PKG00264136-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Maternal and Child Health Bureau Division of Maternal and Child Health Workforce Development

Leadership Education in Neurodevelopmental and Other Related Disabilities

(LEND)

Funding Opportunity Number: HRSA-21-041

Funding Opportunity Type(s): Competing Continuation, New Assistance Listings (CFDA) Number: 93.877

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: February 16, 2021

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: November 16, 2020

Robyn Schulhof, MA, Rita Maldonado, MPH, and Karla Brewer, M.Ed.

Public Health Analysts/Project Officers Telephone: (301) 443-0258; (301) 443-3622; (301) 443-2520 Email: rschulhof@hrsa.gov; rmaldonado@hrsa.gov; kbrewer@hrsa.gov

Authority: 42 U.S.C. § 280i-1 (Title III, § 399BB of the Public Health Service Act) mailto:rschulhof@hrsa.gov mailto:rmaldonado@hrsa.gov mailto:kbrewer@hrsa.gov

HRSA-21-041 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2021 Leadership Education in Neurodevelopmental and Other Related Disabilities (LEND) Training Program. The purpose of the LEND program is to improve the health of individuals who have, or are at risk for developing, autism spectrum disorder and other developmental disabilities by providing graduate-level training in maternal and child health interdisciplinary leadership education in neurodevelopmental and related disabilities programs. LEND trainees should:

(i) receive an appropriate balance of academic, clinical, and community opportunities;

(ii) be culturally competent;

(iii) be ethnically diverse;

(iv) demonstrate a capacity to evaluate, diagnose or rule out, develop, and provide evidence-based interventions to individuals with autism spectrum disorder and other developmental disabilities across their lifespan; and

(v) demonstrate an ability to use a family-centered approach.

You may apply for the LEND Program alone (base award) or for the LEND Program with the possibility of a single 1-year, one-time supplement over the course of the period of performance for this award. Such supplemental funds, awarded at HRSA’s discretion and based on availability of funds and successful performance of the recipient, will enhance LEND training programs’ ability to focus on emerging issues and innovative practices to improve the lives of individuals with ASD/DD (See Attachment 6: Optional LEND Supplement).

The FY 2021 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 appropriately. You should note that this program may be cancelled prior to award.

Funding Opportunity Title:

Leadership Education in Neurodevelopmental and Other Related Disabilities (LEND)

Funding Opportunity Number: HRSA-21-041 Due Date for Applications: February 16, 2021 Anticipated Total Annual Available FY 2021 Funding:

LEND Training Program: $35,245,000

LEND Supplement (optional): up to $550,000 may be available each year

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Estimated Number and Type of Award(s): LEND Training Program:

Up to 55 grants

LEND Supplement (optional): up to 11 supplements per year, pending availability of funds

Estimated Award Amount: LEND Training Program:

Up to $738,000 per year based on listed criteria subject to the availability of appropriated funds. For more information, see Table 2: Allowable Funding Levels.

LEND Supplement (optional): one-time supplement per LEND program, up to $50,000, dependent on the availability of funds each year. May be awarded in any of the 5 budget years for a funding period of 1 year.

Cost Sharing/Match Required: No Period of Performance: LEND Training Program:

July 1, 2021 through June 30, 2026 (5 years)

LEND Supplement (optional): 1-year, one-time supplement within the July 1, 2021 through June 30, 2026 period of performance

Eligible Applicants: Domestic public or nonprofit agencies, including institutions of higher education.

See Title III, § 399BB(e)(1)(A) of the Public Health Service Act. Domestic faith-based and community-based organizations, tribes, and tribal organizations are also eligible to apply.

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

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.

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

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Technical Assistance

HRSA has scheduled the following technical assistance:

Webinar

Day and Date: Friday, December 11, 2020 Time: 1–3 p.m. EST

2-hour TA webinar agenda:

• 1–2 p.m. EST: General NOFO overview

• 2–3 p.m. EST: Attachment 6 Optional LEND Supplement and Attachment 7:

Funding Tier Calculation Instructions Call-In Number: 1-888-913-9966 Participant Code: 6137293 Weblink: https://hrsa.connectsolutions.com/hrsa-21-041-ta/

HRSA will record the webinar and make it available at:

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

https://hrsa.connectsolutions.com/hrsa-21-041-ta/ https://mchb.hrsa.gov/fundingopportunities/default.aspx

