Community Support Program: Cooperative Agreements for Employment Intervention Demonstration Program

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Community Support Program: Cooperative Agreements for Employment

Intervention Demonstration Program

AGENCY: Center for Mental Health Services, Substance Abuse and Mental

Health Services Administration (SAMHSA), HHS.

ACTION: Notice of availability of funds and request for applications.

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*It is important to note that applications are invited based on

the funding levels proposed in the President's budget for fiscal

year 1995. However, this RFA is being announced prior to an

appropriation of funds in order to allow applicants sufficient time

to establish collaboration and coordination and prepare

applications. Solicitation of applications in advance of an

appropriation will also enable the award of appropriated grant funds

in the most expeditious manner and allow prompt implementation and

evaluation of promising employment intervention programs for adults

with severe mental illnesses. All applicants should understand,

however, that final appropriation action will be necessary in order

for CMHS to fund any applications. Questions regarding the status of

the appropriation of funds should be directed to the program

official listed under Contacts for Additional Information in this

notice.

SUMMARY: The Center for Mental Health Services (CMHS) announces the

availability of demonstration grants to document the effectiveness of

programs designed to enhance competitive employment for adults with

severe mental illnesses. Funds will be awarded through the Community

Support Program (CSP) of the Division of Demonstration Programs of

CMHS. This request for applications (RFA) solicits applications for two

types of awards:

Demonstration Sites and a Coordinating Center.

This demonstration program addresses a priority mental health need:

the enhancement of competitive employment for adults with severe mental

illnesses. A collaborative, multisite approach is essential to test the

effectiveness of different employment interventions and synthesize the

intervention results. Because of the complexity of the program,

requiring substantial programmatic involvement of CMHS staff to

facilitate communication and coordination across projects, the

cooperative agreement mechanism is being used.

This notice consists of three parts:

Part I covers information on the legislative authority and the

applicable regulations and policies related to the Community Support

Program: Cooperative Agreements for Employment Intervention

Demonstration Program.

Part II describes the target population, the issue, and the

programmatic goal and discusses eligibility, availability of funds,

period of support and the receipt date for applications.

Part III describes special requirements of the program, the

application process, the review and award criteria and lists contacts

for additional information.

Part I--Legislative Authority and Other Applicable Regulations and

Policies

Cooperative agreements awarded under this RFA are authorized under

Section 520A of the Public Health Service Act, as amended (42 U.S.C.

290bb-32).

Federal regulations at Title 45 CFR Parts 74 and 92, generic

requirements concerning the administration of grants, are applicable to

these awards.

Grants must be administered in accordance with the PHS Grants

Policy Statement dated April 1, 1994 (DHHS Publication No. (OASH) 94-

50,000 (Rev)). This policy statement is effective for all grants with

budget periods beginning on or after April 1, 1994. It also reflects

policies with earlier effective dates. This document supersedes the PHS

Grants Policy Statement dated October 1, 1990, as updated September 1,

1991.

The Catalog of Federal Domestic Assistance (CFDA) number for this

program is 93.125.

Reporting Requirements: Interim and final progress reports and

financial status reports will be required and specified to awardees in

accord with PHS Grants Policy requirements.

The Public Health Service (PHS) is committed to achieving the

health promotion and disease prevention objectives of Healthy People

20001, a PHS-led national activity for setting priority areas.

This RFA, ``Employment Intervention Demonstration Program,'' is related

to the objectives set forth in Chapter 6, Mental Health and Mental

Disorders, in Healthy People 2000: National Health Promotion and

Disease Prevention Objectives.

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\1\Potential applicants may obtain a copy of Healthy People 2000

(Full Report: Stock No. 017-001-00474-0; or Summary Report: Stock

No. 017-001-00473-1) through the Superintendent of Documents,

Government Printing Office, Washington, D.C. 20402-9325 (Telephone:

202-783-3238).

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Part II--Target Population, Issue and the Programmatic Goal and Project

Requirements and Activities, Eligibility and Application Receipt Date

Purpose: The goal of this RFA is the generation of knowledge about

effective approaches for enhancing competitive employment for adults

with severe mental illnesses through support for the implementation and

evaluation of promising employment intervention programs. Applications

are being solicited for Demonstration Sites to conduct a multisite,

cooperative study of employment interventions to enhance competitive

employment. Applications are also being sought for a Coordinating

Center to provide overall coordination and data management and to carry

out the common protocol which will be developed.

Target Population: The population of concern for CSP grants

includes individuals 18 years and older with severe mental illnesses

(including, but not limited to, schizophrenia, schizoaffective

disorders, mood disorders, and severe personality disorders) that

substantially interfere with a person's ability to carry out such

primary aspects of daily living as self-care, household management,

interpersonal relationships, and work or school.

