v2.MODIFIED 4.5.23_FORHP HRSA-23-041 RCORP-CABH.FINAL.pdf

U.S. Department of Health and Human Services

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2023

Federal Office of Rural Health Policy

Rural Strategic Initiatives Division

Rural Communities Opioid Response Program – Child and Adolescent Behavioral Health

Funding Opportunity Number: HRSA-23-041

Funding Opportunity Type: New

Assistance Listings Number: 93.912

Application Due Date: May 24, 2023 MODIFIED on April 5, 2023:

Revision: Extended the Application Due Date.

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

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems may take up to 1 month to complete.

Issuance Date: March 22, 2023

Molly Wirick Program Coordinator, Rural Strategic Initiatives Division Email: mwirick@hrsa.gov

See Section VII for a complete list of agency contacts.

Authority: 42 U.S.C. 912(b)(5) (§ 711(b)(5) of the Social Security Act) https://nih-my.sharepoint.com/personal/sodonnell_hrsa_gov/Documents/FY23%20Children%20and%20Adolescent/mwirick@hrsa.gov

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508 COMPLIANCE DISCLAIMER

Note: Persons using assistive technology may not be able to fully access information in this file. For assistance, email or call one of the HRSA staff listed in Section VII. Agency Contacts.

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2023 Rural Communities Opioid Response Program-Child and Adolescent Behavioral Health (RCORP-CABH). The purpose of this program is to establish and expand sustainable behavioral health care services for children and adolescents aged 5-17 years who live in rural communities.

Funding Opportunity Title: Rural Communities Opioid Response Program – Child and Adolescent Behavioral Health

Funding Opportunity Number: HRSA-23-041

Due Date for Applications: May 24, 2023

Anticipated FY 2023 Total Available Funding:

$9,000,000

Estimated Number and Type of Award(s): Up to nine grants

Estimated Annual Award Amount: Up to $1,000,000 per award

Cost Sharing/Match Required: No

Period of Performance: September 1, 2023 through August 31, 2027 (4 years)

Eligible Applicants: Eligible applicants include all domestic public or private, non-profit, and for-profit, entities.

Tribes and tribal organizations are eligible.

See Section III.1 of this notice of funding opportunity (NOFO) for complete eligibility information.

http://www.hrsa.gov/

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Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in this NOFO and in HRSA’s SF-424 Application Guide. Visit HRSA’s How to Prepare Your Application page for more information.

Technical Assistance

HRSA has scheduled the following webinar:

Tuesday, April 4, 2023 2 – 3:30 p.m. ET Weblink: https://hrsa-gov.zoomgov.com/j/1614316685?pwd=MG52Y1ZvaWZ0Wk9KNkhTazFDSkdOUT0

Attendees without computer access or computer audio can use the dial-in information below.

Call-In Number: 1-833-568-8864 Meeting ID: 161 431 6685 Passcode: 42515175

HRSA will record the webinar. For a recording of the webinar, please email ruralopioidresponse@hrsa.gov.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf https://www.hrsa.gov/grants/apply-for-a-grant/prepare-your-application https://hrsa-gov.zoomgov.com/j/1614316685?pwd=MG52Y1ZvaWZ0Wk9KNkhTazFDSkdOUT09 https://hrsa-gov.zoomgov.com/j/1614316685?pwd=MG52Y1ZvaWZ0Wk9KNkhTazFDSkdOUT09 https://hrsa-gov.zoomgov.com/j/1614316685?pwd=MG52Y1ZvaWZ0Wk9KNkhTazFDSkdOUT09

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Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Narrative

v. Attachments

3. UNIQUE ENTITY IDENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM)

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: NOFO APPLICANT PAGE LIMIT WORKSHEET

APPENDIX B: EXAMPLES OF POTENTIAL CONSORTIUM MEMBERS

APPENDIX C: SAMPLE PERFORMANCE MEASURES

APPENDIX D: RESOURCES FOR APPLICANTS

APPENDIX E: RURAL COMMUNITIES OPIOID RESPONSE PROGRAM (RCORP) AND

THE NATIONAL HEALTH SERVICE CORPS (NHSC)

APPENDIX F: THIRD-PARTY PAYER GUIDANCE

APPENDIX G: ADDITIONAL RELATED HRSA PROGRAMS

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I. Program Funding Opportunity Description

1. Purpose

The Rural Communities Opioid Response Program (RCORP) is a multi-year Health Resources and Services Administration (HRSA) initiative aimed at reducing the morbidity and mortality of substance use disorder (SUD), including opioid use disorder (OUD), in high-risk rural communities. This notice announces the opportunity to apply for funding under the RCORP-Child and Adolescent Behavioral Health (RCORP-CABH) program.

