PKG00262720-instructions.pdf

DEPARTMENT OF

HEALTH AND HUMAN SERVICES

OFFICE OF THE

ASSISTANT SECRETARY FOR HEALTH

Office of Population Affairs and Office on Women’s Health

Funding Opportunity: National Training Center for Family Planning and

Teen Pregnancy Prevention

Opportunity Number:

PA-FPT-20-001 / AH-TPS-20-001 / WH-AST-20-002

Application Due Date:

August 25, 2020 6:00 PM Eastern

OVERVIEW

FEDERAL AGENCY NAME

Office of the Assistant Secretary for Health / Office of Population Affairs and Office on

Women’s Health

FUNDING OPPORTUNITY TITLE

National Training Center for Family Planning and Teen Pregnancy Prevention

ACTION

Notice

ANNOUNCEMENT TYPE

Competitive Cooperative Agreement

FUNDING OPPORTUNITY NUMBER

PA-FPT-20-001 / AH-TPS-20-001 / WH-AST-20-002

CFDA NUMBER AND PROGRAM:

93.260 Family Planning Personnel Training

93.297 Teen Pregnancy Prevention

93.088 Advancing System Improvements for Key Issues in Women's Health

DATES

Application Deadline : Tuesday August 25, 2020 by 6:00 PM Eastern.

Technical Assistance: A technical assistance FAQ will be posted on grants.gov

EXECUTIVE SUMMARY

The Office of Population Affairs (OPA) and the Office on Women’s Health (OWH) announce the availability of funds for Fiscal Year (FY) 2020 cooperative agreements under the authority of section 1003 of the Public Health Service (PHS) Act (42 U.S.C. § 300a–1), Division

A, Title II of the Further Consolidated Appropriations Act, 2020 (Public Law No. 116-94), section 1703(a) of the PHS Act (42 U.S.C. § 300u-2(a)), and section 229 of the PHS Act (42 U.S.C.

§ 237a). A single application will be required consisting of a distinct proposal for each of the three program areas making awards under this announcement. Only one application will be selected for award as 3 cooperative agreements (one each funded by Title X, Teen Pregnancy

Prevention (TPP), and Office on Women’s Health (OWH)) that together will constitute the

National Training Center. Applicants may be either: (a) a public or nonprofit private entity applying to be the awardee of all 3 cooperative agreements; or (b) a formal partnership between a for-profit entity applying to the be the awardee of the TPP and OWH components of the project with a public or non-profit entity able to accept and manage the Title X portion of the funding for the project.

This notice solicits applications to establish and operate a National Training Center for

Family Planning and Teen Pregnancy Prevention to provide training and technical assistance to all OPA-funded Title X family planning service delivery grantees and all OPA-funded Teen

Pregnancy Prevention (TPP) grantees. OWH will collaborate and provide funding support for training and technical assistance for Title X and TPP grantees to address key priority areas for improving women’s reproductive health, including reducing maternal mortality; increasing awareness, accessibility, and quality of preconception health; and increasing fertility awareness and preventing infertility among the millions of women seen by Title X clinics and TPP programs across the country each year.

The goal of the funded training center is to ensure that personnel working in OPA-funded

Title X and TPP projects have the knowledge, skills, and attitudes necessary to effectively deliver high quality services and programs to have the greatest impact on meeting their project goals. The training center receiving funding through this announcement will be expected to:

1. Ensure expertise and the ability to provide training and technical assistance in key priority areas for Title X, OWH, and TPP.

2. Determine competencies needed by Title X and TPP grantee staff for each key priority area.

3. Develop and implement a plan for providing training and technical assistance to support OPA-funded Title X and TPP grantees in each of the key priority areas.

4. Establish and maintain a robust website and knowledge management system to support the training and technical assistance provided to grantees.

5. Monitor, evaluate, and continuously improve the training and technical assistance provided to OPA-funded Title X and TPP grantees in each of the key priority areas.

6. Establish and maintain partnerships, including with OPA and OWH, with grantees, and with other organizations, to support the training and technical assistance plan.

7. Establish and maintain a Leadership Council to secure feedback and buy-in from Title X and TPP grantees for training and technical assistance activities.

8. Communicate and disseminate training and technical assistance products, information, successes, and lessons learned, on a regular basis.

OPA and OWH intend to award a total of 3 cooperative agreements to a single awardee in response to a single application under this announcement for a maximum of $7.4 million available for the first 12-month budget period of a project not to exceed 5 years with the following breakdown of funding across the three awards:

up to $3.5 M is available to address Title X key priority areas (CFDA

93.260), up to $2.4 M is available to address OWH key priority areas (CFDA

93.088), and up to $1.5 M is available to address TPP key priority areas (CFDA

93.297).

