**U.S. Department of Health and Human Services**

**Health Resources and Services Administration**

**Maternal and Child Health Bureau**

**Division of Child, Adolescent and Family Health**

> ***Integrated Health and Behavioral Health Care***
>
> ***for Children, Adolescents and Their Families Grant Program:
> Implementation***
>
> New Competition
>
> *HRSA-06-090*
>
> *Catalog of Federal Domestic Assistance (CFDA) No. 93.110*

**PROGRAM GUIDANCE**

Fiscal Year 2006 []{.mark}

**Application Due Date: March 31, 2006**

**Release Date: *January 31, 2006***

> Contact Name: Sharon Adamo, MS, MBA, RD
>
> Office: Office of Adolescent Health
>
> Telephone: 301/443-3972
>
> Fax: 301/443-1296

Date of Issuance: January 31, 2006

Authority: Title V of the Social Security Act, section 501(a)(2) of the
Social Security Act.

**Table of Contents**

[Executive Summary 2](#__RefHeading___Toc120336182)

[I. Funding Opportunity Description 2](#__RefHeading___Toc120336183)

[1. Purpose 2](#__RefHeading___Toc120336184)

[2. Background 2](#__RefHeading___Toc120336185)

[*i. Program Background* 2](#__RefHeading___Toc120336186)

[*ii.* *Summary of Planning Phase of Initiative*
2](#__RefHeading___Toc120336187)

[*iii. Overview of the Maternal and Child Health Bureau's Mission*
2](#__RefHeading___Toc120336188)

[II. Award Information 2](#__RefHeading___Toc120336189)

[1. Type of Award 2](#__RefHeading___Toc120336190)

[2. Summary of Funding 2](#__RefHeading___Toc120336191)

[III. Eligibility Information 2](#__RefHeading___Toc120336192)

[1. Eligible Applicants 2](#Eligibility_who)

[2. Cost Sharing/Matching 2](#__RefHeading___Toc120336194)

[3. Other 2](#__RefHeading___Toc120336195)

[*i. Maintenance of Effort* 2](#__RefHeading___Toc120336196)

[*ii. Other Limitations* 2](#__RefHeading___Toc120336197)

[IV. Application and Submission Information
2](#__RefHeading___Toc120336198)

[1. Address to Request Application Package
2](#__RefHeading___Toc120336199)

[2. Content and Form of Application Submission
2](#__RefHeading___Toc120336200)

[i. *Application Face Page* 2](#__RefHeading___Toc120336201)

[ii.*.* *Table of Contents* 2](#__RefHeading___Toc120336202)

[iii. *Application Checklist* 2](#__RefHeading___Toc120336203)

[iv. *Budget* 2](#__RefHeading___Toc120336204)

[v. *Budget Justification* 2](#__RefHeading___Toc120336205)

[vi. *Staffing Plan and Personnel Requirements*
2](#__RefHeading___Toc120336206)

[vii. *Assurances* 2](#__RefHeading___Toc120336207)

[viii*.* *Certifications* 2](#__RefHeading___Toc120336208)

[ix. *Project Abstract* 2](#__RefHeading___Toc120336209)

[x. *Program Narrative* 2](#__RefHeading___Toc120336210)

> [1) Need: Understanding of, and Planning Process for, an Integrated
> Health and Behavioral Health Services System for a Community-based
> Population of Children, Adolescents and Their Families
> 2](#__RefHeading___Toc120336211)
>
> [2a) Response: Goals and Objectives 2](#__RefHeading___Toc120336212)
>
> [2b) Response: Strategies and Methods for Attaining Project Goals and
> Objectives 2](#__RefHeading___Toc120336213)
>
> [3) Evaluative Measures 2](#__RefHeading___Toc120336214)
>
> [4) Impact 2](#__RefHeading___Toc120336215)
>
> [5) Resources and Capabilities 2](#__RefHeading___Toc120336216)

[xi. *Appendices* 2](#__RefHeading___Toc120336217)

[3. Submission Dates and Times 2](#__RefHeading___Toc120336218)

[4. Intergovernmental Review 2](#Application_materials)

[5. Funding Restrictions 2](#__RefHeading___Toc120336220)

[6. Other Submission Requirements 2](#__RefHeading___Toc120336221)

[V. Application Review Information 2](#__RefHeading___Toc120336222)

[1. Review Criteria 2](#Review_ReviewCriteria)

[2. Review and Selection Process 2](#__RefHeading___Toc120336224)

[VI. Award Administration Information 2](#__RefHeading___Toc120336225)

[1. Award Notices 2](#__RefHeading___Toc120336226)

[2. Administrative and National Policy Requirements
2](#__RefHeading___Toc120336227)

[3. Reporting 2](#__RefHeading___Toc120336228)

[4. Performance Review 2](#__RefHeading___Toc120336232)

[VII. Agency Contacts 2](#__RefHeading___Toc120336233)

[VIII. Tips for Writing a Strong Application
2](#__RefHeading___Toc120336234)

[Attachment 1 2](#__RefHeading___Toc120336235)

[Part 1: Designated Performance Measure for Integrated Health and
Behavioral Health Care For Children, adolescents and their families
grant Program 2](#__RefHeading___Toc120336236)

[Part 2: Program Specific Forms for Integrated Health and Behavioral
Health Care for Children, Adolescents and their Families Grant Program:
Implementation 2](#__RefHeading___Toc120336239)

**ADDENDUM: Applying Through
Grants.Gov..............................................................................57**

[]{#__RefHeading___Toc120336182 .anchor}**Executive Summary**

The Health Resources and Services Administration/Maternal and Child
Health Bureau/Office of Adolescent Health is providing funds to support
the three-year implementation phase of the *Integrated Health and
Behavioral Health Care for Children, Adolescents and Their Families
Grant Program.* The ultimate goal of this initiative is to develop a set
of local integrated service delivery models that meet the unique needs
of different communities for providing comprehensive health care
services that integrate physical health and medical care, mental health
care, and substance abuse prevention and treatment services for
community-based populations of children, adolescents, and their
families. The first phase of this initiative supported two-year grants
to communities for planning and designing integrated services models
that meet their communities' unique needs. The second phase of this
initiative has three goals: 1) To support the implementation, or
operationalization, of effective and feasible model systems of quality
care for community-based populations of children, adolescents and their
families that meet their comprehensive needs by integrating physical
health and medical care, mental health care, and substance abuse
prevention and treatment services, and by encompassing the continuum of
preventive, intervention, treatment and maintenance services, including
transition assistance and other support services; 2) To position
grantees for on-going development of services integration and
sustainability of the services system beyond Federal funding; and 3) To
strengthen grantees' capacity to evaluate the effectiveness of their own
service systems and to measure their performance. The community-based,
integrated services models are expected to address the following issues:
organizational structure, governance and leadership; legal and
regulatory provisions; functioning in a managed care environment;
collaborative working relationships among health professionals from
diverse disciplines, including education, training, supervision and work
climate; clinical practices meeting accepted standards of patient care
and interventions being evidence-based; information systems and
protection of patient confidentiality; quality assessment and
improvement; relationships with community agencies; and fiscal
management and sustainability. This funding opportunity represents the
third cycle of the program's implementation phase.

