[Federal Register Volume 63, Number 40 (Monday, March 2, 1998)]
[Notices]
[Pages 10226-10229]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-5233]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
Office of Minority Health; Availability of Funds for Grants for
the Bilingual/Bicultural Service Demonstration Grant Program
AGENCY: Office of the Secretary, Office of Minority Health.
ACTION: Notice of availability of funds and request for Applications
for the Bilingual/Bicultural Service Demonstration Program.
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AUTHORITY: This program is authorized under section 1707(d)(1) of the
Public Health Service Act, as amended by Public Law 101-527, the
Disadvantaged Minority Health Improvement Act of 1990.
PURPOSE: The purpose of this Fiscal Year 1998 Bilingual/Bicultural
Service Demonstration Grant Program is to:
(1) Improve and expand the capacity for linguistic and cultural
competence of health care professionals and paraprofessionals working
with limited-English-proficient (LEP) minority communities and
(2) Improve the accessibility and utilization of health care
services among the LEP minority populations.
These grants are intended to demonstrate the merit of programs that
involve partnerships between minority community-based organizations and
health care facilities in a collaborative effort to address cultural
and linguistic barriers to effective health care service delivery and
to increase access to effective health care for the LEP minority
populations living in the United States.
The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of Healthy People
2000, a PHS-led national activity to reduce morbidity and mortality and
to improve the quality of life. Potential applicants may obtain a copy
of Healthy People 2000 which is available through the Government
Printing Office, Washington, DC 20402-9325 or telephone (202) 783-8238
(Full Report: Stock No. 017-001-00474-0). Another reference is the
Healthy People 2000 Review--1997. One free copy may be obtained from
the National Center for Health Statistics, 6525 Belcrest Road, Room
1064, Hyattsville, MD 20782 or telephone (301) 436-8500. (DHHS
Publication No. (PHS) 98-1256)
Background
Large numbers of minorities in the United States are linguistically
isolated. According to the 1990 U.S. Census, 31.8 million persons or 13
percent of the total U.S. population (ages 5 and above) speak a
language other than English at home. Almost 2 million people do not
speak English at all and 4.8 million people do not speak English well.
The 1990 U.S. Census also found that various minority populations and
subgroups are linguistically isolated: Approximately 4 million
Hispanics; approximately 1.6 million Asians and Pacific Islanders;
approximately 282,000 Blacks; and approximately 77,000 Native Americans
and Alaska Natives.
Besides the social, cultural and linguistic barriers, which affect
the delivery of adequate health care, there are other factors that
contribute to the poor health status of LEP minority people. These
factors include:
[[Page 10227]]
Inadequate number of health care providers and other
health care professionals skilled in culturally competent and
linguistically appropriate delivery of services;
Scarcity of trained interpreters at the community level;
Deficiency of knowledge about appropriate mechanisms to
address language barriers in health care settings;
Absence of effective partnerships between major mainstream
provider organizations and LEP minority communities;
Low economic status;
Lack of health insurance; and
Organizational barriers.
Research has suggested that culture provides a unique concept of
disease, risk factors, and preventive actions.\1\ It also has been
indicated that definitions of health and illness are often culturally
determined and therefore, the study of culture and tradition is a
valuable tool in understanding the underlying motives for health
behavior.\2\ The clients' understanding of the Western health care
model, and the cultural ability to accept health education, influences
their access to health care services and their compliance with health
care advice.
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\1\ Evans, P.E. (1988) Minorities and AIDS. Health Education
Research, Vol. 3, No. 1, pp 113-115.
\2\ Toumishey, H. (1993), Multicultural Health Care: An
Introductory Course. In R. Masi, L. Mensah, & K. McLeod (eds.),
Health and Cultures: Exploring the Relationships, pp 113-138. Mosaic
Press, Ontario, Canada.
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It is essential that health care providers, health care
professionals and other staff become informed about their diverse
clientele from a linguistic, cultural and medical perspective. These
individuals should become culturally competent so they can encourage
vulnerable LEP minority populations to access and receive appropriate
health care with more knowledge and confidence.
In FY 1993, the Office of Minority Health (OMH) launched the
Bilingual/Bicultural Service Demonstration Grant Program to
specifically address the barriers that LEP minority populations
encounter when accessing health services.
