ALABAMA DEPARTMENT OF PUBLIC HEALTH TUSCALOOSA COUNTY HEALTH DEPARTMENT (TCHD) REQUEST FOR APPLICATIONS

ALABAMA DEPARTMENT OF PUBLIC HEALTH TUSCALOOSA COUNTY HEALTH DEPARTMENT (TCHD) REQUEST FOR APPLICATIONS ALABAMA PERSONAL RESPONSIBILITY EDUCATION PROGRAM PURPOSE The purpose of this request for applications (RFA) is to enter into a grant agreement with a qualified Community Based Organization (CBO) to provide evidenced-based educational programming to identified adolescents 13-19 years of age in Tuscaloosa and Bibb Counties. This RFA is designed to provide interested applicants with sufficient basic information to submit proposals meeting minimum requirements. BACKGROUND Signed into law on March 23, 2010, the Affordable Care Act, Public Law No. 111-148, amended Title V of the Social Security Act to include the new PREP formula grant program. This statute allowed states to apply for funds for the purpose of replicating evidenced-based programs, effective models that have been proven on the basis of scientific research to change behavior, which means delaying sexual activity, increasing condom or contraceptive use for sexually active youth, or reducing pregnancy among youth. Specifically, the law stipulates that a program must educate adolescents on both abstinence and contraception for the prevention of pregnancy and sexually transmitted infections (STI s), including HIV/AIDS. The law also requires that at least three adulthood preparation subjects be addressed. The Tuscaloosa County Health Department will be focusing on the following: 1. Healthy relationships, such as positive self-esteem and relationship dynamics, friendships, dating, romantic involvement, marriage, and family interactions; 2. Adolescent development, such as the development of healthy attitudes and values about adolescent growth and development, body image, racial and ethnic diversity, and other related subjects; 3. Parent-child communication; 4. Healthy life skills, such as goal-setting, decision making, negotiation, communication and interpersonal skills, and stress management. FUNDING AVAILABLE Funding for this proposal is not to exceed $47,500. Payment is on a monthly reimbursement basis contingent upon the satisfactory completion of services for the period in which services were rendered, and invoices submitted with supporting documentation. Funding will include a part-time position. LENGTH OF GRANT 1

The length of the contract will be from the date of award, October 1, 2012, through September 30, 2013. Funding is for twelve months with the possibility of renewal if all requirements are successfully met by the end of fiscal year 2013. SCOPE OF SERVICE The Tuscaloosa County Health Department is seeking applicants who are highly qualified and skilled in administering evidenced-based, educational programs, and who have been specifically trained in Making Proud Choices and Love Notes curricula, designed to change behaviors, which means delaying sexual activity, increasing condom or contraception use for sexually active youth, or reducing pregnancy among youth. The primary scope of service will be to provide youth ages 13 19, evidenced-based educational programs in a CBO setting. Each participant will complete the 10 class program, from the Making Proud Choices and Love Notes curricula. The target population is considered high-risk or vulnerable for pregnancies, including youth in or aging out of foster care and youth in adjudicated systems. TARGET AUDIENCE The target audience will be adolescents 13 19 years of age, residing in Tuscaloosa and Bibb Counties, and who are currently in foster care or are adjudicated youth. The setting for implementation of this program will be community-based organizations, including the Tuscaloosa Juvenile Detention Center, the Girls Intensive Education and Treatment Facility, and local foster care homes. DESIRED OUTCOMES The desired outcomes for the APREP grant are reduced pregnancy and STI infections in youth in Tuscaloosa and Bibb Counties. Youth will demonstrate increased knowledge and skills related to healthy reproductive choices, interpersonal communication, and relationship concepts as evidenced by identification of: Correct communication tools to refuse sex Effective strategies to negotiate condom use, and Correct techniques to use contraception consistently SCORING CRITERIA The following point system (100 points total) will be the criteria used to score all eligible applications: 25 points = Executive Summary 60 points = Detailed Response 20 points = Capacity to deliver 20 points = Experience in working with high risk population 20 points = Knowledge/training in curricula 15 points = Proposed Budget 2

