U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Division of Grants Management
HHS-2008-IHS-PHN-0003 Billing Code: 4165-16

Department of Health and Human Services
Indian Health Service
Division of Nursing, Women's Health
Women's Health Demonstration Cooperative Agreement Program
Announcement Type: New Cooperative Agreement
Funding Announcement Number: HHS-2008-IHS-PHN-0003
Catalog of Federal Domestic Assistance Number: 93.933

Key Dates: Application Deadline Date: August 27, 2008
Review Date: August 28, 2008
Award Status Notification: September 2, 2008
Earliest Anticipated Start Date: September 2, 2008

I. Funding Opportunity Description
The Indian Health Service (IHS), Office of Clinical and Preventive Services, Division of Nursing, Women's Health (WH), announces a competitive cooperative agreement for the Women's Health Demonstration Cooperative Agreement Program. This program is authorized under the authority of Section 301 (a) of the Public Health Service Act, as amended, and 25 U.S.C. 1653, 25 U.S.C. 1602(13), and 25 U.S.C. 1602(15). This program is described at 93.933 in the Catalog of Federal Domestic Assistance (CFDA).
A. Purpose of the Program
The purpose of the Women's Health Demonstration Cooperative Agreement Program is to address a health facility's capacity to improve access to behavioral health (BH) care for American Indian and Alaska Native (AI/AN) women and female adolescents who are at risk of experiencing domestic violence and sexual assault (DV/SA) and the associated trauma. This cooperative agreement will provide funding for the implementation of trauma-informed BH service delivery within women's primary care clinics. IHS has identified the integration of BH services as a key strategy to improving health outcomes and patient privacy and confidentiality.

No funds will be going to the IHS Service Units. Instead, the funding will go to Tribes and urban Indian health centers with the expectation that when needed, the Tribe, urban Indian health center, and the IHS site will collaborate together to integrate the BH providers that are hired and funded through this grant into the primary care clinics serving women and female adolescents in the IHS site. Funds cannot be used to purchase, administer, or facilitate abortions, including the purchase of Plan B or pharmacy drugs.

B. Background
AI/AN women have the highest rates of intimate partner violence including DV/SA of any other ethnic group in the United States. According to the United States Department of Justice, AI/AN women are 2.5 times more likely to be raped or sexually assaulted as any other ethnic group of women. Over 50% of AI/AN women suffer physical injuries with sexual assault, versus 30% of women in general, and 39% of AI/AN women have experienced intimate partner violence (domestic abuse and rape) during their lifetime - the highest proportion of any ethnic group in the United States.

Studies demonstrate that the trauma of intimate partner violence, including emotional, sexual or physical abuse, can negatively affect health outcomes. For example, people who have experienced significant trauma often develop Post Traumatic Stress Disorder (PTSD). Trauma also is associated with depression, anxiety, panic disorder, substance abuse, physical disorders and chronic medical problems.

Traumatic events overwhelm a person physically and psychologically with intense fear, helplessness, or horror. The normal response to trauma triggers fight/flight or freeze reaction, an altered state of consciousness, numbing, hyper-vigilance and a hyper state of arousal and reaction. The stress leads to central nervous system changes in the brain. Current stress can trigger PTSD , depression and anxiety, self-destructive behaviors such as substance abuse, eating disorders, suicidal actions or other deliberate acts of self-harm, aggression, violence, or rage.

C. Definitions and Health Implications: Domestic Violence, Sexual Assault, Integrated Behavioral Health, Trauma

Domestic Violence (DV) is a pattern of physically and emotionally coercive and violent behaviors that may include physical injury, psychological abuse, sexual coercion and assault, progressive social isolation, stalking, deprivation, intimidation, and threats. These behaviors are perpetrated by someone who is, was, or wishes to be involved in an intimate or dating relationship and are aimed at establishing control by one partner over the other. The rate of DV among Native women has been reported to be the highest of any ethnic group in the United States. Native women are more than twice as likely to be victims of violent crimes committed by an intimate partner. Native women are five times more likely to be a DV homicide victim than the rest of the population.

