Screening and Interventions for Adverse Childhood Experiences (ACEs) in Primary Care Settings Demonstration Project

Screening and Interventions for Adverse Childhood Experiences (ACEs) in Primary Care Settings Demonstration Project is sponsored by Health Resources and Services Administration (HRSA). The purpose of this program is to study how best to implement, in primary care settings, screening protocols and evidence-based interventions for children and adolescents who have experienced ACEs.

The goal is to yield a scalable model for integrating ACEs screening and strength-based, trauma-informed care and services into primary care settings.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES # Maternal and Child Health Bureau # Division of Child, Adolescent and Family Health # Screening and Interventions for Adverse Childhood Experiences in Primary Care Settings Demonstration Project # Funding Opportunity Number: HRSA-21-109 # Funding Opportunity Type(s): New # Assistance Listings (CFDA) Number: 93.

110 # NOTICE OF FUNDING OPPORTUNITY # Application Due Date: May 17, 2021 Ensure your SAM. gov and Grants. gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration. Registration in all systems, including SAM. gov and Grants.

gov, may take up to 1 month to complete. Issuance Date: April 5, 2021 Bethany D. Miller, MSW, M.

Ed. Branch Chief, Adolescent Health, DCAFH Telephone: (301) 945-5156 Authority: 42 U.S.C. 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act) HRSA-21-109 i The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2021 Screening and Interventions for Adverse Childhood Experiences (ACEs) in Primary Care Settings Demonstration Project.

The purpose of this program is to study how best to implement, in primary care settings, screening protocols and evidence-based interventions for children and adolescents who have experienced ACEs. The goal of this program is to yield a model for integrating ACEs screening and strength-based, trauma-informed services into primary care settings.

Funding Opportunity Title: Screening and Interventions for Adverse Childhood Experiences (ACEs) in Primary Care Settings Demonstration Project Funding Opportunity Number: HRSA-21-109 Due Date for Applications: May 17, 2021 Anticipated Total Annual Available Estimated Number and Type of Award(s): Up to one cooperative agreement Estimated Award Amount: Up to $980,000 per year Cost Sharing/Match Required: No Period of Performance: September 1, 2021 through Eligible Applicants: Any domestic public or private entity, including an Indian tribe or tribal organization (as those terms are defined at 25 U.S.C.

§ 450b) is eligible to apply. See 42 CFR § 51a. 3(a).

Domestic faith-based and community-based organizations are also eligible to apply. See Section III. 1 of this notice of funding opportunity (NOFO) for complete eligibility information.

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide, available online at http://www. hrsa. gov/grants/apply/applicationguide/sf424guide.

pdf , except where instructed in this NOFO to do otherwise. HRSA-21-109 ii HRSA has scheduled the following technical assistance: Day and Date: Tuesday, April 13, 2021 Weblink: https://hrsa-gov.zoomgov. com/j/1619019589?

pwd=THFwNHllTW1uK2p0bFhaRFk4dHBaQT09 • Computer audio is recommended (make sure computer speakers are “on”) • Click the link above and select ‘ Join with Computer Audio’ If you won’t have computer access or computer audio, you can use the dial-in information below: • Call-In Number: 1-833-568-8864 • Meeting ID: 161 901 9589 • Participant Code: 37626031 HRSA will record the webinar and make it available at: https://mchb. hrsa.

gov/fundingopportunities/default. aspx . HRSA-21-109 iii I.

PROGRAM FUNDING OPPORTUNITY DESCRIPTION ................................ ...................... 1 1.

PURPOSE ................................................................................................ ...................... 1 2.

BACKGROUND ................................................................................................ ................ 1 II.

AWARD INFORMATION ................................................................................................ .... 4 1.

TYPE OF APPLICATION AND AWARD ................................................................ ................. 4 2.

SUMMARY OF F UNDING ................................................................................................ ... 6 III.

ELIGIBILITY INFORMATION ................................................................ ............................ 6 1.

ELIGIBL E APPLICANTS ................................................................................................ .... 6 2.

COST S HARING /M ATCHING ................................................................ .............................. 6 3.

O THER ................................................................................................ .......................... 6 IV.

APPLICATION AND SUBMISSION INFORMATION ................................ ......................... 7 1.

