PKG00264140-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Advanced Nursing Education - Sexual Assault Nurse

Examiners (ANE-SANE) Program

Funding Opportunity Number: HRSA-21-016 Funding Opportunity Type(s): New, Competing Continuations

Assistance Listings (CFDA) Number: 93.247

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: February 17, 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 17, 2020

Deitra Scott Nurse Consultant Telephone: (301) 945-3113 Email: DScott1@HRSA.gov

Authority: 42 U.S.C. § 296j (Section 811 of the Public Health Service Act) mailto:DScott1@HRSA.gov

HRSA-21-016

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2021 Advanced Nursing Education-Sexual Assault Nurse Examiners (ANE-SANE) Program. The purpose of the ANE-SANE program is to fund advanced nursing education to recruit, train and certify Registered Nurses (RNs), Advanced Practice Registered Nurses (APRNs)1, and Forensic Nurses (FNs) to practice as sexual assault nurse examiners (SANEs). The program aims to increase the supply and distribution of qualified working SANEs and expand access to sexual assault forensic examinations. By expanding access to SANEs, the ANE-SANE program aims to provide better physical and mental health care treatment for survivors of sexual assault and domestic violence leading to better evidence collection and potentially higher prosecution rates.

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: Advanced Nursing Education-Sexual

Assault Nurse Examiners (ANE-SANE) Program

Funding Opportunity Number: HRSA-21-016 Due Date for Applications: February 17, 2021

Anticipated Total Annual Available FY 2021 Funding:

$8,000,000

Estimated Number and Type of Award(s): Approximately 16 grants

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

Cost Sharing/Match Required: No Period of Performance: July 1, 2021 through June 30, 2024

(Three (3) years)

1 Advanced Practice Registered Nurses includes Nurse Practitioners, Nurse Midwives, Clinical Nurse Specialists, and Nurse Anesthetists.

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Eligible Applicants: Eligible applicants include accredited schools of nursing, nursing centers, nurse-managed health clinics, academic health centers, State or local health departments, HRSA-supported Health Centers, Rural Health Clinics, public or non-profit Hospitals, other emergency health care service providers, Federally Qualified Health Centers, Clinics receiving funding under Title X, and other similar public or private non-profit entities.

Federally recognized Indian Tribal Government and Native American Organizations as well as community-based and faith-based non-profit organizations (under IRS 501(c)(3)) may apply if they are otherwise eligible.

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.

Technical Assistance

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

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

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://bhw.hrsa.gov/fundingopportunities/default.aspx

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

II. AWARD INFORMATION

TYPE OF APPLICATION AND AWARD

1. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative

v. Standardized Work Plan (SWP) Form

vi. Attachments

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

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

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Advanced Nursing Education-Sexual Assault Nurse Examiners (ANE-SANE) Program.

Program Purpose

The purpose of the ANE-SANE program is to fund advanced nursing education to train and certify Registered Nurses (RNs), Advanced Practice Registered Nurses (APRNs), and Forensic Nurses (FNs) to practice as sexual assault nurse examiners (SANEs). The program aims to increase the supply and distribution of qualified working SANEs and expand access to sexual assault forensic examinations. By expanding access to SANEs, the ANE-SANE program aims to provide better physical and mental health care for survivors of sexual assault and domestic violence leading to better evidence collection and potentially higher prosecution rates.

Program Goals

The ANE-SANE program is designed to:

1. Increase the supply and distribution of SANEs by increasing the number of RNs, APRNs and FNs trained to practice as SANEs;

2. Expand access to sexual assault forensic examinations by increasing availability of training and supporting certification of qualified SANEs who are skilled and knowledgeable in providing quality care to survivors of sexual assault and domestic violence, especially in rural and underserved settings;

3. Enhance stakeholder support for training and increase retention of SANEs, to ensure the provision of better physical and mental health care of survivors of sexual assault and domestic violence and improved evidence collection; and

4. Cultivate an environment conducive to SANE training and practice through partnerships and technical assistance consultation.