Sexual Assault (SA) consists of a wide range of conduct that may include pressured or coerced sex, sex by manipulation or threat, physically forced sex (rape), or SA accompanied by physical violence. Victims may be coerced or forced to perform a kind of sex they do not want (e.g. sex with third parties, physically painful sex, sexual activity they find offensive, verbal degradation during sex, viewing sexually violent material) or at a time they do not want it (e.g. when exhausted, when ill, in front of children, after a physical assault, or when asleep). These behaviors may happen in many situations, by a married partner or boyfriend, on a date, by a friend or an acquaintance, by a stranger or by a family member such as a parent, sibling or grandparent. Native women are more than 2.5 times more likely to be raped or sexually assaulted than women in the United States in general. The Centers for Disease Control Morbidity Mortality Weekly Report survey, dated 2008, indicated that 39 out of 100 AI/AN women have been raped at some point in their lives. Department of Justice (DOJ) statistics indicate that 34.1 percent of AI/AN women (or one in three) will be raped during their lifetime; the comparable figure for the United States as a whole is less than one in five. Because some victims of violence choose not to report their DV/SA experiences to law enforcement, DV/SA prevalence is likely even higher.

Integrated BH refers to the placement of a credentialed mental health provider who is also trained in substance abuse treatment, such as a licensed clinical social worker (LCSW) or a Psych-Mental Health Nurse Practitioner within one or more primary care clinic(s). This Primary BH Clinician provides BH services through 'brief encounters' to patients who are referred to them by the primary medical provider. Services generally include screening, assessment, diagnosis, and routine management of patients with mental health and substance use disorder problems. Encounters are usually 20 minutes or less in length with 10 minutes for documentation and referral if needed. Follow-up care can be provided within the primary care clinic. Integrating BH care into primary care is made easier if there are enough examining rooms. Specialty mental health care is essential to the success of the integrated BH model. Specialty mental health care is essential for patients with more complicated BH issues such as unstable bi-polar disease or schizophrenia or for patients who may need hospitalization. Specialty mental health care is a necessary for patients who need more extensive BH care; this follow-up care is generally provided in the facility's specialty mental health clinic or by other community providers.

In general, primary medical care and BH services often operate on parallel tracks. Although it is known that medical, mental and substance use disorders often occur in tandem, primary medical care and BH services rarely intersect one another. By integrating BH services into primary care for women and children, health facilities can improve patient outcomes and decrease health care costs.

Trauma means bodily or mental injury usually caused by an external agent. Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life. Unlike commonplace misfortunes, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence or death. Traumatic events confront human beings with the extremes of helplessness and terror, and evoke responses of catastrophe. The common denominator of trauma is a feeling of intense fear, helplessness and loss of control. An event can be considered traumatic if it involves actual or feared death or serious physical or emotional injury. For example, rape or combat and domestic abuse are highly traumatic. Trauma is common for child and adult victims of physical abuse, DV, childhood and adult SA, and psychological abuse.

D. Health Implication
The impact of DV/SA on women's overall health is pervasive but unrecognized. With the high rates of DV and rape among AI/AN populations, we know that many children, adolescents, and adults suffer from trauma and are at risk for depression, PTSD, substance abuse and other chronic medical conditions and diseases such as sexually transmitted infections, unwanted pregnancies, cervical cancer, chronic pain and obesity. DV can also result in homicide or suicide.
Pregnancy and obstetrical complications, including poor weight gain, anemia, first and second trimester bleeding, and preterm labor and birth are significantly higher for abused women. DV is the second leading cause of death for pregnant women.
Other sexual and BH implications are equally serious. Victims of domestic and sexual violence are more likely to experience coercive unprotected sex, birth control sabotage, unintended pregnancy, teen pregnancy, rapid repeat pregnancies, multiple abortions, sexual transmitted infection's (STI) including Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), making the women's clinics, BH and primary care settings critical places for identification and early intervention of abuse.
Optimal management of other chronic conditions such as diabetes, hypertension, and obesity can be problematic for women who either are, or have been, abused. Often times, the perpetrator controls the victim's access to health care and compliance with medical protocols. Emerging research shows that women who are abused are less likely to engage in important preventive health care behaviors such as regular mammography, and are more likely to participate in injurious health behaviors including smoking, alcohol, and other drug abuse. Many studies have documented the fact that DV significantly increases the risk for serious mental health problems which can continue for years after the abuse has ended.
E. Goals
1. To facilitate access to BH care (mental health and substance abuse assessment, diagnosis and on-going management) through primary care.
2. To improve the confidentiality, privacy and 'user friendliness' of mental health and substance abuse services by integrating these services into primary care clinics.