ADDRESS T O R EQUEST APPLICATION PACKAGE ................................ ............................... 7 2.

CONT ENT AND F ORM OF APPLICATION S UBMISSION ................................ .......................... 7 i.

Project Abstract ................................................................................................ ... 9 ii.

Project Narrative ................................................................................................ .. 9 iii.

Budget ............................................................................................................... 14 iv. Budget Narrative ...............................................................................................

14 v. Program-Specific Forms ................................................................................... 15 vi.

Attachments ...................................................................................................... 15 3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER TRANSITION TO T HE U NIQUE E NTIT Y I DENTIFIER (UEI) AND S YST EM FOR AWARD M ANAGEM ENT (SAM) .....

16 4. SUBMISSION DAT ES AND TIM ES ..................................................................................... 17 5.

I NT ERGOV ERNM ENTAL R EVIEW ...................................................................................... 17 6. F UNDING R EST RICTIONS ...............................................................................................

17 V. APPLICATION REVIEW INFORMATION......................................................................... 18 1.

REVIEW C RIT ERIA ......................................................................................................... 18 2. REVIEW AND S EL ECTION P ROCESS ................................................................................

21 3. ASSESSM ENT OF RISK .................................................................................................. 21 VI.

AWARD ADMINISTRATION INFORMATION.................................................................. 22 1. AWARD N OTICES ..........................................................................................................

22 2. ADMINIST RATIV E AND NATIONAL P OLICY R EQUIREM ENTS ................................................ 22 3.

REPORTING ................................................................................................................. 23 VII. AGENCY CONTACTS ...................................................................................................

25 VIII. OTHER INFORMATION................................................................................................ 26 HRSA-21-109 1 # I.

Program Funding Opportunity Description This notice announces the opportunity to apply for funding under the Screening and Interventions for Adverse Childhood Experiences (ACEs) in Primary Care Settings Demonstration Project. The purpose of this program is to study how best to implement, in primary care settings, screening protocols and evidence-based interventions for children and adolescents who have experienced ACEs.

The goal of this program is to yield a model for integrating ACEs screening and strength-based, trauma-informed services into primary care settings. This 3-year demonstration project aims to: • Study how primary care settings can best screen and provide care to children impacted by ACEs, including strengths, limitations, and implementation challenges.

• Produce a scalable model that can help pediatric providers effectively integrate screening with strength-based, trauma-informed care and services in primary care settings. This program is authorized by 42 U.S.C. 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act), which funds Special Projects of Regional and National Significance (SPRANS).

The Explanatory Statement for the Consolidated Appropriations Act, 2021 (PL 116–260), 1 includes funds for a “study focused on the implementation of screening protocols and evidence-based interventions for individuals who have experienced adverse childhood experiences, as described in House Report 116–450.

” 2 In part, the House Report states: “The Committee includes $1,000,000 within SPRANS to fund a study focused on improving child health by implementing screening protocols and evidence-based interventions to individuals who have experienced adverse childhood experiences,,,to yield a model for integrating ACEs screening and trauma-informed strength based care into primary care settings.

The Committee directs HRSA to submit a report with the results of this study to the Committee within three years of enactment of this Act. ” ACEs are defined as potentially traumatic events experienced by infants, children, and adolescents, ages 0–17 years.

1 ACEs include disruptions in the parent-child relationship such as divorce, death of a parent, separation from a parent, parental mental illness, family substance abuse, witnessing interpersonal violence, and experiencing child > 1https://www. congress. gov/116/crec/2020/12/21/CREC-2020-12-21.

pdf-bk4#page=310 > 2https://www. congress. gov/116/crpt/hrpt450/CRPT-116hrpt450.

pdf#page=54 abuse and neglect. In addition to these ACEs, research has found that children may experience additional ACEs resulting from racism and prejudice. 3, 4 In 2018, over 28 million children age 0–17—more than one-third of all US children—had experienced at least one ACE in their lifetime, and more than 20 percent had experienced two or more.

Data from the National Survey of Children’s Health 5 found that 53 percent of Black non-Hispanic and 42 percent of Hispanic children have experienced at least one ACE, compared with 36 percent of white non-Hispanic children. In general, those belonging to underrepresented race, ethnicity, gender, and sexual orientation groups tend to have higher overall exposure to ACEs, as well as variation in the type of ACEs experienced.

