[Federal Register Volume 60, Number 71 (Thursday, April 13, 1995)]
[Notices]
[Pages 18934-18937]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-9143]
[[Page 18933]]
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Part III
Department of Health and Human Services
_______________________________________________________________________
Public Health Service
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Bilingual/Bicultural Service Demonstration Projects in Minority Health;
Availability of Funds and Request for Applications; Notice
Federal Register / Vol. 60, No. 71 / Thursday, April 13, 1995 /
Notices
[[Page 18934]]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Office of the Assistant Secretary for Health; Notice on
Availability of Funds and Request for Applications for Bilingual/
Bicultural Service Demonstration Projects in Minority Health
AGENCY: Office of Minority Health, Office of the Assistant Secretary
for Health.
ACTION: Notice of availability of funds and request for applications
for bilingual/bicultural service demonstration projects in minority
health.
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AUTHORITY: This program is authorized under section 1707(d)(1) of the
Public Health Service Act, as amended in Public Law 101-527.
PURPOSE: To provide support to improve the ability of health care
providers and other health care professionals to deliver linguistically
and culturally competent health services to limited-English-proficient
populations.
APPLICANT ELIGIBILITY: Eligible applicants are public and private
nonprofit minority community-based organizations or health care
facilities serving a targeted minority community.
ADDRESSES/CONTACTS: Applications must be prepared on 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, Office of Minority Health,
Rockwall II Building, Suite 1000, 5515 Security Lane, Rockville, MD
20852, (telephone 301/594-0758) or by Internet E-mail
cwilliams@oash.ssw.dhhs.gov. Completed applications are to be submitted
to the same address.
Technical assistance on the programmatic content for the Bilingual/
Bicultural Grants may be obtained from Ms. Nina Darling or Ms. Rizalina
Galicinao. They can be reached at the Office of Minority Health,
Rockwall II Building, Suite 1000, 5515 Security Lane, Rockville, MD
20852, (telephone 301/594-0769) or by Internet E-mail
ndarling@oash.ssw.dhhs.gov or rgalicin@oash.ssw.dhhs.gov.
In addition, OMH Regional Minority Health Consultants (RMHCs) are
available to provide technical assistance. A listing of the RMHCs and
how they may be contacted is provided in the grant application kit.
Applicants also can contact the OMH Resource Center (OMH/RC) at 1-800-
444-6472 for health information and generic information on preparing
grant applications.
DEADLINE: To receive consideration, grant applications must be received
by the Grants Management Office by May 15, 1995. Applications will be
considered as meeting the deadline if they are either:
(1) Received at the above address on or before the deadline date,
or
(2) Sent to the above address on or before the deadline date and
received in time for orderly processing. Applicants should request a
legibly dated U.S. Postal Service postmark or obtain a legibly dated
receipt from a commercial carrier or U.S. Postal Service. Private
metered postmarks shall not be acceptable as proof of timely mailing.
Applications submitted by facsimile transmission (FAX) will not be
accepted. Applications which do not meet the deadline will be
considered late and will be returned to the applicant unread.
AVAILABILITY OF FUNDS: It is anticipated that in Fiscal Year 1995, the
Office of Minority Health will have approximately $1.3 million
available to support approximately 13 grants of up to $100,000 each
under this program. At least three grants focusing on HIV/AIDS as a
health problem will be funded under this announcement.
PERIOD OF SUPPORT: Support may be requested for a total project period
not to exceed 3 years. Non competing continuation awards will be made
subject to satisfactory performance and availability of funds.
BACKGROUND: The Office of Minority Health is the unit of the U.S.
Department of Health and Human Services that coordinates Federal
efforts to improve the health status of racial and ethnic minority
populations, including American Indians, Alaska Natives, Asian
Americans, Pacific Islanders, African Americans and Hispanics/Latinos.
With the passage of the Disadvantaged Minority Health Improvement Act
(Pub. L. 101-527), the OMH was established in legislation and given a
broad mandate to advance efforts to improve minority health including
supporting research, demonstrations and evaluations of new and
innovative programs that increase understanding of disease risk factors
and support improvement in information dissemination, education,
prevention and service delivery to minority communities. The OMH was
also directed to develop appropriate planning, logistical support, and
technical assistance related to increasing the capabilities of health
care providers and other health care professionals to address cultural
and linguistic barriers to effective health care service delivery, and
to increase access to effective health care for limited-English-
proficient minority populations [Pub. L. 101-527, section 1707(b)(7)].
