USDA WIC Telehealth Innovations Project RFA_FINAL.pdf

WIC Telehealth Innovations Project

USDA WIC Telehealth Innovations Project

Fiscal Year 2019 Request for Applications

Catalog for Federal Domestic Assistance Number (CFDA): 10.528

This project will be awarded as a Cooperative Agreement.

Dates:

Release Date: May 30, 2019

Letter of Intent Due Date: 11:59 PM, Eastern Standard Time (EST), June 25, 2019

Application Due Date: 11:59 PM, Eastern Standard Time (EST), July 29, 2019

Anticipated Award Date: September 19, 2019

Anticipated Project Start Date: September 30, 2019

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0512.

The time required to complete this information collection is estimated to average 45 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

NOTE: Information italicized should be addressed/completed by the Program area.

Information in black should not be changed. If additional information is required it may be added.

IMPORTANT NOTICE

On December 31, 2017, Grants.gov officially retired the legacy .PDF application package as a method to apply for a Federal grant. This changed the way many Grants.gov users completed and submitted their grant applications.

For information on Workspace application process, visit:

https://grants.gov/web/grants/applicants/workspace-overview.html https://communications.grants.gov/app/l/6q3KZ8jGoQl892veDQGyBvbQ/8wUMOSFAzsZ0MK9DNLgLtg/hysv8Unh3EXvtNpco6IwbQ https://communications.grants.gov/app/l/6q3KZ8jGoQl892veDQGyBvbQ/8wUMOSFAzsZ0MK9DNLgLtg/hysv8Unh3EXvtNpco6IwbQ https://grants.gov/web/grants/applicants/workspace-overview.html https://grants.gov/web/grants/applicants/workspace-overview.html

Application Checklist This application checklist provides a list of the required documents; however, FNS expects that applicants will read the entire RFA prior to the submission of their application.

In order to apply, at least four weeks prior to submission, you must have:

Obtained a Dun and Bradstreet Data Universal Numbering System (DUNS) number;

Registered the DUNS number into the System for Award Management (SAM); and, Registered in grants.gov.

When preparing your application, ensure:

Your application format and narrative meet the requirements included in Section IV

“Application and Submission Information,” including page limits, priorities outlined in Section II, and all necessary attachments.

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

All key staff who are paid by this grant.

The percentage of time the project director will devote to the project in full-time equivalents.

Your organization’s fringe benefit amount along with the basis for the computation.

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

Itemized travel expenses (including type of travel), travel justifications and basis for lodging estimates.

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

Information for all contracts, subawards, and justification for any sole-source contracts.

Justification, description and 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, the basis of the indirect costs requested). If none requested, please indicate this in the budget narrative.

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

SF-424 – Application for Federal Assistance (fillable PDF in Grants.gov) SF-424A – Budget Information and Instruction Form (fillable PDF in Grants.gov) SF-424B – Assurances for Non-Construction Programs (fillable PDF in Grants.gov) SF-LLL - Disclosure of Lobbying Activities.

FNS-906 - Grant Program Accounting System & Financial Capability Questionnaire (in

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

When applicable, application packages are required to include the following documents:

AD-3030 – Representations Regarding Felony Conviction and Tax Delinquent Status for

Corporate Applicants (fillable PDF in Grants.gov).

http://www.grants.gov/web/grants/forms.html http://www.grants.gov/web/grants/forms.html https://apply07.grants.gov/apply/forms/sample/SFLLL_1_2-V1.2.pdf

TABLE OF CONTENTS

PAGE

I. PROGRAM DESCRIPTION & OBJECTIVES 5

II. FEDERAL AWARD INFORMATION 11

III. ELIGIBILITY INFORMATION 22

IV. APPLICATION AND SUBMISSION INFORMATION 24

V. APPLICATION REVIEW INFORMATION 33

VI. FEDERAL AWARD ADMINISTRATION INFORMATION 36

VII. FEDERAL AWARDING AGENCY CONTACTS 41

VIII. OTHER INFORMATION 41

ATTACHMENT I: PERIODIC PROGRESS REPORT FORM 47

I. PROGRAM DESCRIPTION & OBJECTIVES

Program Description

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC), is a Federal nutrition assistance program that serves low-income pregnant, postpartum, and breastfeeding women, infants, and children up to five years old who are at nutrition risk. WIC provides nutritious foods, nutrition education including breastfeeding promotion and support, and referrals to health and other social services to participants in all 50 states, 34 Indian Tribal Organizations, American Samoa, the District of Columbia, Guam, the Commonwealth Islands of the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands.

This is an announcement of the availability of funds for one new cooperative agreement for FY 2019-2024 with a public or private academic research institution. In this funding cycle, the USDA anticipates awarding up to $8,500,000 in grant funding to support the implementation and evaluation of telehealth services in WIC. The majority of these funds, $5,000,000, shall be awarded as sub-grants through a competitive process to WIC State Agencies1 for the purpose of implementing telehealth innovations that supplement the nutrition education and breastfeeding support offered in the WIC clinic. The recipient of this cooperative agreement, referred to in this document as the Grantee, will carry out the competitive award process to select sub-grantees, design and conduct evaluations of each sub-grantee’s telehealth innovation project, and produce reports and publications to disseminate the findings.