In FY 1998, the OMH continues to focus on health problem areas
identified in the 1997 OMH Report to Congress. These health areas are:
(1) Heart disease and stroke; (2) cancer; (3) chemical dependency; (4)
diabetes; (5) homicide, suicide, and unintentional injuries; (6) infant
mortality; and (7) HIV/AIDS. Flexibility for communities to define
their own health problem priorities (e.g., asthma, sexually transmitted
diseases (STDs), tuberculosis, female genital mutilation, immunization
and tobacco use) is also encouraged.
Eligible Applicants
Public and private, nonprofit minority community-based
organizations or health care facilities which serve a targeted LEP
minority community. (See Definitions of Minority Community-Based
Organizations and Health Care Facilities found in this announcement.)
Eligibility is limited to: (1) Previously funded Bilingual/Bicultural
Service Demonstration Program grant recipients; and (2) organizations
which previously applied to the Bilingual/Bicultural Service
Demonstration Program and were recommended for approval, but were not
funded due to OMH budget limitations. This will allow previously funded
grantees to build on efforts already initiated under this demonstration
program. It also allows those organizations which designed projects
judged to have merit in a previous objective review process, an
opportunity to submit proposals which meet the requirements set forth
in this announcement.
A linkage must be in place between a minority community-based
organization and a health care facility, one of which is the applicant
organization, and documented in writing as specified under the project
requirements described in this announcement.
Currently funded OMH Bilingual/Bicultural Service Demonstration
Program grantees (Managed Care) are not eligible to apply. National
organizations, for-profit hospitals, universities and schools of higher
learning are not eligible to apply. Applicants may apply to more than
one OMH FY 98 grant program announcement; however, organizations will
not receive funding for more than one OMH grant program concurrently.
Deadline
To receive consideration, grant applications must be received by
the OMH Grants Management Office 60 days after date of publication or
by April 13, 1998. Applications will be considered as meeting the
deadline if they are: (1) Received on or before the deadline date, or
(2) postmarked on or before the deadline date and received in time for
orderly processing. A legibly dated receipt from a commercial carrier
or U.S. Postal Service will be accepted in lieu of a postmark. Private
metered postmarks will not be accepted as proof of timely mailing.
Applications submitted by facsimile transmission (FAX) or any other
electronic format will not be accepted. Applications which do not meet
the deadline will be considered late and will be returned to the
applicant unread.
Addresses/Contacts
Applications must be prepared using Form PHS 5161-1 (Revised July
1992 and approved by OMB under control Number 0937-0189). Application
kits and technical assistance on budget and business aspects of the
application may be obtained from Ms. Carolyn A. Williams, Grants
Management Officer, Division of Management Operations, Office of
Minority Health, Rockwall II Building, Suite 1000, 5515 Security Lane,
Rockville, Maryland 20852, telephone (301) 594-0758. Completed
applications are to be submitted to the same address.
Questions regarding programmatic information and/or requests for
technical assistance in the preparation of grant applications should be
directed to Ms. Cynthia H. Amis, Director, Division of Program
Operations, Office of Minority Health, Rockwall II Building, Suite
1000, 5515 Security Lane, Rockville, Maryland 20852, telephone number
(301) 594-0769.
Technical assistance is also available through the OMH Regional
Minority Health Consultants (RMHCs). A listing of the RMHCs and how
they may be contacted will be provided in the grant application kit.
Additionally, applicants can contact the OMH Resource Center (OMHRC) at
1-800-444-6472 for health information.
Availability of Funds
Approximately $1.2 million is available for award in FY 1998. It is
projected that awards of up to $100,000 total costs (direct and
indirect) for a 12-month period will be made to approximately 10 to 12
competing applicants. Of the total amount obligated, at least $460,000
will be awarded to projects that include HIV/AIDS as one of the
targeted health problem areas to be addressed.
Period of Support
The start date for the Bilingual/Bicultural Service Demonstration
Program grants is September 30, 1998. Support may be requested for a
total project period not to exceed 3 years. Noncompeting continuation
awards of up to $100,000 will be made subject to satisfactory
performance and availability of funds.
Definitions
For purposes of this grant announcement, the following definitions
apply:
Cultural Competency--A set of interpersonal skills that allow
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individuals to increase their understanding and appreciation of
cultural differences and similarities within, among and between groups.