100 = Total REVIEW PROCESS AND CRITERIA A review panel consisting of APREP staff and other BFHS staff with federal program experience will screen proposals received by the due date for required documentation and attachments. Proposals deemed eligible to be considered for the FY 2011 funding will be objectively evaluated against the required implementation and funding criteria outlined in this request for proposal (RFP). The panel s scores, based on their assessments, will be the basis for approving or disapproving FY 2011 funding for APREP. TCHD will immediately notify both approved and non-approved applicant agencies by letter. All submitted proposals will remain with TCHD and shall not be returned to the applicant. REQUIREMENTS FOR APPLICANT NARRATIVE Proposals should be no longer than five (5) pages and should be organized and labeled with the following headings: 1. Project Narrative. The one or two page narrative is to briefly describe the applicant s proposal. This summary should highlight the major features of the proposal. The reader should be able to determine the essence of the proposal by reading the project narrative. 2. Detailed Project Narrative. This section should constitute the major portion of the proposal and must contain at the least the following information: A complete narrative of how the applicant will fulfill the elements of the Scope of Work, the applicant s ability and approach, knowledge of or training in the curricula, and the resources necessary to fulfill the requirements. This should demonstrate the applicant s understanding of the desired overall performance expectations. 3. Proposed Budget. Include a budget and budget narrative for the proposed length of the grant agreement. Describe how the costs were determined. The total cost of the proposal should reflect: Personnel: salaries or wages Personnel: fringe benefits Travel/per diem Supplies and educational materials COPIES AND FORMAT REQUIRED The applicant agency is required to submit one (1) proposal electronically and (1) complete, ink-signed proposal. Each proposal must be UNSTAPLED and UNBOUND. The proposal should be double-spaced on a single side of 8 ½ x 11 plain, white paper with one inch margins and black Times New Roman print with a 12-point font. Pro Children Act 1994 3

BFHS will ensure that all approved applicant agencies will provide a smoke-free workplace and promote the non-use of all tobacco products. In addition, Public Law 103227, the Pro-Children Act of 1994, prohibits smoking in certain facilities (or in some cases, any portion of a facility) in which regular or routine education, library, day care, health care, or early childhood development services are provided to children. Criminal Penalty for False Statements All applicant agencies that knowingly and willfully make or cause to be made false statements or representation of a material fact in connection with APREP will be subject to penalties under United States (U.S.) Code, Title 42 The Public Health and Welfare, Chapter 7 Social Security, Subchapter V Maternal and Child Health Block Grant (Attachment I). Certifications Each applicant must complete the following assurances and submit them with the proposal: 1. Certification of Adherence to Guidelines Regarding Environmental Tobacco Smoke (Attachment F). 2. Certification of Adherence to Advisory on Restrictions on Sectarian Activities (Attachment G). 3. Certification of Adherence to APREP Guidelines (Attachment H). Promotion of Religion A civil rights lawsuit filed by a prominent civil rights group challenged the constitutionality of funding activities that promote a religious point of view. APREP will consider funding proposals from religiously affiliated organizations, but it will not fund organizations which promote a religious point of view. Non-Promotion of Religion Under well-settled law, the U.S. Supreme Court holds that in order for legislation to comply with the Establishment Clause of the U.S. Constitution, the statute must have a secular purpose with its primary effect being one that neither advances nor inhibits religion [Vowen v. Kendrick, 487 U.S. 589(1988)]. In order for the APREP legislation, P.L. 111-148, to comply with the Establishment Clause and the U.S. Supreme Court standards, APREP funds must not be used to promote or teach religion. Additionally, the provision of APREP shall not be conducted in church sanctuaries, synagogues, mosques, chapels, or other rooms that are primarily used for religious worship services unless no other suitable alternative is available. The presentation of any program with religious content must be completely separate from the presentation of the federally funded program by time or location in such a way that it is clear that the two programs are separate and distinct. DEADLINE FOR SUBMISSION 4

Proposals must be received by October 9, 2012, no later than 3:00 P.M., CST. All proposals received after this date will be returned to sender. Please send proposals to: Terina Wood, LCSW Area 3 Social Work Director Tuscaloosa County Health Department 2350 Hargrove Road East Tuscaloosa, Alabama 35405 Terina.wood@adph.state.al.us 5

Request for Proposal CHECKLIST The following checklist is provided to assure that all of the required items (i.e., documentation, assurances, and certifications) have been included in the submitted proposal in the following order: 1. APREP Education Cover Sheet (Attachment A)... 2. Dated cover letter on agency letterhead requesting APREP funds from ADPH for FY 2011 with signature by Authorized Representative. 3. Resume....... 4. Project Narrative 5. Detailed Project Narrative.. 6. Budget Narrative. FINANCIAL SUPPORT AND REPORTING DOCUMENTS 7. APREP Personnel Form (Attachment B). 8. APREP Grant Funding from Other Entities Form (Attachment C). 9. APREP Budget Summary Table (Attachment D). CERTIFICATIONS AND ASSURANCES 10. Certification of Adherence to Guidelines Regarding Environmental Tobacco Smoke (Attachment F). 11. Certification of Adherence to Advisory on Restrictions on Sectarian Activity (Attachment G). 12. Criminal Penalty for False Statements (Attachment H). 13. Certification of Adherence to Guidelines for APREP (Attachment I). 6

