PKG00256999-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Nurse Education, Practice, Quality and Retention (NEPQR) Interprofessional Collaborative Practice Program (IPCP): Behavioral Health Integration (BHI)

Funding Opportunity Number: HRSA-20-012

Funding Opportunity Type(s): New and Competing Continuations Assistance Listings (CFDA) Number: 93.359

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2020

Application Due Date: February 19, 2020

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: December 4, 2019

Leslie Poudrier, MS, BSN, RN Lieutenant Commander, U.S. Public Health Service Public Health Analyst, Bureau of Health Workforce Telephone: (301) 443-3511 Email: lpoudrier@hrsa.gov

Authority: Public Health Service Act, Sections 831 and 831A (42 U.S.C. §§ 296p, 296p-1).

mailto:lpoudrier@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2020 Nurse Education, Practice, Quality and Retention (NEPQR):

Interprofessional Collaborative Practice (IPCP): Behavioral Health Integration (BHI) program, referred to as NEPQR: BHI. The purpose of this program is to increase the access to and quality of behavioral health services through behavioral health integrated team-based care models; and train the future nursing workforce to provide integrated behavioral health services in primary care settings through academic-practice partnerships.

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: Nurse Education Practice, Quality and

Retention (NEPQR) Interprofessional Collaborative Practice Program (IPCP):

Behavioral Health Integration (BHI)

Funding Opportunity Number: HRSA-20-012 Due Date for Applications: February 19, 2020 Anticipated Total Annual Available FY 2020 Funding:

$8,500,000

Estimated Number and Type of Award(s): Approximately 17 cooperative agreements

Estimated Award Amount: Up to $500,000 per year subject to the availability of appropriated funds

Cost Sharing/Match Required: No Period of Performance: July 1, 2020 through

June 30, 2023 (3 years)

Eligible Applicants: Eligible applicants are accredited schools of nursing, health care facilities, or a partnership of such a school and facility.

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 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance HRSA will hold a pre-application technical assistance (TA) webinar(s) for applicants seeking funding through this opportunity. The webinar(s) will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions.

Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://bhw.hrsa.gov/fundingopportunities/default.aspx to learn more about the resources available for this funding opportunity.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://bhw.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 Justification Narrative

v. Attachments

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER AND

SYSTEM FOR AWARD MANAGEMENT

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

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 Nurse Education Practice, Quality and Retention (NEPQR) Interprofessional Collaborative Practice Program (IPCP): Behavioral Health Integration (BHI) program, referred to as NEPQR:

BHI.

Program Purpose

The purpose of this program is to increase the access to and quality of behavioral health services through team-based care models in interprofessional nurse-led primary care teams in rural or underserved areas. In addition, the NEPQR: BHI program will increase the training of the current and future nursing workforce, and strengthen their ability to provide integrated behavioral health care services in primary care settings through academic-practice partnerships.

Program Goals

The goals of this program are 1) to educate and train the current and future nursing workforce to provide interprofessional, evidence-based, integrated behavioral health services, and 2) to reduce barriers to care by addressing social determinants of health through community-based partnerships.

Program Objectives

NEPQR: BHI’s objective is to increase the number of interprofessional nurse-led primary care teams trained in the integration of evidence-based BHI strategies, through academic-practice and community-based partnerships.

HHS and HRSA Priorities

You are encouraged to select and address one of the clinical priorities below which include HHS’s and HRSA’s priorities.

• Ending the crisis of opioid addiction and overdose in America

• Improving mental health access and care

• Delivering value-based care and quality improvement initiatives

• Transforming the workforce –targeting the need

• Utilizing telehealth technology

• Preventing and reducing maternal mortality

2. Background

This program is authorized by Sections 831 and 831A of the Public Health Service (PHS) Act, 42 U.S.C. §§ 296p, 296p-1. The NEPQR program has statutory authority to address the development and enhancement of the nursing workforce. The three priority areas defined in the statute for this program are (1) Education, (2) Practice, and (3) Retention.

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The NEPQR: BHI program addresses the following priority areas:

• Education Priority (Section 831(a)(2) of the PHS Act) o Provide education in new technologies, including distance learning methodologies.

