Improving Access To Care: Using Community Health Workers to Improve Linkage and Retention in HIV Care

Improving Access To Care: Using Community Health Workers to Improve Linkage and Retention in HIV Care Pre-Application Technical Assistance Webinar Funding Opportunity Announcement HRSA-16-185 June 9, 2016 Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau, Division of Community HIV/AIDS Programs Director: Mahyar Mofidi, DMD, PhD Deputy Director: Stacey Evans, PhD

Agenda Acronyms HAB Mission and Secretary s Minority AIDS Initiative Fund Background: NHAS, the HIV Care Continuum and CHW Workforce Integration HRSA-16-185 FOA, SF-424 Application Guide Program Requirements and Expectations Application Structure/Sections Budget Funding Restrictions Attachments Application Review by HRSA Grant Writing and Submission Tips Q & A 2

Acronyms Application Guide CHW DCHAP DGMO DUNS EHB FOA SF 424 Application Guide Community Health Worker Division of Community HIV/AIDS Programs Division of Grants Management Operations Data Universal Numbering System Electronic Handbook Funding Opportunity Announcement GMS Grants Management Specialist HAB HIV/AIDS Bureau PO Project Officer RWHAP Ryan White HIV/AIDS Program SAM System for Award Management SMAIF Secretary s Minority AIDS Initiative Fund TAEC Technical Assistance and Evaluation center 3

Objective The purpose of the webinar is to assist potential applicants in preparing applications that address the requirements of the FOA HRSA-16-185. 4

Secretary s Minority AIDS Initiative This initiative is funded through the Secretary s Minority AIDS Initiative funding (SMAIF) as authorized under The Consolidated Appropriations Act, 2016 (P.L. 114-113), Division H, Title II. Established by Congress in 1999 in response to growing concern about the impact of HIV/AIDS on racial and ethnic minorities in the U.S., the Minority AIDS Initiative (MAI) includes an annual allocation of resources to HHS for the Secretary s MAI Fund (SMAIF). 5

Goal of HRSA-16-185 FOA The goal of this three year cooperative agreement is to increase the utilization of community health workers (CHW): to improve access to and retention in health care; and to improve health outcomes for people living with HIV (PLWH) by strengthening the health care workforce, building healthier communities, and achieving health equity among racial and ethnic minority populations. 6

CHWs and the HIV Care Continuum The project will focus on assisting HIV medical care provider sites, particularly those funded by the Ryan White HIV/AIDS Program (RWHAP), with the support needed to integrate CHWs into an HIV multidisciplinary team model through training, direct technical assistance, and collaborative learning sessions. The use of CHWs supports the goals of the recently updated National HIV/AIDS Strategy (NHAS 2020) Refer to pages 3-4 of the FOA for links and more information NOTE: HRSA-16-185 is a technical assistance project and does not support care and treatment. Source: NHAS 2020 7

Community Health Worker Workforce Integration HRSA and the Centers for Medicare and Medicaid Services (CMS) have studied the impact of CHWs in health care settings. Both agencies identified CHWs as contributing to improved health outcomes while increasing cost effectiveness. CHWs can bridge the gap between the traditional health care system and the community, thereby effectively addressing the social determinants of health and improving health outcomes. See pages 4-5 of the FOA for more information, including citations to the HRSA and CMS studies. 8

Eligibility Eligible organizations may include: National organizations; State, local, and Indian tribal governments; institutions of higher education; Other non-profit organizations (including faith-based, community-based, and tribal organizations); and Academic health science centers involved in addressing HIV-related issues on a national scope and within governmental public health structures.

Summary of Funding The funding is for one cooperative agreement recipient. The ceiling amount is $2,000,000 for each year of the three year project period (9/1/16-8/31/19). Award amount includes up to $750,000 to fund up to 10 RWHAP medical provider sites as subrecipients receiving direct TA to support the development and implementation of their CHW model. Applications requesting more than the ceiling amount will not be considered. Please refer to pages 1 to 2 and 7 of the FOA. 10

Application Guidance Two Components of the HRSA 16-185 Application 1) Program Specific Instructions CHW FOA HRSA-16-185 ( FOA ) 2) HRSA s General Guidance SF-424 Application Guide ( Application Guide ) Links are found throughout the FOA (beginning pp. ii, 8 and 9; the May 2016 version is most current) 11

