Foreign entities are not eligible to compete for, or receive, awards made under this announcement.
Background and Overview
Trauma: Its Prevalence and Impact
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), trauma is a widespread, harmful and costly public health concern. Trauma and traumatic events are defined as “threats to survival and self-preservation” (Janoff-Bullman, 1992). Trauma can happen in response to experiencing violence, abuse, neglect, loss, disaster, war and other emotionally distressing events. Individuals or entire populations, examples of which include slaves and their descendants, Native Americans, Holocaust survivors, and Japanese American’s interred during World War II (ACF, 2017), can experience trauma. Approximately 70 - 90% of adults in the U.S. have been exposed to some type of traumatic event during their lifetime (Kaiser et al, 2017; Kilpatrick et al, 2013). Trauma can occur at any point during the life course, without regard to age, gender, socioeconomic status, race, ethnicity, geography or sexual orientation (SAMHSA, 2014).
Research has shown the connections between exposure to traumatic events and impaired development, poor immune system responses and subsequent health risk behaviors resulting in chronic physical and behavioral health conditions. If left unaddressed, trauma can significantly increase the risk of chronic physical diseases and substance abuse disorders and can affect one’s responsiveness to intervention (SAMHSA, 2014). Additionally, a history of potentially traumatic life events such as losses of, or changes to, resource availability, social roles and networks and physical and mental health (all potentially traumatic occurrences) are being linked to social isolation in older adults (Elder and Retrum, 2012).
Trauma’s impact can also pass from generation to generation. Descendants of trauma victims (many of whom are or will become family caregivers), but who may not have directly experienced a traumatic event themselves, can manifest the signs and symptoms often associated with trauma, including depression, anger, low self-esteem and self-destructive behavior (ACF, 2017). Given the likely widespread and multigenerational impact of trauma across the lifespan, developing appropriate services and supports that serve specific individuals as well as the entire family system in a holistic and family-centered manner may is increasingly necessary.
Holocaust Survivors and Trauma
Currently, approximately 80,000 Holocaust survivors reside in the United States (Hoffman and Weiner, 2019). Victims of the Holocaust endured torture, starvation, imprisonment, forced migration and extermination. Because of these experiences, Holocaust survivors are at higher risk for a variety of physical and emotional conditions, including heart disease, osteoporosis, dental problems, cancer and an overall greater difficulty performing activities of daily living (Van Pelt, 2013). Holocaust survivors are also at high risk for poverty. Those survivors living in the United States are three times more likely to live in poverty than other older adults are. In fact, nearly 35% of survivors live below the poverty level (Hoffman and Weiner, 2019) and often struggle to meet their basic needs, including those for meaningful social interactions (Sherman, 2014).
It is critical when serving Holocaust survivors, other individuals with a history of trauma and/or their family caregivers, that health and social service providers do so in a manner that minimizes triggers and reduces the risk of re-traumatization. Doing so, however, requires their specific knowledge and capacity that puts the individual and/or his family members at the center of such an approach.
PCTI Care for Holocaust Survivors: Progress to Date
Person-centered approaches to supportive service delivery take into account each individual’s experiences, needs, strengths, preferences, and goals. A trauma-informed approach is one in which all individuals and levels of an organization or system have a basic realization about trauma and understand its impacts on individuals, families, groups, organizations and communities (SAMHSA, 2014). First coined by AoA in its 2015 funding announcement, the term Person-Centered, Trauma-Informed (PCTI) care was envisioned as a holistic approach to service provision that promotes dignity, strength and empowerment of trauma victims by incorporating knowledge about trauma in victims’ lives into agency programs, policies and procedures (Eisinger and Bedney, 2018). In the five years since that project got under way, AoA’s grantee the Jewish Federations of North America (JFNA), has made considerable progress developing the PCTI concept and related approaches by funding local, community-based agencies to provide an array of services and supports to Holocaust survivors.