-   Up to \$400,000 is available to support up to two implementation
    grants during project year one at \$200,000 per award. Subject to
    availability of funds, level funding is anticipated for the second
    and third project years.

```{=html}
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```
-   Eligibility: As cited in 42 CFR Part 51a.3(a), any public or private
    entity, including an Indian tribe or tribal organization (as those
    terms are defined at 25 U.S.C. 450b). Faith-based and community
    organizations are eligible to apply for this Federal funding
    opportunity.

-   Cost sharing does not apply to this grant competition.

    []{#__RefHeading___Toc120336183 .anchor}**I. Funding Opportunity
    Description**

    []{#__RefHeading___Toc120336184 .anchor}**1. [Purpose]{.underline}**

The Health Resources and Services Administration's Maternal and Child
Health Bureau announces the availability of funds to support the
**implementation phase** of the initiative*, Integrated Health and
Behavioral Health Care for Children, Adolescents and Their Families.*
Its three goals are to:

1)  Support the implementation**,** or operationalization, of effective
    and feasible model systems of quality care for community-based
    populations of children, adolescents and their families that meet
    their comprehensive needs by integrating physical health and medical
    care, mental health care, and substance abuse prevention and
    treatment services and by encompassing the continuum of preventive,
    intervention, treatment and maintenance services, including
    transition assistance and other support services;

2)  Position grantees for on-going development of services integration
    and sustainability of the services system beyond Federal funding;
    and

3)  Strengthen grantees' capacity to evaluate the effectiveness of their
    own service systems and to measure their performance.

The community-based, integrated services models are expected to address
the following issues: organizational structure, governance and
leadership; legal and regulatory provisions; functioning in a managed
care environment; collaborative working relationships among health
professionals from diverse disciplines, including education, training,
supervision and work climate; clinical practices meeting accepted
standards of patient care and interventions being evidence-based;
information systems and protection of patient confidentiality; quality
assessment and improvement; relationships with community agencies; and
fiscal management and sustainability. This funding opportunity
represents the third cycle of the program's implementation phase.

[]{#__RefHeading___Toc120336185 .anchor}**2. [Background]{.underline}**

[]{#__RefHeading___Toc120336186 .anchor}***i. Program Background***

It is estimated that twenty percent or 11 million children and
adolescents in the United States have a diagnosable behavioral health
problem. Important examples include mood disorders, anxiety disorders,
attention deficit disorders, conduct disorders and substance use
disorders. Almost 70 percent of these children and adolescents do not
receive the services necessary to address these problems. For the
children and adolescents who do receive behavioral health services, care
is often fragmented with minimal coordination of effort between the
primary care and specialty mental health providers involved in the
management of their problems. The rapid growth of managed care has had a
dramatic impact on the delivery of behavioral health care services;
primarily, it has "carved out" behavioral health services from general
health care, which has further compounded the problem of coordinated
access to primary health and behavioral health care services.

Primary health care practitioners can play a critical role in
identifying children and adolescents with behavioral problems and in
participating in the treatment of these youngsters, either by providing
treatment themselves, if appropriate, or co-managing treatment with
mental health or substance abuse prevention/treatment specialists and
collaborating with other relevant services in the community. Conversely,
behavioral health specialists can play an important role in the physical
health care of their patients by ensuring that they receive timely and
appropriate attention to their general health care and medical needs.
Patients with mental health problems need consistent care for their
non-psychiatric problems. In addition, some medical disorders, even in
children and adolescents, present as mental health problems. The
affiliated behaviors of many patients with mental disorders and
substance use problems heighten their risks for premature mortality and
morbidity from trauma and certain medical diseases.

An important contemporary approach to increasing children's and
adolescents' access to behavioral health services and to enhancing the
overall quality of their comprehensive health care is to integrate
mental health and substance abuse prevention and treatment services into
a primary care setting. In integrated systems of care, patients'
diagnoses are less likely to be dichotomized into biological and
psychosocial categories; there is recognition that many diagnoses are
simultaneously biological and psychological.

There are several cogent reasons to integrate services: 1) The large
majority of children and adolescents have access to and utilize primary
health care services. Patients with mental health and substance abuse
problems frequently manifest their emotional distress through both
biological and behavioral symptoms, and present to a primary care
setting for assistance rather than to a traditional mental health
setting. Patients with psychological responses to life cycle changes and
environmental stressors are also more likely to consult their primary
care clinician rather than a mental health professional. 2) Existing
mental health problems and dangerous environmental conditions, such as
chronic physical danger and violence, can be identified and addressed at
an earlier time, which may prevent more serious ramifications and major
trauma, both physical and psychological. 3) Primary care clinicians are
not able to provide appropriate care for the full range of psychological
and psychiatric problems and referral to isolated mental health
providers is frequently not successful. Either patients do not complete
the referral process or they feel stigmatized and abandoned by the
physical health care system, and are not able to establish a therapeutic
relationship with the mental health professional. Options for effective
treatment of mental disorders frequently include psychotropic
medications, which to be used most effectively and safely, frequently
demand an integrated approach to patient management. 4) The large
majority of patients with traditional psychiatric diagnoses are cared
for in out-patient settings. 5) Compared to traditional primary care and
mental health settings, integrated settings increase the satisfaction
levels of both clinicians and patients. 6) The costs of providing care
in integrated settings are well controlled; they are no more expensive
than the costs of traditional care and frequently are less costly.

At this time, however, relatively few models of integrated services
exist. The purpose of the first phase of this initiative was to
stimulate planning for the development of different models of service
systems that integrate physical and medical care services with mental
health care and substance abuse prevention and treatment services, and
are congruent with the community-based needs of a population of children
and adolescents and their families/caregivers. The purpose of the second
phase of this initiative is to implement or operationalize the models of
service integration that were established during a two-year planning
process by existing grantees of the program, *Integrated Health and
Behavioral Health Care for Children, Adolescents and Their Families.*

[]{#__RefHeading___Toc120336187 .anchor}***ii. Summary of Planning Phase
of Initiative***

Previously awarded planning grants provided start-up support (up to
\$100,000 per grantee over the two-year period) for grantees to initiate
and formalize working relationships among public and private community
organizations/agencies/programs and/or state agencies and key
stakeholders to establish a blueprint for the integration of primary
health care and behavioral health services for children, adolescents and
their families in a targeted area with a total population of 100,000 to
250,000 (including an estimated minimal population of children and
adolescents of 25,000). The combined services were to include physical
health and medical care; promotion of mental health and wellness; mental
health diagnostic and treatment services; substance abuse prevention,
diagnostic and treatment services; and related support and ancillary
services (e.g., case coordination; transportation; linkages to
educational, family support, community-based youth programming, and
housing/training/employment assistance). As part of planning efforts,
grantees were required to consider a continuum of care model with regard
to services delivery. That is, applicants were asked to consider the
following service components in their planning efforts: prevention
(promotion of mental wellness), identification, early intervention,
assessment, referral, treatment (allowing for out-patient, in-patient
and residential) and follow-up/ maintenance/on-going care for physical
health, medical, mental health and substance abuse problems. The
planning process was intended to support the development of local
integrated service delivery models that generate outcomes selected by
the applicant for its own targeted, community-based population. The
strategic planning process included methods for securing financial
sustainability of the integrated service model project through local and
state, and public and private support. It was the intent of this
initiative, given the availability of Federal funding resources at the
end of the 2-year planning grant cycle, to position the funded
communities for service system implementation and on-going development
of integration efforts.

The Maternal and Child Health Bureau has supported the initiative,
*Integrating Health and Behavioral Health Care for Children, Adolescents
and Their Families* since 2000, when it awarded eight 2-year planning
grants. A second cohort of planning grants was awarded the following
year, 2001. Each cohort of planning grants was given the opportunity to
apply for 3-year implementation grants. The two parallel cohorts of
implementation grants started in 2002 and 2003; a total of 4
implementation awards have been made, two for each cohort. A third
cohort of eight 2-year planning grants started in 2004 and the current
funding opportunity relates to the implementation phase of this cohort.

[]{#__RefHeading___Toc120336188 .anchor}***iii. Overview of the Maternal
and Child Health Bureau's Mission***

The Maternal and Child Health Bureau (MCHB) responds to matters
affecting the health and well-being of infants, children, adolescents,
mothers and families. The Bureau provides national leadership by working
with States, communities, public-private partners and families to
strengthen the maternal and child health (MCH) infrastructure, assure
the availability and use of medical homes and build knowledge and human
resources required to strengthen and maintain the health, safety and
well-being of the Nation's MCH population. The MCH population consists
of all pregnant women, infants, children, adolescents and their
families, including women of reproductive age, fathers, and children
with special health care needs (CSHCN).

MCH issues of concern include, but are not limited to: Services for
low-income and minority women, children and adolescents; immunizations;
health and safety in child care and foster care; emergency medical
services for children; violence and injury prevention; school health;
environmental health including lead poisoning prevention; adolescent
health, including mental health and suicide prevention; traumatic brain
injury; family health; and a variety of regional and/or national
projects.

All MCHB-supported services or projects have as their goals the
development of: 1) more effective ways to coordinate and deliver new and
existing systems of care; 2) leadership for maternal and child health
programs throughout the United States; 3) innovative outreach techniques
to identify and deliver appropriate care and preventive education to
populations at-risk for disparate health outcomes; 4) a body of
knowledge that can be utilized by any part of the MCH community; and 5)
significant and fundamental improvement in the health and well-being of
our Nation's families and their children.

The MCHB relies heavily on effective communication and interactive
relationships with key organizations to: Support health and
health-related programs and services; encourage efficient use of
resources; strengthen and enhance research to broaden the knowledge base
for MCH programs; train individuals within the various health
professions to provide leadership in the provision of comprehensive
health care to mothers, children and adolescents; and enhance the skills
of State and local MCH personnel.

[]{#__RefHeading___Toc120336189 .anchor}**II. Award Information**

[]{#__RefHeading___Toc120336190 .anchor}**1. Type of Award**

####### The *Integrated Health and Behavioral Health Care for Children, Adolescents and their Families: Implementation Program* uses a grant award funding mechanism. 

[]{#__RefHeading___Toc120336191 .anchor}**2. Summary of Funding**

The project period for the *Integrated Health and Behavioral Health Care
for Children, Adolescents and their Families: Implementation (IHBHC)
Program* is three years and begins on **July 1, 2006**. The *IHBHC
Program* is offered by the Health Resources and Services
Administration's Maternal and Child Health Bureau. Up to \$400,000 is
expected to be available to support two (2) grant awards during project
year one; the award size is expected to be up to \$200,000 per year for
each project year. Subject to availability of funds and satisfactory
grantee performance, level funding is anticipated for the second and
third project years.

[]{#__RefHeading___Toc120336192 .anchor}**III. Eligibility Information**

[]{#Eligibility_who .anchor}

**1. Eligible Applicants**

[]{.mark}

***SPRANS Grants***: As cited in 42 CFR Part 51a.3 (a), any public or
private entity, including an Indian tribe or tribal organization (as
those terms are defined at 25 U.S.C. 450b). Faith-based and community
organizations are eligible to apply for this Federal funding
opportunity.

As announced in the FY *2006* *HRSA Preview*, eligibility is limited to
grantees completing their second planning year (project year 2005-06) as
awarded under HRSA Announcement Number HRSA-04-059, *Integrated Health
and Behavioral Health Care for Children, Adolescents and Their Families:
Planning Program.*

[]{#__RefHeading___Toc120336194 .anchor}**2. Cost Sharing/Matching**

Not applicable.

[]{#__RefHeading___Toc120336195 .anchor}**3. Other**

[]{#__RefHeading___Toc120336196 .anchor}***i. Maintenance of Effort***

Grant funds shall not be used to take the place of current funding for
activities described in the application. Non-Federal funding should be
used to maintain existing activities relevant to the grant at a level
that is not less than expenditures for such activities during the fiscal
year prior to receiving the grant.

[]{#__RefHeading___Toc120336197 .anchor}***ii. Other Limitations***

Applications requesting more than \$200,000 per year will not be
considered for funding.

[]{#__RefHeading___Toc120336198 .anchor}**IV. Application and Submission
Information**

[]{#__RefHeading___Toc120336199 .anchor}**1. Address to Request
Application Package**

**[Application Materials]{.underline}**

Applicants must submit proposals using Public Health Service (PHS)
Application Form PHS-5161-1. This form contains additional general
information and instructions for grant applications, proposal
narratives, and budgets. This form may be obtained by:

> []{.mark}

(1) Downloading it from <http://www.hrsa.gov/grants/forms.htm>

> **or**

(2) Contacting the HRSA Grants Application Center at:

> The Legin Group, Inc.
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123
>
> E-mail: <HRSAGAC@hrsa.gov>
>
> []{.mark}

Instructions for preparing portions of the application that must
accompany Application Form 5161-1 appear in the "Application Format"
section below.

[]{#__RefHeading___Toc120336200 .anchor}**2. Content and Form of
Application Submission**

**[Application Format Requirements]{.underline}**

> The total size of all uploaded files **may not exceed the equivalent
> of 80 pages when printed by HRSA, approximately 10 MB.** **This
> 80-page limit includes the abstract, project and budget narratives,
> attachments, appendices and letters of commitment and support.**
> Standard forms are NOT included in the page limit. Pages must be
> numbered consecutively.
>
> **Applications that exceed the specified limits (approximately 10 MB,
> or that exceed 80 pages when printed by HRSA) will be deemed
> non-compliant. All non-compliant applications will be returned to the
> applicant without further consideration.**

a.  Type of Submission

> HRSA, in providing the grant community a single site to Find and Apply
> for grant funding opportunities, is ***requiring*** applicants for
> this funding opportunity to apply electronically through Grants.gov.
> By using Grants.gov you will be able to download a copy of the
> application package, complete it off-line, and then upload and submit
> the application via the Grants.gov site. You may not e-mail an
> electronic copy of a grant application to us.
>
> **NOTE:** All applicants ***must*** submit in this manner unless the
> applicant is granted a written exemption from this requirement in
> advance by the Director of HRSA's Division of Grants Policy. Grantees
> must request an exemption in writing from <DGPClearances@hrsa.gov>,
> and provide details as to why they are technologically unable to
> submit electronically though the Grants.gov portal. Make sure you
> specify the announcement number you are seeking relief for. As
> indicated in this guidance, HRSA and its Grants Application Center
> (GAC) will only accept paper applications from applicants that
> received prior written approval.

b.  Font:

> Please use an easily readable serif typeface, such as Times Roman,
> Courier, or CG Times. The text and table portions of the application
> must be submitted in not less than 12-point and 1.0 line spacing.
> Applications not adhering to font and line spacing requirements may be
> returned.
>
> []{.mark}

c.  Paper Size and Margins:

> For duplication and scanning purposes, please ensure that the
> application can be printed on 8 ½" x 11" white paper. Margins must be
> at least one (1) inch at the top, bottom, and left and right sides of
> the paper. Please left-align text.

[]{.mark}

d.  Numbering:

> Please number the pages of the application sequentially from page 1
> (Application Face Page) to the end of the application, including
> charts, figures, tables, appendices, and attachments.

e.  Applicant Organization Name:

> Please include the name of the applicant organization on each page.

f.  Section Headings:

> Please put all section headings flush left in **bold** type.

**[Application Format]{.underline}**

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

[]{#__RefHeading___Toc120336201 .anchor}**i**. ***Application Face
Page***

> Public Health Service (PHS) Application Form 5161-1 is provided with
> the application package. Prepare this page according to instructions
> provided in the form itself. For information pertaining to the Catalog
> of Federal Domestic Assistance, the Catalog of Federal Domestic
> Assistance Number is 93.110.
>
> **DUNS Number**
>
> All applicant organizations are required to have a Data Universal
> Numbering System (DUNS) number in order to apply for a grant from the
> Federal Government. The DUNS number is a unique nine-character
> identification number provided by the commercial company, Dun and
> Bradstreet. There is no charge to obtain a DUNS number. Information
> about obtaining a DUNS number can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm )
> or call 1-866-705-5711. Please include the DUNS number next to the OMB
> Approval Number on the application face page. Applications ***will
> not*** be reviewed without a DUNS number.
>
> Additionally, the applicant organization is will be required to
> register with the Federal Government's Central Contractor Registry
> (CCR) in order to do electronic business with the Federal Government.
> Information about registering with the CCR can be found at
> [http://www.hrsa.gov/grants/preview/dunsccr.htm](http://www.hrsa.gov/grants/preview/dunsccr.htm ).

[]{#__RefHeading___Toc120336202 .anchor}**ii.*. Table of Contents***

> Provide a Table of Contents for the remainder of the application
> (including appendices). It should list page numbers, and include both
> main headings and subheadings.

[]{#__RefHeading___Toc120336203 .anchor}**iii. *Application Checklist
***

> The Application Checklist is contained in PHS Grant Application Form
> PHS-5161-1, which is provided with the application package.

[]{#__RefHeading___Toc120336204 .anchor}**iv.** ***Budget***

> Budget Forms and Instructions are contained in PHS Grant Application
> Form PHS-5161-1. Please complete Sections A through F of Standard Form
> 424A (which is part of PHS Application Form PHS-5161-1), and provide a
> line item budget for **each** grant year using the Object Class
> Categories listed in Section B, Item 6 of SF-424A.

[]{#__RefHeading___Toc120336205 .anchor}**v. *Budget Justification***

> Provide a narrative that explains the amounts requested for each line
> in the budget. The budget justification should specifically describe
> how each item will support the achievement of proposed objectives. The
> budget period is for ONE year. However, the applicant must submit
> one-year budgets for **each subsequent** project year (there are two
> \[2\] additional project or budget years for the *Integrated Health
> and Behavioral Health Care for Children, Adolescents and their
> Families: Implementation Program*) at the time of application. That
> is, the applicant should submit a budget request for each of the three
> project years.
>
> Line item information must be provided to explain the costs entered
> for each Object Class Category listed in Section B of Standard Form
> 424A (titled "Budget Information -- Non-Construction Programs" and
> contained in Application Form PHS-5161-1). The budget justification
> must clearly describe each cost element and explain how each cost
> contributes to meeting the project's objectives/goals. Be very careful
> about showing how each item in the "other" category is justified. The
> budget justification **MUST** be concise. Do **NOT** use the
> justification to expand the project narrative.
>
> []{.mark}
>
> [***Budget for Multi-Year Grant Awar***d]{.underline}
>
> This announcement is inviting applications for project periods up to
> three (3) years. Initial awards, which are made on a competitive
> basis, will be for a one‑year budget period. Applications for
> continuation awards beyond the one-year budget period but within the
> three-year project period (that is, for the second and third years)
> will be entertained on a noncompetitive basis, but are subject to
> availability of funds, satisfactory progress of the grantee, and a
> determination that continued funding would be in the best interest of
