PKG00264932-instructions.pdf

HRSA-21-090 i

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Behavioral Health Workforce Education and Training (BHWET)

Program for Paraprofessionals

Funding Opportunity Number: HRSA-21-090 Funding Opportunity Type(s): New

Assistance Listings (CFDA) Number: 93.732

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2021

Application Due Date: April 12, 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: January 12, 2021

Nicole M. Wilkerson Project Officer, Behavioral and Public Health Branch Telephone: (301) 443-7759 Email: BHWET-Para@hrsa.gov

Authority: 42 U.S.C. §§ 294e–1 755(b)(1)(j) and 756(a)(4) of the Public Health Service Act mailto:BHWET-Para@hrsa.gov

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EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2021 Behavioral Health Workforce Education and Training (BHWET) Program for Paraprofessionals.

The purpose of the BHWET Program for Paraprofessionals is to develop and expand community-based experiential training such as field placements and internships to increase the supply of students preparing to become peer support specialists and other behavioral health-related paraprofessionals while also improving distribution of a quality behavioral health workforce. A special focus is placed on the knowledge and understanding of the specific concerns of children, adolescents, and transitional-aged youth in high need and high demand areas at risk for behavioral health disorders.

The BHWET Program for Paraprofessionals emphasizes establishing relationships with community based partners (e.g., emergency departments, faith-based organizations, first responders, judicial systems, health centers, social services, community policing organizations, recovery community organizations or other peer-based recovery support organizations), to increase access to behavioral health services to populations across the lifespan. The program will expand and improve access to quality treatment and foster an integrated approach to address behavioral health prevention, treatment, and recovery services, including but not limited to Opioid Use Disorder (OUD) and other substance use disorder (SUD), in high need and high demand areas.1 The program also emphasizes developmental opportunities and educational support in interdisciplinary collaboration by utilizing team-based care in integrated, interprofessional behavioral health and primary care settings and recruiting a workforce interested in serving high need and high demand areas.

For the purpose of this NOFO, all training will be separated into two levels: Level I pre-service2 (includes didactic and experiential field training) and Level II in-service3 (includes training at a registered Department of Labor apprenticeship site). All paraprofessional training that does not fall under the definition of a registered apprenticeship will be defined as Level I pre-service training as further explained in Appendix A for more details.

Registered apprenticeships (Level II) is not a program requirement. Applicants are not required to implement Level II in their proposals to be considered eligible for this program and will be given full and equitable consideration during the review process.

Under this Notice of Funding Opportunity (NOFO), eligible applicants may submit a maximum of one application for the BHWET Program for Paraprofessionals for either the

1 For purposes of this NOFO high need and high demand areas are identified as sites located within Mental Health Professional Shortage Areas (HPSAs) and/or a Facility Mental HPSA with a score of 16 or above, or within a geographical area considered rural as defined by the HRSA Federal Office of Rural Health Policy (FORHP).

2 See Appendix A for a definition of pre-service of paraprofessional training.

3 See Appendix A for a definition of in-service levels of paraprofessional training.

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Level I pre-service training or both the Level I pre-service training and Level II in-service training.

Funding Opportunity Title: Behavioral Health Workforce and

Education Training (BHWET) Program for Paraprofessionals

Funding Opportunity Number: HRSA-21-090 Due Date for Applications: April 12, 2021 Anticipated Total Annual Available FY 2021 Funding:

Base award: Approximately $16,300,000 One-time funds: $8,000,000

Estimated Number and Type of Award(s): Up to 43 grants Estimated Award Amount: Base award:

• Up to $350,000 per year for programs only implementing Level I pre-service training.

• Up to $500,000 for programs implementing Level I pre-service and Level II in-service training.

One-time funds:

• Approximately $216,000

Awards are subject to the availability of appropriated funds.

See Section II. Award Information for more detail information.