ATTACHMENT A Alabama Personal Responsibility Program Application for Funding FY 2011 Cover Sheet 1. Applicant/Organization Name: a. Organization Director: b. Organization Telephone Number: Fax Number: c. Organization Address: d. E-mail Address: e. Employer Identification Number (EIN): 2. Type of Organization (Check one and specify type if other ) Government Private: For-profit Private: Non-profit Faith-based Organization Other, specify 3. Amount of Funding Requested: 4. Person Completing Application Title: Telephone Number: 5. Financial Officer Name: Title: Telephone Number: 6. To the best of my knowledge and belief all data in this application are true and correct. The document has been duly authorized by the governing body of the applicant and applicant will comply with the attached assurances if the assistance is awarded. Typed Authorized Signature: Signed Authorized Signature: Date: 7

ATTACHMENT B Title Annual Salary Rate APREP Personnel Form (Staff paid with APREP funds) Number Months % Time Total Amount Required $ Fringe Benefits % Sub-Total $ Fringe $ Total $ Agency/Organization Name: FY Grant Period 8

APREP Grant Funding from Other Entities Form (During this FY grant period, excluding this proposal) ATTACHMENT C Agency/Organization from which Grant Funds Are Received Telephone Number of Funding Organization Grant Funding Time Period (Indicate when funding began and when it will end) Total Amount Brief Summary $ $ $ $ $ Agency/Organization Name: FY Grant Period: 9

APREP Budget Summary Table (Instructions: funding from all sources that support this project only) ATTACHMENT D OBJECT CLASS CATEGORIES APREP FUNDS REQUESTED (A) Funding from other Entities (B) TOTAL (C) 1. Personnel 2. Fringe Benefits 3. Travel 4. Supplies 5. Other 6. TOTAL (Sum of 1-5) Column A Amount of funds requested for this project Column B Amount of funds from other entities Column C Sum of A and B FY Project Period: (MONTH/DAY/YEAR-MONTH/DAY/YEAR) Agency or Organization Name: 10

ATTACHMENT E Employee Time and Attendance Record (Instructions: Not required for application, but required at least monthly if funded) Programs Name: Pay Period Ending: Site: Employee Name: Service Provided Mo. Day Yr. Hours Worked (Billed to APREP) Hours Worked (Not Billed to APREP) Total Hours Worked TOTAL HOURS FOR FIRST WEEK TOTAL HOURS FOR SECOND WEEK TOTAL HOURS FOR PAY PERIOD Employee Signature: Date: Supervisor Signature: Date: 11

ATTACHMENT F CERTIFICATION OF ADHERENCE TO GUIDELINES REGARDING ENVIRONMENTAL TOBACCO SMOKE Public Law 103227, Part C Environmental Tobacco Smoke, also known as the Pro Children Act of 1994, requires that smoking not be permitted in any portion of any indoor routinely owned or leased or contracted for by an entity and used routinely or regularly for provision of health, day care, education, or library services to children under the age of 18, if the services are funded by federal programs either directly or through state or local governments, by federal grant, contract, loan, or loan guarantee. The law does not apply to children's services provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug or alcohol treatment. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1000 per day and/or the imposition of an administrative compliance order on the responsible entity. By signing and submitting this certification the organization certifies that it will comply with the requirements of the Act. The organization further agrees that it will require the language of this certification be included in any sub-awards which contain provisions for the children's services and that all sub-recipients shall certify accordingly. I,, on behalf of the (Organization), acknowledge that if said organization is found not to be in compliance with the federal law or the guidelines and rules of the grant, funding will be terminated and the organization will be required to repay funds received from the grant. Organization Program Coordinator Date 12

Advisory on Restrictions on Sectarian Activities ATTACHMENT G Faith-based and community-based organizations are eligible to apply for Alabama Personal Responsibility Education Program (APREP) Grant funding under the Administration for Children and Families (ACF), Department of Health and Human Services (DHHS). Please note, however, that no funds provided through the DHHS/ACF funded PREP programs may be expended for sectarian instruction, worship, prayer, or proselytization. If a religious organization offers such activities, they must be voluntary for the individuals receiving such services and offered separately from the DHHS/ACF funded APREP programming. A DHHS/ACF funded PREP program cannot discriminate in providing APREP programming to an individual on the basis of religion, a religious belief, or a refusal to hold a religious belief. All curricula and educational materials for use in the DHHS/ACF, APREP must not violate these restrictions on sectarian activities. CERTIFICATION OF ADHERENCE TO ADVISORY ON RESTRICTIONS ON SECTARIAN ACTIVITIES On behalf of (Organization), an Alabama Personal Responsibility Education Program (APREP) sub-recipient, I certify that religion (i.e., sectarian instruction, worship, prayer, proselytization) will not be discussed, taught, or promoted by said organization. I also certify that all curricula and educational material used by (Organization) will not violate these restrictions on sectarian activities. I acknowledge that if said organization is found to be non-compliant with DHHS/ACF Advisory on Restrictions on Sectarian Activities, or the guidelines and rules of the grant, funding will be terminated and said organization will be required to repay funds received from the grant during the grant period. Organization Project Coordinator Date 13

