Bonus points will be awarded for states that do not currently have a funded project under this program.
A. Background and Purpose
Administration for Community Living
The Administration for Community Living 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 practice self-determination with regard to their independence, health, and well-being. ACL exists to help all Americans – including people with disabilities and older adults – live and participate in any community.
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.
The TBI State Partnership Program
This announcement solicits applications for the Traumatic Brain Injury State Partnership Program – Partner State Funding Opportunity. This Program is authorized by the Traumatic Brain Injury Reauthorization Act of 2018 (P.L.115-377). In July 1996, Congress enacted the first TBI Act (P.L. 104-166) "to provide for the conduct of expanded studies and the establishment of innovative programs with respect to traumatic brain injury." This legislation allowed for the implementation of a state grants program to improve access to health and other services for individuals with TBIs and their families.
The TBI Reauthorization Act of 2014 (P.L. 113-196) allowed the Department of Health and Human Services Secretary to review oversight of the federal TBI programs (TBI State Partnership Grant program and the TBI Protection and Advocacy program) and reconsider which operating division should lead them. With avid support from TBI stakeholders, the Secretary found that the goals of the federal TBI programs closely align with ACL's mission to advance policy and implement programs that support the rights of older Americans and people with disabilities to live in their communities. As a result, on Oct. 1, 2015, the federal TBI programs moved from the Health Resources and Services Administration to ACL.
The purpose of the overall TBI State Partnership Program is to create and strengthen a system of services and supports that maximizes the independence, well-being, and health of persons with TBI across the lifespan, their families, and their caregivers. Since the passage of the TBI Act of 1996 and through subsequent reauthorizations, state agencies have received federal funding to develop and enhance services, systems, and infrastructure that serve people with TBIs and their family members and caregivers. Various iterations of this program have included small grants to many states and territories, and more recently, larger grants to fewer states.
Focusing on fewer states has allowed a core group of states to maintain well-developed infrastructure, while many states that have not received a recent grant have found it more difficult to create and sustain the infrastructure necessary to maintain services and supports for people with TBIs.
Since the TBI programs transferred to ACL, ACL has sought stakeholder feedback in the form of interviews with individuals who have sustained a TBI and their family members, interviews with experts in TBI research and rehabilitation, presentations to national membership groups and state head injury administrators, and outreach to other federal partners who work on TBI prevention, clinical, and research initiatives. This feedback was collected and detailed in the ACL TBI As-Is Assessment. Following the release of this report in November 2016, ACL received additional stakeholder feedback regarding the scope of the program. Specifically, stakeholders reported that it is important for the program to have a broader reach (i.e., that more states should have access to funding). They also reported that spreading the currently available funding among every eligible grantee would result in insufficient funding for any grantee to develop meaningful infrastructure. ACL also heard about the desire for more national efforts including interstate collaboration regarding services and supports for underserved populations, standardized data collection and metrics, and resource sharing of evidence-based practices.
Additionally, stakeholders from state agencies were excited about the opportunity to collaborate more intentionally with other federal programs, in particular other ACL initiatives such as the Centers for Independent Living and the Aging and Disability Resource Centers.
Through the TBI State Partnership Program, ACL’s goal is two-fold: 1) To help states strengthen and grow their capacity to support and maintain a system of services and supports that will maximize the independence, well-being, and health of persons with TBI and 2) To learn from and call upon the expertise of states that have built and maintained a strong and sophisticated state TBI infrastructure.
For the 2018 funding cycle last year, ACL awarded two tiers of grantees through the TBI State Partnership Program:
14 Partner State Grants
10 Mentor State Grants
Grantees from both tiers are now working together to maximize the program’s impact nationally. Both types of grants provide funding to states for building, enhancing, and expanding basic infrastructure. Additionally, Mentor State Grants are working with Partner State grantees within the context of joint workgroups focused on topics critical to the TBI community and the program. The current workgroups are focused on the following topics:
Advisory Boards and Survivor Engagement
Criminal and Juvenile Justice
Opioid Use, Substance Use, and Mental Health
Return to Learn and Return to Play
Transition and Employment
Using Data to Connect People to Services
Waivers and Trust Funds
Mentor State grantees are also working together with other Mentor State grantees and with ACL to improve the national impact of the TBI program through an effort to create a national, culturally competent, person-centered professional development infrastructure for TBI service professionals.
In order to avoid any issues around duplication of effort, it is ACL's intent under this funding opportunity announcement to award grants to two states that do not currently have a TBI State Partnership Program grant.
This funding opportunity is for the Partner State Grants, and applicants must agree to:
provide the required 2:1 state match (State agencies will be responsible for $1 of project funding for every $2 provided by the federal program. Another way of thinking about this is that grantees will provide 1/3 of the total project funding.);
support a state TBI advisory board;
provide at least one dedicated staff person at 50% FTE;
create an annual TBI state plan;
create and/or expand their state’s TBI registry; and
work independently and with one or more Mentor State grantee(s) to expand and strengthen the Partner State’s capacity to provide access to comprehensive and coordinated services for individuals with TBIs and their families.
