Medical Advocacy Projects Request For Proposal State Fiscal Year 2015/2016 (Letter of Intent due date rev. Feb. 20, 2015)

Transcription

1 Medical Advocacy Projects Request For Proposal State Fiscal Year 2015/2016 (Letter of Intent due date rev. Feb. 20, 2015) IMPORTANT DATES LAST DAY TO SUBMIT LETTER OF INTENT: February 27, 2015 DATE AND TIME OF PREPROPOSAL CALLS: Thursday, February am Thursday, February pm LAST DAY TO SUBMIT QUESTIONS to PCADV Friday, March 20, 2015 APPLICATION DUE DATE: Friday, March 27, 2015 INITIAL FUNDING PERIOD: July 1, 2015 June 30, 2018 CONTINUATION FUNDING AVAILABLE: Two, one- year renewal periods It is anticipated that all applicants will be notified of the outcome of their applications by April 15, The purpose of the Medical Advocacy Program is to support the development, implementation or enhancement of domestic violence medical advocacy projects in the Commonwealth which would assist in the implementation of domestic violence policies and procedures as well as provide training for health care workers to improve hospital, health center and clinic response to domestic violence victims seeking medical treatment. All PCADV funded programs are eligible to apply for funding for Medical Advocacy Projects for SFY 2015/2016. Priority will be given to proposals that build on past institutional change to incorporate work in with new health care providers or in new health care settings. Programs may apply for a maximum of $75,000 to develop and implement a new medical advocacy project or enhance/expand a current project. It is anticipated that projects will be funded for a three-year period, July 1, 2015 through June 30, However, the PCADV reserves the right to renew or extend the contract for an additional two years from July 1, 2018 through June 30, 2020, based on evidence of progress on the program s objectives and the availability of funding to PCADV. These funding guidelines provide the necessary information to complete this application. However, if there are any program-related questions, please contact Carole Alexy via at calexy@pcadv.org. We will respond to all inquiries in writing via , and all questions and responses will be posted on PCADV s website for the review of all potential applicants. Applicants are encouraged to go to for all questions and MAP-1

2 responses pertaining to this announcement. The last day to submit a question related to the completion of this application is Friday, March 20, Deadline: Letters of Intent All applicants who intend to apply for funding under this funding announcement must submit a non-binding letter of intent to Carole Alexy, Director of Contracts, Pennsylvania Coalition Against Domestic Violence, by February 27, Letters of Intent should be submitted electronically to calexy@pcadv.org. Please use MAP Letter of Intent in the subject line of the . PCADV will use letters to forecast the number of peer reviewers needed to review these competitive applications. Please see Appendix A for a sample of a Letter of Intent I-1 General Background The goal of this Request For Proposal (RFP) is to (1) encourage and support collaborative efforts between the domestic violence and health care communities to improve the response of health care providers to domestic violence, and (2) enhance health promotion and violence prevention strategies, capacities and mechanisms among health care providers and in health care locations. Interpersonal and domestic violence is common, the health effects are devastating, and the health costs are substantial. The HHS coverage requirement reflects the importance of screening for violence exposure as an essential component of quality health care delivery. The recent Centers for Disease Control and Prevention (CDC) National Intimate Partner and Sexual Violence Survey 1 provides deeper surveillance data. The CDC survey found victims who experienced high rates of severe intimate partner violence, rape and stalking, reported long- term chronic disease and other health impacts such as Post- Traumatic Stress Disorder (PTSD) symptoms. More than three quarters of domestic violence victims who report the incidents to police seek health care in emergency rooms, but most of them are never identified as being victims of abuse during their hospital visit. These findings, from a 2011 University of Pennsylvania School of Medicine study, point to a missed opportunity to intervene and offer help to women who suffer violence at the hands of an intimate partner. "Emergency departments are a safety net for women with health issues of all kinds, but our study shows we're not doing a good enough job of assessing our patients' entire situation," said Karin V. Rhodes, MD, MS, director of Penn's Division of Emergency Care Policy Research in the department of emergency medicine. "There is no reason in the age of information technology that we should not provide routine screening and referrals to the social services patients can use to protect themselves from future violence." In February of 2013, the U.S. Preventive Services Task Force issued new recommendations to support screening and response to intimate partner violence (IPV), also known as domestic violence (DV), and designated it with a B grade recommending that health plans provide the service. With this and other new coverage requirements for screening and response, addressing DV in the health setting is becoming the standard of care. 1 Centers for Disease Control and Prevention, National Intimate Partner and Sexual Violence Survey 2010 { MAP-2

