18934 Federal Register / Vol. 60, No. 71 / Thursday, April 13, 1995 / Notices

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Public Health Service

Office of the Assistant Secretary for

Health; Notice on Availability of Funds

and Request for Applications for

Bilingual/Bicultural Service

Demonstration Projects in Minority

Health

AGENCY: Office of Minority Health,

Office of the Assistant Secretary for

Health.

ACTION: Notice of availability of funds

and request for applications for

bilingual/bicultural service

demonstration projects in minority

health.

AUTHORITY: This program is authorized

under section 1707(d)(1) of the Public

Health Service Act, as amended in

Public Law 101–527.

PURPOSE: To provide support to improve

the ability of health care providers and

other health care professionals to

deliver linguistically and culturally

competent health services to limitedEnglish-proficient populations.

APPLICANT ELIGIBILITY: Eligible applicants

are public and private nonprofit

minority community-based

organizations or health care facilities

serving a targeted minority community.

ADDRESSES/CONTACTS: Applications

must be prepared on Form PHS 5161–

1 (Revised July 1992 and approved by

OMB under Control Number 0937–

0189). Application kits and technical

assistance on budget and business

aspects of the application may be

obtained from Ms. Carolyn A. Williams,

Grants Management Officer, Office of

Minority Health, Rockwall II Building,

Suite 1000, 5515 Security Lane,

Rockville, MD 20852, (telephone 301/

594–0758) or by Internet E-mail

cwilliams@oash.ssw.dhhs.gov.

Completed applications are to be

submitted to the same address.

Technical assistance on the

programmatic content for the Bilingual/

Bicultural Grants may be obtained from

Ms. Nina Darling or Ms. Rizalina

Galicinao. They can be reached at the

Office of Minority Health, Rockwall II

Building, Suite 1000, 5515 Security

Lane, Rockville, MD 20852, (telephone

301/594–0769) or by Internet E-mail

ndarling@oash.ssw.dhhs.gov or

rgalicin@oash.ssw.dhhs.gov.

In addition, OMH Regional Minority

Health Consultants (RMHCs) are

available to provide technical

assistance. A listing of the RMHCs and

how they may be contacted is provided

in the grant application kit. Applicants

also can contact the OMH Resource

Center (OMH/RC) at 1–800–444–6472

for health information and generic

information on preparing grant

applications.

DEADLINE: To receive consideration,

grant applications must be received by

the Grants Management Office by May

15, 1995. Applications will be

considered as meeting the deadline if

they are either:

(1) Received at the above address on

or before the deadline date, or

(2) Sent to the above address on or

before the deadline date and received in

time for orderly processing. Applicants

should request a legibly dated U.S.

Postal Service postmark or obtain a

legibly dated receipt from a commercial

carrier or U.S. Postal Service. Private

metered postmarks shall not be

acceptable as proof of timely mailing.

Applications submitted by facsimile

transmission (FAX) will not be

accepted. Applications which do not

meet the deadline will be considered

late and will be returned to the

applicant unread.

AVAILABILITY OF FUNDS: It is anticipated

that in Fiscal Year 1995, the Office of

Minority Health will have

approximately $1.3 million available to

support approximately 13 grants of up

to $100,000 each under this program. At

least three grants focusing on HIV/AIDS

as a health problem will be funded

under this announcement.

PERIOD OF SUPPORT: Support may be

requested for a total project period not

to exceed 3 years. Non competing

continuation awards will be made

subject to satisfactory performance and

availability of funds.

BACKGROUND: The Office of Minority

Health is the unit of the U.S.