HHS/OASH encourages applicants to review all program requirements, eligibility information, application format and submission information, evaluation criteria, and other information in this funding announcement to ensure that its application complies with all requirements and instructions.

FUNDING OPPORTUNITY DETAILS

A. DATES

1. Application Deadline

Your application is due August 25, 2020 by 6 p.m. Eastern Time. To receive consideration, you must submit your application electronically via Grants.gov no later than this due date and time. If you do not submit your application by the specified deadline, we will return it to you unread. You must submit electronically via Grants.gov unless you obtain a written exemption from this requirement 2 business days in advance of the deadline from the Director, HHS/Office of the Assistant Secretary for Health (OASH) Grants and Acquisitions Management (GAM)

Division. To obtain an exemption, you must request one via email from the HHS/OASH GAM, and provide details as to why you are technologically unable to submit electronically through

Grants.gov. Your request should be submitted at least 4 business days prior to the application deadline to ensure your request can be considered prior to 2 business days in advance of the deadline. If you request an exemption, include the following in your e-mail request: the

HHS/OASH announcement number; your organization's DUNS number; your organization’s name, address and telephone number; the name and telephone number of your Authorizing

Official; the Grants.gov Tracking Number (for example, GRANT####) assigned to your submission; and a copy of the "Rejected with Errors" notification from Grants.gov. Send the request with supporting documentation to OASH_Grants@hhs.gov. Note: failure to have an active

System for Account Management (SAM) registration prior to the application due date will not be grounds for receiving an exemption to the electronic submission requirement. As a result of the public health emergency for COVID-19, the requirement for an active SAM registration at the time of application submission has been waived (see Section Error! Reference source not found.). However, if you do not have a DUNS number at this time, you should contact the

Grants.gov to establish a temporary DUNS number. Your application will not be accepted through

Grants.gov without this number. Failure to follow Grants.gov instructions to ensure software compatibility will not be grounds for receiving an exemption to the electronic submission requirement.

The HHS/OASH GAM will only accept applications via alternate methods (hardcopy paper via U.S. mail or other provider or PDF via email) from applicants obtaining prior written approval.

If you receive an exemption, you must still submit your application by the deadline. Only applications submitted through the Grants.gov portal or alternate format (hardcopy paper via U.S.

mail or other service or PDF via email) with an approved written exemption will be accepted. See

Section F.8 (“Other Submission Requirements”) for information on application submission mechanisms.

mailto:OASH_Grants@hhs.gov

Executive Order 12372 comment due date: The State Single Point of Contact (SPOC) has

60 days from the application due date to submit any comments. For more information on the SPOC see section F.6 Intergovernmental Review.

To ensure adequate time to submit your application successfully, HHS/OASH recommends that you register as early as possible in Grants.gov since the registration process can take up to one month. You must register an authorizing official for your organization. HHS/OASH does not determine your organization’s authorizing official; your organization makes that designation. For information on registering for Grants.gov, refer to http://www.grants.gov or contact the Grants.gov

Contact Center 24 hours a day, 7 days a week (excluding Federal holidays) at 1-800-518-4726 or support@grants.gov.

Your organization is strongly encouraged to register multiple authorized organization representatives in Grants.gov to ensure someone is available to submit your application.

2. Technical Assistance

A technical assistance Frequently Asked Questions (FAQ) for potential applicants will be maintained on grants.gov.

We recommend you review the entire announcement promptly so you can have any questions answered well in advance of the application due date. We also recommend you subscribe to this announcement in Grants.gov so you receive any amendments, question and answer documents, or other updates.

B. PROGRAM DESCRIPTION:

The Office of the Assistant Secretary for Health, Office of Population Affairs and Office on

Women’s Health, announce the availability of funds for Fiscal Year (FY) 2020 cooperative http://www.grants.gov/ mailto:support@grants.gov agreement awards under the authority of section 1003 of the Public Health Service Act (42 U.S.C.

§ 300a–1), Division A, Title II of the Further Consolidated Appropriations Act, 2020 (Public Law

No. 116-94), section 1703(a) of the PHS Act (42 U.S.C. § 300u-2(a)), and section 229 of the PHS

Act (42 U.S.C. § 237a).