Cost Sharing/Match Required: No

Period of Performance: September 1, 2021 through August 31, (4 years)

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Eligible Applicants State-licensed mental health nonprofit and for-profit organizations (See definition in Section VII). For the purpose of this NOFO, these organizations may include universities, community colleges, and technical schools, which must be accredited by a nationally recognized accrediting agency, as specified by the U.S. Department of Education. Domestic organizations, tribes, and tribal organizations may apply for these funds, if otherwise eligible.

Individuals are not eligible to apply under this NOFO.

All current grant recipients funded under the FY 2017 BHWET Program are eligible to apply.

See Section III.1 of this notice of funding opportunity 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

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

APPENDIX A

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I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Behavioral Health Workforce Education and Training (BHWET) Program for Paraprofessionals.

Program Purpose

The purpose of the BHWET Program for Paraprofessionals is to develop and expand community-based experiential training to increase the supply of students preparing to become peer support specialists and other behavioral health-related paraprofessionals while also improving distribution of a quality behavioral health workforce. A special focus is placed on the knowledge and understanding of the specific concerns of children, adolescents, and transitional-aged youth in high need and high demand areas at risk for behavioral health disorders.

Program Goals

1. Establish relationships with community-based partners (e.g., emergency departments, faith-based organizations, first responders, judicial systems, health centers, social services, community policing organizations, recovery community organizations or other peer-based recovery support organizations to expand and improve access to quality behavioral health services including but not limited to OUD and other SUD prevention, treatment recovery services in high need and high demand areas.

2. Promote collaborative training by utilizing team-based models of care in integrated and interprofessional behavioral health and primary care settings.

3. Recruit a workforce that reflects participation in the institutions’ programs of individuals and groups from different racial, ethnic, cultural, geographic, religious, linguistic, and class backgrounds, and different genders and sexual orientations, interested in serving high need and high demand areas.

Program Objectives

1. Increase the number of experiential training sites to promote peer support specialists and other behavioral health-related paraprofessional student/trainee competencies around evidence-supported behavioral health including but not limited to OUD and other SUD prevention and treatment modalities used in integrated and interprofessional team-based practice settings. Experiential placements must include interdisciplinary training of two or more health disciplines using a team-based care approach to provide quality behavioral health services in high need and high demand areas.

2. Enhance didactic and experiential training activities through the development of competencies in primary and integrated team based trauma-informed care, for peer support specialists and other behavioral health-related paraprofessional students/trainees in Level I pre-service and/or Level II in-service training in a behavioral health-related paraprofessional field.

3. Establish community based partnerships to ensure participation in the institutions’ programs of individuals and groups from different racial, ethnic, cultural, geographic, religious, linguistic, and class backgrounds, and different genders and sexual

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orientations, opportunities for field placements, community education, career development, and provide job placement services.

4. Promote technology integration in the provision of peer support specialist and other behavioral health-related paraprofessional services and training programs, including utilizing telehealth services, implementing strategies to increase digital health literacy, and offering options for distance learning.

5. Reduce financial barriers for peer support specialists and other behavioral health-related paraprofessionals by providing financial support to trainees in the form of tuition/fees, supplies, and stipends.

HHS and HRSA Priorities

Combatting the opioid crisis is an HHS priority, and advancing the competencies of the health workforce is a HRSA priority. The BHWET program addresses these priorities by advancing the behavioral health competencies of the paraprofessional workforce across disciplines, and increasing the behavioral health workforce in high need and high demand areas, through collaboration with community based partnerships.

2. Background

This program is authorized by 42 U.S.C. §§ 294e and e–1. The BHWET Program was established in 2014 to: expand the behavioral health workforce by supporting professionals and paraprofessionals; increase access to behavioral health care services in mental health and substance abuse disorders; develop interprofessional training and integrate behavioral health into primary care; and implement experiential training serving children, adolescents, and transitional-aged youth. Over the years, its purpose has expanded to serve rural, vulnerable and medically underserved individuals across the lifespan, including those with substance use disorders. The program also supports enhanced, didactic and experiential training.

