RFA_FY24 Recognizing MMM Warning Signs.docx

Recognizing & Addressing Maternal Warning Signs for Morbidity & Mortality During Pregnancy & the Postpartum Period

Fiscal Year 2023 Request for Applications (RFA) Assistance Listing Number (ALN): 10.557

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Form RFA 01-23 Application Checklist

This Application Checklist provides applicants with a list of the required actions and documents that must be completed. However, FNS expects that applicants will read the entire RFA prior to the submission of their application and comply with all requirements outlined in the solicitation. The Application Checklist is for applicant use only and should not be submitted as part of the Application Package.

Complete the following at least four weeks prior to submission:

· Obtain a Unique Entity Identifier (UEI) number;

· Register the UEI number in the System for Award Management (SAM); and,

· Register in grants.gov.

When preparing your application, ensure:

· Application format and narrative meet the requirements included in Section 4 – Application and Submission Information. This includes page limits, priorities outlined in Section 5 – Application Review Information, and all necessary attachments.

When preparing your budget, ensure the following information is included:

· All key staff proposed to be paid by this grant.

· The percentage of time the Project Director will devote to the project in full-time equivalents (FTEs).

· Your organization’s fringe benefit rate and amount, as well as the basis for the computation.

· The type of fringe benefits to be covered with Federal funds.

· Itemized travel expenses (including type of travel), travel justification, and basis for lodging estimate.

· Types of equipment and supplies, justifications, and estimates, ensuring that the budget is in line with the project description.

· Information for all contracts and justification for any sole-source contracts

· Justification, description, and an itemized list of all consultant services.

· Indirect cost information (either a copy of a Negotiated Indirect Cost Rate Agreement (NICRA) or if no agreement exists and the applicant has never been approved for a NICRA, they may charge up to 10% de minimis). If an applicant is requesting the de minimis rate or indirect costs are not required, please state this in the budget narrative.

When submitting your application, ensure you have submitted the following:

· FNS-906 – Grant Program Accounting System & Financial Capability Questionnaire

· Negotiated Indirect Cost Rate Agreement (PDF - Upload using the “Add Attachments” button under SF-424 item #15)

· Resumes of key staff

· Letters of support/commitment from key staff and partners

· Additional attachments as required

Table of Contents

1. Program Description and Objectives Executive Summary WIC provides important services to eligible individuals and families; however, research is needed to identify additional opportunities and logical, evidence-based pathways to improve maternal health in the context and with deep understanding of the WIC program. While a body of evidence is available detailing interventions to reduce maternal morbidity and mortality,[footnoteRef:2][footnoteRef:3] there are several limitations to relating this research to the WIC setting: reviews are relatively dated, interventions have largely not been tested in the WIC setting, there is a lack in diversity of populations addressed in these interventions, and technology and service delivery approaches have changed drastically in recent years resulting (e.g., remote and hybrid service delivery). [2: Gülmezoglu AM, Lawrie TA, Hezelgrave N, et al. Interventions to Reduce Maternal and Newborn Morbidity and Mortality. In: Black RE, Laxminarayan R, Temmerman M, et al., editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Apr 5. Chapter 7. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361904/ doi: 10.1596/978-1-4648-0348-2_ch7] [3: Katon JG, Enquobahrie DA, Jacobsen K, Zephyrin L. Policies for Reducing Maternal Morbidity and Mortality and Enhancing Equity in Maternal Health. (2021). Available at; https://www.commonwealthfund.org/publications/fund-reports/2021/nov/policies-reducing-maternal-morbidity-mortality-enhancing-equity. Accessed April 21, 2023. ]

This RFA will provide up to $5,000,000 in funding, through a one-time cooperative agreement, to an external entity that will provide financial, technical, and evaluation to initiate and administer a competitive subgrant program for WIC State and local agencies. Eligible external entities include accredited public and private institutions of higher education (colleges/universities), non-profit research entities, and other non-profit organizations. The legislative authority for this Request for Applications is contained in the Child Nutrition Act of 1966 Section 17 (g)(5)2 as amended. Under this provision, subject to the availability of funds, the Secretary of Agriculture may award competitive grants and cooperative agreements for the support of research projects to further the WIC program.