6, 7 For example, Black non-Hispanic and Hispanic children are more likely to experience ACEs related to systemic racism, such as parental incarceration.

8 The association between ACEs and poor health outcomes demonstrates a dose-response relationship between total number of ACEs experienced and increasing risk for chronic medical conditions, including heart disease, diabetes, and cancer, as well as mental and behavioral health issues, including depression, anxiety, substance misuse, and suicide.

9 Research has found that ACEs can lead to dysregulation of the neuroendocrine system resulting in elevated levels of catecholamines, cortisol, and proinflammatory cytokines that may disrupt neurodevelopment and result in alterations related to emotional regulation and cognitive functioning.

10 Children and adolescents who have experienced ACEs may have difficulty with attention, executive functioning, impulsive behavior, and decision-making.

Mental and behavioral health diagnoses such as attention deficit/hyperactivity disorder (ADHD), internalizing conditions (e.g., anxiety, depression, somatization), and externalizing behaviors (e.g., acting out, hostility, aggression) are more common in children and adolescents who have experienced ACEs. 11 Still, it is important to recognize that there are wide variations in outcomes for those exposed to ACEs.

Protective factors such as > 3Burke NJ, Hellman JL, Scott BG, Weems CF, Carrion VG. The impact of adverse childhood experiences on an urban pediatric population. Child abuse & neglect.

2011 Jun 1;35(6):408-13. > 4Wade Jr R, Cronholm PF, Fein JA, Forke CM, Davis MB, Harkins-Schwarz M, Pachter LM, Bair-Merritt MH. Household and community-level adverse childhood experiences and adult health outcomes in a diverse urban population.

Child abuse & neglect. 2016 Feb 1;52:135-45. > 5https://www.

childhealthdata. org/browse/survey/results? q=7915&r=1 > 6Sacks, V.

and Murphy, D. The prevalence of adverse childhood experiences, nationally, by state and race or ethnicity. Child Trends.

https://www. childtrends. org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity , retrieved 2/26/2021.

> 7Merrick MT, Ford DC, Ports et al. Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States. JAMA Pedia.

2018; 171 (11);1030-1044. > 8Slopen N, Shonkoff JP, Albert MA et al. Racial disparities in child adversity in the U.S. Am J Prev Med 2016; 50 (1): 47-56.

> 9Centers for Disease Control and Prevention (2019). Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

> 10 Koss KJ, Gunnar MR. Annual Research Review: Early adversity, the hypothalamic-pituitary-adrenocortical axis, and child psychopathology. J Child Psychol Psychiatry. 2018 Apr;59(4):327-346.

doi: 10. 1111/jcpp. 12784.

> 11 Rudenstine, Espinosa, McGee, and Routhier. Adverse Childhood Events, Adult Distress, and the Role of Emotion Regulation. Traumatology.

2018; 25(2): doi: 10. 1037/trm0000176. connections with responsive caregivers and support from caring communities may offer emotional and material resources that can buffer against the immediate effects of trauma and ameliorate long-term negative impacts.

12 , 13 These protective factors allow some children and adolescents to thrive despite having experienced ACEs. Providing strength-based, trauma-informed care and interventions may reduce the impact of ACEs on child development and improve overall health.

Strength-based care approaches aim to identify, support, and build a child’s, adolescent’s, or family’s assets, abilities, and resilience to engender trust, foster hope, and support health and healing. 14 , 15 Additionally, trauma-informed care aims to understand, recognize, and promote environments of healing and recovery and avoid inadvertently re-traumatizing children and their families.

16 Although various trauma screening instruments and trauma-informed interventions have been developed, there is less evidence about how to effectively implement these screenings and interventions in pediatric primary care settings.

17 , 18 Strength-based pediatric care allows the child or adolescent and their family to feel valued for their unique strengths, cared about, and develop long-term, trusting relationships with their provider. 19 Well-child visits provide a unique opportunity to provide non-stigmatizing primary prevention, screening, and care for ACEs.

In addition, pediatric providers can also explore with youth and their families the degree to which racism and prejudice may further contribute to ACEs.