F. Description of Funding Opportunity
To integrate BH (mental health and substance abuse service delivery) directly into primary care for women. This includes adding credentialed primary BH providers who are trained and experienced in substance abuse treatment into primary care clinics serving women (prenatal clinics, women's clinics, urgent care clinics, etc.) and developing policies and protocols for operationalizing integrated BH service delivery. The primary care site will be responsible for identifying those patients with BH conditions (depression, anxiety disorders, and alcohol use disorders such as binging or addiction) that can be safely managed through primary care. Likewise the site will be responsible for identifying and referring BH conditions (e.g., unstable bi-polar disease, psychosis, schizophrenia, etc.) to specialty BH clinics/providers.

G. Target Population

The target population for this cooperative agreement is for AI/AN women and female adolescents who are members of Federally-recognized Indian Tribes.

H. Required Activities

Grantees must use funds to carry out the following required activities for the Integrated BH option:

  • Use evidence-based therapies including cognitive-behavioral therapy, problem solving therapy, psychiatric and psychotropic medications, drug and alcohol and depression screening, Alcohol Screening and Brief Intervention (ASBI) which includes Alcohol Use Disorders Identification Test (AUDIT) screening and a brief intervention for substance use disorders and case management using motivational interviewing, training on ASBI is available through the Substance Abuse and Mental Health Services Administration.
  • Place credentialed and licensed mental health providers such as Psych/Mental Health Nurse Practitioners, Licensed Clinical Social Workers, PhD or PsyD, psychologists, and Licensed Professional Counselors into primary care clinics used by women. It is important to note here that the credentialed BH provider may be a staff person employed by a collaborating program or agency. The BH provider does not necessarily need to be a new-hire, but the assistance can be considered in-kind services from a collaborating agency. For example, the Tribe needs to be able to place a credentialed mental health and drug and alcohol counselor in the primary care clinic of the Federal IHS site. The Federal IHS site would work closely with the Tribe to integrate BH care within the Federal site's primary care clinics serving women.
  • Link patients with DV/SA community advocates as appropriate to facilitate healing.
  • Ensure that the Primary BH providers have access to a psychiatrist for at least two hours per month in order to provide them with consultation on diagnosis, treatment and medication management issues. This access may be provided through a personal services contract and is an allowable cost under this grant.
  • Establish a link with a private, State, or County specialty mental health facility and a residential drug and alcohol program to assure that AI/AN patients will be accepted into those facilities/programs. This will require collaboration and negotiation with all pertinent agencies. If mental health and/or substance use disorder services are outsourced, a copy of the contract signature page and a summary of the scope of services must accompany proposal.
  • Establish policies and protocols to govern the integration of BH into primary care. If the integration involves collaboration between the Tribe or urban Indian health centers, and the IHS site, the policy will be expected to reflect that collaboration as well as the specifics of the BH care and integrated system that has been developed.
  • Establish protocols on the specific BH conditions to be treated within the primary care site (e.g., simple depression, anxiety disorders, PTSD, alcohol and other drug screening and brief intervention), and those conditions that will be referred on to the specialty mental health and substance use provider (e.g., unstable bipolar disease, active psychosis, untreated schizophrenia).
  • Use the Patient Health Questionnaire (PHQ-2) to screen and the PHQ-9 to assess patients for depression and to measure effectiveness of depression treatment. Use the AUDIT-3 to screen for alcohol use and a brief intervention using motivational interviewing as the primary care intervention for alcohol. The AUDIT is part of the ASBI referenced above under evidence-based practices and information on it is available on the web at http://www.nasadad.org/resource.php?base_id=788
  • Collect baseline and periodic PHQ-2 and AUDIT-3 scores to measure impact of care. Ideally, grantee will collect data on a regular periodic basis, such as after six weeks, three months, six months, and nine months of treatment.

    II. Award Information

    TYPE OF AWARDS: Cooperative Agreement.

