A. BACKGROUND & PURPOSE:
Administration for Community Living
The Administration for Community Living (ACL) was established in April 2012 to better enable older adults and people with disabilities across their lifespan to fully engage and participate in their communities, make informed decisions, and exercise choice and control with regard to their independence, health, and well-being.
Programs operated by ACL have the expectation of community living as their foundation. ACL programs actively seek to create communities where the necessary information, resources, opportunities, services, and supports are available and accessible so that people with and without disabilities, their families, and their support networks can live, learn, work, play, and prosper. It is expected that the successful applicants to this funding opportunity will demonstrate how these aims will be advanced – particularly through active, meaningful collaboration with individuals with paralysis and independent living and other disability-based organizations. Successful applicants also will provide evidence that individuals with paralysis and other disabilities will be actively and meaningfully engaged throughout all funded activities, including staffing, administration, and governance.
The Paralysis Resource Center State Pilot Program
Last year, ACL awarded two Paralysis Resource Center (PRC) State Pilot Program grants designed to enhance the capacity of community disability programming by improving and/or increasing the services and supports provided by community-based disability organizations working to improve the quality of life for individuals with paralysis. Grantees funded under that announcement are making subawards to community-based organizations across their states that provide long-term services and supports to people with paralysis. In 2019, ACL will continue to fund these two grantees for their second year:
The University of Kentucky Human Development Institute is operating a project called Wellness Edge, that is building connections and partnerships within local communities to enhance, facilitate, and create innovate ways to collaborate and increase access to recreational programs to better serve people with paralysis and their support networks.
The Texas State Independent Living Council has launched the Virtual Independent Living Services Project and is beginning to build supports and services to Texans living with paralysis in unserved or underserved areas of the state. The project is building upon a coalition of direct service providers that is using a virtual bridge to connect Texans living with paralysis to services.
Through this funding opportunity announcement, ACL expects to expand this program by awarding two additional PRC State Pilot Program grants in two additional states to provide quality of life subawards to community based disability agencies that serve people living with paralysis, their families, and their support networks. Applicants should be experienced organizations that can deliver programmatic capacity-building grants across their states to community-based disability organizations that provide long-term services and supports to people with paralysis, their families, and their support networks. Applicants will use the majority of the funding to deliver subawards within their states and provide follow-up technical assistance to these organizations.
In 2019, ACL will also continue to fund a National Paralysis Resource Center (NPRC) that works to improve the health and quality of life of individuals with paralysis by raising awareness of and facilitating access to a broad range of services, tools, and opportunities – including making quality of life subawards on a national scale.
The PRC State Pilot Program is part of an effort to ensure program efficiency and test two approaches for making subawards to community-based organizations that provide long-term services and supports to people with paralysis, their families, and their support networks. Information reported about the efficiency and effectiveness of these subawards will be compared to similar activities by other PRC State Pilot Program grantees as well as the NPRC. ACL will work closely with the PRC State Pilot Program grantees and the NPRC to avoid duplication of subawards within the pilot states.
People Living with Paralysis
For purposes of this funding opportunity announcement and the activities of the State Pilot Program grantees, “paralysis” refers to a range of disabling conditions due to stroke, spinal cord injury, multiple sclerosis, cerebral palsy or any central nervous system disorder and result in difficulty or inability to move the upper or lower extremities.
Typical causes of paralysis include motor vehicle crashes, strokes, falls, acts of violence (primarily gunshot wounds), and sports/recreational activities. The leading cause of paralysis according to a 2013 study was stroke, followed by spinal cord injury and multiple sclerosis. Every year, more than 795,000 people in the United States have a stroke. More than a quarter of a million Americans are currently living with spinal cord injuries (SCI) and there are an estimated 17,500 new spinal cord injuries every year in the United States.
The number of people surviving traumatic injuries continues to grow as a result of improved emergency and acute care. Medical advances and technology has come a long way in the last few decades with new procedures and devices that enable individuals with any central nervous system injury or disorder to live longer and independently in the setting of their choice with support and services.
