U.S. Department of Health and Human Services s2

PART I: COVER PAGE/OVERVIEW

U.S. Department of Health and Human Services

Health Resources and Services Administration

Maternal and Child Health Bureau

Genetic Services

Early and Continuous Screening in the Medical Home

Announcement Type: New Competing

Announcement Number: HRSA 10-128

Catalog of Federal Domestic Assistance (CFDA) No. 93.110

FUNDING OPPORTUNITY ANNOUNCEMENT

Fiscal Year 2010

Letter of Intent Due Date: January 8, 2010

Application Due Date: February 22, 2010

Release Date: December 16, 2009

Date of Issuance: December 16, 2009

Michele Puryear, M.D., Ph.D.

Chief, Genetic Services Branch

Telephone: (301) 443-1080

Fax: (301) 480-1312

Statutory Authority: Social Security Act, Title V, Section 501(a)(2); [42 U.S.C. 701(a)(2)]

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HRSA-10-128 Early and Continuous Screening in the Medical Home

OVERVIEW

The Statutory Authority for the Early and Continuous Screening in the Medical Home funding opportunity is the Social Security Act, Section 501(a)(2); [42 U.S.C. 701(a)(2)].

This announcement solicits applications for Early and Continuous Screening in the Medical Home. This initiative’s activities focus on the use of pediatric practice networks to design, test and implement practice models for early and continuous screening of children, across the life span of a child.

Approximately $500,000 per year will be available to fund one (1) cooperative agreement for 4 years. This program will provide funding for Federal fiscal years 2010 –2013, with the grant ending in 2014. As cited in 42 CFR Part 51a.3(a), any public or private entity, including an Indian Tribe or Tribal organization (as those terms are defined in 25 U.S.C. 450b), is eligible to apply for this Federal funding opportunity.

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HRSA-10-128 Early and Continuous Screening in the Medical Home

Table of Contents

I. Funding Opportunity Description 3

Purpose 3

Background 4

II. AWARD INFORMATION 7

1. Type of Award 5

2. Summary of Funding 6

III. Eligibility Information 6

1. Eligible Applicants 6

2. Cost Sharing/Matching 6

3. Other 6

IV. Application and Submission Information 6

1. Address to Request Application Package 6

2. Content and Form of Application Submission 7

i. Application Face Page 10

ii. Table of Contents 10

iii. Application Checklist 10

iv. Budget 10

v. Budget Justification 10

vi. Staffing Plan and Personnel Requirements 12

x. Program Narrative 13

xi. Program Specific Forms 14

xii. Attachments 15

3. Submission Dates and Times 16

4. Intergovernmental Review 17

5. Funding Restrictions 17

6. Other Submission Requirements 17

V. Application Review Information 18

1. Review Criteria 18

2. Anticipated Announcement and Award Dates 19

VI. Award Administration Information 20

1. Award Notices 20

2. Administrative and National Policy Requirements 20

3. Reporting 22

VII. Agency Contacts 24

VIII. Other Information 25

ix. Tips for Writing a Strong Application 26

APPENDIX A: HRSA ELECTRONIC SUBMISSION GUIDE 28

Appendix B : Core Public Health Services 48

Appendix C: Key Personnel 49

Appendix D: MCHB Administrative Forms and Performance Measures 50

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HRSA-10-128 Early and Continuous Screening in the Medical Home

I.  Funding Opportunity Description

Purpose

The Statutory Authority for the Early and Continuous Screening in the Medical Home funding opportunity is the Social Security Act, Section 501(a)(2); [42 U.S.C. 701(a)(2)].

This announcement solicits applications for Early and Continuous Screening in the Medical Home. This initiative’s activities focus on the use of pediatric practice networks to design, test and implement practice models for early and continuous screening of children, across their life span.

The grant activities for the Early and Continuous Screening in the Medical Home initiative focus on improving screening and surveillance practices within the medical home for all children and adolescents. At its completion the initiative’s products are expected to: 1) promote greater understanding among key stakeholders of the need for and benefits of early and continuous screening for conditions, including congenital and heritable disorders, sensory impairments, developmental delay, autism, mental health disorders, sexually transmitted infections and psychosocial problems; and 2) promote healthcare professionals’ use of evidence-based screening guidelines such as Bright Futures and validated screening tools in their practices.