20 Primary care settings that can screen and care for children who experience ACEs, while recognizing strength-based, mitigating protective factors, have the opportunity to provide safe, stable, nurturing, trauma-informed, strength-based care that can link youth and their families to supports and interventions that will nurture resilience and help National Scientific Council on the Developing Child. (2015).

Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience: Working Paper 13. http://www. developingchild.

harvard. edu Masten AS. Ordinary Magic: Resilience in Development.

New York, NY: Guilford Press; 2014. Duncan PM, Garcia AC, Frankowski BL, Carey PA, Kallock EA, Dixon RD, Shaw JS. Inspiring healthy adolescent choices: a rationale for and guide to strength promotion in primary care.

J Adolesc Health. 2007 Dec;41(6):525-35. doi: 10.

1016/j. jadohealth. 2007.

05. 024. Epub 2007 Aug 29.

PMID: 18023780. 15 Schor EL. Life Course Health Development in Pediatric Practice.

Pediatrics. 2021 Jan 1;147(1). Schor EL.

Life Course Health Development in Pediatric Practice. Pediatrics. 2021 Jan 1;147(1).

National Child Traumatic Stress Network. https://www. nctsn.

org/trauma-informed-care/creating-trauma-informed-systems , retrieved 2/26/2021. Bethell, Carle, Hudziak, Gombojav, Powers, Wade, and Braveman. Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice.

Acad Pediatr. 2017 Sep-Oct; 17(7 Suppl): S51–S69. doi:10.

1016/j. acap. 2017.

04. 161. Campbell, Thomas L.

“Screening for Adverse Childhood Experiences (ACEs) in Primary Care: A Cautionary Note. ” JAM A : the journal of the American Medical Association 323. 23 (2020): 2379–2380.

Web. Bright Futures Implementation Sheet: Elicit Youth and Parental Strengths and Needs. https://brightfutures.

aap. org/Bright%20Futures%20Documents/BF_ElicitParentalStrength_Tipsheet. pdf#s earch=strength Trent M, Dooley DG, Dougé J.

The impact of racism on child and adolescent health. Pediatrics. 2019 Aug 1;144(2).

HRSA-21-109 4 children, adolescents, and their families thrive despite having experienced ACEs. 21 , 22 , 23 , 24 , 25 1. Type of Application and Award Type(s) of applications sought: New HRSA will provide funding in the form of a cooperative agreement.

A cooperative agreement is a financial assistance mechanism where HRSA anticipates substantial involvement with the recipient during performance of the contemplated project. HRSA program involvement will include : • Providing the assistance of experienced HRSA personnel available as participants in the planning and development of all phases of this project.

• Providing ongoing oversight to ensure compliance with the application requirements and expectations outlined in the Purpose , Program Expectations , Project Narrative (see Sections I. 1, IV. 2, and IV.

2. ii), and Reporting (see Section VI. 3).

• Participating and collaborating in the planning, implementation, and evaluation of program activities under this cooperative agreement. • Assessing and evaluating to determine program needs to meet the scope of work described in the NOFO on an ongoing basis.

• Reviewing information on project activities, reports, and any other products prior to dissemination as well as providing review of and advisory input for publications, audiovisuals, and other materials produced under the auspices of this cooperative agreement. This includes the preliminary summary of findings that will be the basis for the required report to Congress (see Program Expectations for additional information).

• Coordinating closely with HRSA’s Office of Communications regarding dissemination of publications completed under this program. • Participating in the planning and scheduling of meetings conducted during the period of the cooperative agreement. • Participating in regular meetings and/or communications with the recipient to assess progress (at minimum monthly check-ins).

> 21 Vu C, Rothman E, Kistin CJ, Barton K, Bulman B, Budzak-Garza A, Olson-Dorff D, Bair-Merritt MH. Adapting the patient-centered medical home to address psychosocial adversity: results of a qualitative study. Academic pediatrics.

2017 Sep 1;17(7):S115-22. > 22 Finkelhor, David. “Screening for Adverse Childhood Experiences (ACEs): Cautions and Suggestions.