Social, cultural and linguistic barriers on the part of both
providers and clients significantly affect the receipt of needed health
care. Among the many factors contributing to the poor health status of
limited-English-proficient minorities are:
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;
A lack of culturally appropriate community health
prevention programs;
Absence of effective partnerships between major mainstream
provider organizations and limited-English-proficient minority
communities;
Low economic status;
Lack of health insurance; and
Organizational barriers.
This RFA specifically addresses the barriers that limited-English-
proficient minority populations face when trying to access health
services.
In the 1990 U.S. Census, language questions asked were (1) Whether
respondents speak another language at home, (2) how well they speak
English (for those who answered yes to the first question), and (3)
which language they speak at home. The census data indicates that 31.8
million persons ages 5 and above (13.8 percent of the total U.S.
population counted by the 1990 census) spoke another language at home.
Of those, 17.9 million people reported that they speak English very
well. Almost 2 million people (1.8 million) do not speak English at
all. An additional 4.8 million people do not speak English well.
Large numbers of minorities in the United States are linguistically
isolated--living in households in which no one 14 years old or over
speaks English and no one who speaks a language other than English
speaks English ``very well.'' The 1990 Census found 1,572,006 Asian and
Pacific Islanders at least 5 years of age to be linguistically
isolated. The percent of Asian and Pacific Islanders who are
linguistically isolated varies by
[[Page 18935]]
subgroup--ranging from 9.7% among Filipinos to 59.8% among Hmong. Among
Pacific Islanders, Tongans had the highest proportion of persons who
were linguistically isolated (18.7%). More than four million Hispanics
are linguistically isolated (4,548,677 or 23.8%). Central Americans
(40.3%) and Dominicans (39.6%) are the most likely to be linguistically
isolated. Among Blacks, 282,147 (0.9%) are linguistically isolated.
Among American Indians, Alaska Natives, 77,802 (4%) are linguistically
isolated.
Definitions
For purposes of this grant announcement, the following definitions
are provided:
(1) Minority Populations--As defined by the Office of Management
and Budget (OMB) Circular No. 15, include: Asisan/Pacific Islanders,
Blacks, Hispanics, and American Indian/Alaska Native.
(2) Limited-English-Proficient Populations--individuals, as defined
above (1), 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.
(3) Minority Community-Based Organization--a public or private non-
profit community-based minority organization or a local affiliate of a
national minority organization that has a governing board composed of
51% or more racial/ethnic minority members, has a significant number of
minorities in key program positions, has an established record of
service to a racial and ethnic minority community.
(4) Health Care Facilities--for purpose of this announcement, a
health care facility is a public nonprofit facility that has an
established record for providing a full range of health care services
to a targeted racial and 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 care center,
or a mental health center.
(5) Community--a defined geographical area in which persons live,
work, and recreate, characterized by: (a) formal and informal
communication channels; (b) formal and informal leadership structures
for the purpose of maintaining order and improving conditions; and (c)
its capacity to serve as a focal point for addressing societal needs,
including health needs. A community should be an appropriate catchment
area in which to address a population's social and health needs.
(6) Bilingual Direct Services--any activity that delivers person to
person health care/health promotion services which is linguistically
and culturally appropriate to limited-English-proficient clientele,
including, for example, translation and interpreter services and health
education course taught bilingually.
(7) Cultural Competency--a set of interpersonal skills that allow
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)
Potential Projects/Activities
A broad range of approaches may be used to respond to this
proposal. However, the projects should concentrate on activities to
improve the ability of health care providers and other health care
professionals to deliver linguistic and culturally competent health
services to limited-English-proficient populations. A proposed program
may include, but is not limited to:
language and cultural competency training for health care
professionals;
bilingual health access or health promotion information in
the native language of the target population(s);
on-site interpretation services; and
trainer development courses on cultural competency.