Statement of Issue: Rehabilitation is an essential component of

care for adults with severe mental illnesses. In order to enhance

independent living as fully as possible, rehabilitation services need

to include appropriate vocational rehabilitation, which may include:

assessment of potential for employment, training, job placement,

continuing support, and reasonable accommodations at the work site. In

addition to providing remuneration and social contacts, employment may

promote improvements in self esteem, independence, community

integration, and self-management of illness. People with psychiatric

disabilities are the second largest group of applicants for vocational

rehabilitation services and have the lowest rate of success. Even with

high client motivation and the support of families, rates of employment

for this population are very low, ranging from 10 percent to 25

percent.

Special attention should be focused on persons from ethnic minority

communities who are over-represented in the adult severe mental illness

population. With involvement of these community members at each stage

of design, implementation and evaluation, culturally competent

interventions can be successful.

Program Goal: This demonstration program addresses a priority

mental health need: competitive employment in integrated settings for

adults with severe mental illnesses. Competitive employment is defined

as a paid position which is open to anyone and pays at least minimum

wages. Employment may include positions in a mental health system as

long as the positions are not restricted to adults with diagnoses of

severe mental illnesses. On-site and/or off-site long-term supports may

be utilized. Because there is a need for systematically bringing

together information concerning employment intervention programs, CMHS

is initiating this program to determine the effectiveness of

interventions. Findings concerning the most effective approaches and

the associated direct costs are needed by policy makers and program

planners.

This program of study is focussed on employment interventions which

will lead to competitive employment. The goal of the intervention,

which may include vocational training and environmental accommodations,

must be competitive employment in mainstream (not sheltered) work

environments. Outcome measures may include, but are not limited to,

days of paid employment within a specified time interval, level of

social and occupational functioning, and consumer and employer

satisfaction.2 Effective employment interventions are an integral

part of a community support system and, therefore, are expected to be

integrated with other services as appropriate.

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\2\Technical assistance, provided upon request, will include a

review of instruments prepared by Cook, J., Bond, G., Hoffschmidt,

S., et al., Assessing Vocational Performance Among Persons with

Severe Mental Illness, published by Thresholds National Research and

Training Center, Chicago, IL: 1992.

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The goals of this program address the themes of the Secretary of

HHS: fostering independence through empowering people served;

preventing future problems; and improving services to customers through

modern management approaches.

Demonstration Site applicants will develop, implement, and evaluate

an intervention with the goal of improving competitive employment. This

multisite, cooperative agreement will also develop a common study

protocol. After grantees are selected for funding, grantees and CMHS

staff will identify issues and study questions which can be examined by

utilizing the data elements in common across the Demonstration Sites.

The utilization of agreed-upon measures which are in common across

Demonstration Sites provides the opportunity to compare intervention

effects for different populations in different geographic locations,

thereby enhancing the generalizability of results, and allows for

statistical analyses that assess the effects of multiple factors on

employment status outcomes.

Progress in employment is often characterized by episodes of

productive employment followed by unemployment. Therefore, a long-term

perspective is needed to appropriately assess outcomes of an

intervention. Successful applicants for this program of study will

include data collection over a period of at least 2 years, and a longer

time interval for data collection is encouraged.

The primary goal of this RFA is the determination of the

effectiveness of interventions. However, information on costs will be

valuable in informing policy decisions for resource allocations.

Effectiveness is defined as the improvement of positive outcomes and

the reduction of adverse outcomes, regardless of costs. An important

component in studying the value of an intervention is the determination

of the costs of the intervention. Because this is an initial

exploration of costs, the focus will be limited to actual direct

expenditures for employment intervention programs and employment site

activities. Costs unique to the evaluation component will not be

included in the analyses. Cost information from this demonstration

program may provide the basis for future studies of cost effectiveness

that would likely be expanded to incorporate financial costs, indirect

costs, and lost-opportunity costs.

Structure and Phases of the MultiSite Program: The study will

involve the cooperation of personnel from (1) a Coordinating Center,

(2) the Demonstration Sites, and (3) the CMHS staff.

Awards will be made for a project period of up to 5 years. For

planning and budgeting purposes, the study can be envisioned as

proceeding in the following three phases.

Phase I: Development of a collaborative study plan (common protocol);

development, refinement, and pilot testing of common methodological

procedures and instruments (baseline and outcome); training in the

common field procedures; examination of validity of proposed

instruments and development of a centralized database and coordinating

structure, intervention start up (months 1-6);

Phase II: Full implementation of service programs, identification and

enrollment of clients; ongoing data collection and evaluation

activities; interim data analyses (months 6-30);

Phase III: Phase-down of intervention programs; end enrollment of

clients in the study; complete follow-up data collection for enrolled

clients; conduct data analyses and produce reports and publications

(months 30-60).