Central to that work is the training and technical assistance designed to build the national capacity to provide PCTI to Holocaust survivors and other older adult populations. In this regard, JFNA has provided considerable training and support to a range of professionals across the aging services network. To date, outcomes of this initial project include the following:
Measurable improvements in a number of quality of life measure of Holocaust survivors including:
Reduced anxiety, depression and loneliness;
Feelings of greater connectedness to others;
Improved access to available community resources;
Feeling more optimistic and able to exercise self-care; and
Feeling more confident in their ability to remain at home.
Measureable improvements in the way professionals from across the aging services network view their abilities to work with victims of trauma, including:
More confidence and comfort working with Holocaust survivors;
More knowledgeable about trauma-informed care, including PCTI approaches;
Enhanced ability to identify and avoid potential triggers for re-traumatization of Holocaust survivors; and
Greater competence in their ability to create and support trauma-informed environments for effective service delivery.
Opportunities to expand PCTI to other older adults and family caregivers
Despite the prevalence of trauma histories in adults age 65 and older, prior to AoA’s 2015 project focused on advancing PCTI supportive services for Holocaust survivors, at the federal level, relatively little work had been done to understand and address the needs of this population or other older adult populations with a history of trauma. The aging process is often accompanied by declines in one's health status or functional abilities (e.g., ability to carry out activities of daily living). When combined with a history of trauma, the aging process itself can serve as a triggering event, making it necessary to ensure that there are appropriate interventions and supports for these individuals and their family caregivers (see Davidson, et al, 2016; Kaiser, et al, 2017; Ladson and Bienenfeld, 2007).
Purpose, Goals and Desired Outcomes
With the above factors in mind, AoA is interested in building upon and expanding the work begun under the 2015 grant program entitled “Advancing Person-Centered, Trauma-Informed Supportive Services for Holocaust Survivors.” The accomplishments of AoA’s previous grant should serve as a springboard for furthering innovations in the delivery of PCTI, while at the same time strengthening the national capacity for delivering such services and supports through a robust and multi-faceted technical assistance approach. For this new project, the grantee will focus on the following two priority areas:
Further the develop and expand the delivery of innovative, community-based PCTI services to:
Holocaust survivors in the U.S.;
Other older adult populations with a history of trauma; and
Family caregivers of these individuals.
National technical assistance to continue growing the capacity of the aging services network to provide PCTI to any older adult with a history of trauma and their family caregivers.
Priority Area 1: Expand the Provision of PCTI Services and Supports
Under this priority area, the successful grantee will further develop and expand the availability and delivery of community-based PCTI supportive services. However, within this priority area, the grantee shall propose approaches for expanding the provision PCTI, supportive services to Holocaust survivors, other older adult populations with a history of trauma, and family caregivers.
Service innovations should incorporate the principles of trauma-informed care as described in SAMSHA’s Concept of Trauma and Guidance for a Trauma-Informed Approach in a person-centered and strengths-based manner, enabling those served to maximize their independence and well-being. The successful grantee will build upon and refine interventions begun under the previous project funded by AoA. To the greatest degree possible, services and innovations developed under this new project will leverage existing national and community-level partnerships, develop new ones and share best practices to enhance program development and service delivery. Examples of possible focus areas for such interventions include (but are not limited to):
Comprehensive care management, including care transitions activities;
Innovations in other care settings (e.g., nursing homes, assisted living facilities, senior centers, etc.)
Trauma-informed lawyering and legal assistance;
Socialization and wellness programs;
Advance planning, end-of-life and palliative care; and
Homecare, nutrition and transportation services.
In proposing approaches in this priority area, applicants should describe how they will make funds available to community-based organizations serving Holocaust survivors, other older adults with histories of trauma and family caregivers. The successful grantee is expected to propose and use a competitive process to solicit, objectively evaluate, select and make sub-awards to community-based programs throughout the United States. Applicants should carefully consider and describe the competitive sub-award process.
IMPORTANT: The successful grantee, including any sub-grantees, will not be permitted to use project funds for construction and/or rehabilitation of buildings; basic research; medical care; income maintenance; or equipment purchases, unless such equipment is demonstrated to be necessary to carry out an activity otherwise fundable under Title IV of the Older Americans Act. Further, the successful grantee shall adhere to all requirements, including those for making and monitoring sub-awards, as outlined in 45 CFR Part 75.