• Practice Priority (Section 831(b)(1-3) of the PHS Act) o Establish or expand nursing practice arrangements in non-institutional settings (e.g., community-based clinics such as Nurse Managed Health Centers (NMHCs), school-based clinics, and Federally Qualified Health Centers (FQHCs)) to demonstrate methods to improve access to primary health care in medically underserved communities;

o Provide care for underserved populations and other high-risk groups such as the elderly, individuals living with HIV/AIDS, individuals with substance use disorders (SUD), the homeless, and victims of domestic violence; and o Provide coordinated care, and other skills needed to practice in existing and emerging organized health care systems.

• Retention Priority (Sections 831(c)(2), 831A(c)(1) of the PHS Act) o Improve the retention of nurses, and enhance patient care that is directly related to nursing activities, by enhancing collaboration and communication among nurses and other health care professionals, and by promoting nurse involvement in the organizational and clinical decision making processes of a health care facility.

According to the National Institutes of Mental Health, approximately 18.9 percent of all U.S. adults were estimated to have a behavioral health condition including mental and/or emotional health disorders. Among those adults, 68 percent will also have comorbid chronic health disorders. Compared to the general population, people with mental illness are more likely to have a decreased life-expectancy from untreated and preventable chronic illnesses like hypertension, diabetes, obesity, and cardiovascular disease that are aggravated by poor health habits such as inadequate physical activity, poor nutrition, smoking, and substance abuse.1

Approximately half of people who experience a mental illness will also experience a SUD at some point in their lives and vice versa. In 2017, an estimated 18.7 million adults in the United States were diagnosed with SUD. Of those individuals, 8.5 million had co-occurring mental illness with nearly half (49 percent) not receiving treatment for either mental or SUD services.2 Barriers to early identification of alcohol and other drug-related problems are stigma and discrimination by health care professionals, insufficient training on addressing alcohol and drug problems in clinical settings and navigating complex healthcare systems.

In response to the significant unmet need for behavioral health services, the NEPQR:

BHI program aims to 1) expand evidence-based practices of integrating behavioral health services into interprofessional nurse-led primary care teams serving underserved populations, 2) establish academic-practice partnerships to educate and train the future

1 SAMHSA-HRSA Center for Integrated Health Solutions. What is Integrated Care? Retrieved from https://www.integration.samhsa.gov/about-us/what-is-integrated-care 2 Substance Abuse Mental Health Service Administration. 2017 NSDUH Annual National Report. Retrieved from https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report.

https://www.integration.samhsa.gov/about-us/what-is-integrated-care https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report

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nursing workforce to provide interprofessional, integrated behavioral health services, and 3) reduce gaps in access to behavioral health services through community-based partnerships.

Primary care settings have become a gateway for many individuals with both behavioral health and primary care needs. Research has shown that more than 70 percent of primary care visits stem from behavioral health issues.3 Behavioral health integration (BHI) as defined by the Agency for Healthcare Research and Quality, is the care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. When adapted to fit into community practices, integrating behavioral health into primary care reduces depression severity and enhances patient experiences.4

Nurse-led primary care teams provide a full range of health services to low-income, underinsured patients in rural, urban, and suburban communities throughout the nation.

Nurse-led primary care teams provide services that include a holistic approach to primary care, health promotion, and disease prevention for the communities in which they serve. In addition, they serve an important role in nursing education, acting as clinical education sites for nurses and other health professionals throughout the United States. Nurse-lead primary care teams are staffed by an interdisciplinary team of healthcare providers, thus uniquely positioned to provide interprofessional approaches to integrated behavioral health and primary care services.

Traditional health care systems provide symptom driven response to acute illnesses and is poorly configured to meet the needs of those with chronic illnesses.5 Behavioral health disorders, such as those associated with substance use addiction, share similar qualities with other chronic health conditions including a tendency to run in families, onset, and course that is influenced by environmental conditions and behavior.6 Consideration to include partners outside of traditional health systems is integral in the care of individuals with behavioral health disorders since behavioral health conditions are affected by numerous factors outside the formal health system.7

Program Definitions A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the Health Workforce Glossary.

