol Neurotol. 2010;31(8):1268-1274. doi:10.1097/MAO.0b013e3181f1ce07.

16 Watkin P, McCann D, Law C, et al. Language ability in children with permanent hearing impairment: the influence of early management and family participation. Pediatrics. 2007;120(3):e694-e701.

doi:10.1542/peds.2006-2116.

17 Kennedy CR, McCann DC, Campbell MJ, et al. Language ability after early detection of permanent childhood hearing impairment. N Engl J Med. 2006;354(20):2131-2141. doi:10.1056/NEJMoa054915.

18 Vohr B, Topol D, Girard N, St. Pierre L, Watson V, Tucker R. Language outcomes and service provision of preschool children with congenital hearing loss. Early Hum Dev. 2012;88(7):493-498.

doi:10.1016/j.earlhumdev.2011.12.007.

19 Pipp-Siegel S, Sedey AL, VanLeeuwen AM, Yoshinaga-Itano C. Mastery motivation and expressive language in young children with hearing loss. J Deaf Stud Deaf Educ. 2003;8(2):133-145.

20 Watkin P, McCann D, Law C, et al. Language ability in children with permanent hearing impairment: the influence of early management and family participation. Pediatrics. 2007;120(3):e694-e701.

doi:10.1542/peds.2006-2116.

21 Pipp-Siegel S, Sedey AL, Yoshinaga-Itano C. Predictors of parental stress in mothers of young children with hearing loss. J Deaf Stud Deaf Educ. 2002;7(1):1-17. doi:10.1093/deafed/7.1.1.

22 Yoshinaga-Itano C, Sedey A, Coulter D, Mehl A. Language of early-and later-identified children with hearing loss. Pediatrics. 1998;102(5):1161-1171. doi:10.1542/peds.102.5.1161.

23 Joint Committee on Infant Hearing, (2007) Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Pediatrics Oct 2007, 120 (4) 898-921; DOI:

10.1542/peds.2007-2333.

https://www.cdc.gov/ncbddd/hearingloss/ehdi-data.html

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risk assessment criteria or whenever parents/caregivers express concern about hearing or language development at every health supervision visit for young children.24

EHDI Legislation Legislation first providing support for the development of state/territory newborn hearing screening and intervention systems was passed by Congress in 2000. The reauthorization of the EHDI Act of 2017, which amended the Public Health Service Act, expands the target population for hearing screening beyond newborns to include young children up to the age of 3. The EHDI legislation also supports programs and systems that “foster family-to-family and deaf and hard-of-hearing consumer-to-family supports;”

the identification or development of educational and medical models “to ensure that children who are identified as deaf or hard-of-hearing through screening receive follow-up by qualified early intervention or health care providers (including those at medical homes for children), and referrals, as appropriate to early intervention services under Part C of the IDEA”; and encourages state agencies to “increase the rate of such follow-up and referral.” Additionally, the legislation calls for ensuring information provided to families when children are identified as deaf or hard-of-hearing is “accurate, comprehensive, up-to-date, and evidence-based as appropriate to allow families to make important decisions for their children in a timely manner.” 25

Family Engagement and Education Family engagement is defined as “patients, families, their representatives, and health professionals working in active partnership at various levels across the health care system to improve health and health care.”26 Family engagement improves quality of care, patient and family satisfaction, and families’ communication and relationships with health care providers. It also reduces health care costs and parent/caregiver anxieties.27

Families need to be empowered and involved in the development of systems to ensure their needs and those of their newborns, infants, and children who are DHH, are addressed. Well-informed families are better able to make decisions to support their family and to lead the healthy development of their children who are DHH. The information provided to families should not only be high quality, “accurate, comprehensive, up-to-date, and evidence-based,”28 but it should be communicated in a

24 Hagan et al. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Bright Futures/American Academy of Pediatrics, 2017: 286-287.

25 Early Hearing Detection and Intervention Act of 2017, Public Health Service Act, Title III, Section 399M (as added by P.L. 106-310, Sec. 702; as amended by P.L. 111-337 and P.L. 115-71. Retrieved from:

https://www.congress.gov/115/plaws/publ71/PLAW-115publ71.pdf.

26 Carman, K.L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C., & Sweeney, J. (2013).

Patient and family engagement: A framework for understanding the elements and developing interventions and policies. Health Affairs, 32(2), 223-231).