The purpose of RCORP-CABH is to establish and expand sustainable behavioral health care services for children and adolescents aged 5-17 years who live in rural communities, and to prevent substance misuse. For the purposes of RCORP-CABH, “behavioral health” encompasses services to address both mental health and substance use disorders. Over the four-year period of performance, award recipients will use RCORP-CABH funding to achieve the following three program goals through a consortium-based approach1:

Goal 1: Service Delivery. Establish new behavioral health prevention, treatment, and recovery services for children and adolescents aged 5-17 years in the target rural service area.

Goal 2: Training and Peer Mentorship. Improve the capacity of rural health care providers, paraprofessionals, non-clinical staff, and community members to care for and support children and adolescents aged 5-17 with behavioral health needs, through providing training and peer mentorship opportunities.

Goal 3: Community Partnerships. Build community partnerships to ensure that children and adolescents, and their families, have access to community resources and human services that support prevention of, treatment of, and recovery from behavioral health disorders.

As a result of these goals, HRSA expects that an increased number of children and adolescents aged 5-17 will receive evidence-based, coordinated behavioral health care and supportive services. Additionally, HRSA expects that all activities implemented under RCORP-CABH will be sustainable by the end of the four-year period of performance.

The target population for RCORP-CABH is:

• Children and adolescents ages 5-17 in HRSA-designated rural counties and rural census tracts who are at risk for, have, or are recovering from a behavioral health disorder;

1 See Program Requirements and Expectations for additional information on consortium requirements.

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• The families and caretakers of children and adolescents ages 5-17 in HRSA-designated rural counties and rural census tracts who are at risk for, have, or are recovering from a behavioral health disorder.

HRSA encourages you to include populations that have historically suffered from poorer health outcomes, health disparities, and other inequities as compared to the rest of the population. Examples of these populations include, but are not limited to racial and ethnic minorities, LGBTQ+ individuals, socioeconomically disadvantaged populations, new immigrants, people who are homeless, and individuals with disabilities.

Additionally, HRSA expects applicants to ensure that all activities supported by RCORP-CABH are culturally and linguistically appropriate for the target rural population that will be served.

For more details, see Program Requirements and Expectations.

2. Background

RCORP-CABH is authorized by 42 U.S.C. 912(b)(5) (§ 711(b)(5) of the Social Security Act). This program supports the President’s National Mental Health Strategy, the U.S.

Surgeon General’s Advisory on Protecting Youth Mental Health, and the U.S.

Department of Health and Human Services (HHS) Overdose Prevention Strategy. Each of these strategic documents points to the importance of addressing the growing behavioral health challenge in the U.S., particularly among children and adolescents.

According to the 2019-2020 National Survey of Children’s Health, 22.6 percent of children aged 3-17 have experienced a mental, emotional, developmental, or behavioral health problem.2 Moreover, in 2020, 546 adolescents aged 12-17 died of a drug overdose – nearly double the number of deaths in 2019.3 Private insurance claims for adolescent substance use disorders and overdoses increased almost 120 percent in April 2020 compared to April 2019.4 Concerningly, research shows that when substance use begins at younger ages, it is more likely to persist into adulthood and increase the risk of addiction.5 6

Mental disorders significantly increase the risk of developing a substance use disorder, and half of all mental disorders start by the age of 14.7 8 From 2009 to 2019, the proportion of high school students reporting persistent feelings of sadness or

