[Federal Register Volume 59, Number 57 (Thursday, March 24, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-6865]
[[Page Unknown]]
[Federal Register: March 24, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
RIN 0905-ZA24
HIV/AIDS Mental Health Services Demonstration Program (Includes
Cooperative Agreements for Services Demonstration Projects and One
Coordinating Center)
AGENCY: Center for Mental Health Services, Substance Abuse and Mental
Health Services Administration, HHS.
ACTION: Request for applications.
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SUMMARY: The Center for Mental Health Services (CMHS), Substance Abuse
and Mental Health Services Administration (SAMHSA), in collaboration
with the Health Resources and Services Administration (HRSA) and the
National Institutes of Health (NIH), announces the availability of
fiscal year (FY) 1994 funds for a new HIV/AIDS Mental Health Services
Demonstration Program.
Because of the complexity of this program, a cooperative agreement
mechanism is being utilized to allow for substantial Federal
programmatic participation in the conduct of the program, and to
facilitate communication and coordination in the overall implementation
and evaluation of the program. The program will include cooperative
agreements for services demonstration projects to provide mental health
services to people affected by and living with HIV/AIDS and a
coordinating center which, in conjunction with the services
demonstration projects, will design and implement the overall
evaluation of the HIV/AIDS Mental Health Services Demonstration
Program. A steering committee will be established to facilitate
coordination and cooperation among the services demonstration projects
and the coordinating center, and to oversee the cooperative agreements.
The HRSA Bureau of Health Resources Development (BHRD) and the NIH
National Institute of Mental Health (NIMH) also will provide funding
support for certain aspects of these cooperative agreements, will
recommend reviewers for the review of applications, will participate on
the steering committee, and will otherwise be involved in the
implementation of the HIV/AIDS Mental Health Services Demonstration
Program.
This notice consists of three parts:
Part I covers information on the legislative authority and the
applicable regulations and policies related to the HIV/AIDS Mental
Health Services Demonstration Program.
Part II describes the purpose, goals and scope of the program and
discusses eligibility, availability of funds, period of support and the
receipt date for applications.
Part III describes special requirements of the program, the
application process, the review and award criteria and lists contacts
for additional information.
Part I--Legislative Authority and Other Applicable Regulations and
Policies
Cooperative Agreements awarded under this RFA are authorized under
Sections 520B (42 U.S.C. 290bb-33), 520 (42 U.S.C. 290bb-31), 501 (42
U.S.C. 290aa), 405 (42 U.S.C. 284), and 464R (42 U.S.C. 285p) of the
PHS Act and 42 U.S.C. 300ff-28.
Federal regulations at Title 45 CFR parts 74 and 92, generic
requirements concerning the administration of grants, are applicable to
these awards.
Cooperative Agreements must be administered in accordance with the
PHS Grants Policy Statement (Rev. April 1, 1994).
The Catalog of Federal Domestic Assistance (CFDA) number for this
program is 93.215.
Interim and final progress reports and financial status and
expenditure reports will be required and specified to cooperative
agreement awardees in accord with PHS Grant Policy requirements.
Healthy People 2000: The Public Health Service (PHS) is committed
to achieving the health promotion and disease prevention objectives of
Healthy People 2000, a PHS-led activity to reduce morbidity and
mortality and improve the quality of life. This Request for
Applications (RFA), HIV/AIDS Mental Health Services Demonstration
Program, is related to the priority of HIV/AIDS infection. Potential
applicants may obtain a copy of Healthy People 2000 (Full Report: Stock
No. 017-001-0474-0; or Summary Report: Stock No. 017-001-00473-1)
through the Superintendent of Documents, Government Printing Office,
Washington, DC 20402-9325 (Telephone: 202-783-3238).
Promoting Nonuse of Tobacco: Studies have clearly established that
the use of tobacco products increases mortality and morbidity, not only
for the primary users of these products but for those in close
proximity to the user. Statistics published by the National Cancer
Institute indicate that cigarette smoking and chewing of tobacco are
responsible for as many as 1,500 deaths per day in the United States.