12 Application Structure Applicants must include the following sections in their application: Project Abstract Project Narrative Introduction Needs Assessment Methodology Work Plan Resolution of Challenges Evaluation and Technical Support Capacity Organizational Information Budget Budget Justification Narrative Line Item Budget Attachments (7)

Project Abstract See section 4.1.ix of HRSA s SF-424 Application Guide. (p.43) The project abstract must also include a brief description of the proposed TAEC structure, overall project goals, and evaluation plan. 13

Project Narrative Introduction Needs Assessment Methodology Work Plan Resolution of Challenges Evaluation and Technical Support Capacity Organizational Information See pages 9-14 in the FOA. 14

Introduction Briefly describe the purpose of the proposed project. Briefly describe the applicant organization and any collaborating organizations to be involved in this project. Summarize your ability to work closely with other entities such as community-based organizations, AETCs and others to carry out successful CHW learning collaborative(s). 15

Needs Assessment The applicant should include a discussion that exhibits an expert understanding of the issues related to the activities described in this cooperative agreement. Highlights of this section include: Summary of the literature Issues impacting CHW implementation and effectiveness Examples of successful CHW implementation Promising models of care using an integrated CHW component Approaches to CHW utilization/integration in RWHAP programs 16

Methodology Propose methods that will be used to address the stated needs and meet each of the previously described program requirements and expectations in this FOA. Five topics must be addressed in the methodology section detailed on pages 10-12 of the FOA. Webinars/Webcasts Direct Technical Assistance Learning Collaboratives CHW Implementation Guide Evaluation Tool 17

Methodology- Webinars/Webcasts Discuss plans for conducting webinars/webcasts open to ANY HIV medical provider on specific topics related to community-based and peer-based CHW programs that address the service needs along the HIV care continuum. Provide a full and clear response to: Topic Selection Methods used for assessing provider training needs Methods for the development of learning concepts and formats Marketing and dissemination to HIV providers Please refer to page 10 of the FOA. 18

Methodology-Direct Technical Assistance Include a detailed plan for conducting a needs assessment to determine the type of direct TA required by RWHAP medical providers to develop and implement a CHW model as an integral part of the multidisciplinary medical team. Discuss how the TA will be provided and the level of collaboration and partnership between the TAEC and selected provider sites. Include a clear description of your sub-award process from initiation to approval, with the corresponding timelines, including the issuance of sub-awards by end of year one. 19

Methodology- Direct Technical Assistance Describe your organizational capacity to expedite sub-awards required under this announcement within year one of the project. Describe a process for the management of selected subrecipients. Describe the methodology for monitoring the performance sites. Please refer to pages 10-11 of the FOA. 20

Methodology-Learning Collaboratives Provide a clear and full description of your approach to leading and coordinating several (minimum of four) collaborative learning sessions. Include a plan for marketing and dissemination of information to all organizations providing HIV medical care for their participation in the collaborative(s). Describe methods you will use to identify experts in the field of evidenceinformed CHW models. 21

Methodology-Learning Collaboratives Discuss how your organization will manage site location selection and logistics, development of meeting agendas and coordination of content in collaboration with HAB for collaborative learning sessions. Note: In conjunction with HAB, the awardee will identify RWHAP medical provider sites in geographic locations with low retention and/or viral suppression rates to develop capacity on the use of CHWs in their program. Please refer to page 11 of the FOA. 22

Methodology-CHW Implementation Guide The CHW Implementation Guide will be a capstone document produced at the end of the project period. The Guide will contain a variety of information relevant to the implementation of an effective CHW program and will be informed by all of the activities conducted during the project period (promising models, evaluation results, practical considerations). Describe the methods used to determine the components of a CHW Implementation Guide. Clearly describe how you will gather the components for the CHW Implementation Guide Please refer to page 11 of the FOA. 23

Methodology-Evaluation Tools Discuss a comprehensive plan for the development of an evaluation tool, for use by the sub-recipient RWHAP medical provider sites receiving direct TA, to assess the effectiveness of CHW models. Include information in the evaluation plan on how improvements in retention and linkage to care will be measured for sub-recipients who have integrated CHWs into an HIV multidisciplinary team. Describe a plan for the collection of evaluation and assessment information from the sub-awarded RWHAP medical provider sites receiving direct TA. Please refer to page 11 of the FOA. 24