Like all ACL programs, the TBI State Partnership Program operates with a solid focus on the principles of the Independent Living Movement. Independent living is a liberation movement and a culture that empowers individuals with disabilities – particularly individuals with significant disabilities – to exercise full choice and control over their lives and to live independently in their communities. It is expected that the successful applicants will demonstrate how the independent living philosophy will be evident throughout the funded activities, including staffing, administration, and governance.
In alignment with ACL’s commitment to independent living and person-centered planning principles, grantees will work across statewide systems towards the creation or enhancement of a person-centered, consumer-directed service delivery system. Grantees should include evidence-based practices. Grantees should include standards for incorporating consumer- direction into service systems at the development, implementation, and quality management levels through authentic consumer leadership on advisory boards, in focus groups, and through surveying, etc.
B. Program Priority Areas
1. State TBI Advisory Board
Per 42 U.S. Code § 300d–52, all recipients of this funding opportunity must agree “to establish an advisory board within the appropriate health department of the State or American Indian consortium or within another department as designated by the chief executive officer of the State or American Indian consortium.”
The State TBI Advisory Board provides an opportunity for grantees to ensure a variety of stakeholders participate in determining the needs of individuals with TBIs, their families, and caregivers within the state. It also creates a structure for statewide cross-systems collaboration, which is essential for systems change work.
Applicants should describe in their applications how their program’s advisory board representation will be in accordance with 42 U.S.C, § 300d–52, which specifies “an Advisory Board shall be composed of representatives of:
(i) the corresponding State, Territory or American Indian consortium agencies involved;
(ii) public and nonprofit private health related organizations;
(iii) other disability advisory or planning groups within the State, Territory or American Indian consortium;
(iv) members of an organization or foundation representing individuals with traumatic brain injury in that State, Territory or region;
(v) injury control programs at the State or local level if such programs exist; and
(vi) a substantial number of individuals with traumatic brain injury, or the family members of such individuals.” which requires participation from individuals with disabilities and their family members, health related organizations, disability advisory groups, and injury control programs (if such programs exist).”
Additionally, ACL believes that high expectations can lead to a stronger, increasingly collaborative, and increasingly person-centered program and that individuals with disabilities need to be engaged in and lead the decision-making processes about their services and supports. The inclusion of survivor voices at all levels of decision-making is a function of those high expectations and is a core value of ACL. That is why TBI state advisory boards must include a significant number of TBI survivors. To this end, applicants should describe the extent to which they will include the following professional and personal affiliations on their advisory board:
People with TBIs (states should work towards ensuring that people with TBIs comprise 50% of the advisory board membership)
Family member(s) of people with TBIs
Center for Independent Living/State Independent Living Council representation
Aging and Disability Resource Center representation (if one exists within your state)
Protection & Advocacy agency representation
Long-term care ombudsman representation
The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) funded TBI Model System Center representation (if one exists within your state)
2. Annual TBI State Plan
During the course of the project, grantees will develop annual state plans that will help them determine how best to improve the services and supports for people living with TBIs in their state. Applicants should describe in their applications, a clear process for how they will develop an annual state plan through the state TBI Advisory Board and also how other people with TBIs, including underserved and inappropriately served individuals will be involved in the plan’s creation. The process should make use of the results of a comprehensive review and analysis of the services, supports, and other assistance available to people with TBIs, as well as the extent of the unmet needs. Annual plans will include goals for closing the gap of unmet needs of people with TBIs in the state along with objectives and activities for the grantees’ funded projects. Grantees will be expected to use the information in their state plans as a foundation for advancing their statewide systems of TBI services, including how such services are targeted and delivered, as well as how known gaps in services are addressed. ACL will review each grantee’s annual state plan.
3. TBI State Registry
In the Children’s Health Act of 2000, Congress authorized the CDC to develop a “National Program of TBI Registries” to collect data about TBI. TBI registries [CT(1] require the following primary functions: data collection; identification (maintaining personal identifiers and contact information); and linking people to services (helping them get information about available services).* The CDC continues to support TBI registries and related data systems.
ACL believes that this existing infrastructure is a valuable method of connecting people with TBIs to available services and supports. Applicants should discuss how they will collaborate with any existing TBI registries or similar data collection efforts in their states and work to better connect individuals to person-centered services. Applicants should describe how they will work to broaden the registries’ or data collection efforts’ impact – for example, working with the existing infrastructure to expand the referral sources (i.e., beyond trauma care or emergency room visits to include primary care physician visits, Vocational Rehabilitation, justice systems, etc.). If no state registry exists, applicants should describe how they will work toward creation of a registry or similar data collection effort. Applicants are permitted but not required to invest in robust information technology in order to fulfill this requirement. Applicants should also describe how they will consider privacy protections and other safeguards for individuals on this registry.
4. Mentorship and Technical Assistance
In addition to the statewide and national initiatives detailed above, Partner States grantees are required to join with other Partner State and Mentor State grantees on at least two grantee workgroups focused on a particular an area of need.
The existing work groups:
Advisory Boards and Survivor Engagement – The Advisory Boards and Survivor Engagement workgroup supports the full participation and authentic leadership of TBI survivors in the service delivery system through advisory board activities, needs assessments, and other state activities.