Starting in Fiscal Year 2021, the BHWET program will: have separate NOFOs for professionals and paraprofessionals; a focus on serving high need and high demand areas; address behavioral health disorders including but not limited to OUD and other SUD services; and include technology integration through the use of telehealth, digital health literacy, and distance learning. For the BHWET Paraprofessional NOFO, stipend support is included for trainees and the new apprenticeship focus to operationalize the in-service training component. More information regarding the history of the BHWET Program and BHW’s investments in behavioral health can be found on HRSA’s website at: https://bhw.hrsa.gov/funding/apply-grant#behavioral-mental-health.

In recent years, the peer support services workforce has evolved to become an essential part of behavioral health treatment, family support, and primary care services.4 Peer support specialists are increasingly being deployed to help those with mental health, opioid and other substance use disorders, and co-occurring behavioral health

4 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. An Assessment of Innovative Models of Peer Support Services in Behavioral Health to Reduce Preventable Acute Hospitalization and Readmissions Environmental Scan Report.2015. https://aspe.hhs.gov/report/assessment-innovative-models-peer-support-services-behavioral-health-reduce-preventable-acute-hospitalization-and-readmissions/1-environmental-scan-report https://bhw.hrsa.gov/funding/apply-grant#behavioral-mental-health https://aspe.hhs.gov/report/assessment-innovative-models-peer-support-services-behavioral-health-reduce-preventable-acute-hospitalization-and-readmissions/1-environmental-scan-report https://aspe.hhs.gov/report/assessment-innovative-models-peer-support-services-behavioral-health-reduce-preventable-acute-hospitalization-and-readmissions/1-environmental-scan-report

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conditions develop and maintain recovery-based goals and resiliency.5 In this role they can help prevent unnecessary acute hospital admissions, avoid preventable readmissions, and lessen over-utilization of Emergency Department facilities.6 The evidence base for these services is emerging, and different service models are expanding.7

In 2018, an estimated 10.3 million people aged 12 or older misused opioids in the past year, including 9.9 million prescription pain reliever misusers and 808,000 heroin users.8 The percentage of people aged 12 or older in 2018 who were past year opioid misusers was lower than the percentages between 2015 and 2017, which was largely driven by declines in pain reliever misuse rather than by changes in heroin use.9

It is estimated that of the 38.6 million Americans with mental health disorders, 18.7 percent (7.2 million of 38.6 million) use prescription opioids.10 Adults with mental health conditions receive 51.4% (60 million of 115 million prescriptions) of the total opioid prescriptions distributed in the United States each year.11 The study also notes that compared with adults without mental health disorders, adults with mental health disorders were significantly more likely to use opioids.12 In adjusted analyses, having a mental health disorder was associated with prescription opioid use overall.13

Mental health disorders are also associated with high levels of disability, high mortality rates, and lost health.14 Between 2017 and 2018, eight of the 12 most frequently reported conditions among children 0-17 years of age were mental, behavioral, and developmental conditions, and 1 in 3 children had at least one adverse childhood experience (ACE), which is strongly related to health problems. Children of racial minorities and experiencing low socioeconomic status were at higher risk of experiencing two or more ACEs.15

Youth involvement in and exposure to violence is related to important psychosocial and behavioral outcomes, including using substances. Survivors of violence are more likely to become victims of other forms of violence and are at higher risk of behaving violently.

Furthermore, people who behave violently are more likely to commit other forms of violence (e.g., youth who bully are more likely to bring guns to school). Intimate partner violence (IPV) is another byproduct of exposure to early violence. Conflict at home is linked to almost all forms of violence perpetration like child maltreatment, teen dating violence, IPV, sexual violence, youth violence, and bullying. Access to mental health and substance use disorder treatment services is one protective measure that lessens

5 Ibid 6 Ibid 7 Ibid 8 Substance Abuse and Mental Health Services Administration (SAMSHA) Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.2018.

https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf 9 Ibid 10 Journal of the American Board of Family Medicine, Opioid Use among Adults with Mental Health Disorders in the United States.

