Transforming Pediatrics for Early Childhood (TPEC)

Transforming Pediatrics for Early Childhood (TPEC) is a grant from the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau that funds initiatives integrating early childhood developmental support into pediatric primary care settings.

The program focuses on transforming how pediatric providers screen, identify, and address developmental and social-emotional concerns in young children during routine well-child visits. Funded under Title V of the Social Security Act, TPEC awards support training, quality improvement, and systems-change efforts in pediatric practices.

Eligible applicants include any domestic public or private entity, Indian tribes and tribal organizations, and faith-based and community-based organizations.

U.S. Department of Health and Human Services ## Maternal and Child Health Bureau ## Division of Home Visiting and Early Childhood Systems ## Transforming Pediatrics for Early Childhood (TPEC) ## Funding Opportunity Number: HRSA-22-141 ## Funding Opportunity Type(s): New ## Assistance Listings (AL/CFDA) Number: 93. 110 ## NOTICE OF FUNDING OPPORTUNITY # Application Due Date: May 23, 2022 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 may take up to 1 month to complete.

Issuance Date: March 24, 2022 Lynlee Tanner Stapleton, Ph. D. Public Health Analyst, Maternal and Child Health Bureau Telephone: (301) 443-5764 Email: lstapleton@hrsa.

gov See Section VII for a complete list of agency contacts. Authority: 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act) HRSA-22-141 i # 508 COMPLIANCE DISCLAIMER Note: Persons using assistive technology may not be able to fully access information in this file.

For assistance, please email or call one of the HRSA staff listed in Section VII. The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2022 Transforming Pediatrics for Early Childhood (TPEC) program.

The purpose of the TPEC program is to establish resource hubs that support the placement of early childhood development (ECD) experts into pediatric practices that serve a high percentage of prenatal-to-five year old (P–5) populations who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) or are uninsured.

For the purposes of this NOFO, HRSA defines pediatric practices broadly, to include a range of settings and providers that offer primary health care services to young children, with a focus on patient-centered medical homes (PCMHs) and similar settings.

To achieve long-term improvements in early developmental health, school readiness, family well-being, and health equity, the primary goals of TPEC are to: 1) improve equitable access to a continuum of ECD services in pediatric PCMHs and similar settings, and 2) improve the capacity of pediatric practices and workforce to deliver high-quality ECD services that address the holistic needs of children and families.

Funding Opportunity Title: Transforming Pediatrics for Early Funding Opportunity Number: HR SA -22 -141 Due Date for Applications: May 23, 2022 Anticipated Total Annual Available FY 2022 Funding: Estimated Number and Type of Award(s): Up to 4 cooperative agreement(s) Estimated Annual Award Amount: Up to $1,000,000 per award Cost Sharing/Match Required: No Period of Performance: September 30, 2022 through September 29, 2026 (4 years) Eligible Applicants: Any domestic public or private entity, including an Indian tribe or tribal HRSA-22-141 ii organization (as those terms are defined at 25 U.S.C.

§ 5304 (formerly cited as 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, except where instructed in this NOFO to do otherwise.

HRSA has scheduled the following technical assistance: Day and Date: Thursday, April 7, 2022 Register for ZoomGov meeting: https://hrsa- gov.zoomgov. com/webinar/register/WN_-yRYCX2nQY-d71lRcjZdsA HRSA will record the webinar and make it available at: https://mchb. hrsa.

gov/fundingopportunities/default. aspx . HRSA-22-141 iii I.

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

P URPOSE ................................................................................................ ............................ 1 2.

B ACKGROUND ................................................................................................ ...................... 1 II.

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

T YPE OF APPLICATION AND AWARD ................................................................ ...................... 4 2.

S UMMARY OF F UNDING ................................................................................................ ........ 6 III.

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

E LIGIBLE APPLICANTS ................................................................................................ .......... 6 2.

COST SHARING /M ATCHING ................................................................................................ ... 6 3.

OTHER ................................................................................................................................ 6 IV. APPLICATION AND SUBMISSION INFORMATION ................................

