PKG00253571-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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

Family Leadership in Language and Learning Center

Funding Opportunity Number: HRSA-20-051

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: August 6, 2019

Michelle Koplitz, MHS Public Health Analyst Telephone: (301) 880-4480 Email: mkoplitz@hrsa.gov

Authority: Public Health Service Act, Title III, Section 399M(a) (42 U.S.C. 280g-1(a)) mailto:mkoplitz@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2020 for the Family Leadership in Language and Learning (FL3) Center.

The purpose of the FL3 Center is to provide technical support to national, state and territory, and local Early Hearing Detection and Intervention (EHDI) systems of care in order to increase family engagement and leadership, and to strengthen family support for families, parents, and caregivers with newborns, infants, and young children up to 3 years of age who are deaf or hard-of-hearing (DHH).

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: Family Leadership in Language and

Learning Center Funding Opportunity Number: HRSA-20-051 Due Date for Applications: November 8, 2019 Anticipated Total Annual Available FY 2020 Funding:

$450,000

Estimated Number and Type of Award(s): Up to one cooperative agreement Estimated Award Amount: Up to $450,000 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 domestic public or private entity, including states (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). Domestic faith-based and community-based organizations, tribes, and tribal organizations (as those terms are defined at 25 U.S.C. 450b) are also eligible to apply.

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: Tuesday, August 27, 2019 Time: 3–4 p.m. ET

Call-In Number: 1-888-790-3407 Participant Code: 9983978 Weblink: https://hrsa.connectsolutions.com/hrsa-20-051-fl3-center-nofo-ta/

This webinar will be captioned.

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-20-051-fl3-center-nofo-ta/ https://mchb.hrsa.gov/fundingopportunities/default.aspx

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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 for the Family Leadership in Language and Learning (FL3) Center.

HRSA takes a comprehensive approach to support the Early Hearing Detection and Intervention (EHDI) system. One form of support is provided through the EHDI National Technical Resource Center (NTRC) (HRSA-20-048) which supports state and territory EHDI systems and professionals. A second form of support, provided through the FL3 Center, focuses on families. The purpose of the FL3 Center is to provide technical support to national, state and territory, and local Early Hearing Detection and Intervention (EHDI) systems of care1 in order to increase family engagement2 and leadership, and to strengthen family support3 for families, parents, and caregivers with newborns, infants, and young children up to 3 years of age4 who are deaf or hard-of-hearing (DHH). 5 This will be achieved by providing national leadership in the following areas:

1) Supporting EHDI Program (HRSA-20-047) recipients in meeting their family engagement, leadership, and family support program objectives through technical assistance, training, education, quality improvement and evaluation.

2) Serving as a technical resource center to increase family engagement, leadership, and support for families, parents, and caregivers of children who are DHH in EHDI systems of care by analyzing, compiling, and disseminating evidence-based and innovative practices, policies, tools, and resources.

3) Increasing the number of parents and caregivers of children who are DHH who are trained to serve as family leaders in EHDI systems; and

4) Developing and sustaining collaborative partnerships with all EHDI Program (HRSA-20-047) recipients and their stakeholders. This includes the Early Hearing Detection and Intervention National Technical Resource Center (EHDI NTRC) (HRSA-20-048) recipient, Advancing Systems of Services for Children

1 For the purposes of this NOFO, the “EHDI systems 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, “family engagement” is defined as the 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. See the Background section of this NOFO for the full citation.

3 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, early intervention, and beyond. See the Background section of this NOFO for the full citation.

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

5 For the purposes of this funding opportunity, “deaf and/or hard-of-hearing” or “DHH” is used 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 also have other disabilities and/or conditions.

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and Youth with Special Health Care Needs (HRSA-18-069) medical home focus area recipient, and other relevant national EHDI system organizations, stakeholders, and programs that represent and/or serve families with children who are DHH.

Optional Project(s) As part of this funding opportunity, you may apply for additional funds, should they become available, up to $50,000 (up to $25,000 for each of the optional projects below), to address an identified need of the EHDI system that enhances family engagement, leadership, and/or support for parents and caregivers of children who are DHH. You may apply for one ($25,000) or both ($50,000) of the following projects:

a) DHH-specific training for family-based organizations and programs that are not experienced in supporting families with children who are DHH.

b) Technical enhancements for the organization to provide training and education through technology platforms that support distance learning and adult education. Technology enhancements may also include database infrastructure development for collecting data, evaluating program activities, and reporting activities.

