Form FOA1 FY11 Competitive FOA

U.S. Department of Health and Human Services

Health Resources and Services Administration

Maternal and Child Health Bureau

Division of Child, Adolescent and Family Health

Maternal, Infant and Early Childhood Home Visiting Program

Competing Supplement

Announcement Number: HRSA-11-179

Catalog of Federal Domestic Assistance (CFDA) No. 93.505

FUNDING OPPORTUNITY ANNOUNCEMENT

Fiscal Year 2011

Application Due Date: June 30, 2011

Ensure your Grants.gov registration and passwords are current immediately!

Deadline extensions are not granted for lack of registration.

Registration may take up to one month to complete.

Release Date: May 31, 2010 (approved but not posted to Grants.gov)

Issuance Date: May 31, 2010 (date posted to/available on Grants.gov)

Audrey M. Yowell, PhD, MSSS

Health Resources and Services Administration

Maternal and Child Health Bureau

5500 Fishers Lane

10-64

Rockville, MD 20857

Email: [email protected]

Telephone: (301) 443-4292

Fax: (301) XXX-XXXX

Authority: This program is authorized by Title V of the Social Security Act, Section 511 (42 U.S.C. 701), as amended by Section 2951 of the Patient Protection and Affordable Care Act of 2010 (Public Law 111-148).

Table of Contents

I. Funding Opportunity Description !Unexpected End of Formula

1. Purpose 1

2. Background 3

II. Award Information 5

1. Type of Award 5

2. Summary of Funding 5

III. Eligibility Information 9

1. Eligible Applicants 9

2. Cost Sharing/Matching 9

3. Other 9

IV. Application and Submission Information 10

1. Address to Request Application Package 10

2. Content and Form of Application Submission 11

i. Application Face Page 16

ii. Table of Contents 16

iii. Application Checklist 16

iv. Budget 16

v. Budget Justification 17

vi. Staffing Plan and Personnel Requirements 18

vii. Assurances 19

viii. Certifications 19

ix. Project Abstract 19

x. Program Narrative 19

xi. Program Specific Forms, if applicable 22

xii. Attachments (Note: these and any other required application attachments MUST be either referenced in the Application Section if already listed, or included as specific “Attachment Numbers” in that portion of your Table of Contents listed in section IV.2.) 22

3. Submission Dates and Times 25

4. Intergovernmental Review 26

5. Funding Restrictions 26

6. Other Submission Requirements 27

V. Application Review Information 28

1. Review Criteria 28

2. Review and Selection Process 39

3. Anticipated Announcement and Award Dates 40

VI. Award Administration Information 40

1. Award Notices 40

2. Administrative and National Policy Requirements 41

3. Reporting 42

VII. Agency Contacts 43

VIII. Other Information 45

ix. Tips for Writing a Strong Application 4

1. Funding Opportunity Description

1. Purpose

The goal of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) competitive grant program is to award additional funding to states that have sufficiently demonstrated the interest and capacity to enhance their home visiting efforts. Successful applicants will be awarded Federal fiscal year (FY) 2011 competitive grant funds, on top of the FY 2011 MIECHV formula based funds, to support the effective implementation of home visiting programs that are part of comprehensive, high-quality early childhood systems in all states. The purpose of this announcement is to promote quality implementation of home visiting programs to attain the outcomes desired.

These competitive awards will continue the Health Resources and Services Administration’s (HRSA) and Administration for Children and Families’ (ACF) commitment to comprehensive family services, coordinated and comprehensive statewide home visiting programs,¹ and effective implementation of evidence-based practices by offering a competitive opportunity to amplify program efforts supported by the MIECHV formula grants program and other state resources.

Some states have already made positive strides towards conceptualizing and implementing statewide home visiting programs that are part of comprehensive early childhood systems. Likewise, other states would benefit from additional fiscal support and technical assistance to build comprehensive, statewide home visiting programs. Accordingly, the FY 2011 funding opportunity announcement (FOA) looks to accomplish two goals:

(1) To recognize and reward the efforts of states and jurisdictions that demonstrate extraordinary innovations in infrastructure, which are necessary to support high-quality, evidence-based home visiting programs embedded in comprehensive, high-quality early childhood systems; and

(2) To support states and jurisdictions that may be taking initial steps toward building high-quality, evidence-based home visiting programs that are part of comprehensive early childhood systems.

To support these goals, this FOA provides two possible funding opportunities: Innovator Grants and Development Grants.

Innovator Grants recognize states and jurisdictions that have already made significant progress towards a high-quality home visiting program or in successfully embedding their home visiting program into a comprehensive, high-quality early childhood system. States applying for this grant will use the funds to either (1) enhance one or more priority elements² of a home visiting program or (2) initiate a statewide expansion of one home visiting priority element currently operating at a local or regional level. Approximately $66 million of the competitive funding will be awarded in FY 2011 for seven to 10 four-year grants.

Development Grants are for states and jurisdictions that currently have modest home visiting programs and want to build on existing efforts, while focusing on one of the priority elements listed below. Approximately $33 million of the competitive FY11 funding will be awarded for 10-12, two-year grants.

This FOA continues the emphasis on rigorous research in the MIECHV program by grounding the proposed work in relevant empirical literature and by including requirements to evaluate work proposed under this grant. Please see Section VIII.1 Other Information: Guidelines for Evaluation.

Home Visiting Program Priority Elements

HRSA and ACF have identified the following eight priority elements. Applicants may propose to address one or more of these priority elements through either an Innovator or Development Grant.

• Priority Element 1: Innovations to support improvements in maternal, child, and family health

• Priority Element 2: Innovations that support effective implementation of home visiting programs or systems

• Priority Element 3: Innovations that support the development of statewide or multi-state home visiting programs

• Priority Element 4: Innovations that support the development of comprehensive early childhood systems that span the prenatal through age eight continuum

• Priority Element 5: Innovations for reaching high-risk and hard-to-engage populations

• Priority Element 6: Innovations that support a family-centered approach to home visiting

• Priority Element 7: Innovations for reaching families in rural or frontier areas

• Priority Element 8: Innovations that support fiscal leveraging strategies to enhance program sustainability

Additional information about each priority element is provided under Section II.2—Summary of Funding: Home Visiting Priority Elements.

2. Background

On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) (P.L. 111-148), historic and transformative legislation designed to make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce. Through a provision authorizing the creation of the Maternal, Infant, and Early Childhood Home Visiting Program³, the Affordable Care Act responds to the diverse needs of children and families in communities at risk and provides an unprecedented opportunity for collaboration and partnership at the Federal, state, and community levels to improve health and development outcomes for at-risk children through evidence-based home visiting programs.

This program is designed: (1) to strengthen and improve the programs and activities carried out under Title V; (2) to improve coordination of services for at-risk communities; and (3) to identify and provide comprehensive services to improve outcomes for families who reside in at-risk communities. The legislation reserves the majority of funding for one or more evidence-based home visiting models. In addition, the legislation supports continued innovation by allowing for up to 25 percent of funding supporting promising approaches that do not yet qualify as evidence-based models.

HRSA and ACF believe that home visiting should be viewed as one of several service strategies embedded in a comprehensive, high-quality early childhood system that promotes maternal, infant, and early childhood health, safety, and development, strong parent-child relationships, and promoting responsible parenting among mothers and fathers. Together, we envision high-quality, evidence-based home visiting programs as part of an early childhood system for promoting health and well-being for pregnant women, children through age eight, and their families. This system would include a range of other programs such as child care, Head Start, pre-kindergarten, special education and early intervention, and the early elementary grades. Recognizing that the goal of an effective, comprehensive early childhood system that supports the lifelong health and well-being of children, parents, and caregivers is broader than the scope of any one agency, HRSA and ACF are working in close collaboration with each other and with other Federal agencies and look forward to partnering with states and other stakeholders to foster high-quality, well-coordinated home visiting programs for families in at-risk communities. HRSA and ACF realize that coordination of services with other agencies has been an essential characteristic of state and local programs for many years and will continue to encourage, support, and promote the continuation of these collaborative activities, as close collaboration at all levels will be essential to effective, comprehensive home visiting and early childhood systems.

HRSA and ACF believe further that this law provides an unprecedented opportunity for Federal, state, and local agencies, through their collaborative efforts, to effect changes that will improve the health and well-being of vulnerable populations by addressing child development within the framework of life course development and a socio-ecological perspective. Life course development points to broad social, economic, and environmental factors as contributors to poor and favorable health and development outcomes for children, as well as to persistent inequalities in the health and well-being of children and families. The socio-ecological framework emphasizes that children develop within families, families exist within a community, and the community is surrounded by the larger society. These systems interact with and influence each other to either decrease or increase risk factors or protective factors that affect a range of health and social outcomes.

Supporting Infrastructure for Quality Implementation of Evidence-based and Evidence-Informed Home Visiting Programs

A growing body of research points to the importance of implementation and infrastructure as necessary factors to support evidence-based programs (Durlak & Dupre, 2008; Fixsen et al., 2005; Rubin et al., 2010; Wilson & Lipsey, 2000). In a meta-analysis of treatment impacts across a range of social service interventions Wilson and Lipsey (2000) found implementation quality was one of the strongest predictors of achieved effect size of the programs.

The implementation science field has identified, and continues to identify, implementation factors related to whether expected outcomes are obtained and the strength of those impacts. Research has begun to highlight the role of the multiple levels of the infrastructure and system to support implementation of evidence based programs. For example, Wandersman and colleagues (2008) proposed the Interactive Systems Framework to elucidate the role of communities in selecting and implementing evidence-based programs and to draw attention to the multi-layered implementation system necessary to support evidence-based programs. The model highlights the necessity of building capacity at all levels of the infrastructure, including service provision and the technical assistance network. Durlak and Dupre (2008) analyzed over 500 empirical studies and identified over 23 different contextual factors related to quality of implementation, including: communities, providers, organizational capacity, and training or technical assistance.

In the largest synthesis of research on implementation to date, Fixsen and colleagues (2005) conclude that quality implementation occurs in a complex ecological framework that includes several aspects: professional development (including initial training, ongoing technical assistance, and fidelity monitoring), staff selection, administrative supports, and systems interventions. Three key aspects of implementation that are currently receiving the most attention in the research field are fidelity, community context, and professional development.

Fidelity. A program must be implemented with an acceptable level of fidelity in order to achieve expected outcomes (Fixsen et al., 2005). Dane and Schneider (1998) examined the extent to which evidence-based programs were implemented as intended and found only approximately 10% of studies even documented adherence; for those that did, lower adherence was related to smaller effects. Hamre and colleagues (2010) found basic adherence was necessary but not sufficient to obtaining child outcomes and instead quality of delivery was the variable most strongly related to outcomes. In order to obtain quality in fidelity, multiple aspects of implementation must be addressed, including such things as recruiting and retaining the clients best suited for the program, establishing a management information system to track data related to fidelity and services, providing ongoing training and professional development for staff, and establishing an integrated resource and referral network to support client needs.

Community context. At a recent meeting on scaling-up of evidence-based practices, there was consensus among the research, practice and policy attendees on the critical nature of community systems to support implementation (Emphasizing Evidence Based Programs for Children and Youth Forum, April 27-28, 2011). In one example, Rubin and colleagues (2010) reported that the effects of the Nurse Family Partnership were found only after three years of implementation and were moderated by community context. Rubin notes that the delayed achievement of the impacts was consistent with the research around implementation in community-based settings. In addition, Rubin and colleagues (2010) found stronger impacts for rural versus urban sites. The researchers noted that aspects of the community may explain these differences; for example, the tendency to facilitate referrals through word of mouth, or the lack of other community resources in the rural communities.