Advanced Education Nurse: means individuals trained in advanced degree programs including individuals in combined R.N./Master’s degree programs, post-nursing master’s certificate programs, or, in the case of nurse midwives, in certificate programs in

3 Gerrity, M. (2016). Evolving models of behavioral health integration: Evidence update 2010–2015. Retrieved from http://www.milbank.org/uploads/documents/10430EvolvingCare/EvolvingCare.pdf 4 Balasubramanian, B. A., Cohen, D. J., Jetelina, K. K., Dickinson, L. M., Davis, M., Gunn, R., ... & Green, L. A.

(2017). Outcomes of integrated behavioral health with primary care. J Am Board Fam Med, 30(2), 130-139.

5 Siminerio, L. M., Piatt, G., & Zgibor, J. C. (2005). Implementing the chronic care model for improvements in diabetes care and education in a rural primary care practice. The Diabetes Educator, 31(2), 225-234.

6 Rice, D. P. (1999). Economic costs of substance abuse, 1995. Proceedings of the Association of American Physicians, 111(2), 119-125.

7 Towe, V. L., Leviton, L., Chandra, A., Sloan, J. C., Tait, M., & Orleans, T. (2016). Cross-sector collaborations and partnerships: essential ingredients to help shape health and well-being. Health Affairs, 35(11), 1964-1969.

https://bhw.hrsa.gov/grants/resourcecenter/glossary http://www.milbank.org/uploads/documents/10430EvolvingCare/EvolvingCare.pdf

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existence on the date that is one day prior to the date of enactment of this section, to serve as nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, nurse educators, nurse administrators, or public health nurses, or in other nurse specialties determined by the Secretary to require advanced education.

Participants: For the purposes of this NOFO, participants are health professions students (whether undergraduate or graduate) and current primary care professionals who participate in education and or training at a NEPQR-BHI supported academic or clinical site.

School of Nursing: means an accredited collegiate, associate degree, or diploma school of nursing in a State where graduates are—

1. authorized to sit for the National Council Licensure Examination-Registered Nurse (NCLEX–RN); or

2. licensed registered nurses who will receive a graduate or equivalent degree or training to become an advanced education nurse as defined by section 811(b).

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New and Competing Continuations

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.

In addition to the usual monitoring and technical assistance provided under the cooperative agreement, HRSA program involvement will include:

• Making available the services of experienced HRSA/BHW personnel as participants in the planning and development of all phases of the project;

• Providing assistance and referrals in the establishment and facilitation of effective collaborative relationships with federal and state agencies, other HRSA-funded projects, and other resource centers and entities that may be relevant to the project’s mission;

• Providing programmatic consultation for development and delivery of training and technical assistance, project data collection methods and a set of core measures and metrics across projects;

• Providing guidance concerning the content, structure and format of required reports;

• Participating, as appropriate, in meetings or site visits conducted during the period of the cooperative agreement;

• Providing information resources;

• Supporting the recipient’s development of plans to disseminate effective clinical and/or community practice models that emerge from the NEPQR: BHI program, and explore opportunities to expand best practice models to diverse populations.

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The cooperative agreement recipient’s responsibilities will include:

• Fulfilling program requirements as detailed in Section IV.2 of this NOFO;

• Participating in ongoing technical assistance with HRSA staff and other stakeholders as applicable;

• Establishing contacts that may be relevant to the project’s mission such as federal and non-federal partners, and other HRSA award recipients;

• Working with HRSA to evaluate priorities and respond to HRSA reporting requirements;

• Developing core data elements that will contribute to a set of shared evaluation measures and metrics across all NEPQR: BHI projects;

• Engage, collaborate, and communicate with HRSA staff for input on project activities, quality improvement, and dissemination of lessons learned and effective practice models; and Carrying out project activities that meet the goals of NEPQR: BHI.

2. Summary of Funding

HRSA expects approximately $8,500,000 to be available annually to fund approximately 18 recipients. You may apply for a ceiling amount of up to $500,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The actual amount available will not be determined until enactment of the final FY 2020 federal appropriation. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner. The period of performance is July 1, 2020 through June 30, 2023 (three years). Funding beyond the first year is subject to the availability of appropriated funds for the NEPQR:

BHI Program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

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

In accordance with Sections 831(g) and 831A(f) of PHS Act, eligible applicants include accredited schools of nursing, as defined by section 801(2), health care facilities, or a partnership of such a school and facility.