Role of Demonstration Sites: Each Demonstration Site grantee, in

collaboration with the Federal staff and the Coordinating Center, will

have responsibility at their own site for service program planning and

implementation, client enrollment and follow up, data collection,

preliminary and final data analysis and interpretation, quality

control, and preparation of reports and publications. In addition, each

Demonstration Site grantee will participate in the development and

activities of the common protocol including providing data to the

Coordinating Center.

Role of the Coordinating Center: For the common protocol which will

be developed in the planning phase, the Coordinating Center will

provide overall study coordination, including data management and

analysis, training in common procedures, distribution of common

materials to all study sites, monitoring of data quality and analysis

of cost data collected by the Demonstration Sites. The Coordinating

Center will also coordinate the pilot testing of the common core

instruments, as agreed upon in the planning phase. CMHS staff will work

with and monitor the Coordinating Center. The Coordinating Center will

develop and maintain a common data repository, containing those data

elements collected by each Demonstration Site which will be used in the

common protocol.

Role of CMHS Staff: CMHS staff will be active participants in all

aspects of the cooperative agreements and will serve as collaborators

with project directors from the Demonstration Sites and the

Coordinating Center. CMHS staff have overall responsibility for

monitoring the conduct and progress of this program and will make

recommendations regarding continuance of the program. CMHS staff will

provide substantial input, in collaboration with the grantees, both in

the planning and conduct of this program.

Role of the Steering Committee: The Steering Committee will be

composed of the project director of the Coordinating Center, the

project directors from each of the Demonstration Sites, and CMHS staff.

In addition, for Demonstration Sites where the State mental health

authority is not the direct applicant, the State mental health

authority will be invited to be a participant as a voting member of the

committee.

All participating grantees will agree to abide by the common

protocol study design and policy recommendations developed by the

Steering Committee and any required CMHS approvals set forth in the

terms and conditions of this cooperative agreement.

Eligibility: Eligible applicants include States, political

subdivisions of states and nonprofit private agencies. Therefore, State

mental health authorities, as well as one or more of public

organizations in a State, such as units of State and local governments,

and nonprofit organizations such as community-based organizations,

universities, colleges and hospitals may be direct applicants.

Entities may apply for either and/or both types of awards

(Demonstration Site and/or Coordination Center).

Availability of Funds: It is estimated that approximately $2.3

million will be available to support approximately four to five awards

to Demonstration Sites and a Coordinating Center under this RFA in FY

95. For each of the 5 years, an average of approximately $300,000 per

year will be available for the Coordinating Center and an average of

$400,000 to $500,000 for each of the Demonstration Sites for each year.

It is anticipated that in years one and five, funding of the

Coordinating Center will be higher than in years two through four.

Funding for Demonstration Sites will be lower in years one and five,

and higher in years two through four. Actual funding levels will depend

upon the availability of appropriated funds.

(Note: CMHS is required by the Public Health Service Act to make

available 15 percent of the funds appropriated under Section 520A

for projects in rural areas.)

Period of Support: Support may be requested for a period of up to 5

years. Annual awards will be made subject to continued availability of

funds and progress achieved.

Applications Receipt Date and Review Schedule: The schedule for

receipt and review of applications under this announcement is as

follows:

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Earliest start

Receipt date IRG review Council review date

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Jan. 10, 1995.... March 1995....... May 1995........ June 1995.

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Consequences of Late Submission: Applications received after the

above receipt date will not be accepted and will be returned to the

applicant without review.

The DRG system requires that applications must be received by the

published application receipt date(s). However, an application received

after the deadline may be acceptable if it carries a legible proof-of-

mailing date assigned by the carrier and the proof-of-mailing date is

not later than one week prior to the deadline date. Private metered

postmarks are not accepted as proof of timely mailing. If the receipt

date falls on a weekend, it will be extended to the following Monday;

if the date falls on a national holiday, it will be extended to the

following work day.

Part III--Special Requirements, Review/Award Criteria and Contacts for

Additional Information

Letter of Intent: Organizations planning to submit an application

in response to this announcement are requested to submit a letter of

intent at least 30 days prior to the receipt date. Such notification is

used by the Center for Mental Health Services for purposes of review

and program planning. This letter is voluntary and does not obligate

the person/organization to submit an application. In addition, the

letter should be no longer than one page and should succinctly

indicate:

--The number and title of the RFA.