From the U.S. Code Online via GPO Access [wais.access.gpo.gov] [Laws in effect as of January 3, 2006] [CITE: 42USC707] ATTACHMENT H TITLE 42--THE PUBLIC HEALTH AND WELFARE CHAPTER 7--SOCIAL SECURITY SUBCHAPTER V--MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT Sec. 707. Criminal penalty for false statements (a) Whoever-- (1) knowingly and willfully makes or causes to be made any false statement or representation of a material fact in connection with the furnishing of items or services for which payment may be made by a State from funds allotted to the State under this subchapter, or (2) having knowledge of the occurrence of any event affecting his initial or continued right to any such payment conceals or fails to disclose such event with an intent fraudulently to secure such payment either in a greater amount than is due or when no such payment is authorized, shall be fined not more than $25,000 or imprisoned for not more than five years, or both. (b) For civil monetary penalties for certain submissions of false claims, see section 1320a-7a of this title. (Aug. 14, 1935, ch. 531, title V, Sec. 507, as added Pub. L. 97-35, title XXI, Sec. 2192(a), Aug. 13, 1981, 95 Stat. 824.) Prior Provisions A prior section 707, act Aug. 14, 1935, ch. 531, title V, Sec. 507, as added Jan. 2, 1968, Pub. L. 90-248, title III, Sec. 301, 81 Stat. 925, related to failure of State plan to comply with provisions of this subchapter, prior to the general revision of this subchapter by section 2192(a) of Pub. L. 97-35. See section 706 of this title. For effective date, savings, and transitional provisions, see section 2194 of Pub. L. 97-35, set out as a note under section 701 of this title. Provisions similar to those comprising former section 707 were contained in sections 505 and 515 of act Aug. 14, 1935, ch. 531, titlev, 49 Stat. 631, 633, as amended (formerly classified to sections 705 and 715 of this title), prior to the general amendment and renumbering of title V of act Aug. 14, 1935, by Pub. L. 90-248, Sec. 301. Authorized Representative Organization Date 14

CERTIFICATION OF ADHERENCE TO GUIDELINES ATTACHMENT I FOR ALABAMA PERSONAL RESPONSIBILITY EDUCATION GRANT PROGRAM I,, on behalf of (Organization), certify that in accordance with the provisions of Section 2953 of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), said organization will adhere to the mandates in the above referenced law requiring that the educational program, to wit, said programming will: 1. Replicate as mandated by APREP evidence-based programs, proven effective on the basis of scientific research to change behaviors, which means delaying sexual activity, increasing condom or contraception use for sexually active youth, or reducing pregnancy among youth. 2. Provide programming as mandated by APREP designed to educate adolescents on both abstinence and contraception, and at least three adulthood preparation subjects, to prevent pregnancy, sexually transmitted infections (STIs), including HIV/AIDs, and assure healthy transition into adult roles. 3. Adhere and comply strictly with curricula content and materials as mandated by APREP. 4. Consider the needs of lesbian, gay, bisexual, transgender, and questioning youth, and deliver all APREP programming inclusive of and non-stigmatizing toward such participants. Alabama Personal Responsibility Education Program (APREP), and all funded sub-recipient organizations certifies compliance with Section 317P (b) (2) of the Public Health Service Act. Mass produced educational materials that are specifically designed to address sexually transmitted diseases/infections (STDs/STIs) are required to contain medically accurate information regarding effectiveness or lack of effectiveness of condoms. APREP will require projects that provide content information about STD/STI or HIV prevention to also provide only project approved, and curriculum related, medically accurate information regarding the effectiveness or lack of effectiveness of condoms and other contraceptives. All project staff should be trained to answer questions that arise during administration of APREP with medically accurate information as part of the approved curricula Reducing the Risk and Relationship Smarts Plus. 15

In addition, I acknowledge that DHHS will select a subset of programs to participate in a Federal impact evaluation. I certify if APREP and/or specifically my program are selected, I certify that we will participate. On behalf of (Organization), I acknowledge that if said project is found not to be in compliance with the state or federal law, or the guidelines and rules of the grant, funding will be terminated and the organization will be required to repay funds received from the grant. Authorized Representative Date Organization 16