27 Marbell, P. (2017). Engaging families in improving the health care system for children with special health care needs. Lucile Packard Foundation for Children’s Health.

28 Early Hearing Detection and Intervention Act of 2017, Public Health Service Act, Title III, Section 399M (as added by P.L. 106-310, Sec. 702; as amended by P.L. 111-337 and P.L. 115-71. Retrieved from:

https://www.congress.gov/bill/115th-congress/house-bill/1539/text https://www.congress.gov/115/plaws/publ71/PLAW-115publ71.pdf https://www.congress.gov/bill/115th-congress/house-bill/1539/text

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timely, culturally sensitive, and understandable format at all stages of the EHDI system.29

Family-to-Family and DHH Adult Consumer-to-Family Support Families with children who are DHH report the most valuable source of support received is specific to their child’s hearing status30 and a preference for connecting with other families that have children who are DHH.31 A growing body of literature demonstrate that “parent-to-parent support groups provide positive assistance in managing the needs of parents with children who have disabilities and their families as they seek service for their child.”32 Family support is defined as “the practices that ensure that the holistic nature of the process for families is sustained through the timelines, policies and procedures by the varying entities that the family encounters through hearing screening, diagnosis, EI, and beyond.”33 Family support should come from professionals, other families who have children who are DHH, adults who are DHH, and current, up-to-date evidence-based information and resources.34

Families with children who are DHH also benefit from access to support, mentorship, and guidance from adults who are DHH.35 However, a 2018 needs assessment revealed that of families surveyed with children who are DHH under the age of 6, only 28 percent of these families were offered formal parent-to-parent support program services, and only 27 percent of these families were offered access to an adult who is DHH as a mentor, role model, or guide.36

Provider Engagement According to the 2013 supplement to the 2007 Joint Commission on Infant Hearing (JCIH) Position Statement, the success of EHDI programs depends on families working in partnership with professionals as a well-coordinated team. Providers and professionals who interact with families at the time of diagnosis should be providing families comprehensive, evidence-based information as noted in the legislation. In

29 Joint Committee on Infant Hearing. (2013) Supplement to the JCIH 2007 Position Statement: Principles and Guidelines for Early Intervention after Confirmation that a Child is Deaf or Hard of Hearing.

Pediatrics. Retrieved from: https://pediatrics.aappublications.org/content/131/4/e1324.

30 Jackson, C.W. (2011). Family supports and resources for parents of children who are deaf or hard of hearing. Am Ann Deaf, 156(4) 343-362.

31 Family Leadership in Language and Learning (2018). Needs Assessment Report. Retrieved from:

https://www.handsandvoices.org/fl3/resources/docs/HV-FL3_NeedsAssessment_19Jul2018_Final-opt.pdf.

32 Henderson, R.J., Johnson, A., and Moodie S., Parent-to-Parent Support for Parents With Children Who are Deaf or Hard of Hearing: A Conceptual Framework. Am Jour of Audiology. 2014.

33 Global Coalition of Parents of Deaf/Hard of Hearing Children (2010). Position Statement and Recommendations for Family Support in the Development of Newborn Hearing Screening Systems (NHS)/Early Hearing Detection and Intervention (EHDI) Systems Worldwide.

34 Global Coalition of Parents of Deaf/Hard of Hearing Children (2010). Position Statement and Recommendations for Family Support in the Development of Newborn Hearing Screening Systems (NHS)/Early Hearing Detection and Intervention (EHDI) Systems Worldwide 35 Watkins S, Pittman P, Walden B. The Deaf Mentor Experimental Project for young children who are deaf and their families. Am Ann Deaf. 1998; 143(1):29-34.