--The name of the potential applicant organization, city and state.

--The name and affiliation of the proposed project director, i.e., the

individual who will be assigned to coordinate the development and

conduct of the project.

--The overall scope of the proposed project, including a brief

description of the likely goals and objectives.

Letters of intent should be directed to: Barbara Silver, PhD,

Acting Director, Office of Extramural Policy and Review, Center for

Mental Health Services, 5600 Fishers Lane, Room 18C-07, Rockville,

Maryland 20857, Attn: RFA/Letter of Intent.

Coordination with Other Federal/Non-Federal Programs: Applicants

seeking support under this announcement are encouraged to coordinate

with other programs. Program coordination helps to better serve the

multiple needs of the patient/client population, maximize the impact of

available resources, and eliminate duplication of services. Applicants

should identify the coordinating organizations by name and address and

describe the process to be used for coordinating efforts. Letters of

commitment specifying the kind(s) and level of support from

organizations (both Federal and non-Federal) which have agreed to work

with the applicant must be attached to this application. CMHS will

consider an applicant's proposed coordination with other Federal/non-

Federal programs in its award decision-making process. (Please see

Award Criteria section.) A list of Federal programs that applicants may

coordinate with is included in the Application kit.

Single State Agency Coordination: Coordination with the Single

State Agency (SSA) for mental health is encouraged to ensure

communication, reduce duplication, and facilitate continuity. Therefore

applicants who are not State mental health authorities must include a

copy of a letter sent to the SSA briefly describing the grant

application. A list of SSAs can be found in the grant application kit.

If the target population falls within the jurisdiction of more than one

State, all representative SSAs should be involved.

Intergovernmental Review (E.O. 12372): Applications submitted in

response to this announcement are subject to the intergovernmental

review requirements of Executive Order 12372, as implemented through

DHHS regulations at 45 CFR Part 100. E.O. 12372 sets up a system for

State and local government review of applications for Federal financial

assistance. Applicants (other than federally recognized Indian Tribal

Authorities) should contact the State's Single Point of Contact (SPOC)

as early as possible to alert them to the prospective application(s)

and to 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. A current listing of SPOCs

is included in the application kit. The SPOC should send any State

process recommendations to the following address: Barbara Silver, PhD,

Acting Director, Office of Extramural Policy and Review, Center for

Mental Health Services, 5600 Fishers Lane, Room 18C-07, Rockville, MD

20857, Attn: SPOC.

The due date for State process recommendations is no later than 60

days after the deadline date for the receipt of applications. The

Center for Mental Health Services does not guarantee to accommodate or

explain SPOC comments that are received after the 60-day cut-off.

Public Health System Reporting Requirements: This program is not

subject to the Public Health System Reporting Requirements.

Promoting Nonuse of Tobacco: Studies have clearly established that

the use of tobacco products increases mortality and morbidity, not only

for the primary users of these products but for those in close

proximity to the user. Statistics published by the National Cancer

Institute indicate that cigarette smoking and chewing of tobacco are

responsible for as many as 1,500 deaths per day in the United States.

Recent studies conducted by the Environmental Protection Agency

indicate that prolonged exposure to second-hand smoke significantly

increases the probability of developing heart and lung disease.

Consistent with its mission to protect and advance the physical and

mental health of the American people, it is the policy of PHS to

strongly encourage all recipients of the PHS grants to provide a smoke-

free work place and promote the nonuse of tobacco products. It is also

the policy of PHS to encourage those recipients which already have a

smoke-free work place and promote the nonuse of tobacco products to

continue such practices. Particular attention should be given to

avoiding exposure to secondary smoke by pregnant women and children.

Additionally, CMHS strongly encourages all cooperative agreement

applicants to implement policies and activities that promote the nonuse

of tobacco products by clients/patients as a goal of treatment.

Application Procedures: Completely separate applications must be

submitted for Demonstration Sites and for the Coordinating Center.

All applicants must use application form PHS 5161-1 (Rev. 7/92),

which contains Standard Form 424 (face page). Grant application kits

(including form PHS 5161-1 with Standard Form 424, complete application

procedures, and accompanying guidance materials for the narrative

approved under OMB No. 0937-0189) may be obtained from: Community

Support Program, Center for Mental Health Services, 5600 Fishers Lane,

Room 11C-22, Rockville, MD 20857, 301/443-3653.

Applicants must submit: (1) an original copy signed by the

authorized official of the applicant organization, with the appropriate

appendices; and (2) two additional, legible copies of the application

and all appendices to the Division of Research Grants, NIH. Center for

Mental Health Services Programs, Division of Research Grants, NIH,

Westwood Building, Room 240, 5333 Westbard Avenue, Bethesda, Maryland

20892*.