2017. https://www.jabfm.org/content/30/4/407 11 Ibid 12 Ibid 13 Ibid 14 Pan American Health Organization. The Burden of Mental Health Disorders in the Region of the Americas, 2018. Washington, D.C.: PAHO; 2018. https://iris.paho.org/bitstream/handle/10665.2/49578/9789275120286_eng.pdf?sequence=10&isAllowed=y 15 Health Resources and Services Administration: Maternal and Child Health. National Survey of Children’s Health Data Brief.

Rockville, MD. 2019. https://mchb.hrsa.gov/sites/default/files/mchb/Data/NSCH/NSCH-2018-factsheet.pdf https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf https://www.jabfm.org/content/30/4/407 https://iris.paho.org/bitstream/handle/10665.2/49578/9789275120286_eng.pdf?sequence=10&isAllowed=y https://mchb.hrsa.gov/sites/default/files/mchb/Data/NSCH/NSCH-2018-factsheet.pdf

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the likelihood of experiencing violence and increasing resilience when a youth is exposed to violence. Additionally, resources and services provided by community agencies as well as connectedness to one’s community have been demonstrated to increase community resilience.16

In comparison to non-rural areas, life expectancy is lower among populations in rural areas of the U.S. Much of rural America lacks access to health care, has a higher rate of chronic health conditions, and poorer quality of life compared with non-rural areas.

On average, there is a 45 percent higher rate of opioid overdose in rural communities than in urban areas. Additionally, rural America has a greater shortage of mental health providers, a smaller number of comprehensive treatment facilities, and fewer detox services per county in contrast to non-rural areas, making these communities an important focus for mental and behavioral health investments.17

The primary care setting is the common point of entry to healthcare for patients in medically underserved communities and is the opportunity for diagnosing missed and/or untreated behavioral health disorders. Making behavioral health services available within the same settings as routine primary care services increases the likelihood that individuals will take advantage of them.18 Integrated models of healthcare delivery not only include workforce partnerships between primary care and behavioral health services, but the valuable addition of paraprofessionals who work at the first stage of contact for patients.19 Paraprofessionals continue to represent an under-utilized segment of the behavioral health workforce.20 The scope of practice for peer support specialists and other behavioral-related paraprofessionals is wide and includes patient screening and education, advocating on behalf of the patient, coordination of care, provision of on-call crisis services, and linkage to additional services.

Over the next decade, it’s projected that the demand for peer support specialists and other behavioral health-related paraprofessionals will continue to increase.21 This will necessitate a workforce that is trained and prepared to meet these needs, which the workforce supply is on track to meet.22 However, sustained investments in support of up-to-date, evidence-based training opportunities will be required to keep up with the dynamic nature of the behavioral health landscape.

16 Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence. 2014. https://www.cdc.gov/violenceprevention/pdf/connecting_the_dots-a.pdf 17 Health Resources and Services Administration, Office of Health Equity. Health Equity Report 2017. Rockville, Maryland: U.S.

Department of Health and Human Services; 2018.https://www.hrsa.gov/sites/default/files/hrsa/health-equity/2017-HRSA-health-equity-report.pdf 18 National Rural Health Association. The Future of Rural Health. 2013.

https://www.ruralhealthweb.org/getattachment/Advocate/Policy-Documents/FutureofRuralHealthFeb-2013.pdf.aspx 19 National Council for Behavioral Health. Center of Excellence for Integrated Health Solutions. Updated 2020.

https://www.integration.samhsa.gov/news/Eliminating_Behavioral_Health_Disparities_and_Improving.pdf 20 Dormond, M. Scope of Practice Alignment with Job Tasks for Paraprofessionals and Addiction Counselors. 2017.