Schools of nursing affiliated with the proposed project must be accredited public or private school. Applicants must provide documentation of current accreditation by a national nurse education accrediting agency or a state agency by the U.S. Department of Education as Attachment 9. Individuals are not eligible to apply.

In addition to the 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the 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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Republic of Palau may apply. Tribes and Tribal organizations may apply for these funds, if otherwise eligible. Foreign entities are not eligible for this HRSA award.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of $500,000 per year non-responsive and will not consider it for funding under this notice.

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

Maintenance of Effort The recipient must agree to maintain non-federal funding for award activities at a level that is not less than expenditures for such activities for the fiscal year preceding the fiscal year for which the entity receives the award, as required by Sec. 803(b) of the PHS Act. Complete the Maintenance of Effort information and submit as Attachment 6.

Multiple Applications Eligible applicants may submit only one application in response to this NOFO. Multiple applications from an organization are not allowable. Separate organizations are those entities that have unique DUNS numbers.

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

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

IV. Application and Submission Information

1. Address to Request Application Package

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

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

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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. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. 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 R&R Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. You must submit 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 SF-424 R&R Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 70 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO.

Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Biographical sketches do count in the page limitation.

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 Attachment 10: Other Relevant Documents.

https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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

Program-Specific Instructions

Program Requirements All funded applicants are required to:

• Provide interprofessional, integrated care by a nurse-led primary care team in a community-based setting.

o The primary care provider must be an advanced practice registered nurse

(APRN).

• Expand an existing nurse-led primary care team with the addition of at least one full-time equivalent (FTE) licensed behavioral health provider.

• Implement an evidence based BHI into the current nurse-led primary care team.

• Provide an assessment on current level of BHI and structural changes necessary to enhance current or new levels of integration (using the six-level framework available from HRSA's Integrated Behavioral Health Resource Library on HRSA’s Integrating Behavioral Health with Primary Medical Care webpage).

• Provide interprofessional education and training for care team providers and clinical staff on BHI competencies; and screen and treat individuals with co-occurring physical and behavioral health needs.

• Participate in data collection efforts that include rapid cycle quality improvement (RCQI) method and additional performance reporting activities as described in Section VI.3.

• Education Priority (Section 831(a)(2) of the PHS Act) o Provide education in new technologies, including distance learning methodologies.

o Practice Priority (Section 831(b)(1-3) of the PHS Act) o Establish or expand nursing practice arrangements in non-institutional settings (e.g., community-based clinics such as Nurse Managed Health Centers (NMHCs), school-based clinics, and Federally Qualified Health Centers (FQHCs)) to demonstrate methods to improve access to primary health care in medically underserved communities;

o Provide care for underserved populations and other high-risk groups such as the elderly, individuals living with HIV/AIDS, individuals with substance use disorders (SUD), the homeless, and victims of domestic violence; and o Provide coordinated care, and other skills needed to practice in existing and emerging organized health care systems.

• Retention Priority (Sections 831(c)(2), 831A(c)(1) of the PHS Act) o Improve the retention of nurses, and enhance patient care that is directly related to nursing activities, by enhancing collaboration and communication among nurses and other health care professionals, and by promoting nurse involvement in the organizational and clinical decision making processes of a health care facility.

Interprofessional collaboration is a required component of all project objectives, and nursing must be one of the professions included in all interprofessional activities.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf https://www.hrsa.gov/behavioral-health/library

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Recipients are required to have all participants obtain National Provider Identifier (NPI) numbers to aid long-term assessment of the program’s impact on access and delivery of quality health care services. This includes:

1. Members of the interprofessional primary care team;

2. Eligible register nurse participants trained by the interprofessional primary care team.

Recipients are also encouraged to have all eligible students obtain NPI numbers, who receive training as a result of the NOFO.