.............................. 7 1. A DDRESS TO REQUEST APPLICATION PACKAGE ................................................................

.... 7 2. C ONTENT AND F ORM OF APPLICATION SUBMISSION ................................

.............................. 7 i. Project Abstract......................................................................................................

12 ii. Project Narrative..................................................................................................... 13 iii.

Budget ..................................................................................................................... 18 iv. Budget Narrative ....................................................................................................

19 v. Attachments............................................................................................................ 20 3.

U NIQUE ENTITY I DENTIFIER (UEI) AND SYSTEM FOR AWARD MANAGEMENT (SAM) .............. 21 4. SUBMISSION DATES AND T IMES ..........................................................................................

22 5. I NTERGOVERNMENTAL REVIEW ........................................................................................... 22 6.

F UNDING RESTRICTIONS .................................................................................................... 22 V. APPLICATION REVIEW INFORMATION .............................................................................

23 1. R EVIEW CRITERIA .............................................................................................................. 23 2.

REVIEW AND SELECTION PROCESS .................................................................................... 26 3. A SSESSMENT OF RISK ........................................................................................................

27 VI. AWARD ADMINISTRATION INFORMATION ...................................................................... 28 1.

A WARD NOTICES ............................................................................................................... 28 2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS ....................................................

28 3. R EPORTING ....................................................................................................................... 30 VII.

AGENCY CONTACTS ......................................................................................................... 32 VIII. OTHER INFORMATION .....................................................................................................

33 APPENDIX A: GLOSSARY ........................................................................................................ 34 APPENDIX B: THE CONTINUUM OF ECD SERVICES AND CONSIDERATIONS FOR ECD EXPERTS ..................................................................................................................................

38 APPENDIX C: EXAMPLES OF TA AND SUPPORT FOR ECD INTEGRATION AND PEDIATRIC PRACTICE TRANSFORMATION .......................................................................... 42 APPENDIX D: RECOMMENDED PARTNERSHIPS ................................................................. 43 HRSA-22-141 1 ## I.

Program Funding Opportunity Description This notice announces the opportunity to apply for funding under the Transforming Pediatrics for Early Childhood (TPEC) program.

The purpose of the TPEC program is to establish resource hubs that support the placement of early childhood development (ECD) experts into pediatric practices 1 that serve a high percentage of prenatal-to-five year old (P–5) populations who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) or are uninsured.

To achieve long-term improvements in early developmental health, school readiness, family well-being, and health equity, the primary goals are to: 1) improve equitable access to a continuum of ECD services 2 in pediatric patient-centered medical home (PCMH) and similar settings, and 2) improve the capacity of pediatric practices and workforce to deliver high-quality ECD services that address the holistic needs of children and families.

Core program objectives to be accomplished during the period of performance include: • Increase the number of ECD experts 2 trained, equipped, and placed in pediatric settings serving Medicaid/CHIP-eligible or uninsured P–5 populations; • Increase the number of pediatric practices offering a continuum of ECD services that includes comprehensive early developmental health 3 promotion/prevention, screening and surveillance, care coordination and linkage, and intervention; • Improve ECD knowledge and competencies among pediatric primary care staff; and • Identify and advance solutions to specific barriers to sustained and holistic ECD service delivery in primary care, such as policy and financing barriers, ECD workforce needs, care coordination, and service gaps.

For more details, see Program Requirements and Expectations . TPEC is authorized by 42 U.S.C. § 701(a)(2) (Title V, § 501(a)(2) of the Social Security Act), as amended, which supports Special Projects of Regional and National Significance (SPRANS) relating to maternal and child health.

Funds from this authority will also support national technical assistance (TA) and coordination for TPEC, > 1We define pediatric practices and settings broadly, to include a range of practices and providers that offer primary health care services to young children, with a focus on patient-centered medical homes (PCMHs) and similar > settings. See Appendix A for more details.