Organizational Linkages
Project goals should promote access to direct services for limited-
English-proficient minority populations by providing continuity of
support to clients for outreach, referral and treatment. Linkages must
be established between minority community based organizations and
appropriate health care facilities. The minority community-based
organizations and the health care facilities must reach out and work
with each other to ensure that limited-English-proficient persons are
in receipt of appropriate health care services. Thus, the applicant,
either the minority community-based organization or the health care
facility must have an established linkage with the other organization
prior to submitting an application.
Application Process
Applicants should pay particular attention to the general and
supplemental instructions provided in the application kit to ensure
that their applications are responsive to each of the concerns under
the following headings:
Background
Provide a description of the problem to be addressed; clearly
identify the scope of the problem including linguistic/cultural
barriers; the limited-English-proficient minority target group(s)
affected; health issues; and the pertinent geographic area/subarea.
Provide documentation supporting the serving of at least 40 percent or
more persons with limited-English proficiency.
Cite the capability and experience of the organization to provide
linguistic and culturally competent health care services.
Goal(s) and Objective(s)
Clearly state the goal(s) of the project. Provide a list of
specific, time-phased, measurable objective(s), including target dates.
Methodology
A project management plan must be included which delineates project
activities specifying responsible parties, methods to be used,
timelines, and anticipated outcomes. Project activities must be linked
to goal(s) and objective(s). Indicate the organization's capability to
collaborate with other health care providers and health care
professionals to effectively reach the target population. Describe the
linkage between the organization and the applicable minority community-
based organization/health care facility.
Personnel/Management
Describe duties, reporting channels, requisite qualifications, and
related experience of personnel who will be responsible for carrying
out the project. Resumes and curriculum vitae of key personnel must be
provided. Describe management capability and experience of proposed
grantee organization.
Evaluation
Specify the approach and provide an example of data collection
instruments that will be used to measure accomplishment of objectives;
the evaluation should include both process and outcome measures.
Provide a concise analysis of how the project will result in a
sustained impact on reducing the problem of access to bilingual/
bicultural health care services. Provide
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information on how the project will be sustained beyond the funding
period and the degree that the project can be replicated.
Budget
Budgets of up to $100,000 total direct and indirect costs per year
may be requested to cover: The cost of personnel, consultants, support
services, materials, and travel. The project budget must include travel
for one project staff member to meet with the OMH Bilingual/Bicultural
Program Director in Washington, D.C. Funds may not be used for
construction, building alterations or renovations. Also, funds may not
be used to purchase equipment except as may be acceptably justified in
relation to conducting the project activities.
All budget requests must be fully justified in terms of the goals
and objectives proposed and include a computational explanation of how
costs were determined.
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. Applications
judged to be complete, conforming, and responsive will be reviewed for
technical merit in accordance with PHS policies.
Applications will be evaluated by Federal and non-Federal reviewers
chosen for their expertise in minority health and their understanding
of the unique health problems and related issues confronted by limited-
English-proficient racial and ethnic populations in the United States.
Applicants are advised to pay special attention to developing
clearly defined goals and objectives for their projects, as well as
providing well-developed study and evaluation designs for the
measurement of project objectives. Both formative and summative
evaluations will be required of the grantee, as well as analysis of how
the project can be improved to reach the desired outcomes. Applicants
should also pay specific attention to the program guidelines, and the
general and supplemental instructions provided in the application kit.
Review Criteria: Applications will be reviewed and evaluated for
evidence of consistency with the requirements of this announcement. Of
specific importance will be the following criteria under the listed
headings. (An indication of the quantitative weight appears in
parentheses after each heading):
Background (25%)
Clarity, specificity, depth and coherence of the described
need(s) and problem(s) of the target-population(s) which includes
linguistic/cultural barriers.
Strength and specificity of the capability of the
organization to provide linguistically and culturally competent health
care services for the target population;
Degree to which the organization is committed to linkage
with the applicable minority community-base organization/health care
facility;
The validity of the documentation supporting the
percentage of limited-English-proficient persons the project will
serve;
Extent and outcomes of past efforts/activities with the
proposed target community; and
Specificity of data on the intended target group.