Recent studies conducted by the Environmental Protection Agency
indicate that prolonged exposure to second-hand smoke significantly
increases the probability of developing heart and lung disease.
Therefore, the CMHS strongly encourages all awardees to provide smoke-
free project and work environments.
A number of the goals of this program are consistent with the
President's Health Care Reform initiative (e.g., providing quality
mental health services, reducing the number of unnecessary inpatient
and outpatient medical visits, and increasing productive work capacity
as a result of receiving these services) and support the DHHS
Secretary's themes of fostering independence through empowering the
people, preventing future problems, and improving services to our
customers.
Part II--Programmatic Purpose, Goals and Scope, Eligibility and
Application Receipt Date
Services Demonstration Projects: CMHS will award competitive
cooperative agreements under Section 520B of the Public Health Service
(PHS) Act to develop or expand programs to provide mental health
services for individuals, their families and others who experience
serious psychological reactions as a result of HIV/AIDS antibody
testing, and to provide mental health services for people with HIV/
AIDS. The services demonstration projects will be responsible for an
evaluation that includes collection of both process and outcome data
and that will document the extent to which the objectives set forth in
the application have been met.
The services demonstration projects will also participate in the
development of an overall evaluation of the HIV/AIDS Mental Health
Services Demonstration Program by the coordinating center, as described
below.
Coordinating Center: CMHS will award one competitive cooperative
agreement to a recipient which, in conjunction with the services
demonstration projects, will design and implement the overall
evaluation of the HIV/AIDS Mental Health Services Demonstration
Program. This will include evaluating the effectiveness and efficiency
of the different approaches or models used for organizing and providing
the mental health services. The coordinating center will also provide
the overall coordination and management of the program data.
Steering Committee: The project directors of the coordinating
center and the services demonstration projects, and CMHS, BHRD and NIMH
representatives, will work collaboratively via a steering committee to
facilitate coordination and communication among the parties. The
steering committee will have the responsibility for overseeing the
cooperative agreements to develop consensus on major decisions and to
facilitate the accomplishment of the HIV/AIDS Mental Health Services
Demonstration Program goals.
Program Description
Purpose: The purposes of the cooperative agreement program are to:
1) Provide a range of high quality mental health services to people
affected by or living with HIV/AIDS; 2) Evaluate the effectiveness and
efficiency of the different approaches or models used for organizing
and providing those services; and 3) Determine the outcome of those
services on the quality of life of the individuals served.
Program Goals and Scope: The goals of this cooperative agreement
program are to:
Provide a range of quality mental health services.
Change risk behaviors and prevent further HIV
transmission.
Increase compliance with medical treatment and enhance
access to existing services.
Reduce the number of unnecessary inpatient and outpatient
medical visits.
Decrease the risk of suicide.
Improve the quality of life for those individuals affected
by and living with HIV/AIDS.
Increase productive work capacity as a result of receiving
these services.
Develop and rigorously evaluate models for replication and
integration into HIV/AIDS delivery systems.
Disseminate information about successful service models.
A. Applications for Services Demonstration Projects Funding
Target Populations: The target population includes people affected
by or living with HIV/AIDS. Within the target population, gay and
bisexual men, racial and ethnic minorities, women, injection drug
users, children and adolescents, adults with serious mental illnesses,
children and adolescents with serious emotional disturbances, the
incarcerated, and people who are homeless are of particular interest.
Demonstrated Need: Unmet need will be a primary criterion in the
review of applications under this announcement. Methodology used to
compile local needs assessment data must be described.
Recommended Approach: Applicants should address, in the
``Approach'' section of the application, the specific mental health
services listed below, and the development of an infrastructure that
includes the additional project elements also described below. The
services may be provided directly or through contract.
Specific Mental Health Services
The application should address at least the first four of the
following services:
HIV/AIDS risk and transmission reduction counseling.