Program Goal HRSA supports EHDI systems at the national, state/territory, and local levels through a coordinated portfolio of programs and technical resource centers 6 that work to ensure that children who are DHH are identified through newborn, infant, and early childhood hearing screening receive appropriate early intervention services. The goal of the FL3 Center is to increase family engagement and leadership, and strengthen family support in EHDI systems of care in order to enable families, parents, and caregivers to optimize the language, literacy, cognitive, social, and emotional development of their children who are DHH.

Program Objectives The recipient will collect and report on the following program objectives. Competing continuation applicants should propose baseline data in their application based on their experience to date. Baseline data for new applicants should be collected and reported to HRSA after the first year of the program.

By March 31, 2024:

1) Increase by 30 percent from baseline the number of technical assistance, education, and training opportunities provided to EHDI Program (HRSA-20-047) recipients and its stakeholders addressing evidence-based practices for family engagement, leadership, and family support.

2) Increase by 20 percent from baseline the number of parents and caregivers of children who are DHH who participate in training opportunities to serve as family leaders in EHDI systems.

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

https://mchb.hrsa.gov/fundingopportunities/?id=cd03ebf4-d0f7-44a6-900f-9cadce70ea75 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

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3) Increase by 10 percent from baseline the number of parents and caregivers of children who are DHH from underrepresented populations7 who participate in training opportunities to serve as leaders in EHDI systems.

4) Increase by 30 percent from baseline the number of individuals accessing the FL3 Center’s web-based resources around language, literacy, social, and emotional development of children who are DHH.

2. Background

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

Approximately 1.7 of every 1,0008 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 deafness is estimated to increase to 6 of every 1,0009 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,10 receptive language,11,12,13,14 expressive language,15,16 and social-emotional development.17,18 To reduce risks for developmental delays in children who are DHH, experts recommend

7 For the purposes of this funding opportunity, “underrepresented populations” is intended to be inclusive of but is not limited to: underrepresented racial and ethnic groups (i.e., Hispanic or Latino, American Indian or Alaskan Native, Asian, Black or African-American, Native Hawaiian or Pacific Islander, two or more races (OMB), nationality, language, locality, sex, sexual orientation, gender identity, disability, socio-economic status, and those who have adopted children who are DHH, etc.

8 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 9 Northern JL, Downs MP. Hearing in children. 5th Ed. Chapter 1, Hearing and hearing loss in children. Baltimore: Williams and Wilkins; 2002.

10 Yoshinaga-Itano C, Sedey AL, Wiggin M, et al. Early Hearing Detection and Vocabulary of Children With Hearing Loss. Pediatrics 2017; 140(2):e20162964 11 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.

12 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.

13 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.

14 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.

15 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.

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 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.

18 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.

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

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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.19 To promote healthy child development pediatric health supervision guidelines call for hearing screening based on risk assessment criteria or whenever parents/caregivers express concern about hearing or language development at every health supervision visit for young children.20

EHDI Legislation Legislation first providing support for the development of state/territory newborn hearing screening and intervention systems was passed by Congress in 1999. 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 under the age of 3.21 This 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 providers or qualified health care providers (including those at medical homes for children), and referrals, as appropriate including to early intervention services under Part C of the Individuals with Disabilities Education Act;” and for state/territory agencies to “increase the rate of such follow-up and referral.” Additionally, the reauthorization 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.” 22

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.” Family engagement23 improves quality of care, parent and family satisfaction, and families’ communication and relationships with health care providers. It also reduces health care cost and parent/caregiver anxieties.24 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.

19 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.

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

21 Retrieved from: https://www.congress.gov/115/plaws/publ71/PLAW-115publ71.pdf 22 Retrieved from: https://www.congress.gov/115/plaws/publ71/PLAW-115publ71.pdf 23 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) 24 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.

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

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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”25 but it should be communicated in a timely, culturally sensitive, and understandable format at all stages of the EHDI system.26

Family-to-Family and DHH Adult Consumer-to-Family Supports Families with children who are DHH report the most valuable source of support received is specific to their child’s hearing status27 and a preference for connecting with other families that have children who are DHH.28 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.”29 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.” Family support30 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.31

Families with children who are DHH also benefit from access to support, mentorship, and guidance from adults who are DHH.32 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.33

Provider Engagement According to the 2013 supplement to the 2007 Joint Committee on Infant Hearing (JCIH) Position Statement, the success of EHDI systems 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

25 Retrieved from: https://www.congress.gov/115/plaws/publ71/PLAW-115publ71.pdf 26 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.

