HIV/AIDS Mental Health Services Demonstration Program (Includes Cooperative Agreements for Services Demonstration Projects and One Coordinating Center)

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

RIN 0905-ZA24

HIV/AIDS Mental Health Services Demonstration Program (Includes

Cooperative Agreements for Services Demonstration Projects and One

Coordinating Center)

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

Health Services Administration, HHS.

ACTION: Request for applications.

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SUMMARY: The Center for Mental Health Services (CMHS), Substance Abuse

and Mental Health Services Administration (SAMHSA), in collaboration

with the Health Resources and Services Administration (HRSA) and the

National Institutes of Health (NIH), announces the availability of

fiscal year (FY) 1994 funds for a new HIV/AIDS Mental Health Services

Demonstration Program.

Because of the complexity of this program, a cooperative agreement

mechanism is being utilized to allow for substantial Federal

programmatic participation in the conduct of the program, and to

facilitate communication and coordination in the overall implementation

and evaluation of the program. The program will include cooperative

agreements for services demonstration projects to provide mental health

services to people affected by and living with HIV/AIDS and a

coordinating center which, in conjunction with the services

demonstration projects, will design and implement the overall

evaluation of the HIV/AIDS Mental Health Services Demonstration

Program. A steering committee will be established to facilitate

coordination and cooperation among the services demonstration projects

and the coordinating center, and to oversee the cooperative agreements.

The HRSA Bureau of Health Resources Development (BHRD) and the NIH

National Institute of Mental Health (NIMH) also will provide funding

support for certain aspects of these cooperative agreements, will

recommend reviewers for the review of applications, will participate on

the steering committee, and will otherwise be involved in the

implementation of the HIV/AIDS Mental Health Services Demonstration

Program.

This notice consists of three parts:

Part I covers information on the legislative authority and the

applicable regulations and policies related to the HIV/AIDS Mental

Health Services Demonstration Program.

Part II describes the purpose, goals and scope of the program 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

Sections 520B (42 U.S.C. 290bb-33), 520 (42 U.S.C. 290bb-31), 501 (42

U.S.C. 290aa), 405 (42 U.S.C. 284), and 464R (42 U.S.C. 285p) of the

PHS Act and 42 U.S.C. 300ff-28.

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

requirements concerning the administration of grants, are applicable to

these awards.

Cooperative Agreements must be administered in accordance with the

PHS Grants Policy Statement (Rev. April 1, 1994).

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

program is 93.215.

Interim and final progress reports and financial status and

expenditure reports will be required and specified to cooperative

agreement awardees in accord with PHS Grant Policy requirements.

Healthy People 2000: The Public Health Service (PHS) is committed

to achieving the health promotion and disease prevention objectives of

Healthy People 2000, a PHS-led activity to reduce morbidity and

mortality and improve the quality of life. This Request for

Applications (RFA), HIV/AIDS Mental Health Services Demonstration

Program, is related to the priority of HIV/AIDS infection. Potential

applicants may obtain a copy of Healthy People 2000 (Full Report: Stock

No. 017-001-0474-0; or Summary Report: Stock No. 017-001-00473-1)

through the Superintendent of Documents, Government Printing Office,

Washington, DC 20402-9325 (Telephone: 202-783-3238).

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.

Therefore, the CMHS strongly encourages all awardees to provide smoke-

free project and work environments.

A number of the goals of this program are consistent with the

President's Health Care Reform initiative (e.g., providing quality

mental health services, reducing the number of unnecessary inpatient

and outpatient medical visits, and increasing productive work capacity

as a result of receiving these services) and support the DHHS

Secretary's themes of fostering independence through empowering the

people, preventing future problems, and improving services to our

customers.

Part II--Programmatic Purpose, Goals and Scope, Eligibility and

Application Receipt Date

Services Demonstration Projects: CMHS will award competitive

cooperative agreements under Section 520B of the Public Health Service

(PHS) Act to develop or expand programs to provide mental health

services for individuals, their families and others who experience

serious psychological reactions as a result of HIV/AIDS antibody

testing, and to provide mental health services for people with HIV/

AIDS. The services demonstration projects will be responsible for an

evaluation that includes collection of both process and outcome data

and that will document the extent to which the objectives set forth in

the application have been met.