    ESTIMATED FUNDS AVAILABLE: The total amount identified for fiscal year (FY) 2008 is $600,000. The awards are for 12 months and the award is $150,000 per year. Continuation Awards are subject to availability of funds and satisfactory performance.

    ANTICIPATED NUMBER OF AWARDS: Four awards will be made under this program announcement.

    PROJECT PERIOD: Three years (thirty-six months).

    AWARD AMOUNT: $150,000, per year.

    PROGRAMMATIC INVOLVEMENT: The IHS Senior Consultant for Women's Health will have substantial oversight to ensure best practice and high quality performance in sustaining this project. The IHS Senior Consultant will:

  • Monitor each grantee's progress in the implementation of program requirements and provide direct assistance to advance the goals of the program and to improve the effectiveness of service delivery.
  • Conduct site visits throughout the budget periods. Additional formal or informal site visits may by conducted, as needed.
  • Ensure that systems-of-care activities under this program are coordinated with IHS.
  • Ensure compliance with the Government Performance and Results Act (GPRA).
  • Provide technical assistance.

    III. Eligibility Information
    1. Eligible Applicants
    The applicant must be one of the following:
    a. Tribes and Tribal organizations as defined in 25 U.S.C. 1603(d) and (e), or
    b. An urban Indian organization as defined in 25 U.S.C. 1603(h), or
    c. A Non-profit Tribal organization as defined by the IHCIA, 25 U.S.C. 1603(e).

    Only one application per Tribe, Tribal or urban Indian organization will be allowed. Applicants must at least have 35,000 encounters annually and provide supporting documentation of their annual encounters.

    2. Cost Sharing or Matching - The Women's Health Demonstration Program does not require matching funds or cost sharing.

    3. Other Requirements

  • If the application budget exceeds $150,000, the application will not be considered for review.
  • Applicants must provide a Tribal Resolution or a 501(c) (3).
  • Tribal Resolution A resolution of the Indian Tribe served by the project must accompany the application submission. An Indian Tribe that is proposing a project affecting another Indian Tribe must include resolutions from all affected Tribes to be served. Applications by Tribal organizations will not require a specific Tribal resolution if the current Tribal resolution(s) under which they operate would encompass the proposed grant activities. Draft resolutions are acceptable in lieu of an official resolution. However, an official signed Tribal resolution must be received by the DGO within 30 days of award, if approved for funding.

    IV. Application and Submission Information
    1. The entire applicant package along with downloadable application instruction may be found at http://www.grants.gov website. Information regarding the electronic application process may be directed to Michelle G. Bulls, at (301) 443 6290.

    Information regarding the DV Pilot Program may be obtained from:
    Carolyn Aoyama, CNM, M.P.H.
    IHS Senior Consultant for Women's Health
    Advanced Practice Nursing and Midwifery
    Office of Clinical and Preventive Services
    Indian Health Service
    801 Thompson Avenue, Suite 300
    Rockville, Maryland 20852
    (301) 443-1840

    General grants information may be obtained from the grants management specialist:
    Ms. Norma Jean Dunne
    Division of Grants Operations
    Indian Health Service
    801 Thompson Avenue, TMP 360
    Rockville, MD 20852
    (301) 443-5204
    Fax: (301) 443-9602

    2. Content and Form of Application submission (if prior approval was obtained for paper submission from the Grants Policy Staff (GPS) in writing:

  • Be single spaced.
  • Be typewritten.
  • Have consecutively numbered pages
  • Use black type not smaller than 12 characters per one inch.
  • Contain a narrative that does not exceed 15 typed pages. The fifteen page narrative does not include the detailed work plan with timeline, standard forms, Tribal resolutions or letters of support (if necessary), table of contents, budget, budget justifications, budget narrative, and/or other appendix items.

    Public Policy Requirements: All Federal wide public policies apply to IHS grants with exception of the discrimination public policy.

    A Letter of Intent is not required.