27 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.

28 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.

29 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.

30 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.

31 Ibid 32 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.

33 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://www.congress.gov/115/plaws/publ71/PLAW-115publ71.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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families comprehensive, evidence-based information as noted in the legislation. In addition, the child’s primary care provider, that also serves as his/her medical home,34 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 raised by 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.35 During this same timeframe, 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.36

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 loss to documentation (LTF/D) rates. Challenges in meeting these goals include limited family engagement, DHH-specific support services,37 parent knowledge about availability and importance of EI services, 38 and pediatric provider knowledge of the 1-3-6 recommendations.39,40 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 in availability and accessibility of pediatric audiologists; limitations in availability of culturally appropriate, evidence-based information for families; inconsistent data sharing

34 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.

35 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 36 Ibid 37 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.

38 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 39 American Academy of Pediatrics (AAP) Early Hearing Detection and Intervention (EHDI) Pediatrician Perspectives: Executive Summary. August 2018.

40 Ibid.

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

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with early childhood programs and services such as those provided through the Program for Infants and Toddlers with Disabilities (Part C) of the Individuals with Disabilities Education Act (IDEA); and limitations in systems integration with other relevant programs and services.

HRSA addresses these issues through a coordinated portfolio of programs focused on enhancing multiple components of the national and state EHDI systems. State EHDI systems face additional challenges, such as limited involvement of families of newborns, infants, and children who are DHH and adults who are DHH at all levels of the EHDI system; lack of parents and caregivers of children who are DHH who are trained to serve as family leaders in their state; and lack of support for families, parents and caregivers of children who are newly-identified as DHH. A national resource center focused on family engagement and leadership in the EHDI system is necessary to identify, review, investigate, compile, and disseminate additional mechanisms, policies, and evidence-based strategies that can improve family engagement, leadership, and support for families of children who are DHH in state EHDI systems of care. The FL3 Center will provide a critical infrastructure to convene national family-based and family-led organizations, family leaders, and community stakeholders to support the state and territory EHDI Programs.

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 cooperative agreement. A cooperative agreement is a financial assistance mechanism where substantial involvement is anticipated between HRSA and the recipient during performance of the contemplated project.

HRSA’s responsibilities will include:

1) Participating, when appropriate, in meetings conducted during the period of performance;

2) Reviewing activities, data, measures, and tools designed and implemented to accomplish this initiative;

3) Participating, as appropriate, in the review of project materials prior to dissemination;

4) Reviewing data associated with program activities;

5) Participating in discussions to assist recipient in program planning and providing technical assistance; and

6) Assisting with the establishment of federal and state/territory interagency partnerships, collaboration, and cooperation that may be necessary for project success.

The cooperative agreement recipient’s responsibilities will include:

1) Completing activities proposed in response to the Program Description;

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2) Participating in face-to-face meetings and/or conference calls with HRSA conducted, at a minimum monthly, during the period of performance;

3) Collaborating with HRSA on ongoing review of activities, budget items, procedures, information/publications prior to dissemination, contracts and interagency agreements through conference calls and/or face-to-face meetings;

4) Assisting with the establishment of federal and state/territory interagency partnerships, collaboration, and cooperation that may be necessary for project success;

5) Providing technical assistance, including training opportunities;

6) Providing leadership, collaboratively with HRSA, in data collection; analysis of evidence-based data; impact and quality improvement data, and any relevant data trends;

7) Providing the federal project officer opportunity to review documents and products prior to dissemination;

8) Producing and disseminating materials, including publishing articles; and

9) Maintaining a stand-alone website that acknowledges HRSA. 41 The website must clearly label all posted individual resources, materials, trainings, and webinars that were developed fully, or in-part, with funds or sponsorship by any other organization, entity, or private for-profit company.

2. Summary of Funding

HRSA estimates approximately $450,000 to be available annually to fund one recipient.

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 $450,000 in total cost (includes both direct and indirect, facilities and administrative costs) per year. In addition to this amount, you may apply for up to $50,000 (up to $25,000 for each of the optional projects) as further described in this NOFO. 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 FL3 Center in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

Optional Project(s) As noted above, as part of this funding opportunity, you may apply for additional funds up to $50,000 (up to $25,000 per project) should they become available, to address an identified need of the EHDI system that enhances family engagement, leadership, and/or support for parents and caregivers of children who are DHH. You may apply for one or both optional projects:

a) DHH-specific training for family-based organizations and programs that are not experienced in supporting families with children who are DHH.

b) Technical enhancements to the organization to provide training and education through technology platforms that support distance learning and adult education.