Program Objectives

To accomplish the goals, ANE-SANE projects will:

1. Financially support participants/trainees through their SANE certification requirements which, at a minimum, include: didactic (classroom or online) education, clinical training, and experiential learning (or practice).

2. Develop academic-practice partnerships, including collaboration with HRSA-supported health centers and critical shortage facilities. These partnerships should promote recruitment of participants/trainees, interagency collaboration, and integrate trauma-informed, evidence-based sexual assault and domestic violence services into training and practice settings.

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3. Incorporate innovative models of training and practice, including virtual, tele-education models, telehealth, and sexual assault response teams (SARTs) to ensure flexible options for learning and practice.

4. Reduce system-level and structural barriers to SANE training and practice through collaborative partnerships and technical assistance consultation.2

HHS and HRSA Priorities This program will build upon HHS and HRSA’s current strategic goals to strengthen and expand the health care workforce to meet America’s diverse needs, and improve access to quality health care services. It is expected that applicants will address the first priority below, and if applicable, also address the second priority:

• Transforming the workforce –by targeting the need

• Strengthening health care access through telehealth

Background

Reported sexual assaults have risen from 323,450 individuals aged 12 or older in 20163 to 772,850 in 2018.4 Affecting more than 10 million adults annually, domestic violence is the willful abusive behavior as part of a systematic pattern of power and control perpetrated by one intimate partner against another, and includes sexual violence.5 Nearly 1 in 5 women and 1 in 12 men have experienced sexual violence by an intimate partner in their lifetime.6 Victims of sexual assault should have access to timely, quality sexual assault services,7 and sexual assault nurse examiners are critical to addressing this significant public safety and public health issue. Due to the traumatic nature of sexual assault, sexual assault forensic examinations should be performed by a specially educated and clinically prepared sexual assault forensic examiner (SAFE) or SANE who can validate and address health concerns, minimize the trauma, promote healing, and maximize the detection, collection, preservation, and documentation of physical evidence related to the assault for potential use by the justice system.8

2 Strengthening Nonprofits: A Capacity Builder’s Resource Library; Delivering Training and Technical Assistance; (2010); https://www.acf.hhs.gov/sites/default/files/ocs/delivering_tta.pdf.

3 Morgan, R. E. and Kena, G., (2018). Criminal Victimization, 2016: Revised, U.S. Department of Justice, Bureau of Justice Statistics 4 Morgan, R. E. and Oudekerk B.A., (2019). Criminal Victimization, 2018, U.S. Department of Justice, Bureau of Justice Statistics 2018 National Crime Victimization Survey (NCVS) 5 National Coalition Against Domestic Violence (2020). Domestic violence. Retrieved from https://assets.speakcdn.com/assets/2497/domestic_violence-2020080709350855.pdf?1596811079991 6 National Coalition Against Domestic Violence (2020). Domestic violence. Retrieved from https://assets.speakcdn.com/assets/2497/domestic_violence-2020080709350855.pdf?1596811079991 7 In 2018, all 50 states received STOP Formula Grant funds https://www.justice.gov/ovw/awards/fy-2018-ovw-grant-awards-program#STOP , requiring states coordinate with regional health care providers to notify victims of sexual assault of the availability of rape exams at no cost to the victims, without regard to whether the victim participates in the criminal justice system: United States Code Sec. 10449 https://www.govinfo.gov/content/pkg/USCODE-2018-title34/html/USCODE-2018-title34-subtitleI-chap101-subchapXIX-sec10449.htm#10449_1_target .