Background

In the United States, hundreds of individuals die as a result of pregnancy and birth related complications annually[footnoteRef:4]; another 50,000 individuals are impacted by complications related to pregnancy and birth experiences [footnoteRef:5]. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is widely considered to be one of the most successful nutrition intervention policies and is an important part of the social safety net intended to improve maternal and child health. More research is needed to understand how interventions to detect early warning signs of maternal morbidity and mortality can be successfully tailored to a WIC setting. Therefore, the goal of this request for applications (RFA) is to initiate and support a rigorous research program that will identify and evaluate the implementation of evidence-based interventions to detect and address (e.g., complete referrals for needed services) early warning signs of maternal morbidity and mortality in the WIC setting. This RFA will provide up to $5,000,000 in funding, through a one-time cooperative agreement, to an external entity to administer a competitive subgrant program for WIC State and local agencies. Eligible external entities include accredited public and private institutions of higher education (colleges/universities), non-profit research entities, and other non-profit organizations. By the end of the cooperative agreement period of performance, the successful recipient of this RFA will accomplish four objectives: [4: Hoyert DL. Maternal mortality rates in the United States, 2021. NCHS Health E-Stats. 2023. DOI: https://dx.doi.org/10.15620/cdc:124678] [5: Centers for Disease Control and Prevention. (2021). Severe Maternal Morbidity in the United States. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html]

1) Develop and share broadly a clear and concise analysis of evidence-based interventions, communications campaigns, and promising models for recognizing and addressing early warning signs of maternal morbidity and mortality that can be evaluated in diverse WIC settings and program delivery approaches. (“Review Evidence”);

2) Competitively select WIC State agencies (SAs) and/or Local agencies (LAs) to evaluate the implementation of evidence-based and promising well-designed interventions intended to identify and address early warning signs of maternal morbidity and mortality in a WIC setting. (“Subgrants”);

3) Provide technical assistance to subgrantees as they rigorously evaluate the interventions implemented by subgrantees, including a process evaluation and cost estimate. (“TA and Evaluation”); and

4) Develop and implement a framework to synthesize findings across subgrant studies and broadly disseminate findings. (“Dissemination”) Program Description Introduction The United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) works to end hunger and promote nutrition security[footnoteRef:6] through the administration of a variety of federal nutrition assistance programs. WIC is a federal nutrition assistance program that serves pregnant, postpartum, and breastfeeding individuals; infants; and children up to five years old with who are low-income and at nutrition risk. WIC provides nutritious foods, nutrition education including breastfeeding promotion and support, and referrals to health and social services to participants in all 50 states, the District of Columbia, 33 Indian Tribal Organizations, American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands. In fiscal year (FY) 2022, roughly 6.3 million women, infants, and children across the United States received WIC benefits.[footnoteRef:7] [6: USDA Food and Nutrition Service. (2022). USDA Actions on Nutrition Security. Available at: https://fns-prod.azureedge.us/sites/default/files/resource-files/usda-actions-nutrition-security.pdf. Accessed on May 4, 2023.] [7: USDA Economic Research Service. WIC Program. Available at: https://www.ers.usda.gov/topics/food-nutrition-assistance/wic-program/ Accessed on September 18, 2023. ]

Legislative Authority:

The legislative authority for this Request for Applications (RFA) is contained in the Child Nutrition Act of 1966 Section 17 (g) (5)[footnoteRef:8] as amended. Under this program, subject to the availability of funds, the Secretary of Agriculture may award competitive grants and cooperative agreements for the support of research projects to further the WIC program. [8: https://www.fns.usda.gov/wic/wic-laws-and-regulations. Accessed on April 1, 2023]

This grant will be awarded as a cooperative agreement. This agreement is a legal instrument reflecting a relationship between the Federal government and the Grantee. Cooperative agreements will allow more involvement and collaboration by FNS in this project.