Department of Health and Human

Services that coordinates Federal efforts

to improve the health status of racial

and ethnic minority populations,

including American Indians, Alaska

Natives, Asian Americans, Pacific

Islanders, African Americans and

Hispanics/Latinos. With the passage of

the Disadvantaged Minority Health

Improvement Act (Pub. L. 101–527), the

OMH was established in legislation and

given a broad mandate to advance

efforts to improve minority health

including supporting research,

demonstrations and evaluations of new

and innovative programs that increase

understanding of disease risk factors

and support improvement in

information dissemination, education,

prevention and service delivery to

minority communities. The OMH was

also directed to develop appropriate

planning, logistical support, and

technical assistance related to

increasing the capabilities of health care

providers and other health care

professionals to address cultural and

linguistic barriers to effective health

care service delivery, and to increase

access to effective health care for

limited-English-proficient minority

populations [Pub. L. 101–527, section

1707(b)(7)].

Social, cultural and linguistic barriers

on the part of both providers and clients

significantly affect the receipt of needed

health care. Among the many factors

contributing to the poor health status of

limited-English-proficient minorities

are:

• Inadequate number of health care

providers and other health care

professionals skilled in culturally

competent and linguistically

appropriate delivery of services;

• Scarcity of trained interpreters at

the community level;

• Deficiency of knowledge about

appropriate mechanisms to address

language barriers in health care settings;

• A lack of culturally appropriate

community health prevention programs;

• Absence of effective partnerships

between major mainstream provider

organizations and limited-Englishproficient minority communities;

• Low economic status;

• Lack of health insurance; and

• Organizational barriers.

This RFA specifically addresses the

barriers that limited-English-proficient

minority populations face when trying

to access health services.

In the 1990 U.S. Census, language

questions asked were (1) Whether

respondents speak another language at

home, (2) how well they speak English

(for those who answered yes to the first

question), and (3) which language they

speak at home. The census data

indicates that 31.8 million persons ages

5 and above (13.8 percent of the total

U.S. population counted by the 1990

census) spoke another language at

home. Of those, 17.9 million people

reported that they speak English very

well. Almost 2 million people (1.8

million) do not speak English at all. An

additional 4.8 million people do not

speak English well.

Large numbers of minorities in the

United States are linguistically

isolated—living in households in which

no one 14 years old or over speaks

English and no one who speaks a

language other than English speaks

English ‘‘very well.’’ The 1990 Census

found 1,572,006 Asian and Pacific

Islanders at least 5 years of age to be

linguistically isolated. The percent of

Asian and Pacific Islanders who are

linguistically isolated varies by
Federal Register / Vol. 60, No. 71 / Thursday, April 13, 1995 / Notices 18935

subgroup—ranging from 9.7% among

Filipinos to 59.8% among Hmong.

Among Pacific Islanders, Tongans had

the highest proportion of persons who

were linguistically isolated (18.7%).

More than four million Hispanics are

linguistically isolated (4,548,677 or

23.8%). Central Americans (40.3%) and

Dominicans (39.6%) are the most likely

to be linguistically isolated. Among

Blacks, 282,147 (0.9%) are linguistically

isolated. Among American Indians,

Alaska Natives, 77,802 (4%) are

linguistically isolated.

Definitions

For purposes of this grant

announcement, the following

definitions are provided:

(1) Minority Populations—As defined

by the Office of Management and

Budget (OMB) Circular No. 15, include:

Asisan/Pacific Islanders, Blacks,

Hispanics, and American Indian/Alaska

Native.

(2) Limited-English-Proficient

Populations—individuals, as defined

above (1), with a primary language other

than English who must communicate in

that language if the individual is to have

an equal opportunity to participate

effectively in and benefit from any aid,

service or benefit provided by the health

provider.

(3) Minority Community-Based

Organization—a public or private nonprofit community-based minority

organization or a local affiliate of a

national minority organization that has

a governing board composed of 51% or

more racial/ethnic minority members,

has a significant number of minorities in

key program positions, has an

established record of service to a racial

and ethnic minority community.

(4) Health Care Facilities—for purpose

of this announcement, a health care

facility is a public nonprofit facility that

has an established record for providing

a full range of health care services to a

targeted racial and ethnic minority

community. Facilities providing only

screening and referral activities are not

included in this definition. A health

care facility may be a hospital,

outpatient medical facility, community

health center, migrant health care

center, or a mental health center.