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget -- Corresponds to Section V’s Review Criterion 6: Support Requested

iv. Budget Justification Narrative -- Corresponds to Section V’s Review Criterion 6:

Support Requested

v. Program-Specific Forms

vi. Attachments

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

TO THE UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEM ENT (SAM)

4. SUBMISSION DATES AND TIM ES

5. INTERGOV ERNM ENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSM ENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIV E AND NATIONAL POLICY REQUIREM ENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: APPLICABLE STANDARDS FOR USING GRANT FUNDS TO SUPPORT

LEND TRAINEES/FELLOWS

APPENDIX B: LOGIC MODEL FOR LEADERSHIP EDUCATION IN

NEURODEVELOPMENTAL DISABILITIES (LEND) GRANT PROGRAM

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I. Program Funding Opportunity Description

1. Purpose

This notice solicits applications for the Leadership Education in Neurodevelopmental and Other Related Disabilities (LEND) training program, and the option of a single, 1-year LEND supplement when funds are available, to expand or develop programs able to diagnose or rule out individuals with autism spectrum disorder (ASD) or other developmental disabilities (DD) across their lifespan.

The purpose of the LEND program is to improve the health of individuals who have, or are at risk for developing, ASD/DD by providing graduate-level training in maternal and child health interdisciplinary leadership education in neurodevelopmental and related disabilities programs. LEND trainees should:

(i) receive an appropriate balance of academic, clinical, and community opportunities;

(ii) be culturally competent;

(iii) be ethnically diverse;

(iv) demonstrate a capacity to evaluate, diagnose or rule out, develop, and provide evidence-based interventions to individuals with ASD/DD across their lifespan; and

(v) demonstrate an ability to use a family-centered approach.

LEND provides interdisciplinary opportunities for trainees to access content and experiences beyond the scope of their respective academic disciplines. The goal of the program is to increase the capacity of the workforce trained to meet the complex needs of individuals with ASD/DD by enhancing the expertise and leadership skills of practicing professionals, families, and self-advocates dedicated to working with and improving the system of care for individuals with ASD/DD.

LEND programs meet these goals through a range of activities. Specific objectives are to:

1) Train graduate and post-graduate students, family members, people with disabilities, and community professionals.

2) Deliver training that includes a balance of academic, clinical, leadership, and community-based learning opportunities framed in an interdisciplinary, and person-/family-centered manner.

3) Engage trainees at varying levels of intensity through long-, medium-, and short-term training opportunities.

4) Engage diverse cohorts of trainees and faculty, including those from underrepresented racial and ethnic groups, geographic regions, and other factors reflecting the broader population.

5) Increase the number of interdisciplinary diagnostic evaluations provided by LEND faculty and trainees.

6) Provide continuing education opportunities for practicing professionals.

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7) Provide technical assistance to local, state, and national programs and agencies to improve the system of care for people with disabilities.

The purpose of the optional LEND Supplement is to enhance LEND training program capacity to respond to emerging needs and support innovative training practices.

2. Background

This program is authorized by 42 U.S.C. § 280i-1 (Title III, § 399BB of the Public Health Service Act, as amended by the Autism Collaboration, Accountability, Research, Education, and Support (CARES) Act of 2019 (Pub. L. 116-60)). In carrying out these provisions, HRSA supports training programs, research, and state systems grants to:

• Improve access to early screening, diagnosis and intervention for children with ASD or other DDs;

• Increase the number of professionals able to diagnose ASD and other DDs;

• Promote the use of evidence-based interventions for individuals at higher risk for

ASD and other DDs as early as possible;

• Increase the number of professionals able to provide evidence-based interventions for individuals diagnosed with ASD or other DDs;

• Provide information and education on ASD and other DDs to increase public awareness;

• Promote research and information distribution on the development and validation of reliable screening tools and interventions for ASD and other DDs; and

• Promote early screening of individuals at higher risk for ASD and other DDs.

The Autism CARES Act of 2019 emphasizes improving health outcomes and the well-being of individuals with ASD/DD across the lifespan.