2 https://www.childhealthdata.org/browse/survey/results?q=8556&r=1 3 https://www.kff.org/coronavirus-covid-19/issue-brief/recent-trends-in-mental-health-and-substance-use-concerns-among-adolescents/ 4 https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/The%20Impact%20of%20COVID- 19%20on%20Pediatric%20Mental%20Health%20-%20A%20Study%20of%20Private%20Healthcare%20Claims%20- %20A%20FAIR%20Health%20White%20Paper.pdf 5 https://www.cdc.gov/ncbddd/fasd/features/teen-substance-use.html 6 https://scholar.google.com/scholar_url?url=https://jamanetwork.com/journals/jamanetworkopen/articlepdf/ 2790601/mccabe_2022_oi_220178_1648050784.8522.pdf&hl=en&sa=T&oi=ucasa&ct=ufr&ei=ACSOY8i6CY_mmgH J8LmQCg&scisig=AAGBfm3IynwXtkmO2U8sRUh-ZcC5dHoeGA 7 https://pubmed.ncbi.nlm.nih.gov/27015718/ 8 https://pubmed.ncbi.nlm.nih.gov/32226481/ https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/ https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf https://www.hhs.gov/overdose-prevention/ https://www.hhs.gov/overdose-prevention/ https://www.childhealthdata.org/browse/survey/results?q=8556&r=1 https://www.kff.org/coronavirus-covid-19/issue-brief/recent-trends-in-mental-health-and-substance-use-concerns-among-adolescents/ https://www.kff.org/coronavirus-covid-19/issue-brief/recent-trends-in-mental-health-and-substance-use-concerns-among-adolescents/ https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/The%20Impact%20of%20COVID-19%20on%20Pediatric%20Mental%20Health%20-%20A%20Study%20of%20Private%20Healthcare%20Claims%20-%20A%20FAIR%20Health%20White%20Paper.pdf https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/The%20Impact%20of%20COVID-19%20on%20Pediatric%20Mental%20Health%20-%20A%20Study%20of%20Private%20Healthcare%20Claims%20-%20A%20FAIR%20Health%20White%20Paper.pdf https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/The%20Impact%20of%20COVID-19%20on%20Pediatric%20Mental%20Health%20-%20A%20Study%20of%20Private%20Healthcare%20Claims%20-%20A%20FAIR%20Health%20White%20Paper.pdf https://www.cdc.gov/ncbddd/fasd/features/teen-substance-use.html https://scholar.google.com/scholar_url?url=https://jamanetwork.com/journals/jamanetworkopen/articlepdf/%202790601/mccabe_2022_oi_220178_1648050784.8522.pdf&hl=en&sa=T&oi=ucasa&ct=ufr&ei=ACSOY8i6CY_mmgHJ8LmQCg&scisig=AAGBfm3IynwXtkmO2U8sRUh-ZcC5dHoeGA https://scholar.google.com/scholar_url?url=https://jamanetwork.com/journals/jamanetworkopen/articlepdf/%202790601/mccabe_2022_oi_220178_1648050784.8522.pdf&hl=en&sa=T&oi=ucasa&ct=ufr&ei=ACSOY8i6CY_mmgHJ8LmQCg&scisig=AAGBfm3IynwXtkmO2U8sRUh-ZcC5dHoeGA https://scholar.google.com/scholar_url?url=https://jamanetwork.com/journals/jamanetworkopen/articlepdf/%202790601/mccabe_2022_oi_220178_1648050784.8522.pdf&hl=en&sa=T&oi=ucasa&ct=ufr&ei=ACSOY8i6CY_mmgHJ8LmQCg&scisig=AAGBfm3IynwXtkmO2U8sRUh-ZcC5dHoeGA https://pubmed.ncbi.nlm.nih.gov/27015718/ https://pubmed.ncbi.nlm.nih.gov/32226481/

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hopelessness increased by 40 percent; the share seriously considering attempting suicide increased by 36 percent; and the share creating a suicide plan increased by 44 percent.9 Moreover, in October 2020, 31 percent of parents said their child’s mental or emotional health was worse than before the COVID-19 pandemic.10 Early intervention in mental health is key to provide the greatest chance of positive patient outcomes.11

Moreover, the U.S. Surgeon General’s Advisory on Protecting Youth Mental Health identifies youth in rural areas as a group “at higher risk of mental health challenges during the pandemic.” Additionally, compared to their urban counterparts, rural children are more likely to experience a total of four or more adverse childhood experiences (ACEs), increasing their risk of substance use disorder.12 Individuals with over 5 ACEs are 7 to 10 times more likely to report illicit drug addiction compared to those without ACEs and are 4 to 12 times more likely to misuse drugs.13

Compounding these challenges for rural children and adolescents, behavioral health services in rural areas can be harder to access. While about 64 percent of all U.S.

counties had at least one mental health facility serving young people, only about 30 percent of highly rural counties had such facilities.14 More than 60 percent of Mental Health Professional Shortage Areas (HPSA) in the U.S. are located in rural areas, representing over 36 million people - including children and adolescents - without adequate access to mental health care providers. 15

II. Award Information

1. Type of Application and Award

Type of applications sought: New

HRSA will provide funding in the form of a grant.

9 https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf 10 https://www.kff.org/coronavirus-covid-19/issue-brief/mental-health-and-substance-use-considerations-among-children-during-the-covid-19-pandemic/ 11 https://link.springer.com/referenceworkentry/10.1007/978-3-319-70134-9_77-1 https://www.sc.edu/study/colleges_schools/public_health/research/research_centers/sc_rural_health_res earch_center/documents/crouchacepce1.pdf 13 https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf 14 https://www.nih.gov/news-events/nih-research-matters/rural-youth-often-lack-access-suicide-prevention-services 15 Health Resources and Services Administration, Shortage Areas, US Department of Health and Human Services. As of February 13, 2022. Available at: https://data.hrsa.gov/topics/health-workforce/shortage-areas https://www.jedfoundation.org/youth-wellbeing-during-covid-19-survey-findings/ https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf https://www.kff.org/coronavirus-covid-19/issue-brief/mental-health-and-substance-use-considerations-among-children-during-the-covid-19-pandemic/ https://www.kff.org/coronavirus-covid-19/issue-brief/mental-health-and-substance-use-considerations-among-children-during-the-covid-19-pandemic/ https://link.springer.com/referenceworkentry/10.1007/978-3-319-70134-9_77-1 https://www.sc.edu/study/colleges_schools/public_health/research/research_centers/sc_rural_health_research_center/documents/crouchacepce1.pdf https://www.sc.edu/study/colleges_schools/public_health/research/research_centers/sc_rural_health_research_center/documents/crouchacepce1.pdf https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf https://www.nih.gov/news-events/nih-research-matters/rural-youth-often-lack-access-suicide-prevention-services https://www.nih.gov/news-events/nih-research-matters/rural-youth-often-lack-access-suicide-prevention-services

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2. Summary of Funding

HRSA estimates approximately $9,000,000 to be available annually to fund nine recipients. You may apply for a ceiling amount of up to $1,000,000 annually (reflecting direct and indirect costs) per year.