36 Family Leadership in Language and Learning (2018). Needs Assessment Report. Retrieved from:

https://www.handsandvoices.org/fl3/resources/docs/HV-FL3_NeedsAssessment_19Jul2018_Final-opt.pdf.

https://pediatrics.aappublications.org/content/131/4/e1324 https://www.handsandvoices.org/fl3/resources/docs/HV-FL3_NeedsAssessment_19Jul2018_Final-opt.pdf https://www.handsandvoices.org/fl3/resources/docs/HV-FL3_NeedsAssessment_19Jul2018_Final-opt.pdf https://www.handsandvoices.org/fl3/resources/docs/HV-FL3_NeedsAssessment_19Jul2018_Final-opt.pdf

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addition, the child’s primary care provider, that also serves as his/her medical home,37 plays an essential role not only in supporting the family, but also in monitoring the child’s developmental skills, the coordination of specialty and service referrals, and the assurance of timely follow-up and educational interventions. However, pediatric primary care providers do not always receive newborn hearing screening results or provide active referrals to audiologists for young children when there are concerns from the parents and caregivers. Continued development of an integrated health information system and implementation of evidence-informed strategies for data sharing and linkage will allow for important health information to be consolidated and shared among the professionals involved in the child’s medical home. This approach not only promotes parents as partners in decision making but fosters coordinated, ongoing, and comprehensive care in the medical home.

Progress to Date HRSA has supported U.S. state and territory EHDI systems since 2000; however, the Centers for Disease Control and Prevention did not begin collecting data from all states until 2008. During the years 2008 to 2016, the rate of all newborns completing a hearing screen by 1 month of age increased from 92.1 percent to 94.8 percent and the rate of those who completed a diagnostic audiological evaluation by 3 months of age increased from 68.1 percent to 75.9 percent, resulting in a total of over 48,000 infants identified as DHH.38 During this same time frame, the rate of enrollment in EI services for those identified to be DHH by 6 months of age increased from 52.8 percent to 67.3 percent.39

Despite success in achieving near-universal newborn hearing screening rates, significant gaps remain with achieving timely diagnostic audiological evaluation and enrollment in EI services and reducing loss to follow-up and documentation (LTF/D) rates. Challenges in meeting these goals include limited family engagement, DHH-specific support services,40 parent knowledge about availability and importance of EI services, 41 and pediatric provider knowledge of the 1-3-6 recommendations.42,43 Additionally, states and territories face unique, individual challenges in addressing the needs of the populations they serve, including differences in geography, race, ethnicity, disability, gender, sexual orientation, family structure, socio-economic status; limitations

37 Joint Committee on Infant Hearing. (2013) Supplement to the JCIH 2007 Position Statement: Principles and Guidelines for Early Intervention after Confirmation that a Child is Deaf or Hard of Hearing.

Pediatrics.

38 Centers for Disease Control and Prevention (2018, September 10). Annual Data Early Hearing Detection and Intervention (EHDI) Program. Retrieved from:

https://www.cdc.gov/ncbddd/hearingloss/ehdi-data.html.

39 Centers for Disease Control and Prevention (2018, September 10). Annual Data Early Hearing Detection and Intervention (EHDI) Program. Retrieved from:

https://www.cdc.gov/ncbddd/hearingloss/ehdi-data.html.

40 Family Leadership in Language and Learning (2018). Needs Assessment Report. Retrieved from:

https://www.handsandvoices.org/fl3/resources/docs/HV-FL3_NeedsAssessment_19Jul2018_Final-opt.pdf.

41 United States Government Accountability Office Report to Congressional Requestors. (2011). Deaf and Hard of Hearing Children – Federal Support for Developing Language and Literacy. GAO-11-357 42 American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention (EHDI) Pediatrician Perspectives: Executive Summary. August 2018.

43 American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention (EHDI) Pediatrician Perspectives: Executive Summary. August 2018.

https://www.cdc.gov/ncbddd/hearingloss/ehdi-data.html https://www.cdc.gov/ncbddd/hearingloss/ehdi-data.html

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in availability and accessibility of pediatric audiologists; limitations in availability of culturally appropriate, evidence-based information for families; inconsistent data sharing with early childhood education programs and services, such as those provided through the Program for Infants and Toddlers with Disabilities (Part C of the Individuals with Disabilities Education A; and limitations in systems integration with other relevant programs and services. This funding opportunity provides mechanisms for states to address these challenges and new requirements from the 2017 reauthorization.

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 estimates approximately $13,865,000 to be available annually to fund 59 recipients. The actual amount available will not be determined until enactment of the final FY 2020 federal appropriation. You may apply for a ceiling amount of up to $235,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The FY 2020 President’s Budget does not request funding for this program.

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, 2020 through March 31, 2024 (4 years). Funding beyond the first year is subject to the availability of appropriated funds for the EHDI Program in subsequent fiscal years, satisfactory recipient performance, and a decision that continuing funding is in the best interest of the Federal Government. Additionally, recipient funding levels may be reduced if programs are unable to fully succeed in achieving goals listed in the application.

