In 2014 ACL introduced the Alzheimer’s Disease Initiative – Specialized Supportive Services (ADI-SSS) grant program using resources from the U.S Department of Health and Human Services Prevention and Public Health Fund. The ADI-SSS program was designed to expand on existing dementia-capability of home and community based service (HCBS) providers through the development and implementation of community level direct service and training programs in support of persons living with dementia and their caregivers.
The ADI-SSS programs funded in 2014, 2015, 2016 and 2017 (funding opportunity announcements: HHS-2014-ACL-AOA-AL-0090, HHS-2015-ACL-AOA-AL-0104, HHS-2016-ACL-AOA-ALGG-0152 and HHS-2017-ACL-AOA-ALGG-0227) were complex in nature, implemented by community-based public and private entities. Those organizations that received funding through the program developed and delivered dementia specific home and community based direct services and training designed to address the following service gaps that were identified through the work of and recommendations from the National Alzheimer's Project Act Advisory Committee:
Provision of effective supportive services to persons living alone with ADRD in the community;
Provision of effective care/supportive services to persons living with moderate to severe impairment from ADR and their caregivers;
Improvement of the quality and effectiveness of programs and services dedicated to individuals aging with intellectual and developmental disabilities with ADRD or those at high risk of developing ADRD; and
Delivery of behavioral symptom management training and expert consultations for family caregivers.
With the ultimate goal of developing model dementia-capable systems within which they can operate, grantees took into consideration key aspects of a dementia-capable HCBS model. Program participants were encouraged to use information found in ACL’s issue brief entitled “Dementia-capable States and Communities: the Basics”.
A dementia-capable HCBS system should:
Identify people with possible dementia and recommend that they see a physician for a timely, accurate diagnosis and to rule out reversible causes of dementia or conditions that resemble it.
Ensure that program eligibility and resource allocation take into account the impact of cognitive disabilities.
Ensure that staff communicate effectively with people with dementia and their caregivers and provide services that are person- and family-centered, offer self-direction of services, and are culturally appropriate.
Educate workers to identify possible dementia, and understand the symptoms of dementia and appropriate services.
Educate the public about brain health, including information about the risk factors associated with developing dementia, first signs of cognitive problems, management of symptoms if individuals have dementia, support programs, and opportunities to participate in research.
Implement quality assurance systems that measure how effectively providers serve people with dementia and their caregivers.
Encourage development of dementia-friendly communities, which include key parts of dementia-capability.
Dementia-capable services within a home and community-based system (HCBS) build upon and integrate existing programs from both private and public sectors. Programs funded to help people with dementia and their caregivers include public sector partners including, not limited to, tribes or tribal organizations, the Administration for Intellectual and Developmental Disabilities (AIDD); the Centers for Medicare & Medicaid Services (CMS); and the Department of Veterans Affairs.
The ADPI Expansion program will not fund research projects. The ADPI expansion effort is designed to expand on the successes of previously funded program to pilot much needed dementia-capable HCBS programs to states and communities, evaluation of program outcomes and using program outcome data to garner support to sustain successful initiatives beyond the federal program period. It is through programs such as this that the Administration for Community Living (ACL) demonstrates its commitment to its mission to maximize the independence, well-being, and health of older adults, people with disabilities, and their families and caregivers.
Funding Opportunity Requirements
Applicants for this cooperative agreement funding opportunity must provide a thorough, concise description of the ACL funded 2014, 2015, 2016 or 2017 ADI-SSS project (HHS-2014-ACL-AOA-AL-0090, HHS-2015-ACL-AOA-AL-0104, HHS-2016-ACL-AOA-ALGG-0152 and HHS-2017-ACL-AOA-ALGG-0227) and the project component being proposed for expansion.
The project narrative will include a comprehensive description of the originally funded project including, but not limited to: a complete description of all project components, the number of people served and/or trained, evaluative outcomes for both persons with dementia and caregivers (including assessment tools), dementia specific evidence-based intervention outcomes, the number of hours of direct service provided and lessons learned.
In addition to the description of the previously funded project, the narrative must include a complete discussion of the program component proposed for expansion under this opportunity The narrative must include a rationale for the chosen initiative, a description of those who will benefit from the activity, as well as a clear explanation of the necessity of the requested additional resources. The expansion rationale will identify the target consumers, the methodology and the desired outcomes for the proposed work, including quality assurance, sustainability and dissemination plans.
GENERAL PROGRAM REQUIREMENTS/COMPONENTS
All applicants to this funding opportunity announcement are subject to the General program items listed below and will consider and include all of them in the development of their application, work and evaluation plans.