The primary focus of the Office of the Assistant Secretary for Health is leading America to healthier lives, especially for those who are most vulnerable, including those who have suffered historic disparities. In support of this vision, the Office of Population Affairs (OPA) promotes health across the reproductive lifespan through innovative, evidence-based adolescent health and family planning programs, services, strategic partnerships, evaluation, and research. OPA administers the Title X program, the Teen Pregnancy Prevention (TPP) Program, and the Embryo

Adoption Awareness program. OPA advises the Secretary of HHS and the Assistant Secretary for

Health on a wide range of topics, including adolescent health, family planning, sterilization, and other population issues. The vision of the Office on Women’s Health (OWH) is that all women and girls achieve the best possible health. OWH provides national leadership and coordination to improve the health of women and girls through policy, education, and innovative programs. OWH supports women and girls through policies, programs, and educational initiatives to improve health. One of OWH’s key focus areas is on improving women’s health across the lifespan, including during the preconception time period; reducing maternal mortality; increasing awareness, accessibility, and quality of preconception health; and increasing fertility awareness and preventing infertility. By partnering with OPA through this FOA, OWH will be able to address these key priority areas related to reproductive health with the millions of women served annually at OPA-supported Title X clinics and by OPA-supported TPP programs.

1. Background

The goal of this announcement is to solicit applications from public and private nonprofit entities to establish and operate a national training center for family planning and teen pregnancy prevention grantees (“training center”) to provide training and technical assistance in key priority areas for family planning, women’s health, and teen pregnancy prevention. Funding a single training center to meet the training and technical assistance needs of both Title X and TPP grantees, rather than two separate training centers, has many benefits. These programs have very different methods of delivery of services, requiring specialized training and technical assistance. However, their missions are complementary and there will be positive synergy of effort. Benefits will include greater efficiency and economies of scale by providing training and technical assistance to grantees with complementary but distinct missions; maximizing funds available for training and technical assistance by reducing overhead, fostering collaboration and coordination across Title X and TPP grantees, and ultimately improving outcomes in building staff capacity to help the people they serve prevent or achieve pregnancy. In addition, the collaboration between OWH and OPA will help connect the OPA-funded Title X and TPP grantees who are working to help millions of women and girls prevent or achieve pregnancy each year with training and technical assistance to address key OWH priorities aimed at reducing maternal mortality, increasing preconception health, and preventing infertility. Lastly, while the training and technical assistance materials developed in this project are developed for OPA grantees and their networks, the materials also may be of use to others who, though not funded by OPA, aim to deliver high quality programs, care, and services in a manner which mirrors the overarching goals and objectives of OPA-funded projects.

The goal of the training center is to ensure that personnel working in OPA-funded Title X and TPP projects have the knowledge, skills, and attitudes necessary to effectively deliver high quality services and programs to have the greatest impact on meeting their project’s goals. The primary audience for the training center is OPA-funded Title X family planning service delivery grantees and TPP grantees. Many OPA grantees (both Title X and TPP) rely on sub-recipient agencies and implementation partners to directly deliver services and implement programs, therefore OPA expects the funded training center will provide training and technical assistance at the sub-recipient, service site, and implementation partner level as a way to support grantee efforts and service delivery networks. More information about the Title X family planning service delivery project and the TPP program is included below and is available on the OPA website at www.hhs.gov/opa.

a. Title X Family Planning Service Delivery Project

Family planning includes a broad range of services related to achieving and preventing pregnancy, and assisting women, men, and couples with achieving their desired number and spacing of children. Section 1001 of Title X of the Public Health Service Act, as amended, authorizes Title X family planning service delivery grants “to assist in the establishment and operation of voluntary family planning projects which shall offer a broad range of acceptable and effective family planning methods and services (including natural family planning methods, infertility services, and services for adolescents).” Title X of the Public Health Service Act, as well as an applicable appropriations provision, requires entities which receive Title X grants or contracts to encourage family participation, especially family participation in the decision of minors to seek family planning services..The regulations for Title X family planning service delivery grants are included in 42 C.F.R. Part 59, Subpart A, which is available at https://www.ecfr.gov/cgi-bin/text-http://www.hhs.gov/opa https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6 idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6. On

February 14, 2020, the U.S. District Court for the District of Maryland issued a permanent injunction against enforcing the 2019 Title X Final Rule in the State of Maryland only. Because of this permanent injunction, all services provided in Maryland must be in compliance with the previous regulations until further notice.

Family planning services are those services offered to women and men that assist them in preventing or achieving pregnancy. These services should be client-centered, defined as care that is respectful of, and responsive to, individual client preferences, needs, and values. Core family planning services for Title X grantees include: (1) discussion with the client about their reproductive life plan; (2) a broad range of acceptable and effective family planning methods and services for delaying or preventing pregnancy; (3) the broad range of family planning services does not include abortion as a method of family planning; (4) pregnancy testing and counseling in accordance with the Title X regulations; and (5) services centered around pre-conception health and achieving pregnancy. Title X projects may also include other preventive health services that are considered beneficial to reproductive health such as HPV vaccination, provision of HIV pre-exposure prophylaxis (PrEP), breast and cervical cancer screening, and screening for obesity, hypertension, smoking, drug and alcohol use, mental health, intimate partner violence, and human trafficking. Priorities and expectations for Title X family planning service delivery grantees are specified in the OPA Funding Opportunity Announcements (FOAs) that were used to award the grant funds and include all of the legal requirements covered within the Title X statute, regulations, https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6 and legislative mandates, as well as other key issues of importance to OPA. The list of relevant

FOAs is included in Appendix C.