Optional Needs Assessment Project As part of the funding opportunity, you may also apply for funds for a 1-year targeted needs assessment on the educational needs of health care professionals and service providers who interact with DHH children and their families at the time of diagnosis.

Funding for this project depends on the availability of funds. If available, the award per recipient will be approximately $10,000. See Section IV.2.ii for further details.

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

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

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III. Eligibility Information

1. Eligible Applicants

Eligible applicants include any state including the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, and the jurisdictions encompassing the former Trust Territory of the Pacific Islands; or any domestic public or private entity, including an Indian tribe or tribal organization. Domestic faith-based and community-based organizations are also eligible to apply.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

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

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

• NOTE: Multiple applications from an organization are not allowable.

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

IV. Application and Submission Information

1. Address to Request Application Package

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

The NOFO is also known as “Instructions” on Grants.gov. You must provide your email address when reviewing or preparing the workspace application package in order to receive notifications including modifications and/or republications of 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.

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

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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 75 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, 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) You, on behalf of the applicant organization certify, by submission of your proposal, that neither you nor your principals are 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 you are unable to attest to the statements in this certification, an explanation shall be included in Attachments 7–15: Other Relevant Documents.

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

Program Description Successful recipients will be expected to address the following activities:

A. Lead efforts to engage and coordinate all stakeholders in the state/territory

EHDI system to meet the goals of this program.

1. Provide a coordinated infrastructure to:

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a. ensure that all newborns are screened by 1 month of age, diagnosed by 3 months of age, and enrolled in EI by 6 months of age (1-3-6 recommendations); and

b. reduce loss to follow-up/loss to documentation.

2. Develop a state/territory plan to expand infrastructure, including data collection and reporting, for hearing screening for children up to age 3 by the end of year 2.

This plan should outline the resources, key stakeholders, partnerships, and services necessary to implement the plan. A public health approach that aligns with other public health and/or service programs within the state should be proposed as well as the role of the EHDI Program (i.e., partnering and collaborating with Maternal and Child Health programs, such as but not limited to the Title V Children and Youth with Special Health Care Needs (CYSHCN) Program; newborn bloodspot screening program; Maternal, Infant, and Early Childhood Home Visiting Program; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); Early Head Start; and Family-to-Family Health Information Centers).

3. Establish and maintain partnerships for referral, training, and information sharing with various state or territory stakeholder organizations and programs that include, but are not limited to, health professionals, service providers, birthing centers, and state or territory organizations and programs. By the end of year 1, and revised annually, recipients should complete an assessment of current partnerships and identify key partners who could help address gaps in the EHDI system.

4. Once annually, at a minimum, convene a state/territory EHDI advisory committee to advise on programs, objectives, and strategies throughout the period of performance. The membership of the committee should represent stakeholders across the EHDI system, including health care professionals (e.g., clinicians who deliver pediatric primary care, pediatric specialists, nurses, EI providers, audiologists, etc.), parents/families of DHH children, and DHH individuals. A minimum of 25 percent of the committee must be comprised of parents of children who are DHH and adults who are DHH. The advisory committee should include organizations that serve families of children who are DHH. Examples of organizations to consider for the advisory committee include but are not limited to:

• State/territory offices/agencies responsible for the implementation of IDEA Part C

• State/territory chapters of the American Academy of Pediatrics

• State/territory Maternal, Infant, and Early Childhood Home Visiting (Home

Visiting) Programs

• State/territory Title V Programs (MCH and CYSHCN)

• Leadership Education in Neurodevelopmental and Related Disabilities

(LEND) Programs

• State/territory schools for the deaf

• State/territory offices of the DHH

• An organization with expertise in addressing diversity, health equity, and cultural competency

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• Family Organizations (e.g., Family-to-Family health information centers, Hands and Voices, Family Voices)

• Women, Infants, and Children (WIC)

• Early Head Start

• Birthing facilities

• State/territory Medicaid agencies

5. By the end of year 2, develop a plan to address diversity and inclusion in the EHDI system to ensure that the state or territory’s EHDI system activities are inclusive of and address the needs of the populations it serves, including geography, race, ethnicity, disability, gender, sexual orientation, family structure, socio-economic status.