> the Federal Government.

**Include the following items in the Budget Justification narrative:**

> [Personnel Costs]{.underline}: Personnel costs should be explained by
> listing each staff member who will be supported from funds, name (if
> identified), position title, percent full time equivalency, annual
> salary, and the exact amount requested for each project year that is
> part of the indirect costs (see next item).
>
> [Indirect Costs]{.underline}: Indirect costs are those costs incurred
> for common or joint objectives that cannot be readily identified but
> are necessary to the operations of the organization (for example, the
> cost of operating and maintaining facilities, depreciation, and
> administrative salaries). For institutions subject to OMB Circular
> A-21, the term "facilities and administration" is used to denote
> indirect costs. If an organization applying for an assistance award
> does not have an indirect cost rate, the applicant may wish to obtain
> one through HHS's Division of Cost Allocation (DCA). Visit DCA's
> website at: http://rates.psc.gov/ to learn more about rate agreements,
> the process for applying for them, and the regional offices which
> negotiate them.
>
> [Fringe Benefits]{.underline}: List the components that compose the
> fringe benefit rate (for example, health insurance, taxes,
> unemployment insurance, life insurance, retirement plan, tuition
> reimbursement). The fringe benefits should be directly proportional to
> that portion of personnel costs that are allocated for the project.
>
> [Travel]{.underline}: List travel costs according to local and long
> distance travel. For local travel, the mileage rate, number of miles,
> reason for travel and staff members/consumers completing the travel
> should be outlined. The budget should also reflect the travel expenses
> associated with proposed participation in meetings, trainings and
> workshops. Each applicant should include funds in the proposed budget
> for the project director and other key project staff to make at least
> two trips annually to the Washington, D.C. area in order to confer
> with HRSA/MCHB/ DCAFH/OAH program staff and participate in working
> meetings of relevant MCHB grantees. Each meeting is estimated to last
> for two days.
>
> [Equipment]{.underline}: List equipment costs and provide
> justification for the need of the equipment to carry out the program's
> goals. Extensive justification and a detailed status of current
> equipment must be provided when requesting funds for the purchase of
> computers and furniture items.
>
> [Supplies:]{.underline} List the items that the project will use under
> the following three categories, as applicable: [Office
> supplies]{.underline}, [medical supplies]{.underline} and [educational
> supplies]{.underline}. Office supplies include paper, pencils, and the
> like; examples of medical supplies are syringes, blood tubes, plastic
> gloves, etc.; and educational supplies include such items as pamphlets
> and educational videotapes. Remember, supplies must be listed using
> these three categories.
>
> [Subcontracts]{.underline}: To the extent possible, all subcontract
> budgets and justifications should be standardized, and contract
> budgets should be presented using the same object class categories
> contained in Section B of Standard Form 424A. Provide a clear
> explanation of each contract's purpose, how the costs were estimated,
> and the specific contract deliverables.
>
> [Other]{.underline}: Place all costs that do not fit into any other
> category into this category and provide an explanation of each cost.
> In some cases, grantee rent, utilities and insurance fall under this
> category if they are not included as part of an approved indirect cost
> rate. Each grantee is expected to contribute \$7,500 during each of
> Project Years II and III (total of \$15,000 per grantee) to a pool
> administered by the grantees for joint dissemination of information
> about project outcomes and the initiative.

[]{#__RefHeading___Toc120336206 .anchor}**vi. *Staffing Plan and
Personnel Requirements***

> Applicants must present a staffing plan and provide a justification
> for the plan that includes education and experience qualifications and
> rationale for the amount of time being requested for each staff
> position. Position descriptions that include the roles,
> responsibilities, and qualifications of proposed project staff must be
> included in Appendix B (see **Section IV.2.xii**). Two-page
> biographical sketches for any key employed personnel that will be
> assigned to work on the proposed project must be included in Appendix
> C (see **Section IV.2.x.5**, Applicant Resources and Capabilities and
> **Section IV.2.xii** for additional information).

[]{#__RefHeading___Toc120336207 .anchor}**vii. *Assurances***

Assurances for Non-Construction Programs (Standard Form 424B) are
contained in Grant Application Form PHS-5161-1. Please complete these
forms and include them in your application package.

[]{#__RefHeading___Toc120336208 .anchor}**viii*. Certifications***

Certifications are contained in Grant Application Form PHS-5161-1 (see
pages 17 -- 19). Please complete these forms and include them in your
application package.

[]{#__RefHeading___Toc120336209 .anchor}**ix. *Project Abstract***

> The project abstract provides a summary of the application. It must be
> single-spaced and limited to one page in length. Because the project
> abstract is often used to provide information to the public and
> Congress, please ensure that it is clear, accurate, concise, and does
> not refer to other parts of the application. The project abstract
> should include a brief description of the proposed grant project
> including the needs to be addressed, the proposed services, and the
> population group(s) to be served. See **Attachment 4, Form 6** for
> complete instructions on developing the project abstract. Please place
> the following information at the top of the project abstract:
>
> Project Title: List the appropriate shortened title for the project.
>
> Project Number: This is the number assigned to the project when
> funded.
>
> Project Director: The name and degree(s) of the project director as
> listed on the
>
> grant application.
>
> Contact Person: The person who should be contacted by those seeking
> information about your project.
>
> Grantee: The organization which receives the grant.
>
> Address: The complete mailing address.
>
> Phone Number: Include area code, phone number, and extension if
> necessary.
>
> Fax Number: Include the fax number.
>
> E-mail address: Include electronic mail address
>
> Website Address: If applicable, include the address for the project's
> World Wide Web site on the Internet.
>
> Project Period: Include the entire funding period for the project, not
> just the one-year budget period.

**Use the following headings to format the project abstract:**

> PROBLEM: Briefly (maximum of 50 words) state the principal health
> problems, status, or issues that are addressed by your project.
>
> GOALS AND OBJECTIVES: Identify up to five (5) goals and time-framed
> objectives per goal for the project.
>
> ACTIVITIES UNDERTAKEN TO MEET PROJECT GOALS: List and describe the
> activities used to attain the goals and objectives, and comment on
> innovation, cost, and other characteristics of the methodology.
>
> COORDINATION: List the State agencies and other organizations involved
> in the project and their roles.
>
> EVALUATION: Briefly describe the methods that will be used to
> determine whether process and outcome objectives are met.

[]{#__RefHeading___Toc120336210 .anchor}**x. *Program Narrative***

> The project narrative provides a comprehensive framework and
> description of all aspects of the program. It should be succinct,
> self-explanatory and well-organized so that reviewers can understand
> the proposed project. The project narrative is restricted to [25
> single-spaced pages]{.underline}, font size 12-point. Applications
> exceeding the 25-page limit will be returned to the applicant [WITHOUT
> REVIEW]{.underline}. All substantive information responding to the
> Program Criteria, which will be used by the Independent Review Panel
> to evaluate each application, must be contained within the project
> narrative.
>
> Appendices are not included in the 25-page limit of the project
> narrative but should be used only to provide supporting documentation,
> for example, organizational charts, timelines, position descriptions,
> 2-page curriculum vitae/biographical sketches of projected staff and
> letters of commitment from participating agencies (see **Section
> IV.2.xii**). As you plan your appendices, remember that the
> [total]{.underline} page limit of the application, including the
> project narrative, the budget and the abstract, and the appendices,
> etc., is 80 pages when printed by HRSA, or approximately 10 MB.
>
> Instructions for preparing each major section of the project narrative
> are outlined below. Follow them carefully, as they form the basis for
> addressing the Review Criteria (see **Section V.1**), which the
> Independent Review Committee will be instructed to use for its
> evaluation and rating of applications submitted to the initiative,
> *Integrated Health and Behavioral Health Care for Children,
> Adolescents and their Families: Implementation Program.* Applicants
> are strongly encouraged to organize their project narratives by these
> five (5) major headings, each of which is explained below. In
> addition, the Independent Review Committee will be instructed to
> evaluate the proposed Budget and Budget Justification (see **Sections
> IV.2.iv -- v**) as Review Criterion 6) Support Requested.
>
> 1\) Need: Understanding of, and Planning Progress for, an Integrated
> Health and Behavioral Health Services System for a Community-based
> Population of Children, Adolescents and Their Families
>
> 2a) Response: Project Goals and Objectives
>
> 2b) Response: Strategies and Methods for Attaining Project Goals and
> Objectives
>
> 3\) Evaluative Measures
>
> 4\) Impact
>
> 5\) Resources and Capabilities

[]{#__RefHeading___Toc120336211 .anchor}**1) [Need: Understanding of,
and Planning Process for, an Integrated Health and Behavioral Health
Services System for a Community-based Population of Children,
Adolescents and Their Families]{.underline}**

> *This section of the Project Narrative serves as an introduction to
> the applicant's proposal and discusses issues key to the Program. It
> should help the reviewers understand such key issues as: The
> conceptual factors important to the development of a model integrated
> services program; the health services needs of the targeted
> community-based population of children, adolescents and their
> families; and the process and outcomes of the applicant's planning
> efforts, including documenting readiness to implement the model
> developed during the planning process. This section should include any
> challenges and barriers that the project seeks to overcome.*

**[INSTRUCTIONS]{.underline}**

> a\) The applicant should demonstrate understanding of the conceptual
> issues important to the development of a model program integrating
> physical health and medical care, mental health care, and substance
> abuse prevention and treatment services for children, adolescents and
> their families.
>
> b\) The applicant should describe and summarize key issues pertinent
> to: (a) the community-based population that its proposed project plans
> to serve, including, for example, such items as its demography and
> cultural beliefs relevant to health, mental health and use of
> services; its community and geographic contexts; the current
> organization of the health care, mental health care, and substance
> abuse prevention and treatment services accessible to it; community
> levels of indicator health, social and environmental problems; and any
> historical events that have affected its physical and/or mental health
> status; (b) staff working in the applicant and co-applicant
> organizations who would be connected with, or affected by, project
> components and activities; (c) stakeholder organizations allied with
> the project. This broad, multi-dimensional description should include
> information that was gathered as part of the planning process and
> should contribute to the rationale for the design of the proposed
> model program.
>
> c\) The applicant should summarize the process of its efforts to plan
> a model program for the integration of physical health and medical
> care, mental health care, and substance abuse prevention and treatment
> services for a population of children, adolescents and their families.
> The applicant should include, but not be limited by, the following in
> its summary:

1\) Brief descriptions of the applicant organization and its
co-sponsoring organizations, including, for example, such items as their
existing relationships with each other and existing relationships with
the communities they serve; their staffing; their involvement with
health plans; the organization of their in-service programs and
interactions with pre-service health professions students and trainees;

2\) A list of the key players and stakeholders involved in the planning
process, and a rationale for why this set is involved in the planning
process;

3\) How needs were assessed of (i) the target population of children,
adolescents and their families; (ii) of the staff working in the
applicant and co-applicant organizations who would be connected with, or
affected by, project components and activities; and (iii) the
stakeholder organizations allied with the project;

> 4\) The methodology of the planning process: how it was organized and
> what staff were responsible for leading it.
>
> 5\) A summary of the resource strategy for attaining financial
> sustainability of the integrated services system after the federal
> funding period.
>
> d\) The Federal application guidance for the planning effort listed 14
> components of a program integrating health and behavioral health care,
> which are outlined below. The applicant should provide a brief summary
> of how its planning process addressed each component and describe what
> issues required resolution as part of preparing for implementation of
> the model. The applicant should describe what progress it has made in
> planning for each component, and address what issues are outstanding
> for each of these components and how it plans to deal with them during
> the implementation phase.

1.  Governance and executive leadership

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1.  Blending of organizational structures and staff; how staff will be
    configured

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1.  Operations and management of services

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1.  Use of facilities and equipment, and materials and supplies

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1.  Financing and allocation of resources; blending of funds and
    resources; fiscal management; fiscal sustainability

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1.  Legal and regulatory issues

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1.  Functioning in a managed care environment, including coping with
    "carve outs" for mental health and substance abuse prevention and
    treatment services

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1.  Involvement of, and interactions among, diverse disciplines,
    including organizational culture and work climate

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1.  Education, training and supervision of clinicians, administrators
    and support staff, as well as the needs of health professions
    students and trainees

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1.  Information systems and medical record keeping; confidentiality of
    patient information, including confidentiality of care for minors as
    appropriate

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1.  Quality assessment and strategies for improvement; ensuring that
    clinical practices meet high standards of care and appropriate
    professional guidelines, and that mental health and substance abuse
    prevention and treatment interventions are evidence-based

2.  Performance measurement; evaluation and monitoring

3.  Relationships and liaison with the community, including other
    organizations that serve children, adolescents and their families,
    as well as families themselves; cooperative activities with other
    organizations

4.  Ongoing strategic planning for sustainability, for future growth and
    development, and for ability to respond to future needs.

> e\) The applicant should analyze the process of its planning effort
> and provide evidence of its readiness for implementation of its model.
> The following questions represent examples of issues that the
> applicant should address. Overall, what were the successes and
> limitations of the planning effort? How successfully were working
> relationships sustained among the applicant and co-sponsoring
> organizations? What strategies did the project use to address and
> resolve communications difficulties? How were tensions and conflicts
> addressed? How did the planning effort deal with barriers and solve
> problems? To what extent did the planning group develop and function
> as a team, including key stakeholders? What attrition occurred among
> members of the planning group, and why did it occur? What problems and
> challenges remain? How does the project plan to address them during
> the implementation phase?

[]{#__RefHeading___Toc120336212 .anchor}**2a) [Response: Goals and
Objectives]{.underline}**

*This section of the project narrative outlines the project's goals and
objectives.*

**[INSTRUCTIONS]{.underline}**

a)  The applicant should state the goals for the proposed project. The
    project goals should be congruent with and address the comprehensive
    intent of the *Integrated Health and Behavioral Health Care for
    Children, Adolescents and Their Families Grant Program:
    Implementation (IHBHC)*, and address the three goals of the
    initiative, as described in **Section I.1.**, Funding Opportunity
    Description, Purpose.

b)  The applicant should provide at least one measurable, time-framed
    outcome objective for each proposed project goal. Outcome objectives
    are specific statements of positive changes to be effected in order
    to achieve the goals of the project. That is, outcome objectives are
    measurable steps for reaching goals. Each objective should be stated
    in measurable terms and should include a specific time frame for
    achievement. Collectively, the proposed outcome objectives should
    frame the set of outcomes that the applicant wants to achieve in
    meeting project goals and in contributing to the *IHBHC Program's*
    intent.

    []{#__RefHeading___Toc120336213 .anchor}**2b) [Response: Strategies
    and Methods for Attaining Project Goals and
    Objectives]{.underline}**

> *This section of the project narrative presents the project's Methods,
> describes its Work Plan, and discusses challenges that are likely to
> be encountered in designing and implementing the proposed activities.*

**[INSTRUCTIONS]{.underline}**

Instructions for this section are divided into three sub-sections:
Description of Methods, Work Plan, and Resolution of Challenges.

[DESCRIPTION OF METHODS]{.underline}

a)  The applicant should describe its intended methodology for
    implementing its model project for integrating health and behavioral
    health care for a community-based population of children,
    adolescents and their families. The estimated minimal population of
    children and adolescents potentially served by the applicant
    organizations should be approximately 25,000. (Based on the design
    of their models, rural applicants may have somewhat smaller
    populations.) Specifically, the applicant should describe proposed
    approaches and activities for achieving project goals and
    objectives. Who will conduct each activity, when, where and how,
    must be explicitly described. Sufficient detail should be included
    so that a reader who is not personally familiar with the applicant's
    community or work done as part of the planning effort will be able
    to understand the proposed methodology clearly and without question.
    The approaches and activities should be logically linked so that
    they form a cohesive whole.

b)  The applicant should ensure that the proposed approaches and
    activities are responsive to the needs of the population that it
    intends to serve and are feasible in the context of the applicant's
    community, including its geographic features, health care
    environment, and the cultural values, beliefs and practices of the
    community's population relevant to health and mental health care.
    The approaches may need to be simultaneously creative and practical.
    Evidence should be provided that the approaches can reasonably be
    expected to be effective. Literature relevant to the methodology may
    be cited as appropriate.

c)  The applicant should ensure that its methodology addresses and
    incorporates the following fourteen components of an integrated
    model for the health and behavioral health care of children,
    adolescents and their families. As indicated, some components may be
    appropriately addressed in other sections of the narrative, but it
    is recommended that the applicant point out such placements.

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5.  Governance and executive leadership. *(May be addressed in
    Sub-section 5, Resources and Capabilities);*

6.  Blending of organizational structures and staff; how staff will be
    configured. *(May be addressed in Sub-section 5, Resources and
    Capabilities).*

7.  Operations and management of services. *(May be addressed in
    Sub-section 5, Resources and Capabilities);*

8.  Use of facilities and equipment, and materials and supplies. *(May
    be addressed in Sub-section 5, Resources and Capabilities);*

9.  Financing and allocation of resources; blending of funds and
    resources; fiscal management; fiscal sustainability *(Instructions
    for the applicant's budget request are contained in Sections IV.2.iv
    -- v. However, the applicant also needs to address the listed fiscal
    issues;)*

10. Legal and regulatory issues;

11. Functioning in a managed care environment, including coping with
    "carve-outs" for mental health and substance abuse prevention and
    treatment services;

12. Involvement of and interactions among diverse disciplines, including
    organizational culture and work climate;

13. Education, training and supervision of clinicians, administrators
    and support staff, as well as needs of health professions students
    and trainees;

14. Information systems and medical record keeping; confidentiality of
    patient information, including confidentiality of care for minors as
    appropriate;

15. Quality assessment and strategies for improvement. (*May be
    addressed in Sub-section 3, Evaluative Measures);*

16. Performance measurement; evaluation and monitoring. *(May be
    addressed in Sub-section 3, Evaluative Measures);*

17. Relationships and liaison with the community, including other
    organizations that serve children, adolescents and their families as
    well as families themselves; cooperative activities with other
    organizations; and

18. On-going strategic planning for sustainability, for future growth
    and development, and for ability to respond to future needs.