The period of performance is September 1, 2023 through August 31, 2027 (4 years).

Funding beyond the first year is subject to the availability of appropriated funds for RCORP-CABH in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

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

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include all domestic public or private, non-profit and for-profit, entities. Tribes and tribal organizations are eligible to apply.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

HRSA may not consider an application for funding if it contains any of the non-responsive criteria below:

• Exceeds the funding ceiling amount

• Fails to satisfy the deadline requirements referenced in Section IV.4

• Fails to propose a service area that is entirely rural as defined by the Rural Health Grants Eligibility Analyzer, and/or lists any non-HRSA-designated rural counties and census tracts in Attachment 8. All service delivery sites supported by RCORP-CABH must be exclusively located in HRSA-designated rural counties and rural census tracts. Within partially rural counties, activities and services supported by this award may only occur in the HRSA-designated rural census tracts. Please reference the Program Requirements and Expectations section for additional guidance.

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

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Multiple Applications

Multiple applications from an organization are not allowed. HRSA will only accept and review your last validated electronic submission before the Grants.gov application due date.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at Grants.gov: HOW TO APPLY FOR GRANTS. If you use an alternative electronic submission, see Grants.gov:

APPLICANT SYSTEM-TO-SYSTEM.

The NOFO is also known as “Instructions” on Grants.gov. You must select “Subscribe” and provide your email address for HRSA-23-041 in order to receive notifications including modifications, clarifications, and/or republications of the NOFO on Grants.gov.

You will also receive notifications of documents placed in the RELATED DOCUMENTS tab on Grants.gov that may affect the NOFO and your application. You are ultimately responsible for reviewing the For Applicants page for all information relevant to this

NOFO.

2. Content and Form of Application Submission

Application Format Requirements Section 4 of HRSA’s SF-424 Application Guide provides general instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, and certifications. You must submit the information outlined in HRSA SF-424 Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in this NOFO and HRSA’s SF-424 Application Guide. You must submit the application in the English language and budget figures expressed in U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the HRSA SF-424 Application Guide for the Application Completeness Checklist to assist you in completing your application.

Application Page Limit The total number of pages that count toward the page limit shall be no more than 60 pages when we print them. HRSA will not review any pages that exceed the page limit.

Using the pages within the page limit, HRSA will determine eligibility using Section III.

Eligibility Information of the NOFO.

https://www.grants.gov/ http://www.grants.gov/applicants/apply-for-grants.html http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/s2s/applicant-system-to-system.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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These items don’t count toward the page limit:

• Standard OMB-approved forms you find in the NOFO’s workspace application package

• Abstract (standard form (SF) "Project_Abstract Summary”)

• Indirect Cost Rate Agreement

• Proof of non-profit status (if it applies)

If there are other items that don’t count toward the page limit, we’ll make this clear in Section IV.2.vi Attachments.

If you use an OMB-approved form that isn’t in the HRSA-23-041 workspace application package, it may count toward the page limit. We recommend you only use Grants.gov workspace forms related with this NOFO to avoid going over the page limit.

Applications must be complete and validated by Grants.gov under HRSA-23-041 before the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. § 3354).

3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachments 9-15: Other Relevant Documents.

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

Program Requirements and Expectations

Service Area Specifications

Delivery of all services supported by RCORP-CABH program funds must exclusively occur in HRSA-designated rural counties and rural census tracts, as defined by the Rural Health Grants Eligibility Analyzer. Within partially rural counties, services supported by this award may only be delivered within HRSA-designated rural census tracts. NOTE: If applicants do not clearly describe an exclusively rural service area and/or if any non-HRSA-designated rural counties and census tracts are listed in Attachment 8, the application will be deemed non-responsive.

https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75#se45.1.75_1371

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Program Goals and Sample Activities16

NOTE: You must propose activities that address all three RCORP-CABH goals.

Additionally, the example activities provided below are only a sampling of possible approaches to addressing RCORP-CABH goals. You should propose activities that are specific to the unique, demonstrated needs of the target rural service area.

Goal 1: Service Delivery. Establish new behavioral health prevention, treatment, and recovery services for children and adolescents aged 5-17 years in the target rural service area.