> 2See Program Requirements and Expectations and Appendix B for details. > 3See Appendix A for a description of early developmental health and family well-being, as used in this NOFO. described in HRSA-22-091 , as part of the Early Childhood Developmental Health System (ECDHS): Evidence to Impact Center.

As part of HRSA’s Maternal and Child Health Bureau (MCHB)’s early childhood systems (ECS) portfolio of programs, TPEC is a new program that provides funding to integrate ECD experts into pediatric practices as a strategy to build and sustain systems of care, to ensure that all families have the full range of services and supports they need— especially during the P–5 period—to build a strong foundation for lifelong health.

ECS programs focus on policies and practices that promote responsive and caring relationships between children and caregivers, strengthen caregiver and child core life skills, reduce sources of family stress, and address the social and structural determinants of health 4 to improve early developmental health and family well-being.

The P–5 period is a critical window of opportunity to optimize child development, family well-being, and school readiness, and to prevent problems later in life. Challenges associated with poverty and structural barriers, such as racism, limit families’ access to services and supports and can lead to long-term health disparities.

The health system— especially pediatric primary care—has strong potential to advance health equity and provide or connect families to developmental services, due to its near-universal reach at early ages.

Despite long-standing recommendations 5,6 regarding the ways in which pediatric providers can advance ECD, data from 2019–2020 indicate that less than 37 percent of young children received a recommended developmental screening from a health provider in the prior year.

7 Pediatricians cite lack of time, staff, and knowledge of or ability to connect with community resources as barriers to ECD promotion, screening, and other preventative practices. 8 Effectively addressing social determinants of health (SDoH), including basic living needs, is a particular challenge for pediatric providers. 9,10 > 4Center on the Developing Child at Harvard University (2017).

Three Principles to Improve Outcomes for Children and Families. https://developingchild. harvard.

edu/resources/three-early-childhood-development-principles-improve- > 5American Academy of Pediatrics (2017). Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 4 th Edition. Doi: https://doi.

org/10. 1542/9781610020237 . > 6Garner AS, Shonkoff JP, Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care & Section on Developmental and Behavioral Pediatrics (2012).

Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 129(1). Available at: www.

pediatrics. org/cgi/content/full/129/1/e224 . > 7Data Resource Center for Child & Adolescent Health (2019).

National Survey of Children’s Health. > https://www. childhealthdata.

org/browse/survey . > 8Morr, M. (2020).

Clinicians Not Adhering to AAP Guidelines for Developmental Disorder Screening. > https://www. clinicaladvisor.

com/home/topics/neurology-information-center/clinicians-not-adhering-to-aap-guidelines- > for-developmental-disorder-screening/ . > 9Garg A, Cull W, Olson L, et al. (2019).

Screening and referral for low-income families’ social determinants of health by US pediatricians. Academic Pediatrics, 19, pp. 875-883.

https://doi. org/10. 1016/j.

acap. 2019. 05.

125 . > 10 Kogan MD, Schuster MA, Yu SM, et al. (2004).

Routine assessment of family and community health risks: parent views and what they receive. Pediatrics, 113 (6 suppl) , pp. 1934-1943.

https://doi. org/10. 1542/peds.

113. S5. 1934 .

Many evidence-informed initiatives have leveraged pediatrics to promote healthy early development and achieve positive outcomes for children and families. 11 This includes well-studied approaches that place an ECD expert within pediatric practices 12 to support practice-wide transformation and deliver a continuum of ECD services to children and families as part of an integrated care team.

13 ,14 This continuum includes developmental health promotion and preventive services for all families, comprehensive screening and surveillance for child and family strengths and needs, linkage and care coordination for follow-up services, and issue-focused consultation or brief intervention.

There have also been successes in leveraging value-based payment structures, health quality metrics, and Medicaid financing to support a continuum of services. 15 ,16 ECD experts can have a range of educational backgrounds and credentials.

Examples include psychologists, social workers, mental health nurses, and community health workers/promotores, or others with lived experience with early childhood health systems and cultural and linguistic connection to the population being served. (See Appendix B for more details). High-quality ECD services are culturally responsive, trauma-informed, and two-generational.