The applicant must work through partnerships with appropriate pediatric healthcare professional organizations such as the American Academy of Pediatrics and the American Board of Pediatrics to disseminate the practice models and other products/publications resulting from this initiative.

Through a pediatric practice network of at least 10 practices, applicants must undertake the activities below. The pediatric network should be well-defined both geographically and by its capacity to deliver pediatric primary care, its capacity to connect families to resources in the community and its collaborations with community organizations.

1)  Support the development, evaluation, and implementation of strategies that will enhance routine screening services within the practice setting. This includes assuring that:

·  all children receive regular and routine screening as recommended by the Bright Futures guidelines;

·  findings from screening are appropriately recorded in the medical record;

·  families are aware of the result of screening tests; and

·  coordinated follow-up care is begun if the screening test is abnormal,

2)  Use quantitative and qualitative data to monitor the impact of any proposed interventions to improve screening services within the practices. Evaluations should include different analyses based on the proposed workplan, and can include: changes in knowledge, attitudes, and beliefs; process measures of change; impact on health outcomes; and, assessment of cost-effectiveness.

3)  Develop and disseminate products based on these findings to help other practices enhance early and continuous screening activities.

4)  Implement strategies to inform other key stakeholders, including families, public health officials, payers, and other health policymakers about the value of early and continuous screening within the medical home.

5)  Identify the implications from all project activities that would effect the implementation of genetic screening in the medical home.

Finally, applicants should identify at least three screening services that they will evaluate at various life stages within the medical home. Special emphasis should be placed on those services that identify conditions that effect developmental outcomes. At least one of these should involve genetic testing.

Background

The American Academy of Pediatrics describes the medical home as a model of delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care.

Recent studies underscore the special importance of the early identification of children with developmental disorders or other disorders that can affect developmental outcomes (e.g., vision or hearing loss). Bright Futures is a national health promotion initiative launched by Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) that includes recommendations for the screening services that all children should receive. Genetic screening already contributes to the early detection of conditions that can interfere with developmental outcomes (e.g., newborn screening, family health history). New tests now under development will further augment the importance of genetic screening. Numerous studies have documented the barriers to offering early and continuous screening as a vital component of comprehensive health care. The goals of this Cooperative Agreement are to identify strategies to overcome these barriers and to prepare for the expansion of screening, including genetic screening, in a pediatric care setting.

Additionally, although disease may be apparent or not, one’s health is not granted at birth. Rather the development of health and disease occur over time. Most adult conditions have their origins in childhood, thereby affected by childhood risk, protective and health promoting factors and influences. (Boyce and Keating, “Should We Intervene?”, and Halfon and Hochstein, “Life Course Health Development” Institute of Medicine, Children’s Health the Nation’s Wealth: Assessing and Improving Child Health, Washington: National Academies Press, 2004) This relationship between child and adult health points to the need for early and continuous screening using a life cycle approach.

Indeed early and continuous screening systems for children are designed ideally to improve the health and well-being of the child starting from birth and throughout his or her life-time and to reduce burdens and improve the quality of life for both the child and his or her family. Newborn dried bloodspot, developmental, behavioral, hearing and vision screening are examples of the many different kinds of screening. Additionally, there is evidence that when screening achieves its goals, it results in cost savings for the health and educational systems and improvements in the quality of life for the affected child and his or her family.

Even though screening can and should happen in a variety of settings, it is important that the medical home be the center of screening activities that occur not only within the practice setting itself (e.g., lead screening) but also serve as the coordinating point for information from screening activities that happen in other locations (e.g., newborn screening conducted in birth hospitals, vision screening conducted in schools). The medical home has been recognized as a model of care that benefits children and youth, especially those with special health care needs. The child’s medical home provider is in the best position to help the family understand and make use of the screening information. As genetic medicine is incorporated into primary care practice and the use genetic screening tools are expanded to primary care practices, the role of the medical home in educating families and coordinating care will become increasingly important and challenging

Ensuring that all children receive recommended early and continuous screening requires the involvement and cooperation of many different stakeholders, including health professionals, public health officials, parents, and researchers. There also is need for training of health professionals and education to assist policy makers and the general public to understand and realize the benefits associated with early and continuous screening and to adopt new evidence-based screening tools into primary care through the medical home model.