A range of mental health treatment services, e.g., group
therapy, supportive counseling, peer counseling, buddy programs,
oversight of psychotropic medication, psychotherapy, and family
therapy, including alternative families, partners, and significant
others.
Diagnostic mental health services, including neurological
consults and psychological testing.
HIV/AIDS antibody pre-test counseling and appropriate
post-test counseling for those who test positive for HIV/AIDS antibody
as well as those who test negative.
Mental health case management services.
Counseling to ensure adherence to tuberculosis and other
treatment regimens.
Outreach mental health services, e.g., educating the
community to facilitate referrals to your project.
Consultation services, e.g., to schools, foster parents,
day care centers, alternative health care sites and clinics that serve
special populations described above.
Home based mental health services.
Additional Project Elements
Applicants should address the development of an infrastructure that
includes the following:
Relationships with or a plan to build relationships with a
variety of other non-HIV/AIDS health, mental health, and support
service providers such as, State Mental Health or Substance Abuse Block
Grant Programs, maternal and child health services, primary health care
services, financial and other resource supports, legal services,
spiritual services, and governmental and private programs.
Relationships with or a plan to build relationships with
other programs for people with HIV/AIDS, such as, the CDC Counseling
and Testing Program, the HRSA Ryan White C.A.R.E. Act Program (Title I
EMAs, Title II States and their consortia, Title III Early Intervention
providers, and Title IV Pediatric Projects), NIH-supported treatment
and research programs, etc.
An appropriate system for determining the eligibility of
people with HIV/AIDS for financial or other resource assistance.
Reimbursement for mental health services provided through
Federal, State, local, or nongovernmental programs of support, e.g.,
Medicaid reimbursement.
Training for individuals providing the services described
in the application.
Funding preference will be given to services demonstration project
applicants that are based at, or have relationships with, entities
providing comprehensive health services to people who are infected with
HIV. For the purposes of this program, comprehensive health services
include services such as those described above in the ``Specific Mental
Health Services'' and ``Additional Project Elements'' sections.
Evaluation: The evaluation should include collection of both
process and outcome data that will document the extent to which the
objectives set forth in the application have been met by the project.
Process evaluations examine the extent to which the project has been
implemented as designed. Outcome evaluations assess the extent to which
the projects have achieved the desired effects at the individual level
as well as the group and community level. The evaluation should
examine: the implementation of HIV/AIDS specific mental health services
and additional project elements at the project and client levels; the
type and frequency of services provided to the individual clients; the
characteristics and needs of recipients of the services; and the
outcome of services.
Services demonstration projects will be expected to participate in
the development of an overall evaluation of the HIV/AIDS Mental Health
Services Demonstration Program that would be implemented by the
coordinating center. The services demonstration project plans may have
to be refined in light of the overall program evaluation plan. The
services demonstration projects must agree to cooperate with CMHS and
the coordinating center on the design and implementation of the overall
program evaluation plan.
Applicants should budget 15-20 percent for the evaluation
activities, and include travel for at least two participants to attend
up to four meetings in the Washington, D.C. area or at a services
demonstration project site for each year of the project period (4
years).
B. Applications for the Coordinating Center Funding
The coordinating center, in conjunction with CMHS and the services
demonstration projects, will, using input from the services
demonstration projects, design and implement the overall evaluation of
the HIV/AIDS Mental Health Services Demonstration Program including: 1)
A description and evaluation of the various models created under this
program in an effort to determine which models might be replicated and
integrated into HIV/AIDS health care delivery systems nationally; and
2) an analysis of changes in client outcomes.
The coordinating center will assist the services demonstration
projects by providing overall evaluation coordination, including data
management and analysis, training in common procedures, and
distribution of necessary materials to all projects. Specifically, the
coordinating center will work with CMHS and the services demonstration
projects in the planning phase to: 1) Provide advice regarding the
evaluation personnel needs at the services demonstration project level;
2) develop criteria for compatible computer equipment; 3) recommend to
the steering committee common outcome measures; and 4) develop common
data collection elements. It is anticipated that these tasks will be
coordinated through a series of meetings of the steering committee to
commence immediately following issuance of the Notices of Grant Award.