Legislative Authority

The legislative authority for this grant announcement is contained in the Child Nutrition Act of 1966 Section 17 (g) (5)2 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 USDA food and nutrition assistance programs. Further, Consolidated Appropriations Act, 2019 (Public Law 116-6) specifically authorizes the allocation of $5,000,000 for telehealth competitive grants to supplement the nutrition education and breastfeeding support offered in the WIC clinic, and to decrease barriers to access to WIC services, particularly in rural communities, and other populations facing barriers to accessing support. The Health Resources and Services Administration (HRSA) defines telehealth as “the use of electronic information and telecommunications technologies to support and promote clinical healthcare, patient and professional health-related education, public health and health

1 Since collaboration among local WIC agencies can enhance the delivery of WIC services, it is strongly recommended that State agencies solicit input from local WIC agencies when developing a proposal for a sub-grant project. Local WIC agencies may also work with their State agencies to develop innovative proposal ideas for sub-grant projects. Regardless of the approach, State agencies are responsible to lead all proposals and partnerships. In coordination with their State, local agencies may manage a project within their jurisdiction.

2 http://www.fns.usda.gov/cnd/governance/Legislation/CNA_1966_12-13-10.pdf http://www.fns.usda.gov/cnd/governance/Legislation/CNA_1966_12-13-10.pdf administration.” Technologies include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications3.

Purpose

The purposes of this Request for Applications (RFA) are to:

• Provide background information and context related to the goals of this funding opportunity;

• Describe the type of cooperative agreement available;

• Describe which entities are eligible to apply for grant funds;

• Solicit funding applications from eligible entities;

• Describe the requirements for submitting a successful application;

• Describe how applications will be reviewed and selected; and,

• Describe the terms and conditions to which Grantees must adhere.

This RFA intends to select one accredited college or university to support and evaluate the implementation of telehealth innovations by competitively selected sub-grantees (i.e., WIC State agencies). Sub-grants awarded to State agencies will fund the implementation of relevant telehealth technologies that show promise for effectively supporting WIC nutrition education and breastfeeding support. These efforts shall be designed to improve customer service and address barriers to access while ensuring WIC participant privacy. The Grantee will design and carry out evaluations of the implemented strategies/solutions. Evaluations shall provide a robust assessment of the implementation process, costs, and impacts on WIC participants as well as WIC program offices and staff. Outcome measures may include, but are not limited to, participant satisfaction, infant feeding practices, dietary habits, and participant retention in WIC.

The evaluation results will be summarized in State-level and summary reports.

Background

Established in 1974, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is administered by the Food and Nutrition Service (FNS) of the U.S. Department of Agriculture (USDA). WIC provides nutritious foods, nutrition education, breastfeeding promotion and support, and referrals to health and other social services to participants at no charge. WIC serves low-income pregnant, postpartum and breastfeeding women, infants, and children up to age 5 who are at nutritional risk.4

WIC Participants

3 https://www.healthit.gov/topic/health-it-initiatives/telemedicine-and-telehealth 4 Food and Nutrition Service (2014). “Nutrition Program Facts: WIC – The Special Supplemental Nutrition Program for Women, Infants and Children.” United States Department of Agriculture. http://www.fns.usda.gov/sites/default/files/WIC-Fact-Sheet.pdf, https://www.healthit.gov/topic/health-it-initiatives/telemedicine-and-telehealth http://www.fns.usda.gov/sites/default/files/WIC-Fact-Sheet.pdf

In April 2016, according to the WIC Participant and Program Characteristics Report (WIC PC 2016), 53.3% of WIC participants5 were children (ages 1 to 4), and infants and women accounted for 23.3% and 23.4% of participants, respectively. Women participants were categorized as pregnant (9.1%), postpartum (6.5%), or breastfeeding (7.8%). Most (85%) pregnant women receiving WIC were between 18 and 34 years of age. Among all WIC participants in WIC PC 2016 58.6% were identified as White only, 20.8% as Black or African American only, 10.3% as American Indian or Alaska Native only, and 4.4% as either Asian only or Native Hawaiian or Other Pacific Islander. In 2016, 41.8% of WIC participants were reported as Hispanic/Latino.

Program Services at WIC Locations Ninety WIC State Agencies (SAs) comprising 50 States, 34 Indian Tribal Organizations (ITOs), American Samoa, District of Columbia, Guam, the Commonwealth of the Northern Mariana Islands, Puerto Rico, and the Virgin Islands administer the program through approximately 1,900 local agencies (LAs) and 10,000 clinics.6 Program benefits including nutrition education, breastfeeding promotion and support, and referrals to health care, social services, and other community providers are provided at the numerous LAs and clinics across the country. Almost three quarters of service sites are located in health departments, health clinics or health centers, with fewer located in non-profit organizations (13%), social service agencies (7%) or hospitals (6%).7 Approximately 26 percent of WIC sites are located in rural areas (FNS, unpublished data).