8 U. S. Department of Justice, A National Protocol for Sexual Assault Medical Forensic Examinations:

Adults/Adolescents, (Washington, D.C.: 2013).

https://www.acf.hhs.gov/sites/default/files/ocs/delivering_tta.pdf https://www.bjs.gov/content/pub/pdf/cv18.pdf https://assets.speakcdn.com/assets/2497/domestic_violence-2020080709350855.pdf?1596811079991 https://assets.speakcdn.com/assets/2497/domestic_violence-2020080709350855.pdf?1596811079991 https://www.justice.gov/ovw/awards/fy-2018-ovw-grant-awards-program#STOP https://www.justice.gov/ovw/awards/fy-2018-ovw-grant-awards-program#STOP https://www.govinfo.gov/content/pkg/USCODE-2018-title34/html/USCODE-2018-title34-subtitleI-chap101-subchapXIX-sec10449.htm#10449_1_target https://www.govinfo.gov/content/pkg/USCODE-2018-title34/html/USCODE-2018-title34-subtitleI-chap101-subchapXIX-sec10449.htm#10449_1_target

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Access to SANEs is vital to survivors of sexual assault and domestic violence, as they provide a bridge between the legal, law enforcement and health care systems.9 Many communities, however, lack experienced, trained, and qualified SANEs who are equipped with the skills and competencies necessary to perform the forensic exams, especially in rural areas. There is a need for more training opportunities to grow the SANE workforce, including more clinical sites, more instructors and preceptors, and more opportunities for continuing education.10 In addition, potential students report difficulty securing funds for training or receiving time off to attend training and continuing education classes.11 Offering students financial support and a variety of innovative training options such as virtual simulation, telehealth, tele-education, etc.,12 provides alternatives to the often difficult process of securing clinical sites and qualified clinical preceptors.

Partnership is essential to recruiting and training SANEs, and increasing quality and access to care. Development of partnerships between medical, legal, and advocacy agencies strengthen their capacity to improve services to crime victims, survivors, and communities.13 The importance of a coordinated approach to ensure comprehensive and cohesive care of sexual assault survivors is well-documented, and shows that established uniform protocols and standardized interaction and responses between agencies leads to better emotional, physical, and judicial outcomes.14 SANE training requires training with the different agencies that respond to sexual assault cases.

Therefore interagency collaboration and partnerships are vital to SANE training and practice. The SART is the most common approach15 and is a foundation for the coordinated efforts between agencies in sexual assault service provision.16 Such partnerships inform the training and practice of SANEs, thereby strengthening the SANE workforce and improving services for sexual assault survivors.17

9 Patterson, D., Resko, S., Pierce-Weeks, J., and Campbell, R. (2014). Delivery and Evaluation of Sexual Assault Forensic (SAFE) Training Programs, Final Report (Detroit, MI: March 2014), https://www.ncjrs.gov/pdffiles1/nij/grants/247081.pdf.

10 United States Government Accountability Office, Sexual Assault: Information on Training, Funding, and the Availability of Forensic Examiners, GAO-16-334 (Washington, D.C.: March 2016).

11 Washington State Department of Commerce, Sexual Assault Nurse Examiners: Study of Sexual Assault Nurse Examiner Availability, Adequacy, Costs, and Training (Olympia, W.A.: December 2016).

12 Eysenbach, G., (2019). Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial.

Journal of Medical Internet Research; 21(3).

13 National Sexual Violence Resource Center, Build Your SART Toolkit, Retrieved from:

https://www.nsvrc.org/sarts/toolkit/3-1 14 Department of Justice, A National Protocol for Sexual Assault Medical Forensic Examinations:

Adults/Adolescents, NCJ 228119 (Washington, D.C.: U.S. Department of Justice, 2013).

15 Greeson, M. and Campbell, R., (2015). Coordinated Community Efforts to Respond to Sexual Assault:

A National Study of Sexual Assault Response Team Implementation. Journal of Interpersonal Violence;

30(14):2470-87.

16 Moylan, C., Lindhorst, T., and Tajima, E. (2015). Sexual Assault Response Teams (SARTs): Mapping a Research Agenda That Incorporates an Organizational Perspective, Violence Against Women;

21(4):516-34.