A comprehensive picture of ASD among children in the United States is best understood by examining two key estimates of ASD prevalence.1 According to the Centers for Disease Control and Prevention, approximately 1 in 54 children have ASD based on an in-depth examination of 11 local areas,2 while parent-reported data from the 2016 National Survey of Children’s Health documented that 1 in 40 children aged 3– 17 years have a diagnosis of ASD.3 Furthermore, even though children can be diagnosed as early as age 2, on average, children identified with ASD were not diagnosed until after age 4.4 Although 2016 Autism and Developmental Disabilities Monitoring Network (ADDM) data suggest no overall difference in ASD prevalence between 8-year-old Black and White children, there were disparities for Black children in early evaluation and diagnosis of ASD. Hispanic children were identified as having ASD less frequently than White or Black children.5

1 Kogan, et al. (2018) The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children. Pediatrics 142(6).

2 Autism and Developmental Disabilities Monitoring Network (2016 data) (http://www.cdc.gov/ncbddd/autism/data.html) 3 Kogan, et al. (2018) The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children. Pediatrics 142(6).

4 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. (2019) Spotlight On:

Delay Between First Concern to Accessing Services https://www.cdc.gov/ncbddd/autism/addm-community-report/delay-to-accessing-services.html 5 Maenner et al. (2020) Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabil ities Monitoring Network, 11 Sites, United States, 2016. MMWR Surveil lance Summary, 69(4).

http://www.cdc.gov/ncbddd/autism/data.html https://www.cdc.gov/ncbddd/autism/addm-community-report/delay-to-accessing-services.html

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The LEND Program focuses on the need for more providers to care for children with, or at risk for, ASD/DD. It is well established that a lack of trained providers limits access to care for children/youth with complex disabilities like ASD and their families. Access to adequate health care is a significant problem for children with special health care needs, and is even more pronounced for those with ASD. Many needs remain unmet for these children and families, particularly pertaining to adequate service provision for their complex needs.6 Since racial and ethnic disparities exist in the early evaluation and diagnosis of ASD, it can be inferred that additional professional training is needed in the field to mitigate these differences, particularly in underserved populations.

The impact of these disparities on health outcomes may be compounded by other social determinants of health (SDOH) across the lifespan. SDOH are conditions in which people are born, grow, live, work, and age. SDOH include factors like socioeconomic status, education, neighborhood and physical environment, community violence, employment, and social support networks, as well as access to health care. Addressing SDOH, which affect a wide range of health, functioning, and quality-of-life outcomes and risks, is in line with HRSA’s objective to improve the health and well-being of individuals and the communities in which they reside.

Both the public health and health care systems lack sufficient numbers of providers trained in systems of care and exposed to interprofessional education and interdisciplinary practices to meet the needs of children with ASD who often have multiple co-occurring conditions. Adults with ASD are also vulnerable to health care disparities because services and medical treatments for individuals with ASD are largely child-focused. As such, a significant barrier to care for adults with ASD is a lack of training for medical providers in treating adults with ASD.7 LEND programs can reduce these health disparities by supporting providers from diverse disciplines that may provide care to individuals with ASD/DD across the lifespan.

Since its inception in 1967, the LEND program has trained tens of thousands of health professionals from a wide variety of disciplines to provide the best possible services and supports for children with developmental disabilities and their families. The Division of MCH Workforce Development at the Maternal and Child Health Bureau at HRSA supports the training of a pipeline of well-trained health professionals and leaders equipped to address the special health needs of MCH populations.8

LEND programs train providers to screen for ASD/DD using the most widely accepted tools in the field. Developmental screening is a priority at the national and state levels and has increased over time. According to 2016 data from the National Survey of Children’s Health, the proportion of children who received a developmental screening varied substantially by income, and uninsured children were less likely than those with either public or private insurance to receive a screening.9 LEND programs collaborate with early screening and early intervention programs in the state to reach as many

6 Cheak-Zamora and Farmer (2015) The Impact of the Medical Home on Access to Care for Children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 45(3).

7 Gerber et al. (2017) Brief Report: Factors Influencing Healthcare Satisfaction in Adults with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 47(6).

8 Kavanagh et al. (2015) The MCH training program: developing MCH leaders that are equipped for the changing health care landscape. Maternal and Child Health Journal, 19(2).

9 Hirai et al. (2018) Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood. JAMA Pediatrics, 172(9).

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children as possible. Developmental screening is also one of the 15 National Performance Measures for State Title V programs, which may increase the focus on screening at the state level.

