1.01Introduction and Program Description
The Department of Health and Social Services (DHSS or Department), Division of Public Health, is requesting proposals from eligible applicants that are either a certified and/or licensed entity by the State of Alaska, as an emergency responder agency. For the purposes of this solicitation, this includes but is not limited to public safety agencies including tribal, municipal, and village jurisdictions, fire, emergency medical services, dispatch centers, and agencies overseeing village safety officer programs and community health aide programs. Priority to agencies that can support a 24/seven day a week response profile to provide Restore Hope in Linkage to Care Collaboration services for the State of Alaska in FY2021 through FY2022.
Program Services are authorized under 7 AAC 78 Grant Programs. Additional governing statutes are Chapter 75 SLA 18, Chapter 97 SLA 18, AS 47.07.036(f), Chapter 3 SLA 20, Public Law 115-271 115th Congress. State of Alaska statutes and regulations are accessible at http://www.law.state.ak.us/doclibrary/doclib.html or through the contact person identified on the cover page of this Request for Proposals (RFP).
The Restore Hope in Linkage to Care Collaboration grant program will support the integration of emergency responders and behavioral health providers in enhancing the connection of people at risk of overdose to substance use disorder treatment and other resources. This program is open to urban, rural, and frontier localities in Alaska. The program will support a variety of integrative models that would include mobile crisis teams, emergency responder mental health collaborative models and additional technology including telehealth needed for the implementation of these models. Priority will be emphasized for peer-integration. The overall model infrastructure should aim to achieve the following applicable goals in the long-term:
- Improved quality of life for Alaskans living with substance use disorder
- Improved capacity in emergency departments to respond to additional crises
- Increased cost-effectiveness of the health care system
- Reduced hospitalizations as a result of overdose
- Reduced overdose mortality
- Reduce recidivism
For the purposes of this funding opportunity, emphasis will be placed on people at risk of overdose. CDC defines "overdose" as "injury to the body (poisoning) that happens when a drug is taken in excessive amounts. An overdose can be fatal or nonfatal". For the purposes of this funding opportunity, "people at risk of overdose" include: people who use, misuse, and dependent or addicted to opioids (including prescriptions, heroin, and/or fentanyl); people who use methamphetamines and/or cocaine; people who use opioids and psychostimulants together or who use opioids in combination with other sedating substances such as alcohol or benzodiazepines; and people who inject opioids and/or methamphetamine and/or cocaine.
1.02Program Goals and Anticipated Outcomes
The proposed project must demonstrate a thorough understanding and support of the grant program goals and outcomes anticipated by the Department.
- By June 30, 2021, establish an emergency responder behavioral health co-responder infrastructure to link people at risk of overdose to Substance Use Disorder (SUD) treatment, and other resources including behavioral health care, and other Social Determinant of Health (SDOH) resources.
- By August 31, 2021, initiate the established emergency responder behavioral health co-responder infrastructure that actively links people at risk of overdose to treatment and other SDOH resources, as well as the processes to track outcome and output data.
- By June 30, 2022, conduct an overall process evaluation of the establishment and implementation of the emergency responder behavioral health co-responder model as evidenced by a submitted report.
- Minimum Outcomes
- Emergency response agencies integrate behavioral health personnel with expertise in SUD prevention and treatment into their operations.
- At least 5 percent (denominator: total calls received involving persons with SUD) or more people struggling with SUD receive SUD treatment as a result of the grantee’s program.
- At least 10 percent (denominator: total calls received involving persons with SUD) or more people struggling with SUD receive SDOH (employment, housing, public assistance, education) resources as a result of this grantee’s program.
Projects must meet or exceed anticipated minimum outcomes described in this RFP.
Applicants must upload a timeline for the initiation of services and project activities. Applicants are expected to establish the infrastructure within three months of the project start date (January 1, 2021), and should do so by the end of the first year of the grant (June 30, 2021). Applicants are expected to implement and operate this infrastructure by August 31, 2021.
Applicant proposals must describe the ways in which the project aligns with program intent. The submitted project proposal will identify agency resources available to the project; describe project activities; and clearly state the project’s anticipated goals, outputs, and outcomes.