> d\) The applicant needs to address how its implementation project will
> include and make special allowances for the comprehensive needs of at
> least one vulnerable sub-population of children and adolescents that
> are not otherwise satisfactorily addressed by the community (e.g.,
> immigrant and refugee families; children and adolescents under the
> supervision of the juvenile court or in the foster care system;
> children and adolescents with special health care needs; children and
> adolescents who do not attend school on a regular basis or who have
> dropped out of school; families who are homeless; children and
> adolescents who are homeless or in other high risk situations).
>
> e\) The applicant needs to incorporate the framework of *Bright
> Futures for Infants, Children and Adolescents* (see **Section VI.2**)
> into its approach, and to utilize its materials as part of the
> education and training of project staff and health professions
> students and trainees as well as in the building of relationships with
> families and the community.
>
> f\) The applicant should describe how its proposed project will strive
> for cultural competence in addressing the needs of the population it
> serves. The applicant should address how cultural competence will be
> addressed at the levels of project governance, project management, and
> clinical service. (Helpful information published by the U.S. DHHS is
> available from: (1) SAMHSA/CMHS's Knowledge Exchange Network at:
> [http://www.mentalhealth.org/publications/allpubs/CA-0015/default.asp]{.underline},
> and (2) *Mental Health: Culture, Race and Ethnicity. A Supplement to
> Mental Health: A Report of the Surgeon General* (2001), at:
> [[http://www.surgeongeneral.gov/library/mentalhealth/cre.)]{.underline}](http://www.surgeongeneral.gov/library/mentalhealth/cre.))
>
> [WORK PLAN]{.underline}
>
> g\) The applicant should include a Work Plan that describes the
> sequence of activities and steps that will be used to carry out each
> proposed methodological approach. The "who, what, when, where, and
> how" of each approach to be utilized must be explicitly described.
>
> h\) A detailed [timeline]{.underline} of proposed project activities
> should be developed by the applicant, and attached as Appendix A (see
> **Section IV.2.xii**). The timeline should link activities to project
> objectives and should cover the three (3) years of the project period.
>
> i\) The applicant should describe a plan for managing the project,
> including its personnel and resources.

####### [Resolution of Challenges]{.underline}

> j\) The applicant should discuss challenges, including both
> opportunities and barriers, that are likely to be encountered in
> designing and implementing the activities described in the Description
> of Methods and Work Plan sections, as well as approaches that will be
> used to address such challenges.

[]{#__RefHeading___Toc120336214 .anchor}**3) [Evaluative
Measures]{.underline}**

*Evaluation and self-assessment are critically important for quality
improvement and assessing the value-added contribution of Title V
Maternal and Child Health investments. Consequently, each discretionary
grant project is expected to incorporate a carefully designed and
well-planned evaluation protocol capable of demonstrating and
documenting measurable progress toward reaching the project's stated
goals through achievement of the project's measurable objectives. The
evaluation protocol should be based on a clear rationale relating the
identified needs of the target population with project goals, grant
activities, and the evaluation measures. Wherever possible, the
measurements of progress toward goals should focus on outcomes and
results over which the project has some degree of influence, rather than
on intermediate measures such as process or outputs. Applicants are
encouraged to incorporate the expertise of a professional evaluation
specialist (either on-staff or as a consultant) at the design stage of
the project methodology. Grantees must comply with the regulations for
the protection of human subjects at 45 CFR part 46 as applicable.*

*[NATIONAL PROGRAM EVALUATION]{.underline}*

*The Maternal and Child Health Bureau/Health Resources and Services
Administration conducted an external national evaluation of the program,
Integrated Health and Behavioral Health Services for Children,
Adolescents and Their Families based on the activities of the first two
cohorts of implementation grantees. (Each original grantee also
conducted its own internal evaluation.) It is expected that the internal
evaluation activities of the current grantee cohort will add to the
findings of the national evaluation. Grantees must agree to use a common
core variable set for evaluation of their projects. Achieving consensus
will take place in the early post-award period.*

**[INSTRUCTIONS]{.underline}**

> a\) The applicant should describe how the project will track whether
> proposed activities are being completed in accordance with the time
> frames established in the project application. This description should
> include a plan for collecting, organizing, and analyzing data related
> to the number and kinds of activities and services provided and should
> specify how data will be used to make project management decisions.
>
> b\) The applicant should present what categories of data it plans to
> track, including data relevant to: patients/clients and the services
> provided to them; staff education/training; relationships with, as
> well as referrals from and to, community organizations and agencies;
> and costs.
>
> c\) The plan should address quality assessment and improvement, and
> discuss how quality of services (for example, access, timeliness of
> care, continuity of care, referral completion, percentage of patients
> lost to follow-up/"falling between the cracks," patient and family
> satisfaction, provider adherence to best practices and use of
> evidence-based interventions, percentage of patients managed using a
> team approach, provider satisfaction) will be monitored; how decisions
> will be made regarding what aspects should be monitored; how findings
> will be communicated to, and used by, staff in order to improve such
> issues as the quality of services provided, staff performance, project
> relationships with its stakeholders, and the work environment.
>
> d\) The monitoring plan should address the cost effectiveness of the
> project model and its key components.

e\) The applicant should describe how it will use an electronic
management information system to track data relevant to the project.

> f\) In designing the outcome evaluation, the applicant should consider
> the effectiveness of the various components of its integrated model of
> services as well as its level of functioning and its effects on
> patients and clients, staff, other key stakeholders, including allied
> community organizations and agencies. Examples of evaluation measures
> that might be considered include, but are not limited to: Access to
> services, appropriate utilization of services (versus over- or
> under-utilization), rate of emergency department use, change in
> service capacity, cost offsets, patient, community and staff
> satisfaction, providers' levels of self-efficacy, level of clinical
> problem identification, accuracy and thoroughness of diagnosis, and
> financial stability.
>
> g\) The applicant must assure that if funded, the status and [ongoing
> results]{.underline} of all project monitoring and evaluation
> activities will be described in annual progress reports.
>
> h\) The applicant must assure that it will collaborate in developing a
> common core set of variables and measurements for monitoring and
> evaluating its project.

[]{#__RefHeading___Toc120336215 .anchor}**4) [Impact]{.underline}**

*This section of the narrative addresses* *the extent and effectiveness
of plans for dissemination of project results, the degree to which the
project activities are replicable, and the sustainability of the project
beyond federal funding.*

**[INSTRUCTIONS]{.underline}**

> a\) The applicant should develop a plan for disseminating information
> about its model project, including its practical experiences with the
> planning and implementation phases and results of evaluation efforts,
> as well as disseminating information about the national initiative,
> *Integrated Health and Behavioral Health Care for Children,
> Adolescents and Their Families*, to multiple audiences at local,
> State, Regional and national levels. Audiences should include, but are
> not limited to, health and mental health professionals and
> practitioners, administrators of organizations that deliver general
> health care, mental health care and substance abuse prevention and
> treatment services, payors, employers, and policy and decision-makers
> at local, State, Regional and national levels.
>
> b\) The applicant must agree to work collaboratively with the other
> grantee funded under this initiative to develop and implement a plan
> for disseminating information about the initiative at a national
> level. Grantees will be expected to pool resources to accomplish this
> task during Project Years II and III (see **Sections IV.2.iv and v**,
> Budget and Budget Justification). (The first four implementation
> grantees pooled resources in order to develop a larger and more
> effective dissemination effort than could have otherwise have been
> achieved).
>
> c\) The applicant needs to commit to, and present a plan for,
> achieving financial sustainability of integrated health and behavioral
> health services for children, adolescents and their families beyond
> the Federal funding period.

[]{#__RefHeading___Toc120336216 .anchor}**5) [Resources and
Capabilities]{.underline}**

*This section of the project narrative describes the applicant's
commitment to the IHBHC Program; experience, skills and knowledge,
including individuals on staff; relevant materials published; previous
work of a similar nature; and information about the applicant's
organization.*

**[INSTRUCTIONS]{.underline}**

> Instructions for this section are divided into four sub-sections:
> Applicant Commitment, Personnel Capacity, Organizational Structure and
> Resources, and Funding History.

[APPLICANT COMMITMENT]{.underline}

**[INSTRUCTIONS]{.underline}**

> a\) The application package should include demonstration of explicit
> leadership commitment to this collaborative project through a dated
> and [jointly signed letter from the directors]{.underline} of the
> physical health/medical care, mental health services, and substance
> abuse prevention and treatment services
> organizations/agencies/programs that participated in the planning
> process. This letter should state: 1) which single organization/
> agency/program will be responsible for the grant award (that is, serve
> as the grantee and assume fiscal and managerial responsibility for the
> funding); 2) how project leadership will be organized; 3) commitment
> to full engagement in the implementation of the developed integrated
> services system model that was produced from the planning process; 4)
> commitment to the required financial match (see **Sections IV.2.iv and
> v)**; commitment to sustaining project activities following withdrawal
> of Federal funding if evaluation findings and performance demonstrate
> promise for beneficial effects and cost effectiveness (see **Section
> IV.2.x.4**); 5) commitment to cooperating fully with an evaluation
> that includes a core common set of variables and measures; (see
> **Section IV.2.x.3**)5; and 6) commitment to full partnership with the
> other funded grantee in dissemination of information about models that
> integrate health and behavioral health care for children, adolescents
> and their families (see **Section IV.2.x.5)**. This letter should be
> contained in Appendix D, Letters of Agreement (see **Section IV.2.
> xii**).
>
> b\) The proposal should include individual, dated letters of
> commitment from other key stakeholders that will actively contribute
> to the implementation process and that may have been a part of the
> planning process. Each stakeholder's letter should be dated and state
> the proposed role of the organization/agency/ program/individual in
> the implementation process and commitment to active involvement in
> project activities. These letters should be contained in Appendix D,
> Letters of Agreement (see **Section IV.2.xii**). Letters of support
> that do not specifically indicate a commitment to the project should
> be listed on one page as part of Appendix F, Other Relevant Documents
> (see **Section IV.2.xii**).

[PERSONNEL CAPACITY]{.underline}

**[INSTRUCTIONS]{.underline}**

> c\) All project personnel should be identified, including both
> individuals for whom support is, and is not, requested. A two-page
> curriculum vitae (Biographical Sketch) should be provided for each
> professional or technical staff member (see Appendix C (Page 26) for
> format of Biographical Sketches).
>
> d\) The applicant must name the proposed director of the project. The
> project director must have a strong background in managing/providing
> clinical services for a population of children, adolescents and their
> families, and a full understanding of the issues inherent in providing
> health, mental health and substance abuse prevention and treatment
> services for them. In addition, the project director must have
> executive or leadership experience as well as experience in leading
> efforts involving multiple stakeholders from a variety of backgrounds.
>
> e\) The applicant should describe the expertise and experience of a
> multidisciplinary staff, sufficient in size, with clinical,
> management, evaluation, information technology, quality improvement,
> and other relevant expertise adequate to address effectively the
> applicant's responsibilities in implementing a model integrating
> health and behavioral health services for children, adolescents and
> their families. Any evidence of special expertise, such as training,
> licensure and specialty certifications, should be described. The
> applicant should also document the capability and experience of key
> project staff in working collaboratively with professionals in
> multiple disciplines and with multiple stakeholder organizations
> involved in efforts to improve the health status and well-being of
> children, adolescents and their families. The applicant should also
> document the special expertise, capabilities, and competencies of any
> proposed contractor and consultants required to perform tasks under
> this grant.
>
> f\) The applicant should document that the project staff understands,
> is sensitive to, and has expertise in addressing issues specific to
> children, adolescents and their families from the range of cultures
> and ethnic groups represented in its community.
>
> g\) The applicant should describe appropriate support staff to
> facilitate the functioning of the professional staff.

[ORGANIZATIONAL STRUCTURE AND RESOURCES]{.underline}

**[INSTRUCTIONS]{.underline}**

> h\) The applicant should clearly describe the proposed project's
> organizational structure, including its:
>
> i\) Relationship(s) to and placement within the applicant and
> co-sponsoring organization(s);
>
> ii\) Relationships with the collaborating and cooperating agencies and
> organizations, as well as with individual stakeholders;
>
> iii\) Governance structure, including any boards of directors and/or
> advisory groups;
>
> iv\) Internal project structure and organization of project staff,
> including volunteers.
>
> i\) The applicant is required to summarize organizational information
> into charts, which should be attached as Appendix E, Project
> Organizational Chart (see **Section IV.2.xii**).

j)  The applicant should describe the resources available for carrying
    out the project, including its facilities and physical space,
    equipment, and information technology resources, including
    management information systems.

[Funding History]{.underline}

k)  The application must include information on all current and past
    (five-year history) funding received by the applicant from public
    (Federal and State) and private sources to conduct projects related
    to the priority area being addressed. Specific information required
    includes:

i\) Source of the funds

ii\) Name of the project and project number

iii\) Funding period

iv\) Contact person and telephone number

v\) Purpose of the grant

> Problems that were encountered in carrying out the objectives of these
> projects should be identified, and the applicant must address how
> these problems were addressed or will be resolved.

[]{#__RefHeading___Toc120336217 .anchor}**xi.** ***Appendices***

> Please provide the following items to complete the content of the
> application. Please note that these are supplementary in nature, and
> are not intended to be a continuation of the project narrative. Be
> sure each appendix is clearly labeled.
>
> ***1) Appendix A: Supplement to Form 424A, Key Personnel (Required. To
> be developed by applicant)***
>
> List all key personnel, including their salaries, percent effort
> devoted to the project and total support requested, including fringe
> benefit rate.

[]{.mark}

> ***2) Appendix B: Job Descriptions for Key Personnel* *(Required. To
> be developed by applicant)***
>
> Provide descriptions of responsibilities for all professional and
> technical positions for which grant support is requested and any
> positions of significance to the program that will be supported by
> other sources. Job descriptions reflect the functional requirements of
> each position, not the particular capabilities or qualifications of
> given individuals. Try to limit each job description to one (1) page
> in length. To save space, job descriptions do not need to be placed on
> separate pages. At a minimum, be sure to spell out the following:

\- Administrative direction and to whom it is provided;

> \- Functional relationships (that is, to whom the individual reports
> and how the position fits within its organizational area in terms of
> training and service functions);

\- Duties and scope of responsibilities; and

> \- Minimum qualifications (that is, the minimum requirements of
> education, training, and experience needed to do the job).
>
> ***3) Appendix C: Biographical Sketches of Key Personnel (Required. To
> be developed by***
>
> ***applicant)***
>
> Include biographical sketches (maximum of two \[2\] pages) for persons
> occupying the key positions identified in Appendix A. Biographical
> sketches should contain the following information: Education
> (institutions attended and their locations, degrees and years
> conferred, fields of study); professional certifications and
> licensure; professional positions/employment in reverse chronological
> order; current grant and contract support; representative
> publications; and any additional information that would contribute to
> the objective review committee's understanding of relevant
> qualifications, expertise and experience. In the event that a
> biographical sketch is included for an identified individual who is
> not yet hired, please include a letter of commitment from that person
> along with the biographical sketch.

[]{.mark}

> ***4) Appendix D: Letters of Agreement and/or Description(s) of
> Proposed/Existing Contracts (Required. To be developed by
> applicant)***
>
> Provide any documents that describe working relationships between the
> proposed project and other programs, agencies and organizations cited
> in the proposal. Documents that confirm actual or pending contractual
> agreements should clearly describe the roles of the subcontractors and
> any deliverables. Letters of agreements must be dated. Include only
> letters of agreement that indicate a specific commitment to the
> project (in-kind services, dollars, staff, space, equipment, etc.)
> List any simple letters of support received by the applicant on a
> single page, but do not include the actual letters in the application.
>
> ***5) Appendix E: Project Organizational Chart (Required. To be
> developed by applicant)***
>
> Provide (a) figure(s) that depict(s): 1) the organizational structure
> of the project, including internal relationships of project staff,
> relationships between project staff and any advisory boards,
> relationships with subcontractors and other significant collaborators;
> and 2) the placement of the project within the structure of its parent
> organization(s).
>
> ***6) Appendix F:** **Timeline (Required. To be developed by
> applicant) ***
>
> The timeline links activities to project objectives and should cover
> the three (3) years of the project period. This table, chart or figure
> details activities necessary to carry out each methodological
> approach, including approaches to major categories of activities and
> appropriate tracking methods. It includes a format to describe the
> "who, what, when, where, and how" of each approach.
>
> ***7) Appendix G: Other Relevant Documents***
>
> This appendix includes any additional documents that are relevant to
> the application. Examples include rosters of Board, Executive
> Committee, or Advisory Council members; and a list of reference
> citations and materials consulted by the applicant in preparation of
> the proposal.

[]{#__RefHeading___Toc120336218 .anchor}**3. Submission Dates and
Times**

**Notification of Intent to Apply**

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

This letter should be sent by March 1, 2006, by mail or fax to:

Director, Division of Independent Review

Director

HRSA Grants Application Center (GAC)

HRSA-06-090

The Legin Group, Inc.

901 Russell Ave., Suite 450

Gaithersburg, MD 20879

*Fax: 877/477-2345*

**Application Due Date:**

> The due date for applications under this grant announcement is [March
> 31, 2006 at 5:00 P.M. Eastern Time]{.underline}. Applications will be
> considered as meeting the deadline if they are E-marked on or before
> the due date.
>
> The Chief Grants Management Officer or a higher-level designee may
> authorize an extension of published deadlines when justified by such
> circumstances as "acts of God" (for example, floods or hurricanes),
> widespread disruptions of mail service, or other disruptions of
> services, such as a prolonged blackout. The authorizing official will
> determine the affected geographical area(s).
>
> Applications must be submitted by 5:00 P.M. Eastern Time on March 31,
> 2006. **To ensure that you have adequate time to follow procedures and
> successfully submit the application, we recommend you start submission
> no later than noon on the due date.** **Applications will be time/date
> stamped electronically, which will serve as receipt of submission.
> After you electronically submit your application, you will receive an
> automatic acknowledgement from Grants. Gov that contains a Grants.gov
> tracking number. HRSA will retrieve your application from
> Grants.gov.**
>
> **Please refer to the Addendum for important specific information on
> registering and applying through Grants.gov.**
>
> **Late applications:**
>
> Applications which do not meet the criteria above are considered late
> applications. The Health Resources and Services Administration (HRSA)
> shall notify each late applicant that its application will not be
> considered in the current competition.

[]{#Application_materials .anchor}**4. Intergovernmental Review**

> The *Integrated Health and Behavioral Health Care for Children,
> Adolescents and Their Families: Implementation Program* is NOT subject
> to the provisions of Executive Order 12372, as implemented by 45 CFR
> 100.

