Office of the Assistant Secretary for Health; Notice on Availability of Funds and Request for Applications for Bilingual/ Bicultural Service Demonstration Projects in Minority Health

AUTHORITY: This program is authorized under section 1707(d)(1) of the

Public Health Service Act, as amended in Public Law 101-527.

PURPOSE: To provide support to improve the ability of health care

providers and other health care professionals to deliver linguistically

and culturally competent health services to limited-English-proficient

populations.

APPLICANT ELIGIBILITY: Eligible applicants are public and private

nonprofit minority community-based organizations or health care

facilities serving a targeted minority community.

ADDRESSES/CONTACTS: Applications must be prepared on Form PHS 5161-1

(Revised July 1992 and approved by OMB under Control Number 0937-0189).

Application kits and technical assistance on budget and business

aspects of the application may be obtained from Ms. Carolyn A.

Williams, Grants Management Officer, Office of Minority Health,

Rockwall II Building, Suite 1000, 5515 Security Lane, Rockville, MD

20852, (telephone 301/594-0758) or by Internet E-mail

[email protected]. Completed applications are to be submitted

to the same address.

Technical assistance on the programmatic content for the Bilingual/

Bicultural Grants may be obtained from Ms. Nina Darling or Ms. Rizalina

Galicinao. They can be reached at the Office of Minority Health,

Rockwall II Building, Suite 1000, 5515 Security Lane, Rockville, MD

20852, (telephone 301/594-0769) or by Internet E-mail

[email protected] or [email protected].

In addition, OMH Regional Minority Health Consultants (RMHCs) are

available to provide technical assistance. A listing of the RMHCs and

how they may be contacted is provided in the grant application kit.

Applicants also can contact the OMH Resource Center (OMH/RC) at 1-800-

444-6472 for health information and generic information on preparing

grant applications.

DEADLINE: To receive consideration, grant applications must be received

by the Grants Management Office by May 15, 1995. Applications will be

considered as meeting the deadline if they are either:

(1) Received at the above address on or before the deadline date,

or

(2) Sent to the above address on or before the deadline date and

received in time for orderly processing. Applicants should request a

legibly dated U.S. Postal Service postmark or obtain a legibly dated

receipt from a commercial carrier or U.S. Postal Service. Private

metered postmarks shall not be acceptable as proof of timely mailing.

Applications submitted by facsimile transmission (FAX) will not be

accepted. Applications which do not meet the deadline will be

considered late and will be returned to the applicant unread.

AVAILABILITY OF FUNDS: It is anticipated that in Fiscal Year 1995, the

Office of Minority Health will have approximately $1.3 million

available to support approximately 13 grants of up to $100,000 each

under this program. At least three grants focusing on HIV/AIDS as a

health problem will be funded under this announcement.

PERIOD OF SUPPORT: Support may be requested for a total project period

not to exceed 3 years. Non competing continuation awards will be made

subject to satisfactory performance and availability of funds.

BACKGROUND: The Office of Minority Health is the unit of the U.S.

Department of Health and Human Services that coordinates Federal

efforts to improve the health status of racial and ethnic minority

populations, including American Indians, Alaska Natives, Asian

Americans, Pacific Islanders, African Americans and Hispanics/Latinos.

With the passage of the Disadvantaged Minority Health Improvement Act

(Pub. L. 101-527), the OMH was established in legislation and given a

broad mandate to advance efforts to improve minority health including

supporting research, demonstrations and evaluations of new and

innovative programs that increase understanding of disease risk factors

and support improvement in information dissemination, education,

prevention and service delivery to minority communities. The OMH was

also directed to develop appropriate planning, logistical support, and

technical assistance related to increasing the capabilities of health

care providers and other health care professionals to address cultural

and linguistic barriers to effective health care service delivery, and

to increase access to effective health care for limited-English-

proficient minority populations [Pub. L. 101-527, section 1707(b)(7)].

Social, cultural and linguistic barriers on the part of both

providers and clients significantly affect the receipt of needed health

care. Among the many factors contributing to the poor health status of

limited-English-proficient minorities are:

Inadequate number of health care providers and other

health care professionals skilled in culturally competent and

linguistically appropriate delivery of services;

Scarcity of trained interpreters at the community level;

Deficiency of knowledge about appropriate mechanisms to

address language barriers in health care settings;

A lack of culturally appropriate community health

prevention programs;

Absence of effective partnerships between major mainstream

provider organizations and limited-English-proficient minority

communities;

Low economic status;

Lack of health insurance; and

Organizational barriers.