Background Maternal health, defined as the health of childbearing individuals during the pregnancy and postpartum periods, can be influenced by pre-pregnancy health and has the ability to impact health throughout the lifespan.[footnoteRef:9] Across the United States, rates of maternal morbidity (any health condition attributed to and/or aggravated by pregnancy and childbirth that has negative outcomes to the woman’s well-being) and mortality (the death of a woman while pregnant or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy) are unacceptably high and increasing at alarming rates.[footnoteRef:10] In 2021, more than 1,200 people died of maternal causes at a rate of almost 33 deaths per 100,000 live births, compared to 861 deaths (23.8 per 100,000 live births) in 2020 and 754 deaths (20.1 per 100,000 live births) in 2019.[footnoteRef:11] More than 80 percent of these deaths can be prevented, and half occur from one week to one year after delivery.[footnoteRef:12] About three quarters of maternal deaths are caused by mental health conditions, hemorrhage, cardiovascular and coronary conditions, infection, thrombotic embolism, and cardiomyopathy based on a review of deaths in 36 States.[footnoteRef:13] Moreover, pregnancy and postpartum complications including anemia, anxiety and depression, hypertension, and infections, among other health conditions, has increased substantially in the US in recent years, impacting more than 50,000 individuals annually.[footnoteRef:14] [9: Williams D. Pregnancy: a stress test for life. Curr Opin Obstet Gynecol. 2003 Dec;15(6):465-71. doi: 10.1097/00001703-200312000-00002. PMID: 14624211. ] [10: Maternal Morbidity and Mortality Web Portal. NIH. Available at https://orwh.od.nih.gov/mmm-portal/what-mmm. Accessed May 2, 2023.] [11: Hoyert DL. Maternal mortality rates in the United States, 2021. NCHS Health E-Stats. 2023. DOI: https://dx.doi.org/10.15620/cdc:124678] [12: Trost SL, Beauregard J, Njie F, et al. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022.] [13: Ibid.] [14: Centers for Disease Control and Prevention. (2021). Severe Maternal Morbidity in the United States. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html ]

While rates of maternal morbidity and mortality are unacceptably high across the US, the distribution of these conditions is exacerbated by systems that have historically put the lives and wellbeing of minority populations at higher risk than their white counterparts.[footnoteRef:15] According to data from the Centers for Disease Control and Prevention (CDC), among the 50,000 reported pregnancy-related health complications recorded annually, Black women are at least three times more likely to die due to a pregnancy-related cause when compared to White women; risk is also substantially elevated for American Indian and Alaskan Native (AIAN) women.[footnoteRef:16] [15: Trost SL, Beauregard J, Njie F, et al. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022.] [16: Centers for Disease Control and Prevention. (2021). Severe Maternal Morbidity in the United States. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html]

Though each instance and circumstance of morbidity or mortality is different and underlying health conditions such as existing cardiovascular disease, hypertension, and diabetes play a role in health risk, racial, ethnic, social, and economic disparities and biases are important factors contributing to disparities in pregnancy-related deaths and adverse outcomes – when these medical conditions are not present, racial disparities persist. Alongside concerns about increasing rates of maternal morbidity and mortality, racial disparities increased during the COVID-19 health emergency. According to a report from the Government Accountability Office (GAO), Black women had the highest maternal mortality rates across all racial and ethnic groups in 2020 and 2021 and also experienced the largest increase compared to the year prior to the pandemic (2019).[footnoteRef:17] Recently, studies have shown that social risk factors including historic exposure to racial trauma, discrimination, systemic barriers to accessing care, implicit bias within the healthcare system, and a lack of trust in established medical systems can result in further harm to individuals who face additional barriers to accessing care and in being believed when expressing their health concerns.[footnoteRef:18] [17: Government Accountability Office. (2022). Outcomes Worsened and Disparities Persisted During the Pandemic. Available at: https://www.gao.gov/assets/gao-23-105871.pdf. Accessed April 28, 2023.] [18: Njoku A, Evans M, Nimo-Sefah L, Bailey J. Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States. Healthcare. 2023; 11(3):438. https://doi.org/10.3390/healthcare11030438]

In light of the increasingly stark maternal health crisis in the US and the stark disparities that exist for populations of color, action is needed to support interventions that improve implementation to address maternal health in federal programs. To this end, the Biden-Harris Administration issued a Fact Sheet in June 2022 detailing a “Maternal Health Blueprint” in which they stated a commitment to “cutting the rates of maternal mortality and morbidity, reducing the disparities in maternal health outcomes, and improving the overall experience during and after pregnancy for people across the country.”[footnoteRef:19] USDA, alongside many partner organizations in the federal government, continues to support efforts to address this issue through research, engagement, and implementation. [19: The White House. FACT SHEET: President Biden’s and Vice President Harris’s Maternal Health Blueprint Delivers for Women, Mothers, and Families. Available at: https://www.whitehouse.gov/briefing-room/statements-releases/2022/06/24/fact-sheet-president-bidens-maternal-health-blueprint-delivers-for-women-mothers-and-families/. Accessed April 2, 2023. ]

Established in 1974, WIC is administered by the Food and Nutrition Service (FNS) of the U.S. Department of Agriculture (USDA) and is one of many federal partners engaged in whole-of-government approaches to combating adverse maternal health outcomes. WIC provides nutritious foods, nutrition education, breastfeeding promotion and support, and referrals to health, social, and community services to participants at no charge. Individuals who are postpartum are eligible for up to 12 months if they are breastfeeding and 6 months if they are not breastfeeding. For pregnant individuals, WIC seeks to improve fetal development and reduce the incidence of low birth weight, short gestation, anemia, and other maternal complications through intervention during the prenatal period. For breastfeeding and postpartum individuals, WIC also seeks to improve dietary intake, promote and support breastfeeding as the optimal method of infant feeding, and continues to provide important referrals to healthcare, social, and other community services.

