PKG00264456-instructions.pdf

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce

Division of Medicine and Dentistry

Integrated Substance Use Disorder Training Program (ISTP)

Funding Opportunity Number: HRSA-21-087

Funding Opportunity Type(s): New

Assistance Listings (CFDA) Number: 93.732

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: February 24, 2021

Ensure your SAM.gov and Grants.gov registrations and passwords are current.

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: December 11, 2020

Program Contact Name: Steve Coulter, MD Title/Office: Project Officer, Bureau of Health Workforce Telephone: (301) 945-3336 Email: scoulter@hrsa.gov

Authority: 42 U.S.C. § 294k (a)(2) (Section 760(a)(2) of the Public Health Service Act) mailto:scoulter@hrsa.gov

HRSA-HRSA-21-087 ii

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2021 Integrated Substance Use Disorder Training Program (ISTP).

The purpose of this program is to expand the number of nurse practitioners, physician assistants, health service psychologists, and/or social workers trained to provide mental health and substance use disorder services in underserved community-based settings that integrate primary care, mental health, and substance use disorder services.

Applicants must propose to plan, develop, and operate a 12 months full-time (24 months half-time) training program for nurse practitioners, physician assistants, health service psychologists, and/or social workers that trains practitioners to provide care for individuals in need of mental health and substance use disorder prevention, treatment, and recovery services.

Funding Opportunity Title: Integrated Substance Use Disorder

Training Program (ISTP) Funding Opportunity Number: HRSA-21-087 Due Date for Applications: February 24, 2021 Anticipated Total Available FY 2021 Funding:

$6,500,000

Estimated Number and Type of Awards: Approximately 2 grants (fully funded at the outset for use over the period of performance)

Period of Performance: July 1, 2021 through June 30, 2026 (5 years)

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Eligible Applicants: Teaching health centers; Federally qualified health centers; Community mental health centers; Rural health clinics;

Health centers operated by the Indian Health Service, Indian tribes, tribal organizations, or urban Indian organizations (as defined in section 4 of the Indian Health Care Improvement Act);

Entities with a demonstrated record of success in providing training for nurse practitioners, physician assistants, health service psychologists, and/or social workers.

Individuals are not eligible to apply under this NOFO.

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

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

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative III. Budget IV. Budget Justification Narrative

v. Attachments

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

HRSA-21-087 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Integrated Substance Use Disorder Training Program (ISTP).

Program Purpose

The purpose of this program is to expand the number of nurse practitioners, physician assistants, health service psychologists, and/or social workers trained to provide mental health and substance use disorder (SUD), including opioid use disorder (OUD) services in underserved community-based settings that integrate primary care, mental health, and SUD services.

Applicants must propose to plan, develop, and operate a 12 months full-time (24 months half-time) training program for nurse practitioners, physician assistants, health service psychologists, and/or social workers that trains practitioners to provide care for individuals in need of mental health and SUD/OUD prevention, treatment, and recovery services.

Program Goals

The ISTP program is designed to foster robust clinical training and augment expertise among clinicians who will see patients at access points of care and provide addiction prevention, treatment, and recovery services. Participants will be practicing professionals from the following disciplines: nurse practitioners, physician assistants, health service psychologists, and/or social workers.

Program Objectives

1. Increase the number of practicing nurse practitioners, physician assistants, health service psychologists, and/or social workers who are trained to provide integrated mental health and SUD/OUD services in a primary care underserved community-based setting.

2. Plan, develop, and operate a training program to provide mental health and

SUD/OUD services in underserved, community-based settings that integrate primary care, mental health, and SUD/OUD prevention, treatment, and recovery services.

3. Increase the number of physician assistants and nurse practitioners that are trained in Medication Assisted Treatment (MAT) with a clinical training component and obtain a data-2000 waiver.

4. Establish a foundation of skills and expertise for the community-based program that supports training nurse practitioners, physician assistants, health service psychologists, and/or social workers to provide mental health and SUD/OUD prevention, treatment, and recovery services utilizing a team-based care model.