The services demonstration projects will also participate in the

development of an overall evaluation of the HIV/AIDS Mental Health

Services Demonstration Program by the coordinating center, as described

below.

Coordinating Center: CMHS will award one competitive cooperative

agreement to a recipient which, in conjunction with the services

demonstration projects, will design and implement the overall

evaluation of the HIV/AIDS Mental Health Services Demonstration

Program. This will include evaluating the effectiveness and efficiency

of the different approaches or models used for organizing and providing

the mental health services. The coordinating center will also provide

the overall coordination and management of the program data.

Steering Committee: The project directors of the coordinating

center and the services demonstration projects, and CMHS, BHRD and NIMH

representatives, will work collaboratively via a steering committee to

facilitate coordination and communication among the parties. The

steering committee will have the responsibility for overseeing the

cooperative agreements to develop consensus on major decisions and to

facilitate the accomplishment of the HIV/AIDS Mental Health Services

Demonstration Program goals.

Program Description

Purpose: The purposes of the cooperative agreement program are to:

1) Provide a range of high quality mental health services to people

affected by or living with HIV/AIDS; 2) Evaluate the effectiveness and

efficiency of the different approaches or models used for organizing

and providing those services; and 3) Determine the outcome of those

services on the quality of life of the individuals served.

Program Goals and Scope: The goals of this cooperative agreement

program are to:

Provide a range of quality mental health services.

Change risk behaviors and prevent further HIV

transmission.

Increase compliance with medical treatment and enhance

access to existing services.

Reduce the number of unnecessary inpatient and outpatient

medical visits.

Decrease the risk of suicide.

Improve the quality of life for those individuals affected

by and living with HIV/AIDS.

Increase productive work capacity as a result of receiving

these services.

Develop and rigorously evaluate models for replication and

integration into HIV/AIDS delivery systems.

Disseminate information about successful service models.

A. Applications for Services Demonstration Projects Funding

Target Populations: The target population includes people affected

by or living with HIV/AIDS. Within the target population, gay and

bisexual men, racial and ethnic minorities, women, injection drug

users, children and adolescents, adults with serious mental illnesses,

children and adolescents with serious emotional disturbances, the

incarcerated, and people who are homeless are of particular interest.

Demonstrated Need: Unmet need will be a primary criterion in the

review of applications under this announcement. Methodology used to

compile local needs assessment data must be described.

Recommended Approach: Applicants should address, in the

``Approach'' section of the application, the specific mental health

services listed below, and the development of an infrastructure that

includes the additional project elements also described below. The

services may be provided directly or through contract.

Specific Mental Health Services

The application should address at least the first four of the

following services:

HIV/AIDS risk and transmission reduction counseling.

A range of mental health treatment services, e.g., group

therapy, supportive counseling, peer counseling, buddy programs,

oversight of psychotropic medication, psychotherapy, and family

therapy, including alternative families, partners, and significant

others.

Diagnostic mental health services, including neurological

consults and psychological testing.

HIV/AIDS antibody pre-test counseling and appropriate

post-test counseling for those who test positive for HIV/AIDS antibody

as well as those who test negative.

Mental health case management services.

Counseling to ensure adherence to tuberculosis and other

treatment regimens.

Outreach mental health services, e.g., educating the

community to facilitate referrals to your project.

Consultation services, e.g., to schools, foster parents,

day care centers, alternative health care sites and clinics that serve

special populations described above.

Home based mental health services.

Additional Project Elements

Applicants should address the development of an infrastructure that

includes the following:

Relationships with or a plan to build relationships with a

variety of other non-HIV/AIDS health, mental health, and support

service providers such as, State Mental Health or Substance Abuse Block

Grant Programs, maternal and child health services, primary health care

services, financial and other resource supports, legal services,

spiritual services, and governmental and private programs.