This RFA specifically addresses the barriers that limited-English-

proficient minority populations face when trying to access health

services.

In the 1990 U.S. Census, language questions asked were (1) Whether

respondents speak another language at home, (2) how well they speak

English (for those who answered yes to the first question), and (3)

which language they speak at home. The census data indicates that 31.8

million persons ages 5 and above (13.8 percent of the total U.S.

population counted by the 1990 census) spoke another language at home.

Of those, 17.9 million people reported that they speak English very

well. Almost 2 million people (1.8 million) do not speak English at

all. An additional 4.8 million people do not speak English well.

Large numbers of minorities in the United States are linguistically

isolated--living in households in which no one 14 years old or over

speaks English and no one who speaks a language other than English

speaks English ``very well.'' The 1990 Census found 1,572,006 Asian and

Pacific Islanders at least 5 years of age to be linguistically

isolated. The percent of Asian and Pacific Islanders who are

linguistically isolated varies by

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subgroup--ranging from 9.7% among Filipinos to 59.8% among Hmong. Among

Pacific Islanders, Tongans had the highest proportion of persons who

were linguistically isolated (18.7%). More than four million Hispanics

are linguistically isolated (4,548,677 or 23.8%). Central Americans

(40.3%) and Dominicans (39.6%) are the most likely to be linguistically

isolated. Among Blacks, 282,147 (0.9%) are linguistically isolated.

Among American Indians, Alaska Natives, 77,802 (4%) are linguistically

isolated.

Definitions

For purposes of this grant announcement, the following definitions

are provided:

(1) Minority Populations--As defined by the Office of Management

and Budget (OMB) Circular No. 15, include: Asisan/Pacific Islanders,

Blacks, Hispanics, and American Indian/Alaska Native.

(2) Limited-English-Proficient Populations--individuals, as defined

above (1), with a primary language other than English who must

communicate in that language if the individual is to have an equal

opportunity to participate effectively in and benefit from any aid,

service or benefit provided by the health provider.

(3) Minority Community-Based Organization--a public or private non-

profit community-based minority organization or a local affiliate of a

national minority organization that has a governing board composed of

51% or more racial/ethnic minority members, has a significant number of

minorities in key program positions, has an established record of

service to a racial and ethnic minority community.

(4) Health Care Facilities--for purpose of this announcement, a

health care facility is a public nonprofit facility that has an

established record for providing a full range of health care services

to a targeted racial and ethnic minority community. Facilities

providing only screening and referral activities are not included in

this definition. A health care facility may be a hospital, outpatient

medical facility, community health center, migrant health care center,

or a mental health center.

(5) Community--a defined geographical area in which persons live,

work, and recreate, characterized by: (a) formal and informal

communication channels; (b) formal and informal leadership structures

for the purpose of maintaining order and improving conditions; and (c)

its capacity to serve as a focal point for addressing societal needs,

including health needs. A community should be an appropriate catchment

area in which to address a population's social and health needs.

(6) Bilingual Direct Services--any activity that delivers person to

person health care/health promotion services which is linguistically

and culturally appropriate to limited-English-proficient clientele,

including, for example, translation and interpreter services and health

education course taught bilingually.

(7) Cultural Competency--a set of interpersonal skills that allow

individuals to increase their understanding and appreciation of

cultural differences and similarities within, among, and between

groups. This requires a willingness and ability to draw on community-

based values, traditions, and customs and to work with knowledgeable

persons of and from the community in developing focused interventions,

communications, and other supports. (Orlandi, Mario A., 1992)

Potential Projects/Activities

A broad range of approaches may be used to respond to this

proposal. However, the projects should concentrate on activities to

improve the ability of health care providers and other health care

professionals to deliver linguistic and culturally competent health

services to limited-English-proficient populations. A proposed program

may include, but is not limited to:

language and cultural competency training for health care

professionals;

bilingual health access or health promotion information in

the native language of the target population(s);

on-site interpretation services; and

trainer development courses on cultural competency.

Organizational Linkages

Project goals should promote access to direct services for limited-

English-proficient minority populations by providing continuity of

support to clients for outreach, referral and treatment. Linkages must

be established between minority community based organizations and

appropriate health care facilities. The minority community-based

organizations and the health care facilities must reach out and work

with each other to ensure that limited-English-proficient persons are

in receipt of appropriate health care services. Thus, the applicant,

either the minority community-based organization or the health care

facility must have an established linkage with the other organization

prior to submitting an application.