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2. Background

This program is authorized by 42 U.S.C. § 294k(a)(2) (Section 760(a)(2) of the Public Health Service (PHS) Act). This funding opportunity further addresses the current Public Health Emergency due to the opioid crisis.1 HRSA recently funded similar training for physicians through the Addiction Medicine Fellowship grant program. This opportunity extends the focus of such training to practicing nurse practitioners, physician assistants, health service psychologists, and/or social workers.

The Centers for Disease Control and Prevention (CDC) estimated that 67,367 Americans died from drug overdose in 20182, and on average 128 Americans die of an opioid overdose every day.3 SUD, including Opioid Use Disorder (OUD) also contribute to more than 70 other conditions requiring medical care and to a wide range of social consequences, costing our nation more than $700 billion each year.4

Over the past several decades, there has been an expanding awareness of the importance of SUD education for many clinicians. The greater emphasis on SUD training corresponds with a wider perception of SUD as a chronic condition that has led in part to the development of SUD training programs.5 As a result, the quantity and quality of education on SUD have improved.6 Despite this improvement in SUD training, the overall emphasis on SUD among various levels of training remains disproportionately low compared with other chronic medical disorders.7,8,9,10,11

Behavioral health care is the continuum of services for persons at risk of or suffering from mental, behavioral, or addictive disorders, such as post-traumatic stress disorder, substance use disorders, and depression. Behavioral health issues are the leading cause of disabilities that contribute to rising healthcare costs in the United States.12 Additionally, there are significant behavioral health disparities in underserved communities. These disparities may be due to lack of access to health care, need for a diverse health care workforce, a lack of information, and the need for culturally and linguistically competent care and programs.

1 Secretary of Health and Human Services, Retrieved May 19, 2020, from https://www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx 2 Center for Disease Control and Prevention. (n.d.). Drug Overdose Deaths. Retrieved May 21, 2020, from https://www.cdc.gov/drugoverdose/data/statedeaths.html 3 National Institute on Drug Abuse. (2018, March). Opioid Overdose Crisis. Retrieved May 21, 2020, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis.

4 Center for Disease Control and Prevention. (n.d.). Understanding the Epidemic. Retrieved May 21, 2020, from https://www.cdc.gov/drugoverdose/epidemic/index.html.

5 Galanter M, Kaufmen E, Schnoll S, Burns J. Postgraduate medical fellowship training in alcoholism and drug abuse: national consensus standards. Am J Drug Alcohol Abuse. 1991;17:1–12.

6 Fleming M, Barry K, Davis A, et al. Medical education about substance abuse: changes in curriculum and faculty between 1976 and 1992.

Acad Med. 1994;69:362–369.

7 Klamen DL. Education and training in addictive diseases. Psychiatr Clin North Am. 1999;22:471–480.

8 Isaacson JH, Fleming M, Kraus M, et al. A national survey of training in substance use disorders in residency programs. J Stud Alcohol.

2000;61:912–915.

9 Spangler JG, George G, Foley KL, Crandall SJ. Tobacco intervention training: current efforts and gaps in US medical schools. JAMA.

2002;288:1102–1109.

10 Powers CA, Zapka JG, Bognar B, et al. Evaluation of current tobacco curriculum at 12 US medical schools. J Cancer Educ. 2004;19:212–219.

11 Prochaska JJ, Fromont SC, Louie AK, et al. Training in tobacco treatments in psychiatry: a national survey of psychiatry residency training directors. Acad Psychiatry. 2006;30:372–378.

12 Behavioral Health, 2016-2017, TECHNICAL REPORT, August 28, 2017, National Quality Forum, Retrieved July 14, 2020, from http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=85831 https://www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx https://www.cdc.gov/drugoverdose/data/statedeaths.html https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis https://www.cdc.gov/drugoverdose/epidemic/index.html

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The ISTP Program aims to provide information to participants throughout their training program about the National Health Service Corps (NHSC) programs, particularly the Loan Repayment Program (LRP), (https://nhsc.hrsa.gov/loan-repayment/index.html) as well as the Indian Health Service (IHS) Loan Repayment Program (https://www.ihs.gov/loanrepayment/) and provide guidance and resources to help them locate employment in NHSC approved sites after they complete the training program.