Relationships with or a plan to build relationships with

other programs for people with HIV/AIDS, such as, the CDC Counseling

and Testing Program, the HRSA Ryan White C.A.R.E. Act Program (Title I

EMAs, Title II States and their consortia, Title III Early Intervention

providers, and Title IV Pediatric Projects), NIH-supported treatment

and research programs, etc.

An appropriate system for determining the eligibility of

people with HIV/AIDS for financial or other resource assistance.

Reimbursement for mental health services provided through

Federal, State, local, or nongovernmental programs of support, e.g.,

Medicaid reimbursement.

Training for individuals providing the services described

in the application.

Funding preference will be given to services demonstration project

applicants that are based at, or have relationships with, entities

providing comprehensive health services to people who are infected with

HIV. For the purposes of this program, comprehensive health services

include services such as those described above in the ``Specific Mental

Health Services'' and ``Additional Project Elements'' sections.

Evaluation: The evaluation should include collection of both

process and outcome data that will document the extent to which the

objectives set forth in the application have been met by the project.

Process evaluations examine the extent to which the project has been

implemented as designed. Outcome evaluations assess the extent to which

the projects have achieved the desired effects at the individual level

as well as the group and community level. The evaluation should

examine: the implementation of HIV/AIDS specific mental health services

and additional project elements at the project and client levels; the

type and frequency of services provided to the individual clients; the

characteristics and needs of recipients of the services; and the

outcome of services.

Services demonstration projects will be expected to participate in

the development of an overall evaluation of the HIV/AIDS Mental Health

Services Demonstration Program that would be implemented by the

coordinating center. The services demonstration project plans may have

to be refined in light of the overall program evaluation plan. The

services demonstration projects must agree to cooperate with CMHS and

the coordinating center on the design and implementation of the overall

program evaluation plan.

Applicants should budget 15-20 percent for the evaluation

activities, and include travel for at least two participants to attend

up to four meetings in the Washington, D.C. area or at a services

demonstration project site for each year of the project period (4

years).

B. Applications for the Coordinating Center Funding

The coordinating center, in conjunction with CMHS and the services

demonstration projects, will, using input from the services

demonstration projects, design and implement the overall evaluation of

the HIV/AIDS Mental Health Services Demonstration Program including: 1)

A description and evaluation of the various models created under this

program in an effort to determine which models might be replicated and

integrated into HIV/AIDS health care delivery systems nationally; and

2) an analysis of changes in client outcomes.

The coordinating center will assist the services demonstration

projects by providing overall evaluation coordination, including data

management and analysis, training in common procedures, and

distribution of necessary materials to all projects. Specifically, the

coordinating center will work with CMHS and the services demonstration

projects in the planning phase to: 1) Provide advice regarding the

evaluation personnel needs at the services demonstration project level;

2) develop criteria for compatible computer equipment; 3) recommend to

the steering committee common outcome measures; and 4) develop common

data collection elements. It is anticipated that these tasks will be

coordinated through a series of meetings of the steering committee to

commence immediately following issuance of the Notices of Grant Award.

The coordinating center will develop and maintain a common data

repository, containing common data files needed by the services

demonstration projects. It is the intention of CMHS that the data be

made available to the larger mental health and HIV/AIDS community as

soon as feasible, in accordance with steering committee recommendations

and in accordance with participant protection policy.

The coordinating center will also provide ongoing technical

assistance on the data collection and evaluation issues to the services

demonstration projects as needed. The coordinating center budget should

be consistent with the purpose of the program, and should reflect the

level of effort anticipated to carry out the proposed tasks.

The steering committee, working with the coordinating center, will

prepare reports for submission to the project officer. An annual

progress report will be prepared by the steering committee.

Applicants for the coordinating center should present a plan for

how best to meet the overall responsibilities described above and the

goals of the HIV/AIDS Mental Health Services Demonstration Program. In

addition, previous relevant experience in data collection and

evaluation, as well as facilities and resources available to complete

the project, should be described.