3 Health Costs of Interpersonal and Domestic Violence The health cares costs of abuse are equally astonishing. A 2009 study of more than 3,000 women (ages 18-64) from a large health plan located in the Pacific Northwest found costs for women suffering on-going abuse were 42 percent higher when compared with non-abused women. Women with recent non- physical abuse had annual costs that were 33 percent higher than non- women age 18 and older within the first 12 months after victimization, range from $2.3 billion to $7 billion dollars. 23(12): CDC estimates that the cost of intimate partner rape, physical assault and stalking totaled $5.8 billion each year for direct medical and mental health care services and lost productivity from paid work and household chores. Of this total, nearly $4.1 billion are for direct medical and mental health care services and productivity losses account for nearly $1.8 billion in the United States in 1995.When updated to 2003 dollars, the cost is more than $8.3 billion, and in 2012 dollars it would be considerably more. 3 Victims of domestic violence report that one of the most important aspects of their interactions with a physician or other health care professional was being listened to about abuse but, too often, health care providers do not discuss abuse with their patients or screen patients for domestic violence. Health care providers are in a unique position to help victims of abuse if they know how to detect domestic violence and provide victims with referrals and support. Health Related Issue Areas: A. Traumatic Brain Injury: Traumatic Brain Injury (TBI) is a major societal problem with public health implications. It is an expectation that women who are victims of domestic violence may be at risk of cumulative damage due to multiple, mild brain injuries. Studies have estimated that blows to the head or face occur in 50 to 90 percent of assaults. 4 For victims of domestic violence, reporting is always an issue due to fear of retribution. If mild brain injury has occurred, and there are cognitive impairments, this compounds the likelihood that the person may not be able to or fear coming forth to report what happened. The nature of how the injury is sustained in addition to the injury itself conspires to make this a frequently undetected injury. Medical Advocacy Projects, with their emphasis on screening and training, provide a unique opportunity to identify TBI in a population whose needs are currently unmet. Through a collaborative relationship with the PA Department of Health, PCADV has developed a training curriculum to educate domestic violence providers, health care providers and other 2 Brown DS, Finkelstein EA, Mercy JA, Methods for Estimating Medical Expenditures Attributable to Intimate Partner Violence. Journal of Interpersonal Violence, 23(12): Max, W, Rice, DP, Finkelstein, E, Bardwell, R, Leadbetter, S The Economic Toll of Intimate Partner Violence Against Women in the United States. Violence and Victims, 19(3) ]. 3 4 Jackson, Philip, Nutter, and Diller, MAP-3

4 stakeholders on the signs, symptoms, etiology and impact of TBI. Domestic violence shelter staff has been trained in TBI screening with the goal of increased identification of TBI in victims of domestic violence and their children. It is thought that through this education, other Commonwealth TBI programs such as the HIP and the COMMCARE waiver can serve as a resource for victims of domestic violence, thereby increasing their independence and improving their health outcomes. B. Reproductive Coercion: Reproductive coercion is one of the least discussed forms of intimate partner violence, and many are unaware that it even exists or that it is a type of abuse. Despite the lack of awareness, reproductive coercion is shockingly common, and many women who experience it are also victims of other forms of intimate partner violence such as physical and psychological abuse Futures Without Violence defines reproductive coercion as threats or acts of violence against a partner s reproductive health or reproductive decision-making. Explaining the link between reproductive coercion and other forms of intimate partner violence, the American College of Obstetricians and Gynecologists (ACOG) 2013 Committee Opinion on reproductive coercion says that reproductive and sexual coercion involves behavior intended to maintain power and control in a relationship related to reproductive health by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent. According to the ACOG, examples of reproductive coercion include hiding, withholding, or destroying a partner s birth control pills; intentionally breaking condoms or removing a condom during sex; not withdrawing during intercourse when that was the agreed upon method of contraception; removing contraceptive patches, rings, or IUDs; attempting to force/ coerce a partner to have an abortion against their will; controlling abortion-related decisions; refusing to wear a condom when a partner wants to use one; pressuring someone to do sexual things when they don t want to; and threatening to end a relationship if a partner doesn t have sex. Elizabeth Miller, MD, PhD., Beth Jordan, MD, Rebecca Levenson, MA, and Jay Silverman, PhD, were among the first researchers to identify and highlight the problem of reproductive coercion. They explain that reproductive coercion can include a variety of explicit male behaviors to promote pregnancy [that is] unwanted by the women. Most commonly, these behaviors include birth control sabotage (interference with contraception) and/or pregnancy coercion, such as telling a woman not to use contraception and threatening to leave her if she doesn t get pregnant. C. Human Trafficking: Human trafficking is a major public health problem, both domestically and internationally. Health care providers are often the only professionals to interact with trafficking victims who are still in captivity. In 2011, the U.S. Department of Justice identified the majority of sex trafficking victims as U.S. citizens, most of whom were under the age of 25. While the studies are few, there are suggestions that health care providers have a higher likelihood than the average person of MAP-4