    3. Submission Dates and Times:
    Applications must be submitted electronically through Grants.gov by 12:00 midnight Eastern Standard Time (EST). If technical challenges arise and the applicant is unable to successfully complete the electronic application process, the applicant should contact Grants Policy Staff (GPS) at 301-443-6290 at least fifteen days prior to the application deadline and advise of the difficulties that your organization is experiencing. The grantee must obtain prior approval, in writing (E-mails are acceptable) allowing the paper submission. If request for paper submission is approved, the original and two copies may be sent to Ms. Norma Jean Dunne, Division of Grants Operations, 801 Thompson Avenue, TMP 360, Rockville, MD 20852. Applications not submitted through Grants.gov, without an approved waiver, may be returned to the applicant without review or consideration. Late applications will not be accepted for processing, and will be returned to the applicant without consideration for funding.

    4. Intergovernmental Review:
    Executive Order 12372 requiring intergovernmental review is not applicable to this program.

    5. Funding Restrictions:
    A. Pre award costs are allowable pending prior approval from the awarding agency. However, in accordance with 45 CFR Part 74, all pre-award costs are incurred at the recipient=s risk. The awarding office is under no obligation to reimburse such costs if for any reason the applicant does not receive an award or if the award to the recipient is less than anticipated.
    B. The available funds are inclusive of direct and appropriate indirect costs.
    C. Only one cooperative agreement will be awarded per applicant.
    D. IHS will not acknowledge receipt of applications.

    6. Other Submission Requirements
    Electronic Submission - The preferred method for receipt of applications is electronic submission through Grants.gov. However, should any technical challenges arise regarding the submission, please contact Grants.gov Customer Support at 1-800-518-4726 or support@grants.gov. The Contact Center hours of operation are Monday Friday from 7:00 a.m. to 9:00 p.m. EST. The applicant must seek assistance at least fifteen days prior to the application deadline. Applicants that do not adhere to the timelines for Central Contractor Registry (CCR) and/or Grants.gov registration and/or requesting timely assistance with technical issues will not be a candidate for paper applications.

    To submit an application electronically, please use the http://www.Grants.gov website and select

  • Apply for Grants
  • link on the home page. Download a copy of the application package on the Grants.gov website, complete it off-line, and then upload and submit the application via the Grants.gov site. You may not E-mail an electronic copy of a grant application to IHS.

    Please be reminded of the following:

  • Under the new IHS application submission requirements, paper applications are not the preferred method. However, if you have technical problems submitting your application on line, please contact directly Grants.gov Customer Support at: http://www.grants.gov/CustomerSupport.
  • Upon contacting Grants.gov obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved and a waiver request from GPS must be obtained.
  • If it is determined that a formal waiver is necessary, the applicant must submit a request, in writing (E-mails are acceptable), to Michelle.Bulls@ihs.gov that includes a justification for the need to deviate from the standard electronic submission process. Upon receipt of approval, a hard-copy application package must be downloaded by the applicant from Grants.gov, completed, and sent directly to the Division of Grants Operations (DGO), 801 Thompson Avenue, TMP 360, Rockville, MD 20852 by August 22, 2008.
  • Upon entering the Grants.gov website, there is information available that outlines the requirements to the applicant regarding electronic submission of an application through Grants.gov, as well as the hours of operation. We strongly encourage all applicants not to wait until the deadline date to begin the application process through Grants.gov as the registration process for CCR and Grants.gov could take up to fifteen working days.
  • To use Grants.gov, you, as the applicant, must have a Data Universal Numbering System (DUNS) number and register in the CCR. You should allow a minimum of ten days working days to complete CCR registration. See below on how to apply.
  • You must submit all documents electronically, including all information typically included on the SF 424 and all necessary assurances and certifications.
  • Please use the optional attachment feature in Grants.gov to attach additional documentation that may be requested by IHS.
  • Your application must comply with any page limitation requirements described in the program announcement.
  • After you electronically submit your application, you will receive an automatic acknowledgment from Grants.gov that contains a Grants.gov tracking number. The IHS DGO will download your application from Grants.gov and provide necessary copies to the cognizant program office. The DGO will not notify applicants that the application has been received.
  • You may access the electronic application for this program at http://www.Grants.gov
  • You may search for the downloadable application package by either the CFDA number or the Funding Opportunity Number. Both numbers are identified in the heading of this announcement.
  • The applicant must provide the Funding Opportunity Number: HHS-2008-IHS-IWHD-0002.