Professional development. The Fixsen and colleagues (2005) review identified professional development, including coaching and ongoing support, to be critical to implementation. Evidence indicates that although initial training is critical, ongoing professional development is also important for implementation. For example, Aarons and colleagues (2009a, 2009b) found home visitors who were given fidelity monitoring along with supervision and consultation had lower levels of emotional exhaustion and burnout, two variables found to negatively impact fidelity. In addition, the home visitors with supervision and consultation were more likely to remain employed by the program, therefore reducing costs and time of hiring and retraining staff.

Infrastructure to support implementation is critical to the success of an evidence based home visiting program (including promising approaches) in achieving the intended impacts. Though the field is growing, rigorous research in real-world settings at scale is necessary to better identify key levers of infrastructure related to the achievement of the desired effects in evidence-based programs and promising approaches.

Researchers regularly state that the available information in many of the efficacy trials currently is lacking in depth and breadth around implementation of the programs. In their detailed synthesis of the literature, Fixsen and colleagues (2005) noted that the proportion of research studies on implementation that utilized rigorous designs was small. An important component of the purpose of the activities to be supported under this grant program is to support quality implementation and the building of infrastructure necessary for quality implementation of evidence-based practices and to rigorously evaluate those supports, with the ultimate goal of building knowledge about the necessary factors to support the capacity of evidence-based programs to achieve their intended outcomes, as well as to build solid foundations to support evidence-based home visiting services to families in at-risk communities.

2. Award Information

1. Type of Award

Funding will be provided in the form of a grant.

2. Summary of Funding

1. Grant Categories

This program will provide funding for two possible grant categories: Innovator Grants for FY 2011 – 2014 and Development Grants for FY 2011- 2012.

Innovator Grants

These grants recognize states and jurisdictions that have already made significant progress towards a high-quality home visiting program or in successfully embedding their home visiting program into a comprehensive, high-quality early childhood system. States applying for this grant will use the funds to either (1) enhance one or more priority elements of a home visiting program or (2) initiate a statewide expansion of one home visiting priority element currently operating at a local or regional level.

Approximately $66 million of the competitive funding will be awarded in FY 2011 for seven to 10 four-year grants. The total grant award may range between $6.6 million to $9.43 million annually. The number of grants awarded for FY 2011 will be contingent upon the quality of the applications and availability of funding. Applicants may apply for a ceiling amount up to $9.43 million annually. Funding beyond the first year is dependent on the availability of appropriated funds for the Maternal, Infant, and Early Childhood Home Visiting Program in subsequent fiscal years, grantee satisfactory performance, and a decision that continued funding is in the best interest of the Federal government.

Development Grants

Development Grants are for states and jurisdictions that currently have modest home visiting programs and want to build on existing efforts, while focusing on one of the priority elements listed below. The intent is for states to use Development Grants as stepping stones towards becoming competitive in receiving an Innovator Grant in the future.

Approximately $33 million of the competitive FY11 funding will be awarded for 10-12, two-year grants. The total grant award may range between $2.75 million and $3.3 million annually. Applicants may apply for up to $3.3 million per year. Funding beyond the first year is dependent on the availability of appropriated funds for the MIECHV program in subsequent fiscal years, grantee satisfactory performance, and a decision that continued funding is in the best interest of the Federal government.

2. Home Visiting Program Priority Elements

As previously mentioned, HRSA and ACF have identified the following priority elements as important components of a home visiting program or system, and of a comprehensive, high-quality early childhood system:

Priority Element 1: Innovations to support improvements in maternal, child, and family health through home visiting programs or systems. Such innovations may include, but are not limited to, the following:

• Home visiting to women at high medical risk;

• Interconception care and counseling;

• The provision of mental health services;

• Obesity prevention;

• Establishing a medical home;

• Tobacco cessation programs;

• Behavioral health (including services for substance abusing caregivers);

• Engaging health service providers in at-risk communities to encourage identification and referral of pregnant women, young children, and families to home visiting programs;

• Fostering partnerships between home visiting programs and other state and local partners to reduce health disparities;

• Innovations to address child development within the framework of life course development and a socio-ecological perspective; or,

• Innovations to support the use of technology in delivery of home visiting services.

Priority Element 2: Innovations that support effective implementation of home visiting programs or systems. Such innovations may include, but are not limited to, the following:

• Supporting, recruiting, training, and retaining staff;

• High-quality supervision;

• Recruiting and retaining participants; or

• Building strong local organizational and management capacity for implementation (e.g., innovations regarding fidelity assessment, monitoring and continuous quality improvement, training and technical assistance, and other quality improvement strategies to support high quality statewide implementation).

Priority Element 3: Innovations that support the development of statewide or multi-state home visiting programs. These innovations may include, but are not limited to, the following:

• Developing cross-model program standards;

• Developing core competencies for home visitors and supervisors;

• Integrated home visiting data systems;

• Common benchmarks across models or states;

• Centralized intake systems; or

• Integrating home visiting services with other medical services (e.g., community health centers, medical homes, etc.).

Priority Element 4: Innovations that support the development of comprehensive early childhood systems that span the prenatal through age eight continuum. These innovations may include, but are not limited to, the following:

• Integrated early childhood data systems that include home visiting programs;

• Coordinated early childhood workforce and professional development systems that include home visitors (including career ladders and pathways, and centralized professional development and training systems);

• The use of home visiting as a “hub” for the development of local place-based early childhood systems that leverage public-private partnerships, data and measurement tools (such as the Early Development Instrument (EDI)); and

• Centralized intake and referral systems to facilitate coordinated strategic planning and service delivery to improve the community environment and support positive child and family health, learning, and development outcomes.

Priority Element 5: Innovations for reaching high-risk and hard-to-engage populations. These innovations may include, but are not limited to, the following:

• Families at greatest risk for negative outcomes related to child maltreatment, substance abuse, domestic violence, or other adversities;

• Families with children involved with the child welfare system;

• Families with dual language learner children;

• Children with developmental delays; parents with disabilities; or

• Families with members in the Armed Forces.

Priority Element 6: Innovations that support a family-centered approach to home visiting. These innovations may include, but are not limited to, the following:

• Engagement of fathers;

• Engagement of non-custodial parents; or

• Engagement of other primary caregivers including grandparents, other relatives and kinship caregivers, or foster parents.

Priority Element 7: Innovations for reaching families in rural or frontier areas through home visiting programs.

Priority Element 8: Innovations that support fiscal leveraging strategies to enhance program sustainability. These innovations may include, but are not limited to, the following:

• Public/private partnerships;

• Medicaid reimbursement; or

• Medicaid/CHIP partnerships.

Innovator Grant applicants may propose to either (1) enhance one or more priority elements of a home visiting program or (2) initiate a statewide expansion of one priority element currently operating at a local or regional level.

Development Grant applicants may implement or build on only one priority element.

Please note: Enhancements of evidence-based home visiting models with one or more of the aforementioned priority elements may constitute an adaptation to the model. For the purposes of the MIECHV program, an acceptable adaptation of an evidence-based model includes changes to the model that have not been tested with rigorous impact research but are determined by the model developer not to alter the core components related to program impacts.

Changes to an evidence-based model that alter the components related to program outcomes could undermine the program’s effectiveness. Such changes (otherwise known as “Drift”) will not be allowed under the funding allocated for evidence-based models. Adaptations that alter the core components related to program impacts may be funded with funds available for promising approaches if the state wishes to implement the program as a promising approach instead of as an acceptable adaptation of an evidence-based model. Per the authorizing legislation, at least 75 percent of the total grant funds (i.e., formula and competitive funds combined) must be used for evidence-based home visiting models. The state may propose to expend up to 25 percent of the total grant funds to support a model that qualifies as a promising approach.

Accordingly, applicants must provide documentation of approval by the model developer to implement the model, with the priority element enhancement, as proposed. The documentation should include verification that the model developer has reviewed and agreed to the competitive application submitted, including any proposed adaptations, support for participation in the national evaluation, and any other related HHS effort to coordinate evaluation and programmatic technical assistance. This documentation should include the state’s status with regard to any required certification or approval process required by the developer.

Applicants are also expected to ground their proposal in relevant empirical work⁴ and include an articulated theory of change. As previously mentioned, all grantees must include an evaluation plan specifying how the proposed initiative will be evaluated using a well-designed and rigorous process. Please see Section VIII.1 Other Information: Evaluation Criteria. The criteria provided are in line with the guidance provided for evaluation of promising approaches in the Supplemental Information Request (SIR) for the Submission of the Updated State Plan for a State Home Visiting Program.⁵ Grantees are also expected to participate in a community of practice relevant to the goal of the grant award.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants of this competitive grant opportunity include all eligible entities as defined in Section 511(k)(1)(A): States, Puerto Rico, Guam, the Virgin Islands, the Northern Mariana Islands, and America Samoa.

2. Cost Sharing/Matching

There are no cost sharing/matching requirements for the Maternal, Infant, and Early Childhood Home Visiting Competitive Grant Program.

3. Other

1. Maintenance of Effort/Non-Supplantation

Funds provided to an eligible entity receiving a grant shall supplement, and not supplant, funds from other sources for early childhood home visitation programs or initiatives. The grantee must agree to maintain non-Federal funding (State General Funds) for grant activities at a level which is not less than expenditures for such activities as of the date of enactment of this legislation, March 23, 2010.

For purposes of maintenance of effort/non-supplantation in this FOA, home visiting is defined as an evidence-based program, implemented in response to findings from a needs assessment, that includes home visiting as a primary service delivery strategy (excluding programs with infrequent or supplemental home visiting), and is offered on a voluntary basis to pregnant women or children birth to age 5 targeting the participant outcomes in the legislation which include improved maternal and child health, prevention of child injuries, child abuse, or maltreatment, and reduction of emergency department visits, improvement in school readiness and achievement, reduction in crime or domestic violence, improvements in family economic self-sufficiency, and improvements in the coordination and referrals for other community resources and supports.”

As with state formula funding for the MIECHV program, if state general revenue funds for evidence-based home visiting programs have fallen below the amount spent under state law and policies in place on March 23, 2010, the award of Federal funds under this program will be presumed to constitute supplantation. The state may rebut this presumption by demonstrating that any reduction in state funding was unrelated to the receipt or availability of Federal Home Visiting program funds. States wishing to provide a rationale which demonstrates compliance with the non-supplantation requirement should submit a justification in writing to HRSA’s Maternal and Child Health Bureau.

While no further requirements apply, applicants meeting the review criteria for “Sustainability and Commitment to Home Visiting” will be awarded additional points in the competitive reviewing process. See Section V.1: Application Review Information–Review Criteria # 7 for both Innovator and Development Grants.

2. Number of Applications

An applicant may only submit one application for either an Innovator Grant or a Development Grant. An applicant may not submit applications for both grant categories. Any applicant submitting applications to both grant categories will be in violation of the application requirements and will not be considered for funding under this announcement.

3. Ceiling Amount

Applications that exceed the ceiling amount for the grant category to which the applicant is applying will be considered non-responsive and will not be considered for funding under this announcement.