WIC provides important services to eligible individuals and families; however, research is needed to identify additional opportunities and logical, evidence-based pathways to improve maternal health in the context and with deep understanding of the WIC program. While a body of evidence is available detailing interventions to reduce maternal morbidity and mortality,[footnoteRef:20][footnoteRef:21] there are several limitations to relating this research to the WIC setting: reviews are relatively dated, interventions have largely not been tested in the WIC setting, there is a lack in diversity of populations addressed in these interventions, and technology and service delivery approaches have changed drastically in recent years resulting (e.g., remote and hybrid service delivery). [20: Gülmezoglu AM, Lawrie TA, Hezelgrave N, et al. Interventions to Reduce Maternal and Newborn Morbidity and Mortality. In: Black RE, Laxminarayan R, Temmerman M, et al., editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Apr 5. Chapter 7. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361904/ doi: 10.1596/978-1-4648-0348-2_ch7] [21: Katon JG, Enquobahrie DA, Jacobsen K, Zephyrin L. Policies for Reducing Maternal Morbidity and Mortality and Enhancing Equity in Maternal Health. (2021). Available at; https://www.commonwealthfund.org/publications/fund-reports/2021/nov/policies-reducing-maternal-morbidity-mortality-enhancing-equity. Accessed April 21, 2023. ]

Program Description To address these gaps and support current and future research and programming to reduce maternal morbidity and mortality, the goal of this RFA is to initiate and support a rigorous research program that will identify and evaluate the implementation of evidence-based interventions to detect and address early warning signs of maternal morbidity and mortality in the WIC setting.

The grantee is expected to propose a robust subgrant program to support WIC SAs and LAs in identifying, selecting, implementing, and evaluating interventions to detect and address early warning signs of maternal morbidity and mortality. The program will evaluate available evidence-based interventions for strength and potential for implementation testing in a WIC setting and to initiate, support, and evaluate a robust subgrant program for WIC SAs and LAs. Findings from this analysis will inform and be broadly disseminated to WIC programs and other interested parties and will be used to inform actions to improve maternal health in groups at highest risk of maternal morbidity and mortality.

The following expands on the activities necessary for the grantee to meet the aforementioned objectives by specifying a minimum set of activities that the grantee will conduct, in collaboration with FNS. In addition to the activities specified below, FNS expects that applicants will propose innovative approaches to meet the overall Goal and Objectives of this cooperative agreement:

Objective 1: Review Evidence The Grantee should conduct a scoping review to identify evidence-based interventions, communications campaigns, technological interventions, screening and referral tools, and promising models (collectively referred to as “interventions” moving forward) for recognizing and addressing early warning signs of maternal morbidity and mortality. Interventions do not need evidence of effectiveness in a WIC setting but should be appropriate for tailored deployment within the scope of WIC Program and consider services provided in WIC settings – including in-person, hybrid, and remote services; rural, urban, tribal, and territories – in order to evaluate aspects of implementation that will determine the success of the intervention and appropriateness for implementation research in a WIC setting.

Applicants should describe a comprehensive strategy for identifying interventions to detect early warning signs of maternal morbidity and mortality and describe how they will gather, extract, and evaluate the strength of evidence and implementation details relevant to deployment in a WIC setting (e.g., cost, time to implement, how the intervention would impact the current clinic operations and participant experience such as clinic visit time). Applicants should clearly describe their proposed approach to identifying and gathering sources for the scoping review, which should include formal academic sources (e.g., PubMed, Web of Science) and informal sources such as federal agency websites (e.g., CDC, NIH). Applicants should make clear how they plan to assess interventions for appropriateness, given the diversity of WIC service delivery modalities (e.g., in-person, remote, hybrid), WIC program settings (e.g., urban, rural, tribal, territory), populations (e.g., pregnant, post-partum; diversity of race, ethnicity, age, language and other identities), and with consideration for the impact that these interventions could have on WIC clinic flow (participant and WIC staff movement through a WIC clinic visit). Applicants shall describe how they would gather important information from WIC agencies, staff, and participants to assess the appropriateness of interventions for a WIC setting and population. This could include but is not limited to the establishment of a technical working group, a small number of focus groups, interviews, or other approaches.