    E mail applications will not be accepted under this announcement.

    DUNS NUMBER
    Applicants are required to have a DUNS number to apply for a grant or cooperative agreement from the Federal Government. The DUNS number is a nine digit identification number, which uniquely identifies business entities. Obtaining a DUNS number is easy and there is no charge. To obtain a DUNS number, access <http://www.dunandbradstreet.com> or call 1 866 705 5711. Interested parties may wish to obtain their DUNS number by phone to expedite the process.

    Applications submitted electronically must also be registered with the CCR. A DUNS number is required before CCR registration can be completed. Many organizations may already have a DUNS number. Please use the number listed above to investigate whether or not your organization has a DUNS number. Registration with the CCR is free of charge.

    Applicants may register by calling 1 888 227 2423. Please review and complete the CCR Registration Worksheet located at http://www.grants.gov/CCRRegister.

    More detailed information regarding these registration processes can be found at http://www.grants.gov.

    V. Application Review Information
    1. Criteria
    If the eligible Tribal applicant expects to place BH providers in IHS women's clinics, the application should demonstrate that they have a strong partnership. The application should include an executed Memorandum of Understanding (MOU) between the Chief Executive Officers of a Tribe and the IHS Service Unit. The MOU must include the scope of integrated care to include BH personnel and type of services to be provided between the IHS and the respective grantees.
    A. Program Goals and Objectives (25 Points)
    1. Include a clear description of the goals and objectives of the program in measurable terms.
    2. Describe how the accomplishment of the objectives will be measured, including whether or not the program is replicable.
    3. Describe tasks and resources needed to implement and complete the project as well as who will perform the tasks.
    4. Provide milestones or a time chart that indicates the expected time that the project will hire the BH provider and the Case Manager and when the project will begin to accept clients.
    B. Background, Need for Assistance, and Capacity (40 points)
    1. Describe and define the target population at the project location (e.g., number of children and female adult active users, number and type of primary care encounters over the past fiscal year to include pediatric, urgent care, women's clinic, adolescents, school based clinic.
    2. Describe the existing health facility resources and community resources, including the availability of AI/AN traditional healing resources, special violence prevention programs, substance abuse treatment referral sources, specialty mental health capacity, and the number of BH providers (and their credentials) who will be integrated into primary care or integrated into the Emergency Department.
    3. Describe the needs of the target population and what efforts have been made in the past to meet the need, as applicable. Examples include the number and type of BH providers and where they provide services, any collaborative efforts and agreements with other intervention programs, availability of program funding from other sources, and training on integrated BH care.
    4. Provide plan for integrating BH into primary care.
    5. Describe grant data collection (PHQ-2 and AUDIT-3 baseline and periodic re-screening data) and how it will support the stated objectives and evaluation of the program.
    6. Describe how the program services will continue after the grant expires.
    7. Describe how specialty mental health and psychiatric backup will be provided to patients. Identify Tribal, Federal, state, local, and private resources, including traditional practitioners as determined by the community, that are part of the mental health/substance abuse referral system. Identify whether the facility has a victim assistance program, as well as any specialty BH treatment.
    8. Demonstrate Tribal or organizational support for the proposed program.

    C. Management Controls (15 points)
    Describe:
    1. How the BH services will be integrated with other primary care services offered by the Tribal or urban sites including how and where integrated services will be provided and the sources of specialty BH service. Will these services be provided in offices that are physically separate from the primary care clinics, or will they be provided in the same area where primary medical patients are seen? Will BH providers be deployed into different clinical areas as members of provider teams or will they operate in a separate clinical area from the other medical providers? Applicant will describe how they will provide 24/7 backup psychiatric consultantion services to their primary BH and medical providers.
    2. Identify where the proposed integrated BH services will be provided.
    3. Identify the rationale for providing such service there, and how the behavioral heatlh service delivery will be integrated into the Tribal or urban primary care service delivery.
    4. Describe the capacity and experience of the applicant organization and other participating organizations with similar projects and populations, including experience in providing culturally appropriate/competent services.
    5. The organization's capacity to manage Federal funds and the organization's capacity for third party billing.

  • Please note, grant funds cannot be used to purchase specialty mental health services.