OPA currently funds 71 Title X family planning service delivery grantees to provide voluntary family planning services to men and women across the United States as authorized under

Section 1001 of Title X of the Public Health Service Act. Those 71 grantees support 776 sub-recipients, and 2,645 service sites. OPA anticipates funding additional Title X family planning service delivery grantees in FY2020 as well as expanding the number of Title X sub-recipients and service sites. In 2018, Title X family planning service delivery grantees provided family planning services to 3.9 million clients through 6.5 million encounters; 87% of clients served were female and 63% were under 30 years of age (2018 FPAR). The grant project period for currently funded

Title X grantees is from April 1, 2019 through March 31, 2022. OPA anticipates funding an estimated 10 new Title X family planning service delivery grantees in 2020 for an estimated two-year project period, and anticipates funding new Title X family planning service delivery grantees in 2022.

b. OWH Advancing System Improvements for Key Issues in Women's Health

OWH provides national leadership and coordination to improve the health of women and girls through policy, education, and innovative programs. One of OWH’s key focus areas include improving women’s health across the lifespan, including preconception health; reducing maternal mortality; increasing awareness, accessibility, and quality of preconception health; and increasing fertility awareness and preventing infertility.

Maternal mortality is defined as “deaths of women while pregnant or within 42 days of being pregnant, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes” (Hovert, 2020). In 2018, the maternal mortality rate in the

United States was 17.4 deaths per 100,000 live births. The maternal mortality rate was 2.5 times higher for non-Hispanic black women (37.1 deaths per 100,000 live births) compared to non-

Hispanic white women (14.7) and 3.1 times higher compared to Hispanic women (11.8). Maternal mortality also increases with age, with the rate for women aged 40 and above (81.9) 7.7 times higher than that for women under age 25 (10.6) (Hovert, 2020).

Preconception health is a woman's health before she becomes pregnant, and it means knowing how health conditions and risk factors could affect a woman or her unborn baby if she becomes pregnant. Taking action on health issues and risks before pregnancy can help prevent problems that might affect the health of the woman or her baby later. Women and men should prepare for pregnancy before becoming sexually active, or at least three months or more before getting pregnant; some actions, such as quitting smoking, reaching a healthy weight, or adjusting medications, should start even earlier. The six most important preconception health actions include taking folic acid daily, stopping smoking and drinking alcohol, getting medical conditions under control, talking to a doctor about over-the-counter and prescription medicines, making sure vaccinations are up to date, and avoiding contact with toxic substances or materials that could cause infection (OWH, 2020).

Infertility is defined as not being able to get pregnant after one year (or six months if a woman is 35 or older) of unprotected sex. Infertility can be caused by a number of different conditions.

Female fertility declines with age, smoking, excessive alcohol use, extreme weight gain or loss, and excessive physical or emotional stress that results in amenorrhea. (CDC, 2020)

By partnering with OPA on this FOA, OWH will be able to reach the millions of women and girls served each year by OPA-funded Title X and TPP programs across the country. The women and girls served by Title X and TPP programs are aiming to either achieve or prevent a pregnancy, which aligns perfectly with OWH’s goals of reducing maternal mortality, improving preconception health, and preventing infertility.

c. Teen Pregnancy Prevention (TPP) Program

The TPP Program is designed to give youth the information and skills to promote optimal health and prevent teen pregnancy and sexually transmitted infections (STIs). Through the TPP

Program, OPA invests in both the implementation of effective programs and the development and evaluation of new and innovative approaches. The TPP Program serves adolescents ages 10-19 and their families, with a focus on populations with the greatest need in order to reduce existing health disparities.