As with other demonstration programs that seek to test new innovations in service delivery and the building of national capacities to meet the needs of specific populations of older adults, the activities conducted in this priority area should closely align with those undertaken in response to Priority Area 2 (described below). Applicants should describe their approaches for ensuring that activities at the local level inform (and are informed by) those at the national level and advance the nationwide capacity and dialogue for more effectively serving Holocaust survivors, other older adults with histories of trauma and family caregivers.
Priority Area 2: National Technical Assistance and Capacity Building
Under this priority, AoA seeks to build on previous technical assistance (TA) efforts by continuing to grow national capacity the capacity to effectively deliver PCTI supportive services to Holocaust survivors and other older adults with histories of trauma and their family caregivers. AoA envisions a multi-faceted approach to technical assistance whereby the grantee is providing technical assistance and support to sub-awardees to the project while at the same time undertaking efforts to advance PCTI practices more broadly through the aging services network.
Applicants are encouraged to propose approaches to technical assistance and capacity building that address any the following areas, as well as others they identify as necessary and relevant, includinig:
The creation of a nationally recognized Technical Assistance and Resource Center for PCTI Supportive Services, rooted in serving Holocaust survivors, but with the added focus of other older adult populations with histories of trauma and family caregivers;
The development, testing, validation and dissemination of education and training programs in PCTI Supportive Services for a broad range of health and human services providers and settings;
The development of partnerships and collaborations necessary for the advancement of research, policy development and service delivery across disciplines and populations (e.g., veterans, Tribes, health care settings, veterans, first responders, etc.); and
Education and training opportunities for a broad range of audiences in a variety of formats and settings.
Additional Application Elements and Considerations
Priority Area Emphasis and Resource Allocation
When developing their proposals, applicants should give careful consideration to the allocation of program resources to each priority area. In doing so, applicants are reminded that Congress and AoA intends for these funds to first be used for supportive services to Holocaust survivors. However, AoA understands that in order to do this effectively, and to realize advancements in the design and delivery of PCTI supportive services, certain flexibilities may be necessary to permit the grantee to make allocation decisions regarding sub-awards, technical assistance and other activities that may necessitate fluctuating amounts under each area over the course of the project.
In this regard, the project work plan and associated budget should reflect applicants’ best estimates of the range of permissible grant activities that will be undertaken, the level of resources necessary for each, and reflect that information in a detailed manner. Applications will be scored, in part, on the extent to which resource allocation across priority areas reflects an understanding of the needs to be addressed and the approaches to be taken.
To successfully meet AoA’s expectations for this initiative, the successful grantee will be one that possesses the organizational capacity to apply multi-faceted and comprehensive approaches in their efforts. To that end, applicants should fully describe their capacity to:
Ensure the expeditious startup of project activities upon notice of award;
Work effectively at both the national and local levels to achieve desired outcomes;
Use efficient and effective strategies that maximize available resources while ensuring measureable impact of service provision and training and TA activities;
Embed all efforts within targeted networks to ensure ownership and long-term sustainability; and
Use technology, where possible, to maximize project reach and impact.
Applicants must possess direct, in-house experience and expertise to carry out the desired activities outlined in this FOA. Applications will be reviewed and scored based, in part, on how well applicants demonstrate key subject-matter expertise, the experience, and the capacity to carry out the tasks proposed.
The use of sub-grants or subcontracts to carry out specific activities is expected in Priority Area 1. Sub-grants/contracts are permissible in Priority Area 2, when the applicant identifies areas where additional expertise is necessary to complete specified goals and objectives. In both priority areas, applicants should fully describe their rationale and criteria for selecting sub-grantees/sub-contractors as well as their approach for managing the activities of all sub-grantees/contractors to ensure successful completion of all tasks in either Priority Area.
Performance Measurement, Outcomes and Evaluation
Performance measurement and evaluation are important components of any new project and allows the project administrators to understand both project strengths and weaknesses and to ensure continuous improvement. Applicants to this funding opportunity should include a comprehensive plan for evaluating and reporting project performance and effectiveness. This plan should include measurable outcomes that demonstrate the benefit of project activities to target populations.