Primary care practices require a proactive, consistent, and explicit process for early and continuous screening. However, little guidance is available on how to structure that screening process so that it is consistent, reliable and continuous. Research to date often focuses on improving one aspect of care within the practice setting. This initiative posits that important generalizable findings can be learned through evaluating a practice network by evaluating different screening services administered to children of different ages.

II. Award Information

1. Type of Award

Funding will be provided in the form of a cooperative agreement. A cooperative agreement, as opposed to a grant, is an award instrument of financial assistance where substantial involvement is anticipated between HRSA and the recipient during performance of the contemplated project. This means that substantial MCHB scientific and/or programmatic involvement with the awardee is anticipated during the performance of this project.

Under the terms of this cooperative agreement, in addition to the usual monitoring and technical assistance provided under grants, Federal responsibilities will include:

§  Participation in meetings conducted during the period of the cooperative agreement;

§  Ongoing review of activities and procedures to be established and implemented for accomplishing the goals of the cooperative agreement;

§  Review of project information prior to dissemination;

§  Review of information on project activities;

§  Assistance around establishing and facilitating effective collaborative relationships with Federal and State agencies, MCHB grant projects, MCHB funded resource centers, and other entities that may be relevant to the project’s mission;

§  Provision of information resources; and

§  Technical assistance concerning health information exchange through a collaborative partnership between HRSA, the Centers for Disease Control and Prevention, and the Office of the National Coordinator.

Awardee responsibilities include:

§  Ongoing review of activities and procedures to be established and implemented for accomplishing the scope of work;

§  Ongoing communication and collaboration with the Federal granting agency, i.e. Federal Project Officer;

§  Ensuring the Federal project officer reviews and approves project information prior to dissemination;

§  Working with the Federal project officer to review information on project activities; and

§  Establishing contacts that may be relevant to the project’s mission such as Federal and State agencies, and other MCHB grant projects that may be relevant to the project’s mission.

2. Summary of Funding

This program will provide funding for Federal fiscal years 2010-2013. Approximately $500,000 is expected to be available annually to fund one (1) cooperative agreement. Funding beyond the first year is dependent on the availability of appropriated funds for Early and Continuous Screening in the Medical Home in subsequent fiscal years, grantee satisfactory performance, and a decision that continued funding is in the best interest of the Federal government.

III. Eligibility Information

1. Eligible Applicants

As cited in 42 CFR Part 51a.3(a), any public or private entity, including an Indian Tribe or Tribal organization (as those terms are defined in 25 U.S.C. 450b) is eligible to apply for this Federal funding opportunity.

2. Cost Sharing/Matching

There is no cost sharing/matching requirement for this program.

3. Other

Applications that exceed the ceiling amount will be considered non-responsive and will not be considered for funding under this announcement.

Any application that fails to satisfy the deadline requirements referenced in Section IV.3 will be considered non-responsive and will not be considered for funding under this announcement.

IV. Application and Submission Information

1.  Address to Request Application Package

Application Materials and Required Electronic Submission Information

HRSA is requiring applicants for this funding opportunity to apply electronically through Grants.gov. All applicants must submit in this manner unless the applicant is granted a written exemption from this requirement in advance by the Director of HRSA’s Division of Grants Policy or designee. Applicants must request an exemption in writing from , and provide details as to why they are technologically unable to submit electronically though the Grants.gov portal. Make sure you specify the announcement number for which you are seeking relief, and include specific information, including any tracking or anecdotal information received from Grants.gov and/or the HRSA Call Center, in your justification request. As indicated in this guidance, HRSA and its Grants Application Center (GAC) will only accept paper applications from applicants that received prior written approval.

Refer to Appendix A for detailed application and submission instructions. Pay particular attention to Section 2, which provides detailed information on the competitive application and submission process.