Nutrition Education As part of its mission to improve the health of nutritionally at-risk women, infants, and children, WIC provides nutrition education, including breastfeeding promotion and support, for its participants. Nutrition education is one of the core benefits of the WIC Program. Federal WIC regulations require that nutrition education inform participants about the connection between nutrition and health and assist participants in making positive changes in dietary and physical activity habits. The content of nutrition education must be relevant to the participant’s individual assessed needs, identified nutrition risks, household conditions, food preferences, and should include information on breastfeeding promotion and support and the use of WIC foods as part of a healthy lifestyle. WIC nutrition assessment, including goal-setting, lays the foundation for individualized nutrition education and care plans, referrals and food package tailoring that help

5 Thorn, B., Kline, N., Tadler, C., Budge, E., Wilcox-Cook, E., Michaels, J., Mendelson, M., Patlan, K. L., & Tran, V. (2018). WIC Participant and Program Characteristics 2016. Prepared by Insight and Abt Associates Under Contract No. AG-3198-B-15-0004.

Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service. Project Officer: Dr. Anthony Panzera. Available online at: www.fns.usda.gov/research-and-analysis 6 Food and Nutrition Service, United States Department of Agriculture (no date). “The Special Supplemental Nutrition Program for Women, Infants and Children: About WIC –WIC At A Glance.” Retrieved 5/7/19 from https://www.fns.usda.gov/wic/about-wic-wic-glance.

7 USDA, FNS, Office of Research and Analysis, National Survey of WIC Participants II Volumes I –IV, by Gary Huang, Daniel M. Geller et al., ICF Macro. Project Officers: Karen Castellanos-Brown and Sheku Kamara, FNS, Alexandria, VA: 2012.

Download full reports at: http://www.fns.usda.gov/ora/ .

http://www.fns.usda.gov/ora/ meet the needs of WIC participants and the goals of the WIC program. Two nutrition education contacts must be offered to all adult WIC participants, and to the parents/caretakers of WIC infants and children, during each 6-month WIC certification period, or at a quarterly rate to participants certified for a period in excess of 6 months.

Finding ways to deliver effective nutrition education and achieve the nutrition education goals of WIC are critical for the continued success of the Program and supports the ongoing process of Revitalizing Quality Nutrition Services (RQNS) in WIC. WIC State agencies are responsible for creating a nutrition service plan, which is responsive to the needs of their participants and identifies goals, objectives and resources in the areas of nutrition education and breastfeeding promotion and support. State Agencies coordinate with local agencies in the development of the local agency nutrition services plan and encourage local agencies to share components of their plan with WIC partners, including other public and private organizations. State WIC Programs may vary in the materials and methods they use to provide nutrition education to WIC participants, but all materials must be consistent with the current federal Dietary Guidelines for Americans. Examples of nutrition education methods provided by WIC include individual and group sessions, food demonstrations, videos, take-home activities, and web-based education.

To assist WIC State and local agencies in the design of their nutrition education services, USDA FNS issued research-based guidance on how to provide effective nutrition education contacts/interventions in WIC. The guidance8 identifies six key elements for effective nutrition education in WIC: 1) review of WIC nutrition assessment; 2) selection of appropriate messages;

3) selection of counseling methods/teaching strategies; 4) selection of delivery medium; 5) selection of informational/ environmental reinforcements; and 6) selection of appropriate follow-

up. For effective nutrition education, defined as leading participants towards positive behavior change, to occur, all six elements should be a part of each nutrition intervention with WIC participants.

Over the past few years, interest in and use of telehealth in clinical settings has grown. Many geographic WIC State agencies now offer online nutrition education or texting-based services.

Findings from the WIC Nutrition Education Study9 showed that technology-based nutrition education is more common in urban areas. According to a review of Fiscal Year 2014 WIC State Plans, 65% of State Plans for geographic States had policies including online and internet-based education, whereas only 18% of the ITOs and territories with State Plans submitted included these type of policies. Larger sites and the Southwest region were also found to make greater use of technology-based nutrition education. Offsite technology-based nutrition education (e.g. on-

8 https://wicworks.fns.usda.gov/resources/wic-nutrition-education-guidance 9Cates, S., Capogrossi, K., Eicheldinger, C., et al., RTI International, and Sallack, L., and K. Deehy, Altarum Institute. (2016).

WIC Nutrition Education Study: Phase I Report. Prepared under Contract No. AG-3198-D-12-0082. Project Officer: Karen Castellanos-Brown. Alexandria, VA: USDA, Food and Nutrition Service. Available at: http://www.fns.usda.gov/ops/wic-studies.