4. Deadlines

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

• Address to Request Application Package

1. Application Materials and Required Electronic Submission Information

HRSA requires applicants for this funding opportunity announcement to apply electronically through Grants.gov. This robust registration and application process protects applicants against fraud and ensures only that only authorized representatives from an organization can submit an application. Applicants are responsible for maintaining these registrations, which should be completed well in advance of submitting your application. All applicants must submit in this manner unless they obtain a written exemption from this requirement in advance by the Director of HRSA’s Division of Grants Policy. Applicants must request an exemption in writing from [email protected], and provide details as to why they are technologically unable to submit electronically through the Grants.gov portal. Your email must include the HRSA announcement number for which you are seeking relief, the organization’s DUNS number, the name, address, and telephone number of the organization and the name and telephone number of the Project Director as well as the Grants.gov Tracking Number (GRANTXXXX) assigned to your submission along with a copy of the “Rejected with Errors” notification you received from Grants.gov. HRSA and its Grants Application Center (GAC) will only accept paper applications from applicants that received prior written approval. However, the application must still be submitted under the deadline. Applicants that fail to allow ample time to complete registration with CCR and/or Grants.gov will not be eligible for a deadline extension or waiver of the electronic submission requirement.

All applicants are responsible for reading the instructions included in HRSA’s Electronic Submission User Guide, available online at http://www.hrsa.gov/grants/userguide.htm. This Guide includes detailed application and submission instructions for both Grants.gov and HRSA’s Electronic Handbooks. Pay particular attention to Sections 2 and 5 that provide detailed information on the competitive application and submission process.

Applicants must submit proposals according to the instructions in the Guide and in this funding opportunity announcement in conjunction with Application Form SF-424. The forms contain additional general information and instructions for applications, proposal narratives, and budgets. The forms and instructions may be obtained from the following site by:

1. Downloading from http://www.grants.gov, or

2. Contacting the HRSA Grants Application Center at:

910 Clopper Road

Suite 155 South

Gaithersburg, MD 20878

Telephone: (877) 477-2123

[email protected]

Each funding opportunity contains a unique set of forms and only the specific forms package posted with an opportunity will be accepted for that opportunity. Specific instructions for preparing portions of the application that must accompany Application Form SF-424 appear in the “Application Format” section below.

1. Content and Form of Application Submission

Application Format Requirements

The total size of all uploaded files may not exceed the equivalent of 80 pages when printed by HRSA, or a total file size of 10 MB. This 80-page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support. Standard forms are NOT included in the page limit.

Applications that exceed the specified limits (approximately 10 MB, or 80 pages when printed by HRSA) will be deemed non-responsive. All application materials must be complete prior to the application deadline. Applications that are modified after the posted deadline will also be considered non-responsive. Non-responsive applications will not be considered under this funding announcement.

Application Format

Applications for funding must consist of the following documents in the following order:

SF-424 Non-Construction – Table of Contents

• It is mandatory to follow the instructions provided in this section to ensure that your application can be printed efficiently and consistently for review.

• Failure to follow the instructions may make your application non-responsive. Non-responsive applications will not be considered under this funding opportunity announcement.

• For electronic submissions, applicants only have to number the electronic attachment pages sequentially, resetting the numbering for each attachment, i.e., start at page 1 for each attachment. Do not attempt to number standard OMB approved form pages.

• For electronic submissions, no Table of Contents is required for the entire application. HRSA will construct an electronic table of contents in the order specified.

• When providing any electronic attachment with several pages, add a Table of Contents page specific to the attachment. Such pages will not be counted towards the page limit.

Application Section	Form Type	Instruction	HRSA/Program Guidelines
Application for Federal Assistance (SF-424)	Form	Pages 1, 2 & 3 of the SF-424 face page.	Not counted in the page limit
Project Summary/Abstract	Attachment	Can be uploaded on page 2 of SF-424 - Box 15	Required attachment. Counted in the page limit. Refer to the funding opportunity announcement for detailed instructions.
Additional Congressional District	Attachment	Can be uploaded on page 3 of SF-424 - Box 16	As applicable to HRSA; not counted in the page limit.
Application Checklist Form HHS-5161-1	Form	Pages 1 & 2 of the HHS checklist.	Not counted in the page limit.
Project Narrative Attachment Form	Form	Supports the upload of Project Narrative document	Not counted in the page limit.
Project Narrative	Attachment	Can be uploaded in Project Narrative Attachment form.	Required attachment. Counted in the page limit. Refer to the funding opportunity announcement for detailed instructions. Provide table of contents specific to this document only as the first page.
SF-424A Budget Information - Non-Construction Programs	Form	Page 1 & 2 to supports structured budget for the request of Non-construction related funds.	Not counted in the page limit.
Budget Narrative Attachment Form	Form	Supports the upload of Project Narrative document.	Not counted in the page limit.
Budget Narrative	Attachment	Can be uploaded in Budget Narrative Attachment form.	Required attachment. Counted in the page limit. Refer to the funding opportunity announcement for detailed instructions.
SF-424B Assurances - Non-Construction Programs	Form	Supports assurances for non-construction programs.	Not counted in the page limit.
Project/Performance Site Location(s)	Form	Supports primary and 29 additional sites in structured form.	Not counted in the page limit.
Additional Performance Site Location(s)	Attachment	Can be uploaded in the SF-424 Performance Site Location(s) form. Single document with all additional site location(s)	Not counted in the page limit.
Disclosure of Lobbying Activities (SF-LLL)	Form	Supports structured data for lobbying activities.	Not counted in the page limit.
Other Attachments Form	Form	Supports up to 15 numbered attachments. This form only contains the attachment list.	Not counted in the page limit.
Attachment 1-15	Attachment	Can be uploaded in Other Attachments form 1-15.	Refer to the attachment table provided below for specific sequence. Counted in the page limit.

• To ensure that attachments are organized and printed in a consistent manner, follow the order provided below. Note that these instructions may vary across programs.

• Evidence of Non-Profit status and invention related documents, if applicable, must be provided in the other attachment form.

• Additional supporting documents, if applicable, can be provided using the available rows. Do not use the rows assigned to a specific purpose in the program funding opportunity announcement.

• Merge similar documents into a single document. Where several pages are expected in the attachment, ensure that you place a table of contents cover page specific to the attachment. The Table of Contents page will not be counted in the page limit.

Attachment Number	Attachment Description (Program Guidelines)
Attachment 1	Tables, Charts, etc.
Attachment 2	Job Descriptions for Key Personnel
Attachment 3	Biographical Sketches of Key Personnel
Attachment 4	Letters of Agreement and/or Description(s) of Proposed/Existing Contracts
Attachment 5	Project Organizational Chart
Attachment 6	Maintenance of Effort Documentation
Attachment 7	For Multi-Year Budgets—Budgets for Years 1 – 4 (Innovator Grants) or Budgets for Years 1 and 2 (Development Grants)
Attachment 8	Summary Progress Report
Attachment 9	Timeline
Attachment 10	Model Developer Approval Letter
Attachment 11	Other Relevant Documents not specified elsewhere in the Table of Contents
Attachment 12
Attachment 13
Attachment 14
Attachment 15

Application Format

1. Application Face Page

Complete Application Form SF-424 provided with the application package. Prepare according to instructions provided in the form itself. For information pertaining to the Catalog of Federal Domestic Assistance, the CFDA Number is 93.XXX.

DUNS Number

All applicant organizations (and subrecipients of HRSA award funds) are required to have a Data Universal Numbering System (DUNS) number in order to apply for a grant or cooperative agreement from the Federal Government. The DUNS number is a unique nine-character identification number provided by the commercial company, Dun and Bradstreet. There is no charge to obtain a DUNS number. Information about obtaining a DUNS number can be found at http://fedgov.dnb.com/webform or call 1-866-705-5711. Please include the DUNS number in item 8c on the application face page. Applications will not be reviewed without a DUNS number. Note: A missing or incorrect DUNS number is the number one reason for applications being “Rejected for Errors” by Grants.gov. HRSA will not extend the deadline for applications with a missing or incorrect DUNS. Applicants should take care in entering the DUNS number in the application.

Additionally, the applicant organization (and any subrecipient of HRSA award funds) is required to register annually with the Federal Government’s Central Contractor Registry (CCR) in order to do electronic business with the Federal Government. CCR registration must be maintained with current, accurate information at all times during which an entity has an active award or an application or plan under consideration by HRSA. It is extremely important to verify that your CCR registration is active and your MPIN is current. Information about registering with the CCR can be found at http://www.ccr.gov.

2. Table of Contents

The application should be presented in the order of the Table of Contents provided earlier. Again, for electronic applications no table of contents is necessary as it will be generated by the system. (Note: the Table of Contents will not be counted in the page limit.)

2. Application Checklist

Complete the HHS Application Checklist Form HHS 5161-1 provided with the application package.

2. Budget

Complete Application Form SF-424A Budget Information – Non-Construction Programs provided with the application package.

Please complete Sections A, B, E, and F, and then provide a line item budget for each year of the project period using Section B Budget Categories of the SF-424A. Applicants must use the Section B columns (2) through (4) for subsequent budget years (up to four years). For year 5, please submit a copy of Section B of the SF-424A as Attachment XX.

2. Budget Justification

Provide a narrative that explains the amounts requested for each line in the budget. The budget justification should specifically describe how each item will support the achievement of proposed objectives. The budget period is for ONE year. However, the applicant must submit one-year budgets for each of the subsequent budget periods within the requested project period (usually one to four years) at the time of application. Therefore, for Innovator Grants applicants must submit one-year budgets for years one (1) through four (4). Development Grant applicants must submit budgets for years one (1) and two (2).

Line item information must be provided to explain the costs entered in the SF-424A budget form. The budget justification must clearly describe each cost element and explain how each cost contributes to meeting the project’s objectives/goals. Be very careful about showing how each item in the “other” category is justified. For subsequent budget years, the justification narrative should highlight the changes from year one or clearly indicate that there are no substantive budget changes during the project period. The budget justification MUST be concise. Do NOT use the justification to expand the project narrative.

Budget for Multi-Year Award

This announcement is inviting applications for project periods up to four (4) years. Development grant applicants must submit applications for a four-year project period. Innovator Grant applicants must submit applications for two-year project periods. Awards, on a competitive basis, will be for a one-year budget period; although the project period may be four (4) years for Innovative Grants and two (2) years for Development Grants.  Submission and HRSA approval of your Progress Report(s) and any other required submission or reports is the basis for the budget period renewal and release of subsequent year funds.  Funding beyond the one-year budget period but within the four-year and two-year project periods is subject to availability of funds, satisfactory progress of the awardee, and a determination that continued funding would be in the best interest of the Federal government.

Include the following in the Budget Justification narrative:

Personnel Costs: Personnel costs should be explained by listing each staff member who will be supported from funds, name (if possible), position title, percentage of full-time equivalency, and annual salary.

Fringe Benefits: List the components that comprise the fringe benefit rate, for example health insurance, taxes, unemployment insurance, life insurance, retirement plans, and tuition reimbursement. The fringe benefits should be directly proportional to that portion of personnel costs that are allocated for the project.

Travel: List travel costs according to local and long distance travel. For local travel, the mileage rate, number of miles, reason for travel and staff member/consumers completing the travel should be outlined. The budget should also reflect the travel expenses associated with participating in meetings and other proposed trainings or workshops.

Equipment: List equipment costs and provide justification for the need of the equipment to carry out the program’s goals. Extensive justification and a detailed status of current equipment must be provided when requesting funds for the purchase of computers and furniture items that meet the definition of equipment (a unit cost of $5,000 or more and a useful life of one or more years).

Supplies: List the items that the project will use. In this category, separate office supplies from medical and educational purchases. Office supplies could include paper, pencils, and the like; medical supplies are syringes, blood tubes, plastic gloves, etc., and educational supplies may be pamphlets and educational videotapes. Remember, they must be listed separately.