17 Henry, Shantee, The Development, Implementation, and Evaluation of a Sexual Assault Nurse Examiner Training Program (2020). Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects. 43. https://kb.gcsu.edu/dnp/43 https://www.ncjrs.gov/pdffiles1/nij/grants/247081.pdf https://www.nsvrc.org/sarts/toolkit/3-1

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Limited stakeholder support is a challenge to maintaining a supply of trained examiners.18 Obtaining support and collaboration from stakeholders, like hospitals and law enforcement, can be difficult19. Complex issues of local policies, state laws, and reimbursement protocols create barriers to stakeholder involvement, limit access to services, and negatively impact SANE training. These complex issues must be addressed in order to reduce/remove system-level and other structural barriers.

National SANE coordinators recommend use of technical assistance consultancy models that facilitate collaboration between agencies to effectively address jurisdiction-specific barriers, and limited stakeholder support.20 For the ANE-SANE program, technical assistance consultation should target reduction of system-level and structural barriers to SANE training and practice, promotion of partnerships, and enhancement of stakeholder support.

The ANE-SANE program facilitates SANE training programs to develop innovative methods for provision of effective experiential learning so that participants/trainees can attain the clinical practice hours required for SANE certification. Applicants are encouraged to integrate innovative, virtual training options into SANE training. It is essential for SANE applicants to develop robust community partnerships that strengthen SANE training opportunities and increase access to domestic violence and sexual assault services. In order to increase the supply, access and distribution of SANEs in rural and/or underserved settings, applicants are encouraged to partner with HRSA-supported health centers to recruit, train and provide experiential learning experiences to participants/trainees. There are nearly 1,400 HRSA-supported health centers operating across the United States. To find the location of the closest health center, utilize the locator tool (https://www.findahealthcenter.hrsa.gov/). Collaboration with other HRSA-funded programs leverages federal investments, to better address community and clinician needs especially in rural and underserved areas.

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs can be located at the Health Workforce Glossary. In addition, the definitions below apply to the ANE-SANE Program for Fiscal Year 2021.

Communities of Practice (CoPs) – Communities of practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. Communities of practice is a strategy for performance improvement.21 Examples of some method improvements include: problem solving, requests for information, seeking experience, reusing assets, coordination and synergy, discussing

18 United States Government Accountability Office, Released December 12, 2018, SEXUAL ASSAULT, Information on the Availability of Forensic Examiners https://www.gao.gov/assets/700/695914.pdf 19 United States Government Accountability Office, Sexual Assault: Information on Training, Funding, and the Availability of Forensic Examiners, GAO-16-334 (Washington, D.C.: March 2016).

20 NVSC National SANE Coordinator Symposium, 2009, Final Report and Recommendations. Retrieved from: https://www.nsvrc.org/sites/default/files/2012-04/Publications_NSVRC_Reports_First-National- SANE-Coordinator-Symposium.pdf 21 Wegner, Ettienne, Communities of Practice: A Brief Introduction, (2011), University of Oregon:

Scholars’ Bank, https://scholarsbank.uoregon.edu/xmlui/handle/1794/11736.

https://www.findahealthcenter.hrsa.gov/ https://bhw.hrsa.gov/grants/resourcecenter/glossary https://www.gao.gov/assets/700/695914.pdf https://www.nsvrc.org/sites/default/files/2012-04/Publications_NSVRC_Reports_First-National-SANE-Coordinator-Symposium.pdf https://www.nsvrc.org/sites/default/files/2012-04/Publications_NSVRC_Reports_First-National-SANE-Coordinator-Symposium.pdf

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developments, documentation projects, visits, mapping knowledge, and identifying gaps.

Experiential Learning – The concept that learning occurs during and from experience, processing of knowledge and skills through experience, reflections, experimentation, and application and involving learners in concrete activities that enable them to experience what they are learning.22 For ANE-SANE, experiential learning involves SANE-related practice hours required to complete training or obtain certification, including but not limited to providing patient care, teaching/precepting, consulting, and participating in peer review. ANE-SANE encourages innovative forms of clinical experiential learning.