(5) Community—a defined

geographical area in which persons live,

work, and recreate, characterized by: (a)

formal and informal communication

channels; (b) formal and informal

leadership structures for the purpose of

maintaining order and improving

conditions; and (c) its capacity to serve

as a focal point for addressing societal

needs, including health needs. A

community should be an appropriate

catchment area in which to address a

population’s social and health needs.

(6) Bilingual Direct Services—any

activity that delivers person to person

health care/health promotion services

which is linguistically and culturally

appropriate to limited-Englishproficient clientele, including, for

example, translation and interpreter

services and health education course

taught bilingually.

(7) Cultural Competency—a set of

interpersonal skills that allow

individuals to increase their

understanding and appreciation of

cultural differences and similarities

within, among, and between groups.

This requires a willingness and ability

to draw on community-based values,

traditions, and customs and to work

with knowledgeable persons of and

from the community in developing

focused interventions, communications,

and other supports. (Orlandi, Mario A.,

1992)

Potential Projects/Activities

A broad range of approaches may be

used to respond to this proposal.

However, the projects should

concentrate on activities to improve the

ability of health care providers and

other health care professionals to

deliver linguistic and culturally

competent health services to limitedEnglish-proficient populations. A

proposed program may include, but is

not limited to:

• language and cultural competency

training for health care professionals;

• bilingual health access or health

promotion information in the native

language of the target population(s);

• on-site interpretation services; and

• trainer development courses on

cultural competency.

Organizational Linkages

Project goals should promote access to

direct services for limited-Englishproficient minority populations by

providing continuity of support to

clients for outreach, referral and

treatment. Linkages must be established

between minority community based

organizations and appropriate health

care facilities. The minority communitybased organizations and the health care

facilities must reach out and work with

each other to ensure that limitedEnglish-proficient persons are in receipt

of appropriate health care services.

Thus, the applicant, either the minority

community-based organization or the

health care facility must have an

established linkage with the other

organization prior to submitting an

application.

Application Process

Applicants should pay particular

attention to the general and

supplemental instructions provided in

the application kit to ensure that their

applications are responsive to each of

the concerns under the following

headings:

Background

Provide a description of the problem

to be addressed; clearly identify the

scope of the problem including

linguistic/cultural barriers; the limitedEnglish-proficient minority target

group(s) affected; health issues; and the

pertinent geographic area/subarea.

Provide documentation supporting the

serving of at least 40 percent or more

persons with limited-English

proficiency.

Cite the capability and experience of

the organization to provide linguistic

and culturally competent health care

services.

Goal(s) and Objective(s)

Clearly state the goal(s) of the project.

Provide a list of specific, time-phased,

measurable objective(s), including target

dates.

Methodology

A project management plan must be

included which delineates project

activities specifying responsible parties,

methods to be used, timelines, and

anticipated outcomes. Project activities

must be linked to goal(s) and

objective(s). Indicate the organization’s

capability to collaborate with other

health care providers and health care

professionals to effectively reach the

target population. Describe the linkage

between the organization and the

applicable minority community-based

organization/health care facility.

Personnel/Management

Describe duties, reporting channels,

requisite qualifications, and related

experience of personnel who will be

responsible for carrying out the project.

Resumes and curriculum vitae of key

personnel must be provided. Describe

management capability and experience

of proposed grantee organization.

Evaluation

Specify the approach and provide an

example of data collection instruments

that will be used to measure

accomplishment of objectives; the

evaluation should include both process

and outcome measures. Provide a

concise analysis of how the project will

result in a sustained impact on reducing

the problem of access to bilingual/

bicultural health care services. Provide
18936 Federal Register / Vol. 60, No. 71 / Thursday, April 13, 1995 / Notices

information on how the project will be

sustained beyond the funding period

and the degree that the project can be

replicated.

Budget

Budgets of up to $100,000 total direct

and indirect costs per year may be

requested to cover: The cost of

personnel, consultants, support

services, materials, and travel. The

project budget must include travel for

one project staff member to meet with

the OMH Bilingual/Bicultural Program

Director in Washington, D.C. Funds may

not be used for construction, building

alterations or renovations. Also, funds

may not be used to purchase equipment

except as may be acceptably justified in

relation to conducting the project

activities.