Over the course of this new, five-year project, AoA seeks outcomes that might include, but are not limited to, the following:
Measurable reductions in isolation, depression, anxiety and poor health outcomes of Holocaust survivors, other older adults with histories of trauma and family caregivers;
Measureable decreases in emergency room visits and/or hospital readmissions;
Measurable improvements in the ability of Holocaust survivors and other older adults with a history of trauma to exercise self-care tasks and to remain in their homes and communities;
Documented increases in the number of PCTI programs and services for family caregivers of any older adult with a history of trauma;
Measurable and sustained increases in both organizational and individual staff knowledge and comfort working with Holocaust survivors and other older adults with a history of trauma;
Enhanced national capacity to provide person-centered, trauma-informed supportive services to any older adult with a history of trauma and/or their family caregivers.
Applicants are encouraged to propose additional and/or different outcomes, based on the approaches they opt to employ in response to this FOA and should describe how they will identify and collect information necessary to document and describe both outputs and outcomes for all activities undertaken in both priority areas of this cooperative agreement. Applications should include a description of expected sources for output and outcome data and the methods for how such data will be gathered (e.g., surveys of consumers and/or providers, collection and review of administrative data and records), analyzed, evaluated and reported.
Collaboration, Partnerships and Project Governance
To most effectively accomplish the goals and objectives outlined in this FOA, AoA anticipates that the successful applicant will demonstrate the commitment to broad collaboration with other national and local organizations with diverse areas of expertise. Potential partnerships might include those with organizations that work specifically with Holocaust survivors; mainstream aging services providers; entities with expertise in trauma-informed and/or person-centered approaches; entities that focus on evaluation and performance measurement and others with expertise relevant to this initiative.
Applicants should describe the partner organizations and the role of each in the planning, development and implementation of the proposed project. Letters of support from partnering organizations should be included as part of the application package and should reflect the unique contributions of each entity. Letters of support will be reviewed and evaluated to determine likely value of each named partner and its relative impact to the proposed project.
In addition, a steering committee can be an effective method of ensuring that diverse ideas are considered in the planning and implementation of any new project. Applicants for this opportunity should explain if, and how, they will use a steering committee to assist their efforts and include a listing of the types individuals (e.g. consumers, professionals and organizations) that will be invited to participate.
Given this project's orientation as a demonstration program, AoA anticipates that the grantee will develop a robust and far-reaching dissemination strategy designed to ensure that project information, best practices and other information are available and shared broadly. Applicants should describe their dissemination plans and articulate the methods (e.g., electronic, in-person, print, etc.) by which such activities are to occur.
Through this funding opportunity, AoA expects to realize tangible, measurable and sustainable enhancements to national and local capacities to provide person-centered, trauma-informed supportive services to Holocaust survivors, other older adults with histories of trauma and their family caregivers. Applications will be scored, in part, on the extent to which a plan for the project’s sustainability beyond the period of Federal funding is articulated and appears feasible.
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Eisinger, M.A., and Bedney, B. (2018). Teaching about trauma: Models for training service providers in person-centered, trauma-informed care. Kavod, 8, http://kavod.claimscon.org/2018/02/teaching-about-trauma-models-for-tra…
Elder, K., and Retrum, J. (2012). Framework for Isolation in Adults Over 50. AARP Foundation. https://www.aarp.org/content/dam/aarp/aarp_foundation/2012_PDFs/AARP-Fo…
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Sherman, L. (2014). Aging in Comfort: Assessing the Special Needs of America’s Holocaust Survivors. Testimony before the U.S. Senate Special Committee on Aging, January 15, 2014. https://www.aging.senate.gov/imo/media/doc/Sherman_1_15_14.pdf
United States Department of Health and Human Services, Administration for Children and Families (ACF). (2017). Resource Guide to Trauma-Informed Human Services.
United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Van Pelt, J. (2013). Supporting Elder Holocaust Survivors. Social Work Today, 13, 8.