Underlying all TPP projects is a commitment to reinforcing the Adolescent Health:

Think, Act, Grow® (TAG) five essentials for adolescent health, while using an optimal health approach and systems thinking. The integration of optimal health and systems thinking will effectively deliver solutions that have the greatest impact on eliminating health disparities;

achieving optimal health; and preventing teen pregnancy, STIs, and associated risk behaviors, while also increasing protective factors. The TAG five essentials for adolescent health are: (1) positive connections with supportive people; (2) safe and secure places to live, work, and play; (3) access to high quality and teen-friendly health care; (4) opportunities to engage as learners, leaders, team members, and workers; and (5) coordinated adolescent and family-centered services.1

Optimal health is a dynamic balance of physical, emotional, social, spiritual, and intellectual health. The optimal health model focuses on population-level interventions that promote the best possible health outcome for the community while also meeting individuals where they are to https://youth.gov/youth-topics/tag https://youth.gov/youth-topics/tag provide them with the knowledge, skills, and motivation to make appropriate changes that will lead them towards a position of increasingly lower risk2. A systems thinking approach helps us to see the “big picture” in which the issue of teen pregnancy and STIs exists. It provides a framework to help examine the factors involved in the problem, the relations between these factors, and changes over time. With an understanding of the system, public health practitioners can then identify multiple leverage points where significant impacts can be made in an effort to create a healthier system and achieve optimal health. Additional priorities and expectations for TPP grantees are spelled out in the FOAs used to fund the TPP grantees (see Appendix C).

OPA anticipates funding an estimated 110 TPP grantees in 2020, the majority of which will be newly funded in 2020 for an anticipated three-year project period that would end in 2023. Funding for 29 current TPP grantees will end in 2021, and OPA anticipates funding a new group of TPP grantees in 2021 and 2023. TPP grantees fall into one of the following categories:

Replicating programs that have been proven effective to identify how to bring effective programs to scale and build an understanding of what components are important to program success;

Saturating communities and/or populations with the greatest needs and disparities by replicating effective programs with fidelity and providing supportive services using a systems thinking approach;

Establishing, coordinating, and supporting a multidisciplinary network of partners to develop, refine, and test innovative interventions and to disseminate those demonstrated to be effective.

Rigorously evaluating promising interventions that have demonstrated project merit, positive preliminary evidence, readiness, and feasibility.

d. Previous Training and Technical Assistance Related to Title X and TPP

To date, training and technical assistance has been provided to Title X grantees by the

Family Planning National Training Center (FPNTC) through an OPA-funded cooperative agreement. All previously developed Title X technical assistance products are housed on the

FPNTC website at www.fpntc.org. In addition, OPA developed numerous technical assistance products and conducted several trainings to provide support for its TPP grantees through various contracts. All previously developed TPP technical assistance products are housed on the OPA website at https://www.hhs.gov/ash/oah/resources-and-training/tpp-and-paf-resources/index.html.

This FOA represents the first time OPA will be providing training and technical assistance to both the Title X and TPP grantees through a joint training center. OPA and OWH expect that, in addition to developing new materials, the funded recipient will review and use previously developed training and technical assistance products, and will continually update and enhance publically available products to ensure compliance with current Federal regulations, nationally recognized standards of care, evidence-based practices, and culturally competent and linguistically appropriate strategies in order to best meet grantee needs.

2. Expectations

The funded training center who receives funding through this FOA will be expected to:

a. Ensure expertise and the ability to provide training and technical assistance in key priority areas for Title X, OWH, and TPP.

The goal of the funded training center is to ensure that personnel working in OPA-funded Title

X and TPP projects have the knowledge, skills, and attitudes necessary to effectively deliver high quality services and programs and to have the greatest impact on meeting their project goals. Key http://www.fpntc.org/ https://www.hhs.gov/ash/oah/resources-and-training/tpp-and-paf-resources/index.html priority areas for training and technical assistance have been identified for Title X, OWH, and

TPP. The training center is expected to maintain expertise and the ability to provide training and technical assistance to OPA grantees in all of the key priority areas, and to deliver training and technical assistance grounded in evidence-based principles and using culturally and linguistically appropriate strategies. In addition, the successful applicant will maintain knowledge of the most current research and standards of care in order to act as a resource on a broad range of adolescent health, family planning, reproductive health, and other related health and preventive care issues for OPA grantees and their networks.

1) Key Priority Areas for Title X Family Planning Service Delivery

OPA expects that the training center will provide training and technical assistance for Title

X family planning service delivery in the following key priority areas, which are derived from the

World Health Organization’s (WHO) Health Systems Framework, a health systems strengthening approach to promote health outcomes. OPA adapted the Six Building Blocks of a Health System from the Framework3 based on OPA’s expectations for Title X family planning service delivery grantees.

(a) Service Delivery:

WHO’s Health System Framework states “good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimal waste of resources.” For Title X grantees, training and technical assistance in this priority area includes ensuring widespread implementation of quality family planning services at all levels of the Title X system, using and applying the national contraceptive care measures; encouraging family participation in family planning, especially in https://www.hhs.gov/opa/performance-measures/index.html https://www.hhs.gov/opa/performance-measures/index.html the decision of minors to seek family planning services; ensuring that Title X projects have the knowledge base to meet the statutory requirement to provide fertility awareness methods of family planning; expanding family planning services to areas of unmet need, applying an optimal health approach to Title X family planning service delivery, integrating Title X services within primary care, providing youth-friendly services, establishing and maintaining strong referral networks, and expanding the provision of related preventive health services that are beneficial to reproductive health.