Methodology-Final Items Describe your approach to providing HAB with recommendations for revisions and improvements to the implementation of project activities during years two and three for the final creation of implementation and assessment tools, the CHW Implementation Guide, a final evaluation report and other reporting deliverables. Include an overall dissemination plan that outlines approaches to the dissemination of information and lessons learned obtained as a result of this project at various peer-related conferences, meetings and other professional outlets. Please refer to pages 11-12 of the FOA. 25

Work Plan The work plan should be presented in a table format and include (1) goals; (2) objectives that are specific, measurable, achievable, realistic and time-framed (SMART); (3) action steps; (4) personnel responsible for each action step (including any consultants and contractors) used to achieve each of the activities proposed and (5) anticipated dates of completion. Although goals for the work plan are to be written for the entire three-year project period, objectives and action steps are required only for the goals set for year one. The work plan is Attachment 1 in your submission. Please refer to page 12 of the FOA. 26

Resolution of Challenges Describe the challenges that are likely to be encountered in the development and implementation of an effective, sustainable and integrated CHW program within varied medical settings serving racial and ethnic minority populations, and propose strategies that have been, or may be, employed to overcome these challenges. Be sure to discuss expected challenges in completing work plan tasks noted in the FOA, including challenges in: Providing TA to RWHAP providers within a variety of settings; Effectively assessing the success of the CHW programs being implemented; and Coordination of collaboratives and group learning dynamics. Be sure to propose strategies or methods for overcoming and mitigating the challenges you expect to face in achieving work plan goals. Please refer to pages 12-13 of the FOA. 27

Evaluation and Technical Support Capacity Discuss an evaluation plan that will be used to measure achievement of program objectives and impact of the program including a plan to evaluate the effectiveness of project activities for each of the three areas as described in Section I. 2. Background. Describe how you will evaluate the effectiveness of learning collaboratives in developing capacity and sustainability of CHW programs among participants. Include a multi-site evaluation plan that will measure the impact of the implementation of a CHW program including a description on how to measure the overall value and impact of the activities proposed on organizations receiving direct TA. Describe your organization s capacity and that of any collaborating partners to conduct comprehensive multi-site evaluations on the effectiveness of CHW models implemented by selected RWHAP provider sites that received direct TA. 28

Evaluation and Technical Support Capacity Describe the organizational and/or the collaborating partner s organizational expertise and capacity in developing evaluation tools to assess the effectiveness of medical care models and/or models that integrate non-clinical personnel as part of the medical team. Describe the components of evaluation tools and/or techniques that will measure improvements in linkage and retention in care as a result of the newly implemented CHW models. Describe how newly developed evaluation tools will be assessed and tested to ensure they are effective in collecting data that will measure the impact of the CHW model on improvements in retention and linkage to care. Please refer to page 13 of the FOA. 29

Organizational Information Describe your organization s mission and structure, scope of current activities and experience in providing TA. Describe your organization s knowledge and/or experience in conducting technical assistance on the use of peers and/or CHWs serving racial/ethnic minorities and underserved populations to improve linkage to care and retention. Describe the level of experience in program development, specifically related to CHW and peer programs. Describe past experience in needs assessments, supporting collaborative learning/ta, logistical planning/facilitation for large meetings, and disseminating information. 30

Organizational Information Organizational Information Describe key staff involved in the project. Identify personnel members who will be responsible for managing/ providing TA as described in the methodology section. If consultants and/or contractors will be used to provide any of the proposed services, describe their roles and responsibilities on the project. Signed letters of agreement, memorandum of understanding, and descriptions of proposed and/or existing contracts related to the proposed project should be included in Attachment 4. Include a one-page project organizational chart as Attachment 5. Please refer to pages 13-14 of the FOA. 31

Staffing Plan and Biographical Sketches Include the Staffing Plan as Attachment 2. Table format is recommended. Include all key staff (names and positions) for the proposed project and their roles in the project implementation. Include consultants and/or contractors and their roles and responsibilities in the project and its implementation. Include Biographical Sketches of key project staff as Attachment 3. See the Application Guide for addition information on the staffing plan and biographical sketches. Please refer to page 14 of the FOA. 32

Budget Three parts: 1. SF-424A Budget Information From the Application Package 2. Specific Line Item Budget (Attachment 6) 3. Budget Justification Narrative Please refer to pages 15-17 of the FOA. 33