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*If an overnight carrier or express mail is used, the Zip Code

is 20816.

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Review Process: Applications submitted in response to this RFA will

be reviewed for technical merit in accordance with established PHS/

SAMHSA peer review procedures for grants.

Applications that are accepted for review will be assigned to an

Initial Review Group (IRG) composed primarily of non-Federal experts.

Notification of the IRG's recommendation will be sent to the applicant

upon completion of the initial review. In addition, the IRG

recommendations on technical merit of applications will undergo a

second level of review by the appropriate advisory council whose review

may be based on policy considerations as well as technical merit.

Applications may be considered for funding only if the advisory council

concurs with the IRG's recommendation for approval.

Review Criteria for Demonstration Site Applications: The points

noted in the parentheses for each criterion indicate the maximum number

of points the reviewers may assign to that criterion. These points will

be used to calculate a raw score for each application. The raw score

will be converted to the official priority score.

Significance of the Project (30)

Potential significance of the proposed project for

increasing the knowledge of effective employment interventions,

including original approaches and documenting the effectiveness of

established approaches.

Appropriateness of the applicant's proposed project to the

goals of this announcement.

Consistency of the proposed project relative to the

knowledge base of evaluating employment interventions.

Adequacy and Appropriateness of Project Plans (20)

In terms of the applicant's stated goals and objectives.

In terms of the project management plan, implementation

plan, and proposed staffing and resources.

In terms of cultural competency for all aspects of project

plans, addressing factors such as gender, age, ethnicity, and other

relevant characteristics.

Adequacy and Appropriateness of Evaluation Plans (35)

In terms of the adequacy to determine the effectiveness of

the intervention, including overall effectiveness, relative

effectiveness of components, and cost effectiveness.

In terms of the applicant's stated goals and objectives.

In terms of the proposed staffing and resources, project

management plan, and implementation plan.

In terms of cultural competency for all aspects of

evaluation plans, addressing factors such as gender, age, ethnicity,

and other relevant characteristics.

Appropriateness of Staffing, Project Organization, and

Resources (15)

Qualifications and experience of the project director and

other key personnel, including representation of appropriate cultural

groups in staff.

Adequacy of available resources (e.g., facilities,

equipment).

Capability and experience of the applicant organization

with multisite projects.

Adequacy of support for the project from other relevant

organizations.

Appropriateness of the proposed budget for each of the

requested years (the IRG may recommend either increases or decreases in

the budget based on their review of the application or on the adequacy

of the budget justification).

Review Criteria for Coordinating Center Applications:

Significance of the Project (20)

Understanding the issues and advantages in using a

multisite approach in the development of the common protocol, including

the logistics of convening program meetings.

Adequacy of plans for enhancing cooperation, and

preventing or ameliorating problems in cooperation among grantees.

Adequacy and Appropriateness of Evaluation Plans (40)

In terms of development of the common protocol, training,

an appropriate data base structure, security measures and procedures

for safeguarding of data.

In terms of data analysis based on the common protocol.

In terms of potential evaluation concerns unique to this

population and this type of program.

Appropriateness of Staffing, Project Organization, and Resources (40)

Qualifications and experience of the proposed staff in

similar multisite efforts.

Adequacy of the existing and proposed facilities and

resources.

Appropriateness of proposed budget for each of the

requested years.

Award Criteria: Applications recommended for approval by the

Initial Review Group and the CMHS Advisory Council will be considered

for funding on the basis of their overall technical merit as determined

through the review process. Other award considerations may include:

Availability of funds.

Coordination with other Federal/non-Federal programs.

For Demonstration Sites, complementarity of designs and

interventions, including factors such as ethnic groups, geographic

area, socioeconomic status, mental illness diagnosis.

In accordance 520A of the Public Health Service Act, no more than

10 percent of a grant may be expended for administrative expenses.

Contacts for Additional Information: Questions concerning program

issues may be directed to: Martha Ann Carey, PhD, RN, Community Support

Program, Center for Mental Health Services, 5600 Fishers Lane, room

11C-22, Rockville, MD 20857, (301) 443-3653.

Questions regarding grants management issues may be directed to:

Ms. Carole Edison, Grants Management Office, Center for Mental Health

Services, 5600 Fishers Lane, room 15C-05, Rockville, Maryland 20857,

(301) 443-4456.

Dated: August 24, 1994.

Richard Kopanda,

Acting Executive Officer, SAMHSA.

[FR Doc. 94-21290 Filed 8-29-94; 8:45 am]

BILLING CODE 4162-20-P