In fiscal year (FY) 2018, the 52 LEND programs collectively trained 1,495 long-term trainees (300+ hours of training); 5,436 medium-term trainees (40–299 hours of training); and 13,323 short-term trainees (less than 40 hours of training). Eighty-two percent of the 658 LEND program graduates who completed a survey 5 years following program completion indicated that they are engaged in work related to MCH populations. Further, 90 percent of respondents indicated that they participate in leadership activities in academic, clinical, public health practice, and/or public policy and advocacy activities after completing the training program. In FY 2018, LEND training programs reported collaborating with State Title V (MCH) agencies or other MCH-related programs to provide 3,113 technical assistance activities to almost 101,856 recipients.10

The LEND programs have made a unique contribution to the field by providing comprehensive, interdisciplinary leadership training to providers and students who screen, diagnose, and treat those with ASD/DD. In FY 2016–2018, the LEND programs provided interdisciplinary diagnostic services to 316,518 children to confirm or rule out ASD/DD.11 LEND programs train a wide range of disciplines including, but not limited to, psychology, speech-language pathology, audiology, physical therapy, as well as family members and individuals with disabilities. In FY 2018, 93 percent of former long-term trainees were working in an interdisciplinary manner 5 years after training (n=718) and 97 percent 10 years after training (n=330).10 LEND programs also promote innovative practice models that enhance cultural/linguistic responsiveness, partnerships among disciplines, and person-/family-centered approaches to care.

This training opportunity empowers both clinical providers and non-clinicians to further develop and impact the state and national systems of care, and to become leaders in the field. LEND programs have a long history of including family faculty and trainees in order to enhance family participation at all levels of program design, implementation, and evaluation. The intent is to fully integrate within maternal and child health leadership training programs the family voice, promote family centeredness, and offer development opportunities to family leaders in the field.12 LEND programs have increasingly included self-advocates as trainees, providing these trainees the opportunity to build on their own lived experiences to develop advocacy, leadership, and other relevant skills.13 One study found that other trainees in the program state that the inclusion of self-advocate trainees strengthened their own leadership skills.14

10 Discretionary Grant Information System (DGIS). (2018) 11 National Information and Reporting System (NIRS), 2016–2018 (not publically available) 12 Goldfarb et al. (2019) Fabric not Fringe: Weaving Family Involvement throughout Training and Practice for Professionals and Advocates Working with Individuals with Disabilities and Special Health Care Needs. Association of University Centers on Disability.

https://www.aucd.org/docs/publications/2019_family_fabric.pdf 13 Kaufman and Baer. (2015). The Purposeful Inclusion and Support of People with Disabilities in LEND Training Challenges, Strategies, and Guidance. Association of University Centers on Disability.

https://www.aucd.org/docs/publications/purposeful_inclusion_support_pwd_in_lend_2015.pdf 14 Rosenberg et al. (2018) Reflections on the contributions of self-advocates to an interdisciplinary leadership development program for graduate students in health affairs. Disability and Health Journal, 11.

https://mchb.hrsa.gov/training/projects.asp?program=9 https://www.aucd.org/docs/publications/2019_family_fabric.pdf https://www.aucd.org/docs/publications/purposeful_inclusion_support_pwd_in_lend_2015.pdf

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MCHB places emphasis on improving service delivery to women, children, adolescents, and families from communities with limited access to comprehensive care including those from underserved populations and rural areas. This same emphasis applies to improving service delivery to children with special health care needs, including those with ASD/DD. LEND recipients are strongly encouraged to work collaboratively with State Title V agencies and other MCH training programs to maximize access to MCH services, with emphasis on ASD/DD.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought:

LEND Training Program: Competing Continuation, New LEND Supplement: Optional Supplement

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $35,245,000 to be available annually to fund up to 55 LEND training program recipients. The actual amount available will not be determined until enactment of the final FY 2021 federal appropriation. You may apply for a ceiling amount according to Table 2: Allowable Funding Levels. The total cost amount includes both direct and indirect, facilities and administrative costs per year. The FY 2021 President’s Budget does not request funding for this program. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds appropriately. The period of performance is July 1, 2021 through June 30, 2026 (5 years). Funding beyond the first year is subject to the availability of appropriated funds for LEND 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.