This requires a willingness and ability to draw on community-based
values, traditions and customs, and to work with knowledgeable persons
of and from the community in developing focused interventions,
communications and other supports. (Orlandi, Mario A., 1992.)
Health Care Facility--A public nonprofit facility that has an
established record for providing comprehensive health care services to
a targeted, LEP racial/ethnic minority community. Facilities providing
only screening and referral activities are not included in this
definition. A health care facility may be a hospital, outpatient
medical facility, community health center, migrant health center, or a
mental health center.
Limited-English-Proficient Populations (LEP)--Individuals (as
defined in Minority Populations below) with a primary language other
than English who must communicate in that language if the individual is
to have an equal opportunity to participate effectively in and benefit
from any aid, service or benefit provided by the health provider.
Minority Community-Based Organization--A public or private
nonprofit community-based minority organization or a local affiliate of
a national minority organization that has: A governing board composed
of 51 percent or more racial/ethnic minority members, a significant
number of minorities in key program positions, and an established
record of service to a racial/ethnic minority community.
Minority Populations--American Indian or Alaska Native, Asian,
Black or African-American, Hispanic or Latino, and Native Hawaiian or
other Pacific Islander. (Revision to the Standards for the
Classification of Federal Data on Race and Ethnicity, Federal Register,
Vol. 62, No. 210, pg. 58782, October 30, 1997.)
Project Requirements
Each project funded under this demonstration grant is to:
1. Address at least one, but no more than three, problem health
areas identified in the Background section.
2. Carry out activities to improve and expand the capacity of
health care providers and other health care professionals to deliver
linguistically and culturally competent health care services to the
target population. Potential activities may include: Language and
cultural competency training and curricula development, bilingual
health access or health promotion information in the native language or
on-site interpretation services. Traditional or innovative training
models may include portable training products such as CD-ROMs, video
tapes, or on-line distance based learning formats for continuing
education.
3. Carry out activities to improve access to health care for the
LEP population. Potential activities may include those that will
educate the target population on the importance of health promotion and
disease prevention; enhance the ability of the target population to
communicate their health care concerns to health care providers; and
increase their understanding of health education information and
improve compliance with health care treatments. The applicant may
utilize culturally and/or linguistically appropriate informational or
communication technologies, such as printed materials which may have
pictorial messages, mass media, public service announcements and
neighborhood outreach and electronic systems including kiosks as an
educational tool; or forums, seminars or workshops to promote
information exchange among the targeted LEP population and the health
care professionals.
4. Have an established, formal linkage between a minority
community-based organization and a health care facility, one of which
is the applicant, prior to submission of an application. The linkage
must be confirmed by a signed agreement between the applicant and
linkage organizations which specifies in detail the roles and resources
that each entity will bring to the project, and states the duration and
terms of the linkage. The document must be signed by individuals with
the authority to represent the organizations (e.g., president, chief
executive officer, executive director).
Use of Grant Funds
Budgets of up to $100,000 total cost (direct and indirect) per year
may be requested to cover costs of: Personnel, consultants, supplies
(including screening and outreach supplies), equipment, and grant-
related travel. Funds may not be used for medical treatment,
construction, building alterations, or renovations. All budget requests
must be fully justified in terms of the proposed goals and objectives
and include a computational explanation of how costs were determined.
Criteria for Evaluating Applications
Review of Applications: Applications will be screened upon receipt.
Those that are judged to be incomplete, nonresponsive to the
announcement or nonconforming will be returned without comment. Each
organization may submit no more than one proposal under this
announcement. If an organization submits more than one proposal, all
will be deemed ineligible and returned without comment. Accepted
applications will be reviewed for technical merit in accordance with
PHS policies. Applications will be evaluated by an Objective Review
Panel chosen for their expertise in minority health and their
understanding of the unique health problems and related issues
confronted by the racial/ethnic minority populations in the United
States.
Applicants are advised to pay close attention to the specific
program guidelines and general and supplemental instructions provided
in the application kit.
Application Review Criteria: The technical review of applications
will consider the following generic factors:
Factor 1: Background (15%)
Adequacy of: Demonstrated knowledge of the problem at the local
level; demonstrated need within the proposed community and target
population; demonstrated support and established linkage(s) in order to
conduct the proposed model; and extent and documented outcome of past
efforts and activities with the target population.