Finding and accessing the right long-term services and supports can be a daunting task for individuals with paralysis and their families – ultimately leading to increased healthcare costs and loss of independence. Individuals with paralysis can experience depression, isolation and a drop in social interactions. The current lack of opportunity for people with paralysis to experience programs aimed at increasing quality of life is unavailable or nonexistence.
All activities funded under this grant will promote greater independence, equality, choice, and control for individuals with paralysis and help them more fully integrate into their communities. The funded activities will be designed to directly improve the quality of life of individuals with paralysis by building the programmatic capacity of community based disability organizations in the community that serve these individuals.
B. PROGRAM ACTIVITIES:
There are three objectives within this funding opportunity announcement.
Providing Subawards to Community-based Disability Organizations
Collaborating and Partnering with Other Organizations, Agencies, and Programs
1. Providing Subawards to Community-based Disability Organizations
The majority of the PRC State Pilot Program funds will be used to assist community based disability programs by increasing their capacity to serve people with paralysis, their families, and their support networks. Capacity building activities are those that produce measurable effects and result in community programs that are better able to provide increased or improved services and supports to individuals with paralysis, their families, and their support networks.
ACL expects the grantee to propose and use a competitive process to solicit, objectively evaluate, select, and make sub-awards to direct service providers throughout the state that the applicant resides in. Applicants should describe how they will provide follow-up technical assistance to community-based disability organizations across their states that provide long-term services and supports to people with paralysis and other disabilities, their families, and their support networks.
Applicants will describe how they will issue financial subawards to community-based disability programs through a competitive process in an amount representing at least 65 percent of the total federal funds requested.
This activity is intended to recognize and support organizations that assist individuals with paralysis, their families and support networks in ways that increase independence, provides social and education opportunities, and decreases depression, isolation and opportunities for social interactions.
For this funding opportunity, the definition of paralysis includes stroke, spinal cord injury, MS, cerebral palsy, or any central nervous system injury or disorder resulting in difficulty or inability to move the upper or lower extremities.
Applicants should carefully consider and describe the competitive process by which sub-awards will be made to other organizations for the purposes of providing innovative, direct services to people with paralysis. Such descriptions should include: 1) a proposed timeline detailing the competition solicitation, application review and awarding process; 2) areas of focus for sub- awards; 3) the range of services to be funded; 4) how those services will enhance existing services for people with paralysis, their families, and their support networks; and 5) how provider networks outside those that typically provide services to people with paralysis might be engaged.
Examples of programmatic capacity building:
Installing accessible playground equipment;
Investing in accessible transportation
Career training and employment support services
Internship program for students with disabilities
Developing physical activity or injury prevention program
Applicants will focus these efforts on one or more priority areas of need for people with paralysis in their states. Examples of priority areas of need are but not limited to:
Improving accessibility to services and supports
Providing assistive technology
Expanding employment opportunities
Facilitating nursing home transitions
Establishing creative transportation options
Supporting families and caregivers
Ffacilitating access to integrated or specialized recreation
Further, applicants are strongly encouraged to identify specific steps the project would take to help achieve two or more of the following HHS wide public health goals: reduce inappropriate use of opioid medications; effectively treat individuals with paralysis and co-occurring serious mental illness; and/or reduce childhood obesity. Also, applicants should identify how the project would make progress on two or more of the five ACL pillars and goals:
Better connect older persons and individuals with disabilities of all ages to resources;
Protect the rights and prevent the abuse of such individuals;
Support families and caregivers;
Enhance the employment opportunities of people with disabilities and older workers; and
Strengthen the reach, capacity, and business acumen of community based organizations.
Applicants funded under this announcement will describe how they will make subawards to community-based disability organizations across their states that provide long-term services and supports to people with any type of paralysis, their families, and their support networks and how they will provide follow-up technical assistance as a means to build the capacity of the subawardee organizations’ programming. Applicants will describe how they will work with subawardees to intentionally seek to make the best use of existing community resources in their projects.
ACL will work closely with applicants to ensure that funds are used appropriately and in the most effective manner possible. Within 45 days of receipt of an award under this announcement, applicants will be required to develop, with guidance from and in consultation with ACL, a detailed subaward work plan, which they will submit to ACL.