In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Application Guide (including the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

i. Project Abstract See Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

The Abstract must include:

1. A brief overview of the project as a whole;

2. Specific, measurable objectives that the project will accomplish;

3. Which of the HHS and HRSA clinical priorities will be addressed by the project (if applicable);

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

and

5. Statement of funding preference (if applicable).

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:

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

You must describe the purpose and need for the proposed project, including:

• Target population served, including demographics, health status, social determinants of health, unmet health care needs including primary care behavioral health care services (and the prevalence/incidence of primary care and behavioral health disorders within the target community/population, including health status indicators and unmet health needs), and barriers to care;

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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• Current nurse-led primary care team, level of BHI and structural changes necessary to enhance current level of integration (using the six-level framework available from HRSA's Integrated Behavioral Health Resource Library on HRSA’s Integrating Behavioral Health with Primary Medical Care webpage: http://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf);

• Unmet education and training needs of the primary care team and clinical support staff that will participate in this project; and

• Unmet education and training needs for interprofessional health professions students and curricula modifications/enhancements needed.

RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections

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

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

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

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.). Additionally, you must:

• Describe the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance identified in the Methodology section.

• Describe the timeframes, deliverables, and key partners required during the award period of performance to address each of the needs described in the Purpose and Need section.

• Explain how the work plan is appropriate for the program design and how the targets fit into the overall timeline of award implementation.

• Identify meaningful support and collaboration with key stakeholders (including community, academic and organizational partners) in planning, designing and implementing all activities, including development of the application and the extent to which these contributors reflect the needs of the target population served.

• Describe your process to track participants who complete the training program into employment one year after program completion, including the use of NPIs.

NPI tracking of participants is required.

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

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

(b).

Propose methods that you will use to address the stated needs and meet each of the previously described program goals and objectives in this NOFO. Your approach to these objectives should be specific, measurable, achievable, realistic, and timely (within the period of performance). Propose methods that you will use to http://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf http://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

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address the objectives including the roles of partners, system level and organizational change initiatives, educational strategies and curricula enhancements that will be used to accomplish the objectives of the project.

In addition to integrating behavioral health services into primary care, applicants must develop and implement a program for the training of primary care professionals and health professions students who will provide healthcare to individuals in need of physical and behavioral health services in primary care settings. Training must be interprofessional and focus on the integration of behavioral health prevention and treatment in primary care.

In the Methodology section of your application, you must include a detailed description of key activities such as:

• Implementing evidence-based BHI strategies in interprofessional nurse-led primary care teams; including current level of integration and forecasting how the program will progress to higher level of health care integration.

o HRSA's Integrated Behavioral Health Resource Library provides evidence-based BHI strategies and additional resources to BHI implementation.

• Training and interprofessional education of the primary care workforce, including clinical support staff to support BHI and to address the care of individuals with physical and behavioral needs in primary care settings.

• Establishing partnerships:

o Describe the role of the academic-practice partnership, profession/disciplines and the numbers of participants /students you expect to train, and any didactic or experiential learning enhancements to be made during the period of performance.

o Describe the role of the community-based partnership in creating linkages to care, the process of information sharing, and how follow up care will occur.

Logic Model You must submit a logic model for designing and managing the project. A logic model is a one-page diagram that presents the conceptual framework for a proposed project and explains the links among program elements to achieve the relevant outcomes. While there are many versions of logic models, for the purposes of this notice the logic model should summarize the connections between the:

• Goals of the project (e.g., objectives, reasons for proposing the intervention, if applicable);

• Assumptions (e.g., beliefs about how the program will work and support resources. Base assumptions on research, best practices, and experience);

• Inputs (e.g., organizational profile, collaborative partners, key personnel, budget, other resources);

• Target population (e.g., the individuals to be served; the students to be trained);

• Activities (e.g., approach, listing key intervention, if applicable);

• Outputs (i.e., the direct products or deliverables of program activities); and https://www.hrsa.gov/behavioral-health/library

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• Outcomes (i.e., the results of a program, typically describing a change in people or systems).

Although there are similarities, a logic model is not a work plan. A work plan is an “action” guide with a time line used during program implementation; the work plan provides the “how to” steps. A logic model is a visual diagram that demonstrates an overview of the relationships between the 1) resources and inputs, 2) implementation strategies and activities, and 3) desired outputs and outcomes in a project. You can find additional information on developing logic models at the following website:

https://www.cdc.gov/oralhealth/state_programs/pdf/logic_models.pdf.