10 Uscher-Pines, L., Mehrotra, A., & Bogen, D. L. (2017). The emergence and promise of telelactation. American journal of obstetrics and gynecology, 217(2), 176-178.

https://wicworks.fns.usda.gov/resources/wic-nutrition-education-guidance line) was the type most commonly reported and was typically used as a form of secondary nutrition education or to reinforce nutrition education received at the clinic. Telephone counseling, video conferencing and on-site technology based nutrition education (e.g. kiosk-based) was rarely used. Also, more than half of local agencies reported that less than 10% of the participants they serve receive technology-based nutrition education. However, rigorous and sufficiently powered evaluations to estimate the impact of these practices on outcomes of interest are lacking.

Telehealth Services in WIC There is a developing, but limited, evidence base documenting the benefits and challenges associated with telehealth in the WIC population. Studies of telehealth services for breastfeeding support find that some participants find it more convenient and comfortable to receive breastfeeding support from the comfort of their own homes10,11. Additionally, these services allow mothers to receive timely assistance (within minutes or hours) rather than having to wait for an appointment. This timely support can make the difference for a mother choosing whether or not to continue breastfeeding. One study suggested that virtual support may be more effective because it allows mothers to gain the confidence to independently problem-solve13.

Some studies found cost savings associated with telehealth services relative to in-person services, potentially allowing more mothers to be served more frequently with the same resources10,12,13. Similarly, nutrition education offered online or through video conferencing provides another option for participants that may face challenges getting to the WIC clinic.

Despite the growing interest in and availability of telehealth technologies, there remain a number of challenges associated with its implementation. A critical challenge is lack of internet connectivity, which can be a particular problem in rural areas. Issues related to establishing secure and private internet connections also pose confidentially risks to WIC participants. The use of internet-based services also poses risks to the confidentiality of participants’ identity and personal information.

Summary

10 Uscher-Pines, L., Mehrotra, A., & Bogen, D. L. (2017). The emergence and promise of telelactation. American journal of obstetrics and gynecology, 217(2), 176-178.

11 California WIC Association. (2018). TeleWIC: Keeping Up with the Times. Retrieved March 25, 2019 from http://www.calwic.org/storage/documents/reports/2018/WIC_VideoConferencing_Brief_fnl_pages.pdf 12 Langabeer, J. R., Champagne-Langabeer, T., Alqusairi, D., Kim, J., Jackson, A., Persse, D., & Gonzalez, M. (2017). Cost– benefit analysis of telehealth in pre-hospital care. Journal of Telemedicine and Telecare, 23(8), 747-751.

13 Levin, K., Madsen, J. R., Petersen, I., Wanscher, C. E., & Hangaard, J. (2013). Telemedicine diabetes consultations are cost-effective, and effects on essential diabetes treatment parameters are similar to conventional treatment: 7-year results from the Svendborg Telemedicine Diabetes Project. Journal of Diabetes Science and Technology, 7(3), 588-595.

http://www.calwic.org/storage/documents/reports/2018/WIC_VideoConferencing_Brief_fnl_pages.pdf

While there is limited evidence to establish the benefits of telehealth services for breastfeeding and nutrition education, the interventions tested thus far demonstrate the potential of these approaches. Current research on WIC telehealth interventions suggests they have the potential to positively impact participant satisfaction14,15, knowledge attainment16,17, and adoption of healthy behaviors by WIC participants16, 17,18,19,20, but this evidence is limited and many questions remain. Further research on telehealth interventions for the WIC population would serve to provide the WIC program with better evidence for informed recommendations. For example, adequately powered randomized controlled trials or other rigorous study designs are needed to determine the effectiveness of telehealth services for nutrition education, including breastfeeding support, and the impact of their use on dietary habits, infant feeing practices, including breastfeeding rates, participant satisfaction and retention, and addressing identified nutrition risks. Rigorous studies investigating the effectiveness of telehealth technologies in addressing barriers to accessing nutrition education that meets the needs of WIC participants in rural areas or other communities are also needed. This Cooperative Agreement provides an opportunity to address these evidence gaps while supporting broader implementation of innovative approaches to meet the needs of WIC participants.

Key Objectives The present solicitation supports the WIC Program through building the evidence base for the effective use of telehealth in supplementing WIC services related to nutrition education and breastfeeding support and addressing barriers to participant access of these services.

Below is a list of the Program objectives, to which proposed activities should be clearly aligned in the Activities/Indicators Tracker under Section II:

# Objectives

1. To competitively select State Agencies to implement promising and well-designed telehealth innovations that supplement the WIC nutrition education including

14 Au L. E., Whaley, S. E., Gurzo, K., Meza, M., & Ritchie, L. D. (2016). If you build it they will come: Satisfaction of WIC participants with online and traditional in-person nutrition education. Journal of Nutrition Education and Behavior, 48, 336-342.

15 Unpublished Report. (2017). FY 2014 Arizona WIC SPG Final Report.

16 Au, L. E., Whaley, S. E., Gurzo, K., Meza, M., & Rosen, N. J., & Ritchie, L. D. (2017). Evaluation of online and in-person nutrition education related to salt knowledge and behaviors among Special Supplemental Nutrition Program for Women, Infants, and Children Participants. Journal of the Academy of Nutrition and Dietetics, 117(9), 1384-1395.