Applicants should also identify a relevant implementation and dissemination science framework (e.g., CFIR, RE-AIM) that will guide information extraction from sources identified above and should explain why the designated framework is appropriate for the project and how the approach will meet the goal and objectives outlined for this partnership. The scoping review should, in addition to describing intervention and evaluation elements, evaluate the strength of findings and potential for implementation in a WIC setting.

Applicants should propose a process for disseminating the results of their evidence review to a broad audience, most notably WIC SAs and LAs. The resulting reports should include, but are not limited to, information about the overall goal of the interventions identified, reach, effectiveness/efficacy, adoption, implementation, and maintenance. Applicants should describe a process for identifying a number of interventions most appropriate for testing implementation in a WIC setting and ensure that elements of the intervention are available to use for implementation during the subsequent subgrant process. Applicants should describe how they will assess, from the interventions evaluated in Objective 1, a subset of interventions most appropriate for implementation in WIC setting, including the criteria for the selection, how interested parties’ perspectives would be included in the decision making process, and how these interventions will be described in detail to potential subgrant applicants (WIC State agencies, as described in Objective 2). Dissemination shall be thoroughly described and should include the formation of a toolkit or other similar deliverable that could be used by subgrant applicants to determine which evidence-based intervention might be most appropriate and realistic for implementation testing in different WIC settings, given the diversity of populations and needs. Applicants should also propose innovative approaches to disseminating findings from this review to larger audiences including the broader research community and programs serving similar populations (e.g., Federally Qualified Health Centers).

Objective 2: Subgrants During the period of performance of the cooperative agreement, the Grantee shall initiate and maintain a competitive subgrant program to foster innovative implementation and dissemination science research related to identifying and addressing early warning signs of maternal morbidity and mortality in WIC settings, building on information gathered during Objective 1.

The Grantee will conduct at least one round of competitive subgrants, making funding available to WIC State and local agencies. Subgrant applicants who propose projects focused on addressing health equity among populations with the highest risk for adverse outcomes will be given priority (e.g., populations with high rates of maternal morbidity and mortality; those living in maternity care deserts). Applicants shall include a description of how they could assess need, such as using the Maternal and Child Health Bureau’s Maternal and Infant Health Mapping Tool[footnoteRef:22] or another similar, data-driven, approach to assessing disparities, need, and risk. In preparation for subgrants, the Grantee will draft and complete the required paperwork, which will be approved by FNS. When describing how they will administer subgrant program(s), applicants should consider that FNS intends for the SA and LA subgrant application process to be as simple as possible. As such, applicants shall describe how they will provide technical assistance to WIC SAs and LAs that wish to apply for subgrant funding (e.g., webinars, office hours). The Grantee will also create and implement a plan for the pre-application phase, and how they will provide technical assistance for interested subgrant applicants in communities with limited access to resources supporting maternal health, communities with high rates of maternal morbidity and mortality, and areas with high rates of maternal health disparities (more requirements for technical assistance are included under Objective 3). [22: Maternal and Child Health Bureau, Health Resources and Services Administration, Maternal and Infant Health Mapping Tool. Available at https://data.hrsa.gov/maps/mchb/. Accessed September 19, 2023. ]

Using information gathered when addressing Objective 1, Applicants should propose a target number and scale of subgrants and the number of rounds through which subgrants shall be administered as well as a justification for each element of the approach. The subgrant RFA will describe the subgrant opportunity, explain subgrantee eligibility, and establish evaluation criteria for the subawards.

Subgrant applications should include, at a minimum, a full research narrative including a clearly defined set of research questions and objectives that articulate how the proposed project will provide insights into the effectiveness of implementation strategies in their WIC setting; the proposed data source(s) used for the analysis; a detailed budget justification; letters of support, if needed; documentation of procedures used to maintain the quality and integrity of data and analyses; and bio sketches for key members of the research team. Before the subgrant RFA is published, FNS must approve all RFA content. Applicants for this RFA should build at least a 6-week review timeline into their overall project guidelines.

Applicants should also describe how they will publicize the subgrant opportunity to WIC SAs and LAs, with specific attention to how the opportunity will include a focus on addressing health equity. Ensuring equitable access to the subgrant program is an FNS priority; therefore, applicants should directly address this equity priority in their applications and describe how they intend to operationalize the equity opportunity in this subgrant program. Applicants should also describe how subgrant applicants will receive equitable consideration for subgrant awards through the subgrant application evaluation process. If necessary, the applicant will be responsible for supporting subgrant awardee IRB applications as necessary.