[]{#__RefHeading___Toc120336220 .anchor}**5. Funding Restrictions**

> []{.mark}
>
> Applicants responding to this announcement may request funding for a
> project period of up to three (3) years, at no more than \$200,000 per
> year. Applications requesting funds greater than \$200,000 per year
> will not be considered for funding. Awards to support projects beyond
> the first budget year will be contingent upon Congressional
> appropriation, satisfactory progress in meeting the project's
> objectives, and a determination that continued funding would be in the
> best interest of the government.

[]{#__RefHeading___Toc120336221 .anchor}**6. Other Submission
Requirements**

> Except in rare cases (please refer back to IV.2.a for specifics), HRSA
> will no longer accept applications for grant opportunities in paper
> form. Applicants submitting for this funding opportunity are
> ***required*** to submit ***electronically*** through Grants.gov. To
> submit an application electronically, please use the
> [http://www.Grants.gov](http://www.Grants.gov/) apply site. When using
> Grants.gov you will be able to download a copy of the application
> package, complete it off-line, and then upload and submit the
> application via the Grants.gov site.
>
> As soon as you read this, whether you plan on applying for a HRSA
> grant later this month or later this year, it is incumbent that your
> organization ***immediately register*** in Grants.gov and become
> familiar with the Grants.gov site application process. If you do not
> complete the registration process you will be unable to submit an
> application. The registration process can take up to one month, so you
> need to begin immediately.
>
> To be able to successfully register in Grants.gov, it is necessary
> that you complete all of the following required actions:
>
> • Obtain an organizational Data Universal Number System (DUNS) number
>
> • Register the organization with Central Contractor Registry (CCR)
>
> • Identify the organization's E-Business POC (Point of Contact)
>
> • Confirm the organization's CCR "Marketing Partner ID Number (M-PIN)"
> password
>
> • Register an Authorized Organization Representative (AOR)
>
> • Obtain a username and password from the Grants.gov Credential
> Provider
>
> Instructions on how to register, tutorials and FAQs are available on
> the Grants.gov web site at [www.grants.gov](http://www.grants.gov/).
> Assistance is also available from the Grants.gov help desk at
> <support@grants.gov> or by phone at 1-800-518-4726.
>
> More specific information, including step-by-step instructions on
> registering and applying, can be found in the Addendum to this
> guidance.
>
> Please understand that we will not consider additional information
> and/or materials submitted after your initial application. You must
> therefore ensure that all materials are submitted together.
>
> Online applications are still required to submit ONE form in signed
> hard copy: the SF-424/5161 Face Sheet, since all other elements of the
> application have been captured and transmitted electronically. 
>
> **Formal submission of the electronic application:** Applications
> completed online are considered formally submitted when the
> Authorizing Official electronically submits the application to HRSA.
> However, to complete the submission requirements, a paper copy of the
> SF-424/5161 Face Sheet must be printed, signed, and submitted to the
> HRSA Grants Application Center at the following address and received
> by not later that five days after the due date.
>
> The HRSA Grants Application Center
>
> The Legin Group, Inc.
>
> Integrated Health and Behavioral Health Care for Children, Adolescents
> and Their Families Grant Program: Implementation
>
> Announcement No. HRSA-06-090
>
> CFDA No. 93.110
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877/477-2123
>
> In addition, please scan the signed Face Sheet and include it as an
> attachment in your electronic submission.
>
> Applications will be considered as having met the deadline if: (1) the
> application has been successfully transmitted electronically by your
> organization's Authorizing Official through Grants.gov on or before
> the deadline date and time, and (2) the signed SF-424/5161 Face Sheet
> is received by HRSA by no later that five (5) days after the
> application due date.
>
> It is incumbent on applicants to ensure that the AO is available to
> submit the application to HRSA by the application due date. We will
> [not]{.underline} accept submission or re-submission of incomplete,
> rejected, or otherwise delayed applications after the deadline.
>
>  

[]{#__RefHeading___Toc120336222 .anchor}**V. Application Review
Information**

[]{#Review_ReviewCriteria .anchor}

**1. Review Criteria**

> Procedures for assessing the technical merit of grant applications
> have been instituted to provide for an objective review of
> applications and to assist the applicant in understanding the
> standards against which each application will be judged. Critical
> indicators, or Program Review Sub-Criteria, have been developed for
> each review criterion to assist the applicant in presenting pertinent
> information related to that criterion and to provide the reviewer with
> a standard for evaluation. Review criteria are outlined below with
> specific detail and scoring points.
>
> Review Criteria are used to review, evaluate and rate applications.
> The *Integrated Health and Behavioral Health Care for Children,
> Adolescents and Their Families Grant Program: Implementation* uses six
> (6) "General Review Criteria," which are outlined below. Applicants
> should pay strict attention to addressing these criteria, as they are
> the basis upon which members of the Independent Review Panel will
> judge their applications. Applicants should refer to **Sections I.1,
> I.2** and **IV.2.x** of the Application Guidance for statements of
> program expectations and instructions for preparing the Project
> Narrative, which together will assist them in preparing applications
> that address the Review Criteria as defined by the Program Review
> Sub-Criteria.
>
> **[Criterion 1]{.underline} [Need: Understanding of, and Planning
> Process for, an Integrated Health and Behavioral Health Services
> System for a Community-based Population of Children, Adolescents and
> Their Families ]{.underline}**
>
> **\[This component accounts for 20% of the total Objective Review
> score.\]**

1)  The applicant demonstrates a clear and comprehensive understanding
    of the conceptual issues important to the development of a program
    integrating physical health and medical care, mental health care,
    and substance abuse prevention and treatment services for children,
    adolescents and their families.

2)  The applicant demonstrates a clear and comprehensive understanding
    of the issues and problems faced by, as well as the strengths
    of: (a) the population and community that it intends to serve
    through project effort; (b) the staff working in the applicant and
    co-sponsoring organizations who would be connected with, or affected
    by, project components and activities; and (c) the stakeholder
    organizations allied with the project.

3)  The applicant demonstrates that it conducted a complete and
    comprehensive planning process that capably addressed the multiple
    elements of an integrated health and behavioral health care program
    for children, adolescents and their families.

4)  The applicant provides convincing evidence of its readiness to
    implement the model it had developed during the planning process.

5)  The applicant demonstrates a clear understanding of the specific
    issues and practical challenges that it encountered during the
    planning process, an appreciation of the issues and problems that
    will need to be addressed as part of implementation efforts, and
    indicates a successful approach to solving problems.

**[Criterion 2a)]{.underline} [Response: Goals and
Objectives]{.underline}**

> **\[This component accounts for 10% of the total Objective Review
> score.\]**
>
> 1\) The applicant presents a set of substantive and realistic project
> goals that comprehensively frame the intent of the *Integrated Health
> and Behavioral Health Care for Children Adolescents, and Their
> Families Grant Program: Implementation*, including the three goals set
> forth in Section I.1, Program Purpose and Goals.
>
> 2\) The applicant identifies one or more substantive, relevant,
> time-framed and measurable outcome objectives for each specified
> project goal.
>
> 3\) The applicant provides convincing evidence that achievement of the
> outcome objectives is feasible within the stated time frames.
>
> **[Criterion 2b)]{.underline} [Response: Strategies and Methods for
> Attaining Project Goals and Objectives]{.underline}**
>
> **\[This component accounts for 20% of the total Objective Review
> score.\]**

1)  The applicant describes sets of activities that substantively
    address each project goal and objective.

2)  The applicant provides a clear, detailed description of the
    methodology and links the components of the overall approach in a
    logical manner.

3)  The approach is technically sound and feasible, based on a logical
    rationale, and evidence-based. The evidence is convincing that the
    project activities, if well executed, are capable of attaining
    project objectives.

4)  The approach and activities specifically address the outlined
    components of an integrated health and behavioral health care
    program.

5)  The approach is responsive to the needs of the community-based
    population and consistent with the context of the community.

6)  The approach includes activities that address the unique needs of
    vulnerable sub-populations in the community the proposed project
    intends to serve.

7)  The approach incorporates the framework of *Bright Futures for
    Infants, Children and Adolescents* (see **Section VI.2**) and
    utilizes its materials as part of the education and training of
    project staff and health professions students and trainees as well
    as in the building of relationships with families and the community.

8)  The applicant describes how the proposed project will strive for
    cultural competence in addressing the needs of the population(s) it
    serves.

9)  The applicant provides a coherent discussion of possible challenges,
    including barriers and opportunities, to implementing and conducting
    project activities and attaining project objectives, and presents
    practical strategies for addressing these challenges.

10) The project timeline is complete and realistic, and covers the
    entire three year span of the proposed project.

**[Criterion 3)]{.underline} [Evaluative Measures]{.underline}**

> **\[This component accounts for 10% of the total Objective Review
> score.\]**

1)  A comprehensive array of key activities that warrant tracking,
    including clinical service activities, is identified.

2)  Proposed methods for tracking each activity and collecting the
    appropriate information are described, are feasible and economical,
    and take advantage of electronic technologies.

3)  The plan includes a realistic and practical description of how
    monitoring data are to be analyzed, synthesized and used in managing
    the project.

4)  The plan addresses quality improvement in a meaningful and useful
    way and includes active staff participation in it.

5)  The plan ensures that providers use clinical "best practices" and
    that mental health and substance abuse prevention and treatment
    interventions are evidence-based.

6)  The plan addresses cost effectiveness of the project model and its
    key components.

7)  There is convincing evidence of the strength of the project's plans
    for evaluation. The plan is logical and technically sound.

8)  The plan includes a description of how progress in achieving outcome
    objectives will be measured.

9)  The plan for information and data analysis is described fully, is
    logical and practical, and is able to yield meaningful findings.

10) The plan will yield a program evaluation designed to produce annual
    qualitative and quantitative reports on progress throughout the
    duration of the project.

**[Criterion 4)]{.underline} [Impact]{.underline}**

> **\[This component accounts for 15% of the total Objective Review
> score.\]**

1)  The applicant presents a meaningful and realistic plan that
    describes how appropriate materials will be developed for multiple
    audiences regarding integration of health and behavioral health care
    for children, adolescents and their families.

2)  The applicant describes a meaningful and realistic plan about how
    its project information will reach multiple audiences at local,
    State, Regional and national levels.

3)  The applicant commits to working collaboratively with its fellow
    grantee, including the pooling of resources, to develop and
    implement a plan for dissemination of information about the
    initiative at a national level.

4)  The applicant commits to and presents a realistic plan for achieving
    financial sustainability of providing integrated health and
    behavioral health services for children, adolescents and their
    families beyond the Federal funding period.

**[Criterion 5)]{.underline} [Resources and Capabilities]{.underline}**

> **\[This component accounts for 20% of the total Objective Review
> score.\]**

1)  The biographical sketch of the proposed Project Director
    demonstrates a sufficiently strong background in managing/providing
    clinical services for a population of children, adolescents and
    their families; in understanding the issues inherent in providing
    health, mental health and substance abuse prevention and treatment
    services for them; in executive or leadership experience; and in
    leading efforts involving multiple stakeholders from a variety of
    backgrounds.

2)  The biographical sketches of the project director and other key
    personnel document appropriate education, expertise, skills and
    experience that are relevant and necessary to this project,
    including but not limited to, licensure, training, specialty
    certifications; program evaluation and management; information
    technology expertise.

3)  The applicant describes appropriate support staff to facilitate the
    functioning of the professional staff and a sufficiently large staff
    overall to carry out the work of the initiative.

> 4\) The applicant describes an appropriate and adequate organizational
> structure for governance and oversight, implementing and conducting
> project activities, administrative relationships with the sponsoring
> organizations, and maintaining constructive relationships with other
> organizations whose assistance is necessary to achieve project goals
> and outcome objectives and to implement project activities.
>
> 5\) The applicant demonstrates understanding of, sensitivity to, and
> expertise in addressing issues specific to children, adolescents and
> their families from the range of cultures and ethnic groups
> represented in its community.
>
> 6\) Adequate physical space and resources, including information
> technologies, are available for conducting project activities.
>
> **[Criterion 6)]{.underline} [Support Requested]{.underline} -- The
> reasonableness of the proposed budget in relation to the objectives,
> the complexity of the activities, and the anticipated results.**
>
> **\[This component accounts for 5% of the total Objective Review
> score.\]**
>
> 1\) Degree to which the budget request conforms to the funding level
> of the *IHBHC Program*, as stated in the Application Guidance.
>
> 2\) Provision of a detailed budget request and justification for each
> year of the three-year project period.
>
> 3\) Degree to which the budget justification documents logically and
> in adequate detail how and why each line item request (such as
> personnel, travel, equipment, supplies, information technology, and
> contractual services) supports the objectives and activities of the
> proposed project.
>
> 4\) How convincing the evidence is that the estimated cost to the
> government of the project is reasonable, considering its anticipated
> results.
>
> 5\) The applicant performs a major substantive role in carrying out
> the proposed project; that is, a contract with another party is not
> used as a conduit for an award under this initiative to another party.

[]{#__RefHeading___Toc120336224 .anchor}**2. Review and Selection
Process**

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

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

The maximum possible points that each scoring criterion could attain are
outlined below:

+-------------------------------+--------------------------------------+
| **CRITERION**                 | *Integrated Health and Behavioral    |
|                               | Health Care for Children,            |
|                               | Adolescents and Their Families.*     |
+-------------------------------+--------------------------------------+
| 1\. Need                      | **20**                               |
+-------------------------------+--------------------------------------+
| 2\. Response                  | **30**                               |
|                               |                                      |
| Goals and Objectives          | \(10\)                               |
|                               |                                      |
| > Strategies and Methods      | \(20\)                               |
+-------------------------------+--------------------------------------+
| 3\. Evaluative Measures       | **10**                               |
+-------------------------------+--------------------------------------+
| 4\. Impact                    | **15**                               |
+-------------------------------+--------------------------------------+
| 5\. Resources and             | **20**                               |
| Capabilities                  |                                      |
+-------------------------------+--------------------------------------+
| 6\. Support Requested         | **5**                                |
+-------------------------------+--------------------------------------+
| **TOTAL POINTS**              | **100**                              |
+-------------------------------+--------------------------------------+

[]{#__RefHeading___Toc120336225 .anchor}**VI. Award Administration
Information**

[]{#__RefHeading___Toc120336226 .anchor}**1. Award Notices**

> Each applicant will receive written notification of the outcome of the
> objective review process, including a summary of the expert
> committee's assessment of the application's merits and weaknesses, and
> whether the application was selected for funding. Applicants who are
> selected for funding may be required to respond in a satisfactory
> manner to Conditions placed on their application before funding can
> proceed. Letters of notification do not provide authorization to begin
> performance.
>
> The Notice of Grant Award sets forth the amount of funds granted, the
> terms and conditions of the grant, the effective date of the grant,
> the budget period for which initial support will be given, the
> non-Federal share to be provided (if applicable), and the total
> project period for which support is contemplated. Signed by the Grants
> Management Officer, it is sent to the applicant agency's Authorized
> Representative, and reflects the only the authorizing document. It
> will be sent prior to the start date of July 1, 2006.

[]{#__RefHeading___Toc120336227 .anchor}**2. Administrative and National
Policy Requirements**

> Successful applicants must comply with the administrative requirements
> outlined in 45 CFR Part 74 or 45 CFR Part 92, as appropriate.
>
> [PUBLIC POLICY ISSUANCE]{.underline}

[]{.mark}

> [HEALTHY PEOPLE 2010]{.underline}
>
> ***Healthy People 2010*** is a national initiative led by the U.S.
> Department of Health and Human Services (DHHS) that sets priorities
> for all HRSA programs. *Healthy People 2010* has two major goals: (1)
> To increase the quality and years of a healthy life; and (2) Eliminate
> our Nation's health disparities. The program consists of 28 focus
> areas and 467 objectives. HRSA has actively participated in the work
> groups of all the focus areas, and is committed to the achievement of
> *Healthy People 2010* goals.
>
> Applicants must summarize the relationship of their projects to the
> goals of *Healthy People 2010* and specifically identify the proposed
> objectives that will promote *Healthy People 2010* goals.
>
> Copies of *Healthy People 2010* may be obtained from the
> Superintendent of Documents or downloaded at the *Healthy People 2010*
> website: [http://www.health.gov/healthypeople/document]{.underline}/.
>
> [BRIGHT FUTURES FOR INFANTS, CHILDREN AND ADOLESCENTS]{.underline}
>
> The Maternal and Child Health Bureau has sponsored the initiative,
> *Bright Futures for Infants, Children and Adolescents,* since 1990.
> Its mission is to promote and improve the health, education, and
> well-being of infants, children, adolescents, families, and
> communities. The goals of *Bright Futures* are to:

-   Enhance health professionals' knowledge, skills, and practice of
    developmentally appropriate health care in the context of family and
    community;

-   Promote desired social, developmental, and health outcomes of
    infants, children, and adolescents;

-   Foster partnerships between families, health professionals, and
    communities; and

-   Increase family knowledge, skills, and participation in health
    promotion and prevention activities.

> In particular, *Bright Futures in Practice: Mental Health,* Volumes I
> (*Practice Guide*) and II (*Toolkit*) (2002) contain information and
> guidelines relevant to the *IHBHC Program: Implementation.*
>
> Materials have been produced by three grantees. Additional information
> is available on the following websites:

<http://brightfutures.org/>

[http://www.brightfuturesforfamilies.org](http://www.brightfuturesforfamilies.org/)

<http://brightfutures.aap.org/web/>

[]{.mark}

[ENVIRONMENTAL TOBACCO SMOKE]{.underline}

> The Public Health Service strongly encourages all award recipients to
> provide a smoke-free workplace and to promote the non-use of all
> tobacco products. Further, Public Law 103-227, the Pro-Children Act of
> 1994, prohibits smoking in certain facilities (or in some cases, any
> portion of a facility) in which regular or routine education, library,
> day care, health care or early childhood development services are
> provided to children.

[]{.mark}

[]{#__RefHeading___Toc120336228 .anchor}**3. Reporting**

The successful applicant under this guidance for competitive
applications must:

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

b.  Submit a Payment Management System Quarterly Report. The reports
    identify cash expenditures against the authorized funds for the
    grant. Failure to submit the report may result in the inability to
    access grant funds. Submit report to the:

> Division of Payment Management
>
> DPM/FMS/PSC/ASAM/HHS
>
> PO Box 6021
>
> Rockville, MD 20852
>
> Telephone: (301) 443-1660;

c.  Submit a Financial Status Report. A financial status report is
    required within 90 days of the end of each grant year. The report is
    an accounting of expenditures under the project that year;

d.  Submit a Progress Report.

e.  Submit other required reports and heed reporting requirements for
    designated performance measures and administrative data. See