The coordinating center will develop and maintain a common data
repository, containing common data files needed by the services
demonstration projects. It is the intention of CMHS that the data be
made available to the larger mental health and HIV/AIDS community as
soon as feasible, in accordance with steering committee recommendations
and in accordance with participant protection policy.
The coordinating center will also provide ongoing technical
assistance on the data collection and evaluation issues to the services
demonstration projects as needed. The coordinating center budget should
be consistent with the purpose of the program, and should reflect the
level of effort anticipated to carry out the proposed tasks.
The steering committee, working with the coordinating center, will
prepare reports for submission to the project officer. An annual
progress report will be prepared by the steering committee.
Applicants for the coordinating center should present a plan for
how best to meet the overall responsibilities described above and the
goals of the HIV/AIDS Mental Health Services Demonstration Program. In
addition, previous relevant experience in data collection and
evaluation, as well as facilities and resources available to complete
the project, should be described.
Eligibility: Applications may be submitted by public and nonprofit
private entities, such as community mental health centers, community-
based organizations providing HIV/AIDS care and related services, State
and local health departments, universities, colleges, hospitals, and
alternative health and mental health care entities that serve medically
disenfranchised populations. Entities may apply for either or both
types of award (services demonstration project and coordinating
center). Entities staffed largely by women and minorities are
especially encouraged to apply.
Availability of funds: It is estimated that approximately $1.2
million total (direct and indirect costs) will be available in FY 94
and that additional funding up to a total of $3.4 million may be
available through further collaboration with other agencies for
services demonstration projects. It is anticipated that 8-12 services
demonstration projects will be awarded under this Request for
Applications (RFA) in FY 94. Actual funding levels will depend upon the
availability of funds at the time of the award. It is expected that an
additional $700,000 total (direct and indirect costs) will be available
for a coordinating center.
Period of Support: Support may be requested for an initial period
of up to 4 years. Annual awards will be made subject to continued
availability of funds and progress achieved.
Application Receipt and Review Schedule: The schedule for receipt
and review of applications under this announcement is as follows:
------------------------------------------------------------------------
Earliest start
Receipt date IRG review Council review date
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May 26, 1994..... July 1994........ Sept. 1994...... Sept. 1994.
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Applications must be received by the published application receipt
date. An application received after the deadline may be acceptable if
it carries a legible proof-of-mailing date assigned by the carrier and
the proof-of-mailing date (private metered postmarks are not acceptable
as proof of timely mailing) is not later than one week prior to the
deadline date. If the receipt date falls on a weekend, it will be
extended to the following Monday; if the date falls on a national
holiday, it will be extended to the following work day.
Consequences of Late Submission: Applications received after the
above receipt date will not be accepted and will be returned to the
applicant without review.
Part III--Special Requirements, Review/Award Criteria and Contacts for
Additional Information
Letter of Intent: Organizations planning to submit an application
for a services demonstration project and/or the coordinating center are
encouraged to submit a letter of intent at least 30 days prior to the
receipt date. Such notification is used by the
CMHS for purposes of review and program planning. This letter is
voluntary and does not obligate the person/organization to submit an
application.
In addition, the letter should be no longer than one page and
should succinctly indicate:
--the number and title of the RFA
--the name of the potential applicant organization, city and state
--the name and affiliation of the proposed project director, i.e., the
individual who will be assigned to coordinate the development and
implementation of the project
--the overall scope of the proposed project, including a brief
description of the likely goals and objectives
Letters of intent should be addressed to: Director, Office of
Evaluation, Extramural Policy, and Review, Center for Mental Health
Services, 5600 Fishers Lane, room 18C-07, Rockville, Maryland 20857,
ATTN: RFA/Letter of Intent. FAX: 301/443-7912.