SANE Certification – Demonstrates through objective validation to colleagues, clients, employers, and the public at-large that the nurse has the knowledge and expertise required for this specialty practice, and possesses an ongoing professional commitment to providing quality patient care. Nurses can seek national credentialing as Sexual Assault Nurse Examiner-Adult/Adolescent (SANE-A®) and/or Sexual Assault Nurse Examiner-Pediatric/Adolescent (SANE-P®) or Combination Adult/Adolescent and Pediatric/Adolescent from the International Association of Forensic Nurses (IAFN).23 Depending on the state, examiners may also become certified through a state certifying body, such as a state board of nursing24 – these requirements vary by region. ANE- SANE projects may support participants/trainees to obtain national or state certification as applicable.

SANE Training – Specific didactic and clinical training is required for nurses who perform medical forensic exams on adult, adolescent, or pediatric patients following sexual violence or assault, preparing them in the psychological, medical and forensic care of sexual assault patients.23 The goal of training is for examiners to be able to effectively evaluate and address survivors’ health concerns, minimize their trauma and promote their healing during and after the exam, and to detect, collect, preserve, and document physical evidence related to the assault for potential use by the legal system.25

Sexual Assault Response Team (SART) - A sexual assault response team is an organized group of individuals, professionals, and officials who promote a community-wide approach to end sexual violence and help victims of sexual assault to navigate the complexities of medical, emotional, and legal issues. Core members typically include

22 Murray, R., (2018). An Overview of Experiential Learning in Nursing Education, Advances in Social Sciences Research Journal; 5(1).

23 International Association of Forensic Nurses, Commission for Forensic Nursing Certification. Sexual Assault Nurse Examiner (SANE-A and SANE-P) Certification Examination Handbook (Elkridge, M.D.:

2018).

24 United States Government Accountability Office, Sexual Assault: Information on Training, Funding, and the Availability of Forensic Examiners, GAO-16-334 (Washington, D.C.: March 2016).

25 International Association of Forensic Nurses, Sexual Assault Nurse Examiner (SANE) Education Guidelines (Elkridge, M.D.: 2015).

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advocates, law enforcement officers, forensic medical examiners—including sexual assault nurse examiners (SANEs), forensic laboratory personnel, and prosecutors.26

Stakeholders – Stakeholders include those who may be impacted directly or indirectly by the implementation of a SANE training program. They may have direct or indirect contact with survivors. Examples include: Emergency Department , Law enforcement, Community-based service providers, Sexual assault victim service providers, Hospitals, Criminal justice officials, Criminal laboratories, Faith-based community groups, Advocacy groups, Government officials, Policymakers, Tribal Councilmembers.27

System-level Barriers – System-level and structural barriers to SANE training and practice include aspects of the sexual assault and domestic violence services system that negatively impact the training and practice of SANEs.28 Some examples of system-level and structural barriers to SANE training include: lack of interagency collaboration, lack of standardized policies and protocols, limited stakeholder support, lack of resources, and lack of sites for SANE training and practice.29

II. Award Information

Type of Application and Award

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

HRSA will provide funding in the form of a grant.

26 National Sexual Violence Resource Center, Build Your SART Toolkit, Retrieved from:

https://www.nsvrc.org/sarts/toolkit/2-2 27 Office of Justice Programs, Office for Victims of Crime, SANE Program Development and Operation Guide, https://www.ovcttac.gov/saneguide/building-a-sustainable-sane-program/partners-and-stakeholders/ 28 Population-based Public Health Nursing, Levels of Care, LA County Department of Public Health, 2007, retrieved from: http://publichealth.lacounty.gov/phn/docs/Level%20of%20Care.pdf 29 Data collected from awardee reports describe that SANE training and practice is affected by several system-level and structural barriers including: lack of participation from the State Attorney General’s office, lack of internet access at rural sites, cell phone carriers not working at the rural clinical training sites, no Standard of Practice amongst various regional practices for SANE training and employment, clinical training sites only committed to training individuals who they would eventually employ, insufficient tracking system of regional clinical hours , lack of training equipment at clinical training sites (gynecological tables, speculums, etc.), and a lack of support for SANE training programs among hospital administration.