5 interacting with victims of human trafficking during their captivity. Most victims are undetected due to lack of provider awareness and training. Moreover, healthcare facilities lack protocols to respond to identified cases of human trafficking. Trafficking is a health care issue because addressing the physical and mental health of a survivor is central to the restoration of his or her well-being. Counter-trafficking work is a multidisciplinary effort and health care professionals can and should participate in a variety of roles. It is the expectation that all medical advocacy projects will focus their efforts on each of the issue areas described above during the 2015/16 SFY. I-2 Purpose The purpose of the Medical Advocacy Program shall be to support the development, implementation or enhancement of domestic violence medical advocacy projects in the Commonwealth which would assist in the implementation of domestic violence policies and procedures as well as provide training for health care workers to improve hospital, health center and clinic response to domestic violence victims seeking medical treatment. I-3 Scope This RFP contains instructions governing the proposals to be submitted and the material to be included therein; a description of the services to be provided, general evaluation criteria; budgetary requirements, funding levels and other requirements to be met by each applicant. I-4 Funding Programs may apply for a maximum of $75,000 to develop and implement a new medical advocacy project or enhance/expand a current project. I-5 Eligibility All PCADV funded programs are eligible to apply for funding for Medical Advocacy Projects for SFY 2015/2016. Priority will be given to proposals that build on past institutional change to incorporate work in with new health care providers or in new health care settings. 1-6 Program Elements Each domestic violence medical advocacy project shall: Demonstrate active collaboration between a local community-based domestic violence program and the hospital(s), health center(s) or clinic(s) participating in the project. Develop and implement uniform multidisciplinary domestic violence policies and procedures that incorporate the roles and responsibilities of all staff who provide services or interact with victims of domestic violence, including the identification of victims of domestic violence through universal screening. Develop and implement a multidisciplinary, comprehensive and ongoing domestic violence education and training program for hospital, health center or clinic personnel adapted to the particular hospital s, health center s or clinic s demographics, policies, staffing patterns and resources. The training program shall include, but is not limited to, MAP-5

6 identifying characteristics of domestic violence, screening patients for domestic violence, appropriately documenting in the medical record and offering referral services, including domestic violence resources available in the community. Provide educational materials to inform victims of domestic violence about the services and assistance available through the domestic violence program. Develop formal project assessment procedures, including, but not limited to, coordinating and collecting data for the evaluation of the project. PART II: APPLICATION PROCESS II-1 Question & Answer Sessions Two (2) Q&A sessions will be held on the dates specified below. The purpose of these sessions is to clarify any points in the RFP, which may not have been clearly understood. Call One: Thursday, February 26, :00AM 11:00AM Call Two: Thursday, February 26, :00 PM 3:00 PM A Call-in number will be provided, via , to all programs submitting Letters of Intent. Participation is optional. II-2 Inquiries re: the RFP These funding guidelines provide the necessary information to complete this application. However, if there are any program-related questions, please contact Carole Alexy via at calexy@pcadv.org. We will respond to all inquiries in writing via , and all questions and responses will be posted on PCADV s website for the review of all potential applicants. Applicants are encouraged to go to for all questions and responses pertaining to this announcement. The last day to submit a question related to the completion of this application is Friday, March 20, II-3 Response Date Completed applications, together with all required attachments, must be received by PCADV on or before 5:00 pm on Friday, March 27, Applications shall be submitted electronically, by ing all documents in a Word/Excel format to the attention of Carole Alexy, Director of Contracts, at calexy@pcadv.org. Indicate in the Subject line of the MAP APPLICATION. Faxed copies of proposals will be administratively rejected. II-4 Funding Period It is anticipated that projects will be funded for a three-year period, July 1, 2014 through June 30, However, the PCADV reserves the right to renew or extend the contract for an additional two years from July 1, 2018 through June 30, II-5 Incurring Costs PCADV is not liable for any costs incurred by applicants prior to issuance of a contract. MAP-6