At a minimum, recipients must use RCORP-CABH funds to establish one new prevention, treatment, and recovery service line in the target rural service area, for a total of at least three new behavioral health care service lines (one each in prevention, treatment, and recovery). For the purposes of RCORP-CABH “new behavioral health care service line” refers to the establishment of an evidence-based behavioral health prevention, treatment or recovery service for children and adolescents in a location where it does not currently exist. Note that this is a minimum requirement;

you may (and are encouraged to) propose more than three new service lines and should ensure that the scope of proposed new services and size of target rural population to be served are commensurate with the requested award amount.

Services may address both substance use and mental health disorders and should be appropriate to the specific needs and characteristics of children and adolescents, as well as their families, in the target rural service area.

Services should be easily accessible and available. This may include offering services during extended hours (such as nights and weekends) or in easily accessible locations (such as in local schools or community gathering places).

Service delivery activities may also include administrative capacity-building that is required to support the addition of new service lines, such as billing and coding supports, upgraded electronic health records, etc.

Examples of allowable activities under Goal 1 include, but are not limited to, the following:

16 Note: No child or adolescent should be denied services because of their age.

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Prevention Services

• Implement regular mental health and substance use disorder screenings in school health clinics and ensure that students are referred to treatment as appropriate.

• Create free after-school programming for children and adolescents at risk of behavioral health disorders.

• Facilitate access to naloxone for children and adolescents at risk of an overdose, as well as their families, and provide information and/or training on how to administer it.

• Increase and support the use of school- and community-based prevention programs that are evidence-based to prevent misuse of opioids and other substances, and that educate children and adolescents on the rising dangers of fentanyl.

Treatment Services

New behavioral health treatment service lines may include, but are not limited to psychotherapy, counseling, support groups, and prescription medication as appropriate. The following activities are examples of how you may support the establishment of a new behavioral health care treatment service line:

• Purchase a mobile health unit to provide family-centered behavioral health care treatment at easily accessible locations or after work hours.

• Perform minor renovations at school health clinics or pediatrician’s offices, to allow for integration of behavioral health care (such as support groups and psychotherapy) and primary care services for students. Note: please reference the Funding Restrictions section of the NOFO for more information about minor renovations.

• Recruit new behavioral health care providers, through leveraging National Health Service Corps (NHSC) and other workforce programs or offering recruitment/hiring incentives.

• Support the salary of health care providers offering new behavioral health care service lines until patient volume is sufficient to sustain services.

Recovery Services

• Establish a supportive housing program for adolescents in recovery.

• Establish a recovery community organization to provide support to children and adolescents in recovery.

• Create recovery-friendly spaces in the local schools where children and adolescents in recovery can go if they need extra support during the school day.

https://nhsc.hrsa.gov/ https://nhsc.hrsa.gov/

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Goal 2: Training and Peer Mentorship. Improve the capacity of rural health care providers, paraprofessionals, non-clinical staff, and community members to care for and support children and adolescents aged 5-17 with behavioral health needs, through providing training and peer mentorship opportunities.

You must propose training and peer mentorship activities for rural health care providers, paraprofessionals, non-clinical staff, and community members.

Examples of activities for Goal 2 include, but are not limited to:

• Implement a peer parent support program for parents and caregivers who have children diagnosed with a behavioral health disorder.

• Implement a clinical peer mentorship program to connect and support behavioral health care providers who treat children and adolescents.

• Implement a non-clinical peer mentorship program to connect and support paraprofessionals or non-clinical staff who work with children and adolescents with behavioral health care needs.

• Train existing behavioral health providers on additional evidence-based therapy methods such as Motivational Interviewing and Cognitive Behavioral Therapy.

• Train existing pediatric primary care providers on mental health and SUD medication management for children and adolescents.

• Train non-behavioral health care providers (e.g., pediatricians, family medicine providers) and non-clinical providers (e.g., school counselors) on the link between mental health and substance use disorder, to build awareness of opportunities to prevent future substance misuse in adulthood.

Goal 3: Community Partnerships. Build community partnerships to ensure that children and adolescents, and their families, have access to community resources and human services that support prevention of, treatment of, and recovery from behavioral health disorders.

You should ensure a “whole-person” approach to service delivery, which is integrated and coordinated with community resources and human services that can support successful prevention, treatment, and recovery. Community partnerships may include consortium members but should also extend to other relevant community/human services organizations that are not directly involved in the management of the proposed project.

To that end, examples of activities for Goal 3 include, but are not limited to:

• Work with local transportation resources to provide children and adolescents with free transport to appointments (with the approval of a parent/guardian).

• Coordinate with childcare providers to offer childcare for parents/caregivers with multiple children, so that they can attend treatment appointments.

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• Coordinate with a local food bank to ensure that families with a child/adolescent in recovery have consistent access and reliable access to healthy food.

• Coordinate with local schools to implement recovery-friendly before- and after-school activities.