Statement of Need
- This opportunity requires the proposed integration of behavior health personnel or peer support; this can occur by the agency either hiring personnel or establishing a contractual partnership with a behavioral health organization. Describe how your agency will benefit from integration of behavioral health personnel and/or peer supports.
- In this description, for the years of 2018 and 2019, identify the number of calls responded to, at point of crisis, that involved people with suspected or reported risk of overdose.
Development/Building upon Existing Infrastructure
- Describe the emergency response behavioral health model you will use to achieve the minimum and/or long-term outcomes. Models to consider include Mobile Crisis Teams (MCT) including emergency responder mental health co-responder model, Mobile Integrated Teams (MIT), or police mental health collaborations. Examples across the country are in Attachment A.
- Identify your proposed program’s foundational values and principles for building trust with behavioral health partners and those your agency serves. For instance, how will your agency reduce stigma and balance the value sets of law enforcement, harm reduction, and overall health care.
- Describe the behavioral health personnel and/or agency you will integrate into your operations to utilize this model. This may include peer support specialists, mental health clinicians, and other behavioral health providers. Describe the level of education the clinician will have. Preference for someone with a minimum of a Chemical Dependency Counselor Two Certification and or someone with a Bachelors of Art/Science in Social Work.
- Describe the partnerships you have to support this overall model. Partnerships include those with emergency response, behavioral health, emergency department, community coalition, and/or primary care relationships. Identify potential partnerships in linking people living in urban areas and experiencing difficulty with living in rural communities to support them in living in his/her rural community, if relevant and appropriate.
- Describe the technology you will integrate to support the operations of this model. Technology may include interfacing with videoconferencing tools, tablets, etc. to communicate, existing connection to websites like www.treatmentconnection.com, or utilizing hotlines.
- Describe how existing and new personnel will receive training in the following areas:
- Team building
- Arrest vs. treatment
- Stigma reduction training
- Overdose identification and the importance of naloxone and/or other appropriate treatments
- Trauma and its effects on substance use disorder and mental illness
- Trauma-informed care training
- Cultural responsiveness
- Describe processes for confidentiality and sharing data with behavioral health and/or substance use disorder treatment agencies. Identify the capacity to develop a data use sharing agreement. https://camdenhealth.org/wp-content/uploads/2015/10/Camden-County-Police-Department-and-Camden-Coalition-Data-Sharing-Agreement.pdf
- Illustrate and describe a process map/flow chart of how you propose your program will operate.
- Describe how your program will actively link people at risk of overdose to treatment and other resources. This includes employment, housing, peer support, and public assistance.
Monitoring, Evaluation, and Quality Improvement
- Describe the indicators your agency will use to monitor the overall development, implementation, and outcomes of this work.
Planning and Workforce Development Indicator
a. # of involved personnel who have received training in the following training areas:
o Team building
o Arresting vs. treating
o Stigma reduction training
o Overdose identification and the importance of naloxone
o Trauma and its effects on substance use disorder and mental illness
o Trauma-informed care training
o Cultural responsiveness
a. # of people served who are at risk of overdose
b. # of referrals to treatment distributed to people at risk of overdose
c. # of people at risk of overdose who engage in treatment by referral or no referral
d. # of people who enroll in a substance use disorder treatment program as a result of the interaction with the program
e. # of referrals to those who are at risk of overdose to the following services:
o Mental Health Services
o Primary Care
o Domestic Violence Prevention Support
o Public Assistance
o Other social services
f. # of people who are at risk of overdose engaged in the resources in part e.
2. Describe the sources of data collection for these indicators.
3. Describe how you will analyze this data to integrate strategies for program improvement.
4. Describe how you will report out this data to funders, program staff, and other relevant stakeholders.
1.04Program Evaluation Requirements and Reporting
Results Based Budgeting Framework
Results based budgeting provides a framework in which allocated resources support, and are justified by, a set of outputs and expected results. Within this framework, actual performance and achieved outcomes are measured by objective performance measures.
Projects are required to align with program objectives expressing Department priorities and core services. Projects will use performance measures to evaluate progress toward meaningful outcomes, and to initiate data collection and reporting consistent with Department priorities.