All budget requests must be fully

justified in terms of the goals and

objectives proposed and include a

computational explanation of how costs

were determined.

Review of Applications: Applications

will be screened upon receipt. Those

that are judged to be incomplete,

nonresponsive to the announcement, or

nonconforming will be returned without

comment. Each organization may

submit no more than one proposal

under this announcement. If an

organization submits more than one

proposal, all will be deemed ineligible

and returned without comment.

Applications judged to be complete,

conforming, and responsive will be

reviewed for technical merit in

accordance with PHS policies.

Applications will be evaluated by

Federal and non-Federal reviewers

chosen for their expertise in minority

health and their understanding of the

unique health problems and related

issues confronted by limited-Englishproficient racial and ethnic populations

in the United States.

Applicants are advised to pay special

attention to developing clearly defined

goals and objectives for their projects, as

well as providing well-developed study

and evaluation designs for the

measurement of project objectives. Both

formative and summative evaluations

will be required of the grantee, as well

as analysis of how the project can be

improved to reach the desired

outcomes. Applicants should also pay

specific attention to the program

guidelines, and the general and

supplemental instructions provided in

the application kit.

Review Criteria: Applications will be

reviewed and evaluated for evidence of

consistency with the requirements of

this announcement. Of specific

importance will be the following criteria

under the listed headings. (An

indication of the quantitative weight

appears in parentheses after each

heading):

Background (25%)

• Clarity, specificity, depth and

coherence of the described need(s) and

problem(s) of the target-population(s)

which includes linguistic/cultural

barriers.

• Strength and specificity of the

capability of the organization to provide

linguistically and culturally competent

health care services for the target

population;

• Degree to which the organization is

committed to linkage with the

applicable minority community-base

organization/health care facility;

• The validity of the documentation

supporting the percentage of limitedEnglish-proficient persons the project

will serve;

• Extent and outcomes of past efforts/

activities with the proposed target

community; and

• Specificity of data on the intended

target group.

Goals and Objectives (15%)

• Relevance of the proposed goals

and objectives to this announcement

and the OMH mission;

• Merit of the proposed objectives,

including their measurability and

relevance to the stated project goals, and

soundness/attainability of the time

frame specified; and

• Soundness/attainability of

proposed impacts/results/products.

Methodology (25%)

• Strength of the work plan and

specific activities proposed, including

their scope and relevance to each of the

stated objectives and projected

outcomes;

• The degree to which the linguistic

and cultural competence skills will

provide the health care providers and

health care professionals with the

ability to increase outreach effectiveness

to the target population(s);

• Evidence that the organization has

the established linkages with

appropriate health care facilities to

provide continuity of support to clients

for outreach, referral and treatment; and

• Clearly defined project timeline,

Gantt Chart or Pert Chart is included as

it relates to project planning,

implementation, and program

evaluation.

Personnel/Management (15%)

• Strength of proposed grantee

organization’s management capability;

• Adequacy of qualifications,

experience, linguistic and cultural

competence of proposed personnel;

• Evidence that the proposed staff can

effectively outreach and work with the

targeted community; and

• Evidence of clear lines of authority

and accountability among proposed

staff, volunteers, managers, and

collaborators.

Evaluation (20%)

• The strength of the evaluation plan:

includes formative and summative

evaluation designs; the likelihood that

the proposed objectives can be

measured; and the linguistic and

cultural competence of the project can

be assessed;

• Clarity and specificity of proposed

qualitative and quantitative measures of

project accomplishments;

• Soundness of proposed data

analysis and reporting methods;

• Evidence that a project can be

replicated;

• Evidence that the proposed

implementation plan and bring about

the desired outcome(s); and

• If the proposed project provides

direct services, likelihood that services

will be sustained beyond the expiration

of the 3 year funding period.

Budget/Financial Plan (0%)

The budget items will be commented

on, but not rated by the review panel.