Eligibility: Applications may be submitted by public and nonprofit

private entities, such as community mental health centers, community-

based organizations providing HIV/AIDS care and related services, State

and local health departments, universities, colleges, hospitals, and

alternative health and mental health care entities that serve medically

disenfranchised populations. Entities may apply for either or both

types of award (services demonstration project and coordinating

center). Entities staffed largely by women and minorities are

especially encouraged to apply.

Availability of funds: It is estimated that approximately $1.2

million total (direct and indirect costs) will be available in FY 94

and that additional funding up to a total of $3.4 million may be

available through further collaboration with other agencies for

services demonstration projects. It is anticipated that 8-12 services

demonstration projects will be awarded under this Request for

Applications (RFA) in FY 94. Actual funding levels will depend upon the

availability of funds at the time of the award. It is expected that an

additional $700,000 total (direct and indirect costs) will be available

for a coordinating center.

Period of Support: Support may be requested for an initial period

of up to 4 years. Annual awards will be made subject to continued

availability of funds and progress achieved.

Application Receipt 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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May 26, 1994..... July 1994........ Sept. 1994...... Sept. 1994.

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Applications must be received by the published application receipt

date. 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 (private metered postmarks are not acceptable

as proof of timely mailing) is not later than one week prior to the

deadline date. 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.

Consequences of Late Submission: Applications received after the

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

applicant without review.

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

Additional Information

Letter of Intent: Organizations planning to submit an application

for a services demonstration project and/or the coordinating center are

encouraged to submit a letter of intent at least 30 days prior to the

receipt date. Such notification is used by the

CMHS 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

implementation 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 addressed to: Director, Office of

Evaluation, Extramural Policy, and Review, Center for Mental Health

Services, 5600 Fishers Lane, room 18C-07, Rockville, Maryland 20857,

ATTN: RFA/Letter of Intent. FAX: 301/443-7912.

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, to maximize the impact

of available resources, and to eliminate duplication of services.

Applicants should identify the coordinating organizations by name and

address and describe the process used/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 included in the application

appendices. Examples of Federal programs with which applicants may find

coordination productive are included in the complete application kit.

Public Health System Reporting Requirements: The services

demonstration projects are subject to the Public Health Service

Requirements. Under these requirements, the community-based

nongovernmental applicant must prepare and submit a Public Health

System Impact Statement (PHSIS). The PHSIS is intended to provide

information to State and local health officials to keep them apprised

of proposed health services applications submitted by community-based

nongovernmental organizations within their jurisdictions.

Community-based nongovernmental applicants are required to submit

the following information to the head of the appropriate State and

local health agencies, including the State HIV/AIDS directors and the

State mental health directors, no later than the application receipt

date of May 26, 1994.

a. A copy of the face page of the application (Standard Form 424).

b. A summary of the project (PHSIS), not to exceed one page, which

provides:

(1) A description of the population to be served.

(2) A summary of the services to be provided.

(3) A description of the coordination planned with the appropriate

State or local health agencies.

State and local governments and Indian Tribal Authority applicants

are not subject to the Public Health Service Reporting Requirements.

This subsection applies to services demonstration project

applicants only.

Intergovernmental Review (E.O. 12372): Applications for services

demonstration projects, 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 governments) 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: Director, Office of Evaluation, 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 CMHS

does not guarantee to accommodate or explain SPOC comments that are

received after the 60-day cut-off. This subsection applies to the

services demonstration project applicants only.

Role of Federal Staff in Cooperative Agreements: The Cooperative

Agreement mechanism includes substantial post-award Federal

programmatic participation in the conduct of the project. It is

anticipated that CMHS staff participation in this program will be

substantial. In addition to the general project officer function of

monitoring the conduct and progress of the services demonstration

projects and making recommendations about continuance of the project,

CMHS staff will be active participants in planning and implementing the

HIV/AIDS Mental Health Services Demonstration Program through

participation on the steering committee, promoting exchange of relevant

information among the services demonstration projects, and

participating in and/or providing support services for training,

evaluation, and data collection. CMHS staff will also monitor the

function and activities of the coordinating center, assuring that

progress is satisfactory, and required reporting is timely. A program

representative from CMHS, BHRD and NIMH will participate on the

steering committee, each with a single vote.