    **Section VI.3.iii and Attachment 1,** which together provide an
    explanation and list of reporting requirements on designated
    performance measures and administrative data.

**Successful applicants receiving grant funds will be required, within
120 days of the Notice of Grant Award (NGA), to register in HRSA's
Electronic Handbooks (EHBs) and electronically complete the program
specific data forms that appear in Attachment 1 of this guidance**.** **
This requirement entails the provision of budget breakdowns in the
financial forms based on the grant award amount, the project abstract
and other grant summary data, and objectives for the performance
measures.

[]{#__RefHeading___Toc120336232 .anchor}**4. Performance Review**

> HRSA's Office of Performance Review (OPR) serves as the agency's focal
> point for reviewing and enhancing the performance of HRSA funded
> programs within communities and States. On a regularly scheduled
> basis, HRSA grantees are required to participate in a performance
> review of their HRSA funded program(s) by a review team from one of
> the ten OPR regional divisions. Grantees should expect to participate
> in a performance review at some point during their project period.
> When a grantee receives more than one HRSA grant, each of the
> grantee's HRSA funded programs will be reviewed during the same
> performance review.
>
> The purpose of performance review is to improve the performance of
> HRSA funded programs. Through systematic pre-site and on-site
> analysis, OPR works collaboratively with grantees and HRSA
> Bureaus/Offices to measure program performance, analyze the factors
> impacting performance, and identify effective strategies and
> partnerships to improve program performance, with a particular focus
> on outcomes. Upon completion of the performance review, grantees are
> expected to prepare an Action Plan that identifies key actions to
> improve program performance as well as addresses any identified
> program requirement issues. Performance reviews also provide direct
> feedback to the agency about the impact of HRSA policies on program
> implementation and performance within communities and States.
>
> For additional information on performance reviews, please visit:
> <http://www.hrsa.gov/performancereview>.

[]{#__RefHeading___Toc120336233 .anchor}**VII. Agency Contacts**

Applicants are encouraged to request assistance in the development of
the application.

For additional information regarding business, administrative or fiscal
issues related to the awarding of a grant under the Application Guidance
for the *Integrated Health and Behavioral Health Care for Children,
Adolescents and Their Families Grant Program: Implementation*,
applicants may contact:

Ms. Theda Duvall

Lead Grants Management Specialist

Division of Grants Management Operations

Health Resources and Services Administration

Parklawn Building, Room 11A-16

5600 Fishers Lane

####### Rockville, Maryland 20857

Telephone: 301/443-3414

Fax: 301/443-6686

E-mail: [tduvall@hrsa.gov]{.underline}

To obtain additional information relating to technical and program
issues under this initiative, applicants may contact:

Sharon Adamo, MS, MBA, RD

Division of Child, Adolescent and Family Health

Maternal and Child Health Bureau, HRSA

Parklawn Building, Room 18A-39

5600 Fishers Lane

Rockville, Maryland 20857

Telephone: 301/443-3972

Fax: 301/443-1296

E-Mail: [sadamo@hrsa.gov]{.underline}

[]{#__RefHeading___Toc120336234 .anchor}**VIII. Tips for Writing a
Strong Application**

**Include DUNS Number.** You must include a DUNS Number to have your
application reviewed. Applications ***will not*** be reviewed without a
DUNS number. To obtain a DUNS number, access
[www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
1-866-705-5711. Please include the DUNS number next to the OMB Approval
Number on the application face page.

**Keep your audience in mind.** Reviewers will use only the information
contained in the application to assess the application. Be sure the
application and responses to the program requirements and expectations
are complete and clearly written. Do not assume that reviewers are
familiar with the applicant organization. Keep the review criteria in
mind when writing the application.

**Start preparing the application early.** Allow plenty of time to
gather required information from various sources.

**Follow the instructions in this guidance carefully.** Place all
information in the order requested in the guidance. If the information
is not placed in the requested order, you may receive a lower score.

**Be brief, concise, and clear.** Make your points understandable.
Provide accurate and honest information, including candid accounts of
problems and realistic plans to address them. If any required
information or data is omitted, explain why. Make sure the information
provided in each table, chart, attachment, etc., is consistent with the
proposal narrative and information in other tables.

**Be organized and logical.** Many applications fail to receive a high
score because the reviewers cannot follow the thought process of the
applicant or because parts of the application do not fit together.

**Be careful in the use of appendices.** Do not use the appendices for
information that is required in the body of the application. Be sure to
cross-reference all tables and attachments located in the appendices to
the appropriate text in the application.

**Carefully proofread the application.** Misspellings and grammatical
errors will impede reviewers in understanding the application. Be sure
pages are numbered (including appendices) and that page limits are
followed. Limit the use of abbreviations and acronyms, and define each
one at its first use and periodically throughout application.

**Print out and carefully review an electronic application**. When
submitting electronically, print out the application before submitting
it to ensure appropriate formatting and adherence to page limit
requirements.

[]{#__RefHeading___Toc120336235 .anchor}**Attachment 1**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

[]{#__RefHeading___Toc120336236 .anchor}**Part 1: Designated Performance
Measure for Integrated Health and Behavioral Health Care for Children,
Adolescents and Their Families Grant Program: Implementation**

**PM 10: The degree to which MCHB supported have programs have
incorporated cultural competence elements into their policies,
guidelines, contracts, and training.**

+-----------------------------------+-----------------------------------+
| **10 PERFORMANCE MEASURE**        | The degree to which MCHB          |
|                                   | supported programs have           |
| **Goal 2: Eliminate Health        | incorporated cultural competence  |
| Barriers & Disparities**          | elements into their policies,     |
|                                   | guidelines, contracts and         |
| **(Develop and promote health     | training.                         |
| services and systems of care      |                                   |
| designed to eliminate disparities |                                   |
| and barriers across MCH           |                                   |
| populations)**                    |                                   |
|                                   |                                   |
| **Level: Grantee**                |                                   |
|                                   |                                   |
| **Category: Cultural Competence** |                                   |
+-----------------------------------+-----------------------------------+
| **GOAL**                          | To increase the number of MCHB    |
|                                   | supported programs that have      |
|                                   | integrated cultural competence    |
|                                   | into their policies, guidelines,  |
|                                   | contracts and training.           |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **MEASURE**                       | The degree to which MCHB          |
|                                   | supported programs have           |
|                                   | incorporated cultural competence  |
|                                   | elements into their policies,     |
|                                   | guidelines, contracts and         |
|                                   | training.                         |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DEFINITION**                    | Attached is a checklist of 23     |
|                                   | elements that demonstrate         |
|                                   | cultural competency. Please check |
|                                   | the degree to which the elements  |
|                                   | have been implemented. The answer |
|                                   | scale is 0-69. Please keep the    |
|                                   | completed checklist attached.     |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **HEALTHY PEOPLE 2010 OBJECTIVE** | Related to Objective 16.23:       |
|                                   | Increase the proportion of States |
|                                   | and jurisdictions that have       |
|                                   | service systems for children with |
|                                   | or at risk for chronic and        |
|                                   | disabling conditions as required  |
|                                   | by Public Law 101-239.            |
|                                   |                                   |
|                                   | Related to Objective 23.11        |
|                                   | (Developmental) Increase the      |
|                                   | proportion of State and local     |
|                                   | public health agencies that meet  |
|                                   | national performance standards    |
|                                   | for essential public health       |
|                                   | services.                         |
|                                   |                                   |
|                                   | Related to Objective 23.15        |
|                                   | (Developmental) Increase the      |
|                                   | proportion of Federal, Tribal,    |
|                                   | State, and local jurisdictions    |
|                                   | that review and evaluate the      |
|                                   | extent to which their statutes,   |
|                                   | ordinances, and bylaws assure the |
|                                   | delivery of essential public      |
|                                   | health services.                  |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **DATA SOURCE(S) AND ISSUES**     | -   Attached data collection form |
|                                   |     to be completed by grantees.  |
|                                   |                                   |
|                                   | -   There is no existing national |
|                                   |     data source to measure the    |
|                                   |     extent to which MCHB          |
|                                   |     supported programs have       |
|                                   |     incorporated cultural         |
|                                   |     competence elements into      |
|                                   |     their policies, guidelines,   |
|                                   |     contracts and training.       |
+-----------------------------------+-----------------------------------+
|                                   |                                   |
+-----------------------------------+-----------------------------------+
| **SIGNIFICANCE**                  | Over the last decade, researchers |
|                                   | and policymakers have emphasized  |
|                                   | the central influence of cultural |
|                                   | values and cultural/linguistic    |
|                                   | barriers: health seeking          |
|                                   | behavior, access to care, and     |
|                                   | racial and ethnic disparities. In |
|                                   | accordance with these concerns,   |
|                                   | cultural competence objectives    |
|                                   | have been: (1) incorporated into  |
|                                   | the MCHB strategic plan; and (2)  |
|                                   | in guidance materials related to  |
|                                   | the Omnibus Budget Reconciliation |
|                                   | Act of 1989 (OBRA '89), which is  |
|                                   | the legislative mandate that      |
|                                   | health programs supported by MCHB |
|                                   | Children with Special Health Care |
|                                   | Needs (CSHCN) provide and promote |
|                                   | family centered, community‑based, |
|                                   | coordinated care.                 |
+-----------------------------------+-----------------------------------+

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

**DATA COLLECTION FORM FOR DETAIL SHEET #10**

Using a scale of 0-3, please rate the degree to which your grant program
has incorporated the following cultural competence elements into your
policies, guidelines, contracts and training.

+------+------+------+------+------------------------------------------+
| *    | *    | *    | *    | **Element**                              |
| *0** | *1** | *2** | *3** |                                          |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **CORE FUNCTIONS:** Our organization     |
|      |      |      |      | incorporates the following culturally    |
|      |      |      |      | competent core function elements:        |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Performs needs/assets assessments    |
|      |      |      |      |     with the culturally diverse groups   |
|      |      |      |      |     we serve.                            |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Collects and analyzes data according |
|      |      |      |      |     to different cultural groups (e.g.   |
|      |      |      |      |     race, ethnicity, language).          |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Designs services to meet the needs   |
|      |      |      |      |     of culturally diverse groups (e.g.   |
|      |      |      |      |     use of traditional healers, flexible |
|      |      |      |      |     times of services, language          |
|      |      |      |      |     services).                           |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 4.  Uses data on different groups for    |
|      |      |      |      |     program development.                 |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 5.  Considers barriers and the provision |
|      |      |      |      |     of appropriate strategies to address |
|      |      |      |      |     them.                                |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 6.  Evaluates and monitors quality       |
|      |      |      |      |     services (via customer satisfaction  |
|      |      |      |      |     surveys, focus groups, chart         |
|      |      |      |      |     reviews).                            |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to incorporate         |
|      |      |      |      | cultural competence in the core          |
|      |      |      |      | functions? *None\_\_\_ Informal\_\_\_    |
|      |      |      |      | Formal\_\_\_ In process\_\_\_*           |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **TRAINING/HUMAN RESOURCES**: Our        |
|      |      |      |      | organization incorporates the following  |
|      |      |      |      | culturally competent training/human      |
|      |      |      |      | resource elements:                       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Employs a culturally diverse and     |
|      |      |      |      |     linguistically and culturally        |
|      |      |      |      |     competent staff.                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Ensures the provision of training,   |
|      |      |      |      |     both in orientation and ongoing      |
|      |      |      |      |     professional development, for staff, |
|      |      |      |      |     volunteers, contractors and          |
|      |      |      |      |     subcontractors in the area of        |
|      |      |      |      |     cultural and linguistic competence.  |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to incorporate         |
|      |      |      |      | cultural competence in training and      |
|      |      |      |      | human resources?                         |
|      |      |      |      |                                          |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **COLLABORATION:** Our organization      |
|      |      |      |      | collaborates with informal community     |
|      |      |      |      | leaders/groups (e.g. natural networks,   |
|      |      |      |      | informal leaders, spiritual leaders,     |
|      |      |      |      | ethnic media, family advocacy groups) in |
|      |      |      |      | various aspects of the following         |
|      |      |      |      | categories::                             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Program planning                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Service delivery                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Evaluation/monitoring of services    |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **COLLABORATION:** Our organization      |
|      |      |      |      | collaborates with families of culturally |
|      |      |      |      | diverse groups in various aspects of the |
|      |      |      |      | following categories:                    |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 4.  Program planning                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 5.  Service delivery                     |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 6.  Evaluation/monitoring of services    |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to support the above   |
|      |      |      |      | mentioned collaborative activities?      |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+

+------+------+------+------+------------------------------------------+
|      |      |      |      | **RESOURCE ALLOCATION:** Our             |
|      |      |      |      | organization's allocation of resources   |
|      |      |      |      | adequately meets the unique access,      |
|      |      |      |      | information and service needs of         |
|      |      |      |      | culturally diverse groups in the         |
|      |      |      |      | following program areas:                 |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Planning                             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Implementation                       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Evaluation/Monitoring (e.g. customer |
|      |      |      |      |     satisfaction surveys, focus groups)  |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to support the         |
|      |      |      |      | allocation of fiscal resources for the   |
|      |      |      |      | needs and services for culturally        |
|      |      |      |      | diverse groups?                          |
|      |      |      |      |                                          |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+
|      |      |      |      | **CONTRACTS:** Our agency puts language  |
|      |      |      |      | in contracts that addresses our goals to |
|      |      |      |      | incorporate cultural competence for      |
|      |      |      |      | culturally and linguistically diverse    |
|      |      |      |      | groups in the following areas**:**       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 1.  Needs/assets assessments             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 2.  Outreach                             |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 3.  Specialized services                 |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 4.  Training for                         |
|      |      |      |      |     contractors/subcontractors           |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 5.  Sufficient funds to support 1-e      |
+------+------+------+------+------------------------------------------+
|      |      |      |      | 6.  Reporting requirements for a-e       |
+------+------+------+------+------------------------------------------+
|      |      |      |      | Is there a policy to support monitoring  |
|      |      |      |      | of contractors/ subcontractors?          |
|      |      |      |      |                                          |
|      |      |      |      | *None\_\_\_ Informal\_\_\_ Formal\_\_\_  |
|      |      |      |      | In process\_\_\_*                        |
+------+------+------+------+------------------------------------------+

0=Not Met

1=Partially Met

2=Mostly Met

3=Completely Met

Total the numbers in the boxes (possible 0‑69 score)
\_\_\_\_\_\_\_\_\_\_

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

[]{#__RefHeading___Toc120336239 .anchor}**Part 2: Program Specific Forms
for Integrated Health and Behavioral Health Care for Children,
Adolescents and Their Families Grant Program: Implementation**

**FORM 1**

**MCHB PROJECT BUDGET DETAILS FOR FY 2006**

**1. MCHB GRANT AWARD AMOUNT** \$\_\_\_\_\_\_\_\_\_**\_**

**2. UNOBLIGATED BALANCE** \$\_\_\_\_\_\_\_\_\_**\_**

**3. MATCHING FUNDS** (Required: Yes \[ \] No \[ \] If yes, amount)
\$\_\_\_\_\_\_\_\_\_\_

> A. Local funds \$\_\_\_\_\_\_\_

B.  State funds \$\_\_\_\_\_\_\_

C.  Program Income \$\_\_\_\_\_\_\_

D.  Applicant/Grantee Funds \$\_\_\_\_\_\_\_

> E. Other funds \$\_\_\_\_\_\_\_

**4. OTHER PROJECT FUNDS** (Not included in 3 above)
\$\_\_\_\_\_\_\_\_\_\_

> A. Local funds \$\_\_\_\_\_\_\_

B.  State funds \$\_\_\_\_\_\_\_

C.  Program Income (Clinical or Other) \$\_\_\_\_\_\_\_

D.  Applicant/Grantee Funds (includes in-kind) \$\_\_\_\_\_\_\_

> E. Other funds (including private sector, e.g., \$\_\_\_\_\_\_\_
>
> Foundations)

**5**. **TOTAL PROJECT FUNDS** (Tota2l lines 1 through 4)
\$\_\_\_\_\_\_\_\_\_\_

**6. FEDERAL COLLABORATIVE FUNDS**

(Source(s) of additional Federal funds contributing to the project)

A.  Other MCHB Funds (Do not repeat grant funds from Line 1)

> 1\) SPRANS \$\_\_\_\_\_\_\_\_
>
> 2\) CISS \$\_\_\_\_\_\_\_\_
>
> 3\) SSDI \$\_\_\_\_\_\_\_\_
>
> 4\) Abstinence Education \$\_\_\_\_\_\_\_\_
>
> 5\) Healthy Start \$\_\_\_\_\_\_\_\_

6)  EMSC \$\_\_\_\_\_\_\_\_

7)  Bioterrorism \$\_\_\_\_\_\_\_\_

8)  Traumatic Brain Injury \$\_\_\_\_\_\_\_\_

9)  State Title V Block Grant \$\_\_\_\_\_\_\_\_

10) Other \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_