17 Au, L. E., Whaley, S., Rosen, N. J., Meza, M., & Ritchie, L. D. (2016). Online and in-person nutrition education improves breakfast knowledge, attitudes, and behaviors: A randomized trial of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children. Journal of the Academy of Nutrition and Dietetics, 116(3), 490-500.

18 Bensley, R., Anderson, J., Brusk, J., Mercer, N., & Rivas J. (2011). Impact of Internet vs traditional Special Supplemental Nutrition Program for Women, Infants, and Children nutrition education on fruit and vegetable intake. Journal of the American Dietetic Association, 111, 749-755.

19 Gilmore, L. A., Klempel, M. C., Martin, C. K., Myers, C. A., Burton, J. H., Sutton, E. F., & Redman, L. M. (2017).

Personalized mobile health intervention for health and weight loss in postpartum women receiving women, infants, and children benefit: A randomized controlled pilot study. Journal of Women's Health, 26(7), 719-727.

20 Martinez-Brockman, J. L., Harari, N., & Perez-Escamilla, R. (2017). Lactation Advice Through Texting Can Help (LATCH):

An Analysis of Intensity of Engagement via Two-Way Text Messaging. The FASEB Journal, 31(1_supplement), 650-618.

breastfeeding support offered in the WIC clinic, while decreasing barriers to access among WIC participants.

Develop an award competition (RFP) with clear selection criteria Disseminate and promote award opportunity, offering guidance to potential applicants Evaluate the applications received and recommend selections Fund the WIC State Agencies selected

2. To rigorously evaluate the interventions implemented by sub-grantees, including a process evaluation and cost estimate.

Develop a basic research model to evaluate telehealth innovations Support the sub-grantee in implementing their intervention in line with the study design Secure IRB approvals Develop or identify validated instruments and other methods of data collection Track the implementation process of telehealth innovation by each State Agency sub-grantee, including use of resources and associated costs Carry out data collection to inform evaluation Analyze data collected

3. To disseminate findings to inform the WIC Program at the Federal, State, and local level, and contribute to the evidence base related to telehealth.

Produce State-specific reports Produce a Final report that includes all study instruments Produce publications and conduct presentations

4. To coordinate meetings that provide meaningful opportunities for information-sharing and project coordination.

Conduct an orientation meeting (in person with FNS) Conduct a closeout meeting (in person with FNS) Lead a Post-Award meeting (webinar with sub-grantees) Lead a Post-Implementation meeting (webinar with sub-grantees) Conduct other convening’s as proposed

II. FEDERAL AWARD INFORMATION

Funding

The grant is a one-time funding opportunity that will be awarded on a competitive basis, subject to the availability of federal funds. Approximately $8.5 million is available for funding this opportunity, $5 million of which shall be awarded through a competitive, sub-grant process to WIC State agencies. The sub-grant funds (not to exceed $5 million) can be used to support a variety of telehealth interventions, including but not limited to the use of telehealth tools provided by WIC staff as well as clinical services and technologies provided by third-party vendors. FNS will accept one application package per applicant. The Grantee will be responsible for utilizing their awarded amount (1) to carry out a competition to award sub-grants to WIC

State agencies to use telehealth technologies to supplement the nutrition education and breastfeeding support offered in the WIC clinic, and to decrease barriers to access to WIC services, particularly in rural communities, (2) to evaluate the interventions, and (3) disseminate findings. This grant award is contingent upon the availability of Federal funding.

Cooperative Agreement

This grant will be awarded in the form of 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 the project.

Purpose of Cooperative Agreement

1) The Grantee (Recipient) shall work cooperatively with FNS to: Develop and manage a competitive sub-grant award process to WIC State agencies (SAs) to design and implement telehealth innovations expected to supplement the nutrition education and breastfeeding support offered in the WIC clinic. The goal of these sub-grants is to decrease barriers to accessing WIC services, particularly in rural communities. The Grantee shall propose and justify a specific focus for the sub-grants that fits within the scope described in Priority Areas. While FNS anticipates at least 5 sub-grants to WIC State agencies of approximately $1,000,000 each, applicants shall propose the target number and scale of sub-grants. The Grantee will award, monitor, and evaluate the sub-grantee’s intervention with the cooperation of the sub-grantee.

a) The Grantee will develop and execute a competitive Request for Proposals (RFP) process. The RFP will describe the opportunity, explain eligibility for the sub-grants, and establish evaluation criteria for the award. The Applicant to this RFA shall describe and justify their approach for managing the competitive RFP sub-grant award process they plan to administer, their evaluation criteria to evaluate and rank SA proposals, their plans for promoting the opportunity among SAs, and their plans for managing and collaborating with sub-grantees upon award.

The Applicant to this RFA shall ensure the competitive sub-grant RFP clearly articulates eligibility criteria. To be eligible for a sub-grant, applicants must be a WIC State agency.

Since collaboration among local WIC agencies can enhance the delivery of WIC services, it is strongly recommended that State agencies solicit input from local WIC agencies when developing a proposal for a sub-grant project. Local WIC agencies may also work with their State agencies to develop innovative proposal ideas for sub-grant projects.