6. Develop and implement a strategy to monitor and assess program performance in meeting the stated program purpose and objectives that would contribute toward continuous quality improvement (QI) throughout the period of performance. Identify existing gaps and challenges in the state/territory’s EHDI Program and use a QI approach to address unique needs of the state/territory’s system of care, such as:

• Ability to meet the 1-3-6 recommendations

• Expansion of screening up to age 3

• Loss to follow up/documentation

• Provider outreach and education

• Data collection

• Telehealth

• EI referral and/or enrollment

• Outreach to underserved populations

• Late onset hearing loss

• Partnerships across Title V and other early childhood programs

• Family engagement and family support

• Other topics of choice, pending approval from HRSA You should identify a minimum of two areas for improvement to address throughout the 4-year period based on identified needs. Recipients will be required to report annually to HRSA on progress towards addressing these issues using a QI approach including goals, methods, timelines for improvement, and stakeholders involved.

7. Develop, maintain, and promote a website or webpage for the state/territory that is user friendly with accessible, culturally appropriate information for families and professionals that is accurate, comprehensive, up-to-date, and evidence-based, as appropriate to allow families to make important decisions for their children in a timely manner, including decisions with respect to the full range of assistive hearing technologies and communication modalities, as appropriate.

8. Plan for project sustainability after the period of federal funding ends. HRSA expects recipients to sustain key elements of their projects, e.g., strategies for maintaining the website or services and interventions that have been effective in

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improving practices and those that have led to improved outcomes for the target population.

B. Engage, educate, and train health professionals and service providers in the

EHDI system.

1. Conduct outreach and education to health professionals and service providers in the EHDI system about the following:

a. The 1-3-6 recommendations and the importance of timely screening, diagnosis, referral, and enrollment into EI services.

b. The need for hearing screening up to age 3 to identify, diagnose, and enroll into EI those infants who pass a newborn screen but later develop hearing loss.

c. The benefits of a patient/family-centered medical home and family engagement in the care of a DHH child.

d. The importance of communicating accurate, comprehensive, up-to-date, evidence-based information to allow families to make important decisions for their children in a timely manner, including decisions with respect to the full range of assistive hearing technologies and communications modalities, as appropriate.

e. State/territory-specific EHDI system information.

2. Outreach and education activities may include, but are not limited to, sharing information via webinars, workshops, hospital grand rounds, presentations at professional conferences, professional newsletters, web-based content, social media, listserves, and other communication channels, as appropriate.

a. Collaborate, as appropriate, with the HRSA-16-190 (Pediatric Audiology Competitive Supplement to Leadership Education in Neurodevelopmental and Related Disabilities (LEND)) recipients, the HRSA-18-069 (National Resource Center for Patient/Family-Centered Medical Home (NRC- PFCMH) recipient, and any relevant future recipients to engage and educate health professionals and service providers to help reach program goals.

C. Strengthen capacity to provide family support and engage families with children who are DHH as well adults who are DHH throughout the EHDI system.

1. Engage families throughout all aspects of the project, involving family partners in the development, implementation, and evaluation of the EHDI Program.

2. Conduct outreach and education to inform families about opportunities to be involved in different roles within the state EHDI system and collaborate with various leaders and policy makers in addressing the challenges to and providing solutions for the EHDI system. Recipients should consider a variety of communications methods to engage consumers including, but not limited to, texting, social media, videos, and other communication platforms.

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3. Facilitate partnerships among families, health care professionals, and service providers to ensure that providers understand the best strategies to engage families.

4. Use 25 percent of funding for family engagement and family support activities.

Possible activities include: 1) providing funds to a statewide family-based organization(s) or program(s) that provide(s) family support services to families with DHH children; 2) conducting family engagement and family support activities within the state/territory EHDI Program if led by DHH adult consumers or families of children who are DHH; or 3) a combination of contracted and state/territory EHDI Program family engagement and support activities. Below is a list of possible activities:

a. Programs and activities that provide direct family-to-family support services to parents and families with a child newly identified as DHH.

b. Programs and activities that provide direct DHH adult consumer-to-family support services to parents and families with a child newly identified as

DHH.

c. Stipends to family leaders who have a child who is DHH to participate on the state/territory EHDI advisory committee.

d. Salary for family leaders who have a child who is DHH or DHH adult consumers to serve as a staff member for the EHDI Program conducting family engagement and family support activities.

e. Other family support activities, pending approval from HRSA.