ACL will work with applicants to finalize their program strategy into a concrete competitive subaward work plan. ACL must review and approve this plan prior to the issuance of any competitive subawards, plans, and/or procedures for the issuance of competitive subawards under this announcement. Any plans and procedures for issuance of competitive subawards must follow the language as outlined in the subaward strategy section below.
Subaward Strategy Requirements
Applicants for the PRC State Pilot Program should describe in detail how they will conduct a statewide competitive subaward program that incorporates the following criteria (see Section V.1.):
At least 65 percent of the total annual federal funds awarded will be issued through a competitive statewide subaward process.
The proposed subaward process should describe how the approach will ensure that funds are used for programmatic capacity building activities that further the ability of the subawardees to improve or increase their services and/or supports to individuals with paralysis, their families, and their support networks.
The proposed subaward process should describe how the subaward application process will be completely open without any projects being pre-selected or otherwise given a competitive advantage or discriminated against.
The proposed subaward process should describe how the proposed outreach activities for subaward applications will be broad and inclusive of a range of organizations that serve people with paralysis, including both secular and faith-based nonprofit organizations.
Applicants will describe how they will provide follow up technical assistance to the organizations to which they issue subawards in order to maximize the impact of the subawards.
The proposed subaward process should describe how subawards amounts will be appropriate to the projects and needs expressed by the subaward applicants. ACL expects most subaward amounts will generally be between $10,000 and $25,000.
Applicants should describe how subawards will be made available to organizations with a history of providing services and supports to individuals with paralysis and their families and support networks in order to help them live more independently, to more fully integrate into their communities (for example, through transitions from institutions back into the community or by providing transportation and employment opportunities), and to alleviate burnout on the part of their families and others that assist them.
Applicants should describe how all subawards will promote greater independence, equality, choice, and control for individuals with paralysis and help them more fully integrate into their communities.
Applicants should ensure that there will be no requirement for subaward applicants to provide matching funds and no preference given in the selection process if any offer matching funds in their applications.
Applicants should describe how they will make subawardees to nonprofit organizations that serve people with paralysis in the United States.
Applicants should describe how they will not provide subaward recipients a second subaward for the duration of the funded period. Such organizations may continue to receive technical assistance provided by the applicant.
Applicants should describe how they will require subawardees to expend their subawards within a 12-month period and not allow subawards to be used to provide medical services, nor direct fundraising activities.
Applicants for the PRC State Pilot Program should understand that, as grantees, they will be accountable for all federal funds received including all subawards provided under the grant program. Applicants should describe how they will ensure the subawards are used for the intended purposes of this program and that expenditures comply with both program and federal regulations. Applicants should also discuss how they will monitor, provide TA, and report on subaward activities.
2. Measuring Performance:
The applicants should describe how they will collect information to document and describe output and outcomes for the activities described in this funding announcement opportunity. Applications to this announcement should include a brief description of expected sources for output and outcome data and methods for data collection (e.g., surveys of consumers, reviews of administrative records).
Applicants should discuss how they will measure the efficiency of the subaward making process as well as the efficacy of subawards (individually and in combination) on individuals with paralysis, their families, and their support networks. Specifically, the applicant will measure the costs of administering the subawards, the award rate (i.e., the number of subawards dived by the number of applications received), the percentage of the subawards that are completed on time and on budget, the level of satisfaction of the subawardees with the application / award process, the number of people proposed to be served throughout the life of the subaward compared to how many are served, and the level of satisfaction of the beneficiaries (i.e., individuals with paralysis, their families, and their support networks) with the outcome of the subaward. The applicant will also identify and propose a plan to collect at least one objective measure of the subaward specific benefits to individuals with paralysis, their families, and their support networks.
3. Collaborating and Partnering with Other Organizations, Agencies, and Programs:
Collaboration and partnership will be critical for the success of the PRC State Pilot Program. PRC State Pilot Program applicants should have strong understanding of agencies and organizations vested in paralysis. Applicants should describe who they are currently partnering with and how they will reach out to, partner, and collaborate with other agencies and organizations that have similar goals, policy initiatives, and social practice. Applicants should describe how they will promote awareness and usage of the PRC State Pilot Program subgrants within the disability and aging networks and other community based organizations. ACL funds many initiatives that naturally work together and could potentially be strong community partners for the applicant. ACL houses the Administration on Aging, the Administration on Intellectual and Developmental Disabilities and the Independent Living Administration. Applicants should describe their collaborative efforts with other federally funded programs such as but not limited to the ones listed below.