• Enhance discharge coordination from emergency departments, juvenile detention centers, etc., to ensure smooth transitions to community-based care and access to needed supportive services.

• Enhance care coordination among community partners to ensure that children, adolescents, and their families are seamlessly connected with all needed services to support prevention, treatment, and recovery from a behavioral health disorder, and receive regular follow-up and case management assistance.

• Support families in navigating health care insurance coverage for needed behavioral health services, such as through providing benefits counseling (e.g., assisting with navigating coverage, enrolling in insurance, documentation, prior authorization, assistance with reimbursement, etc.).

Service Delivery Timeline

RCORP-CABH award recipients are expected to begin delivering at least three new behavioral health care services (one each of prevention, treatment, and recovery) no later than the end of the first year of the award and to increase the number of children and adolescents receiving services each subsequent year of the period of performance. You should accomplish this by increasing the number of children and adolescents receiving the behavioral health services deployed in year one, and/or by establishing additional behavioral health services in years two, three, and four of the award.

Service Delivery Modality

RCORP-CABH award recipients should deliver care and services via modalities that are most appropriate and effective for the target rural population. If opting to use telehealth, you must clearly demonstrate that it is the most effective and sustainable modality for serving children and adolescents in the target rural service area. You must also clearly demonstrate that use of telehealth will still lead to improved delivery of behavioral health services within the target rural service area.

Sustainability and Third-Party Reimbursement

Award recipients should ensure that all services covered by reimbursement are billed and every reasonable effort is made to obtain payment from third-party payers. Only after award recipients receive a final determination from the insurer regarding lack of full reimbursement should RCORP-CABH funds be used to cover the cost of services for

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underinsured individuals. At the same time, award recipients may not deny services to any individual because of an inability to pay.

HRSA expects RCORP-CABH recipients will work to ensure that project activities can be sustained after the four-year period of performance concludes. Award recipients should accomplish this by increasing patient volume throughout the period of performance, establishing effective billing and coding practices, assisting with enrolling patients into health insurance (e.g., Medicaid, Children’s Health Insurance Program- CHIP, private insurance, etc.), locating alternative funding sources, etc. HRSA will provide recipients with technical assistance to support sustainability planning throughout the period of performance.

Consortium Member Requirements

Given the complex and multifaceted nature of rural child and adolescent behavioral health, recipients must establish a multi-sectoral consortium to implement and ensure the integration and coordination of project activities. Consortiums must consist of at least four separately owned entities, including the applicant organization, and represent a diversity of sectors relevant to behavioral health care for children and adolescents. HRSA will consider applications with fewer than four consortium members, including the applicant organization, to be non-responsive.

HRSA strongly encourages you to consider engaging consortium members from the following sectors:

• Primary Care (including pediatric and family medicine practices)

• Crisis Care (including first responders and hospital emergency departments)

• Education

• Child Care

• Child Welfare

• Juvenile Justice

Each consortium member should be fully integrated into the project, with clear roles and responsibilities in the execution of the proposed work plan. Consortium members should commit to meeting regularly (at least once a quarter), coordinating project efforts, sharing aggregate data for performance reporting, sustaining services after the period of performance concludes, and developing approaches to ensure continuity of operations to minimize the impact of potential service disruptions such as public health emergencies or natural disasters.

At least 50 percent of consortium members must be physically located within the target rural service area. HRSA will consider applications with less than 50 percent of consortium members located in the target rural service area non-responsive.

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You must provide a letter of support from each consortium member reflected in the work plan (see Attachment 7). If awarded, a single letter of commitment signed by all participating consortium members establishing the consortium must be submitted within 90 days of the project start date.

HRSA strongly encourages you to consider budgeting RCORP-CABH funds to support consortium member participation in the project.

Learning Collaborative

HRSA requires all award recipients to participate in the RCORP-CABH learning collaborative, facilitated by the RCORP technical assistance provider. The learning collaborative will offer the opportunity to network, share best practices, address challenges, and receive targeted technical assistance to advance the efforts of all participants. You must designate one individual to serve as the point of contact for the learning collaborative.

Required Staffing

You must identify individuals who will fulfill the following roles in the proposed project:

• Project Director

• Health Care Navigator

• Learning Collaborative Point of Contact

• Data Coordinator

Please see Section IV’s Organizational Information for more details on this requirement.

Copy of RCORP-CABH Application

You will be expected to submit a copy of your RCORP-CABH application to the HRSA-funded RCORP technical assistance provider and evaluator to provide them with background and context for your proposed project. You may redact information that you do not wish to share with the technical assistance provider or evaluator from the copy of your application that you submit to them. Please see Section VI’s Reporting for additional information.