http://www.behavioralhealthworkforce.org/wp-content/uploads/2017/05/FA3P3_SOP-Parapro_Addiction-Couns_Full-Report_v2.pdf 21 Health Resources and Services Administration, Bureau of Health Workforce, Allied Health Workforce Projections, 2016-2030:

Community Health Workers.2019. https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/community-health-workers-2016- 2030.pdf 22 Health Resources and Services Administration, Bureau of Health Workforce, Allied Health Workforce Projections, 2016-2030:

Community Health Workers.2019. https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/community-health-workers-2016- 2030.pdf https://www.cdc.gov/violenceprevention/pdf/connecting_the_dots-a.pdf https://www.cdc.gov/violenceprevention/pdf/connecting_the_dots-a.pdf https://www.hrsa.gov/sites/default/files/hrsa/health-equity/2017-HRSA-health-equity-report.pdf https://www.hrsa.gov/sites/default/files/hrsa/health-equity/2017-HRSA-health-equity-report.pdf https://www.ruralhealthweb.org/getattachment/Advocate/Policy-Documents/FutureofRuralHealthFeb-2013.pdf.aspx https://www.integration.samhsa.gov/news/Eliminating_Behavioral_Health_Disparities_and_Improving.pdf http://www.behavioralhealthworkforce.org/wp-content/uploads/2017/05/FA3P3_SOP-Parapro_Addiction-Couns_Full-Report_v2.pdf https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/community-health-workers-2016-2030.pdf https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/community-health-workers-2016-2030.pdf https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/community-health-workers-2016-2030.pdf https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/community-health-workers-2016-2030.pdf

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Technology can play a major role in how individuals seek, find, and understand health information. The BHWET program aims to promote technology integration in the training programs it supports. Strategies to improve digital health literacy and the uptake of health technology increase availability and access to health information, as well as patient engagement, leading to improved health outcomes.23 Additionally, offering options for distance learning can allow peer support specialists and other behavioral health-related paraprofessional students who may face barriers to receiving in-person didactic training continued learning. Telehealth can be an important tool for delivering services and resources to HRSA’s target populations.

Telehealth is defined as the use of electronic information and telecommunications technologies to support and promote, at a distance, health care, patient and professional health-related education, health administration, and public health.

Applicants are strongly encouraged to use telehealth in their proposed service delivery plans when feasible or appropriate. Additional information on telehealth can be found at https://telehealth.hhs.gov/. In addition, if you use broadband or telecommunications services for the provision of health care, HRSA strongly encourages you to seek discounts through the Federal Communication Commission’s Universal Service Program. For information about such discounts, see https://www.usac.org/rural-health-care/. Patients may also be eligible for free or low cost mobile or broadband services through the Universal Service Lifeline program at https://www.lifelinesupport.org/.

HRSA has a number of investments targeting opioid use disorder and substance use disorder across its Bureaus and Offices that you may be able to leverage. For information on HRSA-supported resources, technical assistance, and training, visit here:

https://www.hrsa.gov/opioids.

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. Additional definitions specific to the FY 2021 BHWET Program for Paraprofessionals can be found in Section VIII.

II. Award Information

1. Type of Application and Award

Type(s) of applications sought: New

HRSA will provide funding in the form of a grant.

23 Health Resources and Services Administration, Bureau of Health Workforce. Behavioral Health Workforce Projections, 2017- 2030. 2018. https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/bh-workforce-projections-fact-sheet.pdf https://telehealth.hhs.gov/ https://telehealth.hhs.gov/ https://www.usac.org/rural-health-care/ https://www.usac.org/rural-health-care/ https://www.lifelinesupport.org/ https://www.hrsa.gov/opioids https://bhw.hrsa.gov/grants/resourcecenter/glossary https://bhw.hrsa.gov/grants/resourcecenter/glossary https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/bh-workforce-projections-fact-sheet.pdf

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2. Summary of Funding

HRSA estimates approximately $16,300,000 to be available annually to fund approximately 43 recipients.