Application Procedures: All applicants must use application form

PHS 5161-1 (Rev. 7/92), which contains Standard Form 424 (face page).

The following information should be typed in Item Number 10 on the face

page of the application form:

RFA# SM-94-02: HIV/AIDS Services Demonstration (for services

demonstration projects).

RFA# SM-94-02: HIV/AIDS Coordinating Center (for coordinating center).

If an entity is applying for both cooperative agreements (services

demonstration projects and coordinating center), then 2 separate face

pages and applications should be submitted.

Application kit (including form PHS 5161-1 with Standard Form 424

and complete application procedures) may be obtained from: Global

Exchange, Inc., 7910 Woodmont Avenue, Suite 400, Bethesda, MD 20814-

3015, (301) 656-3100.

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 following address: Center for Mental Health

Services Programs, Division of Research Grants, NIH, Westwood Building,

room 240, 5333 Westbard Avenue, Bethesda, Maryland 20892.*

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

is 20816.

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 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 recommendation for approval.

Review Criteria: The following criteria will be used in the

technical merit review of services demonstration project applications.

The points noted in 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.

adequacy of documentation of unmet need, including a

description of special population(s) to be served, if applicable, and

the availability of and access to the current mental health delivery

system by people affected by and living with HIV/AIDS (30)

adequacy and appropriateness of the goals and objectives,

and approach, including the specific mental health services to be

provided and the additional project elements that assure the

development of an infrastructure (25);

appropriateness of the proposed project in terms of (1)

budget, (2) management plan, (3) personnel, (4) time frame, (5)

resources, and (6) adequacy, availability, and accessibility of

facilities (20)

appropriateness of the proposed evaluation design and

methodology (15)

experience of the applicant in delivering mental health

services (10)

The following criteria will be used in the technical merit review

of the coordinating center applications. The points noted in

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.

adequacy of the overall plan, addressing structure and

scientific rigor of the evaluation, and plans for data quality (30)

adequacy of plans for coordination, technical assistance,

and training (25)

qualifications and experience of the principal

investigator and proposed staff in statistics, data analysis,

evaluation, and large-scale data collection efforts (25)

appropriateness of budget, personnel, facilities,

resources, and time frame (20)

Award Criteria and Funding Preference: Services demonstration

project applications recommended for approval by the IRG and the

appropriate advisory council will be considered for funding on the

basis of overall technical merit as determined through the review

process, geographic distribution, evidence of agreement for cooperation

with the coordinating center in the overall program evaluation, variety

of settings (e.g., community mental health centers and community-based

organizations providing HIV/AIDS care and related services), and the

availability of funds. In addition, funding preference will be given to

applicants that are based at, or have relationships with, entities

providing comprehensive health services to people who are infected with

HIV.

Coordinating center applications recommended for approval by the

IRG and the appropriate advisory council will be considered for funding

on the basis of overall technical merit as determined through the

review process, suitability for working with the services demonstration

projects funded, and the availability of funds.

Contacts for Additional Information

Questions concerning program issues may be directed to: Ms. Elaine

Corrigan, Program Management Officer, CMHS HIV/AIDS Program, 5600

Fishers Lane, room 11C-21, Rockville, MD 20857, (301) 443-7817.

Questions regarding grants management issues may be directed to:

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

Services, 5600 Fishers Lane, room 15-87, Rockville, Maryland 20857,

(301) 443-4456.

Dated: March 15, 1994.

Richard Kopanda,

Acting Executive Officer, SAMHSA.

[FR Doc. 94-6865 Filed 3-23-94; 8:45 am]

BILLING CODE 4162-20-M