Application Process

Applicants should pay particular attention to the general and

supplemental instructions provided in the application kit to ensure

that their applications are responsive to each of the concerns under

the following headings:

Background

Provide a description of the problem to be addressed; clearly

identify the scope of the problem including linguistic/cultural

barriers; the limited-English-proficient minority target group(s)

affected; health issues; and the pertinent geographic area/subarea.

Provide documentation supporting the serving of at least 40 percent or

more persons with limited-English proficiency.

Cite the capability and experience of the organization to provide

linguistic and culturally competent health care services.

Goal(s) and Objective(s)

Clearly state the goal(s) of the project. Provide a list of

specific, time-phased, measurable objective(s), including target dates.

Methodology

A project management plan must be included which delineates project

activities specifying responsible parties, methods to be used,

timelines, and anticipated outcomes. Project activities must be linked

to goal(s) and objective(s). Indicate the organization's capability to

collaborate with other health care providers and health care

professionals to effectively reach the target population. Describe the

linkage between the organization and the applicable minority community-

based organization/health care facility.

Personnel/Management

Describe duties, reporting channels, requisite qualifications, and

related experience of personnel who will be responsible for carrying

out the project. Resumes and curriculum vitae of key personnel must be

provided. Describe management capability and experience of proposed

grantee organization.

Evaluation

Specify the approach and provide an example of data collection

instruments that will be used to measure accomplishment of objectives;

the evaluation should include both process and outcome measures.

Provide a concise analysis of how the project will result in a

sustained impact on reducing the problem of access to bilingual/

bicultural health care services. Provide

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information on how the project will be sustained beyond the funding

period and the degree that the project can be replicated.

Budget

Budgets of up to $100,000 total direct and indirect costs per year

may be requested to cover: The cost of personnel, consultants, support

services, materials, and travel. The project budget must include travel

for one project staff member to meet with the OMH Bilingual/Bicultural

Program Director in Washington, D.C. Funds may not be used for

construction, building alterations or renovations. Also, funds may not

be used to purchase equipment except as may be acceptably justified in

relation to conducting the project activities.

All budget requests must be fully justified in terms of the goals

and objectives proposed and include a computational explanation of how

costs were determined.

Review of Applications: Applications will be screened upon receipt.

Those that are judged to be incomplete, nonresponsive to the

announcement, or nonconforming will be returned without comment. Each

organization may submit no more than one proposal under this

announcement. If an organization submits more than one proposal, all

will be deemed ineligible and returned without comment. Applications

judged to be complete, conforming, and responsive will be reviewed for

technical merit in accordance with PHS policies.

Applications will be evaluated by Federal and non-Federal reviewers

chosen for their expertise in minority health and their understanding

of the unique health problems and related issues confronted by limited-

English-proficient racial and ethnic populations in the United States.

Applicants are advised to pay special attention to developing

clearly defined goals and objectives for their projects, as well as

providing well-developed study and evaluation designs for the

measurement of project objectives. Both formative and summative

evaluations will be required of the grantee, as well as analysis of how

the project can be improved to reach the desired outcomes. Applicants

should also pay specific attention to the program guidelines, and the

general and supplemental instructions provided in the application kit.

Review Criteria: Applications will be reviewed and evaluated for

evidence of consistency with the requirements of this announcement. Of

specific importance will be the following criteria under the listed

headings. (An indication of the quantitative weight appears in

parentheses after each heading):

Background (25%)

Clarity, specificity, depth and coherence of the described

need(s) and problem(s) of the target-population(s) which includes

linguistic/cultural barriers.

Strength and specificity of the capability of the

organization to provide linguistically and culturally competent health

care services for the target population;

Degree to which the organization is committed to linkage

with the applicable minority community-base organization/health care

facility;

The validity of the documentation supporting the

percentage of limited-English-proficient persons the project will

serve;

Extent and outcomes of past efforts/activities with the

proposed target community; and

Specificity of data on the intended target group.

Goals and Objectives (15%)

Relevance of the proposed goals and objectives to this

announcement and the OMH mission;

Merit of the proposed objectives, including their

measurability and relevance to the stated project goals, and soundness/

attainability of the time frame specified; and

Soundness/attainability of proposed impacts/results/

products.

Methodology (25%)

Strength of the work plan and specific activities

proposed, including their scope and relevance to each of the stated

objectives and projected outcomes;

The degree to which the linguistic and cultural competence

skills will provide the health care providers and health care

professionals with the ability to increase outreach effectiveness to

the target population(s);

Evidence that the organization has the established

linkages with appropriate health care facilities to provide continuity

of support to clients for outreach, referral and treatment; and

Clearly defined project timeline, Gantt Chart or Pert

Chart is included as it relates to project planning, implementation,

and program evaluation.