After subgrant selection, the Grantee will submit updated project summaries to FNS for the publication of subgrant projects on the FNS website and will schedule and hold a virtual meeting, inviting subgrantees, key FNS staff, and members of the grantee’s implementation team.

Objective 3: Technical Assistance and Evaluation In order to support well-designed rigorous evaluations that contribute to the WIC program mission and effectiveness, the grantee will provide technical assistance and evaluation support using an implementation science framework (e.g., CFIR, RE-AIM) to subgrantees for the duration of all subgrant projects. Approaches to providing support could include but are not limited to regular subgrantee meetings, communities of practice, and expert consultation. In addition to providing individualized and collaborative evaluation and technical support, Applicants should describe a clear plan to synthesize findings such that information will be generalizable for WIC agencies and broader audiences.

The Applicant should include a clear description of how they intend to support subgrant awardees throughout the process (including pre-application TA, see Objective 2), focusing on aspects of dissemination and implementation science that are most relevant to the WIC program. Support should focus on evaluation of the following:

(1) How the applicant will regularly communicate with subgrantees and the frequency of this communication;

(2) How the applicant will support subgrantees to develop capacity to maintain interventions after the subgrant period concludes;

(3) How the applicant will coordinate opportunities for subgrantees to hear and learn from each other through a structured learning collaborative, coordinated evaluations, or other approach that includes regular dialogue between subgrantees;

(4) How the applicant will collaborate with FNS and support subgrantees to disseminate findings to WIC SAs and LAs after the conclusion of the project; and

(5) How the applicant will liaise with FNS and encourage dialogue between the program and subgrantees to maximize collaborative learning opportunities and identify opportunities for scaling successful interventions after the conclusion of the subgrant period.

Objective 4: Synthesis and Dissemination Finally, the Grantee will develop and implement a framework to synthesize and disseminate findings. Applications for this USDA RFA should articulate the proposed approach to developing an evaluation plan for subgrant projects. Other measures, including key performance indicators (KPIs), shall be included in the evaluation to capture relevant outcomes and process metrics. The synthesis should describe subgrantee interventions and evaluations, individually, and draw from collective learning across grant and subgrantee activities to promote generalizability across WIC settings. The synthesis should include tools to increase uptake and scale-up of evidence-based interventions specific to the WIC setting and promote dissemination to key interested parties. In addition, the Grantee should develop state-specific reports appropriate for dissemination on the FNS website.

FNS encourages proposals that include innovative dissemination strategies and that focus on the translation of research findings into actionable recommendations and useful tools for FNS and WIC SAs and LAs. The grantee should develop and maintain a comprehensive strategy to disseminate results of funded subgrant studies through print or electronic methods, including but not limited to, innovative use of web-based communication, social media, infographics, podcasts, newsletters, working papers, and webinars. The grantee will also be responsible for supporting and encouraging subgrantees to broadly disseminate findings from their individual evaluations to a variety of audiences and through multiple mechanisms. Foremost, the Grantee shall support subgrantees as they disseminate findings to other WIC agencies at meetings and conferences.

Minimum set of research questions to address though this RFA

· What are the characteristics and effectiveness of evidence-based interventions focused on identifying, addressing, and preventing maternal morbidity and mortality in the setting of WIC Program’s services or similar settings?

· What are the most effective strategies to incorporate evidence-based approaches to identifying, addressing, and preventing maternal morbidity and mortality into WIC setting?

· How can interventions to improve WIC staff ability to recognize and address (e.g., complete appropriate referrals for) early warning signs maternal morbidity and mortality to assure integration and program integrity?

· How is implementation impacted by contextual factors and how can contextual factors be modified to enhance the chances for intervention success?

· Are there existing practices, biases, or interventions that could be discontinued or modified to improve early detection of maternal morbidity and mortality warning signs in the WIC setting?

Key Objectives Below is a list of the Program Objectives. As noted in Section 4, within the “Activities/Indicators Tracker,” proposed activities should be clearly aligned to these objectives and their associated activities and indicators.

Application proposals must include all four objectives identified below. Note that if awarded, grantees will be required to report on progress towards activities aligned with the required objective(s) and must use the FNS-908 Performance Progress Report. Carefully considering proposed activities and indicators will prepare grantees for their progress reporting requirements if awarded.