At present, policies and practices that support access to ECD experts and high-quality ECD services are not consistently implemented for Medicaid-eligible populations. 17 ,18 Systems change that builds implementation infrastructure and addresses financing, regulatory, logistical, and workforce barriers is needed to increase the availability of and access to ECD expertise.

19 The TPEC program is designed to address these limitations See Peacock-Chambers E, Ivy K & Bair-Merritt M. (2017). Primary Care Interventions for Early Childhood Development: A Systematic Review.

Pediatrics , 140(6): e20171661. https://doi. org/10.

1542/peds. 2017-1661 . See https://www.

pediatricssupportingparents. org/ and https://www. healthysteps.

org/ for examples, and Appendix B for program expectations. Talmi, A. , Millar, A.

, Buchholz, M. , Burnett, B. , & Wolcott, C.

(2020). BHIPP:0–5: Primary care practice transformation in early childhood behavioral health integration. Clinical Practice in Pediatric Psychology.

Advance online publication. https://doi. org/10.

1037/cpp0000380 . Garner A. S.

, Yogman M. , Committee on Psychosocial Aspects of Child and Family Health, Section on Developmental and Behavioral Pediatrics, Council on Early Childhood. (2021).

Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health. Pediatrics, 148 (2) e2021052582; DOI: https://doi. org/10.

1542/peds. 2021-052582 . Cohen Ross, D.

, Guyer, J. , Lam, A. , Toups, M.

(2019). Fostering Social and Emotional Health through Pediatric Primary Care: A Blueprint for Leveraging Medicaid and CHIP to Finance Change. Washington, DC: Center for the Study of Social Policy.

Available at: https://cssp. org/resource/medicaid-blueprint/ . National Academies of Sciences, Engineering, and Medicine.

(2021). Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care (Chapter 9). Washington, DC: The National Academies Press.

https://doi. org/10. 17226/25983 .

Smith, S. , Granja, M. R.

, Nguyen, U. , Rajana, K. (2018).

How States Use Medicaid to Cover Key Infant and Early Childhood Mental Health Services: Results of a 50-State Survey (2018 Update). New York: National Center for Children in Poverty, Mailman School of Public Health, Columbia University. Available at: http://www.

nccp. org/publications/pdf/text_1211. pdf .

Bethell, C. , Peck. C.

, Abrams, M. , et al. (2002).

Partnering with Parents to Promote the Healthy Development of Young Children Enrolled in Medicaid . The Commonwealth Fund. Available at https://www.

commonwealthfund. org/publications/fund-reports/2002/sep/partnering-parents-promote-healthy- development-young-children . National Academies of Sciences, Engineering, and Medicine.

(2019). Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity . Washington, DC: The National Academies Press.

https://doi. org/10. 17226/25466 .

HRSA-22-141 4 and integrate all facets of early developmental health and family well-being promotion into pediatric practices that serve such low-income populations. About MCHB and the Strategic Plan MCHB administers programs with focus areas in maternal and women’s health, adolescent and young adult health, perinatal and infant health, child health, and children with special health care needs.

To achieve its mission of improving the health and well-being of America’s mothers, children, and families, MCHB is implementing a strategic plan that includes the following four goals: Goal 1: Assure access to high-quality and equitable health services to optimize health and well-being for all MCH populations Goal 2: Achieve health equity for MCH populations Goal 3: Strengthen public health capacity and workforce for MCH Goal 4: Maximize impact through leadership, partnership, and stewardship This program addresses MCHB’s goals to assure access to high-quality and equitable health services to optimize health and well-being for all MCH populations and to strengthen public health capacity and workforce for MCH.

Specifically, the program aims to ensure that all young children and their families—especially those within communities that have been traditionally underserved or marginalized in health systems—can access a continuum of high-quality health promotion, prevention, early intervention, and treatment services. It also aims to improve workforce capacity to deliver integrated developmental health services within pediatric primary care.