” Child abuse & neglect 85 (2018): 174–179. Web. > 23 Title IV-E Prevention Services Clearinghouse, https://preventionservices.

abtsites. com/ , retrieved 2/26/2021. > 24 National Child Traumatic Stress Network, 2018.

https://www. nctsn. org/sites/default/files/resources/fact-sheet/trauma_informed_integrated_care_for_children_and_families_in_healthcare_settings.

pdf , retrieved 2/26/2021. > 25 https://astho. org/ASTHOBrief/ACEs-A-Look-at-Primary-Prevention-Priorities/ • Assisting the recipient in identifying and facilitating linkages with federal interagency and state contacts as necessary for the successful completion of tasks and activities identified in the approved scope of work.

The cooperative agreement recipient’s responsibilities will include: • Adhering to the process of planning, implementing, and evaluating program activities as outlined in this NOFO. • Establishing, at a minimum, monthly check-ins with HRSA program staff, with increased frequency of meetings as needed.

• Responding in a timely and appropriate manner to requests by the HRSA project officer to collaborate on short-term, long-term, and ongoing projects. • Assuring sufficient staff with sufficient time commitment to successfully perform the activities as defined in this NOFO. • Collaborating with the federal project officer on planning/implementing new activities.

• Seeking prior approval from the federal project officer when hiring new key project staff, including for example, principal investigators or program managers at all primary care settings participating in the demonstration project.

• Consulting with the HRSA project officer when scheduling any meetings that pertain to the scope of work and at which the HRSA project officer’s attendance would be appropriate (as determined by the project officer). • Providing quarterly written reports, in a format developed in partnership with the HRSA project officer, to HRSA synthesizing program results to date.

• Providing summary aggregate data to HRSA upon request, in particular being able to provide data on emergent issues. • Responding to the project officer’s comments, questions, and requests in a timely manner in order to collaborate on short-term, long-term, and ongoing activities within the approved work plan.

A response to rapid-response requests may require a shorter turnaround, to be determined by the project officer on a case-by-case basis.

• Providing the HRSA project officer with adequate time and opportunity to review, provide advisory input, and approve at the program level, any publications, audiovisuals, and other materials produced under the auspices of this cooperative agreement (such review should start as part of concept development and include review of drafts and final products).

This includes the written summary of the study that will be the basis for the required report to Congress (see Program Expectations for additional information). • Providing the HRSA project officer with an electronic copy of, or electronic access to, each product developed under the auspices of this project.

• Ensuring that all products developed or produced, either partially or in full, under the auspices of this cooperative agreement are fully accessible and available for free to members of the public. • Adhering to HRSA guidelines pertaining to acknowledgement and disclaimer on all products produced by HRSA award funds (see Acknowledgement of Federal Funding in Section 2. 1 of HRSA’s SF-424 Application Guide ).

• Assuring HRSA will be identified as a funding sponsor on written products, presentations, and during meetings and conferences relevant to cooperative agreement activities. HRSA-21-109 6 • Including the acknowledgement and disclaimer information required on all products supported by HRSA award funds, on manuscripts with or without MCHB personnel listed as co-author.

• Collaborating and communicating with the HRSA program staff and other key stakeholders. • Supporting all related activities outlined in this NOFO. HRSA estimates approximately $980,000 to be available annually to fund one recipient.

You may apply for a ceiling amount of up to $980,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The period of performance is September 1, 2021 through August 31, 2024 (3 years).

Funding beyond the first year is subject to the availability of appropriated funds for the Screening for Adverse Childhood Experiences in Primary Care Settings program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements at 45 CFR part 75 . # III. Eligibility Information Any domestic public or private entity, including an Indian tribe or tribal organization (as those terms are defined at 25 U.S.C.

§ 450b) is eligible to apply. See 42 CFR § 51a. 3(a).

Domestic faith-based and community-based organizations are also eligible to apply. Cost sharing/matching is not required for this program. HRSA will consider any application that exceeds the ceiling amount non-responsive and will not consider it for funding under this notice.

HRSA will consider any application that exceeds the page limit referenced in Section_IV non-responsive and will not consider it for funding under this notice. HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV. 4 non-responsive and will not consider it for funding under this notice.

Multiple applications from an organization are not allowable. HRSA-21-109 7 HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants. gov application due date as the final and only acceptable application.

# IV. Application and Submission Information 1. Address to Request Application Package HRSA requires you to apply electronically.