ACL’s Assistive Technology program provides funds to each state and territory to support state efforts to improve the provision of assistive technology to individuals with disabilities. People with paralysis usually rely on durable medical equipment for mobility needs. Assistive technology (AT) comes in a variety of forms that include low tech AT devises such as a magnifier or Easy Reacher to high tech devises such as complex rehabilitation equipment. Partnering with these agencies can help connect options or needed equipment to those seeking assistance.
The Centers for Independent Living (CILs) Program: There are 354 federally funded centers across the country that are consumer-controlled, community-based, cross- disability, non-residential, private nonprofit agencies that provides Independent Living services. CILs are required to provide the core services of information and referral, peer support, individual and system advocacy, independent living skills trainings and transition or diversion services from institutional setting and post-secondary transition to higher education and/or employment. Many CILs are also offer: sign language interpreters, support groups, assistance in securing housing or shelter, personal assistance services, transportation referral and assistance, mobility training, rehabilitation technology, recreation, and other services necessary to improve the ability of individuals with significant disabilities to live independently in their homes and communities.
An Area Agency on Aging (AAA) is a public or private nonprofit agency designated by a state to address the needs and concerns of all older persons at the regional and local levels. AAAs coordinate and offer services that help older adults remain in their homes, if that is their preference, aided by services such as home-delivered meals, homemaker assistance, and whatever else it may take to make independent living a viable option. By making a range of supports available, AAAs make it possible for older individuals to choose the services and living arrangements that suit them best.
The No Wrong Door (NWD) System initiative is a collaborative effort of the ACL, the Centers for Medicare & Medicaid Services (CMS), and the Veterans Health Administration (VHA). The development, implementation and oversight of a state’s NWD System has the support of the Governor and active involvement of the multiple state agencies that administer programs that effect LTSS populations. The NWD System initiative builds upon the Aging and Disability Resource Center (ADRC) program and supports efforts to streamline access to long-term services and support (LTSS) options by providing the infrastructure to promote the collaboration of local service organizations, making service delivery more efficient and person-centered. NWD Systems simplify access to LTSS, and are a key component of LTSS systems reform. These entities are made up of community agencies and partner on many HHS initiatives collectively.
Veteran's Directed Home and Community Based Services (VD-HCBS) Program is a partnership between ACL and the Veteran’s Health Administration (VHA) to serve veterans of all ages through the VD-HCBS Program. The VD-HCBS program provides veterans with opportunities to self-direct their LTSS and continue living independently at home. Eligible Veterans manage their own flexible budgets, decide what mix of goods and services best meet their needs, and hire and supervise their own workers. Person-centered counselors within Aging & Disability Network Agencies provide facilitated assessment and care/service planning, arrange fiscal management services, and provide ongoing counseling and support to veterans, their families, and caregivers.
1.United States. Congress. House. Committee on Energy and Commerce. Christopher and Dana Reeve Paralysis Act: Report (To Accompany H.R. 1727) (Including Cost Estimate of the Congressional Budget Office). Volume 110, Issue 378 of Report. U.S. Government Printing Office, http://www.gpo.gov/fdsys/pkg/CRPT-110hrpt937/html/CRPT-110hrpt937.htm; 2007.
Christopher and Dana Reeve Paralysis Act. Centers for Disease Control and Prevention:10. Disability and Health Program. Available at: http://www.cdc.gov/ncbddd/disabilityandhealth/programs.html; 2013. Accessed 09.07.13.
3 Consolidated Appropriations Act of 2014
4 Research & Practice; Prevalence and Causes of Paralysis—United States, 2013 Brian S. Armour, PhD, Elizabeth A. Courtney-Long, MA, MSPH, Michael H. Fox, ScD, Heidi Fredine, MPH, and Anthony Cahill, PhD (Am J Public Health. Published online ahead of print August 23, 2016: e1–e3. oi:10.2105/AJPH.2016.303270) accessed 12-8, 2017