If you will be implementing only Level I pre-service training, you may apply for a ceiling amount (including both direct and indirect costs) of up to $350,000 total cost per year. If you will be implementing Level I pre-service and Level II in-service training, you may apply for a ceiling amount of $500,000 per year.

Additionally, HRSA estimates approximately $8,000,000 in additional one-time funds in the first year of the period of performance. You may apply for approximately $216,000.

See Section IV.2.iv Budget Justification for more details.

The period of performance is September 1, 2021 through August 31, 2025. Funding beyond the first year is subject to the availability of appropriated funds for the BHWET Program in subsequent fiscal years, satisfactory recipient progress, and a decision that continued funding is in the best interest of the Federal Government. HRSA may reduce a recipient’s funding levels beyond the first year if it is unable to fully succeed in achieving the goals listed in the application.

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.

III. Eligibility Information

1. Eligible Applicants

For the purposes of this program, eligible applicants include:

• State-licensed mental health nonprofit and for-profit organizations (see definition in Section VII). These organizations must be able to support programs for Level I pre-service, and Level II in-service, as applicable, training of peer support specialists and other behavioral health-related paraprofessionals.

• For the purposes of this NOFO, these organizations may include academic institutions, including universities, community colleges, and technical schools.

Native American tribal organizations may meet this definition if appropriately licensed by an applicable Tribal government or political subdivision.

Note: Individuals are not eligible to apply under this NOFO.

In addition to the 50 states, eligible entities include the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

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U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Domestic faith-based and community-based organizations, tribes, and tribal organizations may also apply for these funds, if otherwise eligible.

Current BHWET award recipients whose grants are scheduled to end on August 31, 2021 are eligible to apply for this funding opportunity.

If funded, for-profit organizations are prohibited from earning profit from the federal award (45 CFR part 75.216(b)).

Accreditation/Approval Documentation

Entities must be accredited by a nationally recognized accrediting agency, as specified by the U.S. Department of Education or must be approved by the state government to provide a behavioral health-related paraprofessional certificate program. Programs must be recognized by the state government(s) within the proposed geographic coverage of the training program, and information regarding state certification or licensure for the individuals completing these training programs must be included. Applicants must provide a copy of their active accreditation or active approval from the state government as Attachment 6.

Failure to submit Attachment 6 may be considered by HRSA as non-responsive and ineligible for consideration. Applicants are required to maintain their accreditation or state approval status throughout the period of performance and notify HRSA of any change in status.

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, or the Republic of Palau.

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 $350,000 per year for Level I training and $500,000 per year for Levels I and II training 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 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 (MOE) information and submit as Attachment 5. HRSA will consider any application that fails to satisfy the requirement to provide MOE information non-responsive and will not consider it for funding under this notice.

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). Organizations where multiple programs are interested in applying under this funding announcement, you may collaborate across programs to 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.

Experiential Training Sites HRSA will consider any application that fails to include Attachment 2 and Attachment 4 non-responsive and will not consider it for funding under this notice.

Beneficiary Eligibility Trainees must be enrolled full or part time in the certificate program receiving the grant award in order to receive tuition and stipend support. In addition, trainees must be eligible to work in the United States. A trainee receiving support from grant funds under this program must be a citizen, national, or permanent resident of the United States.

Individuals on temporary or student visas are not eligible to participate.

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.

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

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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 HRSA’s 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-21-090, 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 14: Other Relevant Documents.