Purpose of Cooperative Agreement FNS. To the extent practicable, FNS is available to provide technical consultation to the Grantee as needed. FNS will comment on major project aspects and issues in advance of their implementation in a manner and timeframe agreed upon between the Grantee and FNS.

At FNS’s discretion, FNS involvement with the Grantee may include:

1. Providing comments on and having ongoing conversations with the Grantee regarding their plans to meet this RFA’s requirements;

2. Reviewing administration, dissemination, and evaluation (once designed) plans associated with implementing the selected telehealth innovations at WIC agencies funded by this cooperative agreement;

3. Approving the date and time of meetings or conferences;

4. Approving the agendas for meetings or conferences;

5. Reviewing and co-authoring manuscripts;

6. Receiving copies of all Grantee-produced documents (e.g. Final report, peer-reviewed publication upon submission) resulting from this cooperative agreement.

Grantee: For purposes of this RFA, the Grantee is the accredited public and private institutions of higher education (colleges/universities), non-profit research entities, or other non-profit organizations that will be competitively selected based on the merits of its application. The Grantee has overall responsibility for administering the competitive subgrant RFA, awarding and monitoring subgrants, coordinating project implementations, evaluating project success, providing technical and evaluation-based assistance, developing and disseminating deliverables and implementation practices/tools, and reporting to FNS.

The Grantee shall:

1. Select or hire appropriately credentialed personnel to manage and operate project components.

2. Delegate responsibilities to their staff or other partners as appropriate.

3. Conduct appropriate training and provide necessary support for staff, partners, and subgrantees to successfully handle project responsibilities. These responsibilities include, but are not limited to:

a. providing data on participating WIC State and local agencies and external organizations to FNS,

b. providing subgrantees training and/or consultation on Section 508 compliance to ensure that all documents circulated or published meet Section 508 standards,

c. fulfilling obligations to FNS, and

d. coordinating site visits to participating sites for FNS if requested.

4. Keep FNS informed on critical junctures and checkpoints after award of cooperative agreement, including updates to plans that are submitted in preliminary form in the application, as well as plans developed after award of subgrants.

5. Meet specific obligations and approval points as specified by the cooperative agreement (FNS has provided reference review timelines throughout this RFA).

6. Submit timely progress reports, financial reports, and annual reports throughout the award period and submit a final progress report and final financial report.

7. Attend and facilitate grant and subgrant progress meetings.

8. Ensure subgrantees account for project funds separately from Federal food and nutrition assistance administrative funds and establish financial and managerial reporting controls to assure project funds are not commingled or used inappropriately. The Grantee must establish and maintain documented evidence clearly demonstrating expenditures of project funds are used solely for project purposes. A separate and distinct audit trail must be established and maintained for the expenditure of project funds that clearly demonstrates that they are used solely for project purposes.

9. Provide FNS with any data files created and used to generate reports, presentations, and publications resulting from this grant. Such data shall be accompanied with analytic code, source code, output files, and codebooks and other applicable documentation sufficient for FNS to replicate analyses.

10. Carry out all activities necessary to fulfill the items as described in this RFA.

11. Coordinate other grant-related dissemination activities.

12. Ensure you include the requirement of a signed subaward agreement with all subaward organizations (signed by the sub awardees authorized official).

13. For internal use and informational purposes, provide FNS with an electronic copy of all documents resulting from this cooperative agreement.

This grant will be awarded in the form of a Cooperative Agreement. The roles and responsibilities of the FNS and the Cooperator are as follows:

The Grantee shall work cooperatively with FNS to:

1. Within 4 weeks of the start of this cooperative agreement’s period of performance, host a kick-off and project planning meeting where the Grantee will present its proposal and its plan to disseminate the RFA and work with USDA and relevant partners to form project ideas. Additionally, potential evaluation strategies shall be presented, and the implementation and evaluation framework shall be presented and discussed.

2. Within 6 weeks of the start of this cooperative agreement’s period of performance, submit a project timeline based on the proposal and any changes discussed during the kick-off and project planning meetings.

3. Grantee is expected to set up a project website for communication and dissemination of resources and materials related to this project. All web content must be approved by FNS prior to launch. FNS requires 2 weeks for review and 1 week to approve final website.

4. Two months prior to the scheduled release of the subgrantee RFA, lead a virtual meeting with FNS during which the Grantee presents and explains the subgrant RFA, including the communication plan for the RFA, to FNS.