(b) Health workforce:

WHO’s Health System Framework states “a well-performing health workforce is one which works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances.” For Title X grantees, training and technical assistance in this priority area includes supporting and training the Title X workforce; enhancing grantees’ abilities to ensure network-wide completion of required Title X training; enhancing grantees’ efforts in recruiting, onboarding, and maintaining sufficient numbers and mix of staff, while ensuring staff are fairly and sufficiently distributed across the service delivery network;

supporting grantee efforts to develop and maintain competent, responsive, productive and efficient staff; developing, maintaining, and enhancing systems to identify training needs and leverage opportunities to build staff skills and knowledge; ensuring that the Title X workforce receive the training needed for compliance with statutory (and, as applicable, regulatory) program integrity provisions; and fostering a culture in which staff perceive that they work in an organizationa l context that supports and recognizes their efforts to provide quality care.

(c) Health Information and Technology:

WHO’s Health System Framework states “a well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status.” For Title X grantees, training and technical assistance in this priority area includes strengthening health information technology systems, processes, and outputs in order to achieve greater interoperability , availability, and usefulness of health information; strengthening the capture of structured data elements within EHR systems using data to improve service delivery and program management;

establishing and using knowledge management systems; supporting grantee information and education efforts; and maintaining systems and processes to promote knowledge development and sharing across the entire Title X network.

(d) Contraceptive and other medical products:

WHO’s Health System Framework includes a building block to ensure equitable access to essential medical products “of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use.” For Title X grantees, training and technical assistance in this priority area includes helping grantees ensure Title X clients have timely, uninterrupted access to a broad range of contraceptive methods (optimally on a same-day basis) and the supplies and equipment needed to provide other family planning services (e.g., pregnancy tests, STD tests, Pap tests, training and other materials on fertility awareness methods of family planning). It may include, for example, strengthening supply chain processes, monitoring stock and stock-outs, and developing systems to ensure same-day access to needed supplies and equipment.

(e) Financial sustainability:

WHO’s Health System Framework states “a good health financing system raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment.” For Title X grantees, training and technical assistance in this priority area include helping service grantees understand their organization’s financial health and create a plan to sustain it; create robust billing and financial reimbursement systems to support long-term sustainability; diversify their revenue sources; develop sound administrative and financial practices, such as practices to ensure compliance with statutory and regulatory program integrity provisions, ensuring timely billing and collections, regular review of financial metrics, or enrolling clients in health insurance programs; and strengthen income generation efforts, such as through partnerships with primary care providers, offering value-added services, and outreach to new Title X client populations.

(f) Leadership and management:

WHO’s Health System Framework states “leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition building, the provision of appropriate regulations and incentives, attention to system-design, and accountability.” For Title X grantees, training and technical assistance in this priority area includes supporting grantees in setting a vision for family planning service delivery and meeting the reproductive health needs of all those in need of services (including those who are in need and not currently receiving care), managing change in response to internal and external influences, monitoring subrecipients and partners, and working with subrecipients to ensure quality, efficiency, and continuous improvement, as well as compliance.

2) Key Priority Areas for OWH

OPA and OWH expect that the training center will provide training and technical assistance for both Title X and TPP grantees in the following key priority areas.

(a) Maternal Mortality:

Maternal mortality includes raising awareness of the issue of maternal mortality and existing disparities in maternal mortality, and addressing the causes and contributing factors to maternal mortality.

(b) Preconception Health:

Preconception health includes increasing awareness, accessibility, and quality of preconception health; and increasing number and percentage of women who receive quality preconception healthcare.

(c) Fertility awareness and factors leading to infertility:

Fertility awareness and factors leading to infertility include raising awareness about fertility and infertility prevention; promoting healthy behaviors that can help maintain and preserve fertility; and promoting prevention, early detection, and treatment of conditions that can threaten fertility.

Given the breadth of the topics of preconception health and fertility awareness and factors leading to infertility, it is expected that the funded recipient will work with OPA and OWH, along with other Federal partners identified by OPA and OWH (e.g., Office of Minority Health, Health

Resources and Services Administration, Centers for Disease Control and Prevention) to determine the specific area of focus within the broader context of (1) preconception health and (2) fertility awareness and factors leading to infertility each year. The specific area of focus within preconception health for Year One has been pre-determined to be early detection of high blood pressure as a pre-determinant for maternal mortality. The specific areas of focus for future years will be determined prior to submission of the recipient’s continuation application.