• Evidence that required budget items

are consistent with stated goals and are

appropriate to the level of effort

required.

Award Criteria: Funding decisions

will be determined by the Deputy

Assistant Secretary of Minority Health,

Office of Minority Health and will take

under consideration: the

recommendations/ratings of review

panels as well as program balance

which includes geographic and race/

ethnicity distribution, and health

problem areas having the greatest

impact on minority health in terms of

causes of death. Preference will be given

to applicants who have received grants

under the Bilingual/Bicultural Program.

Supplementary Information: This

announcement for Fiscal Year 1995

Bilingual/Bicultural Service

Demonstration Grants focuses on the six

health problems identified by the

Secretary’s Task Force on Black and

Minority Health as having the greatest

impact on minority health in terms of

causes of death: (1) Cancer; (2)

cardiovascular disease and stroke; (3)

chemical dependency; (4) diabetes; (5)

homicides; and (6) infant mortality.

Additional areas of concern under this

announcement include HIV infection,
Federal Register / Vol. 60, No. 71 / Thursday, April 13, 1995 / Notices 18937

access to and financing of health care,

health professions personnel

development, data collection and

analysis, and surveillance. Proposals

should include strategies that will

address these problems in a culturally

competent and linguistically

appropriate manner.

These health priorities also are

addressed in the Health Objectives for

the Nation, Healthy People 2000, which

the Public Health Service (PHS) is

committed to achieving. Potential

applicants may obtain a copy of Healthy

People 2000 (Full Report: Stock No.

017–001–00474–0) or Healthy People

2000 (Summary Report: Stock No. 017–

001–00473–1) through the

Superintendent of Documents,

Government Printing Office,

Washington, DC 20402–9325

(telephone: 202/783–3238).

State Reviews: E.O. 12372 sets up a

system for state and local government

review of proposed Federal assistance

applications.

Applicants [other than federallyrecognized Indian tribal governments]

should contact their State Single Point

of Contact (SPOCs) as early as possible

to alert them to the prospective

applications and receive any necessary

instructions on the state process. For

proposed projects serving more than one

state, the applicant is advised to contact

the SPOC of each affected State. All

comments from a state office must be

received within 60 days after the

application deadline by the Office of

Minority Health’s Grants Management

Officer. A list of addresses of the SPOCs

is enclosed with the application kit

material.

Provision of Smoke-Free Workplace

and Non-Use of Tobacco Products by

Recipients of PHS Grants: The Public

Health Service strongly encourages all

grant recipients to provide a smoke-free

workplace and to promote the non-use

of all tobacco products. In addition,

Public Law 103–227, the Pro-Children

Act of 1994, prohibits smoking in

certain facilities (or in some cases, any

portion of a facility) in which regular or

routine education, library, day care,

health care or early childhood

development services are provided to

children.

Public Health System Reporting

Requirements: This program is subject

to Public Health Systems Reporting

Requirements. Under these

requirements, a community-based

nongovernmental applicant must

prepare and submit a Public Health

System Impact Statement (PHSIS). The

PHSIS is intended to provide

information to state and local health

officials to keep them apprised of

proposed health services grant

applications submitted by communitybased nongovernmental organizations

within their jurisdictions.

Community-based nongovernmental

applicants are required to submit the

following information to the head of the

appropriate state and local health

agencies in the area(s) to be impacted no

later than the Federal application

receipt due date: (a) A copy of the face

page of the applications (SF 424), (b) a

summary of the project (PHSIS), not to

exceed one page, which provides: (1) a

description of the population to be

served, (2) a summary of the services to

be provided, (3) a description of the

coordination planned with the

appropriate state or local health

agencies.

The Catalog of Federal Domestic

Assistance number is 93.105.

Dated: March 23, 1995.

Clay E. Simpson, Jr.,

Acting Deputy Assistant Secretary for

Minority Health.

[FR Doc. 95–9143 Filed 4–12–95; 8:45 am]

BILLING CODE 4160–17–M