5. Consult with the HRSA-20-051 recipient (the Family Leadership in Language and Learning (FL3 Center) for resources, technical assistance, training, education, QI and evaluation to strengthen the infrastructure and capacity for family engagement and family support in the state/territory.

D. Facilitate improved coordination of care and services for families and children who are DHH through the development of mechanisms for formal communication, training, referrals and/or data sharing between the state/territory EHDI Program and early childhood programs including the IDEA Part C program.

1. Assess the status of coordination across early childhood programs and develop a plan to improve coordination and care services through a variety of mechanisms based on the current level of integration across programs including early childhood programs (IDEA Part C, Home Visiting, Early Head Start, and other state early childhood program services). By the end of year 1, recipients will be expected to demonstrate evidence of planning and stakeholder engagement through development of a written plan. By the end of year 3, recipients should demonstrate evidence of formal communication, training, referrals and/or data sharing.

E. Recipients will also be expected to:

1. Participate in the Annual Early Hearing Detection and Intervention (EHDI) Meeting: budget for one or two staff and one family leader to attend this annual meeting.

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2. Work with the HRSA-20-048 program recipient (the EHDI National Technical Resource Center (NTRC)) to implement the various initiatives that are listed in this NOFO and outlined in the work plan. The EHDI NTRC will be responsible for continuing to provide technical assistance when a need is determined by the recipient or the MCHB project officer.

F. Optional Needs Assessment Project

As part of this funding opportunity, you may also apply for funds for a 1-year targeted needs assessment on the educational needs of health care professionals and service providers who interact at the time of diagnosis. Details in the Methodology section, see page 15 below.

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.

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)

a. Briefly describe the purpose of the proposed project, the methods to be used, and the projected outcomes.

NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion 1 (Need) Data should be used and cited whenever possible to support the information provided. This section will help reviewers understand the populations, the health care systems, and the communities you will serve with the proposed project.

a. Describe the state/territory EHDI system, stakeholders, and target populations, including an overview of how the state/territory is performing with regard to the 1-3-6 recommendations.

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b. Describe the needs of the population and barriers to receiving hearing screening and diagnoses and enrolling in intervention for newborns, infants, and children up to age 3 and their families and how the project plans to overcome them.

c. Describe disparities based on race, ethnicity, gender identity, sexual orientation, geography, socio-economic status, disability status, primary language, health literacy, and other relevant dimensions.

d. Discuss any relevant barriers in the service area that the project plans to overcome.

METHODOLOGY -- Corresponds to Section V’s Review Criteria 2 (Response), 3

(Evaluative Measures), 4 (Impact) and 6 (Support Requested)

Propose methods that will be used to address the stated needs and meet each of the previously described program goal, objectives, requirements and expectations listed in the Purpose and Program Description sections in this NOFO, which includes the following:

a. Lead efforts to engage all stakeholders in the state/ territory EHDI system to improve developmental outcomes for children who are DHH. (See Program Description pages 9–13 for a full description of what to address.)

b. Describe strategies for engaging, educating, and training health professionals and service providers in the EHDI system about the activities described in the Program Description. (See pages 9–13)

c. Describe strategies to strengthen the capacity to provide family support and engage families with children who are DHH as well adults who are DHH throughout the EHDI system. This should include a description of how you will engage families throughout all project levels, involving family partners in the development, implementation, and evaluation of the EHDI Program.

(See pages 9–13)

d. Describe methodologies to assess the current status of coordination across early childhood programs and develop a plan to improve coordination of care and services for families and DHH children. This can be described through a variety of mechanisms based on the current level of integration across programs including the early childhood programs listed in the Program Description. (See pages 9–13)

e. Additionally, propose:

i. Plans for participating in the Annual Early Hearing Detection and Intervention (EHDI) Meeting: budget may include one or two staff and one family leader to attend this annual meeting.

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ii. Plans to work with the HRSA-20-051 (FL3 Center), HRSA-20-048 (EHDI NTRC), HRSA-16-190 (LEND), and HRSA-18-069 (NRC-PFCMH) recipients to implement the various initiatives that are listed in this NOFO.

iii. A statement regarding project sustainability after the period of federal funding ends.

f. Optional Needs Assessment Project

To…