To learn more about MCHB and the bureau’s strategic plan, visit https://mchb. hrsa. gov/about .

MCHB is committed to promoting equity in health programs for mothers, children, and families. This includes addressing SDoH, such as poverty and intimate partner violence, that affect a wide range of health, functioning, and quality-of-life outcomes and risks and can disproportionately affect underserved communities.

MCHB offers definitions of equity, health equity, SDoH, and underserved communities in Appendix A as a foundation for the development of programs that intend to improve access and equity among all communities. 1. Type of Application and Award Type of applications sought: New.

HRSA will provide funding in the form of cooperative agreements. A cooperative agreement is a financial assistance mechanism where HRSA anticipates substantial involvement with the recipient during the performance of the proposed project.

HRSA-22-141 5 In addition to the usual monitoring and TA provided directly to award recipients, HRSA program involvement will include: • Review of and collaborative input on the activities, procedures, measures, and tools for accomplishing the goals of the cooperative agreement; • Review and approval of implementation plans, performance measurement plans, and HRSA-required reports, and assistance in addressing identified challenges; • Review and feedback on written documents, including information and materials for the activities conducted through the cooperative agreement, before submission for publication or public dissemination; • Establishment of federal interagency partnerships, collaboration, and cooperation necessary to conduct the project; and • Assistance with the development of effective collaborations across recipient sites, other HRSA-funded award recipients, and other entities relevant for the successful completion of tasks and activities identified in the approved work plan.

The cooperative agreement recipient’s responsibilities will include: • Completion of activities that advance the goals of the cooperative agreement, consistent with the Notice of Funding Opportunity (NOFO), approved application, and subsequent approved project revisions or refinement; • Ongoing, timely communication and collaboration with the federal project officer, including response to inquiries about progress, budget, and activities; • Advance notice of any publications or materials produced; allowing the opportunity for review before distribution under the auspices of the cooperative agreement; and including a funding acknowledgment on all products, as designated in the Notice of Award (NOA); • Participation in face-to-face meetings, conference calls, and site visits during the period of performance; • Assurance that all performance and progress reports or other administrative information, as designated by HRSA in the NOA or subsequent Requests for Information (RFI), will be completed and submitted on time; • Collaboration with HRSA and/or designee in program-wide TA, evaluation, and continuous quality improvement (CQI) efforts; and • Development and submission of updated performance measurement and evaluation plans within 60 days of the start of each project year.

HRSA-22-141 6 HRSA estimates approximately $4,000,000 to be available annually to fund up to four recipients. You may apply for a ceiling amount of up to $1,000,000 total cost (includes both direct and indirect, facilities and administrative costs) per year. The period of performance is September 30, 2022 through September 29, 2026 (4 years).

Funding beyond the first year is subject to the availability of appropriated funds for the TPEC program in subsequent fiscal years, satisfactory progress, and a decision that continued funding is in the best interest of the Federal Government.

In the event of additional appropriations for this program, HRSA may fund additional applicants from the rank order list, extend the period of performance, and/or invite proposals from award recipients for supplemental funding. HRSA may reduce or take other enforcement actions regarding recipient funding levels beyond the first year if they are unable to make adequate progress toward achieving the goals listed in the application.

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.

§ 5304 (formerly cited as 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. If funded, for-profit organizations are prohibited from earning profit from the federal award (see 45 CFR § 75.

216(b)). Cost sharing/matching is not required for this program. HRSA may not consider an application for funding if it contains any of the non-responsive criteria below: • Exceeds the ceiling amount • Fails to satisfy the deadline requirements referenced in Section IV.

4 • Does not include all required application elements, including a project abstract, a complete project narrative, a budget, a budget narrative, and required attachments. HRSA-22-141 7 NOTE: Multiple applications from an organization are not allowable. HRSA may select only one entity to implement the program in a particular state, territory, jurisdiction, or tribal area .

HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, before the Grants. gov application due date as the final and only acceptable application. Eligible applicants may elect to jointly develop, implement, and evaluate the proposed program.