Personnel/Management (15%)

Strength of proposed grantee organization's management

capability;

Adequacy of qualifications, experience, linguistic and

cultural competence of proposed personnel;

Evidence that the proposed staff can effectively outreach

and work with the targeted community; and

Evidence of clear lines of authority and accountability

among proposed staff, volunteers, managers, and collaborators.

Evaluation (20%)

The strength of the evaluation plan: includes formative

and summative evaluation designs; the likelihood that the proposed

objectives can be measured; and the linguistic and cultural competence

of the project can be assessed;

Clarity and specificity of proposed qualitative and

quantitative measures of project accomplishments;

Soundness of proposed data analysis and reporting methods;

Evidence that a project can be replicated;

Evidence that the proposed implementation plan and bring

about the desired outcome(s); and

If the proposed project provides direct services,

likelihood that services will be sustained beyond the expiration of the

3 year funding period.

Budget/Financial Plan (0%)

The budget items will be commented on, but not rated by the review

panel.

Evidence that required budget items are consistent with

stated goals and are appropriate to the level of effort required.

Award Criteria: Funding decisions will be determined by the Deputy

Assistant Secretary of Minority Health, Office of Minority Health and

will take under consideration: the recommendations/ratings of review

panels as well as program balance which includes geographic and race/

ethnicity distribution, and health problem areas having the greatest

impact on minority health in terms of causes of death. Preference will

be given to applicants who have received grants under the Bilingual/

Bicultural Program.

Supplementary Information: This announcement for Fiscal Year 1995

Bilingual/Bicultural Service Demonstration Grants focuses on the six

health problems identified by the Secretary's Task Force on Black and

Minority Health as having the greatest impact on minority health in

terms of causes of death: (1) Cancer; (2) cardiovascular disease and

stroke; (3) chemical dependency; (4) diabetes; (5) homicides; and (6)

infant mortality. Additional areas of concern under this announcement

include HIV infection,

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access to and financing of health care, health professions personnel

development, data collection and analysis, and surveillance. Proposals

should include strategies that will address these problems in a

culturally competent and linguistically appropriate manner.

These health priorities also are addressed in the Health Objectives

for the Nation, Healthy People 2000, which the Public Health Service

(PHS) is committed to achieving. Potential applicants may obtain a copy

of Healthy People 2000 (Full Report: Stock No. 017-001-00474-0) or

Healthy People 2000 (Summary Report: Stock No. 017-001-00473-1) through

the Superintendent of Documents, Government Printing Office,

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

State Reviews: E.O. 12372 sets up a system for state and local

government review of proposed Federal assistance applications.

Applicants [other than federally-recognized Indian tribal

governments] should contact their State Single Point of Contact (SPOCs)

as early as possible to alert them to the prospective applications and

receive any necessary instructions on the state process. For proposed

projects serving more than one state, the applicant is advised to

contact the SPOC of each affected State. All comments from a state

office must be received within 60 days after the application deadline

by the Office of Minority Health's Grants Management Officer. A list of

addresses of the SPOCs is enclosed with the application kit material.

Provision of Smoke-Free Workplace and Non-Use of Tobacco Products

by Recipients of PHS Grants: The Public Health Service strongly

encourages all grant recipients to provide a smoke-free workplace and

to promote the non-use of all tobacco products. In addition, Public Law

103-227, the Pro-Children Act of 1994, prohibits smoking in certain

facilities (or in some cases, any portion of a facility) in which

regular or routine education, library, day care, health care or early

childhood development services are provided to children.

Public Health System Reporting Requirements: This program is

subject to Public Health Systems Reporting Requirements. Under these

requirements, a community-based nongovernmental applicant must prepare

and submit a Public Health System Impact Statement (PHSIS). The PHSIS

is intended to provide information to state and local health officials

to keep them apprised of proposed health services grant applications

submitted by 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 in the area(s) to be impacted no later than the

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

the applications (SF 424), (b) a summary of the project (PHSIS), not to

exceed one page, which provides: (1) a description of the population to

be served, (2) a summary of the services to be provided, (3) a

description of the coordination planned with the appropriate state or

local health agencies.

The Catalog of Federal Domestic Assistance number is 93.105.

Dated: March 23, 1995.

Clay E. Simpson, Jr.,

Acting Deputy Assistant Secretary for Minority Health.

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

BILLING CODE 4160-17-M