The NHSC is committed to strengthening the primary care workforce through the recruitment and retention of high quality primary care providers at NHSC-approved sites. The NHSC LRP provides loan repayment assistance to qualifying health care professionals in exchange for a commitment to serve in a Health Professional Shortage Area. The NHSC plans to provide eligible clinicians who have completed a HRSA-funded ISTP with priority status when applying for NHSC LRP awards. Details concerning the priority status for eligible clinicians who have completed the ISTP will be announced in a forthcoming NHSC Application and Program Guidance to be released beginning the first program competitive cycle, following the awarding of the ISTP program grant funds or subsequently thereafter.

HRSA has a number of investments targeting OUD and other SUDs across its Bureaus and Offices For information on HRSA-supported resources, technical assistance, and training, visit here: https://www.hrsa.gov/opioids.

Telehealth can be an important tool for improving access to quality health care, especially for underserved and economically or medically vulnerable populations.

Applicants are encouraged to reach out to one of the 12 HRSA-supported Regional Telehealth Resource Centers (https://www.hrsa.gov/rural-health/telehealth), which provide technical assistance to organizations and individuals who are actively providing or interested in providing telehealth services to rural and/or underserved communities.

Additional information on telehealth can be found at https://telehealth.hhs.gov/.

Program Definitions

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

In addition, the following definitions apply to the Integrated Substance Use Disorder Training Program (ISTP) for Fiscal Year 2021:

Underserved, Community-based Setting is a care delivery site that provides integrated mental health and substance use disorder services in underserved community-based primary care settings. For purposes of this NOFO, a community-based setting includes, but is not limited to, a Teaching Health Center; federally qualified health center; community mental health center; rural health clinic; Health center operated by the Indian Health Service, an Indian tribe, a tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act). See Section III.1 Eligibility for definition of these terms.

Digital Literacy means the ability of an individual to find, evaluate, and compose clear information through writing and other media on various digital platforms.

https://nhsc.hrsa.gov/loan-repayment/index.html https://www.ihs.gov/loanrepayment/ https://www.hrsa.gov/opioids https://www.hrsa.gov/rural-health/telehealth https://telehealth.hhs.gov/ https://bhw.hrsa.gov/grants/resourcecenter/glossary

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Health Service Psychologists are certified and licensed practitioners, holding a Ph.D. or equivalent graduate degree in clinical or counseling psychology, who provide preventive, consultative, assessment, and treatment services in a broad range of settings, including independent or group practice, multidisciplinary clinics, counseling centers, or hospitals.

Medication-Assisted Treatment (MAT) – MAT, including opioid treatment programs (OTPs), combines behavioral therapy and Food and Drug Administration (FDA) approved medications to treat SUD.

Medication Assisted Treatment (MAT) DATA 2000-Waived Provider - Through the Drug Addiction Treatment Act of 2000 (DATA 2000), the Comprehensive and Addiction and Recovery Act (CARA) of 2016, and the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act of 2018 health practitioners who meet certain qualifications are allowed to treat opioid dependency with medications approved by the FDA—including buprenorphine— in treatment settings other than Opioid Treatment Programs. The Act permits qualified providers to obtain a waiver from the separate registration requirements of the Narcotic Addict Treatment Act of 1974 to treat opioid dependency with Schedule III, IV, and V medications or combinations of such medications that have been approved by FDA for that indication.