Regardless of the approach, State agencies are responsible to lead all proposals and partnerships. In coordination with their State, local agencies may manage a project within their jurisdiction.

At a minimum, each sub-grantee (WIC State agency) must use the funds to (1) implement an existing telehealth intervention that supplements the nutrition education and/or breastfeeding support offered in the WIC clinic and decreases barriers to access to WIC nutrition education or breastfeeding support for participants; OR design and implement a telehealth tool that supplements and is within the scope of the nutrition education and/or breastfeeding support offered in the WIC clinic and decreases barriers to access to WIC nutrition education or breastfeeding support for participants. (The qualified professionals offering support through the telehealth tool may be WIC staff); and (2) cooperate with the Grantee to support the evaluation of the intervention’s effectiveness. State and regional diversity should be considered when evaluating and ranking sub-grantee State agencies to ensure that sub-grant activities serve diverse participant populations, particularly those in rural communities and other areas where access is a barrier. Additionally, special consideration shall be made for proposals to use open source software and technology, and/or develop systems that can be easily tailored and adopted by other State agencies at little or no cost.

b) The RFP shall require that, at a minimum, proposals include the following:

A concise description of the telehealth innovation to be implemented or developed and how it fits into the project’s overall objectives as presented to FNS; A description of the populations served by the sub-grantee applicant, including how the proposed intervention addresses barriers to access and reflects the social and cultural environment relevant to the populations served;

A description of how the tool will facilitate the ability of WIC staff to increase access to nutrition education and breastfeeding support for WIC participants.

A description of how the solution will be used to deliver only allowable WIC services by qualified professionals;

A description regarding the sustainability of the innovation beyond the grant period, should the effort be successful;

Documentation of procedures and protocols used to ensure the privacy and safety of WIC participants when interacting via the proposed technology e.g., a secure platform that meets federal and state HIPAA requirements and Federal WIC requirements;

A description articulating whether the sub-grantee is able to implement the intervention in a randomized fashion or with comparison and treatment groups;

A commitment to providing the Grantee with the data needed to evaluate the intervention as implemented, and supporting the Grantee in data collection efforts;

Documentation of procedures used to maintain the quality and integrity of all data and analyses; and, Demonstrated compliance with Federal Program Regulations for all proposed strategies/solutions.21

c) The Grantee will submit to FNS summaries of all proposals submitted by those applying for sub-grants and discuss the top proposals with FNS. At a minimum, the summaries shall include the name of each State agency and their point-of-contact for the project, award amount, a brief description of the proposed intervention and timeline, a scoring synopsis, and recommendations for selection. FNS will make final selection decisions for the sub-grants.

d) After sub-grantees are selected, the Grantee will submit updated summaries of selected sub-grantee projects for publication on FNS’s website and host a web-based Post-Competition Project Meeting. The Grantee will coordinate a web-based Post- Competition Meeting whereby the sub-grantees present the projects they will implement.

FNS will provide feedback during this meeting and through subsequent communications.

2) Evaluate the sub-grantee interventions. The Grantee will execute a rigorous evaluation of implemented strategies/solutions that documents impact on relevant outcomes (e.g. dietary and feeding behaviors, breastfeeding outcomes, etc.) as well as participant retention and satisfaction. Other measures shall be included in the evaluation to capture relevant proximal outcomes and process metrics; all included process variables and outcomes must be clearly specified to support standard measures. The Grantee will conduct a thorough process evaluation to describe how the intervention was implemented, including measures of reach, dose (if applicable), ease of use, and satisfaction. The process evaluation will also document the resources associated with implementation, cost-efficiency, challenges encountered and how they were addressed, and whether the intervention was implemented as intended and in accordance with WIC program guidance. Estimates of the cost to sustain the intervention beyond the grant period shall also be developed.

a) Work collaboratively with sub-grantee recipients to support implementing the intervention in a way that supports rigorous evaluation. The Grantee shall submit an evaluation plan to FNS for review and approval that details the evaluation design, data collection methods, and analytical approach for each intervention within three months of awarding sub-grants. The evaluation plan will outline the study design, key outcome measures with operational definitions clearly stated, and a timeline outlining specific implementation and evaluation milestones.

b) Secure institutional review board (IRB) approval as needed to carry out evaluation-related data collection activities.

21 https://www.fns.usda.gov/sites/default/files/wic/WICRegulations-7CFR246.pdf

c) Use (or develop) validated instruments and sound methodological and statistical methods to conduct the evaluation. Where possible, standard measures shall be used across interventions.

d) Provide sub-grantees with technical assistance, as needed, for evaluation-related activities they must carry out, and provide sub-grantees with evaluation results to inform practices and reporting.