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

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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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), include the following:

1. Provide participant/trainee support for tuition, fees, supplies and stipends to peer support specialists and other behavioral health-related paraprofessional trainees for no less than six months and no more than 12 months;

2. Establish or expand the number of experiential training sites in high need and high demand areas, in order to recruit and place peer support specialists and other behavioral health-related paraprofessional trainees in these areas;

3. Recruit a workforce of peer support specialists and other behavioral health-related paraprofessionals that reflects participation in the institutions’ programs of individuals and groups from different racial, ethnic, cultural, geographic, religious, linguistic, and class backgrounds, and different genders and sexual orientations, interested in serving high need and high demand areas;

4. Demonstrate knowledge and understanding of the concerns of the population served, especially individuals with mental disorder symptoms or diagnoses, particularly children and adolescents, and transitional-age youth;

5. Enhance the existing paraprofessional certificate program(s) through curriculum development or enhancement and inclusion of experiential learning in the form of field placements or internships including pre-service or in-service training to understand the specific concerns of the targeted population in behavioral health including but not limited to OUD and other SUD prevention, treatment and recovery services in high need and high demand areas;

6. At the time of application, applicants must already have in place at least one certificate training program in a behavioral health-related paraprofessional field. Examples of certificate programs include those that train individuals to become one of the following: peer support specialist, peer support counselor, community health worker, outreach worker, social services aide, mental health worker, substance abuse/addictions counselor, promotor/a, youth worker, and peer counselor (for full list of occupations see the definition in Section VIII);

7. The certificate program must provide Level I pre-service training that includes both didactic and experiential training in the form of a field placement in an integrated, interprofessional setting and provide a certificate upon completion to prepare trainees to enter the workforce immediately upon program completion. Trainees may be new to the field or may be peer support specialists or other behavioral health-related paraprofessionals who are already practicing and want additional credentials to advance their employability;

8. Establish community-based partnerships in high need and high demand areas (e.g. hospitals, crisis centers, emergency departments, state and local health departments, health centers, social services, faith-based organizations, community policing organizations, judicial systems, recovery community

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organizations or other peer-based recovery support organizations to provide experiential training, career development, and job placement services to assist peer support specialists and other behavioral health-related paraprofessional trainees in obtaining employment following graduation from the program;

9. If implementing a Level II in-service registered apprenticeship training model, aim for at least 50 percent of the Level I program completers to enter into a Level II in-service registered apprenticeship program;

10. Promote the integration of behavioral health into primary care settings to improve access to quality behavioral health services, including but not limited to OUD and other SUD prevention, treatment and recovery, in high need and high demand areas;

11. Recruit a peer support specialists and other behavioral health-related paraprofessional workforce that reflects participation in the institutions’ programs of individuals and groups from different racial, ethnic, cultural, geographic, religious, linguistic, and class backgrounds, and different genders and sexual orientations, interested in serving high need and high demand areas;

12. Include technology integration by providing options for distance learning and developing didactic and experiential training activities that address strategies for providing telehealth services and increasing digital health literacy;

13. Use an evidence-based continuous monitoring tool to evaluate program objectives and make adjustments as needed to improve program outputs and outcomes over the four-year project period;

14. Collect specified program and performance data and disseminate findings to appropriate audiences. Participate in program evaluations during and upon completion of the project period;

15. Collaborate regularly during the project period with other BHWET Program for Paraprofessional grant recipients (e.g. the grantee engagement platform, consortium developed by recipients in state or nearby states, etc.) to leverage resources, enhance interdisciplinary training, and collaborate across regions;

and

16. Support career development in behavioral health and encourage career progression for behavioral health paraprofessionals, including but not limited to conducting OUD and other SUD prevention, treatment and recovery services.

Additional Program Areas of Focus:

Additionally, the BHWET program welcomes applications that intend to incorporate the following areas of focus into their programs. Please note that that these are not program requirements, but are encouraged activities, and all applications will be given fair and equitable consideration.

Level II in-service Registered Apprenticeships for Paraprofessionals –To improve recruitment and retention and support career development for trainees, the BHWET program encourages its paraprofessional programs to implement a training model that incorporates registered apprenticeships. For the purposes of this NOFO, and as described by the U.S. Department of Labor or a State Apprenticeship Agency, Level II in-service registered apprenticeship is a system of training behavioral health-related

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paraprofessional trainees that receive on-the-job training once they have completed didactic and experiential field training and attained the required Level I pre-service certificate. Applicants who intend to utilize this training structure can find additional information and instructions in Appendix A.