HRSA supports such an approach when it appropriately increases the efficiency and scale of proposed activities. In these cases, the application must be submitted by one eligible applicant that proposes to provide subawards to other eligible applicant(s) to jointly develop, implement, and evaluate this program. ## 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 Grants. gov: HOW TO 2.

Content and Form of Application Submission Application Format Requirements Section 4 of HRSA’s SF-424 Application Guide provides general instructions for the budget, budget narrative, staffing plan, and personnel requirements, assurances, certifications, etc. You must submit the information outlined in the HRSA SF-424 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 HRSA SF-424 Application Guide for the Application Completeness Checklist. HRSA-22-141 8 Application Page Limitation The total size of all uploaded files included in the page limit shall be no more than the equivalent of 50 pages when printed by HRSA.

The page limit includes the project and budget narratives, and attachments required in the Application Guide and this NOFO. Please note: Effective April 22, 2021, the abstract is no longer an attachment that counts in the page limit. The abstract is the standard form (SF) "Project Abstract Summary.

” Standard OMB-approved forms included in the workspace application package do not count in the page limit. If you use an OMB-approved form that is not included in the workspace application package for HRSA-22-141, 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 50 will not be read, evaluated, or considered for funding. Applications must be complete, within the maximum specified page limit, and validated by Grants. gov under HRSA-22-141 before 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.

§3354). 3) If you are unable to attest to the statements in this certification, you must include an explanation in Attachments 7–15: Other Relevant Documents . See Section 4.

1 viii of HRSA’s SF-424 Application Guide for additional information on all Program Requirements and Expectations Recipients are responsible for the placement of ECD experts in multiple pediatric primary care settings within a state, territory, jurisdiction, or tribal area; 20 pediatric practice partners must serve a high percentage 21 of P–5 populations who are eligible for > 20 This NOFO uses the terms ‘state’ and ‘state-level’ for brevity, but these are inclusive of each state of the United > States, the District of Columbia, each territory or possession of the United States, and each Indian Tribe (as defined in section 4 of the Indian Self-Determination and Education Assistance Act (25 U.S.C.

§ 5304)). > 21 HRSA defines “a high percentage of P–5 populations who are eligible for Medicaid or CHIP or are uninsured” to mean one or both of the following: 1) a service population with at least 50% Medicaid or CHIP-eligible or uninsured, or 2) a Medicaid/CHIP or uninsured utilization rate of at least one standard deviation above the average for pediatric primary care practices in the state that receive Medicaid payments.

Medicaid or CHIP or are uninsured. HRSA encourages applications that are from, or propose strong partnerships with, the organizations listed in Appendix D in order to successfully engage pediatric practices and support state-level infrastructure required for effective program implementation.

HRSA expects ECD experts placed through this program to deliver or facilitate a continuum of ECD services (promotion, surveillance and screening, care coordination and linkage, and intervention), in line with Bright Futures recommendations, AAP Policy Statements and Guidance , and PCMH guidelines . Additional elements may be implemented based upon practice capacity and population need.

See Appendix B for more details regarding expectations and resources. Recipients must collaborate with the Early Childhood Developmental Health System (ECDHS): Evidence to Impact Center (described in HRSA-22-091 ), if funded to support TPEC, to improve program quality, align efforts with current evidence and work of other recipients, and support program-wide evaluation.

Successful applications will address the following program expectations: 1. Facilitate the placement of ECD experts into pediatric practices. a.

Funding recipients may provide support to pediatric practice partners to hire new staff or train existing staff to achieve core ECD competencies and serve relevant functions, as further described below. Recipients may also provide support for additional staffing, site infrastructure, data collection, and reporting to facilitate ECD expert placement.

o HRSA prefers that ECD experts function in a full-time, in-person capacity within the placement setting, but encourages the use of innovative approaches, including telehealth, where appropriate, to meet patient needs effectively.