Mental Health Professional Shortage Areas can be found using the HPSA Find Tool at https://data.hrsa.gov/tools/shortage-area/hpsa-find

Mental Health Services in primary healthcare involves diagnosing and treating people with mental disorders; putting in place strategies to prevent mental disorders and ensuring that primary healthcare workers are able to apply key psychosocial and behavioral science skills, for example, interviewing, counselling and interpersonal skills, in their day to day work in order to improve overall health outcomes in primary healthcare.13

National Provider Identifier (NPI) – The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers and health plans. The NPI is a unique identification number for covered health care providers. Additional information about NPIs can be found at the following site: https://nppes.cms.hhs.gov/.

Opioid Use Disorder (OUD) is a problematic pattern of opioid use leading to clinically significant impairment or distress occurring within a 12-month period.

Participant means, for the purposes of this NOFO, a practicing nurse practitioner, physician assistant, health service psychologist, or social worker who receives training

13 What is primary care mental health?: WHO and Wonca Working Party on Mental Health. (2008). Mental health in family medicine, 5(1), 9–13. Retrieved July 9, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777553/.

https://data.hrsa.gov/tools/shortage-area/hpsa-find https://nppes.cms.hhs.gov/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777553/

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to become more proficient in providing mental health, OUD and SUD services in underserved community-based settings.

Substance Use Disorder (SUD) means a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance related problems.

II. Award Information

1. Type of Application and Award

Type of applications sought: New

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA estimates approximately $6,500,000 will be available to fund two recipients. You may apply for a ceiling amount of up to $3,250,000 in total cumulative costs, with a ceiling amount of $650,000 per year (includes both direct and indirect/facilities and administrative costs). All funds will be awarded the first year for use over the entire period of performance. The period of performance is July 1, 2021 through June 30, 2026 (5 years).

This program notice is subject to the appropriation of funds and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner.

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

Limitations on indirect cost rates.

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.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants for the ISTP are:

• A Teaching Health Center (as defined in PHS Act Section 749A(f)), or 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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• A Federally Qualified Health Center (as defined in section 1905(l)(2)(B) of the Social Security Act)14, or

• A Community Mental Health Center (as defined in section 1861(ff)(3)(B) of the Social Security Act), or

• A Rural Health Clinic (as defined in section 1861(aa) of the Social Security Act), or

• A health center operated by the Indian Health Service, an Indian tribe, a tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act), or

• An entity with a demonstrated record of success in providing training for nurse practitioners, physician assistants, health service psychologists, and/or social workers.

For purposes of this NOFO, an entity with a demonstrated record of success in providing training for nurse practitioners, physician assistants, health service psychologists, and/or social workers is an existing accredited training program for one or more of the eligible disciplines that train practicing professionals.

Provide documentation of applicant organization’s eligibility as specified in this section as Attachment 9.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Beneficiary Eligibility A participant or faculty/instructor receiving support from grant funds must be a citizen, national, or permanent resident of the United States.

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of $3,250,000 for the entire 5 year period, and $650,000 per year (direct and indirect costs), 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.

14 Social Security Act. Retrieved on July 9, 2020 from https://www.ssa.gov/OP_Home/ssact/title19/1905.htm.

https://www.ssa.gov/OP_Home/ssact/title19/1905.htm

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Maintenance of Effort The recipient must agree to maintain non-federal funding for award activities at a level that is not less than expenditures for such activities maintained by the entity for the fiscal year preceding the fiscal year for which the entity receives the award, as required by 42 U.S.C. § 295n–2. Complete the Maintenance of Effort information and submit as Attachment 6.

Multiple Applications NOTE: 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).

An applicant may apply for funding to train practicing nurse practitioners, physician assistants, health service psychologists, and/or social workers, however you must submit a single application.

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. Applications received without the required information will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

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 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 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

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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 80 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-21-087, 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. 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).

3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachment 13: Other Relevant Documents.

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

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

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Program-Specific Instructions

Program Requirements

1. Provide training to practicing nurse practitioners, physician assistants, health service psychologists, and/or social workers, either by developing or enhancing a program, clinical rotation or training track in underserved community-based settings to provide integrated mental health and SUD/OUD services. The training must include team-based care practices for /prevention, treatment, and recovery services in settings that integrate primary care and mental health and SUD/OUD services. The interprofessional team may include community health workers (CHW), Peer Recovery Specialists, or other behavioral/mental health paraprofessionals.