7 II-6 Proposals To be considered, applicants must submit a complete response to this RFP using the format provided in Part III. Proposals must be complete when submitted. No supplements will be accepted beyond the proposal due date unless requested by PCADV. II-7 Program Scope and Allowable Expenses Funding may be used to develop and implement or to maintain or expand an existing Medical Advocacy Project, the primary purpose of which is to develop and implement collaborative teams of domestic violence and health care-community representatives to provide training and follow-up technical assistance to health care institutions, providers and staff in order to increase their capacity to appropriately identify and respond to domestic violence. The intent is not to create on-site staff for the health care provider. II-8 Data Collection/Reporting Requirements Applicants that receive funding under this initiative must provide data that measure the results of their work. At minimum, the following data are required from Medical Advocacy Programs on a monthly basis to PCADV: Number of victims receiving domestic violence services who were referred by a hospital/health care facility or provider, Number and types of people receiving training from project staff, and Number and types of training. In addition, Medical Advocacy Project staff will be asked to provide, twice yearly, anecdotal information illustrating the impact of the project including information on policies/procedures revised or implemented. Project staff will also be expected to work cooperatively with the PCADV to develop and implement appropriate project outcomes as part of the statewide coordinated data collection/reporting project. II-9 Contractor Responsibilities All MAP-funded contractors will be required to assume responsibility for all services offered in their proposals whether or not they produce them. PCADV will consider the selected applicant to be the sole point of contact with regard to contractual matters. Contractor responsibilities for state fiscal year will reflect the requirements enumerated in the Contract Agreement; Payment Provisions; Domestic Violence Program, Reporting and Fiscal Standards; and the PA Department of Human Services Rules and Regulations. II-10 Contract Monitoring and Sanctions for Non-Compliance: PCADV reserves the right to monitor contract compliance and performance. Failure to perform according to the contract or failure to comply with any PCADV approved corrective action plan could result in PCADV suspending payments to the program/organization until the deficiency is corrected. MAP-7

8 Prior to the imposition of a sanction for non-compliance, PCADV may provide a written corrective action plan to the contractor regarding the details of the non-compliance. The corrective action plan will specify the period of time during which the program must bring its performance back into compliance with contract requirements. If, at the end of the specified time period, the program has complied with the corrective action plan requirements, PCADV will take no further action. If, however, the program has not complied with the corrective action plan requirements, PCADV will proceed with the imposition of sanctions. PCADV may suspend, refuse to renew or terminate any contract executed in support of a Medical Advocacy Project in accordance with the terms of the contract and applicable laws and regulations. In addition to these remedies, PCADV may impose monetary sanctions or withhold payments to the program if the program fails to comply with the quality or performance requirements of the executed contract or any provisions stated in law. Written notice will be provided to the program specifying the sanctionable offense, the sanction to be imposed, the grounds for such sanction and either the length of the suspension or the amount of payments to be withheld. PCADV will also specify program actions that are necessary before the withheld payments will be released. PART III: APPLICATION FORMAT III-1 Application Requirements Applications must use the following page format requirements: 8 ½ x 11-inch paper One-inch margins Type no smaller than 12 point, Times New Roman font: 10 pt. may be used for the work plan. Number all pages of the narrative and the work plan. III-2 Required Attachments Complete applications must include the following attachments: All application sections as described in section III-3 below Job descriptions for all project staff included in the budget Signature Page III-3 Information Required From Applicants To be considered, the proposal must respond to all requirements outlined in this section of the RFP. Any other information thought to be relevant, but not applicable to the enumerated categories, should be provided as an appendix to the proposal. A. Statement of Need New and Current Projects (25 Points) State in succinct terms your understanding of the specific needs of domestic violence victims in your community who seek health care services in hospitals, health centers/clinics or family planning clinics. Be sure to include information concerning the barriers/obstacles to be overcome in order to ensure MAP-8