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1. Summary of Funding

HRSA estimates approximately $8,000,000 to be available annually to fund 16 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 of up to $500,000 total cost (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, 2024 (3 years). Funding beyond the first year is subject to the availability of appropriated funds for ANE-SANE in subsequent fiscal years, satisfactory recipient progress, 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 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.

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

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III. Eligibility Information

1. Eligible Applicants

Eligible applicants include domestic accredited schools of nursing, nursing centers, nurse-managed health clinics, academic health centers, State or local health departments, HRSA-supported health centers, Rural Health Clinics, public or non-profit Hospitals, other emergency health care service providers, Federally Qualified Health Centers, Clinics receiving funding under Title X, and other similar public or private non-profit entities. Federally recognized Indian Tribal Government and Native American Organizations, as well as nonprofit (Internal Revenue Service (IRS) 501(c)(3) status) community-based and faith-based organizations may apply if they are otherwise eligible.

The eligible state government entities include the 50 states, and the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Individuals and foreign entities are not eligible under this NOFO.

Where required, applicants that do not include an official letter of accreditation or the Letter of Reasonable Assurance as specified in the instructions for Attachment 1 will be considered non-responsive and will not be considered for funding under this notice.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

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

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

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Maintenance of Effort (MoE) The recipient must agree to maintain non-federal funding for award activities at a level that is not less than expenditures for such activities maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives the award. Such Federal funds are intended to supplement, not supplant, existing non-Federal expenditures for such activities. Complete the Maintenance of Effort information and submit as Attachment 2.

Multiple Applications Multiple applications from an organization are not allowable. An organization is defined by having a valid Data Universal Numbering System (DUNS) number or Unique Entity Identifier (UEI).

For example, eligible applicants can submit only one application per campus or clinical facility; a single campus or clinical facility with the same DUNS number is not allowable.

A campus is defined as a division of a university that has its own grounds, buildings (e.g., school of nursing) and faculty. A clinical facility is defined as a health care facility, whether part of a system or not, which has its own grounds containing its own leadership (Chief Nursing Officer, Chief Medical Officer, Chief Executive Officer, etc.).

Independent organizations are those entities that have unique DUNS numbers or UEIs.

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

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

Beneficiary Eligibility (Participants and Trainees) An eligible participant or trainee must be a citizen, national, or permanent resident of the United States. Individuals on temporary or student visas are not eligible to receive ANE- SANE support. Award recipients must use this funding to support participants/trainees who are either: (1) currently practicing generalist Registered Nurses, Advanced Practice Registered Nurses or Forensic Nurses; or (2) students in Advanced Nursing Education programs, including Advanced Practice Registered Nursing and Forensic Nursing Programs.

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 NOFO following the directions provided at http://www.grants.gov/applicants/apply-for-grants.html.

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

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The NOFO is also known as “Instructions” on Grants.gov. You must 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 justification, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the SF-424 R&R Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files included in the page limit may not exceed the equivalent of 60 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Biographical sketches do count in the page limitation. Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-21-016, 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. It is therefore 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.

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).

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

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3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachment 9: Other Relevant Documents.