5. Prior to selection of subgrantees, submit to FNS the proposals and summaries of all proposals submitted and discuss the proposals with FNS. The timeline should allow 2 weeks for FNS to review. At a minimum, summaries shall include the following information: the name of the academic organization and point of contact for the project, the requested award amount, a brief description of the proposed project and data sources, and a subgrant timeline. FNS will approve final selection decisions for the subgrants.

6. Should any subgrant applicants who are not selected request a debrief or explanation, the Grantee is responsible for addressing the request. FNS does not need to review or participate in requests for debriefs. Should the Grantee want FNS to review debrief plans or explanation, the timeline should allow 1 week for FNS review.

7. After subgrantees are selected, publish updated summaries of selected subgrant projects on the public-facing website created for this effort and, upon request, prepare publication material for FNS’s website. Materials related to or intended for use by subgrantees that will be posted on the public-facing website or FNS’s website require FNS’s review and approval. The timeline should allow 1 week for FNS to review any materials for website posting.

8. Following award of subgrants, host a virtual post-competition project meeting with FNS and the subgrant awardees. This meeting will provide an opportunity for subgrantees to present an overview of their project plans and concepts to FNS and the Grantee, who will provide feedback during this meeting and through subsequent communications. The Grantee will also use this opportunity to identify opportunities to coordinate and/or share implementation evaluations across subgrant projects, if possible and relevant.

9. In collaboration with subgrantees, evaluate the overall project being funded by USDA and document the impact, however significant, that the overall project has on understanding the relationship between subgrant research implementation and measures related to the identification and improvement of maternal health outcomes. Applications for this USDA RFA should articulate the proposed approach to developing an evaluation plan for subgrant projects. Other measures, including KPIs, shall be included in the evaluation to capture relevant outcomes and process metrics.

10. Fulfill reporting requirements:

a. Subgrantee reporting requirements: The Grantee shall require that each subgrantee submit quarterly progress reports as part of their subgrant requirements. The Grantee shall submit these subgrantee quarterly progress reports to FNS as well. Similarly, the Grantee shall require that each subgrantee submit a final report by the end of the subgrantee’s period of performance, and the Grantee shall also submit the subgrantees’ final report to FNS. Final reports shall describe the subgrant projects; the approach to evaluation, including methodology and any guiding theories or framework; results of the implemented projects; and a discussion of strengths, limitations, lessons learned, and possible next steps in dissemination. Final reports must also include an executive summary.

b. Grantee reporting requirements: The Grantee will submit to FNS quarterly progress reports, annual progress reports, and a final report. The Grantee also must submit Subgrantee reports to FNS.

c. In addition to subgrantee progress and final reports, the Grantee shall submit its own quarterly and final report to FNS. Similar to the requirements for subgrantee reports, the Grantee’s final report shall include an executive summary; a summary of the overall project as well as the subgrant projects funded through this RFA; the approach to evaluation, including methodology and any guiding theories or framework; results of the implemented projects; a discussion of strengths, limitations, lessons learned, and recommendations for future research; and next steps for dissemination of project information, results, and materials to various audiences.

11. Host an informational webinar for potential applicants to coincide with the posting of the subgrantee RFA(s) to help inform potential subgrantee applicants, provide answers to questions, and provide details about available technical assistance. Presentation materials for the informational webinar must be reviewed and approved by FNS. Timeline should include 2 weeks for FNS review.

12. Aid subgrantees in identifying appropriate evidence-based interventions to research and test, given individual applicants’ population needs and implementation context. Technical assistance includes, but is not limited to, providing guidance and technical support and, when needed, consult with FNS.

13. Sponsor and coordinate meetings for subgrantee projects. First, a kick-off and planning orientation meeting at the beginning of the cooperative agreement. Last, a closeout session with subgrantees at the project’s completion.

14. Provide FNS with an electronic copy of all dissemination materials (for example, outreach materials and documents, PowerPoint slides, and demonstration and operational versions of applications) resulting from grant and subgrant activity at the time of submission for publication and in final form when published. FNS will provide comments and approval on documentation at FNS discretion. All materials generated by efforts funded through this cooperative agreement must be reviewed and approved by FNS before general distribution. Information to be published by FNS on the USDA website requires FNS review and clearance.

15. Work collaboratively with the FNS and FNS-sponsored contractors on an as-needed basis to clarify work being accomplished and to participate in any research and evaluation efforts related to WIC and maternal health.

Interim Deliverables Once awarded, the Grantee will provide quarterly progress reports…