```{=html}
<!-- -->
```
B.  Other HRSA Funds

```{=html}
<!-- -->
```
1)  HIV/AIDS \$\_\_\_\_\_\_\_\_

2)  Primary Care \$\_\_\_\_\_\_\_\_

3)  Health Professions \$\_\_\_\_\_\_\_\_

4)  Other \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_

##### Other Federal Funds

1\) CMS \$\_\_\_\_\_\_\_\_

2.  SSI \$\_\_\_\_\_\_\_\_

3.  Agriculture (WIC/other) \$\_\_\_\_\_\_\_\_

4.  ACF \$\_\_\_\_\_\_\_\_

5.  CDC \$\_\_\_\_\_\_\_\_

6.  SAMHSA \$\_\_\_\_\_\_\_\_

7.  NIH \$\_\_\_\_\_\_\_\_

8.  Education \$\_\_\_\_\_\_\_\_

9.  Other: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_

> \$\_\_\_\_\_\_\_\_
>
> \$\_\_\_\_\_\_\_\_

**7. TOTAL COLLABORATIVE FEDERAL FUNDS**
\$[\_\_\_\_\_\_\_\_]{.underline}

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

**INSTRUCTIONS FOR COMPLETION OF FORM 1**

**MCH BUDGET DETAILS FOR FY 2006**

Line 1. Enter the amount of the Federal MCHB grant award for this
project.

Line 2. Enter the amount of carryover from the previous year's award, if
any (the unobligated balance).

Line 3. Indicate if matching funds are required by checking the
appropriate choice. If matching funds are required, enter the total
amount of the matching funds received or committed to the project. List
the amounts by source on lines 3A through 3D as appropriate. Do not
include "overmatch" funds. Any additional funds over and above the
amount required for matching purposes should be reported in Line 4.
Where appropriate, include the dollar value of in-kind contributions.

Line 4. Enter the amount of other funds received for the project, by
source on Lines 4A through 4E, specifying amounts from each source. Do
not include those amounts included in Line 3 above. Also include the
dollar value of in-kind contributions.

Line 5. Enter the sum of lines 1 through 4

Line 6. Line 6. Enter the amount of other Federal funds received on the
appropriate lines (A.1 through C.9) **other** than the MCHB grant award
for the project. Such funds would include those from other Departments,
other components of the Department of Health and Human Services, or
other MCHB grants or contracts.

Line 6C.1. Enter only project funds from the Center for Medicare and
Medicaid Services. Exclude Medicaid reimbursement, which is considered
Program Income and should be included on Line 3C or 4C.

If lines 6A.10, 6B.4, or 6C.9 are utilized, specify the source(s) of the
funds in the order of the amount provided, starting with the source of
the most funds. If more space is required, add a footnote at the bottom
of the page showing additional sources and amounts.

Line 7. Enter the sum of Lines 6A.1 through 6C.9.

**NOTE: MCHB Training Grants must fill out Section "V. Detailed Budget"
of the currently approved HRSA-6025 in addition to this form.**

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

**FORM 2**

**PROJECT FUNDING PROFILE**

<table>
<colgroup>
<col style="width: 19%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="2"><strong>FY ____</strong></td>
<td colspan="2"><strong>FY ____</strong></td>
<td colspan="2"><strong>FY ____</strong></td>
<td colspan="2"><strong>FY ____</strong></td>
<td colspan="2"><strong>FY ____</strong></td>
</tr>
<tr class="even">
<td></td>
<td>Budgeted</td>
<td>Budgeted</td>
<td>Budgeted</td>
<td>Expended</td>
<td>Budgeted</td>
<td>Budgeted</td>
<td>Budgeted</td>
<td>Expended</td>
<td>Budgeted</td>
<td>Expended</td>
</tr>
<tr class="odd">
<td><p>1. MCHB Grant Award Amount</p>
<p><em>(Line 1, Form 2)</em></p></td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
</tr>
<tr class="even">
<td>2. Unobligated Balance <em>(Line 2, Form 2)</em></td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
</tr>
<tr class="odd">
<td>3. Matching Funds (if required) <em>(Line 3, Form 2)</em></td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
</tr>
<tr class="even">
<td><p>4. Other Project Funds</p>
<p><em>(Line 4, Form 2)</em></p></td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
</tr>
<tr class="odd">
<td>5. Total Project Funds <em>(Line 5, Form 2)</em></td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
</tr>
<tr class="even">
<td>6. Total Federal Collaborative Funds <em>(Line 7, Form 2)</em></td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
<td>$</td>
</tr>
</tbody>
</table>

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

**INSTRUCTIONS FOR THE COMPLETION OF FORM 2**

**PROJECT FUNDING PROFILE**

Complete all required data cells. If an actual number is not available,
use an estimate. Explain all estimates in a footnote.

The form is intended to provide "at a glance" funding data on the
estimated budgeted amounts and actual expended amounts of an MCH
project.

For each fiscal year, the data in the columns labeled ***Budgeted*** on
this form are to contain the same figures that appear on the Application
Face Sheet (SF-424) and Lines 1 through 7 of Form 1. The lines under the
columns labeled ***Expended*** are to contain the actual amounts
expended for each grant year that has been completed.

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

**FORM 4**

**PROJECT BUDGET AND EXPENDITURES**

**BY TYPES OF SERVICES**\*

**FY \_\_\_\_\_ FY \_\_\_\_\_**

**[TYPES OF SERVICES]{.underline} [Budgeted]{.underline}
[Expended]{.underline} [Budgeted]{.underline} [Expended]{.underline}**

**I. [Direct Health Care Services]{.underline}** \$ \$ \$ \$
[\_\_\_\_\_\_\_\_\_]{.underline}

> (Basic Health Services and Health
>
> Services for CSHCN.)

**II. [Enabling Services]{.underline}** \$ \$ \$ \$
[\_\_\_\_\_\_\_]{.underline}

> (Transportation, Translation,

Outreach, Respite Care, Health

> Education, Family Support Services,

Purchase of Health Insurance,

> Case Management, and Coordination
>
> with Medicaid, WIC, and Education.)

**III.** **[Population-Based Services]{.underline}** \$ \$ \$ \$
[\_\_\_\_\_\_\_]{.underline}

> (Newborn Screening, Lead Screening,
>
> Immunization, Sudden Infant Death
>
> Syndrome Counseling, Oral Health,
>
> Injury Prevention, Nutrition, and

Outreach/Public Education.)

**IV.** **[Infrastructure Building Services]{.underline}** \$ \$ \$ \$
[**\_\_\_\_\_\_\_**]{.underline}

> (Needs Assessment, Evaluation, Planning,
>
> Policy Development, Coordination,
>
> Quality Assurance, Standards Development,
>
> Monitoring, Training, Applied Research,

Systems of Care, and Information Systems.)

**V. TOTAL \$ \$ \$ \$ [\_\_ \_\_\_\_ ]{.underline}**

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

> **INSTRUCTIONS FOR THE COMPLETION OF FORM 4**

**PROJECT BUDGET AND EXPENDITURES BY TYPES OF SERVICE**S

Complete all required data cells. If an actual number is not available,
make an estimate. Please explain all estimates in a footnote.
Administrative dollars should be allocated to the appropriate level(s)
of the pyramid on lines I, II, II or IV. If an estimate of
administrative funds use is necessary, one method would be to allocate
those dollars to Lines I, II, III and IV at the same percentage as
program dollars are allocated to Lines I through IV.

Note: Lines I, II and II are for projects providing services. If grant
funds are used to build the infrastructure for direct care delivery,
enabling or population-based services, these amounts should be reported
in Line IV (i.e., building data collection capacity for newborn hearing
screening).

Line I [Direct Health Care Services]{.underline} - enter the budgeted
and expended amounts for the appropriate fiscal year completed and
budget estimates only for all other years.

> **Direct Health Care Services** are those services generally delivered
> one-on-one between a health professional and a patient in an office,
> clinic or emergency room which may include primary care physicians,
> registered dietitians, public health or visiting nurses, nurses
> certified for obstetric and pediatric primary care, medical social
> workers, nutritionists, dentists, sub-specialty physicians who serve
> children with special health care needs, audiologists, occupational
> therapists, physical therapists, speech and language therapists,
> specialty registered dietitians. Basic services include what most
> consider ordinary medical care, inpatient and outpatient medical
> services, allied health services, drugs, laboratory testing, x-ray
> services, dental care, and pharmaceutical products and services. State
> Title V programs support - by directly operating programs or by
> funding local providers - services such as prenatal care, child health
> including immunizations and treatment or referrals, school health and
> family planning. For CSHCN, these services include specialty and
> sub-specialty care for those with HIV/AIDS, hemophilia, birth defects,
> chronic illness, and other conditions requiring sophisticated
> technology, access to highly trained specialists, or an array of
> services not generally available in most communities.

Line II [Enabling Services]{.underline} - enter the budgeted and
expended amounts for the appropriate fiscal year completed and budget
estimates only for all other years.

> **Enabling Services** allow or provide for access to and the
> derivation of benefits from, the array of basic health care services
> and include such things as transportation, translation services,
> outreach, respite care, health education, family support services,
> purchase of health insurance, case management, coordination of with
> Medicaid, WIC and educations. These services are especially required
> for the low income, disadvantaged, geographically or culturally
> isolated, and those with special and complicated health needs. For
> many of these individuals, the enabling services are essential - for
> without them access is not possible. Enabling services most commonly
> provided by agencies for CSHCN include transportation, care
> coordination, translation services, home visiting, and family
> outreach. Family support activities include parent support groups,
> family training workshops, advocacy, nutrition and social work.

Line III [Population-Based Services]{.underline} - enter the budgeted
and expended amounts for the appropriate fiscal year completed and
budget estimates only for all other years.

> **Population Based Services** are preventive interventions and
> personal health services, developed and available for the entire MCH
> population of the State rather than for individuals in a one-on-one
> situation. Disease prevention, health promotion, and statewide
> outreach are major components. Common among these services are newborn
> screening, lead screening, immunization, Sudden Infant Death Syndrome
> counseling, oral health, injury prevention, nutrition and
> outreach/public education. These services are
>
> generally available whether the mother or child receives care in the
> private or public system, in a rural clinic or an HMO, and whether
> insured or not.

Line IV [Infrastructure Building Services]{.underline} - enter the
budgeted and expended amounts for the appropriate fiscal year completed
and budget estimates only for all other years.

> **Infrastructure Building Services** are the base of the MCH pyramid
> of health services and form its foundation. They are activities
> directed at improving and maintaining the health status of all women
> and children by providing support for development and maintenance of
> comprehensive health services systems and resources including
> development and maintenance of health services standards/guidelines,
> training, data and planning systems. Examples include needs
> assessment, evaluation, planning, policy development, coordination,
> quality assurance, standards development, monitoring, training,
> applied research, information systems and systems of care. In the
> development of systems of care it should be assured that the systems
> are family centered, community based and culturally competent.

Line V [Total]{.underline} -- enter the total amounts for each column,
budgeted for each year and expended for each year completed.

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

> **FORM 6**

**MATERNAL & CHILD HEALTH DISCRETIONARY GRANT**

**PROJECT ABSTRACT**

**FOR FY 2006**

**PROJECT:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**I. PROJECT IDENTIFIER INFORMATION**

1\. Project Title:

2\. Project Number:

3\. E-mail address:

**II. BUDGET**

1\. MCHB Grant Award \$\_\_\_\_\_\_\_\_\_\_\_\_\_

(Line 1, Form 2)

2\. Unobligated Balance \$\_\_\_\_\_\_\_\_\_\_\_\_\_

(Line 2, Form 2)

3\. Matching Funds (if applicable) \$\_\_\_\_\_\_\_\_\_\_\_\_\_

> (Line 3, Form 2)

4\. Other Project Funds \$\_\_\_\_\_\_\_\_\_\_\_\_\_

> (Line 4, Form 2)

5\. Total Project Funds \$\_\_\_\_\_\_\_\_\_\_\_\_\_

> (Line 5, Form 2)

#### III. TYPE(S) OF SERVICE PROVIDED (Choose all that apply)

\[ \] Direct Health Care Services

> \[ \] Enabling Services
>
> \[ \] Population-Based Services
>
> \[ \] Infrastructure Building Services

##### PROJECT DESCRIPTION OR EXPERIENCE TO DATE

> A. Project Description

1.  Problem (in 50 words, maximum):

2.  Goals and Objectives: (List up to 5 major goals and time-framed
    objectives per goal for the project)

> Goal 1:

Objective 1:

Objective 2:

Goal 2:

Objective 1:

Objective 2:

Goal 3:

Objective 1:

Objective 2:

**Attachment 1 (cont)**

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

> **FORM 6 (cont)**

**MATERNAL & CHILD HEALTH DISCRETIONARY GRANT**

**PROJECT ABSTRACT**

**FOR FY 2006**

Goal 4:

Objective 1:

Objective 2:

Goal 5:

Objective 1:

Objective 2:

3.  Activities undertaken to meet project goals

4.  Specify the primary *Healthy People 2010* objectives(s) (up to
    three) which this project addresses:

> a\.
>
> b\.
>
> c\.

5\. Coordination (List the State, local health agencies or other
organizations involved in the project and their roles)

6\. Evaluation (briefly describe the methods which will be used to
determine whether process and outcome objectives are met)

B. Continuing Grants ONLY

##### Experience to Date (For continuing projects ONLY):

***2. Website URL and annual number of hits***

**V. KEYWORDS**

**VI. ANNOTATION**

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

> **INSTRUCTIONS FOR THE COMPLETION OF FORM 6**
>
> **PROJECT ABSTRACT**

**NOTE:** All information provided should fit into the space provided in
the form. The completed form should be no more than 3 pages in length.
Where information has previously been entered in forms 1 through 5, the
information will automatically be transferred electronically to the
appropriate place on this form.

**Section I -- Project Identifier Information**

Project Title: List the appropriate shortened title for the project.

> Project Number: This is the number assigned to the project when
> funded, and will, for new projects, be
>
> filled in later.

E-mail address: Include electronic mail addresses.

**Section II -- Budget**

> These figures will be transferred from Form 1, Lines 1 through 5.

**Section III - Types of Services**

> Indicate which type(s) of services your project provides, checking all
> that apply (consistent with Form 5). Form 5 is not applicable to
> *Integrated Health and Behavioral Health Care for Children,
> Adolescents and Their Families Grant Program: Implementation*.

#### Section IV -- Program Description OR Current Status (DO NOT EXCEED THE SPACE PROVIDED)

A. NEW PROJECTS are to complete the following items:

1.  A brief description of the project and the problem it addresses such
    as preventive and primary care services for pregnant women, mothers,
    and infants; preventive and primary care services for children; and
    services for Children with Special Health Care Needs.

2.  A statement of the project goals (maximum of five) in priority
    order. Examples are: To reduce the barriers to the delivery of care
    for pregnant women; and to reduce the infant mortality rate for
    minorities. On an annual basis, MCHB will capture each project's top
    goals in an information system for comparison, tracking, and
    reporting purposes; you must list at least 1 and no more than 5
    goals. For each goal, list the two most important objectives. The
    objectives must be specific (e.g., decrease incidence by 10%) and
    time limited (by 2006).

3.  A list of the primary Healthy People 2010 goal(s) that the project
    addresses.

4.  A description of the programs and activities used to attain the
    goals and objectives, and commentary on the innovation, cost, and
    other characteristics of the proposed methodology. Lists with
    numbered items can be used in this section.

5.  A description of the coordination planned and carried out, if
    applicable, with State and/or local health and other public sector
    agencies and private sector organizations in areas(s) served by the
    project.

6.  A brief description of the evaluation methods that will be used to
    assess the success of the project in attaining its goals and
    objectives.

    B.  CONTINUING PROJECTS are to complete the following items:

    ```{=html}
    <!-- -->
    ```
    1.  A brief description of the major activities and accomplishments
        over the past year (not to exceed 200 words).

    2.  Website address (URL) and number of hits annually, if
        applicable.

**Section V - Key Words**

Key words describe the project, including populations served. A standard
master list will be made available to funded projects, which will be
asked to choose key words from the list.

**Section VI -- Annotation**

> Provide a three- to five-sentence description of your project that
> identifies the project's purpose; the needs and problems that are
> addressed; the goals and objectives of the project; the activities
> that will be used to attain the goals; and the materials that will be
> developed.

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

**FORM 7**

**DISCRETIONARY GRANT PROJECT**

**SUMMARY DATA**

1.  **Project Service Focus**

> \[ \] Urban/Central City \[ \] Suburban \[ \] Metropolitan Area (city
> & suburbs)
>
> \[ \] Rural \[ \] Frontier \[ \] Border (US-Mexico)

2.  **Project Scope**

> \[ \] Local \[ \] Multi-county \[ \] State-wide
>
> \[ \] Regional \[ \] National

3.  **Grantee Organization Type**

> \[ \] State Agency

\[ \] Community Government Agency

\[ \] School District

\[ \] University/Institution Of Higher Learning (Non-Hospital Based)

\[ \] Academic Medical Center

\[ \] Community-Based Non-Governmental Organization (Health Care)

\[ \] Community-Based Non-Governmental Organization (Non-Health Care)

\[ \] Professional Membership Organization (Individuals Constitute Its
Membership)

\[ \] National Organization (Other Organizations Constitute Its
Membership)

\[ \] National Organization (Non-Membership Based)

\[ \] Independent Research/Planning/Policy Organization

\[ \] Other
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

4.  **Project Infrastructure Focus** (from MCH Pyramid) if applicable

\[ \] Guidelines/Standards Development And Maintenance

\[ \] Policies And Programs Study And Analysis

\[ \] Synthesis Of Data And Information

\[ \] Translation Of Data And Information For Different Audiences

\[ \] Dissemination Of Information And Resources

\[ \] Quality Assurance

\[ \] Technical Assistance

\[ \] Training

\[ \] Systems Development

\[ \] Other

**5. Products and Dissemination**

  -------------------------------------------------------- --------------
  PRODUCTS                                                 NUMBER

  Peer reviewed Journal Article                            

  Book/Chapter                                             

  Report/Monograph                                         

  Presentation                                             

  Doctoral Dissertation                                    

  Other:                                                   
  -------------------------------------------------------- --------------

**6. Demographic Characteristics of Project Participants for Clinical
Services Projects**

+-----------+--------+------+--------+--------+-------+-------+-----+---+
|           | **RACE |      |        |        |       | **E   |     |   |
|           | (In    |      |        |        |       | THNIC |     |   |
|           | dicate |      |        |        |       | ITY** |     |   |
|           | all    |      |        |        |       |       |     |   |
|           | that   |      |        |        |       |       |     |   |
|           | ap     |      |        |        |       |       |     |   |
|           | ply)** |      |        |        |       |       |     |   |
+===========+========+======+========+========+=======+=======+=====+===+
|           | Am     | A    | Black  | Native | White | His   | Not |   |
|           | erican | sian | or     | Ha     |       | panic | Hi  |   |
|           | Indian |      | A      | waiian |       | or    | spa |   |
|           | or     |      | frican | or     |       | L     | nic |   |
|           | Alaska |      | Am     | Other  |       | atino |     |   |
|           | Native |      | erican | P      |       |       | or  |   |
|           |        |      |        | acific |       |       | Lat |   |
|           |        |      |        | Is     |       |       | ino |   |
|           |        |      |        | lander |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Pregnant  |        |      |        |        |       |       |     |   |
| Women     |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Children  |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Children  |        |      |        |        |       |       |     |   |