Successful applicants will propose a phased approach for implementation of their projects. The phases are described as follows:
Planning Phase: The period during which the grantee refines their proposed program implementation and evaluation plans, based on the plans contained in their expansion project application. The resulting plans will be the ACL/AoA approved roadmap for the grantee to accomplish the goals, objectives, and core components of ACL/AoA funded program.
All grantees are required to complete dementia capability assessments throughout the duration of their grant. Those grantees with active community grants will not be required to complete two assessments, but rather complete a single assessment at the onset of the expansion program (with the original and expansion grant activities as considerations in the response) and annual assessments each Fall in conjunction with their semi-annual reporting over the course of the grant. Those grantees without active community grants will be required to complete an assessment at the onset of their program and each Fall in conjunction with their semi-annual reporting. All programs will include a final assessment at the end of the grant period.
Expansion grant applicants are to propose a planning phase of not more than TWO months from the notification date of the grant award. During this planning phase, grantees will be able to access no more than 15 percent of total grant funding to refine and expand on the work and evaluation plans submitted with their applications. ACL/AoA will be actively involved during the planning phase of the grant. At the conclusion of the planning phase, the grantee must receive ACL/AoA's approval of their work and evaluation plans, upload those plans into the reporting system, complete dementia-capability assessment as described above and participate in a “Planning Phase Exit Conference”. Upon completion of those steps, grantees will progress to the Implementation Phase and access the remaining 85 percent of cooperative agreement funding.
Implementation Phase: The period during which the grantees implement their approved plan for accomplishing the goals, objectives, and core components of these objectives, as well as the evaluation of planned program activities. All grantees will complete annual dementia-capability assessments each Fall, over the course of the grant period. Those grantees with active community grants will not be required to complete separate assessments for their original and expansion grants, but rather complete a single assessment with the original and expansion grant activities as considerations in the response and an annual assessment thereafter.
Direct Service Requirement
All successful applicants are required to dedicate 50% of the total program budget to the provision of direct services to persons living with dementia and caregivers. A definition of direct service is provided in the funding opportunity announcement Appendix. Budget narratives included in the program application should include clear identification of the lines with the budget where the funds for the required direct services will reside.
Applicants must identify in the project narrative and in the project work plan the intended, measureable outcomes (i.e. improved quality of life, reduced depression, stress/burden) of the proposed direct services, as well as providing estimates of persons served by each programmatic component. ACL's National Alzheimer's and Dementia Resource Center (NADRC) created a compendium of Evaluation Measures Resources that could provide assistance in identifying desired measurable outcomes of program activities.
Grantees are required to collect information on services provided under the authority of existing or future approved data collections.
All successful grant applications MUST include a plan for a robust, evaluation of the proposed expansion project. Applicants with existing programs (some 2015, 2016, 2017) should be prepared to work with their current evaluators to infuse the new program components into the existing evaluation framework. Applicants whose previously funded project has ended (2014 and some 2015) will propose a robust, third party evaluation of the proposed expansion project.
Successful applicants and their partners will be required to conduct assessment of the dementia-capability over the course of their program, using either the National Alzheimer’s and Dementia Resource Center's (NADRC) 2017 Dementia Capability Assessment;Tool created by the NADRC or another tool approved by ACL program staff. The dementia-capability assessments should be included as a consideration in the overall program evaluation.
Those grantees with active community grants will not be required to complete two assessments, but rather complete a single assessment at the onset of the expansion program (with the original and expansion grant activities as considerations in the response) and annual assessments each Fall in conjunction with their semi-annual reporting over the course of the grant. Those grantees without active community grants will be required to complete an assessment at the onset of their program and each Fall in conjunction with their semi-annual reporting. All programs will include a final assessment at the end of the grant period. Use of a progressive assessment model will ensure that, at the conclusion of the grant period, programs will be able to document their progress by reporting on the aspects of their project that were successful and those that were not, as well as the lessons learned.
Expansion program evaluations should, at a minimum, determine the effectiveness and impact of the strategies and processes used for execution of project goals at both the systems development and consumer (service provision) level. Applicants MUST include outcome measures in the proposed program and evaluation plans (ACL will NOT fund any project that does not include measurable outcomes).
More information on evaluation expectations can be found in Section V of this funding opportunity announcement.
Successful applicants are to draw on the expertise of ACL/AoA program staff and existing AoA- sponsored resources to develop, implement, and sustain their strategic work and evaluation plans. All grantees are required to participate in technical assistance activities as they pertain to the program development, management and integration. This includes, but is not limited to, participation in regularly scheduled technical assistance conference calls, web casts, grant peer informative collaboratives and one-on-one technical assistance opportunities initiated by ACL/AoA staff, resource center staff or the grantees.