Criminal and Juvenile Justice – The Criminal and Juvenile Justice workgroup is focused on the many individuals who have sustained a TBI and are currently involved in the justice system or transitioning back into community living. Many states are working to screen individuals for potential TBIs and connect them with appropriate supports. The workgroup supports the training of correctional officers, probation officers, and other professionals in the criminal justice system to understand the needs of justice-involved individuals who have sustained TBI.
Opioid Use, Substance Use, and Mental Health – The Opioid Use, Substance Use, and Mental Health workgroup collaborates across this critical intersection of often disconnected support services to address vulnerabilities within the TBI community. Opioid misuse is a common risk factor following TBI, and the challenges of chronic pain management are further complicated by reactions to the current crisis. Moreover, many individuals who have sustained a TBI also experience co-occurring mental health disorders.
Return to Learn and Return to Play – The Return to Learn and Return to Play workgroup is focused on helping professionals, families, and TBI survivors navigate post-TBI transitions. Following TBI, school-aged children often require assistance returning successfully to school and sports.
Sustainable Partnerships – The Sustainable Partnerships workgroup focuses on establishing partnerships between lead state agencies and other stakeholders to ensure the long-term success of TBI programs. Through robust partnerships, State Partnership Program grantees are able to create comprehensive systems of services and supports for individuals who have sustained a TBI, their families, and their support networks.
Transition and Employment – The Transition and Employment workgroup is focused on how to support individuals who have sustained TBI and are seeking to reenter the workforce. The workgroup develops resources that help survivors know their rights and help potential employers understand the skillsets and accommodation needs of their survivor employees.
Underserved Populations – The Underserved Populations workgroup is working to determine how to effectively reach and serve communities that are often overlooked. TBI often goes undiagnosed among certain populations such as rural communities, homeless veterans, and native and tribal populations.
Using Data to Connect People to Services – The Using Data to Connect People to Services workgroup focuses on state TBI registries and data collection. TBI registries contain protected prevalence data that helps states provide more targeted outreach to TBI survivors, including information and referral to TBI survivors.
Waivers and Trust Funds – The Waivers and Trust Funds workgroup collaborates to support and further develop state TBI waivers and TBI trust funds. Waivers are an avenue for TBI survivors to access and pay for services. Trust funds help ensure program sustainability through additional funding.
In addition to advancing the field in these focus areas, workgroups also serve as a forum for Partner State grantees to work alongside Mentor State grantees and benefit from their leadership and experience. Applicants should indicate in their applications which of the workgroups they are most interested in working on.
Travel is not required for these activities, but it is allowed.
5. Program Sustainability Plan
Through this funding opportunity, ACL expects to realize tangible, measurable, and sustainable advancements in the capacity of states to serve people with TBIs, their families, and caregivers. Applicants should propose in their applications a plan for their project’s sustainability, beyond the period of federal funding, that is reasonable and feasible. Applicants are encouraged to consider and propose a range of potential approaches for ensuring sustainability of project efforts for three to seven years once federal funding has ended.
6. Grantee Meeting
Additionally, grantees will participate in a national or regional TBI-related conference that will be convened by ACL or ACL partners. This event will provide grantees with the opportunity to learn from each other, to share educational resources and promising practices, and expand partnerships across states. Applications should include budgets that request sufficient resources for at least two individuals affiliated with the program to travel to and participate in a national or regional TBI-related conference annually. Applicants' budgets should take into consideration any potential extra costs related to reasonable accommodations that may be necessary for TBI survivors who may be traveling.
7. Performance reporting
Applicants should describe how they will report on the impact of their projects, including in the areas of:
Increased capacity to provide access to comprehensive and coordinated services for individuals with TBIs and their families
The strengthening of a system of services and supports that maximizes the independence, well-being, and health of persons with TBI across the lifespan, their families, and their caregivers
Improved national coordination and collaboration around TBI services and supports
The establishment of innovative programs with respect to TBI
Improved access to health and other services for individuals with TBIs and their families
Please see proposed performance measures for these grants in the Attachments section. ACL is in the process of obtaining clearance to use these measures through the US Office of Management and Budget. But, it is not anticipated that the measures will change significantly from what is presented here[CT(2] .
Other Allowable Activities
Applicants should describe how they will use any remaining funds for other activities that strengthen a system of services and supports that maximizes the independence, well-being, and health of persons with TBIs across the lifespan. Examples of some of these allowable activities are listed below. This list is illustrative and not exhaustive.
Hosting trainings for service professionals in the state who are working with people with TBIs
Providing training for people with TBIs on areas of interest such as employment, advocacy, independent living skills, peer support, TBI self-management, health promotion, or cross disability systems change
Screening people for TBIs
Providing information and referral services
Providing resource facilitation
Establishing/enhancing a TBI Home and Community-Based Services (HCBS) waiver within the state
Establishing/enhancing a TBI trust fund in the state
Performing a needs and resources assessment for specific populations
Hosting or presenting at conferences
Establishing/enhancing a peer or family mentorship program or support groups