Contractual: Applicants are responsible for ensuring that their organization or institution has in place an established and adequate procurement system with fully developed written procedures for awarding and monitoring all contracts. Applicants must provide a clear explanation as to the purpose of each contract, how the costs were estimated, and the specific contract deliverables. Reminder: recipients must notify potential subrecipients that entities receiving subawards must be registered in the Central Contractor Registry (CCR) and provide the recipient with their DUNS number.

Other: Put all costs that do not fit into any other category into this category and provide an explanation of each cost in this category. In some cases, rent, utilities and insurance fall under this category if they are not included in an approved indirect cost rate.

Applicants may include the cost of access accommodations as part of their project’s budget, including sign interpreters, plain language and health literate print materials in alternate formats (including Braille, large print, etc.); and cultural/linguistic competence modifications such as use of cultural brokers, translation or interpretation services at meetings, clinical encounters, and conferences, etc.

Indirect Costs: Indirect costs are those costs incurred for common or joint objectives which cannot be readily identified but are necessary to the operations of the organization, e.g., the cost of operating and maintaining facilities, depreciation, and administrative salaries. For institutions subject to OMB Circular A-21, the term “facilities and administration” is used to denote indirect costs. If an organization applying for an assistance award does not have an indirect cost rate, the applicant may wish to obtain one through HHS’s Division of Cost Allocation (DCA).  Visit DCA’s website at: http://rates.psc.gov/ to learn more about rate agreements, the process for applying for them, and the regional offices which negotiate them.

2. Staffing Plan and Personnel Requirements

Applicants must present a staffing plan and provide a justification for the plan that includes education and experience qualifications and rationale for the amount of time being requested for each staff position. Position descriptions that include the roles, responsibilities, and qualifications of proposed project staff must be included in Attachment 2 Biographical sketches for any key employed personnel that will be assigned to work on the proposed project must be included in Attachment 3. When applicable, biographical sketches should include training, language fluency and experience working with the cultural and linguistically diverse populations that are served by their programs.

2. Assurances

Complete Application Form SF-424B Assurances – Non-Construction Programs provided with the application package.

2. Certifications

Use the Certifications and Disclosure of Lobbying Activities Application Form provided with the application package.

2. Project Abstract

Provide a summary of the application. Because the abstract is often distributed to provide information to the public and Congress, please prepare this so that it is clear, accurate, concise, and without reference to other parts of the application. It must include a brief description of the proposed project including the needs to be addressed, the proposed services, and the population group(s) to be served.

Please place the following at the top of the abstract:

• Project Title

• Applicant Name

• Address

• Contact Phone Numbers (Voice, Fax)

• E-Mail Address

• Web Site Address, if applicable

The project abstract must be single-spaced and limited to one page in length.

2. Program Narrative

This section provides a comprehensive framework and description of all aspects of the proposed program. It should be succinct, self-explanatory and well organized so that reviewers can understand the proposed project.

Instructions for preparing each major section of the project narrative are outlined below. Follow them carefully, as they form the basis for addressing the Review Criteria (see Section V), which will be used for the evaluation and rating of applications submitted to the Maternal, Infant, and Early Childhood Home Visiting Program. Applicants are strongly encouraged to organize their project narratives by these seven (7) major headings, each of which is explained below:

Use the following section headers for the Narrative:

• Introduction

The introduction must provide:

• A brief description of the project’s proposed purpose;

• Applicants for Innovator Grants: A description of the state’s history of significant progress towards implementing a high-quality home visiting program, in a comprehensive, high-quality early childhood system;

• Applicants for Development Grants: A description of the steps previously taken towards addressing one of the aforementioned priority elements in their home visiting program;

• A clear description of the problem, the proposed intervention, and the anticipated benefit of the project;

• The priority element(s) that will be addressed:

• Applicants for Innovators Grants may propose to either (1) enhance one or more priority elements of a home visiting program or (2) initiate a statewide expansion of one home visiting priority element currently operating at a local or regional level.

• Applicants for Development Grants may implement or build on only one priority element.

• A description of how the priority element(s) identified and the proposal will build on, or enhance, the applicant’s existing MIECHV program;

• A logic model for the proposed project that builds on the logic model for the existing state MIECHV program, but makes a distinction between the existing program and what this additional grant would provide.

• NEEDS ASSESSMENT

This section should provide a thorough assessment of the applicant’s current home visiting program. Accordingly, this assessment must:

• Identify the existing gaps in the applicants home visiting program and discuss any relevant barriers in the service area that the project hopes to overcome;

• Communicate the perceived impact of these gaps and barriers on the applicants ability to provide comprehensive family services, coordinated and comprehensive statewide home visiting program, within a high-quality early childhood system;

• Provide the estimated number of families that will be reached by the proposed project; and

• Explain how the priority element(s) selected will reach the applicants desired outcomes for the proposed initiative.

Demographic data should be used and cited whenever possible to support the information provided.

• Methodology

• Specify the evidence-based model(s) or promising approach(es) that will be supported by the competitive funding. The HHS criteria for evidence-based models and a list of the approved evidenced-based models is located under Section VIII—Other Information.

• Clearly describe the goals and objectives using an approach that is specific, time-oriented, measurable, and responds to the identified challenges facing the proposed project.

• Propose methods that will be used to meet each of the previously-described program requirements and expectations in this FOA. Applicants are expected to ground their proposed methods in relevant empirical work and have an articulated theory of change. For the purposes of this FOA, empirical work includes evidence from research, theory, practice, context, or cultural knowledge.

• Work Plan

• Describe the activities or steps that will be used to achieve each of the activities proposed during the entire project period in the Methodology section.

• Use a time line that includes each activity and identifies responsible staff. The description of the project methodology should extend across the two or four years of the project efforts. A project timeline that spans the two or four years of project effort should be formulated and attached as Attachment 9.

• As appropriate, identify meaningful support and collaboration with key stakeholders in planning, designing, implementing and evaluating all activities, including development of the application and, further, the extent to which these contributors reflect the cultural, racial, linguistic and geographic diversity of the populations and communities served. A list of required and recommended partners is provided in Section VIII.5—Other Information: List of Required and Recommended Partners. Consistent with the guidance in the 2^nd SIR, these partners have been identified to demonstrate agreement and support for the proposed initiative and to ensure that home visiting is part of a continuum of early childhood services within the state.

• Provide a plan to ensure incorporation of project goals, objectives, and activities into the ongoing work of the eligible applicant and any other partners at the end of the federal grant.

• Resolution of Challenges

Discuss challenges that are likely to be encountered in designing and implementing the activities described in the Work Plan, and approaches that will be used to resolve such challenges.

• Evaluation and Technical Support Capacity

• Describe current experience, skills, and knowledge, including individuals on staff, materials published, and previous work of a similar nature.

• Demonstrate evidence of organizational experience and capability to coordinate and support planning, implementation, and evaluation of a comprehensive plan to meet the objectives of this initiative.

• Describe an evaluation plan that will: (1) measure whether the intended outcomes of the project were attained (2) monitor the efficiency of the proposed project activities, and (3) meet the definitions of rigor and other evaluation criteria stipulated under Section VIII.1—Other Information: Guidelines for Evaluation. Project level evaluation methodology should be specific and related to the stated goals, objectives, and priorities of the project. Applicants shall include a proposed evaluation plan with all of the elements discussed in Section (i) under Other Information below.

• Organizational Information

• Provide information on the applicant organization’s current mission and structure, the scope of the organization’s current activities related to home visiting and early childhood systems, and an organizational chart. Describe how these all contribute to the ability of the organization to conduct the program requirements and meet program expectations.

• Information about the organization’s record of accomplishments may be included under Attachment 8: Accomplishments Summary.

• Provide information on the program’s resources and capabilities to support provision of culturally and linguistically competent and health literate services.

• Describe how the unique needs of target populations of the communities served are routinely assessed and improved. Also describe the organizational capacity of any partnering agencies or organizations involved in the implementation of the project.

• Describe the adequacy of resources to continue the proposed project after the grant period ends and the state’s demonstrated commitment to home visiting.

• Provide an assurance that cuts in state funding will not be made to a broad array of home visiting programs in the future.

2. Program Specific Forms, if applicable

There are no program specific forms for the Maternal, Infant, and Early Childhood Home Visiting Program’s Competitive Grant Application.

2. Attachments

Note: these and any other required application attachments MUST be either referenced in the Application Section if already listed, or included as specific “Attachment Numbers” in that portion of your Table of Contents listed in section IV.2.

Please provide the following items to complete the content of the application. Please note that these are supplementary in nature, and are not intended to be a continuation of the project narrative. Unless otherwise noted, attachments count toward the application page limit. Each attachment must be clearly labeled.

Attachment 1: Tables, Charts, etc.

To give further details about the proposal (e.g., Gantt or PERT charts, flow charts, etc.).

Attachment 2: Job Descriptions for Key Personnel

Keep each to one page in length as much as is possible. Include the role, responsibilities, and qualifications of proposed project staff.

Attachment 3: Biographical Sketches of Key Personnel

Include biographical sketches for persons occupying the key positions described in Attachment 2, not to exceed two pages in length. In the event that a biographical sketch is included for an identified individual who is not yet hired, please include a letter of commitment from that person with the biographical sketch.

Attachment 4: Letters of Agreement and/or Description(s) of Proposed/Existing Contracts (project specific)

Provide any documents that describe working relationships between the applicant organization and other agencies and programs cited in the proposal. Documents that confirm actual or pending contractual agreements should clearly describe the roles of the subcontractors and any deliverable. Letters of agreement must be dated.

Attachment 5: Project Organizational Chart

Provide a one-page figure that depicts the organizational structure of the project, including subcontractors and other significant collaborators.

Attachment 6: Maintenance of Effort/Non-Supplantation Documentation, if applicable.

Funds provided to an eligible entity receiving a grant shall supplement, and not supplant, funds from other sources for early childhood home visitation programs or initiatives. The grantee must agree to maintain non-Federal funding (State General Funds) for grant activities at a level which is not less than expenditures for such activities as of the date of enactment of this legislation, March 23, 2010.

For purposes of maintenance of effort/non-supplantation in this FOA, home visiting is defined as an evidence-based program, implemented in response to findings from a needs assessment, that includes home visiting as a primary service delivery strategy (excluding programs with infrequent or supplemental home visiting), and is offered on a voluntary basis to pregnant women or children birth to age 5 targeting the participant outcomes in the legislation which include improved maternal and child health, prevention of child injuries, child abuse, or maltreatment, and reduction of emergency department visits, improvement in school readiness and achievement, reduction in crime or domestic violence, improvements in family economic self-sufficiency, and improvements in the coordination and referrals for other community resources and supports.”

As with state formula funding for the MIECHV program, if state general revenue funds for evidence-based home visiting programs have fallen below the amount spent under state law and policies in place on March 23, 2010, the award of Federal funds under this program will be presumed to constitute supplantation. The state may rebut this presumption by demonstrating that any reduction in state funding was unrelated to the receipt or availability of Federal Home Visiting program funds. States wishing to provide a rationale which demonstrates compliance with the non-supplantation requirement should submit a justification in writing to HRSA’s Maternal and Child Health Bureau.

Attachment 7: Budgets for Years 1 – 4 (Innovation Grants) or Budgets for Years 1 and 2 (Development Grants)

After using columns (1) through (4) of the SF-424A Section B for a two- or four-year project period, the applicant will need to submit the budgets for years one through four (as applicable) as an attachment. They should use the SF-424A Section B.