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

i. Project Abstract Use the Standard OMB-approved Project Abstract Summary Form that is included in the workspace application package. Do not upload the abstract as an attachment or it may count toward the page limit. For information required in the Project Abstract Summary Form, see Section 4.1.ix of HRSA’s SF-424 Application Guide.

http://www.hrsa.gov/grants/apply/applicationguide/sf424guide.pdf

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NARRATIVE GUIDANCE

To ensure that you fully address the review criteria, the table below provides a crosswalk between the narrative language and where each section falls within the review criteria. Any forms or attachments referenced in a narrative section may be considered during the objective review.

Narrative Section Review Criteria

Introduction (1) Need

Needs Assessment (1) Need

Methodology (2) Response and (4) Impact

Work Plan (2) Response

Resolution of Challenges (2) Response

Evaluation and Technical Support Capacity

(3) Evaluative Measures and

(5) Resources/Capabilities

Organizational Information (5) Resources/Capabilities

Budget Narrative (6) Support Requested

ii. Project Narrative This section provides a comprehensive description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and organized in alignment with the sections and format below so that reviewers can understand the proposed project.

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

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INTRODUCTION -- Corresponds to Section V’s Review Criterion #1: Need

Clearly and succinctly summarize the following:

A) The target rural service area, including all rural counties and/or rural census tracts that the proposed project will serve. NOTE: If you propose target rural service areas that are not fully rural, HRSA will consider your application non-responsive. This includes applications that indicate partially rural counties and do not specify specific rural census tract numbers to be served.

B) The characteristics and needs of the target rural population.

C) How the proposed project will meet the needs of the target rural population.

D) How the proposed project will achieve the goals and purpose of RCORP-

CABH.

E) Your organization’s capacity to implement and sustain the proposed project.

NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion #1: Need

Provide the following data and statistics from appropriate and timely sources (e.g., local, state, tribal, and federal) to fully justify the need for the proposed project.

Where possible, compare the data for the target rural population to regional, statewide, and/or national data to demonstrate need. Please cite the data sources (including year) used to provide these data.

A) Target Rural Population

i) Provide demographic and social determinants of health indicators that clearly demonstrate the behavioral health needs of the target rural population.

ii) Describe the extent to which the target rural population includes child and adolescent subpopulations that have historically suffered from poorer health outcomes, health disparities, and other inequities compared to the rest of the target population. Examples of these populations include, but are not limited to, persons/people experiencing homelessness, racial and ethnic minorities, people who are pregnant, LGBTQ individuals, socioeconomically disadvantaged populations, new immigrants, and individuals with disabilities.

iii) Detail which segments of the target rural population are most at risk for, and/or are most likely to be diagnosed with behavioral health disorders.

Segments may include, but are not limited to, certain age groups within the 5-17 target age range, racial/ethnic groups, gender identity, and socioeconomic status.

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B) Prevalence and impact of behavioral health disorders

i) Clearly and completely describe the prevalence and impact of behavioral health disorders among children and adolescents within the target rural service area. Examples can include, but are not limited to, the number/ percentage of children/adolescents diagnosed with SUD, the number/percentage of children/adolescents diagnosed with mental health disorders, and the number of child/adolescent emergency room visits resulting from drug overdose or suicide attempts.

C) Existing services

i) Describe the existing child and adolescent behavioral health prevention, treatment, and recovery services offered within the target rural service area. Include any federal, state, and/or locally funded behavioral health entities serving children and adolescents in the target rural service area, such as other RCORP projects, HRSA’s Pediatric Mental Health Care Access program, or SAMSHA’s Project AWARE (Advancing Wellness and Resiliency in Education). See Appendix G for information on additional HRSA programs related to RCORP-CABH which may be operating in the target rural service area. Additionally, please reference the RCORP website for a list of active RCORP award recipients in each program— Implementation, Neonatal Abstinence Syndrome, Psychostimulant Support, MAT Access, Overdose Response, and Behavioral Health Care Support—as well as this table of RCORP award recipient service areas for more information.

ii) If no specific child and adolescent behavioral health services exist within the target rural service area, please explicitly state this and describe how and where children and adolescents are receiving behavioral health care.

iii) Specifically describe any existing child and adolescent behavioral health prevention, treatment, and recovery services currently offered at the location(s) where new behavioral health care services will be delivered under the proposed project. At a minimum, describe the current services offered, existing infrastructure available, and workforce currently employed at the site(s).

iv) Provide an overview of the community resources and human services available within the target rural service area to support children and adolescents affected by behavioral health disorders and their families.