2. Collaborate and establish formal relationships between one or more clinical community based training sites and an academic institution to create a foundation of skills and expertise to provide mental health and SUD/OUD prevention, treatment, and recovery services on integrated, interprofessional teams.

3. Develop and implement trainings for nurse practitioners, physician assistants, health service psychologists, and/or social workers to provide mental health and SUD/OUD treatment services, remotely via telehealth and other distance learning modalities.

4. Design team based training approaches for participants to improve digital literacy for patients and their families impacted by mental health and OUD/SUD. The team based training approaches to improve digital literacy may be carried out through teams that incorporate paraprofessionals.

5. Provide MAT Waiver training for physician assistants and nurse practitioners in community based settings along with an additional clinical training beyond the didactic component.

6. Support faculty/instructor/interprofessional training team development activities to support the ISTP program goals and objectives listed on page one of the NOFO.

7. Collect National Provider Identifier (NPI) numbers of participants who participate in the programs.

8. Provide information to participants throughout their training program about the National Health Service Corps (NHSC) programs, particularly the Loan Repayment Program, (https://nhsc.hrsa.gov/loan-repayment/index.html) as well as the Indian Health Service (IHS) Loan Repayment Program (https://www.ihs.gov/loanrepayment/) and provide guidance and resources to help them locate employment in NHSC approved sites after they complete the program.

https://nhsc.hrsa.gov/loan-repayment/index.html https://www.ihs.gov/loanrepayment/

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

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

The Abstract must include:

1. A brief overview of the project as a whole

2. The specific, measurable objectives that the project will accomplish

3. The clinical priorities that will be addressed by the project

4. A description of how the proposed project will be accomplished, i.e., the

"who, what, when, where, why and how" of a project

5. Identify all disciplines to be trained o nurse practitioners o physician assistants o health service psychologists o social workers

6. State if a funding priority is being requested, and which criterion applies. Refer to Section V 2 ReviewandSelectionProcesss.

The project abstract must be single-spaced and is limited to one page in length.

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. It must address the goals and purpose of the NOFO and the strategies to be used in attaining the goals and meeting the funding opportunity’s purpose.

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

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

This section will help reviewers understand the organization that would receive funding for training as well as the needs of the areas that participants would ultimately serve.

Describe the purpose and need for the proposed project including the following:

1. The state and local (e.g., community, county) health status indicators including overdose rate, morbidity and mortality statistics related to behavioral health, SUD, including OUD in the community.

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2. The demographics of the community and the clinical training site(s) population(s) that participants will serve, data on the social determinants of health, behavioral health disparities, and status of access to integrated primary care and mental health and SUD/OUD services, that will be addressed through the proposed project.

3. The efforts towards and success for the recruitment and retention of nurse workers who are trained to recognize, diagnose, and treat mental health and

SUD/OUD.

4. The need for physician assistants and nurse practitioners to be trained in MAT, to receive clinical training, and to obtain DATA-2000 waivers.

5. The need to develop or enhance evidence based practices, trainings, clinical rotations, and clinical curriculum content standards to train and provide SUD/OUD treatment services remotely via telehealth and other distance learning modalities. Current team based training approaches and need to improve digital literacy for patients and families impacted by OUD/SUD.

6. The training needs for faculty/instructor(s) at the applicant’s educational and/or clinical training sites.

7. The current telehealth capacity and use in educational programs at the applicant’s clinical training sites and the need (if any) for enhancing telehealth use in service delivery and training.

8. Clinical training site(s) where the participants will train, including the information depicted in Attachment 10, Table 1.

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 that demonstrates your experience implementing a project of the proposed scope. A sample work plan can be found here:

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.

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

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

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

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

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

Attach the Work plan as Attachment 1.

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

1. Describe your overall objectives (specific, measureable, achievable, realistic, and time framed) 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.