Attachment 8:  Accomplishment Summary

A well planned accomplishment summary can be of great value by providing a record of accomplishments.  The accomplishments of applicants are carefully considered during the review process; therefore, applicants are advised to include a brief summary (no more than five pages) of their accomplishments.  The summary should provide a concise, yet thorough, presentation of the applicant’s experience, including but not limited to the following:

The applicant’s experience in:

1. Implementing home visiting programs;

2. Fostering the integration of home visiting programs into early childhood systems;

3. Promoting effective policy to support and strengthen home visiting programs;

4. Evaluating programs and using the information received to improve the quality of home visiting programs and early childhood systems;  

5. Improving outcomes for families served by the home visiting program; and  

6. Providing services to vulnerable or high-risk populations

7. Other items?

Attachment 9: Timeline (Required. To be developed by applicant)

The timeline links activities to project objectives and should cover the four (4) year project period for Innovator Grants or the two (2) year project period for Development Grants. This table, chart, or figure details activities necessary to carry out each methodological approach, including approaches to major categories of activities and appropriate tracking methods. It includes a format to describe the “who, what, when, where, and how” of each approach.

Attachment 10: Model Developer Approval Letter

States electing to implement an approved evidence-based model must provide documentation of approval by the developer to implement the model as proposed. The documentation should include verification that the model developer has reviewed and agreed to the plan as submitted, including any proposed adaptation, support for participation in the national evaluation, and any other related HHS efforts to coordinate evaluation and programmatic technical assistance. This documentation should include the state’s status with regard to any required certification or approval process required by the developer.

Attachment 11: Other Relevant Documents

Include here any other documents that are relevant to the application, including letters of support. Letters of support must be dated.

Include only letters of support which specifically indicate a commitment to the project/program (in-kind services, dollars, staff, space, equipment, etc.) Letters of agreement and support must be dated. List all other support letters on one page.

1. Submission Dates and Times

Notification of Intent to Apply

An applicant is eligible to apply even if no letter of intent is submitted. The letter should identify the applicant organization and its intent to apply, and briefly describe the proposal to be submitted. Receipt of Letters of Intent will not be acknowledged.

This letter should be sent by June 10, 2011, by mail or fax to:

Director, Division of Independent Review

HRSA Grants Application Center (GAC)

HRSA-XX-XXX

910 Clopper Road, Suite 155 South

Gaithersburg, MD 20878

Fax: (877) 477-2345

Application Due Date

The due date for applications under this funding opportunity announcement is June 30, 2011 at 8:00 P.M. ET. Applications completed online are considered formally submitted when the application has been successfully transmitted electronically by your organization’s Authorized Organization Representative (AOR) through Grants.gov and has been validated by Grants.gov on or before the deadline date and time.  

The Chief Grants Management Officer (CGMO) or designee may authorize an extension of published deadlines when justified by circumstances such as natural disasters (e.g., floods or hurricanes) or other disruptions of services, such as a prolonged blackout. The CGMO or designee will determine the affected geographical area(s).

Applications must be submitted by 8:00 P.M. ET. To ensure that you have adequate time to follow procedures and successfully submit the application, we recommend you register immediately in Grants.gov (see Appendix XX) and complete the forms as soon as possible, as this is a new process and may take some time.

Please refer to Appendix XX for important specific information on registering, and Appendix XX, Section XX for important information on applying through Grants.gov.

Late applications:

Applications which do not meet the criteria above are considered late applications. Health Resources and Services Administration (HRSA) shall notify each late applicant that its application will not be considered in the current competition.

1. Intergovernmental Review

The Maternal, Infant, and Early Childhood Home Visiting Program is not a program subject to the provisions of Executive Order 12372, as implemented by 45 CFR 100.

2. Funding Restrictions

Innovator Grants

Approximately $66 million of the competitive funding will be awarded in FY 2011 for seven to 10 four-year grants. The total grant award may range between $6.6 million to $9.43 million annually. The number of grants awarded for FY 2011 will be contingent upon the quality of the applications and availability of funding. Applicants may apply for a ceiling amount up to $9.43 million annually. Funding beyond the first year is dependent on the availability of appropriated funds for the Maternal, Infant, and Early Childhood Home Visiting Program in subsequent fiscal years, grantee satisfactory performance, and a decision that continued funding is in the best interest of the Federal government.

Development Grants

Approximately $33 million of the competitive FY11 funding will be awarded for 10-12, two-year grants. The total grant award may range between $2.75 million and $3.3 million annually. Applicants may apply for up to $3.3 million per year. Funding beyond the first year is dependent on the availability of appropriated funds for the Maternal, Infant, and Early Childhood Home Visiting Program in subsequent fiscal years, grantee satisfactory performance, and a decision that continued funding is in the best interest of the Federal government.

Applications with budget requests exceeding the specified ceiling for each grant will be deemed non-compliant, and will not be considered for funding. These applications may be returned without further review. Awards to support projects beyond the first budget year but within the two to four year project period will be contingent upon Congressional appropriation, satisfactory progress in meeting the project’s objectives, and a determination that continued funding would be in the best interest of the Government.

2. Other Submission Requirements

As stated in Section IV.1, except in very rare cases HRSA will no longer accept applications in paper form. Applicants submitting for this funding opportunity are required to submit electronically through Grants.gov. To submit an application electronically, please use the http://www.Grants.gov APPLY site. When using Grants.gov you will be able to download a copy of the application package, complete it off-line, and then upload and submit the application via the Grants.gov site.

It is essential that your organization immediately register in Grants.gov and become familiar with the Grants.gov site application process. If you do not complete the registration process you will be unable to submit an application. The registration process can take up to one month.

To be able to successfully register in Grants.gov, it is necessary that you complete all of the following required actions:

• Obtain an organizational Data Universal Number System (DUNS) number

• Register the organization with Central Contractor Registry (CCR)

• Identify the organization’s E-Business Point of Contact (E-Biz POC)

• Confirm the organization’s CCR “Marketing Partner ID Number (M-PIN)” password

• Register and approve an Authorized Organization Representative (AOR)

• Obtain a username and password from the Grants.gov Credential Provider

Instructions on how to register, tutorials and FAQs are available on the Grants.gov web site at http://www.grants.gov. Assistance is also available 24 hours a day, 7 days a week (excluding Federal holidays) from the Grants.gov help desk at [email protected] or by phone at 1-800-518-4726. Applicants should ensure that all passwords and registration are current well in advance of the deadline.

It is incumbent on applicants to ensure that the AOR is available to submit the application to HRSA by the published due date. HRSA will not accept submission or re-submission of incomplete, rejected, or otherwise delayed applications after the deadline. Therefore, you are urged to submit your application in advance of the deadline. If your application is rejected by Grants.gov due to errors, you must correct the application and resubmit it to Grants.gov before the deadline date and time. Deadline extensions will not be provided to applicants who do not correct errors and resubmit before the posted deadline.

If, for any reason, an application is submitted more than once prior to the application due date, HRSA will only accept the applicant’s last validated electronic submission prior to the application due date as the final and only acceptable submission of any competing application submitted to Grants.gov.

Tracking your application: It is incumbent on the applicant to track application by using the Grants.gov tracking number (GRANTXXXXXXXX) provided in the confirmation email from Grants.gov. More information about tracking your application can be found at http://www07.grants.gov/applicants/resources.jsp. Be sure your application is validated by Grants.gov prior to the application deadline.

V. Application Review Information

1. Review Criteria

Procedures for assessing the technical merit of applications have been instituted to provide for an objective review of applications and to assist the applicant in understanding the standards against which each application will be judged. Critical indicators have been developed for each review criterion to assist the applicant in presenting pertinent information related to that criterion and to provide the reviewer with a standard for evaluation. Review criteria are outlined below with specific detail and scoring points.

Review criteria are used to review and rank Innovator and Development Grant applications. This competitive grant application has seven review criteria for each type of grant:

INNOVATOR GRANTS (Total 100 points)

1. NEED (15 points)—Refer to Narrative Sections “Introduction” and “Needs Assessment”

In determining the need for the project, the following factors will be considered:

• The extent to which the applicant clearly describes the problem and the proposed intervention, and the extent to which the applicant clearly describes the anticipated benefit of the project; and

• The extent to which the proposed project represents an exceptional approach to the priorities the applicant is seeking to meet (i.e., addresses a largely unmet need and is a practice, strategy, or program that demonstrates need for expansion).

2. RESPONSE (25 points)—Refer to Narrative Sections “Introduction,” “Methodology,” “Work Plan,” and “Resolution of Challenges”

1. Purpose, Goals and Objectives (5 points):

The extent to which the proposed project responds to the “purpose” included in the program description. The strength of the proposed goals and objectives and the relationship to the identified project. In determining these aspects of the proposal, the following factors will be considered:

• The extent to which the activities described in the application (scientific or other) are capable of addressing the problem and attaining the project objectives; and

• The extent to which the proposed project has a clear set of goals and an explicit strategy (i.e., logic model), with actions that are (i) aligned with the priorities the applicant is seeking to meet, and (ii) expected to result in achieving the goals, objectives and outcomes of the proposed project.

(b) Strength of Evidence (20 points)

• Applicants will be evaluated by the extent to which the applicant selects a model(s) with the strongest evidence base from among models that fit the applicant’s goals and capacities, i.e. the extent to which the effectiveness of the home visiting model(s) selected has been supported by rigorous research and fits with the applicant’s goals and capacities. In determining the quality of the evidence base, the following factors will be considered:

• Study design quality;

• The substantive impact for the individuals served;

• Duration of findings, replication of findings;

• Quality of measures on which impacts were obtained; and

• Presence of null effects or unfavorable/ambiguous findings, and independence of the evaluator.

In determining fit with goals and capacities, the following factors will be considered:

• Fit of the evidence base for the selected model with each of the program goals identified by the applicant;

• Applicant’s experience with the selected model(s); and

• Local conditions and capacities that increase the likelihood of successful model implementation. Reviewers are looking for proposals that emphasize fit, not just those that argue selected home visiting models have high-quality evidence-bases.

3. EVALUATIVE MEASURES (15 points)—Refer to Narrative Sections “Methodology” and “Evaluation Technical Support Capacity”

The effectiveness of the method proposed to monitor and evaluate the project results. Evaluative measures must be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which the attainment of program objectives can be attributed to the project. In determining the quality of the evaluation, the following factors will be considered:

• (6 points) The extent to which the methods of the evaluation will include a rigorous, well-implemented design (as defined under Section VIII.1 Other Information: Guidelines for Evaluation) and the extent to which the methods of the evaluation will provide high quality implementation data and performance feedback.

• (3 points) The extent to which the evaluation will provide sufficient information about the key elements and approach of the project to facilitate replication or testing in other settings.

• (3 points) The extent to which the proposed project plan includes sufficient resources to effectively carry out the project evaluation.

• (3 points) The extent to which the proposed evaluation meets the standards of a high or moderate quality study design as defined by the Home Visiting Evidence of Effectiveness review, and is independent, as defined for the purposes of this FOA as the project implementer is not evaluating the impact of the project.

3. IMPACT (10 points)—Refer to Narrative Sections “Methodology” and “Evaluation Technical Support Capacity”

The feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable. In determining the degree of impact, the following factors will be considered:

• The extent to which the proposed project can be replicated successfully in a variety of settings, if positive results are obtained. Evidence of this ability includes the proposed project’s demonstrated success in multiple settings with different kinds of individuals, the availability of resources and expertise required for implementing the project with fidelity and the proposed project’s evidence of relative ease of use and user satisfaction.

• The extent to which the applicant proposes using appropriate mechanisms to broadly disseminate information on its project to support replication.