41 https://www.hrsa.gov/grants/manage/acknowledge-hrsa-funding https://www.hrsa.gov/grants/manage/acknowledge-hrsa-funding

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Technology enhancements may also include database infrastructure development for collecting data, evaluating program activities, and reporting activities

You should propose a budget and work plan to conduct one or both optional projects.

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

III. Eligibility Information

1. Eligible Applicants

Any domestic public or private entity, including states (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). Domestic faith-based and community-based organizations, tribes, and tribal organizations (as those terms are defined at 25 U.S.C.

450b) are also eligible to apply.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

An applicant may NOT apply for both the Family Leadership in Language and Learning Center (HRSA-20-051) and the Early Hearing Detection and Intervention National Technical Resource Center (HRSA-20-048). If an applicant does apply for both funding opportunities, the applicant will be considered non-responsive and both applications will be disqualified.

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.

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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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.

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 70 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.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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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 8–15: Other Relevant Documents.

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

Program Description

A successful applicant of the FL3 Center will propose methodologies and strategies to provide national leadership to achieve the following:

1) Technical Assistance, Training, and Education

a) Develop a mechanism to regularly assess the family engagement, leadership, and family support needs of the EHDI Program (HRSA-20-047) recipients and stakeholders.

b) Provide culturally-sensitive, family-centered technical assistance, training, and education to EHDI Program (HRSA-20-047) recipients and their stakeholders related to achieving their program objectives and required activities, specifically those addressing family support and engagement, including the following:

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

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

c) Establish a mechanism that allows the EHDI Program (HRSA-20-047) recipients and its stakeholders to request technical assistance and a mechanism to track the type of technical assistance provided.

d) Develop resources that address the families’ role in all aspects of the EHDI system including:

a. The availability, access, and quality of family support services including family-to-family42 support programs and DHH adult consumer-to-family43 support programs.

b. Family-professional partnerships and the benefits of quality, coordinated care in a family-centered medical home.

42 For the purposes of this document, a “family-to-family support program” consists of services and supports provided in response to the needs of a given family through a family-led organization or program. Types of support and services provided will be based on the capacity of the family-led organization or program and may include, but are not be limited to: direct parent-to-parent support, information, education, technical assistance, training, and referral.

43 For the purposes of this document, “DHH adult consumer-to-family support program” consists of services and supports provided by a trained DHH adult who has the knowledge and skills to mentor, support, and guide families and their children who are DHH in culturally and linguistically sensitive ways and to serve as communication/language and social role models and mentors.

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c. Evidence-based and evidence-informed practices for supporting language, literacy, social, and emotional development in children who are DHH.

e) Develop a curriculum and deliver leadership training for parents and caregivers to become family leaders in the EHDI system.

f) Collaborate with the EHDI NTRC (HRSA-20-048) recipient to ensure resources developed and disseminated are family-friendly and inclusive of family needs.

g) Develop a mechanism to convene national Learning Communities comprised of teams including state/territory EHDI Coordinators, state/territory stakeholders leading family engagement, leadership, and/or family support activities for the EHDI Program (HRSA-20-047) recipients to share best practices and successful strategies used to address specific, identified challenges in state/territory EHDI systems.

2) Partnership Building and National Leadership

a) Convene an advisory committee to advise the FL3 Center on supporting EHDI Program (HRSA-20-047) recipients and their stakeholders or contractors as well as national EHDI systems and stakeholders more broadly to:

i. Advise on the direction of the FL3 Center, including guidance on addressing family engagement, leadership, and family support gaps in EHDI systems and other emerging issues.

ii. Leverage expertise of advisory committee members to develop recommendations to increase access to family-to-family support program and DHH adult consumer-to-family support program services.

b) Develop and sustain partnership activities with relevant national EHDI system organizations and stakeholder groups to:

i. Advance family engagement and leadership opportunities.

ii. Enhance family-professional partnerships with health care professionals.

c) Convene an annual meeting for family leaders of state/territory EHDI

Program (HRSA-20-047) activities for family engagement, leadership, and family support.

d) Engage and collaborate with deaf-based organizations and programs that operate evidence-based DHH adult consumer-to-family support programs, or have evidence-based resources to learn best practices and to integrate new knowledge into FL3 Center resources and training curriculums.

e) Develop strategies to support meaningful inclusion of DHH adults within national, state/territory, and local EHDI systems.

f) Collaborate with the EHDI NTRC (HRSA-20-048) recipient, the Advancing Systems of Services for Children and Youth with Special Health Care Needs (HRSA-18-069) medical home focus area recipient, and the Pediatric Audiology Competitive Supplement to Leadership Education in

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Neurodevelopmental and Related Disabilities (LEND) (HRSA-16-190) recipients.

g) Develop a Diversity and Inclusion Plan that addresses inclusion of underrepresented populations (e.g., rural, urban, race, ethnicity, disability, gender, sexual orientation, family structure, SES) in family engagement, leadership, and family support across the national and state/territory EHDI systems.