22 o HRSA expects programs to scale up the number of practices in their state with an integrated ECD expert, and to increase the number of P– 5 families reached, as primary outcomes during the period of performance. HRSA encourages recipients to develop and implement their pediatric practice engagement strategy in partnership with pediatric practitioners and related advisors, to ensure feasibility.

Initial pediatric practice partners should be engaged within the first 6 months; additional partners may be added later in the project. HRSA will request letters of agreement from initial practice partners within 180 days after award. o ECD experts should function as part of an integrated primary care team, 23 rather than an isolated specialty provider.

Specific functions of > 22 Telehealth is defined as the use of electronic information and telecommunications technologies to support and promote, at a distance, health care, patient and professional health-related education, health administration, and public health. Find more information at Telehealth. hhs.

gov . Funding and other resources to support telehealth access > is available through the Federal Communication Commission’s Universal Service Program . > 23 See National Academies of Sciences, Engineering, and Medicine.

(2021). Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care (Chapter 5). Washington, DC: The National Academies Press.

> https://doi. org/10. 17226/25983 .

ECD experts and other staffing supports should reflect patient population, practice, and systems context and needs. o Recipients may facilitate ECD expert placement within pediatric practice partner settings via direct financial support (e.g., subawards), in-kind contributions of staff time or other shared resources, TA, and/or other means.

The type and amount of support provided should reflect both current practice capacity and broader health and early childhood systems contexts (e.g., existence of Medicaid/CHIP reimbursement codes for developmental health services, local workforce availability).

TPEC program funds may help support partial or full staffing costs; however, HRSA strongly encourages the use of alternative funding sources to the maximum extent possible in support of long-term sustainability of ECD placements. 2. Provide training, TA, and implementation resources for pediatric practices.

a. In addition to the placement of ECD experts into partner pediatric practices, HRSA expects recipients to provide ongoing training, TA, and implementation resources and support to pediatric practice partners throughout the period of performance, to achieve practice transformation that reaches P–5 families.

o This may include support for ECD expert recruitment and other staffing changes, expansion of ECD services, and other practice and organizational changes (see Appendix C ). Recipients may provide this support directly and/or through partnerships with other national, state, or local organizations, including those that provide training and TA for specific practice transformation models or family interventions. b.

Resources and supports should reflect the needs of pediatric practices that serve Medicaid or CHIP-eligible and uninsured populations, reduce burden on practices, leverage existing resources, centralize common processes, and achieve economies of scale across practices. HRSA expects recipients to work closely with pediatric practice partners to develop and implement plans for sustaining ECD services beyond the federal funding period.

HRSA encourages efforts to promote shared learning and innovation across practices. c. Note: HRSA does not require use of a particular model of ECD practice enhancement or transformation; rather, HRSA expects recipients to focus on delivering culturally and linguistically appropriate, high-quality services that advance early developmental health and well-being outcomes over time as outlined in Appendix B .

HRSA-22-141 11 3. Develop a plan and partner to address policy and financing barriers, ECD workforce needs, care coordination, service gaps, and other barriers to sustained ECD services. a.

In the first year, recipients should identify key barriers to ECD service delivery in target pediatric settings and develop a plan for reducing or resolving these barriers during the period of performance. Key barriers should include those that inhibit sustained spread and scale of ECD services. b.

Recipients are expected to partner with state and local early childhood systems and pediatric practice transformation efforts (recommended partners are in Appendix D ).

These partnerships should advance both practice-level goals (e.g., engaging Medicaid or CHIP-eligible and uninsured families in health services, connecting patients to and coordinating with comprehensive services in the community) and systems-wide solutions (e.g., workforce development improvements, centralized or coordinated intake and referral systems).

Physician champions can be key partners at both practice and program levels to guide program activities and promote practice transformation efforts. c. Recipients are expected to maintain awareness of relevant policy and financing efforts in their state and to develop and implement a plan for sustainable financing of ECD integration efforts during and beyond the period of performance.

Close partnerships with health system payers— especially Medicaid and CHIP—and other public and private funding streams to support ECD integration will be critical to program success. Plans may include development or use