Coordination with Other Federal/Non-Federal Programs: Applicants
seeking support under this announcement are encouraged to coordinate
with other programs. Program coordination helps to better serve the
multiple needs of the patient/client population, to maximize the impact
of available resources, and to eliminate duplication of services.
Applicants should identify the coordinating organizations by name and
address and describe the process used/to be used for coordinating
efforts. Letters of commitment specifying the kind(s) and level of
support from organizations (both Federal and non-Federal) which have
agreed to work with the applicant must be included in the application
appendices. Examples of Federal programs with which applicants may find
coordination productive are included in the complete application kit.
Public Health System Reporting Requirements: The services
demonstration projects are subject to the Public Health Service
Requirements. Under these requirements, the 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 applications submitted by community-based
nongovernmental organizations within their jurisdictions.
Community-based nongovernmental applicants are required to submit
the following information to the head of the appropriate State and
local health agencies, including the State HIV/AIDS directors and the
State mental health directors, no later than the application receipt
date of May 26, 1994.
a. A copy of the face page of the application (Standard Form 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.
State and local governments and Indian Tribal Authority applicants
are not subject to the Public Health Service Reporting Requirements.
This subsection applies to services demonstration project
applicants only.
Intergovernmental Review (E.O. 12372): Applications for services
demonstration projects, submitted in response to this announcement are
subject to the intergovernmental review requirements of Executive Order
12372, as implemented through DHHS regulations at 45 CFR Part 100. E.O.
12372 sets up a system for State and local government review of
applications for Federal financial assistance. Applicants (other than
federally recognized Indian tribal governments) should contact the
State's Single Point of Contact (SPOC) as early as possible to alert
them to the prospective application(s) and to 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. A current listing of SPOCs is included in the
application kit. The SPOC should send any state process recommendations
to the following address: Director, Office of Evaluation, Extramural
Policy, and Review, Center for Mental Health Services, 5600 Fishers
Lane, Room 18C-07, Rockville, MD 20857, Attn: Spoc.
The due date for State process recommendations is no later than 60
days after the deadline date for the receipt of applications. The CMHS
does not guarantee to accommodate or explain SPOC comments that are
received after the 60-day cut-off. This subsection applies to the
services demonstration project applicants only.
Role of Federal Staff in Cooperative Agreements: The Cooperative
Agreement mechanism includes substantial post-award Federal
programmatic participation in the conduct of the project. It is
anticipated that CMHS staff participation in this program will be
substantial. In addition to the general project officer function of
monitoring the conduct and progress of the services demonstration
projects and making recommendations about continuance of the project,
CMHS staff will be active participants in planning and implementing the
HIV/AIDS Mental Health Services Demonstration Program through
participation on the steering committee, promoting exchange of relevant
information among the services demonstration projects, and
participating in and/or providing support services for training,
evaluation, and data collection. CMHS staff will also monitor the
function and activities of the coordinating center, assuring that
progress is satisfactory, and required reporting is timely. A program
representative from CMHS, BHRD and NIMH will participate on the
steering committee, each with a single vote.
Application Procedures: All applicants must use application form
PHS 5161-1 (Rev. 7/92), which contains Standard Form 424 (face page).
The following information should be typed in Item Number 10 on the face
page of the application form:
RFA# SM-94-02: HIV/AIDS Services Demonstration (for services
demonstration projects).
RFA# SM-94-02: HIV/AIDS Coordinating Center (for coordinating center).
If an entity is applying for both cooperative agreements (services
demonstration projects and coordinating center), then 2 separate face
pages and applications should be submitted.
Application kit (including form PHS 5161-1 with Standard Form 424
and complete application procedures) may be obtained from: Global
Exchange, Inc., 7910 Woodmont Avenue, Suite 400, Bethesda, MD 20814-
3015, (301) 656-3100.