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

Program-Specific Instructions

Program Requirements

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

1. Develop academic-practice partnerships to recruit participants/trainees, provide clinical and experiential training, and integrate trauma informed, evidence-based sexual assault services into community health practice and rural and/or undeserved settings. The partnerships must provide support and coordination to ensure participants/trainees complete the state/national requirements for SANE training and certification. You are encouraged to partner with HRSA-supported health centers, other HRSA-funded sites, critical shortage facilities, and other organizations that address social determinants of health as part of a coordinated systems of care;

2. Provide financial support for participants/trainees to complete SANE didactic training, clinical training, and experiential learning and certification exams;

3. Develop or enhance clinical training sites;

4. Integrate innovative models and ensure flexible options for training and practice, to include virtual, tele-education models, telehealth, SARTs, etc. Funds may be used to develop or enhance technological or other innovative training options;

5. Provide support and resources towards engagement in communities of practice, increased retention, counseling support, continuing education, and burnout prevention;

6. Participate in Awardee Cohort Collaboration30 efforts to bolster project success.

Collaboration activities include sharing resources and solutions, and developing and disseminating best practices related to SANE training, practice and retention;

and

7. Secure technical assistance for SANE program expert consultation. The intent of the technical assistance is to improve processes and address system-level and structural barriers to SANE training and practice such as enhancement of

30 Awardee cohort collaboration include all activities that provide a platform for awardees to come together and share best practices. Examples include: awardee-led meetings, conferences, and chat-discussions.

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

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stakeholder support, development of standardized protocols and promotion of effective interagency collaboration. See Appendix A.

Entities must be ready to continue and adapt project activities in the event of a public health emergency – both those that are expected and unexpected. A training-focused emergency preparedness plan is critical for HRSA-funded projects and helps ensure that grantees are ready to respond, can coordinate effectively, and can implement recovery plans when emergencies disrupt project activities. Applicants must develop and maintain a flexible training-focused emergency preparedness plan in case of public health emergencies, to ensure continuation of programmatic and training activities including clinical experiential training.

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

The Abstract must include:

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

2. The type of entity applying (e.g., school of nursing, nurse-managed health clinic, Community Health Center, State or local government, Rural Health Clinic, Hospitals, HRSA-supported health center, including the description of partners).

3. Specific, measurable objectives that the project will accomplish (i.e., the number of SANEs to be trained and/or certified, geographic location of training, population served, types of clinical training sites, types of virtual clinical technology, etc.).

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

5. If applicable, a statement indicating eligibility for funding preference.

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.

Applicants’ projects should aim to enhance stakeholder support, and reduce system-level and/or other structural barriers to SANE training. This can be achieved by collaborating with community partners and utilizing technical assistance consultation.31

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

31 Technical assistance (TA) is the process of providing targeted support to an organization with a development need or problem. It is commonly referred to as consulting. TA is one of the most effective methods for building the capacity of an organization.

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

This section will help reviewers understand the organization that would receive funding for training, as well as the needs of the communities that participants/trainees would ultimately serve. Use and cite demographic data whenever possible to support the information provided.

• Briefly describe the purpose of the proposed project.

• Discuss the target population served by this segment of the health workforce, as well as the social determinants of health and health disparities impacting the population or communities served, including:

o Demographics of the population affected32 (e.g., number of people who experienced sexual assault, age, sex, race/ethnicity, gender identity, etc.);

o Describe the targeted discipline to be trained and outline the need for the training program, including current number of trained and/or certified SANEs in the target community and number of SANEs required to meet the current demand for services;

o Provide a target number for how many SANEs you will be able to train and/or certify, if awarded;

o Provide current SANE training (including clinical training sites, qualified preceptors and experiential learning sites) and retention resources available;

o Provide current SANE certification resources available, including availability of a state level SANE certification that permits practice in the jurisdiction;

o Provide current number of health care facilities offering SANE programs and estimated number of programs needed.

o Describe barriers to preparing SANEs to provide and integrate sexual assault services into community health practice and rural and underserved settings; and o Describe barriers to SANE training, stakeholder support, collaboration, and development of uniform and cohesive interagency sexual assault processes and response, including utilization of a

SART.

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

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

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

Provide a detailed work plan narrative that demonstrates your plan for implementing a project of the proposed scope. Include a detailed description of how the proposed project will be accomplished. The work plan describes project activities, outlines a

32 See CDC reference for rationale on importance of demographics including gender identity, as available, to support reducing health disparities: https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/collecting-sexual-orientation.html.

https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/collecting-sexual-orientation.html https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/collecting-sexual-orientation.html

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specific set of goals and objectives, as well as the concrete steps that will be used to achieve those goals and objectives.