3. RESOURCES/CAPABILITIES (15 points)—Refer to Narrative Sections “Introduction,” “Evaluation Technical Support Capacity,” and “Organizational Information”

The capabilities of the applicant organization, the facilities, and the personnel to fulfill the needs and requirements of the proposed project. Past performance will also be considered. The application will also be evaluated based on the experience of the applicant in implementing the proposed project. In determining this review criterion, the following factors will be considered:

• The extent to which the applicant provides history of significant progress towards implementing a high-quality home visiting program or in successfully embedding their home visiting program into a comprehensive, high-quality early childhood system.

• The extent to which the applicant provides information and the data to demonstrate that it has already significantly addressed the priority area at a regional or state level and has made significant improvements in other areas of early childhood systems.

• The extent to which the applicant proposes to reach an appropriate number of individuals by the proposed project and has the capacity to reach the proposed number of individuals during the course of the grant period.

• The extent to which project personnel are qualified by training and/or experience to implement and carry out the projects.

• The extent to which the applicant demonstrates capacity (e.g., in terms of qualified personnel, financial resources, management capacity) to bring the project to scale on a regional or state level working direction or through partners, either during or following the end of the grant period.

3. SUPPORT REQUESTED (5 points)—Refer to Budget Section

Includes the reasonableness of the proposed budget for each year of the project period in relation to the objectives, the complexity of the research activities, and the anticipated results. The following will be taken into consideration:

• The extent to which costs, as outlined in the budget and required resources sections, are reasonable given the scope of work; and

• The extent to which key personnel have adequate time devoted to the project to achieve project objectives.

3. SUSTAINABILITY AND COMMITMENT TO HOME VISITING (15 points)—Refer to Narrative Sections “Methodology” and “Work plan”

The adequacy of resources to continue the proposed project after the grant period ends and the state’s demonstrated commitment to home visiting. The following will be taken into consideration:

• (6 points) The extent to which the eligible applicant demonstrates:

• The resources to operate the project beyond the length of the grant, including a multi-year financial and operating model and accompanying plan;

• Commitment of any other partners;

• Evidence of broad support from stakeholders critical to the project’s long-term success; and

• A significant state-funding commitment to home visiting. These points are only available if the applicant qualifies for points under the next criterion—maintaining overall effort.

• (3 points) Maintaining Overall Effort: Assurance that cuts in state funding will not be made to a broad array of home visiting programs⁶ in the future.

• (4 points) The extent to which a state commits to increasing its overall state spending on a broad array of home visiting programs from the spending level in place on the date the FOA is released.

• (2 points) A plan for the incorporation of project goals, objectives, and activities into the ongoing work of the eligible applicant and any other partners at the end of the federal grant.

DEVELOPMENT GRANTS (Total 100 Points)

1. NEED (20 points)—Refer to Narrative Sections “Introduction” and “Needs Assessment”

In determining the need for the project, the following factors will be considered:

• The extent to which the applicant clearly describes the problem and the proposed intervention, and the extent to which the applicant clearly describes the anticipated benefit of the project; and

• The extent to which the proposed project represents an exceptional approach to the priorities the applicant is seeking to meet (i.e., addresses a largely unmet need and is a practice, strategy, or program that demonstrates need for expansion).

2. RESPONSE (25 points)—Refer to Narrative Sections “Introduction,” “Methodology,” “Work Plan,” and “Resolution of Challenges”

2. Purpose, Goals and Objectives (5 points):

The extent to which the proposed project responds to the “purpose” included in the program description. The strength of the proposed goals and objectives and their relationship to the identified project. In determining these aspects of the proposal, the following factors will be considered:

• The extent to which the activities described in the application (scientific or other) are capable of addressing the problem and attaining the project objectives; and

• The extent to which the proposed project has a clear set of goals and an explicit strategy (i.e., logic model), with actions that are (i) aligned with the priorities the applicant is seeking to meet, and (ii) expected to result in achieving the goals, objectives and outcomes of the proposed project.

(b) Strength of Evidence (20 points)

• Applicants will be evaluated by the extent to which the applicant selects a model(s) with the strongest evidence base from among models that fit the applicant’s goals and capacities, i.e. the extent to which the effectiveness of the home visiting model(s) selected has been supported by rigorous research and fits with the applicant’s goals and capacities. In determining the quality of the evidence base, the following factors will be considered:

• Study design quality;

• The substantive impact for the individuals served;

• Duration of findings, replication of findings;

• Quality of measures on which impacts were obtained; and

• Presence of null effects or unfavorable/ambiguous findings, and independence of the evaluator.

In determining fit with goals and capacities, the following factors will be considered:

• Fit of the evidence base for the selected model with each of the program goals identified by the applicant;

• Applicant’s experience with the selected model(s); and

• Local conditions and capacities that increase the likelihood of successful model implementation. Reviewers are looking for proposals that emphasize fit, not just those that argue selected home visiting models have high-quality evidence-bases.

3. EVALUATIVE MEASURES (15 points)—Refer to Narrative Sections “Methodology” and “Evaluation Technical Support Capacity”

The effectiveness of the method proposed to monitor and evaluate the project results. Evaluative measures must be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which the attainment of program objectives can be attributed to the project. In determining the quality of the evaluation, the following factors will be considered:

• (6 points) The extent to which the methods of the evaluation will include a rigorous, well-implemented design as defined under Section VIII.1 Other Information: Guidelines for Evaluation; and

The extent to which the methods of the evaluation will provide high quality implementation data and performance feedback.

• (3 points) The extent to which the evaluation will provide sufficient information about the key elements and approach of the project to facilitate replication or testing in other settings.

• (3 points) The extent to which the proposed project plan includes sufficient resources to effectively carry out the project evaluation.

• (3 points) The extent to which the proposed evaluation meets the standards of a high or moderate quality study design as defined by the Home Visiting Evidence of Effectiveness review, and is independent, as defined for the purposes of this FOA as the project implementer is not evaluating the impact of the project.

3. IMPACT (10 points)—Refer to Narrative Sections “Methodology” and “Evaluation Technical Support Capacity”

The feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable. In determining the degree of impact, the following factors will be considered:

• The extent to which the proposed project can be replicated successfully in a variety of settings, if positive results are obtained. Evidence of this ability includes the proposed project’s demonstrated success in multiple settings with different kinds of individuals, the availability of resources and expertise required for implementing the project with fidelity and the proposed project’s evidence of relative ease of use and user satisfaction.

• The extent to which the applicant proposes using appropriate mechanisms to broadly disseminate information on its project to support replication.

3. RESOURCES/CAPABILITIES (15 points)—Refer to Narrative Sections “Introduction,” “Evaluation Technical Support Capacity,” and “Organizational Information”

The capabilities of the applicant organization, the facilities, and the personnel to fulfill the needs and requirements of the proposed project. Past performance will also be considered. The application will also be evaluated based on the experience of the applicant in implementing the proposed project. In determining this review criterion, the following factors will be considered:

• The extent to which the applicant has demonstrated prior effort in implementing a high-quality home visiting program or in successfully embedding their home visiting program into a comprehensive, high-quality early childhood system.

• The extent to which the applicant provides information and the data to demonstrate that it has already significantly addressed the priority area at a regional or state level and has made significant improvements in other areas of early childhood systems.

• The extent to which the applicant proposes to reach an appropriate number of individuals by the proposed project and has the capacity to reach the proposed number of individuals during the course of the grant period.

• The extent to which project personnel are qualified by training and/or experience to implement and carry out the projects.

• The extent to which the applicant demonstrates capacity (e.g., in terms of qualified personnel, financial resources, management capacity) to bring the project to scale on a regional or state level working direction or through partners, either during or following the end of the grant period.

3. SUPPORT REQUESTED (5 points)—Refer to Budget Section

Includes the reasonableness of the proposed budget for each year of the project period in relation to the objectives, the complexity of the research activities, and the anticipated results. The following will be taken into consideration:

• The extent to which costs, as outlined in the budget and required resources sections, are reasonable given the scope of work; and

• The extent to which key personnel have adequate time devoted to the project to achieve project objectives.

3. SUSTAINABILITY AND COMMITMENT TO HOME VISITING (10 points)—Refer to Narrative Sections “Methodology” and “Work plan”

The adequacy of resources to continue the proposed project after the grant period ends and the state’s demonstrated commitment to home visiting. The following will be taken into consideration:

• (6 points) The extent to which the eligible applicant demonstrates:

• The resources to operate the project beyond the length of the grant, including a multi-year financial and operating model and accompanying plan;

• Commitment of any other partners;

• Evidence of broad support from stakeholders critical to the project’s long-term success; and

• A significant state-funding commitment to home visiting. These points are only available if the applicant qualifies for points under the next criterion—maintaining overall effort.

• (3 points) Maintaining Overall Effort: Assurance that cuts in state funding will not be made to a broad array of home visiting programs in the future.

• (4 points) The extent to which a state commits to increasing its overall state spending on a broad array of home visiting programs from the spending level in place on the date the FOA is released.

• (2 points) A plan for the incorporation of project goals, objectives, and activities into the ongoing work of the eligible applicant and any other partners at the end of the federal grant.

2. Review and Selection Process

The Division of Independent Review is responsible for managing objective reviews within HRSA. Applications competing for Federal funds receive an objective and independent review performed by a committee of experts qualified by training and experience in particular fields or disciplines related to the program being reviewed. In selecting review committee members, other factors in addition to training and experience may be considered to improve the balance of the committee, e.g., geographic distribution. Each reviewer is screened to avoid conflicts of interest and is responsible for providing an objective, unbiased evaluation based on the review criteria noted above. The committee provides expert advice on the merits of each application to program officials responsible for final selections for award.

Applications that pass the initial HRSA eligibility screening will be reviewed and rated by a panel based on the program elements and review criteria presented in relevant sections of this program announcement. The review criteria are designed to enable the review panel to assess the quality of a proposed project and determine the likelihood of its success. The criteria are closely related to each other and are considered as a whole in judging the overall quality of an application.

Funding Priorities

A funding priority is defined as the favorable adjustment of combined review scores of individually approved applications when applications meet specified criteria. An adjustment is made by a set, pre-determined number of points. The Maternal, Infant, and Early Childhood Home Visiting Program has eight (8) funding priorities:

• Priority Element 1: Innovations to support improvements in maternal, child, and family health

• Priority Element 2: Innovations that support effective implementation of home visiting programs or systems

• Priority Element 3: Innovations that support the development of statewide or multi-state home visiting programs

• Priority Element 4: Innovations that support the development of comprehensive early childhood systems that span the prenatal through age eight continuum

• Priority Element 5: Innovations for reaching high-risk and hard-to-engage populations

• Priority Element 6: Innovations that support a family-centered approach to home visiting

• Priority Element 7: Innovations for reaching families in rural or frontier areas

• Priority Element 8: Innovations that support fiscal leveraging strategies to enhance program sustainability

Innovator Grant applicants may propose to either (1) enhance one or more priority elements of a home visiting program or (2) initiate a statewide expansion of one priority element currently operating at a local or regional level.

Development Grant applicants may implement or build on only one priority element.

Home Visiting Program Priority Elements

HRSA and ACF have identified the eight priority elements as important components of a home visiting program or system, or a comprehensive, high-quality early childhood system. These elements are outlined above under Section II.2: Summary of Funding.

2. Anticipated Announcement and Award Dates

It is anticipated that awards will be announced prior to the start date of September 30, 2011.

VI. Award Administration Information

1. Award Notices

Each applicant will receive written notification of the outcome of the objective review process, including a summary of the expert committee’s assessment of the application’s merits and weaknesses, and whether the application was selected for funding. Applicants who are selected for funding may be required to respond in a satisfactory manner to Conditions placed on their application before funding can proceed. Letters of notification do not provide authorization to begin performance.