9 accessibility to domestic violence services for victims. Describe the changes that are needed within the health care community to insure the identification of, and provision of services to, victims of domestic violence. B. For Programs Requesting Funding For New Project Development and Implementation: (35 Points) 1. Describe the need for the project as demonstrated by data and statistics of local significance. 2. Describe the health care facilities/systems that will be the focus of your efforts in 2015/16. Are health care personnel in those facilities currently screening for domestic violence on a regular basis? 3. Describe how a coordinated on-site system will be developed and implemented to provide hospital, health center/clinic-based domestic violence services, upon request, to identified victims of domestic violence receiving health care services. 4. Describe the ongoing and follow-up support services that will be offered, i.e., how victims of domestic violence can access assistance beyond those services received in the health care setting. 5. Describe how the confidentiality of client information will be ensured and the manner in which access to medical records/case conferences by project staff will be addressed. 6. Describe all training planned for health care systems/facilities in 2015/ Describe how you will monitor/evaluate the success of your efforts. C. For Programs Currently Funded for Medical Advocacy Projects: (35 Points) 1. Provide a brief description of the current project, including the names and locations of the hospitals/health centers/clinics, etc.; the goals of the project; the number of victims of domestic violence referred/served in the past five years and the services provided. 2. Describe the composition of the team convened for the purpose of advising the overall project and how the team currently functions in that capacity. 3. Provide a brief description of efforts undertaken by project staff to effectuate institutional change in hospitals, health centers/clinics, etc. 4. Describe any unanticipated barriers to project implementation. 5. Describe your project s current domestic violence education and training program for hospital, health center and/or clinic personnel. 6. Describe any materials that have been developed/utilized, i.e. brochures, protocols, training curricula, etc. 7. Describe the project s evaluation/quality assurance and problem solving procedures currently in place. 8. Describe how the confidentiality of client information is ensured and the manner in which access to medical records/case conferences by project staff is addressed. 9. Describe the continued need for the project as demonstrated by data and statistics of local significance. MAP-9

10 D. WORK PLAN (25 Points) Detail your plan for accomplishing the work identified in Section III-3, above. The work plan must include (1) the goals of the project; (2) specific and measurable objectives; (3) specific strategies and/or tasks for accomplishing the goals/objectives; (4) person(s) responsible; and (5) time lines for completion. Be sure to include the names of the health care systems/facilities/providers targeted for change as well as indicate how you will prioritize those systems/facilities/providers. E. PERSONNEL (10 Points) Describe the staffing pattern for the proposed project, clearly linking responsibilities to project tasks and specifying the contributions to be made by key staff/consultants. The personnel description must include the following: 1. The domestic violence program personnel who will be involved in the project. 2. The health care facility personnel who will be involved with the project. 3. Where personnel will be physically located during the time they are working on this project. 4. The responsibilities each person will have for this project. 5. The experience of all personnel who will be involved in this project. Describe the required experience/education for each position included in the budget. Indicate who will supervise project personnel. Describe that individual's experience and expertise. Attach resumes for key staff and job descriptions for all project positions as an appendix to this proposal. III-4 BUDGET (5 Points) Every application must include a 12-month budget. The budget must be complete, reasonable, and cost-effective in relation to the proposed project. The budget should provide the basis for the computation of all project-related costs. It should cover the cost of all components of the project. There must be a clear link between the proposed activities and the proposed budget items. The budget should include only those activities, products and resources that are necessary for project implementation and discussed in the project narrative. III-5 REVIEW PROCESS All applications will be subject to an internal review by PCADV staff and an external review conducted by a team of impartial professionals. Proposals that fail to meet the requirements, as set forth in this RFP may be administratively rejected. Criteria for the external review will include: Completeness of the application; A clear description of the need for the proposed project; The proposed activities are within the scope of the program; Whether the minimum requirements for the project have been met; MAP-10

11 Is there a clear description of how confidentiality of client information will be ensured and the manner in which access to medical records/case conferences by project staff will be addressed; Is there a clear description of the changes that are needed within the health care community to insure the identification of, and provision of services to, victims of domestic violence? Are plans for institutional systems change clearly described? Community partners are clearly identified. Is there a clear link between proposed activities and proposed budget items? It is anticipated that all applicants will be notified of the outcome of their applications by April 15, MAP-11