HRSA encourages you to apply through Grants. gov using the SF-424 workspace application package associated with this notice of funding opportunity (NOFO) following the directions provided at http://www. grants.

gov/applicants/apply-for-grants. html . 2.

Content and Form of Application Submission Section 4 of HRSA’s SF-424 Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the Application Guide in addition to the program-specific information below.

You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in the terms of U.S. dollars (45 CFR § 75. 111(a)).

See Section 8. 5 of the Application Guide for the Application Completeness Checklist. The total size of all uploaded files included in the page limit shall not exceed the equivalent of 60 pages when printed by HRSA.

The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support required in the Application Guide and this NOFO. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit. Please note: If you use an OMB-approved form that is not included in the workspace application package for HRSA-21-109, it may count against the page limit.

Therefore, we strongly recommend you only use Grants. gov workspace forms associated with this NOFO to avoid exceeding the page limit. Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit.

It is therefore important to take appropriate measures to ensure your application does not exceed the specified page limit. Any application exceeding the page limit of 60 will not be read, evaluated, or considered for funding. HRSA-21-109 8 Applications must be complete, within the maximum specified page limit, and validated by Grants.

gov under the correct funding opportunity number prior to the deadline.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification 1) You certify on behalf of the applicant organization, by submission of your proposal, that neither you nor your principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75. 371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C.

§ 3321). 3) Where you are unable to attest to the statements in this certification, an explanation shall be included in Attachment 7 : Other Relevant Documents . See Section 4.

1 viii of HRSA’s SF-424 Application Guide for additional information on all certifications. Program-Specific Instructions This program expects recipients to respond to the instructions to HRSA in the Explanatory Statement submitted by the House Committee on Appropriations, 26 as well as in House Report 116-450, 27 both of which accompanied the Consolidated Appropriations Act, 2021 (P. L.

116-260). Based on the Explanatory Statement and House Report, the recipient is expected to: • Conduct a demonstration project on improving child health by implementing evidence-based screening protocols and interventions to children and adolescents who have experienced ACEs.

The goal of the demonstration will be to yield a model for effectively integrating ACEs screening and strength based, trauma-informed care into primary care settings. • Provide data, analysis, and findings from this demonstration project to HRSA, to be incorporated into a required report to the House Committee on Appropriations.

• Obtain sufficient data to make meaningful and valid interpretations, which necessitates the recipient to provide a written summary in August 2023 of the preliminary findings of the demonstration up to that point in time. • Continue the demonstration project beyond the submission of the report to Congress, as the period of award continues after the report due date (i.e., December 27, 2023).

The significance and time-sensitive nature of this critically important work for children and adolescents necessitates that the proposed project focus on integrated models that are already operational and that can be feasibly studied under time constraints.

To facilitate the swift implementation of this demonstration project and to maximize the data available to inform the report to Congress, applicants should include in their > 26 https://www. congress. gov/116/crec/2020/12/21/CREC-2020-12-21.

pdf-bk4#page=310 > 27 https://www. congress. gov/116/crpt/hrpt450/CRPT-116hrpt450.

pdf#page=54 application their plan to identify primary care practices/clinics that will participate in this demonstration project and be prepared to provide documentation of such participation (e.g., letters of commitment) within 30 days of their award.

In addition to conducting the demonstration, the recipient will conduct other project activities that continue until the end of the award period that meet the program requirements and expectations of this NOFO.

Such activities may include, but are not limited to the: • development of a manuscript for publication • additional written, audio, or video summary(ies) of the screening and intervention model products/tools for broader dissemination to practices, providers, families, youth, and the general public • continuing medical educational materials for providers • dissemination of plans and protocols that can be easily adopted, integrated, and utilized by pediatric care settings In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following: See Section 4.

1. ix of HRSA’s SF-424 Application Guide . This section provides a comprehensive framework and description of all aspects of the proposed project.

It should be succinct, self-explanatory, consistent with forms and attachments, and well-organized so that reviewers can understand the proposed project. HRSA recognizes the varying capacity, readiness, and maturity across primary care settings for the integration of ACEs screening, referrals, and intervention.

The program narrative should reflect the challenges inherent to studying a variety of primary care practices/clinics, serving a diversity of populations in the successful integration of ACEs screening, referrals, and intervention.