    D. KEY PERSONNEL (10 points)
    1. Provide a resume, qualifications, and position description for the program director and key personnel in accordance with the PHS 5161 under Program Narrative 6(a) Staffing and Position Data.
    2. Provide a list of staff who will participate in the project, showing the role of each and their level of effort and qualifications.
    3. Describe additional community advocacy staff resouces or community mental health/subtance abuse detox or residential care organizations that will be part of the referral network.

    E. BUDGET (10 points)
    1. Provide an itemized estimate of costs and a justification for the proposed program for the first year on SF 424A, Budget Information Non-Construction Programs, and brief program narratives and budgets for years two and three.
    2. Allow for a narrative justification that describes the expenditures and the justification for the expenditures.
    3. Indicate special start-up costs.
    2. Review and Selection Process
    Applications meeting eligibility requirements that are complete, responsive and conform to this program announcement will be reviewed for merit by the Field Reader appointed by the IHS to review and make recommendations on these applications. The review will be conducted in accordance with the IHS Objective Review Guidelines. The technical review process ensures selection of quality projects in a national competition for limited funding. Applications will be evaluated and rated on the basis of the evaluation criteria listed in Section V. The criteria are used to evaluate the quality of a proposed project and determine the likelihood of success. Each application will be reviewed and assigned a numerical score which will assist the IHS Senior Nurse Consultant to determine which proposals will be funded if the amount of WH funding is not sufficient to support all approved applications. Applications recommended for approval will be ranked and forwarded to the DGO for award. All disapproved applications will be returned to the applicant.

    3. Anticipated Announcement and Award Dates
    The IHS anticipates award status announcement date of September 2, 2008 and award date of September 2, 2008.

    VI. Award Administration Information
    1. Award Notices.
    The Notice of Award (NoA) will be initiated by the DGO and will be mailed via postal mail to each entity that is approved for funding under this announcement. The NoA will be signed by the Grants Management Officer, and this is the authorizing document for which funds are dispersed to the approved entities. The NoA will serve as the official notification of the grant award and will reflect the amount of Federal funds awarded, the purpose of the grant, the terms and conditions of the award, the effective date of the award, and the budget/project period. The NoA is the legally binding document. Applicants who are approved but unfunded or disapproved based on their Objective Review score will receive a copy of the Executive Summary which identifies the weaknesses and strengths of the application submitted.
    2. Administrative Requirements
    Grants are administrated in accordance with the following documents:

  • This Program Announcement.
  • Administrative Requirements: 45 CFR Part 92, AUniform Administrative Requirements for Grants and Cooperative Agreements to State, Local and Tribal Governments,@ or 45 CFR Part 74,
  • Uniform Administrative Requirements for Awards to Institutions of Higher Education, Hospitals, Other Non-profit Organizations, and Commercial Organizations.@
  • Grants Policy Guidance: HHS Grants Policy Statement, January 2007.
  • Cost Principles: OMB Circular A-87,
  • State, Local, and Indian
  • (Title 2 Part 225).
  • Cost Principles: OMB Circular A-122,
  • Non-profit Organizations@ (Title 2 Part 230).
  • Audit Requirements: OMB Circular A-133,
  • Audits of States, Local Governments, and Non-profit Organizations.@

    3. Indirect Costs:
    This section applies to all grant recipients that request reimbursement of indirect costs in their grant application. In accordance with HHS Grants Policy Statement, Part II-27, IHS requires applicants to have a current indirect cost rate agreement in place prior to award. The rate agreement must be prepared in accordance with the applicable cost principles and guidance as provided by the cognizant agency or office. A current rate means the rate covering the applicable activities and the award budget period. If the current rate is not on file with the DGO at the time of award, the indirect cost portion of the budget will be restricted and not available to the recipient until the current rate is provided to the DGO.

    Generally, indirect costs rates for IHS grantees are negotiated with the Division of Cost Allocation http://rates.psc.gov/ and the Department of the Interior (National Business Center) http://www.nbc.gov/acquisition/ics/icshome.html. If your organization has questions regarding the indirect cost policy, please contact the DGO at (301) 443-5204.