Your work plan must be submitted through the Standardized Work Plan (SWP) Form. The work plan must account for all functions or activities identified in the application.

The SWP form is organized by budget period and must include all activities and deliverables for each objective and program goal. Objectives may be categorized by organizational priorities by selecting applicable priorities on the SWP form. Form instructions are provided along with the SWP form, and are included in the application package found on Grants.gov.

If you make subawards or expend funds on contracts, describe how your organization will ensure proper documentation of funds in Attachment 9.

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

#2 (b).

• Describe your objectives and proposed activities, and provide evidence for how they link to the project purpose and stated needs. Propose methods that you will use to address the stated needs and meet each of the previously described program requirements and expectations in this NOFO. If applicable, include a plan to disseminate reports, products, and/or project outputs so project information is provided to key target audiences.

Specifically, describe the following:

• Rationale and evidence base behind proposed activities, including existing trauma informed, evidence-based tools and methods used in the proposed SANE didactic and clinical training, and virtual learning options;

• How the proposed activities and training strategies will address the barriers to training identified in the Purpose and Need section above;

• Details of how the project will conduct the following activities: (1) recruitment and selection of participants/trainees, (2) determination of location and types of didactic and clinical training, (3) development/enhancement of clinical skills training as applicable, (4) use of clinical skills instructors and/or preceptors,

(5) provision of support for SANE certification exams, (6) provision of resources and support for training and practice retention, and (7) consultation with SANE expert for technical assistance;

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• An emergency preparedness plan that is training-focused, to ensure continuation of programmatic training activities in case of public health emergencies;

• Innovative models/approaches to be used to train, certify and retain participants/trainees in practice, and why the approaches are considered innovative; and

• Collaborative partnerships established to accomplish the project goals including partners’ roles, deliverables, and leveraged resources (include Memoranda of Understanding [MOUs] in Attachment 4).

Logic Model Submit a logic model for designing and managing the project. A logic model is a one-page diagram that presents the conceptual framework for a proposed project and explains the links among program elements to achieve the relevant outcomes.

While there are many versions of logic models, for the purposes of this notice the logic model should summarize the connections between the:

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

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

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

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

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

• Outputs (i.e., the direct products or deliverables of program activities); and

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

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

http://www.acf.hhs.gov/sites/default/files/fysb/prep-logic-model-ts.pdf.

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

#2 (c)

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

Information must include, but is not limited to the following:

• A plan for resolving challenges with project implementation and the achievement of the proposed goals and objectives including, recruitment, didactic training, clinical training sites, experiential learning sites, retention, http://www.acf.hhs.gov/sites/default/files/fysb/prep-logic-model-ts.pdf

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interagency collaboration, and partnership roles and responsibilities; as well as a plan for handling identified contingencies that may arise;

• A plan for resolving challenges with establishing or expanding academic-practice partnerships; and

• A plan for resolving challenges to address system-level and structural barriers to SANE training and practice.

IMPACT -- This section includes two sub-sections— (a) Evaluation and Technical Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b).

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

You must demonstrate evidence that the evaluative measures selected will be able to assess: 1) the extent to which the program objectives have been met; 2) the extent to which the program objectives can be attributed to the project; and 3) the ability to disseminate findings.

Describe the plan for program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation must monitor ongoing processes and progress toward meeting goals and objectives of the project.

Demonstrate how you will track participants/trainees from recruitment, training, experiential learning to completion of state/national certification requirements, and completion of state/national SANE certifications; and how you will track the retention of SANE trained/certified nurses including participation in SARTs.

The Evaluation Plan must:

• Describe how you are able to support the data collection (including one year participants/trainees follow-up data), reporting, replication, extension, and…