The Notice of Award sets forth the amount of funds granted, the terms and conditions of the award, the effective date of the award, the budget period for which initial support will be given, the non-Federal share to be provided (if applicable), and the total project period for which support is contemplated. Signed by the Grants Management Officer, it is sent to the applicant’s Authorized Organization Representative, and reflects the only authorizing document. It will be sent prior to the start date of September 30, 2011.

2. Administrative and National Policy Requirements

Successful applicants must comply with the administrative requirements outlined in 45 CFR Part 74 Uniform Administrative Requirements for Awards and Subawards to Institutions of Higher Education, Hospitals, Other Nonprofit Organizations, and Commercial Organizations or 45 CFR Part 92 Uniform Administrative Requirements For Grants And Cooperative Agreements to State, Local, and Tribal Governments, as appropriate.

HRSA grant and cooperative agreement awards are subject to the requirements of the HHS Grants Policy Statement (HHS GPS) that are applicable based on recipient type and purpose of award. This includes, as applicable, any requirements in Parts I and II of the HHS GPS that apply to the award. The HHS GPS is available at http://www.hrsa.gov/grants/. The general terms and conditions in the HHS GPS will apply as indicated unless there are statutory, regulatory, or award-specific requirements to the contrary (as specified in the Notice of Award).

Cultural and Linguistic Competence

HRSA is committed to ensuring access to quality health care for all. Quality care means access to services, information, materials delivered by competent providers in a manner that factors in the language needs, cultural richness, and diversity of populations served. Quality also means that, where appropriate, data collection instruments used should adhere to culturally competent and linguistically appropriate norms. For additional information and guidance, refer to the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) published by HHS and available online at http://www.omhrc.gov/CLAS. Additional cultural competency and health literacy tools, resources and definitions are available online at http://www.hrsa.gov/culturalcompetence and http://www.hrsa.gov/healthliteracy.

Trafficking in Persons

Awards issued under this funding opportunity announcement are subject to the requirements of Section 106 (g) of the Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104). For the full text of the award term, go to http://www.hrsa.gov/grants/trafficking.html. If you are unable to access this link, please contact the Grants Management Specialist identified in this funding opportunity to obtain a copy of the Term.

PUBLIC POLICY ISSUANCE

HEALTHY PEOPLE 2020 is a national initiative led by HHS that sets priorities for all HRSA programs. The initiative has two major goals: (1) to increase the quality and years of a healthy life; and (2) eliminate our country’s health disparities. The program consists of 38 focus areas containing measurable objectives. HRSA has actively participated in the work groups of all the focus areas, and is committed to the achievement of the Healthy People 2020 goals. More information about Healthy People 2020 may be found online at http://www.healthypeople.gov/.

National HIV/AIDS Strategy (NHAS)

The National HIV/AIDS Strategy (NHAS) has three primary goals: 1) reducing the number of people who become infected with HIV, 2) increasing access to care and optimizing health outcomes for people living with HIV, and 3) reducing HIV-related health disparities.  The NHAS states that more must be done to ensure that new prevention methods are identified and that prevention resources are more strategically deployed.  Further, the NHAS recognizes the importance of early entrance into care for people living with HIV to protect their health and reduce their potential of transmitting the virus to others.  HIV disproportionately affects people who have less access to prevention, care and treatment services and, as a result, often have poorer health outcomes.  Therefore, the NHAS advocates adopting community-level approaches to identify people who are HIV-positive but do not know their serostatus and reduce stigma and discrimination against people living with HIV.

To the extent possible, program activities should strive to support the three primary goals of the NHAS.  As encouraged by the NHAS, programs should seek opportunities to increase collaboration, efficiency, and innovation in the development of program activities to ensure success of the NHAS.  Programs providing direct services should comply with Federally-approved guidelines for HIV Prevention and Treatment (see http://www.aidsinfo.nih.gov/Guideliines/Default.aspx as a reliable source for current guidelines). More information can also be found at http://www.whitehouse.gov/administration/eop/onap/nhas

Smoke-Free Workplace

The Public Health Service strongly encourages all award recipients to provide a smoke-free workplace and to promote the non-use of all tobacco products. Further, Public Law 103-227, 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.

3. Reporting

The successful applicant under this funding opportunity announcement must comply with the following reporting and review activities:

1. Audit Requirements

Comply with audit requirements of Office of Management and Budget (OMB) Circular A-133. Information on the scope, frequency, and other aspects of the audits can be found on the Internet at http://www.whitehouse.gov/omb/circulars_default.

2. Payment Management Requirements

Submit a quarterly electronic Federal Financial Report (FFR) Cash Transaction Report via the Payment Management System.  The report identifies cash expenditures against the authorized funds for the grant or cooperative agreement. The FFR Cash Transaction Reports must be filed within 30 days of the end of each calendar quarter. Failure to submit the report may result in the inability to access award funds. Go to http://www.dpm.psc.gov for additional information.

3. Status Reports

1) Federal Financial Report. The Federal Financial Report (SF-425) is required within 90 days of the end of each budget period. The report is an accounting of expenditures under the project that year. Financial reports must be submitted electronically through EHB. More specific information will be included in the Notice of Award.

3. Progress Report(s). The awardee must submit a progress report to HRSA on an annual basis.  Submission and HRSA approval of your Progress Report(s) triggers the budget period renewal and release of subsequent year funds. This report has two parts. The first part demonstrates grantee progress on program-specific goals.  The second part collects core performance measurement data including performance measurement data to measure the progress and impact of the project. Further information will be provided in the award notice.

3) Final Report(s). A final report is due within 90 days after the project period ends.  The final report collects program-specific goals and progress on strategies; core performance measurement data; impact of the overall project; the degree to which the grantee achieved the mission, goal and strategies outlined in the program; grantee objectives and accomplishments; barriers encountered; and responses to summary questions regarding the grantee’s overall experiences over the entire project period.  The final report must be submitted on-line by awardees in the Electronic Handbooks system at https://grants.hrsa.gov/webexternal/home.asp.

4. Transparency Act Reporting Requirements

New awards (“Type 1”) issued under this funding opportunity announcement are subject to the reporting requirements of the Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Pub. L. 109–282), as amended by section 6202 of Public Law 110–252, and implemented by 2 CFR Part 170. Grant and cooperative agreement recipients must report information for each first-tier subaward of $25,000 or more in Federal funds and executive total compensation for the recipient’s and subrecipient’s five most highly compensated executives as outlined in Appendix A to 2 CFR Part 170 (available online at http://www.hrsa.gov/grants/ffata.html). Competing continuation (“Type 2”) awardees may be subject to this requirement and will be so notified in the Notice of Award.

VII. Agency Contacts

Applicants may obtain additional information regarding business, administrative, or fiscal issues related to this funding opportunity announcement by contacting:

Mickey Reynolds

Grants Management Specialist

HRSA Division of Grants Management Operations, OFAM

Parklawn Building, Room 11A-02

5600 Fishers Lane

Rockville, MD 20857

Telephone: (301) 443-0724

Fax: (301) 443-6686

Email: [email protected]

Additional information related to the overall program issues and/or technical assistance regarding this funding announcement may be obtained by contacting:

Audrey M. Yowell, PhD, MSSS

Health Resources and Services Administration

Maternal and Child Health Bureau

5600 Fishers Lane

10-64

Rockville, MD 20857

Email: [email protected]

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: [email protected]

Applicants may need assistance when working online to submit the remainder of their information electronically through HRSA’s Electronic Handbooks (EHBs). For assistance with submitting the remaining information in HRSA’s EHBs, contact the HRSA Call Center, Monday-Friday, 9:00 a.m. to 5:30 p.m. ET:

HRSA Call Center
Telephone: (877) 464-4772

TTY: (877) 897-9910
Fax: (301) 998-7377
E-mail: [email protected]

VIII. Other Information

1. Guidelines for Evaluation

HRSA and ACF expect that initiatives funded under this grant will contribute to the development of a knowledge base around successful strategies for the effectiveness, implementation, adoption and sustainability of evidence-based home visiting programs.

HRSA and ACF have a particular interest in approaches that develop knowledge about:

• Efficacy in achieving improvements in the benchmark areas and participant outcomes specified in the legislation.

• Factors associated with developing or enhancing the State’s capacity to support and monitor the quality of evidence-based programs; and

• Effective strategies for adopting, implementing, and sustaining evidence-based home visiting programs.

Furthermore, HRSA and ACF are especially interested in the use of evaluation strategies that emphasize the use of research to help guide program planning and implementation (e.g., participatory or empowerment evaluation).⁷ To support the State’s evaluation efforts, States must allocate an appropriate level of funds for a rigorous evaluation in all years of the grant.

HRSA and ACF expect States to engage in an evaluation of sufficient rigor to demonstrate potential linkages between project activities and improved outcomes. Rigorous research incorporates the four following criteria:

Credibility: Ensuring what is intended to be evaluated is actually what is being evaluated; making sure that descriptions of the phenomena or experience being studied are accurate and recognizable to others; ensuring that the method used is the most definitive and compelling approach that is available and feasible for the question being addressed. If conclusions about program efficacy are being examined, the study design should include a comparison group (i.e., randomized control trial or quasi-experimental design); see the HomVEE website for standards for study design in estimating program impacts: http://www.acf.hhs.gov/programs/opre/homvee).

Applicability: Generalizability of findings beyond current project (i.e., when findings "fit" into contexts outside the study situation). Ensuring the population being studied represents one or more of the population being served by the program.

Consistency: When processes and methods are consistently followed and clearly described, someone else could replicate the approach, and other studies can confirm what is found.

Neutrality: Producing results that are as objective as possible and acknowledge the bias brought to the collection, analysis, and interpretation of the results.

Accordingly, the evaluation plan should:

• Discuss how the evaluation will be conducted;

• Articulate the proposed evaluation methods, measurement, data collection, sample and sampling (if appropriate), timeline for activities, plan for securing IRB review, and analysis;

• Identify the evaluator, cost of the evaluation, and the source of funds;

• Use an appropriate comparison condition, if the research is measuring the impact of the promising or new home visiting model on participant outcomes; and

• Include a logic model or conceptual framework that shows the linkages between the proposed planning and implementation activities and the outcomes that these are designed to achieve.

For assistance in developing a logic model, see http://toolkit.childwelfare.gov/toolkit/. HHS has already initiated a contract for the provision of technical assistance for evaluation of the initiatives funded by this grant and will be providing information about the technical assistance available to States.

If the State does not have the in-house capacity to conduct an objective, comprehensive evaluation of the promising approach, then HRSA and ACF advise that the State subcontract with an institution of higher education, or a third-party evaluator specializing in social sciences research and evaluation, to conduct the evaluation. In either case, it is important that the evaluators have the necessary independence from the project to assure objectivity. A skilled evaluator can help develop a logic model and assist in designing an evaluation strategy that is rigorous and appropriate given the goals and objectives of the proposed project.

Additional assistance may be found in a document titled "Program Manager's Guide to Evaluation." A copy of this document can be accessed at: http://www.acf.hhs.gov/programs/opre/other_resrch/pm_guide_eval/reports/pmguide/pmguide_toc.html.

2. Criteria for Evidence-Based Model(s)

On July 23, 2010, a Federal Register Notice was published requesting comment on proposed evidence criteria for home visiting models.⁸ Approximately 140 letters providing comments were received and considered in developing the final criteria to identify evidence-based home visiting models for the purposes of the MIECHV Program.