Goals and Objectives (15%)
Relevance of the proposed goals and objectives to this
announcement and the OMH mission;
Merit of the proposed objectives, including their
measurability and relevance to the stated project goals, and soundness/
attainability of the time frame specified; and
Soundness/attainability of proposed impacts/results/
products.
Methodology (25%)
Strength of the work plan and specific activities
proposed, including their scope and relevance to each of the stated
objectives and projected outcomes;
The degree to which the linguistic and cultural competence
skills will provide the health care providers and health care
professionals with the ability to increase outreach effectiveness to
the target population(s);
Evidence that the organization has the established
linkages with appropriate health care facilities to provide continuity
of support to clients for outreach, referral and treatment; and
Clearly defined project timeline, Gantt Chart or Pert
Chart is included as it relates to project planning, implementation,
and program evaluation.
Personnel/Management (15%)
Strength of proposed grantee organization's management
capability;
Adequacy of qualifications, experience, linguistic and
cultural competence of proposed personnel;
Evidence that the proposed staff can effectively outreach
and work with the targeted community; and
Evidence of clear lines of authority and accountability
among proposed staff, volunteers, managers, and collaborators.
Evaluation (20%)
The strength of the evaluation plan: includes formative
and summative evaluation designs; the likelihood that the proposed
objectives can be measured; and the linguistic and cultural competence
of the project can be assessed;
Clarity and specificity of proposed qualitative and
quantitative measures of project accomplishments;
Soundness of proposed data analysis and reporting methods;
Evidence that a project can be replicated;
Evidence that the proposed implementation plan and bring
about the desired outcome(s); and
If the proposed project provides direct services,
likelihood that services will be sustained beyond the expiration of the
3 year funding period.
Budget/Financial Plan (0%)
The budget items will be commented on, but not rated by the review
panel.
Evidence that required budget items are consistent with
stated goals and are appropriate to the level of effort required.
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/ratings of review
panels as well as program balance which includes geographic and race/
ethnicity distribution, and health problem areas having the greatest
impact on minority health in terms of causes of death. Preference will
be given to applicants who have received grants under the Bilingual/
Bicultural Program.
Supplementary Information: This announcement for Fiscal Year 1995
Bilingual/Bicultural Service Demonstration Grants focuses on the six
health problems identified by the Secretary's Task Force on Black and
Minority Health as having the greatest impact on minority health in
terms of causes of death: (1) Cancer; (2) cardiovascular disease and
stroke; (3) chemical dependency; (4) diabetes; (5) homicides; and (6)
infant mortality. Additional areas of concern under this announcement
include HIV infection,
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access to and financing of health care, health professions personnel
development, data collection and analysis, and surveillance. Proposals
should include strategies that will address these problems in a
culturally competent and linguistically appropriate manner.
These health priorities also are addressed in the Health Objectives
for the Nation, Healthy People 2000, which the Public Health Service
(PHS) is committed to achieving. Potential applicants may obtain a copy
of Healthy People 2000 (Full Report: Stock No. 017-001-00474-0) or
Healthy People 2000 (Summary Report: Stock No. 017-001-00473-1) through
the Superintendent of Documents, Government Printing Office,
Washington, DC 20402-9325 (telephone: 202/783-3238).
State Reviews: E.O. 12372 sets up a system for state and local
government review of proposed Federal assistance applications.
Applicants [other than federally-recognized Indian tribal
governments] should contact their State Single Point of Contact (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. All comments from a state
office must be received within 60 days after the application deadline
by the Office of Minority Health's Grants Management Officer. A list of
addresses of the SPOCs is enclosed with the application kit material.
Provision of Smoke-Free Workplace and Non-Use of Tobacco Products
by Recipients of PHS Grants: The Public Health Service strongly
encourages all grant recipients to provide a smoke-free workplace and
to promote the non-use 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
the following information to the head of the appropriate state and
local health agencies in the area(s) to be impacted no later than the
Federal application receipt due date: (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.
The Catalog of Federal Domestic Assistance number is 93.105.
Dated: March 23, 1995.
Clay E. Simpson, Jr.,
Acting Deputy Assistant Secretary for Minority Health.
[FR Doc. 95-9143 Filed 4-12-95; 8:45 am]
BILLING CODE 4160-17-M