Budget See HRSA s SF- 424 Application Guide section 4.1.iv and v (pp. 31-39) and FOA section IV.2.iii (pp. 15-17) for instructions on preparing the budget and budget justification narrative. The budget should include: Personnel name and title, fringe benefits, total personnel costs, consultant costs by individual consultant, sub-awards for direct TA recipients, supplies, staff travel, stipends, other expenses by individual expense, total direct costs, indirect costs, and total costs. Annual salary and total project FTE should be included, as well as all costs by major activity. Upload a specific line item budget in the recommended PDF format as Attachment 6. 34

Budget Justification Narrative Applicants should provide specific, detailed justifications for all allocated items in the program specific line item budget. For example, travel or training costs must specify the unit cost per person and the number of persons to be involved per activity. If indirect costs are requested, a current negotiated indirect cost rate agreement must be submitted as Attachment 7. 35

Salary Limitation Cap The Consolidated Appropriations Act, 2016, Division H, 202, (P.L. 114-113) continues the Executive Level II capped salary amount that may be awarded and charged to HRSA grants and cooperative agreements. Award funds may not be used to pay the salary of an individual at a rate in excess of Executive Level II or $185,100 annually (exclusive of fringe). The salary limitation also applies to sub-awards/subcontracts. Please see Section 4.1.iv Budget Salary Limitation of HRSA s SF-424 Application Guide for additional information. 36

Example: Salary Limitation Individual s full time salary: $255,000. Amount that may be claimed on the Federal grant due to the legislative salary limitation: Individual s base full time salary adjusted to Executive Level II: $185,100. 50% of time will be devoted to project Direct salary: $92,550 Fringe (25% of salary): $23,137.50 Total: $115,687.50 37

Cost Allowability Allowable Cost - Meets the criteria for authorized expenditures specified in the cost principles, program legislation, and program policy. The costs must also be: Allocable Reasonable Necessary 38

Funding Restrictions/ Unallowable Costs Charges that are billable to third party payers (e.g., private health insurance, prepaid health plans, Medicaid, Medicare, HUD, other RWHAP funding including ADAP); To directly provide housing or health care services (e.g., HIV care, counseling and testing) that duplicate existing services; Pre-Exposure (PrEP) or Post-Exposure Prophylaxis (npep); Cash payments to intended recipients of RWHAP services; Syringe services programs; Purchase, construction of new facilities or capital improvements to existing facilities; Purchase or improvement to land; Purchase vehicles; Fundraising expenses; Lobbying activities and expenses; and International travel 39

Summary of Attachments Attachment 1 Attachment 2 Attachment 3 Attachment 4 Attachment 5 Attachment 6 Attachment 7 Attachment 8 Attachment 9-15 Work Plan Staffing Plan and Job Descriptions for Key Personnel Biographical Sketches of Key Personnel Letters of Agreement and/or Description(s) of Proposed/Existing Contracts (project specific) Project Organization Chart Program Specific Line Item Budget Indirect Cost Rate Agreement, if applicable Tables, Charts, etc. Other Relevant Documents 40

What is Counted toward Page Limit? Abstract Project Narrative Work Plan Staffing Plan for Key Personnel Letters of Support and/or Commitment Line-item Budget Budget Justification Narrative All Attachments (except where noted on pp. 16-17 of FOA) APPLICATIONS CANNOT EXCEED 80 PAGES! Applications that exceed the page limit will not be considered under this announcement. 41

Application and Submission HRSA requires applicants for this funding opportunity announcement to apply electronically through Grants.gov. Applicants must download the SF-424 application package associated with this funding opportunity following the directions provided at Grants.gov. Application due date in Grants.gov: July 12, 2016 11:59 p.m. EST 42

Application Format Requirements Files names may not exceed 50 characters Attachments must be clearly labeled Applicants are strongly encouraged to submit 48 hours in advance to ensure they receive Grants.gov confirmation of receipt and validation 43

Application Review Information Criterion Corresponding Sections Score 1 NEED Section IV s Introduction and Needs Assessment 15 points 2 RESPONSE Section IV s Methodology, Work Plan and Resolution of Challenges 3 EVALUATIVE MEASURES Section IV s Evaluation and Technical Support Capacity 35 points 10 points 4 IMPACT Section IV s Methodology and Work Plan 10 points 5 RESOURCES/ CAPABILITIES Section IV s Organizational Information 20 points 6 SUPPORT REQUESTED Section IV s Budget and Budget Narrative 10 points 44