Taking into account the legislative requirements, the original criteria contained in the Federal Register Notice, and the comments received, HHS will consider a model eligible for evidence-based funding for the purposes of the Affordable Care Act MIECHV Program if it meets one of the two criteria below.⁹

A program is considered evidence-based and eligible for funding if it meets either of the following minimum criteria:

• At least one high-quality or moderate-quality impact study of the model has found favorable, statistically significant impacts in two or more of the eight outcome domains described below, or

• At least two high-quality or moderate-quality impact studies of the model using non-overlapping analytic different samples with one or more favorable, statistically significant impacts in the same domain.

For the purposes of the criteria, different samples are defined as non-overlapping participants in the analytic sample. To meet either criterion, the impacts must be found for the full sample or, if found for subgroups but not for the full sample, impacts must be replicated in the same domain in two or more studies using different samples. Isolated positive findings, and effects found only for a subgroup but not the full sample in a study, raise concerns about false positives that may be artifacts of multiple statistical tests rather than reflecting true results. The requirements for replication of positive findings across samples or for findings in two or more outcome domains are meant to guard against this problem. HHS recognizes the importance of subgroup findings for determining effects on subgroups of the population of interest, including specific racial or ethnic groups, and the HomVEE website includes information on subgroup findings, whether replicated or not.

Additionally, per the legislation, if the model has met the above criteria based on findings from randomized control trial(s) only, then one or more impacts in an outcome domain must be sustained for at least one year after program enrollment, and one or more impacts in an outcome domain must be reported in a peer-reviewed journal (as required under section 511(d)(3)(A)(i)(I) of the law). Information regarding duration of impacts and publication venue will be available for all studies on the HomVEE website.

The relevant outcome domains are:

(1) Maternal health

(2) Child health

(3) Child development and school readiness, including improvements in cognitive, language, social-emotional, or physical development

(4) Prevention of child injuries and maltreatment

(5) Parenting skills

(6) Reductions in crime or domestic violence

(7) Improvements in family economic self-sufficiency

(8) Improvements in the coordination and referrals for other community resources and supports

HRSA and ACF acknowledge that there is not a one-size-fits-all program for any individual grantee and therefore encourage States to consider more than one model to adopt for their home visiting needs.

3. HomVEE Executive Summary

4. Models That Meet The HHS Criteria for Evidence of Effectiveness

As of the date of release of this SIR, the following models meet the criteria for evidence of effectiveness for the MIECHV program (as described above). HHS intends to continue to review the available evidence of effectiveness for other home visiting models and, as described above, will review models that have not been reviewed at the request of a state and will re-review models that were determined not to meet the evidence-based criteria at the request of a state, model developer, researcher, or others.

All states will be notified of determinations made as a result of a request for a review or re-review of a program model.

As noted, extensive information about these and other programs that have been reviewed is available on the HomVEE website (http://www.acf.hhs.gov/programs/opre/homvee).

(Note: Models are listed alphabetically)

Early Head Start – Home-Based Option

Population served: Early Head Start (EHS) targets low-income pregnant women and families with children birth to age three years, most of whom are at or below the Federal poverty level or who are eligible for Part C services under the Individuals with Disabilities Education Act in their state.

Program focus: The program focuses on providing high quality, flexible, and culturally competent child development and parent support services with an emphasis on the role of the parent as the child’s first, and most important, relationship. EHS programs include home- or center-based services, a combination of home- and center-based programs, and family child care services (services provided in family child care homes).

Family Check Up

Population served: Family Check-Up is designed as a preventative program to help parents address typical challenges that arise with young children before these challenges become more serious or problematic. The target population for this program includes families with risk factors including: socioeconomic; family and child risk factors for child conduct problems; academic failure; depression; and risk for early substance use. Families with children age 2 to 17 years old are eligible for Family Check-Up.

Program focus: The program focuses on the following outcomes: (1) child development and school readiness and (2) positive parenting practices.

Healthy Families America (HFA)

Population served: HFA is designed for parents facing challenges such as single parenthood, low income, childhood history of abuse, substance abuse, mental health issues, and/or domestic violence. Individual programs select the specific characteristics of the target population they plan to serve. Families must be enrolled prenatally or within the first three months after a child’s birth. Once enrolled, services are provided to families until the child enters kindergarten.

Program focus: HFA aims to (1) reduce child maltreatment; (2) increase use of prenatal care; (3) improve parent-child interactions and school readiness; (4) ensure healthy child development; (5) promote positive parenting; (6) promote family self-sufficiency and decrease dependency on welfare and other social services; (7) increase access to primary care medical services; and (8) increase immunization rates.

Healthy Steps

Population served: Healthy Steps is designed for parents with children from birth to age 30 months. Healthy Steps can be implemented by any pediatric or family medicine practice. Residency training programs can also implement Healthy Steps. Community health organizations, private practices, hospital based clinics, child health development organizations, and other types of clinics can also become Healthy Steps sites if a health care clinician is involved and the site is based in or linked to a primary health care practice. Any family served by the participating practice or organization can be enrolled in Healthy Steps.

Program focus: The program focuses on the following outcomes: (1) child development and school readiness; and (2) positive parenting practices.

Home Instruction for Parents of Preschool Youngsters (HIPPY)

Population served: Home Instruction for Parents of Preschool Youngsters (HIPPY) aims to promote preschoolers’ school readiness by supporting parents in the instruction provided in the home. The program is designed for parents who lack confidence in their ability to prepare their children for school, including parents with past negative school experiences or limited financial resources. HIPPY offers weekly activities for 30 weeks of the year, alternating between home visits and group meetings (two one-on-one home visits per month and two group meetings per month). HIPPY sites are encouraged to offer the three-year program serving three to five year olds, but may offer the two-year program for four to five year olds. The home visiting paraprofessionals are typically drawn from the same population that is served by a HIPPY site, and each site is staffed by a professional program coordinator who oversees training and supervision of the home visitors.

Program focus: Home Instruction for Parents of Preschool Youngsters aims to promote preschoolers’ school readiness.

Nurse-Family Partnership (NFP)

Population served: The Nurse-Family Partnership (NFP) is designed for first-time, low-income mothers and their children. It includes one-on-one home visits by a trained public health nurse to participating clients. The visits begin early in the woman’s pregnancy (with program enrollment no later than the 28th week of gestation) and conclude when the woman’s child turns two years old. During visits, nurses work to reinforce maternal behaviors that are consistent with program goals and that encourage positive behaviors and accomplishments. Topics of the visits include: prenatal care; caring for an infant; and encouraging the emotional, physical, and cognitive development of young children.

Program focus: The Nurse-Family Partnership program aims to improve maternal health and child health; improve pregnancy outcomes; improve child development; and improve economic self-sufficiency of the family.

Parents as Teachers

Population served: The goal of the Parents as Teachers (PAT) program is to provide parents with child development knowledge and parenting support. The PAT model includes home visiting for families and professional development for home visiting. The home visiting component of PAT provides one-on-one home visits, group meetings, developmental screenings, and a resource network for families. Parent educators conduct the home visits, using the Born to Learn curriculum. Local sites decide on the intensity of home visits, ranging from weekly to monthly and the duration during which home visitation is offered. PAT may serve families from pregnancy to kindergarten entry.

Program focus: The Parents as Teachers program aims to provide parents with child development knowledge and improve parenting practices.

5. List of Required and Recommended Partners

Both the initial FOA and the subsequent Supplemental Information Requests required sign-off by the agencies listed below. For purposes of meeting requirements of this competitive funding opportunity announcement, states must provide evidence of substantive involvement in the project planning, implementation, and evaluation by representatives of the agencies listed below:

• Director of the state’s Title V agency;

• Director of the state’s agency for Title II of the Child Abuse Prevention and Treatment Act (CAPTA);

• The state’s child welfare agency (Title IV-E and IV-B), if this agency is not also administering Title II of CAPTA;

• Director of the state’s Single State Agency for Substance Abuse Services;

• The state’s Child Care and Development Fund (CCDF) Administrator;

• Director of the state’s Head Start State Collaboration Office; and

• The State Advisory Council on Early Childhood Education and Care authorized by 642B(b)(1)(A)(i) of the Head Start Act.

To ensure that home visiting is part of a continuum of early childhood services, HRSA and ACF also strongly urge states to seek consensus from:

• The state’s Individuals with Disabilities Education Act (IDEA) Part C and Part B Section 619 lead agency(ies);

• The state’s Elementary and Secondary Education Act Title I or state pre-kindergarten program; and

• The state’s Medicaid/Children’s Health Insurance program (or the person responsible for Medicaid Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program).

The state is encouraged to coordinate this application to the extent possible with:

• The state’s Domestic Violence Coalition;

• The state’s Mental Health agency;

• The state’s Public Health agency, if this agency is not also administering the state’s Title V program;

• The state’s identified agency charged with crime reduction;

• The state’s Temporary Assistance for Needy Families agency;

• The state’s Supplemental Nutrition Assistance Program agency; and

• The state’s Injury Prevention and Control (Public Health Injury Surveillance and Prevention) program (if applicable).

9. Tips for Writing a Strong Application

A concise resource offering tips for writing proposals for HHS grants and cooperative agreements can be accessed online at: http://www.hhs.gov/asrt/og/grantinformation/apptips.html.

1 A “state home visiting program” is an overall effort, by the MIECHV grantee, to effectively implement home visiting models (or a single home visiting model) in the state’s at-risk community(ies) to promote improvements in the benchmark and participant outcome areas as specified in the legislation.

2 The priority elements, listed below, have been identified by HRSA and ACF and reflect critical components which have the potential to strengthen home visiting programs. These elements encourage innovation and support the development or strengthening of an evidence-base in areas where the evidence is currently weak or lacking.

3 See http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590enr.txt.pdf, pages 216-225.

4 “Empirical work” includes evidence from research, theory, practice, context, or cultural knowledge.

5 See Appendix C, page 35, of Supplemental Information Request for the Submission of the Updated State Plan for a State Home Visiting Program: http://www.hrsa.gov/grants/manage/homevisiting/sir02082011.pdf.

6 A “broad array of home visiting programs” includes all programs that meet the following definition of home visiting: a program that includes home visiting as a primary service delivery strategy (excluding programs with infrequent or supplemental home visiting), and is offered on a voluntary basis to pregnant women or children birth to age 5 targeting one or more of the participant outcomes in the legislation: improved maternal and child health, prevention of child injuries, child abuse, or maltreatment, and reduction of emergency department visits, improvement in school readiness and achievement, reduction in crime or domestic violence, improvements in family economic self-sufficiency, and improvements in the coordination and referrals for other community resources and supports.

7 Participatory evaluation engages stakeholders in the development, implementation, and interpretation of evaluation results to maximize the usefulness of the results for stakeholders. Empowerment evaluation supports stakeholders to learn the tools on conducting effective evaluation to foster inquiry and self-evaluation or installation of continuous quality improvement.

8 Department of Health and Human Services, Health Resources and Services Administration, Administration for Children and Families, Maternal, Infant, and Early Childhood Home Visiting Program; Request for Public Comment, 75 Federal Register 141 (23 July 2010), pp. 43172-43177.

9 For the purposes of the MIECHV, home visiting models have been defined as programs or initiatives in which home visiting is a primary service delivery strategy and in which services are offered on a voluntary basis to pregnant women, expectant fathers, and parents and caregivers of children birth to kindergarten entry, targeting participant outcomes which may include improved maternal and child health; prevention of child injuries, child abuse, or maltreatment, and reduction of emergency department visits; improvement in school readiness and achievement; reduction in crime or domestic violence; improvements in family economic self-sufficiency; improvements in the coordination and referrals for other community resources and supports; or improvements in parenting skills related to child development.

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