Factor 2: Goals and Objectives (15%)
Merit of the objectives, their relevance to the program purpose and
stated problem, and their attainability in the stated time frames.
Factor 3: Methodology (35%)
Appropriateness of proposed approach and specific activities for
each objective. Logic and sequencing of the planned approaches in
relation to the objectives and program evaluation. Soundness of the
established linkages.
Factor 4: Evaluation (20%)
Thoroughness, feasibility and appropriateness of the evaluation
design, and data collection and analysis procedures. Potential for
replication of the project for similar target populations and
communities.
Factor 5: Management Plan (15%)
Applicant organization's capability to manage and evaluate the
project as determined by: The qualification of
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proposed staff or requirements for ``to be hired'' staff; proposed
staff level of effort; management experience of the lead agency; and
experience of each member of the linkage as it relates to its defined
roles and the project.
Award Criteria
Funding decisions will be determined by the Deputy Assistant
Secretary of Minority Health, Office of Minority Health, and will take
under consideration: The recommendations and ratings of the review
panel, geographic and racial/ethnic distribution, and health problem
areas having the greatest impact on minority health. Consistent with
the Congressional intent of Public Law 101-527, section 1707(c)(3),
consideration will be given to projects targeting Asian, American
Samoan, and other Pacific Islander populations. Consideration will also
be given to projects proposed to be implemented in Empowerment Zones
and Enterprise Communities.
Reporting and Other Requirements
General Reporting Requirements
A successful applicant under this notice will submit: (1) Annual
progress report; (2) an annual Financial Status Report, and (3) a final
progress report and Financial Status Report in the format established
by the Office of Minority Health, in accordance with provisions of the
general regulations which apply under ``Monitoring and Reporting
Program Performance,'' 45 CFR part 74, subpart J, with the exception of
State and local governments to which 45 CFR part 92, subpart C
reporting requirements apply.
Provision of Smoke-Free Workplace and Nonuse of Tobacco Products by
Recipients of PHS Grants
Ths Public Health Service strongly encourages all grant recipients
to provide a smoke-free workplace and to promote the nonuse of all
tobacco products. In addition, 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.
Public Health System Reporting Requirements
This program is subject to Public Health Systems Reporting
Requirements. Under these requirements, a community-based
nongovernmental applicant must prepare and submit a Public Health
System Impact Statement (PHSIS). The PHSIS is intended to provide
information to State and local health officials to keep them apprised
of proposed health services grant applications submitted by community-
based nongovernmental organizations within their jurisdictions.
Community-based, nongovernmental applicants are required to submit,
no later than the Federal due date for receipt of the application, the
following information to the head of the appropriate state and local
health agencies in the area(s) to be impacted: (a) A copy of the face
page of the applications (SF 424), (b) a summary of the project
(PHSIS), not to exceed one page, which provides: (1) A description of
the population to be served, (2) a summary of the services to be
provided, (3) a description of the coordination planned with the
appropriate State or local health agencies. Copies of the letters
forwarding the PHSIS to these authorities must be contained in the
application materials submitted to the Office of Minority Health.
State Reviews
This program is subject to the requirements of Executive Order
12372 which allows States the option of setting up a system for
reviewing applications from within their States for assistance under
certain Federal programs. The application kit to be made available
under this notice will contain a listing of States which have chosen to
set up a review system and will include a State Single Point of Contact
(SPOC) in the State for review. Applicants (other than federally
recognized Indian tribes) should contact their SPOCs as early as
possible to alert them to the prospective applications and receive any
necessary instructions on the State process. For proposed projects
serving more than one State, the applicant is advised to contact the
SPOC of each affected State. The due date for State process
recommendations is 60 days after the application deadline by the Office
of Minority Health's Grants Management Officer. The Office of Minority
Health does not guarantee that it will accommodate or explain its
responses to State process recommendations received after that date.
(See ``Intergovernmental Review of Federal Programs,'' Executive Order
12372, and 45 CFR part 100 for a description of the review process and
requirements.)
OMB Catalog of Federal Domestic Assistance
The OMB Catalog of Federal Domestic Assistance Number for the
Bilingual and Bicultural Service Demonstration Program is 93.105.
Clay E. Simpson, Jr.,
Deputy Assistant Secretary for Minority Health.
[FR Doc. 98-5233 Filed 2-27-98; 8:45 am]
BILLING CODE 4160-17-M