Application: Where is it? Located at www.grants.gov Search by announcement #: HRSA-16-185 Adobe Reader 8.1.1 version or later is required Also found at www.hrsa.gov/grants Applicants must use both the FOA and the SF-424 Application Guide to successfully complete and submit an application 45

Grant Submission Tips Read the FOA and the Application Guide carefully and follow instructions. Include your agency name and the name of this application on all pages. Refer to the Application Guide, p. 54, section 4.7. for additional Tips for Writing a Strong Application. Project Abstract instructions are on pages 47 and 50 in the Application Guide. Apply early; don t wait until the last minute in case you run into challenges! Make sure the person who can submit for your organization will be available. Have all your PIN numbers and passwords handy! 46

SF-424 Application Guide Tips What is funding amount to be entered for SF-424 #18a (cover page)? Provide the year one budget period funding total of the proposed project period. Do NOT go over the ceiling funding amount listed in the FOA. SF-424 cover sheet is a standard form. For additional information please go to: http://www.grants.gov/web/grants/form-instructions/sf-424-instructions.html Where do I upload the project abstract? Upload on page 2 of the SF-424 Box #15. Select Add Attachments to upload the project abstract. See page 43 in the SF-424 Application Guide. 47

Application Assistance Applicants may need assistance when working online to submit their application forms electronically. Applicants should always obtain a case number when calling for support. For assistance with submitting the application in Grants.gov, contact Grants.gov 24 hours a day, seven days a week, excluding Federal holidays at: Grants.gov Contact Center Telephone: 1-800-518-4726 E-mail: support@grants.gov iportal: http://grants.gov/iportal 48

Grants.gov Contact Information When to contact Grants.gov Helpdesk Error messages Other technical issues Application DID NOT transmit to HRSA If you have any submission problems, please contact Grants.gov immediately! Electronic Submission User Guide: http://www.hrsa.gov/grants/apply/userguide.pdf Grants.gov Contact Center: 1-800-518-4726 or support@grants.gov or https://grants-portal.psc.gov/welcome.aspx?pt=grants (24/7 except Federal holidays) 49

Tracking Grants.gov Submissions Applicant should receive four emails Submission Receipt E-mail Submission Receipt (receive within 2 business days) Track My Application link Submission Validation E-mail 2 nd e-mail from Grants.Gov validating your application OR Rejection with errors Grantor Agency Retrieval Email Third e-mail from Grants.Gov HRSA has confirmed receipt of application package Grants.Gov website http://www.grants.gov/applicants/apply_for_grants.jsp 50

Tracking Grants.gov Submissions 4 Emails Agency Tracking Number Assignment E-mail Grants.Gov website http://www.grants.gov/applicants/apply_for_grants.jsp An applicant must receive four (4) emails to have successfully submitted an application through Grants.gov. Receipt of all four separate emails may occur over a week s time. Do not wait until the last minute to submit an application! 51

4 E-mails in Grants.govnts.gov SF424 Application Guide, 8.2.5, pp. 61-62 52 52

Grants.gov Message upon Application Upload Home> Apply for Grants > Confirmation Thank you for submitting your grant application package via Grants.gov. Your application is currently being processed by the Grants.gov system. Once your submission has been processed, Grants.gov will send email messages to advise you of the progress of your application through the system. Over the next 24 to 48 hours, you should receive two emails. The first will confirm receipt of your application by the Grants.gov system, and the second will indicate that the application has either been successfully validated by the system prior to transmission to the grantor agency or has been rejected due to errors. IMPORTANT NOTICE: If you do not receive a receipt confirmation and either a validation confirmation or a rejection email message within 48 hours, please contact us. The Grants.gov Contact Center can be reached by email at support@grants.gov, or by telephone at 1-800-518-4726. Always include your Grants.gov tracking number in all correspondence. The tracking numbers issued by Grants.gov look like GRANTXXXXXXXXX. 53 53

Agency Contacts For program issues and/or technical assistance regarding this funding announcement, contact: Mahyar Mofidi, Tel: 301-443-2075 Fax: 301-443-1839, Email: MMofidi@hrsa.gov For business, administrative, or fiscal issues related to this funding opportunity announcement, contact: Karen Mayo, Tel: (301) 443-3555 Fax: (301) 594-4073, E-mail: KMayo@hrsa.gov 54

Questions and Answers Session 55

Thank You 56