    4. Reporting
    A. Progress Report. Program progress reports are required annually. These reports will include a brief comparison of actual accomplishments to the goals established for the period, or, if applicable, provide sound justification for the lack of progress, and other pertinent information as required. A final report must be submitted within 90 days of expiration of the final budget/project period.
    B. Financial Status Report (FSR). Annual financial status reports must be submitted within 90 days of expiration of the budget/project period. Standard Form 269 (long form) will be used for financial reporting. The final FSR must be submitted within 90 days of expiration of the last budget/project period.

    Failure to submit required reports within the time allowed to the DGO may result in suspension or termination of an active grant, withholding of additional awards for the project, or other enforcement actions such as withholding of payments or converting to the reimbursement method of payment. Continued failure to submit required reports may result in one or both of the following: (1) the imposition of special award provisions; and (2) the non funding or non award of other eligible projects or activities. This applies whether the delinquency is attributable to the failure of the grantee organization or the individual responsible for preparation of the reports.

    5. Telecommunication for the hearing impaired is available at: TTY
    (301) 443-6394.

    VII. Agency Contact(s)
    For program-related information regarding the Women's Health Demonstration Pilot Initiative Program:

    Carolyn Aoyama, CNM, M.P.H.
    Senior Consultant for Women's Health and Advanced Practice Nursing
    Office of Clinical and Preventive Services
    Indian Health Service
    801 Thompson Avenue, Suite 326
    Rockville, Maryland 20852
    (301) 443-1840, carolyn.aoyama@ihs.gov

    For general information regarding this announcement:

    Ms. Orie Platero
    Office of Clinical and Preventive Services
    Indian Health Service
    801 Thompson Avenue, Suite 326
    Rockville, Maryland 20852
    (301) 443-2522

    For specific grant-related and business management information:

    Ms. Norma Jean Dunne
    Division of Grants Operations
    Indian Health Service
    801 Thompson Avenue, TMP Suite 360
    Rockville, Maryland 20852
    (301) 443-5204

    VIII. Other Information
    The Department of Health and Human Services (HHS) is committed to achieving the health promotion and disease prevention objectives of Healthy People 2010, a HHS-led activity for setting priority areas. This project will aid the accomplishment of Healthy People 2010. Potential applicants may obtain a printed copy of Healthy People 2010, (Summary Report No, 017-001-00549-5) or CD-ROM, Stock No. 017-001-00549-5, through the Superintendent of Documents, Government Printing Office, P.O. Box 371954, Pittsburgh, PA 15250-7945, (202) 512-1800. You may also access this information at the following website: http://www.healthypeople.gov/Publications.

    The IHS is focusing efforts on three Health Initiatives that, linked together, have the potential to achieve positive improvements in the health of AI/AN people. These three initiatives are Health Promotion/Disease Prevention, Management of Chronic Disease, and Behavioral Health. Further information is available at the Health Initiatives website: http://www.ihs.gov/NonMedicalPrograms/DirInitiatives/index.cfm.

    Date: ___________________ _____________________________
    Robert G. McSwain.
    Director
    Indian Health Service


    (301) 443-5204

    VIII. Other Information
    The Department of Health and Human Services (HHS) is committed to achieving the health promotion and disease prevention objectives of Healthy People 2010, a HHS-led activity for setting priority areas. This project will aid the accomplishment of Healthy People 2010. Potential applicants may obtain a printed copy of Healthy People 2010, (Summary Report No, 017-001-00549-5) or CD-ROM, Stock No. 017-001-00549-5, through the Superintendent of Documents, Government Printing Office, P.O. Box 371954, Pittsburgh, PA 15250-7945, (202) 512-1800. You may also access this information at the following website: http://www.healthypeople.gov/Publications.

    The IHS is focusing efforts on three Health Initiatives that, linked together, have the potential to achieve positive improvements in the health of AI/AN people. These three initiatives are Health Promotion/Disease Prevention, Management of Chronic Disease, and Behavioral Health. Further information is available at the Health Initiatives website: http://www.ihs.gov/NonMedicalPrograms/DirInitiatives/index.cfm.

    Date: ___________________ ________________________
    Christopher Mandregan, Jr., M.P.H.
    Acting Deputy Director
    Indian Health Service

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