3) Communication and Dissemination

a) By the end of Year 2, develop a public facing, freestanding culturally and linguistically competent website with current best practices, models, and resources for family engagement, leadership, and support for the EHDI system, which contains information that is accurate, comprehensive, up-to-date, and evidence-based.

b) Develop a strategic communications plan for regular communications and outreach to EHDI Program (HRSA-20-047) recipients and their stakeholders and to national EHDI system stakeholders.

c) Ensure information, resources, tools, technical assistance, trainings, and education about family engagement, leadership, and family support is available through multiple channels to EHDI Program (HRSA-20-047) recipients, their stakeholders, and families.

d) Ensure information provided to families 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.”44

e) Collaborate with national experts in language and literacy acquisition, and social and emotional development in children who are DHH:

i. Identify the latest up-to-date, evidence-based findings for early childhood language, literacy, social, and emotional development in children who are DHH.

ii. Develop resources and/or training opportunities that highlight and summarize current research about early childhood language, literacy, social and emotional development for children who are DHH.

iii. Disseminate to parents and EHDI system stakeholders and professionals for families to support and track their DHH child’s language, literacy, social, and emotional development and its milestones.

f) Communicate the importance of enrollment of children who are DHH in early intervention services such as those supported by Part C of the IDEA.

4) Evaluation

a) Develop a plan to evaluate progress of FL3 Center activities in meeting goals and objectives of the cooperative agreement.

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

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b) Disseminate evidence-based resources for EHDI Program (HRSA-20-047) recipients to evaluate family engagement, leadership, and family support in state/territory EHDI systems.

5) Optional Project(s) As part of this funding opportunity, you may apply for additional funds to address an identified need of the EHDI system that enhances family engagement, leadership, and/or support for parents and caregivers of children who are DHH.

You may apply for one or both optional projects:

c) DHH-specific training for family-based organizations and programs that are not experienced in supporting families with children who are DHH.

d) Technical enhancements to the organization’s capacity to provide training and education through technology platforms that support distance learning and adult education. Technology enhancements may also include database infrastructure development for collecting data, evaluating program activities, and reporting activities.

Details are provided in the Methodology section 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

Briefly describe the purpose of the proposed project. You should include a discussion that exhibits a solid understanding of the EHDI system and the status of family engagement, leadership, and family support activities in state/territory EHDI programs. Include how the EHDI Program (HRSA-20-047) recipients will be supported to accomplish their program objectives.

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

This section outlines the needs of the community and/or organizations you plan to serve with the proposed project. Use and cite demographic data whenever possible to support the information provided.

1. Describe and document the target population and its unmet health needs.

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

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2. Describe the needs of EHDI systems and the population of children who are DHH and their families.

3. Describe the needs of EHDI systems for families to be engaged and trained as leaders in order to support parents with children newly identified as DHH.

4. Describe disparities based on race, ethnicity, gender identity, sexual orientation, geography, socioeconomic status, disability status, primary language, non-English speaking populations, health literacy, and other relevant dimensions that should be considered. Include sociocultural-determinants of health and health disparities affecting the population or communities served and unmet.

5. Discuss any relevant barriers in the service area that the project hopes to overcome.

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

(3) Evaluative Measures, (4) Impact, and (6) Support Requested Describe how you will serve as the technical assistance resource center for family engagement, leadership, and support in EHDI systems. Describe the methods that will be utilized to operationalize the following activities (as outlined in Section 1.

Purpose and Section IV Program Description):

1. Provide Technical Assistance, Training, and Education to EHDI Program (HRSA-20-047) recipients. This should include a description of mechanisms developed to assess the TA, training and educational needs of the EHDI Program (HRSA-20-047) recipients. (See pages 11–12 for a full description of what to address.)

2. Partnership Building and National Leadership – This includes convening an advisory committee and developing…