Applicants must submit: (1) an original copy signed by the
authorized official of the applicant organization, with the appropriate
appendices; and (2) two additional, legible copies of the application
and all appendices to the following address: Center for Mental Health
Services Programs, Division of Research Grants, NIH, Westwood Building,
room 240, 5333 Westbard Avenue, Bethesda, Maryland 20892.*
*If an overnight carrier or express mail is used, the Zip Code
is 20816.
Review Process: Applications submitted in response to this RFA will
be reviewed for technical merit in accordance with established PHS/
SAMHSA peer review procedures for grants.
Applications that are accepted for review will be assigned to an
Initial Review Group (IRG) composed primarily of non-Federal experts.
Notification of the IRG recommendation will be sent to the applicant
upon completion of the initial review. In addition, the IRG
recommendations on technical merit of applications will undergo a
second level of review by the appropriate advisory council whose review
may be based on policy considerations as well as technical merit.
Applications may be considered for funding only if the advisory council
concurs with the IRG recommendation for approval.
Review Criteria: The following criteria will be used in the
technical merit review of services demonstration project applications.
The points noted in parentheses for each criterion indicate the maximum
number of points the reviewers may assign to that criterion. These
points will be used to calculate a raw score for each application. The
raw score will be converted to the official priority score.
adequacy of documentation of unmet need, including a
description of special population(s) to be served, if applicable, and
the availability of and access to the current mental health delivery
system by people affected by and living with HIV/AIDS (30)
adequacy and appropriateness of the goals and objectives,
and approach, including the specific mental health services to be
provided and the additional project elements that assure the
development of an infrastructure (25);
appropriateness of the proposed project in terms of (1)
budget, (2) management plan, (3) personnel, (4) time frame, (5)
resources, and (6) adequacy, availability, and accessibility of
facilities (20)
appropriateness of the proposed evaluation design and
methodology (15)
experience of the applicant in delivering mental health
services (10)
The following criteria will be used in the technical merit review
of the coordinating center applications. The points noted in
parentheses for each criterion indicate the maximum number of points
the reviewers may assign to that criterion. These points will be used
to calculate a raw score for each application. The raw score will be
converted to the official priority score.
adequacy of the overall plan, addressing structure and
scientific rigor of the evaluation, and plans for data quality (30)
adequacy of plans for coordination, technical assistance,
and training (25)
qualifications and experience of the principal
investigator and proposed staff in statistics, data analysis,
evaluation, and large-scale data collection efforts (25)
appropriateness of budget, personnel, facilities,
resources, and time frame (20)
Award Criteria and Funding Preference: Services demonstration
project applications recommended for approval by the IRG and the
appropriate advisory council will be considered for funding on the
basis of overall technical merit as determined through the review
process, geographic distribution, evidence of agreement for cooperation
with the coordinating center in the overall program evaluation, variety
of settings (e.g., community mental health centers and community-based
organizations providing HIV/AIDS care and related services), and the
availability of funds. In addition, funding preference will be given to
applicants that are based at, or have relationships with, entities
providing comprehensive health services to people who are infected with
HIV.
Coordinating center applications recommended for approval by the
IRG and the appropriate advisory council will be considered for funding
on the basis of overall technical merit as determined through the
review process, suitability for working with the services demonstration
projects funded, and the availability of funds.
Contacts for Additional Information
Questions concerning program issues may be directed to: Ms. Elaine
Corrigan, Program Management Officer, CMHS HIV/AIDS Program, 5600
Fishers Lane, room 11C-21, Rockville, MD 20857, (301) 443-7817.
Questions regarding grants management issues may be directed to:
Ms. Carole Edison, Grants Management Officer, Center for Mental Health
Services, 5600 Fishers Lane, room 15-87, Rockville, Maryland 20857,
(301) 443-4456.
Dated: March 15, 1994.
Richard Kopanda,
Acting Executive Officer, SAMHSA.
[FR Doc. 94-6865 Filed 3-23-94; 8:45 am]
BILLING CODE 4162-20-M