Indirect costs under training awards to organizations other than state, local, or Indian tribal governments will be budgeted and reimbursed at a rate of 8 percent of modified total direct costs rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost amounts for equipment, tuition and fees, and subawards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

In addition, up to $550,000 per year may be available annually to fund up to 11 LEND optional supplements for emerging issues and innovative training enhancements, described in Attachment 6. In this application, you may apply for a ceiling amount of up 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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to $50,000 total cost (includes both direct and indirect, facilities and administrative costs) to be awarded through this supplement opportunity. Each grantee may be awarded a one-time, 1-year supplement during 1 of the 5 budget years. The actual amount available will not be determined until enactment of the final FY 2021 federal appropriation and appropriations going forward until 2026.

Base funding opportunity under this NOFO

Type of Award Estimated # of

Awards Estimated $ of Award/Year

Total Program Funds/Year

LEND Training Program up to 55 $464,000 – $738,000 approx.

$35,245,000

• New LEND programs will be funded at a maximum of $464,000 per year. New programs are defined as applicants who are not currently the recipients of record for a LEND award.

• The funding level tier selected applies to all 5 years of the grant.

• See Table 2: Allowable Funding Levels for funding levels and criteria.

Optional supplemental funding opportunity under this NOFO

Type of Award Estimated # of

Awards Estimated $ of Award

Total Program Funds/Year

Optional LEND Supplement

Up to 11 per year Each grantee may receive a one-time award of up to $50,000 once in any of the 5 budget periods

Up to $550,000 per year pending availability of funds

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include domestic public or non-profit agencies, including institutions of higher education. See Title III, § 399BB(e)(1)(A) of the Public Health Service Act.

Domestic faith-based and community-based organizations, tribes, and tribal organizations are also eligible to apply.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

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

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

NOTE: Multiple applications from an organization are not allowable.

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.

A student/trainee/fellow receiving support from grant funds must be a citizen of the United States or a foreign national having in his/her possession a visa permitting permanent residence in the United States, or a non-citizen national.

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.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for each NOFO you are reviewing or preparing in the workspace application package in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov. You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this NOFO.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the 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.

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

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Application Page Limit

The total size of all uploaded files may not exceed the number of pages listed in the table below when printed by HRSA.

LEND Base Award 80 pages

LEND Supplement (optional as Attachment 6) 4 pages

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. Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-21-041, it may count against the page limit.

Therefore, we strongly recommend you only use Grants.gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit.

Therefore, it is important 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 for funding.

The optional LEND Supplement may be up to 4 pages in length and does not count against the 80 page limit of the LEND training program application. The page limit for the supplement includes the project narrative, budget narrative, and any other descriptive information. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3321).

3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachments 8–15: Other Relevant Documents.

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

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

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

ii. Project Narrative This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and well-organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

• INTRODUCTION -- Corresponds to Section V’s Review Criterion 1: Need

This section will relate the project objectives to the purpose of the grant program described in Section I.1. Purpose of this NOFO. State here whether you are also applying for the LEND Supplement.

In your application:

• Briefly describe the training program, and state concisely the importance of the project.

• Describe the relationship between the proposed project and Section I.1 Purpose section of this NOFO.

• NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion 1: Need

The program should be developed upon an understanding of the national, regional, state, and local demand for the training.

In your application:

• Identify the gaps which the project intends to fill.

• Describe the unmet needs of the community and the target population.

• Describe social determinants of health and health disparities for individuals with ASD/DD. Include and cite data to support the information provided.

• Discuss relevant barriers in the service area that the project aims to overcome.

• Provide an overview of the community and organizational needs that the proposed project will address.

• Document needs related to services and systems of care for individuals with ASD/DD.

• Describe how your program will fulfill a need in your geographic area in terms of training needed among health professionals to screen, diagnose, or serve children with ASD/DD to address gaps in the system of care.

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

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• METHODOLOGY -- Corresponds to Section V’s Review Criteria 2: Response, 5.

Impact

This section describes the proposed program’s methodology across a number of areas.

Goals and Objectives

The proposed program goals and objectives should be responsive to the Autism CARES Act of 2019 and the needs described in the needs assessment. They should aim to reduce barriers to screening, diagnosis, and interventions by training professionals to use appropriate tools and practices.

In your application:

• State the overall goal(s) and objectives of the project. The objectives should be specific, measurable, attainable, relevant, and time-based (SMART) for each project year.

