Behavioral health is the promotion of mental health and well-being, the treatment of mental and substance use disorders, and the support of those who experience and/or are in recovery from these conditions. Anyone, regardless of age or ability, can experience a behavioral health condition, such as depression, substance misuse, or suicidal thoughts. Behavioral health problems are not a normal part of aging or of living with a disability, but older people and people with disabilities are less likely to receive mental health treatment.  Recent reports (August 2020) show dramatic increases in the number of U.S. adults struggling with mental health and/or substance abuse issues, along with increased numbers of adults seriously considering suicide. 
Chronic conditions, including depression, are prevalent among older adults. Approximately 80% of older adults have at least one chronic condition, and 50% have two or more. Specific to behavioral health, depression is more common in people who have co-occurring illnesses or who have limited function.  Data from the National Chronic Disease Self-Management Education Database show that approximately 21% of program participants indicate a diagnosis of anxiety and/or depression.  Evidence-based programs such as Healthy IDEAS and PEARLS (see Appendix C for more information) are designed to combat depression experienced by older adults. To learn more, visit https://acl.gov/programs/health-wellness/behavioral-health .
Additionally, chronic pain is a considerable health challenge facing older adults. Chronic pain is persistent discomfort that lasts for at least three months; it can be caused by a variety of factors, including chronic conditions. In the United States, older and middle-aged adults account for about 80% of those who experience chronic pain.  Common chronic conditions that may cause pain include arthritis, diabetes, and cancer, in addition to neuropathic conditions, surgeries, or injuries. Both the Chronic Pain Self-Management Program and evidence-based physical activity programs can be important tools for pain management (see Appendix C for more information). To view an issue brief on implementing evidence-based programs to address chronic pain, visit https://www.ncoa.org/resources/issue-brief-implementing-evidence-based-….
Evidence-based chronic disease self-management education (CDSME) programs can help mitigate chronic disease burden by empowering participants to better manage their conditions. The acronym, CDSME, is being used in this announcement as an umbrella term for community-based education programs specifically designed to enhance patient self- management of chronic conditions (including behavioral health concerns and chronic pain). These programs focus on building multiple health behaviors and generalizable skills such as goal setting, decision making, problem solving, and self-monitoring, and are proven to maintain or improve health outcomes of older adults with chronic conditions.  Similarly, a self-management support program is a community-based, behavioral change intervention that is proven to increase one or more skills or behaviors relevant to chronic disease self-management such as physical activity or medication management.
AoA has supported CDSME and other evidence-based health promotion programs for many years through grants, as well as collaborations on various federal initiatives. For example, Prevention and Public Health Fund initiatives in 2020 supported 11 CDSME grantees. Additionally, Older Americans Act Title III-D funding supports a broader portfolio of evidence-based disease prevention and health promotion activities. For more information about ACL’s CDSME Program, including grantee profiles, please visit: https://www.acl.gov/programs/health-wellness/chronic-disease-self-manag….
This funding opportunity is designed for applicants to propose how they will develop capacity for, deliver, and sustain evidence-based self-management education and support programs that address behavioral health and/or chronic pain among older adults and adults with disabilities.
Goal 1: Through robust partnerships, develop a strategy for addressing behavioral health and/or chronic pain among older adults and adults with disabilities living in your community.
Goal 2: Significantly increase the number of older adults and adults with disabilities who participate in evidence-based self-management education and/or self-management support programs to empower them to better manage these chronic condition(s), while concurrently pursuing the sustainability of these programs beyond the end of the grant period.
Please refer to Appendix A (Glossary of Terms) for definitions of CDSME and self- management support programs. Applicants for this funding opportunity must propose to deliver one or more CDSME and/or self-management support programs. The program(s) proposed must be on the list of pre-approved interventions found in Appendices B and C of this funding announcement.
All applicants must propose to implement at least one program that can be delivered in a remote format, i.e., by video conference, phone, mailed toolkit + phone, or some other format that does not have an in-person component. The National Council on Aging (NCOA) maintains a website that tracks remote program guidance by program (https://www.ncoa.org/news/ncoa-news/center-for-healthy-aging-news/track…). However, all applicants should contact the program administrator(s) for any program(s) they are interested in delivering remotely to confirm that: 1) the programs are allowed for remote delivery; and 2) that training is readily available for applicants who need it. Note that the NCOA website includes programs on the pre-approved list in Appendix B and C, as well as other programs not on the list. For this funding opportunity, applicants may ONLY propose programs on the pre-approved lists in Appendix B and C.
All applicants who do not have adequate existing capacity for any in-person and/or remote program(s) they are proposing must include a letter from the program administrator indicating that they will be able to get training in the program no later than three months after the start date of the grant (if selected for funding).
 “Behavioral Health.” Administration for Community Living, July 2019, https://acl.gov/programs/health-wellness/behavioral-health.
 Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1external icon.
 “Depression Is Not a Normal Part of Growing Older” Centers for Disease Control and Prevention, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Jan. 2017, www.cdc.gov/aging/mentalhealth/depression.htm.
 “National Chronic Disease Self-Management Education Resource Center: Program Highlights and Charts.” National Council on Aging, Jan. 2019, www.ncoa.org/resources/national-chronic-disease-self-management-educati….
 “Issue Brief: Implementing Evidence-Based Programs to Address Chronic Pain.” National Council on Aging, 2018, www.ncoa.org/resources/issue-brief-implementing-evidence-based-programs….
 Brady, Teresa. “Strategies to Support Self-Management in Osteoarthritis.” AJN, American Journal of Nursing, vol. 112, no. 3, 2012, pp. 54–60., doi:10.1097/01.naj.0000412653.56291.ab.