2. Describe how you plan to develop effective tools and strategies for ongoing faculty/instructor development, outreach, collaborations, and clear lines of communication.

3. Describe how you plan to develop effective tools and strategies for ongoing development and recruitment of nurse practitioners, physician assistants, health service psychologists, and/or social workers.

4. Describe a plan for partnering with academia and community based programs in making decisions on the program and identifying their priority needs and solutions with efforts to involve patients, families, and communities.

5. Describe a plan to disseminate reports, products, and/or project outputs so project information is provided to key audiences. Explain why your project is innovative and provide the context for why it is innovative.

6. Provide a training chart as Attachment 12 with projected number of participants and discipline(s) to be admitted and complete the program each year of the project.

7. Provide a one page logic model appropriate for designing and managing the project that includes objectives, activities, and short, intermediate and long term outcomes and attach as Attachment 7.

8. Provides a plan to collect post-program completion employment data, including demographics on participants, and how you will obtain the NPI number required for BHW performance reports.

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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. Include attention to the following as applicable:

1. Describe challenges related to achievement of project objectives, carrying out the work plan according to the proposed timetable, and project implementation.

2. Describe challenges in recruiting participants, faculty/instructor or adjunct faculty in the clinical training sites.

3. Describe challenges in arranging placements in underserved, community-based programs for the learning experiences.

4. Identify obstacles in obtaining experiences in sites that offer telehealth.

5. For each challenge, describe optional plans to resolve these challenges.

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

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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)

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

variables to be measured; expected outcomes of the funded activities;

and a description of how all key evaluative measures will be reported.

2. Identify the lead evaluator with qualifications. Describe current experience, skills, and knowledge for lead evaluators, including individuals on staff, materials published, and previous work of a similar nature.

3. Describe any potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles.

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

5. Describe the systems and processes that will support your organization's collection of HRSA’s performance measurement requirements for this program. At the following link, you will find the required data forms for this program:

http://bhw.hrsa.gov/grants/reporting/index.html

6. Describe the data collection strategy to accurately collect, manage, analyze, store, and track/report data (e.g., assigned skilled staff, data management software) to measure process and impact/outcomes, and explain how the data will be used to inform program development and service delivery in a way that allows for accurate and timely reporting of performance outcomes.

7. Document the procedure for assuring the data collection, management, storage, and reporting of NPI numbers for individuals participating in the Program.

8. Describe current experience, skills, and knowledge for lead evaluators, including individuals on staff, materials published, and previous work of a similar nature. Describe any potential obstacles for implementing the http://bhw.hrsa.gov/grants/reporting/index.html

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program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles.

9. Describe the evaluation and reporting plan and indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

10. Describe your process to track participants after program completion for up to 1 year, to include collection of participants’ NPI. (Note:

Participants who receive HRSA funds as a result of this award are encouraged to apply for an NPI number for the purpose of collecting post-program completion employment demographics).

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

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

Performance Reporting Plan:

HRSA requests that you collect the following preliminary list of data annually.

1. Number, setting, and location of clinical training site(s).

2. Number, discipline, demographics of participants, hours trained in clinical training site(s) and number of participant-patient encounters, including telehealth encounters.

3. Number and type of new or enhanced activities (e.g. trainings, curriculum, courses, evidence-based models, rotations, seminars) and other innovative methods to be developed, enhanced, and implemented in the project.

4. Number of participants who intend to serve in rural (as applicable) and or underserved areas upon completion of training.

5. Program training type and learning activities.

6. Description of learning activities in rural (as applicable) and /or underserved areas.

7. Number of faculty/instructor who received training related to the project objectives.

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

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8. Characteristics of faculty/instructor professional development activities related to the project objectives.

9. Number of nurse practitioners and physician assistants who receive training related to DATA 2000 waiver to provide MAT treatment, and integrated behavioral health in primary care.