1) LEND Trainees

• Long-term trainees

Long-term trainees (LTT) complete 300+ hours of LEND didactic and experiential training. LEND training is in addition to a trainee’s graduate or post-graduate discipline-related training, including clinical and leadership requirements. LEND training provides additional disability perspectives to each trainee beyond what they would receive in their discipline’s training program.

LEND trainees demonstrate interest in a career serving individuals with disabilities.

This should include a commitment to leadership and improving the system of care for people with ASD/DD by acquiring knowledge and skills to evaluate and diagnose or rule out ASD/DD; interest in developing and providing evidence-based interventions; and a commitment to providing interdisciplinary, person-/family-centered, and culturally responsive care.

Recruitment and retention of qualified trainees representing diverse backgrounds is a priority for DMCHWD. Training programs develop innovative means of creating a pathway for future students from diverse groups at the high school, community college, and undergraduate levels. LEND Performance Measure, Training 06 requires annual reporting on the number and percentage of LTTs from underrepresented racial and ethnic groups (see Reporting).

Program Expectations

LEND programs should bring together faculty and LTTs from multiple disciplines for the interdisciplinary process to be effectively demonstrated, developed, and practiced. Programs should provide ample opportunities for trainees to collaborate

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with one another in an interdisciplinary manner, even when training is delivered remotely.

Trainee cohorts should include diverse disciplines with a similar make-up of the disciplines represented by the core faculty (see Faculty Disciplines). The programs should strive to have a balance of trainees representing clinical and non-clinical disciplines. No single trainee discipline should make up more than 25 percent of a LEND cohort. Each cohort should have the minimum number of trainee and faculty disciplines represented as described in Table 2: Allowable Funding Levels.

Annually, each LTT cohort should include at least one family member trainee. See description in Table 1: Long-Term Trainee Criteria.

By year 3 of the project, each LTT cohort must also include a person with a disability as a self-advocate trainee. Self-advocates participating in LEND will build upon the skills and knowledge acquired through their lived experience with disability to develop and enhance their leadership expertise and share a disability perspective with other trainees.

Table 1 depicts the educational level generally supportable for trainees/fellows by discipline as well as a description and recruitment criteria for other LTTs.

Table 1: Long-term Trainee Criteria

Trainee Disciplines Qualifications by discipline Applied behavioral analysis Audiology Disability studies Human genetics/genetic counseling Health administration Nursing Nutrition Occupational therapy Physical therapy Public health Social work Special education/education Speech-language pathology School psychology/school counseling

Trainees from these professional disciplines are master’s or doctoral candidates, or post-master’s and post-doctoral fellows. Trainees may also be practicing professionals from the community with graduate degrees or commensurate work or leadership experience.

While the emphasis of the program is generally providers serving children and adolescents, programs may recruit LTTs who intend to provide services to adults with ASD/DD when they enter the workforce.

Medicine, pediatric providers

Medical students and those preparing for relevant pediatric medical specialties and subspecialties, including developmental-behavioral pediatrics, neurodevelopmental disabilities, medicine-pediatrics, child and adolescent psychiatry, pediatric neurology, and/or medical genetics. Practicing providers also may participate as trainees.

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Trainee Disciplines Qualifications by discipline Medicine, adult providers

Medical students and those preparing for relevant medical specialties and subspecialties that will serve transition-aged youth and/or adults with ASD/DD throughout the lifespan. Practicing providers also may participate as trainees.

Pediatric or adult dentistry

Dental students and those preparing for dental specialties and subspecialties with interest in caring for individuals with

ASD/DD.

Family members Required, a minimum of one family LTT each year.

Parents and siblings of those with neurodevelopmental disabilities, including ASD, with demonstrated interest in developing leadership skills and sharing family perspectives with the trainee cohort. No educational minimum is required for participation as a LEND trainee, nor is current enrollment in an academic program.

Self-advocates/individuals with disabilities (including those with intellectual disabilities)

Required, a minimum of one self-advocate LTT each year, beginning at least in year 3.

Demonstrated readiness to develop leadership skills and share disability perspectives with the trainee cohort. No educational minimum is required for participation as a LEND trainee, nor is current enrollment in an academic program.