You should address challenges inherent to this study and propose strategies that are feasible and will yield a model for integrating ACEs screening and strength-based, trauma-informed services into primary care settings. For example, ACEs screenings include questions about child abuse and neglect, as well as intimate partner violence; you should describe safety measures that will be taken when child safety concerns are identified.

Successful applications will contain the information below. Please use the following section headers for the narrative: HRSA-21-109 10  INTRODUCTION -- Corresponds to Section V’s Review Criterion 1: NEED Briefly describe the purpose of the proposed project, demonstrating a clear understanding of the aims, expectations, and timeline of the project that is consistent with Section I: Purpose of this NOFO.

 NEEDS ASSESSMENT -- Corresponds to Section V’s Review Criterion 1: NEED Provide a detailed needs assessment that describes gaps, strengths, and challenges in integrating ACEs screening, referrals, and interventions in primary care settings. Use demographic and other data to describe the scope and needs of communities you will address with this program.

• Outline the needs of primary care providers to successfully integrate ACEs screening and strength-based, trauma-informed services into primary care settings. • Provide a brief literature review that discusses existing models for these services, and the extent to which these models have been integrated in a variety of primary care practices/clinics, serving a diversity of populations.

• Discuss any relevant barriers that primary care practices/clinics face that the demonstration project can address. This section will help reviewers understand the community and/or organization that you will serve with the proposed project.

 METHODOLOGY -- Corresponds to Section V’s Review Criteria 2: RESPONSE and 3: EVALUATIVE MEASURES Propose methods that include specific goals and objectives that you will use to address the stated needs and meet each of the program requirements and expectations in this NOFO.

Ensure the following core activities are integrated into the proposal: Planning, Design, and Development of the Demonstration Project Describe a preliminary plan for the design, development, and implementation of the demonstration project. The plan should take into consideration that a summary of methods and preliminary findings of the demonstration will be needed by HRSA by August 31, 2023, to complete the report to Congress.

Your plan should address the following elements: • Literature review of existing strength-based, trauma-informed approaches/protocols/models to integrate ACEs screening and interventions in primary care settings. • An evaluation plan that includes preliminary research/evaluation questions to guide the evaluation of the effectiveness of the integration of ACEs screening, referrals, and interventions into primary care settings.

The evaluation plan should include features of the demonstration project design, quantitative and qualitative methodologies, data sources, data collection instruments, and intervention and comparison groups, if proposed.

• Plan to recruit pediatric primary care practices/clinics (and documentation of support from those already identified) to participate in the demonstration that includes: HRSA-21-109 11 o Settings that serve diverse populations (e.g., geography, urbanicity, income, race, and ethnicity of patient populations); o Providers who come from diverse backgrounds (e.g., race, ethnicity, gender identity, sexual orientation, etc.); o Providers who have varying professional credentials (e.g., medical assistants, nurses, nurse practitioners, physician assistants, physicians, social workers); and o Settings that operate in various practice structures (e.g., independent practice, affiliated university practice, Federally Qualified Health Center).

o Composition of intervention and comparison groups, if proposed. • Plan to assure research protections for human subjects, including children and youth, where applicable. • Plan to seek Institutional Review Board (IRB) approval (IRB approval is not required at the time of application submission but must be received prior to initiation of any activities involving human subjects).

Demonstration Project Implementation Describe how the demonstration project will be implemented, including the following details: • Methods that you will use to address the previously described program requirements and expectations in this NOFO.

• Development of effective tools and strategies for outreach, collaborations, clear communication, and information sharing/dissemination with efforts to involve patients, families, and communities. • Description of how and from whom data will be collected (e.g., using existing data, primary data collection mechanisms, aggregate versus individual level data), including human subject and other approvals, and schedule.

• Overview of any existing agreements you have with primary care providers who are integrating ACEs screening and strength-based, trauma-informed care into primary care settings, as well as plans for collaboration with other practices/clinics to meet the program requirements and expectations in this NOFO.

• Description of how you will establish partnerships and/or arrangements (e.g., memoranda of understanding, data use agreements, contracts) as appropriate with other organizations to implement the demonstration project. Data Analysis, Interpretation, Reporting, and Dissemination Describe your plan for collecting, analyzing,