Health Center Collaboration –Health centers provide culturally competent, comprehensive primary care services in an integrated setting to communities in high need and high demand areas. Applicants can collaborate with these centers to develop experiential training opportunities and leverage partnerships for future employment opportunities for program completers.

Violence Prevention – Applications can address the role that intimate partner violence and youth violence play in the behavioral health outcomes of individuals in high need and high demand areas by incorporating plans for didactic and experiential training that recognizes and supports victims through an understanding of trauma-informed care.

Behavioral health service delivery will ideally also include the provision of culturally and linguistically appropriate care for populations within the community.

Loan Repayment Programs – To reduce financial burdens that students and trainees may face, applicants can connect graduates to HRSA-sponsored SUD Treatment and Recovery (STAR) Loan Repayment Program sites. STAR is a HRSA program that provides loan repayment assistance for individuals working in a full-time substance use disorder (SUD) treatment job that involves direct patient care in a Health Professional Shortage Area (HPSA) designated for Mental Health or a county where the average drug overdose death rate exceeds the national average.

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

The Abstract must include:

1. The discipline(s) for which you are applying;

2. The requested funding amount;

3. A brief overview of the project as a whole (i.e. proposed services, needs addressed, target population(s), etc.);

4. A summary of the proposed project goals for which funding is requested;

5. How the proposed project will be accomplished (i.e., the “who, what, when, where, why, and how”) of the project;

6. Specific, measurable objectives that the project will accomplish; and

7. If applicable, a statement indicating eligibility for funding preference and/or funding priority.

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.

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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

Briefly describe the purpose of the proposed project and outline the needs of the training program. Discuss the target population(s) served by the behavioral health workforce of focus, as well as the social determinants of health and the health disparities impacting the population or communities served. Use and cite demographic data whenever possible to support the information provided. This section will help reviewers understand the organization that would receive funding for training, as well as the needs of the communities that trainees would ultimately serve.

Please include the following:

• Describe the area of focus for the unmet need for behavioral health including but not limited to OUD and other SUD prevention, treatment and recovery services in high need high demand areas;

• Describe the need for evidence-based behavioral health workforce training, particularly as it pertains to integrated, interdisciplinary team-based care in the behavioral health discipline of focus;

• Describe the health needs of the target population(s) served by the proposed experiential training site(s);

• Discuss the current scope of representation of individuals and groups from different racial, ethnic, cultural, geographic, religious, linguistic, class backgrounds, different genders, and sexual orientations in the behavioral health field;

• Discuss the current capacity of the local community to meet the needs of populations in high need and high demand areas and how the proposed project activities will strengthen community based partnerships to improve health outcomes;

• Detail the information regarding experiential training site(s) shown in Table 1 and submit as Attachment 4;

• Describe the current implementation of technology integration, including telehealth services, initiatives to address digital health literacy, and options for distance learning, how it supports the needs of the trainees and the target population(s) they serve; and

• As applicable, describe any current innovative models of care that deliver integrated and coordinated behavioral health and primary care services, incorporate trauma-informed care, and address intimate partner violence and youth violence. In particular, describe how this service delivery focuses on culturally appropriate care for populations within the community.

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Table 1: Experiential Training Sites Site Name

Experiential Site Address (Example:

XX Main Street, Town, State, Zip Code)

Number of Proposed

BHWET

Paraprofessionals Trained

Number of trainee hours or hours in rotation

Mental Health HPSA Score using the HPSA Find Tool https://data.hrsa.gov/tools/shortage-area/hpsa-find

Geographical area considered Rural as defined by the HRSA Federal Office of Rural Health Policy (FORHP) as found in the Am I Rural tool https://www.ruralhealthinfo.org/am-i-rural

RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections — (a) Work Plan; (b) Methodology/Approach; and…