Other trainee disciplines may be considered with consultation with the assigned MCHB project officer (PO), after award. To obtain approval, the program must demonstrate that the trainee intends to work with disability populations in the future, and that the program has an appropriate faculty mentor and learning opportunities for the trainee.

While MCHB recognizes that specialties/subspecialties of medicine are distinct, any specialties that are listed under “medicine, pediatric providers” will count as a single discipline towards meeting the interdisciplinary requirements listed in Table 2: Allowable Funding Levels. The same applies to “medicine, adult providers.”

This will ensure that training cohorts include a wide array of clinical and non-clinical trainees.

Current undergraduate students cannot be considered long-term LEND trainees unless they are filling a family or self-advocate discipline position, and the exception has been approved by the MCHB project officer.

Trainee support varies by discipline in accordance with standards of the profession, availability of other support, nature of training required to meet program goals, and other factors. Appendix A: Applicable Standards for Using Grant Funds

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to Support LEND Trainees/Fellows defines trainees and fellows and provides guidelines for trainee/fellow support.

LEND LTTs generally are expected to complete their training within a 12-month period. However, trainees may complete a second year of long-term LEND training if the following criteria apply:

1. If a trainee is unable to complete the long-term LEND training (300+ hours) in a 12-month period, it is allowable to spread out the requirements over 2 years. In these circumstances, a clear-cut completion plan from the training program is required, while also meeting the flexibilities needed by these trainees to complete the program. The curriculum and level of engagement should be determined when the trainee is recruited and commits to the program.

o In general, this exception to use a second year applies to family member and self-advocate trainees. However, if trainees in other disciplines need similar accommodations, approval from the MCHB PO is required, after award.

o In such scenarios, the trainee may only count once toward the minimum number of LTTs required in Table 2: Allowable Funding Levels.

o Family and self-advocate trainees completing long-term LEND training over 2 years may only count toward the family and self-advocate trainee requirement for 1 year.

o In this scenario, the trainee may receive a total of one LEND stipend over the 2-year LEND training experience from these grant funds.

The stipend can be prorated and disbursed at the discretion of the program leadership, and in accordance with institution policies. For maximum stipends, see Appendix A: Applicable Standards for Using Grant Funds to Support LEND Trainees/Fellows.

o In performance reports, these trainees may be counted as MTTs in 1 year and LTTs in the other, at the discretion of the recipient, to ensure they receive follow-up surveys after completion of the LEND program.

2. At the program’s discretion, certain trainees may opt to complete an additional year of 300+ hour LEND training to enhance their leadership, clinical, teaching, or other skills. They must complete a different LEND curriculum (including new clinical and community placements or leadership and teaching opportunities), than what was completed during their first year as a LTT.

o In this additional year, these trainees may be counted as LTTs, but cannot be used to meet the minimum LTT numbers for recipient’s awarded funding level stated in Table 2: Allowable Funding Levels.

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o In performance reports, these LTTs are counted as LTTs each year but should only receive follow-up surveys in years 2, 5, and 10 after completion of the LEND program.

Former LTTs must be tracked and surveyed for 10 years post-graduation to track the leadership trajectories of trainees and to quantify the impact of LEND programs. This data will be reported on LEND Performance Measures, Training 10, 11, and 12, see Reporting. Innovative ways to maintain contact with former trainees are encouraged in order to ensure long-term tracking and reduce loss to follow-up.

• Medium- and short-term trainees

Medium- and short-term trainees are defined as those engaged in didactic or practical experiences through LEND, as part of a formal course of study. This could include a residency program, rotation, internship, practicum, fellowship, or an advancement in academic credentials through a course of study. These trainees generally do not include practicing professionals engaging in continuing education.

Medium-term trainees fall into two tiers: those who complete 40–149 hours, and those who complete 150–299 hours of training (known as advanced medium-term). Stipends for advanced medium-term trainees are at the discretion of the recipient. Short-term trainees complete 1–39 hours of training per year.

Program Expectations

LEND programs are required to implement medium- and/or short-term training to expand the future workforce of clinicians and/or community providers prepared to serve individuals with ASD/DD. LEND programs can choose to train both medium-term and short-term trainees, or one or the other. Only long-term and advanced medium-term trainees may receive stipends from the grant funds.

For LEND Trainees section, in your application:

• Include criteria for and a description of methods of long-term trainee recruitment and selection.