3) Disseminate findings broadly among the WIC research (academic) and WIC practitioner communities. At a minimum, FNS requires submission of the following reports: annual reports; quarterly progress reports using FNS 906: PERIODIC PROGRESS REPORT FORM (see Attachment 1); subgrantee-specific final reports; a final summary report to be publicly released in coordination with FNS; and at least one submission to a peer-reviewed journal. The State-specific reports will provide a plain language account of the implemented innovation, the facilitators and barriers to its implementation, evaluation results, and any recommendations for sustained implementation and/or adoption by other State Agencies. The final summary report shall describe the supported sub-grantee projects, the approach to evaluation including methodology and any guiding theories or frameworks, results of the implemented evaluation, and a discussion of strengths, limitations, and possible next steps in research and dissemination. This report will include an executive summary. In addition, the Grantee shall plan to present research findings at academic and professional conferences and the Grantee shall plan to participate in committees, working groups, communities, and forums where WIC participant research and maternal, child, infant, and family health services are discussed.

a) For internal use and informational purposes, the Grantee shall provide FNS with an electronic copy of all manuscripts and other dissemination materials (for example, outreach materials and documents, Power point slides, demonstration and operational versions of applications) resulting from this grant and sub-grant activity at the time of submission for publication and in final form when published.

b) FNS requires the Grantee to host periodic meetings with sub-grantees to discuss any issues related to project implementation and evaluation, especially issues related to data collection. FNS also requires the Grantee to host web-based Roundtable Sessions to convene periodic discussions with other researchers on the topic of innovations in WIC-related telehealth, especially among other State and local WIC agencies and with other programs that also serve low-income women, infant, and child populations.

c) The Grantee will host a web-based Post-Implementation Project Meeting whereby the Grantee and its sub-grantees will present on their projects and summarize initial findings from their work.

d) All reports and manuscripts generated by efforts funded through this Cooperative Agreement must be reviewed by FNS before general distribution or submission to peer review for publication in scientific journals. Reports to be published by FNS on the USDA webpage require FNS review and clearance. Manuscripts that include the

FNS point-of-contact as a co-author (where appropriate based on authorship guidelines) must be reviewed and cleared by FNS before submission to peer-review for scientific journals.

4) Sponsor and coordinate meetings with FNS:

Two in-person meetings will take place at FNS headquarters in Alexandria, VA: An Orientation meeting at the beginning of the cooperative agreement period and a Closeout session at the project’s completion.

a) The Orientation Meeting shall be held within 45 days after award. Personnel will present information on the chosen focus area for the competitive RFP process and possible intervention strategies with FNS. The Grantee will also present an updated administration plan for the competitive RFP process. FNS staff will provide input during the presentation and subsequently on any materials generated for the meeting via email.

Additionally, potential evaluation strategies will be presented.

b) The Closeout Session shall be held toward the end of the grant period and will include presentations of project findings, successes achieved through grant-funded efforts, problems encountered with implementation, and other lessons learned from completing this project. Grantee researchers will provide FNS the presentations (e.g., PowerPoint slideshows) after the conference. Any required administrative grant closeout procedures, if needed, may be completed at this time. The Final Financial report and Final Progress report will be due 90 days after the grants period of performance end date.

Two additional meetings, hosted by the Grantee, will provide opportunities for the selected sub-grantees to share information with FNS:

c) The Post-Competition Project Meeting shall be held within 90 days of awarding the sub-grants. This meeting will provide an opportunity for sub-grantees to share their project plans with other sub-grantees and FNS, and receive feedback before implementation.

d) The Post-Implementation Project Meeting shall be held 3-6 months prior to the end of sub-grant period and will provide an opportunity for sub-grantees to share their experiences with implementing their intervention along with preliminary lessons learned.

PROCUREMENT STANDARDS

The recipient will adhere to all procurement standards, including those listed below, if applicable, as found in 2 CFR 200.318 through 2 CFR 200.326. When procuring property and services under a Federal award, a State must follow the same policies and procedures used for procurements from its non-Federal funds. State recipients will comply with 2 CFR 200.322.

1) Sub-recipient compliance: The Recipient (Selected Applicant) will ensure that sub-recipients are in compliance with applicable Federal administrative requirements and cost principles. No funds shall be provided to an eligible collaborator or contractor before such an agreement is signed by all parties.

2) Competition: All procurement transactions must be conducted in a manner providing full and open competition consistent with 2 CFR 200.319.

3) Suspension/Debarment: The Recipient agrees to ensure that all sub-recipients are neither excluded nor disqualified under the Suspension and Debarment rules found at 2 CFR Parts 180 and 417 by doing any one of the following:

a. Checking the System for Awards Management (SAM) to determine if the applicant or grantee has been debarred or suspended. This information can be found at www.sam.gov.

b. Collecting a certification that the entity is neither excluded nor disqualified. Because a Federal certification form is no longer available, the Grantee or sub-Grantee electing this must devise its own.

c. Including a clause to this effect in the sub-recipient agreement and in any procurement contract expected to equal or exceed $25,000, awarded by the Recipient or a sub-recipient within any agreements.