D) Gaps in Existing Services

NOTE: Identified gaps should clearly align with and justify the need for the proposed project and the goals of the RCORP-CABH program.

i) Clearly and comprehensively describe gaps in behavioral health prevention, treatment, and recovery services that the proposed project will address.

https://mchb.hrsa.gov/training/pgm-pmhca.asp https://mchb.hrsa.gov/training/pgm-pmhca.asp https://www.samhsa.gov/school-campus-health/project-aware https://www.samhsa.gov/school-campus-health/project-aware https://www.hrsa.gov/rural-health/opioid-response https://www.hrsa.gov/rural-health/opioid-response https://www.rcorp-ta.org/sites/default/files/2022-10/10.06.22%20Updated%20Counties%20Served%20All%20Cohorts%20%20for%20Portal_0.xlsx

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ii) Clearly and comprehensively describe gaps in the capacity of the existing behavioral health care workforce that the proposed project will address.

iii) Describe gaps in the integration and coordination of community resources and human services available within the target rural service area to support children, adolescents, and families affected by behavioral health disorders.

iv) Describe the of barriers to access behavioral health care services for children and adolescents in the target rural service area (e.g., lack of transportation, stigma, lack of family support).

If you encounter difficulty obtaining data, HRSA encourages you to contact your state or local health departments and/or refer to data and information provided by the Rural Health Information Hub and the Opioid Misuse Community Assessment Tool developed by NORC at the University of Chicago. If you are still unable to locate appropriate and accurate data, please provide an explanation for why the data could not be found and how you will ensure that you will be able to meet HRSA reporting requirements if awarded.

METHODOLOGY -- Corresponds to Section V’s Review Criteria #2: Response and #4: Impact

A) Goal 1: Service Delivery. Establish new behavioral health prevention, treatment, and recovery services for children and adolescents aged 5-17 years in the target rural service area.

i) Clearly and comprehensively describe the new behavioral health care services that will be provided under the proposed project. Clearly describe the mode of service delivery for each proposed new service line (e.g., telehealth, mobile unit, etc.). As a reminder, recipients must use RCORP- CABH funds to establish one new prevention, one new treatment, and one new recovery service line in the target rural service area, for a total of at least three new service lines.

ii) Provide a compelling justification for how the proposed new service lines and mode of delivery are appropriate to the specific needs and characteristics of children and adolescents, as well as their families, in the target rural service area.

a) If opting to use telehealth, clearly demonstrate that 1) it is the most effective and sustainable modality for serving children and adolescents in the target rural service area, and 2) use of telehealth will still lead to improved delivery of behavioral health services within the target rural service area.

iii) Describe how you will engage and support the families of children and adolescents receiving behavioral health prevention, treatment, and recovery services.

https://www.ruralhealthinfo.org/ https://www.norc.org/Research/Projects/Pages/national-opioid-misuse-community-assessment-tool.aspx https://www.norc.org/Research/Projects/Pages/national-opioid-misuse-community-assessment-tool.aspx

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iv) Describe how the proposed new service lines will be easily accessible and available to the target population, including those that have historically suffered from poorer health outcomes, health disparities, and other inequities as compared to the rest of the population. Examples may include offering services during extended hours (such as nights and weekends) or in easily accessible locations (such as in local schools or community gathering places). NOTE: HRSA expects applicants to ensure that all activities supported by RCORP-CABH are culturally and linguistically appropriate for the target rural population that will be served.

B) Goal 2: Training and Peer Mentorship. Improve the capacity of rural health care providers, paraprofessionals, non-clinical staff, and community members to care for and support children and adolescents aged 5-17 with behavioral health needs, through providing training and peer mentorship opportunities.

i) Clinical health care providers (e.g., pediatricians, family medicine physicians, licensed clinical social workers, clinical psychologists, etc.)

b) Describe in detail how you will use training and peer mentorship to improve the capacity of clinical rural health care providers to care for and support children and adolescents aged 5-17 with behavioral health needs.

c) Describe how you will identify and engage clinical rural health care providers to participate in training and peer mentorship.

d) Describe how trainings and peer mentorship will be easily accessible for clinical rural health care providers in the target rural service area.

e) Describe how training and peer mentorship opportunities will address gaps in the capacity of clinical rural health care providers care for children and adolescents with behavioral health needs.

ii) Paraprofessionals (e.g., peer recovery support specialists, emergency responders, etc.)

a) Describe in detail how you will use training and peer mentorship to improve the capacity of paraprofessionals to care for and support children and adolescents aged 5-17 with behavioral health needs.

b) Describe how you will identify and engage paraprofessionals to participate in training and peer mentorship.

c) Describe how trainings and peer mentorship will be easily accessible for paraprofessionals in the target rural service area.

d) Describe how training and peer mentorship opportunities will address gaps in the capacity of paraprofessionals to care for children and adolescents with behavioral health needs.

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iii) Non-clinical staff (e.g., teachers, school administrators, after-school program staff, etc.)

a) Describe in detail how you will use training and peer mentorship to improve the capacity of non-clinical staff to care for and support children and adolescents aged 5-17 with behavioral health needs.

b) Describe how you will identify and engage non-clinical staff to participate in training and/or peer mentorship.

c) Describe how trainings and peer mentorship will be easily accessible for non-clinical staff in the target rural service area.

d) Describe how training and peer mentorship opportunities will address gaps in the capacity of non-clinical staff care for children…