10. Number of individuals who received a DATA2000 waiver to provide MAT.

11. Number of training activities focused on team-based training. Number and occupation of paraprofessionals involved in interdisciplinary teams.

12. Quality, quantity and distribution of pre-award mental health and SUD/OUD services.

13. Effects of the program on prevalence of untreated mental illness and SUD/OUD in the communities served.

14. Number of participant -patient encounters, including telehealth encounters as applicable, with previously untreated SUD/OUD patients.

(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion #3 (b) Provide a clear plan for project sustainability after the period of federal funding ends, including a description of specific actions you will take to (a) highlight key elements of your grant projects, e.g., training methods or strategies, which have been effective in improving practices; (b) obtain future sources of potential funding;

as well as (c) provide a timetable for becoming self-sufficient. Recipients are expected to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population. Discuss challenges that are likely to be encountered in sustaining the program and approaches that will be used to resolve such challenges.

1. Plans for exploring future sources of potential funding.

2. Proposed timetable for becoming self-sufficient.

3. Challenges that are likely to be encountered to sustain the program and proposed approaches that will be used to resolve these challenges.

Specify how the plan addresses sustaining key elements of the supported activities such as participant training, educational strategies, partnerships; tangible next steps for continuing the project activities and evaluation beyond the duration of the project.

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ORGANIZATIONAL INFORMATION, RESOURCES, and CAPABILITIES -- Corresponds to Section V’s Review Criterion #4

Succinctly describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project. Provide information on your organization’s current mission and structure, including an organizational chart, relevant experience, and scope of current activities, and describe how these elements all contribute to the organization’s ability to implement the program requirements and meet program expectations. (A project organizational chart is requested in Section IV.2.v./vi., Attachment 4). Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs so as to avoid audit findings. Describe how the unique needs of target populations of the communities served are routinely assessed and improved.

The staffing plan and job descriptions for key faculty/staff must be included in Attachment 2 (Staffing Plan and Job Descriptions for Key Personnel).

However, the biographical sketches must be uploaded in the SF-424 RESEARCH & RELATED Senior/Key Person Profile (Expanded) form that can be accessed in the Application Package under “Mandatory.” Include biographical sketches for persons occupying the key positions, not to exceed TWO pages in length each. In the event that a biographical sketch is included for an identified individual who is not yet hired, please include a letter of commitment from that person with the biographical sketch. When applicable, biographical sketches should include training, language fluency, and experience working with diverse populations that are served by their programs.

Describe the following:

1. The assets and past experience of your organization in conducting training for nurse practitioners, physician assistants, health service psychologists, and/or social workers trained to provide mental and substance use disorders services in underserved community-based settings that integrate primary care and mental and substance use disorders services.

2. The mission of the applicant organization and the organization’s commitment to providing integrated services in underserved, community- based settings.

3. Capacity of the faculty/instructor to provide the didactic, field experiences, and clinical experiences for participants, evidence of linking training to best practices, and examples of other training programs that can improve health outcomes and strengthen the workforce.

4. Documentation of a qualified staffing plan as Attachment 2 and project organizational chart as Attachment 4.

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5. Evidence of institutional support such as letters of agreement and support, in-kind contribution of faculty/instructor, staff and resources, other partners providing support, provided in Attachments 3 and 8.

6. Documentation that the applicant organization has developed linkages for clinical trainings in underserved community based settings as defined by this NOFO. Include Documentation of Clinical Sites as Attachment 10.

7. Documentation of institutional resources to provide training and services through telemedicine and telehealth that provides a rationale for equipment and technical support requested in this application.

8. Capacity of the program to provide the type and volume of learning experiences, academic partnerships, and community resources needed for participants to meet the competencies and clinical training experiences required for the program.

In the Attachments section (IV. 2. v./vi., Attachment 2), attach a complete staffing plan and job descriptions for key personnel. Bio sketches of Key Personnel should be uploaded in the SF-424 R&R Senior/Key Person Profile form.

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

• Senior/key personnel name

• Position Title

• Education/Training - beginning with…