3) Key Priority Areas for TPP Grantees

OPA expects that the training center will provide training and technical assistance for TPP grantees in the following key priority areas, which are based on OPA’s expectations for grantees included in their FOAs.

(a) Program Design:

Program design includes program planning, pilot testing, using an implementation science framework, using an optimal health approach, systems thinking, design thinking and user engagement, and fostering innovation.

(b) Program Implementation:

Program implementation includes implementation quality, fidelity, adaptations, recruitment and retention of youth and their families, participant engagement, effective group/classroom management, facilitation techniques, staff training and capacity building, and project management.

(c) Stakeholder Engagement and Sustainability:

Stakeholder engagement and sustainability includes youth engagement, caregiver engagement, community engagement, partnerships, referral networks, and program sustainability.

(d) Communication and Dissemination:

Communication and dissemination include developing a strategic dissemination and communication plan, assessing communication preferences of program stakeholders, developing key messages, developing communications strategies and products to match stakeholder needs and preferences, graphic design, storytelling, program packaging, publishing and presenting program results and lessons learned.

(e) Evaluation, Learning, and Continuous Quality Improvement:

Evaluaton, learning and continuous quality improvement include program evaluation;

program improvement; collecting and using data to monitor, evaluate, and improve; and continuous quality improvement.

(f) Content Expertise:

Content expertise includes adolescent health, health equity, optimal health, teen pregnancy prevention, prevention of STIs, working with vulnerable populations and communities with great need, risk and protective factors, positive youth development, and trauma-informed care.

b. Determine competencies needed by Title X and TPP grantee staff for each key priority area (expectation (a)).

Define specific competencies needed by staff to successfully operationalize each of the key priority areas described above (expectation (a)) and develop specific learning objectives for those competencies. For Title X grantees, this includes staff at the grantee, subrecipient, and service site levels. For TPP grantees, this includes grantee staff, subrecipients, and other implementation partner staff.

c. Develop and implement a plan for providing training and technical assistance to support OPA-funded Title X and TPP grantees in each of the key priority areas.

The funded training center is expected to develop and implement a plan for providing training and technical assistance to the Title X and TPP grantees to build the needed competencies among staff in each of the key priority areas. The plan should describe a method of determining training and technical assistance needs; how the training and technical assistance will be provided using methodologies that draw on research and best practice in training, adult learning, and implementation science; and plans for monitoring, evaluating, and improving training and technical assistance over time.

The plan is expected to include the provision of training and technical assistance at varying levels of intensity (i.e., universal, selected, and targeted) using diverse strategies and approaches

(e.g., in-person or online training and follow-up support, training of trainers, individual or group technical assistance, coaching, mentoring, peer-to-peer support, syntheses of available research and best practices, development of resources and tools, and virtual learning). The training and technical assistance plan should account and plan for the diverse needs of new staff versus seasoned staff; different needs of staff in different organizational levels of the project (i.e., grantee, subrecipient, service site, implementation partner); and the varying needs of grantees over the course of their grant project. The description of the training and technical assistance modalities should note the scientific evidence that the selected modalities change any of the following outcomes: trainee knowledge, skills and attitudes; trainee practice/behavior; and/or client outcomes. The plan should include delivery modalities that do not rely exclusively upon in-person meetings; however, in-person meetings are also allowable as needed and appropriate.

The varying levels of intensity for training and technical assistance include:

A universal level of training and technical assistance that is designed to meet the needs of all or most grantees, designed to be delivered over a short period of time and/or in an easily accessible format (e.g., prepackaged e-learning courses or webinars that are applicable to all grantees and their subrecipients, technical assistance materials that grantees (or sub-recipients and/or service sites) can use with only minor modifications, in-person skill-building trainings). OPA and OWH expect that the funded training center will offer numerous universal training and technical assistance opportunities to all Title X and TPP grantees each year. Applicants who choose to use any copyrighted materials in their proposed project must include a signed agreement with the developer or purveyor of the materials that demonstrates that the applicant has permission to use the materials as planned.

A selected level of training and/or technical assistance that is more targeted and designed for a sub-set of grantees (or sub-recipients and/or service sites) that have a particular interest or need for assistance (e.g., creation of learning collaboratives comprised of several grantees with shared learning objectives). OPA and OWH expect that the funded training center will provide multiple selected training and technical assistance opportunities each year to different subsets of Title X and TPP grantees.