4) USDA/FNS acknowledgement: Unless otherwise advised by the Agency, the Recipient will acknowledge the support of USDA FNS whenever publicizing the work under this grant. To this end, the Grantee must include in any publication resulting from work performed under this grant an acknowledgment in substantially the form set below:

“This project has been funded at least in part with Federal funds from the U.S. Department of Agriculture. The contents of this publication do not necessarily reflect the view or policies of the U.S. Department of Agriculture, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.”

Priority Areas

FNS is particularly interested in telehealth innovations including replicable interactive tools, technical, or other practical solutions that provide effective breastfeeding counseling and/or nutrition education to WIC participants. FNS expects the sub-grants to fund a variety of telehealth interventions, including interventions that would address common barriers found in rural settings. At least one sub-grant shall be awarded in each of the two priority areas. The two priorities for sub-grantee projects are to:

• Implement an existing telehealth solution to ensure timely access to nutritional or breastfeeding support for WIC participants by qualified professionals. Qualified professionals include registered dietitians (RD) and/or breastfeeding experts (i.e. IBCLC) who meet State staffing requirements and can provide expertise in complex nutrition and breastfeeding topics that are in accordance with WIC guidance and within program scope. Contacts made through this solution should integrate with and supplement (not duplicate) WIC services by addressing challenges identified through the participants’ nutrition and/or breastfeeding assessment (e.g. high-risk) or barriers to access.

• Develop an online (mobile-friendly) resource or tool to provide nutritional or breastfeeding support to WIC participants that is within the scope of the nutrition education and/or breastfeeding support offered in the WIC clinic. The support is provided by qualified professionals, including registered dietitians (RD) and/or breastfeeding experts (i.e. IBCLC) who meet State staffing requirements and can provide expertise in complex nutrition and breastfeeding topics that are in accordance with WIC guidance and within program scope. The qualified professionals providing support may be WIC staff.

Contacts made through the resource or tool integrate with and supplement (not duplicate) WIC services by addressing challenges identified through the participants’ nutrition and/or breastfeeding assessment (e.g. high-risk) or barriers to access. The resource or tool may: 1) Provide nutrition education content relevant to identified nutrition risk(s) and common participant concerns; 2) Incorporate evidence-based strategies to maximize participant engagement or impact on participant nutrition behaviors; 3) Reflect evidence-based best practices for the delivery and reinforcement of nutrition messages; and 4) Provide features to enable WIC staff to analyze assessments and monitor use of the tool and its impact on participant dietary habits and/or health to support continual improvement.

Examples of approaches that may be explored include but are not limited to:

• Platforms that use referrals and assessments from a WIC Competent Professional Authority to connect participants with appropriate follow-up counseling on complex nutrition and/or breastfeeding problems with qualified professionals. Any counseling contacts would be well documented, and information would be provided timely to WIC staff to enable follow-up.

• Development and implementation of a tool to supplement services provided by WIC staff with tailored, up-to-date, and effective counseling to WIC participants that is within the scope of the nutrition education and/or breastfeeding support offered in the WIC clinic. Features may include nutrition information on common topics of interest, suggested prompts, talking points, or take-away messages to facilitate productive and meaningful discussions with participants, and strategies that improve the ability of WIC staff to engage participants and reflect participant-centered nutrition education practices, including goal setting. The tool may also facilitate tailoring information to the nutritional and/or breastfeeding needs of participant, care plan development, and appropriate follow-up.

Award Period and Project Timeline

FNS plans to announce the selected Grantee by September 30, 2019 and enter into the Cooperative Agreement with the Grantee by September 30, 2019. The Grantee will be allowed to use the funds consistent with its application plans. The period of performance for this Cooperative Agreement is four years and nine months with an end date no later than June 30, 2024.

Program Specific Requirements

Applicants must demonstrate the following program specific requirements in their proposals:

1. Experience with and/or capacity for designing, implementing, and coordinating a competitive RFP process that solicits proposals from WIC State agencies. All applications must clearly articulate an administration plan for awarding competitive sub-grants to WIC State agencies;

2. Experience conducting high-quality evaluations in partnership with WIC or similar public health agencies, as evidenced by reports, publications, and/or other materials (while an evaluation plan is not required in the proposal to this RFA, the Grantee will be required to submit a formal evaluation plan to FNS once competitive sub-grants are awarded);

3. Knowledge about telehealth technologies and their effective use in public health or related venues, including familiarity with currently available telehealth tools and the evidence base on their effectiveness;

4. Experience with and/or capacity for providing high-quality, evaluation-based technical assistance to WIC and other public health agencies and to community practitioners;

5. A dissemination plan that presents broad dissemination strategies as well as projects that clearly stipulate how products of research could be used with SA partners across geographies;

6. Description of the expected set of final deliverables that will be submitted and/or published by the Grantee during and at the end of the Cooperative Agreement. All reports or products generated by efforts funded through this Cooperative Agreement are subject to review by FNS before publication. This includes review of manuscripts (with inclusion of the FNS point-of-contact as a co-author where appropriate based on authorship guidelines) before submission to peer-review for scientific journals, communications materials meant for general and WIC audiences about the research, and other items;

7. All applications must address how the findings will be disseminated to stakeholders (policy officials, state and local…