The Department Priorities, Core Services, Objectives, and Performance Measures of Effectiveness and Efficiency for this program are:
- Health and Wellness Across the Lifespan
- Health Care Access, Delivery & Value
Department Core Services
- Protect and Promote the Health of Alaskans
- Provide Quality of Life in a Safe Living Environment for Alaskans
- Facilitate Access to Affordable Health Care for Alaskans
- Decrease substance abuse and dependency
- Increase the number of Alaskans with behavioral health issues who report improvement in key life domains
- Improve access to health care
- % of referrals of people who are at risk of overdose enrolled in treatment
- % of referrals of people who are at risk of overdose utilizing referral resources
- % of people served who are at risk of overdose
- % of referrals to treatment provided to people who are at risk of overdose
- % of referrals to other resources who are at risk of overdose
The applicant’s proposed evaluation plan will incorporate the performance measures of effectiveness and efficiency identified above. Applicants can propose additional performance measures for evaluating the project’s progress in achieving results supportive of program goals and outcomes.
Required reporting will include:
- Cumulative Fiscal Reports recording overall grant and match expenditures by budget line; and
- Program Reports in the format prescribed by the program.
- All sub-recipients of this Centers for Disease Control and Prevention (CDC) funding are required to collect and report certain data so that CDC can meets its obligations under the Government Performance and Results (GPRA) Modernization ACT of 2010. Recipients will be required at a minimum to report the number of referrals distributed to link people to substance use disorder treatment and other resources; as well as the number of people who received those referrals engaged in services.
1.05Target Population and Service Area
Applicants must clearly describe the population targeted by the project, including the area or communities that will be served. Proposals will be evaluated for compatibility with the program’s intended target population identified in this solicitation.
Target Population: The target population for the solicited services is people who are at risk of overdose who receive emergency services from either law enforcement, fire, or emergency medical services.
Service Areas and Communities: The service areas and communities requested for the services solicited are statewide with preference to areas that experience high rates of overdose morbidity and mortality.
Funds available for this program are anticipated to total $750,000 for two years from the Centers for Disease Control and Prevention (CDC), Overdose Data to Action grant. The amount of funding awarded per each year will be $375,000 awarded to up to three recipients.
Proposed Budget: The applicant must submit a budget proposal for the first fiscal year of the project. The proposed budget detail and narrative, will support the program’s results based service delivery and staffing requirements stated in this RFP.
The proposed budget will be fully compliant with the limitations described in this RFP, and those detailed in 7 AAC 78.160 (Costs). Regulations are provided under the GEMS Documents tab.
Grant funds may not be used to:
- Purchase naloxone;
- Implement or expand drug "take back" programs or other drug disposal programs (e.g. drop boxes or disposable bags);
- Purchase fentanyl test strips;
- Directly fund or expand direct provision of substance abuse treatment programs.
Resources specific to budgeting are also available under the GEMS Documents tab. DHSS Grant Budget Preparation Guidelines provide information and guidance about budget lines, cost detail groupings, and narrative requirements. Grantee User Manual Part I provides detailed instructions for entering a budget proposal in the chapter "Responding to a Solicitation."
Other Agency Funding: Prior to submitting a proposal, applicants are required to list all other agency funding received and applied for. This task must be completed by an Agency Power User in the Other Funding section of the Agency Administration tab. This is part of the pre-award risk assessment required under Uniform Guidance 2 CFR 200.
Indirect Costs: If the proposed budget includes indirect costs, 7 AAC 78.160(p) requires a copy of the agency’s current federally approved Indirect Cost Rate Agreement. The agreement is to be uploaded in the Agency Administration tab. Lapsed agreements can be used if uploaded with the negotiating federal agency’s written approval to continue using the rate until a new agreement is negotiated.
Payment for Services/Grant Income: If applicable to the services proposed in response to this solicitation, awarded grantees will have a Medicaid Provider Number or apply to obtain one, and will make reasonable effort to bill all eligible services to Medicaid and any other available sources of payment before seeking grant support for delivery of the proposed services. DHSS funds are the payer of last resort. Reimbursement of clinicians will not be not be provided by the grant funding.
In the applicant’s proposed budget, anticipated receipts and expenditures for all grant income must be evident in the detail and narrative. Fiscal reports for awarded income generating projects will include the receipts and expenditure of all grant income.