(c) RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion

#2 (c)

Discuss challenges that you are likely to encounter in designing and implementing the activities described in the work plan, and approaches that you will use to resolve such challenges.

In this section, provide information including, but not limited to:

• Challenges related to project implementation and the achievement of the proposed goals and objectives (i.e. recruitment and retention of care team members and/or interprofessional healthcare students; billing/payment systems;

and health information technology);

• Challenges related to the workforce development such as recruitment and retention and interprofessional education and training;

• Challenges related to establishing or expanding academic-practice or community-based partnerships, as applicable;

• Challenges with increasing the number of didactic or experiential learning hours focused on behavioral health prevention and treatment in primary care;

• Resources and plans available to resolve and overcome these challenges and obstacles.

IMPACT -- This section includes two sub-sections— (a) Evaluation and Technical

Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b).

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

You must describe the plan for program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation must monitor ongoing processes and progress toward meeting goals and objectives of the project. Include descriptions of the inputs (e.g., key evaluation personnel and organizational support, collaborative partners, budget, and other resources); key processes; variables to be measured; expected outcomes of the funded activities;

and a description of how all key evaluative measures will be reported. In the Attachments section (IV. 2. v., Attachment 2), you must attach a complete staffing plan and job descriptions for key personnel. Bio sketches of Key Personnel should be uploaded in the SF-424 R&R Senior/Key Person Profile form. You must https://www.cdc.gov/oralhealth/state_programs/pdf/logic_models.pdf

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demonstrate evidence that the evaluative measures selected will be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which these can be attributed to the project.

You must also describe the systems and processes that will support your organization's collection of HRSA’s performance measurement requirements for this program. At the following link, you will find the required data forms for this program: http://bhw.hrsa.gov/grants/reporting/index.html. Describe the data collection strategy to accurately collect, manage, analyze, store, and track/report data (e.g., assigned skilled staff, data management software) to measure process and impact/outcomes, and explain how the data will be used to inform program development and service delivery in a way that allows for accurate and timely reporting of performance outcomes. Document the procedure for assuring the data collection, management, storage, and reporting of NPI numbers for individuals (as applicable) participating in the Program. Describe current experience, skills, and knowledge, including individuals on staff, materials published, and previous work of a similar nature.

Include any potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles. The evaluation and reporting plan also should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

Describe your process to obtain participant employment data one year after graduation, including the use of NPI. (Note: Participants who benefit from HRSA funds and sponsored activities as a result of this award must apply for an NPI for the purpose of collecting post-graduation employment demographics).

You must include a plan for Rapid Cycle Quality Improvement (RCQI) for the continuous monitoring of ongoing project processes, outcomes of implemented activities, and progress toward meeting award goals and objectives and the implementation of necessary adjustment to planned activities to effect course corrections. Additional information on RCQI is available at the following website:

http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/.

Program Impact Evaluation You must include an impact evaluation plan (Attachment 10) that demonstrates how your project will show program impact for patient access, quality, and cost measures.

(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion

#3 (b)

You must provide a clear plan for project sustainability after the period of federal funding ends, including a description of specific actions you will take to (a) highlight key elements of your award projects, e.g., training methods or strategies, http://bhw.hrsa.gov/grants/reporting/index.html http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/ http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/

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which have been effective in improving practices; (b) obtain future sources of potential funding; as well as (c) provide a timetable for becoming self-sufficient.

Recipients are expected to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population. You must discuss challenges that are likely to be encountered in sustaining the program and approaches that will be used to resolve such challenges.

ORGANIZATIONAL INFORMATION, RESOURCES AND CAPABILITIES --

Corresponds to Section V’s Review Criterion #4

Succinctly describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project. Provide information on your organization’s current mission and structure, including an organizational chart, relevant experience, and scope of current activities, and describe how these elements all contribute to the organization’s ability to conduct the program requirements and meet program expectations. (A project organizational chart is requested in Section IV.2.v., Attachment 4.) You must include the following information:

Project Director Qualification: Identify one Project Director. The Project Director for the proposed project must be a licensed Registered Nurse. NOTE: There may only be one Project Director for the NEPQR: BHI project.