| with      |        |      |        |        |       |       |     |   |
| Special   |        |      |        |        |       |       |     |   |
| Health    |        |      |        |        |       |       |     |   |
| Care      |        |      |        |        |       |       |     |   |
| Needs     |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Women     |        |      |        |        |       |       |     |   |
|           |        |      |        |        |       |       |     |   |
| (Not      |        |      |        |        |       |       |     |   |
| Pregnant) |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| Other     |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+
| TOTALS    |        |      |        |        |       |       |     |   |
+-----------+--------+------+--------+--------+-------+-------+-----+---+

######### **Clients' Primary Language(s)**

######### \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

######### **Resource/TA and Training Centers ONLY**

######### **Answer all that apply.**

a.  Characteristics of Primary Intended Audience(s)

> \[ \] Policy Makers/Public Servants
>
> \[ \] Consumers

\[ \] Providers/Professionals

b\. Number of Requests Received/Answered: \_\_\_/\_\_\_\_

c.  Number of Continuing Education credits provided: \_\_\_\_\_\_\_

d.  Number of Individuals/Participants Reached: \_\_\_\_\_\_\_

e.  Number of Organizations Assisted: \_\_\_\_\_\_\_

f.  Major Type of TA or Training Provided:

> \[ \] continuing education courses,

\[ \] workshops,

\[ \] on-site assistance,

\[ \] distance learning classes

\[ \] other

**Attachment 1 (cont)**

**OMB \# 0915-0272**

**Expiration date:  January 31, 2006**

**INSTRUCTIONS FOR THE COMPLETION OF FORM 7**

**PROJECT SUMMARY**

**NOTE:** All information provided should fit into the space provided in
the form. Where information has previously been entered in forms 2
through 9, the information will automatically be transferred
electronically to the appropriate place on this form.

**Section 1 -- Project Service Focus**

> Select all that apply

**Section 2 -- Project Scope**

> Choose the one that best applies to your project.

**Section 3 -- Grantee Organization Type**

> Choose the one that best applies to your organization.

**Section 4 -- Project Infrastructure Focus**

> If applicable, choose all that apply.

**Section 5 -- Products and Dissemination**

> Indicate the number of each type of product resulting from the
> project.

**Section 6 -- Demographic Characteristics of Project Participants (for
Clinical Services Projects)**

> Please fill in each of the cells as appropriate.

**Section 7 -- Clients Primary Language(s) (for Clinical Services
Projects)**

> Indicate which languages your clients speak as their primary language,
> other than English. List up to three.

**Section 8 -- Resource/TA and Training Centers (Only)**

> Answer all that apply.

**ADDENDUM**

**APPLYING THROUGH GRANTS.GOV**

**Prepare to Apply through Grants.gov:**

HRSA, in providing the grant community a single site to Find and Apply
for grant funding opportunities, is [requiring]{.underline} applicants
for this funding opportunity to apply electronically through Grants.gov.
By using Grants.gov you will be able to download a copy of the
application package, complete it off-line, and then upload and submit
the application via the Grants.gov site. You may [no]{.underline}t
e-mail an electronic copy of a grant application to us.

Please understand that we will not consider additional information
and/or materials submitted after your initial application. You must
therefore ensure that all materials are submitted together.

**Note: Except in rare cases, paper applications will NOT be accepted
for this grant opportunity. If you believe you are technologically
unable to submit an on-line application you MUST contact the Director of
the Division of Grants Policy, at <DGPClearances@hrsa.gov> and explain
why you are technologically unable to submit on-line. . Make sure you
specify the announcement number you are requesting relief for. HRSA and
its Grants Application Center (GAC) will only accept paper applications
from applicants that received prior written approval.**

In order to apply through Grants.gov the Applicant must register with
Grants.gov. This is a three step process that must be completed by any
organization wishing to apply for a grant opportunity. The registration
process will require some time. Therefore, applicants or those
considering applying at some point in the future should register
**[immediately]{.underline}**. Registration in Grants.gov does not
require the organization to apply for a grant; it simply provides the
organization the required credentials so that the organization may apply
for a grant in the future. Registration is required only once.

**Get started now and complete the one-time registration process to
begin submitting grant applications as soon as you read this.**

You don't need to be registered to search or to begin selecting,
downloading and completing grant applications. Registration is required
to submit applications. Therefore, it is essential that your
organization be registered prior to attempting to submit a grant
application or your organization will not be able to do so. **Be sure to
complete the process early as the registration process may take some
time (anywhere from 5 days to 1 month)**.

**There are three steps to the registration process:**

**Step 1:** Register your organization

**Step 2:** Register yourself as an Authorized Organization
Representative

**Step 3:** Get authorized by your organization to submit grants

These instructions will walk you through the three basic registration
steps. Additional assistance is available at Grants.gov at
[www.grants.gov](http://www.grants.gov/). Individual assistance is
available at <http://www.grants.gov/Support> or 1-800-447-8477.
Grants.gov also provides a variety of support options through online
Help including Context-Sensitive Help, Online Tutorials, FAQs, Training
Demonstration, User Guide, and Quick Reference Guides.

Follow this checklist to complete your registration---

1\. Register Your Organization

\- Obtain your organization's Data Universal Number System (DUNS) number

\- Register your organization with Central Contractor Registry (CCR)

\- Identify your organization's E-Business POC (Point of Contact)

\- Confirm your organization's CCR "Marketing Partner ID Number (M-PIN)"
password

2\. Register Yourself as an Authorized Organization Representative (AOR)

\- Obtain your username and password

\- Register your username and password with Grants.gov

3\. Get Yourself Authorized as an AOR

\- Contact your E-Business POC to ensure your AOR status

\- Log in to Grants.gov to check your AOR status

The Grants.gov/Apply feature includes a simple, unified application
process to enable applicants to apply for grants online. The information
applicants need to understand and execute the steps is at
[http://www.grants.gov/GetStarted](../www.grants.gov/GetStarted).
Applicants should read the Get Started steps carefully. The site also
contains registration checklists to help you walk through the process.
HRSA recommends that you download the checklists and prepare the
information requested before beginning the registration process.
Reviewing information required and assembling it before beginning the
registration process will save you time and make the process faster and
smoother.

**REGISTER YOUR ORGANIZATION**

Before you can apply for a grant via Grants.gov, your organization must
obtain a Data Universal Number System (DUNS) number and register early
with the Central Contractor Registry (CCR).

**Obtain your organization's DUNS number**

A DUNS number is a unique number that identifies an organization. It has
been adopted by the Federal government to help track how Federal grant
money is distributed. Ask your grant administrator or chief financial
officer to provide your organization's DUNS number.

***-How do you do it?*** If your organization does not have a DUNS
number, call the special Dun & Bradstreet hotline at 1-866-705-5711 to
receive one free of charge.

***- How long will this take?*** You will receive a DUNS number at the
conclusion of the phone call.

**Register your organization with CCR**

The CCR is the central government repository for organizations working
with the Federal government. Check to see if your organization is
already registered at the CCR website. If your organization is not
already registered, identify the primary contact who should register
your organization.

When your organization registers with CCR, it will be required to
designate an E-Business Point of Contact (E-Business POC). The designee
authorizes individuals to submit grant applications on behalf of the
organization and creates a special password called a Marketing Partner
ID Number (M-PIN) to verify individuals authorized to submit grant
applications for the organization.

**-*How do you do it? ***Visit the CCR website at
[http://www.ccr.gov](http://www.ccr.gov/). Check whether your
organization is already registered or register your organization right
online. Be certain to enter an MPIN number during this process as this
is an optional field for the CCR registration but
[mandatory]{.underline} for Grants.gov.

***- How long will this take?*** It may take a few days for you to
collect the information needed for your organization's registration, but
once you finish the registration process, you can move on to Step 2 the
very next business day. Note it will take up to a month for the total
registration- therefore this should be done as soon as possible.

**GET AUTHORIZED as an AOR by Your Organization**

The registration process is almost complete. All that remains is the
final step ---getting authorized. Even though you have registered, your
E-Business POC must authorize you so Grants.gov will know that you are
verified to submit applications.

**- Obtain your E-Business POC authorization**

After your Authorized Organizational Representative (AOR) profile is
completed, your organization's E-Business POC will receive an email
regarding your requested AOR registration, with links and instructions
to authorize you as an AOR.

***- How do you do it?*** Instruct your E-Business POC to login to
Grants.gov at http://www.grants.gov/ForEbiz and enter your
organization's DUNS number and M-PIN. They will select you as an AOR
they wish to authorize and you will be verified to submit grant
applications.

***- How long will this take?*** It depends on how long it takes your
E-Business POC to log in and authorize your AOR status. You can check
your AOR status by logging in to Grants.gov at
http://www.grants.gov/ForApplicants.

**REGISTER YOURSELF as an Authorized Organization Representative (AOR)**

Once the CCR Registration is complete, your organization is finished
registering. You must now register yourself with Grants.gov and
establish yourself as an AOR, an individual authorized to submit grant
applications on behalf of your organization. There are two elements
required to complete this step --- both must be completed to move onto
Step 3.

**1. Obtain your username and password**

In order to safeguard the security of your electronic information, and
to submit a Federal grant application via Grants.gov, you must first
obtain a username and password from the Grants.gov Credential Provider.

***- How do you do it?*** Just register with Grants.gov's Credential
Provider at http://www.grants.gov/Register1. You will need to enter your
organization's DUNS number to access the registration form. Once you
complete the registration form you will be given your username and you
will create your own password.

***- How long will this take?*** Same day. When you submit your
information you will receive your username and be able to create your
password.

2\. **Register with Grants.gov**

Now that you have your username and password, allow about 30 minutes for
your data to transfer from the Credential Provider, then you must
register with Grants.gov to set up a short profile.

**\> *How do you do it? ***Simply visit http://www.grants.gov/Register2
to register your username and password and set up your profile.
Remember, you will only be authorized for the DUNS number which you
register in your Grants.gov profile.

**\> *How long will this take? ***Same day. Your AOR profile will be
complete after you finish filling in the profile information and save
the information at Grants.gov.

You have now completed the registration process for Grants.gov. If you
are applying for a [new or competing continuation]{.underline} you may
find the application package through Grants.gov FIND. If you are filling
out a [non-competing continuation]{.underline} application you
[must]{.underline} obtain the announcement number through your program
office, and enter this announcement number in the search field to pull
up the application form and related program guidance. Download the
required forms and enter your current grant number in the appropriate
field to begin the non-competing continuation application which you will
then upload for electronic submittal through Grants.gov. For
continuation applications which require submittal of performance
measures electronically, instructions are provided in the program
guidance on how to enter the HRSA electronic handbooks to provide this
information.

**How to submit an electronic application to HRSA via Grants.gov/Apply**

[a. Applying using Grants.gov.]{.underline} Grants.gov has a full set of
instructions on how to apply for funds on its website at
<http://www.grants.gov/CompleteApplication>. The following provides
simple guidance on what you will find on the Grants.gov/Apply site.
Applicants are encouraged to read through the page entitled, "Complete
Application Package" before getting started. Grants.gov allows
applicants to download the application package, instructions and forms
that are incorporated in the instructions, and work off line. In
addition to forms that are part of the application instructions, there
will be a series of electronic forms that are provided utilizing a
PureEdge reader. The PureEdge Reader is available free for download from
the Grants.gov/Get Started site. The PureEdge Reader allows applicants
to read the electronic files in a form format so that they will look
like any other Standard or HRSA form. The PureEdge forms have content
sensitive help. To use this feature you will need to click on the icon
at the top of the page that features an arrow with a question mark. This
engages the content sensitive help for each field you will need to
complete on the electronic form. The PureEdge forms can be downloaded
and saved on your hard drive, network drive(s), or CDs.

MacIntosh Users will need to use the Virtual PC emulator software, which
allows PC software to run on MacIntosh platforms.

[b. Mandatory Fields on PureEdge Forms.]{.underline} In the PureEdge
forms you will note fields that will appear with a yellow background
color on the data fields to be completed. These fields are mandatory
fields and they **must** be completed to successfully submit your
application.

[c. Completion of SF-424 Fields First.]{.underline} The PureEdge forms
are designed to fill in common required fields such as the applicant
name and address, DUNS number, etc., on all PureEdge electronic forms.
**To trigger this feature, an applicant must complete the SF-424
information first.** Once it is completed the information will transfer
to the other forms.

[d. Customer Support.]{.underline} The grants.gov website provides
customer support via (800) 518-GRANTS (this is a toll-free number) or
through e-mail at <support@grants.gov>. The customer support center is
open from 7:00 a.m. to 9:00 p.m. Eastern time, Monday through Friday,
except federal holidays, to address grants.gov technology issues. For
technical assistance to program related questions, contact the number
listed in the Program Section of the program you are applying for.

**Timely Receipt Requirements and Proof of Timely Submission**

a\. Electronic [Submission.]{.underline} All applications must be
received by [www.grants.gov/Apply](http://www.grants.gov/Apply) **by
5:00 P.M. Eastern Time** on the due date established for each program.

Proof of timely submission is automatically recorded by Grants.gov. An
electronic time stamp is generated within the system when the
application is successfully received by Grants.gov. The applicant will
receive an acknowledgement of receipt and a tracking number from
Grants.gov with the successful transmission of their application.
Applicants should print this receipt and save it, along with facsimile
receipts for information provided by facsimile, as proof of timely
submission. When HRSA successfully retrieves the application from
Grants.gov, Grants.gov will provide an electronic acknowledgment of
receipt to the e-mail address of the AOR. Proof of timely submission
shall be the date and time that Grants.gov receives your application.

Applications received by grants.gov, after the established due date and
time for the program, will be considered late and will not be considered
for funding by HRSA. [HRSA suggests that applicants submit their
applications during the operating hours of the Grants.gov Support Desk,
so that if there are questions concerning transmission, operators will
be available to walk you through the process.]{.underline} Submitting
your application during the Support Desk hours will also ensure that you
have sufficient time for the application to complete its transmission
prior to the application deadline. Applicants using dial-up connections
should be aware that transmission should take some time before
Grants.gov receives it. Grants.gov will provide either an error or a
successfully received transmission message. The Grants.gov Support desk
reports that some applicants abort the transmission because they think
that nothing is occurring during the transmission process. Please be
patient and give the system time to process the application. Uploading
and transmitting many files, particularly electronic forms with
associated XML schemas, will take some time to be processed.

Note the following additional information regarding submission of all
HRSA applications through Grants.gov:

• You must submit all documents electronically, including all
information typically included on the SF424 and all necessary assurances
and certifications.

• Your application must comply with any page limitation requirements
described in this program announcement.

• After you electronically submit your application, you will receive an
automatic acknowledgement from Grants.gov that contains a Grants.gov
tracking number. HRSA will retrieve your application from Grants.gov.

Online applications are required to submit ONLY one form in signed hard
copy: the SF-424/5161 Face Sheet, since all other elements of the
application have been captured and transmitted electronically. This face
page should be sent to HRSA's Grants Application Center at:

The HRSA Grants Application Center

> The Legin Group, Inc.
>
> Attn: Integrated Health and Behavioral Health Care for Children,
> Adolescents and their Families Grant Program: Implementation
>
> Program Announcement No. HRSA-06-090
>
> CFDA No. 93.110
>
> 901 Russell Avenue, Suite 450
>
> Gaithersburg, MD 20879
>
> Telephone: 877-477-2123

**Formal Submission of the Electronic Application**

Applications completed online are considered formally submitted when the
Authorizing Official electronically submits the application to HRSA
through Grants.gov. However, to complete the submission requirements, a
hard-copy of the SF-424/5161 Face Sheet must be printed, signed, and
submitted to the HRSA Grants Application Center. The SF-424/5161 can be
printed from the online application.

For an online application, the signed SF-424/5161 must be sent to the
HRSA GRANTS APPLICATION CENTER at the above address and received by HRSA
by no later than five days after the due date.

Applications will be considered as having met the deadline if: (1) the
application has been successfully transmitted electronically by your
organization's Authorizing Official through Grants.gov on or before the
deadline date and time, and (2) the signed SF-424/5161 Face Sheet is
received by HRSA no later than five days after the deadline date.

**Performance Measures for Competitive Applications**

Many HRSA guidances include specific data forms and require performance
measure reporting. If the completion of performance measure information
is indicated in this guidance, successful applicants receiving grant
funds will be required, within **120 days** of the Notice of Grant Award
(NGA), to register in HRSA's Electronic Handbooks (EHBs) and
electronically complete the program specific data forms that appear in
Attachment 1 of this guidance. This requires the provision of budget
breakdowns in the financial forms based on the grant award amount, the
project abstract and other grant summary data, and objectives for the
performance measures.

**Performance Measures for Non-Competing Continuation Applications**

For applications which require submittal of performance measures
electronically through the completion of program specific data forms,
instructions will be provided both in the program guidance and through
an e-mail, notifying grantees of their responsibility to provide this
information, and providing instructions on how to do so.