A targeted level of training and technical assistance that is tailored to address a unique need of a specific grantee, and likely to occur over a longer period of time with multiple interactions (e.g., individualized technical assistance, one-on-one coaching). OPA and

OWH expect that all Title X and TPP grantees will have the opportunity to request targeted training and technical assistance, and that the specific number of grantees receiving targeted assistance will depend on available resources and grantee need, and will likely fluctuate from year to year.

The funded training center is expected to ensure that all training and technical assistance materials are culturally appropriate, age-appropriate, medically accurate, and trauma-informed

(see Glossary of Terms in Appendix B). The recipient is expected to conduct their own review of all training and technical assistance materials, as well as implementation practices and services related to the project, to ensure they are culturally appropriate, age-appropriate, medically accurate, and trauma-informed. The training center is also expected to provide eligible training participants with continuing education credits, hours, units or their equivalent, which are accepted in all 50 states and the District of Columbia.

In addition, the regulations set out at 42 CFR part 59, subpart C that govern grants to provide training for family planning service providers, require that the following assurances be included within an approvable application (§59.205): (1) No portion of the Federal funds will be used to train personnel for programs where abortion is a method of family planning; (2) No portion of the

Federal funds will be used to provide professional training to any student as part of his/her education in pursuit of an academic degree; and (3) No project personnel or trainees shall on the grounds of sex, religion, or creed be excluded from participation in, be denied the benefits of, or be subjected to discrimination under the project. Applicants must include these assurances as an

Appendix to their applications.

d. Establish and maintain a robust website and knowledge management system to support the training and technical assistance provided to grantees.

The funded training center is expected to develop and maintain a robust website that includes a national, electronic, web-based repository for all training and technical assistance for

OPA-funded Title X and TPP grantees. The repository is expected to include training and technical assistance materials newly developed with support from this FOA, as well as relevant training and technical assistance materials developed previously by OPA or through other OPA-funded cooperative agreements and contracts. Including previously developed materials may require linking to materials on other websites and/or transferring materials from other websites to the new https://www.ecfr.gov/cgi-bin/text-idx?SID=47e35369082b828057b506b2411bdb22&mc=true&node=sp42.1.59.c&rgn=div6 web-based repository. All training and technical assistance materials should be readily accessible to all grantees to access when most convenient for them. The recipient’s website is expected to have a high-quality search function that makes it easy for grantees to find what they’re looking for and is easy to navigate around the website.

The website is also expected to include a knowledge management system that allows grantee users (grantees, subrecipients, service sites, and implementation partners) to develop an individua l training plan and to track training they have completed or plan to complete. This knowledge management system should be able to capture people’s learning and display in real time trainings that are completed and incomplete. OPA and OWH expect the system will have multiple levels of functionality and access, including both staff-level accounts and administrator-level accounts to enhance grantees’ ability to configure, assign, and monitor training plans completed by their subrecipients and implementation partners. The knowledge management system should allow grantees to track training provided directly by the funded training center as well as training offered by others that are relevant to Title X and TPP. It should clearly indicate the trainings for Title X grantees that are required by the Title X regulations as spelled out in 42 CFR part 59.17, https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6.

e. Monitor, evaluate, and continuously improve the training and technical assistance provided to OPA-funded Title X and TPP grantees in each of the key priority areas.

The funded training center is expected to continuously monitor, evaluate, and improve the training and technical assistance developed and/or delivered through this cooperative agreement.

Monitoring and evaluation should include an assessment of the process for developing and providing training and technical assistance to grantees and the extent to which the training and https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6 https://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6 technical assistance provided met the grantee needs and was found to be beneficial. It is expected that the recipient will use information received from grantees through monitoring and evaluation to make continuous improvement to the training and technical assistance provided through this

FOA.

Monitoring and evaluation should be flexible and adaptable to be able to ask the most critical questions for determining usability, satisfaction, quality, and outcomes for the training and technical assistance provided.

As part of monitoring and evaluation, the funded training center is expected to collect a common set of performance measures to assess reach and implementation of the project. The funded training center will work collaboratively with OPA and OWH to determine the final performance measures and will collect and report performance measure data to OPA and OWH on a semi-annual basis in the programmatic progress reports.

f. Establish and maintain partnerships, including with OPA and OWH, with grantees, and with other organizations, to support the training and technical assistance plan.

To maximize funds and avoid duplication, the funded training center is expected to coordinate and collaborate with OPA and OWH staff and contractors, with grantees, and with partners.

The funded recipient is expected to work closely with OPA and OWH leadership, the OPA training coordinator, and OPA and OWH project officers to ensure that the training center activities are coordinated with all other OPA activities for grantees. OPA project officers are assigned to work directly with a portfolio of Title X and TPP grantees to monitor grantee progress and provide support and technical assistance to help grantees meet and exceed OPA expectations.