Capabilities of the Applicant Organization: Provide evidence of existing nurse-led, interprofessional primary care and the capacity for evidence-based BHI. Describe how the organizational structure, including the capability and commitment of administration, management and governing board, is appropriate for the implementation, operations, and oversight necessary to implement integrated services and curriculum enhancements. Provide a letter of support from the President of the academic institution or other higher level academic officer that demonstrates the institution’s commitment to the project. In addition, provide a letter of support from each partner organization or department, internal and external, involved in your proposed project; include letters of support as Attachment 8.

Staff: Describe capacity and institutional mechanisms to establish the interprofessional core care team. The core care team must include an Advanced Practice registered nurse as the primary care provider; and the addition of at least 1.0 behavioral health FTE in personnel (direct hire staff and/or contractor(s), or supported with in-kind resources). Provide the qualifications and position descriptions for the leadership and care team; include as Attachment 2. Include a biographical sketch (no more than 1 page) for key personnel; bio sketches should be uploaded in the SF-424 R&R Senior/Key Person Profile form. If staff are required but not yet identified, describe the recruitment and retention plan to meet the project’s needs. If applicable, describe how tele-behavioral health will contribute to the implementation of the project.

Biographical sketches, not exceeding two pages per person, should include the following information:

• Senior/key personnel name

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• Position Title

• Education/Training - beginning with baccalaureate or other initial professional education, such as nursing, including postdoctoral training and residency training if applicable:

o Institution and location o Degree (if applicable) o Date of degree (MM/YY) o Field of study

• Section A (required) Personal Statement. Briefly describe why the individual’s experience and qualifications make him/her particularly well-suited for his/her role (e.g., PD/PI) in the project that is the subject of the award.

• Section B (required) Positions and Honors. List in chronological order previous positions, concluding with the present position. List any honors. Include present membership on any Federal Government public advisory committee.

• Section C (optional) Peer-reviewed publications or manuscripts in press (in chronological order). You are encouraged to limit the list of selected peer-reviewed publications or manuscripts in press to no more than 15. Do not include manuscripts submitted or in preparation. The individual may choose to include selected publications based on date, importance to the field, and/or relevance to the proposed research. Citations that are publicly available in a free, online format may include URLs along with the full reference (note that copies of publicly available publications are not acceptable as appendix material).

• Section D (optional) Other Support. List both selected ongoing and completed (during the last 3 years) projects (federal or non-federal support). Begin with any projects relevant to the project proposed in this application. Briefly indicate the overall goals of the projects and responsibilities of the Senior/Key Person identified on the Biographical Sketch.

Institutional Resources: Describe available institutional resources, including health IT systems.

Partnerships and Community Support: Describe how the proposed academic-practice and community-based organization partnership will contribute to meeting the goals and objectives of the proposed project. Include current signed and dated letters of agreement and/or Memorandums of Agreement (MOA) (include as Attachment 3).

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NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, this table provides a crosswalk between the narrative language and where each section falls within the review criteria. Any attachments referenced in a narrative section may be considered during the objective review.

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

Response to Program Purpose:

(a) Work Plan

(b) Methodology/Approach

(c) Resolution of Challenges

(2) Response to Program Purpose

(a) Work Plan

(b) Methodology/Approach

(c) Resolution of Challenges

Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

(3) Impact:

(a) Evaluation and Technical Support Capacity

(b) Project Sustainability

Organizational Information, Resources and Capabilities

(4) Organizational Information, Resources and Capabilities

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

iii. Budget See Section 4.1.iv of HRSA’s SF-424 R&R Application Guide. Please note: the directions offered in the SF-424 R&R Application Guide may differ from those offered by Grants.gov. Follow the instructions included in the R&R Application Guide and the additional budget instructions provided below. A budget that follows the R&R Application Guide will ensure that, if HRSA selects the application for funding, you will have a well-organized plan, and by carefully following the approved plan can avoid audit issues during the implementation phase.

If applicable (i.e., competitions with subawards/subcontracts), each sub--award/subcontract requires separate budget information (i.e., line item budget form and budget justification narrative):

Subawards/subcontracts A detailed line-item budget form is required for each sub-award and should be uploaded to the R&R Sub-award Budget Attachment(s) Form.

The R&R Subaward Budget Attachment Form limits the number of attachments for subawards to 10.