• Include a description of which disciplines will be included and how they will contribute to your interdisciplinary trainee cohort.

• Describe the program’s strategies for recruiting and retaining trainees from diverse backgrounds and for evaluating the success of the efforts.

• Describe plans to include trainees/faculty in other states or territories to increase the regional or national reach of LEND training network, if applicable.

• Demonstrate a strategy for including and supporting self-advocate trainees in each LTT cohort starting in or before year 3.

• Include a plan for tracking and reporting on the longitudinal follow-up data about graduates’ employment, research, leadership, advocacy efforts, programs initiated, publications submitted, etc.

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• Describe how medium- and/or short-term trainees will be recruited and engaged in the program and in the didactic, clinical, and field experiences available to LTTs.

• Describe the training opportunities, experiential and didactics, of any planned cohorts of medium- and/or short-term trainees, if applicable.

• Describe how MTT and STT opportunities are structured, if your program offers individualized experiences using the LTT program as a menu of options.

2) Curriculum and Training Content

A strong LEND curriculum for LTTs will incorporate interdisciplinary clinical, leadership, and didactic content to meet the broad range of trainee needs, and prepare trainees to address the full range of neurodevelopmental disabilities, with a focus on ASD/DD. Additionally, the training will prepare trainees for future leadership roles.

Program Expectations

Provide a comprehensive syllabus, including descriptions of courses, workshops, seminars, and field experiences, that will help guide the training program. The syllabus should describe each of the following elements to indicate a comprehensive long-term training program will be offered.

• Interdisciplinary Clinical and Practicum Experience for Trainees

Trainees should experience a variety of clinical settings with appropriate faculty mentorship. Training may occur within clinical settings under the direction of the funded program as well as in community-based settings. The available training opportunities and settings should reflect the cultural, social, and ethnic diversity of the community.

Opportunities for non-clinical trainees to observe and engage in clinics should be provided to these trainees as they may work with clinicians in the future and can help clinicians view the clinical setting from a new perspective. Family and self-advocate trainees should participate in clinical settings, when possible. This will provide models to families and patients on ways to engage in peer advocacy, providing feedback to clinicians from a perspective of lived experience, and helping families navigate the clinical process.

Training should be based on a comprehensive, interdisciplinary clinical services model which is person-/family-centered and culturally and linguistically responsive.

As appropriate to their discipline, the curriculum should prepare trainees to evaluate, diagnose or rule out, develop, and provide evidence-based interventions to individuals with ASD/DD.

Field placements in educational settings, state/local agencies, and other settings may be appropriate in addition to or in lieu of clinical placement. Such practicum sites must provide comprehensive, community-based services in a variety of institutional and rural/urban community-based settings and serve individuals with

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ASD/DD and other special health care needs. Practicum sites in underserved communities are especially impactful for trainees. You are encouraged to coordinate training opportunities with MCHB-funded recipients, Autism CARES recipients, and State Title V programs. Field experiences in interdisciplinary settings are also encouraged.

• Leadership Skills

LEND curriculum must include content and experiences to promote the development of effective leadership skills and prepare trainees to move beyond excellent clinical practice or health administration to leadership through practice, research, teaching, administration, and legislative systems change. The leadership curriculum must prepare trainees to engage effectively in interdisciplinary practice.15 Strong LEND curricula will be informed by the MCH Leadership Competencies.

The leadership curriculum should instruct trainees on effective communication and teaching skills, as well as presentation skills appropriate for a variety of professional and community audiences. Training should provide opportunities to practice, demonstrate, and document effective teaching and communication to and with diverse constituencies (professionals, self-advocates, families, children and youth with ASD/DD public health leaders, etc.). These experiences should incorporate multiple forms of communication (verbal and written) in diverse venues and methods of delivery. Conflict resolution skills also should be addressed, if possible.

• Didactic Training Content

Neurodevelopmental and related disabilities, with a focus on ASD/DD.

LEND programs should provide didactic training on effective tools for screening and diagnosing ASD/DD; the social environment—the family, community, school, work opportunities; and other issues relevant to health care and other transitions for young adults with ASD/DD. LEND curricula should incorporate instruction on conceptual models of disability (e.g., social, cultural, neurodiversity, and medical models) and examine the intersection of disability with other life experiences.

Examples of various models of disability can be found at:…