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Agenda 2/14/2023 Item #11A ( Report back to the Board as to information and services provided through the COVID-19 Extra Mile Farmworker grant)02/ 14/2023 EXECUTIVE SUMMARY Report to the Board of County Commissioners (Board) relative to the information and services being provided to the public through the COVID-19 Extra Mile Migrant Farmworker Community grant. (Companion item to item 10A) OBJECTIVE: To report back to the Board as to information and services being provided through the COVID-19 Extra Mile Farmworker grant, HHS Grant Number 1 NU58DP007038-01-00 Awarded to Collier County on August 23, 2021. CONSIDERATIONS: On April 15, 2021, County Staff became aware of potential federal grant funding for Collier County residents hard hit by the COVID-19 pandemic. On May 24, 2021, Collier County applied for a grant through the Department of Health & Human Services for the "Collier County Community Health Coalition (CCCHC): Advancing Accessible and Equitable Healthcare Systems in Extra Mile Migrant Farmworker Communities." Collier County sought to use the grant funding to improve access to quality healthcare in the Immokalee and Golden Gate areas of Collier County since farmworkers in those communities were front-line, at high risk during the COVID-19 pandemic with limited access to quality healthcare. On June 8, 2021, the Board approved, "After -the -Fact", the submittal of the grant application which sought total funding over a 3-year period of $1,446,255 for the program. On September 28, 2021, the Board unanimously approved Year 1 funding to the program of $421,744 consistent with an HHS Grant Award in that amount dated August 23, 2021. As will be more fully discussed below, the conditions attached to the grant were included in the Board's packet on this Agenda Item on September 28, 2021. Grants were awarded to sixty-eight (68) different governmental entities throughout the United States, including counties in at least twenty (20) different states. The intent of the awarded funds is to strengthen community resiliency to fight COVID-19 among priority populations. By definition priority populations are those with increased prevalence of COVID-19 and are disproportionately impacted by long-standing health disparities related to sociodemographic characteristics, geographic regions, and economic strata. Examples include, racial and ethnic minority groups, persons who are economically disadvantaged, justice -involved, experiencing homelessness, or have certain underlying medical conditions that increase COVID-19 risk. As part of the application process, the county's migrant farmworker community was identified as a priority population. The county was awarded this grant opportunity along with seven of the eight eligible states within the state of Florida's Health and Human Services region. On December 14, 2021, the Board approved a Subrecipient Agreement with Collier Health Services for the hiring and training of six (6) new Community Health Workers (CHWs) to service the farmworker communities within Collier County. The Year 1 Award of $421,744 was premised on Collier County's application that sought to begin "to address the barriers that migrant farmworkers have historically faced in accessing healthcare." The goal, at the end of the 3-year grant period, was to give 75,000 Collier County residents access to quality healthcare who previously had no such access. At the Board's December 13, 2022, meeting, a number of public speakers raised concerns about this grant, specifically as to the conditions of the grant. The Board asked for and received an update from the County Attorney on January 10, 2023. Jamie Ulmer, President and CEO of Collier Health Services, spoke about the services being provided under the grant. At that meeting, the Board requested a follow-on report on the information and services being provided under the grant. Community Health Workers' (CHWs) role in the community is to raise awareness and inform people about access to healthcare services, increase access to health and screening, and enhance communication between the community and local health providers. Some of the educational resources provided are maps to healthcare network locations and other community health centers, information on TDAP vaccines and COVID-19 symptoms, and the benefits and risks of vaccines. There is additional information that is being provided on Influenza VIS and the Packet Pg. 192 02/ 14/2023 benefits and risks of flu shots. Under Federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to implement the requirements of HIPAA. The HIPAA Security Rule protects a subset of information covered by the Privacy Rule. The Privacy Rule also contains standards for individuals' rights to understand and control how their health information is used. A major goal of the Privacy Rule is to make sure that individuals' health information is properly protected while allowing the flow of health information needed to provide and promote high -quality healthcare, and to protect the public's health and well-being. The Privacy Rule permits important uses of information while protecting the privacy of people who seek care and healing. These directives imposed by the Federal government are carried down to these awarded grant funds. The Extra Mile Migrant Farmworker grant -supported program provides resources for the hiring and training of Community Health Workers to provide outreach and healthcare referral services to advance accessible and equitable healthcare in "Extra Mile" communities. While the services include COVID-related response efforts, COVID efforts are a small portion of the overall healthcare services being provided. The definition of extra mile communities is communities that experience health disparities caused by a combination of geographic distance and isolation, language and literacy barriers, socioeconomic status, and historically rooted cultural divides. Collier County's extra -mile communities are largely comprised of migrant farmworker populations and experience high levels of poverty. The grant funds are being utilized to support farmworker communities considered "Extra Mile" under the grant. Services are primarily provided to Immokalee. Serviced communities are expected to be expanded to include Everglades City, Goodland, Chokoloskee, and Copeland in addition to Immokalee. - Current Primary Focus: Outreach and engagement on health services within our community. - Program Plan: Advance accessible & equitable healthcare system in extra -mile communities. - Healthcare outreach events to hardest hit communities for families affected by Hurricane Ian. The project provided care packages to include food, cleaning supplies, clothing, water, and hygiene kits. - Tdap vaccine event: 250+Tdap vaccines were provided by the mobile outreach team - Promote general health issues such as flu and flu vaccines, waterborne disease, and other general health concerns. - Patient care referrals for the following services: • Adult Care • Dental • Vaccine event • Vision/Eye - Provide complimentary emergency response to Hurricane Ian victims. - Expand Mental Health Services to Collier residents. - Collaboration with Community Healthcare agencies to develop referral systems. - CHW ( 2-person team) -20 home visits/mo., I group presentation, and 1 media( 6 mo.). - Integrate primary care services - medical, dental, mental health, etc. Attached are related outreach materials being utilized to implement the program. Also provided is the progress report required by the Grantor, the annual evaluation, and the performance measures report under this program. FISCAL IMPACT: There is no new fiscal impact associated with this item. This project is budgeted in Housing Grant Fund (705) Project 33772. Packet Pg. 193 11.A 02/ 14/2023 GROWTH MANAGEMENT IMPACT: None. LEGAL CONSIDERATIONS: RECOMMENDATION: To accept the Grant update and outreach materials for the COVID-19 Extra Mile Migrant Farmworker Community grant, Project (33772). Prepared By: Maggie Lopez. Budget Analyst III, Office of Management & Budget Tanya Williams, Department Head, Public Services Division ATTACHMENT(S) 1. Updated Covid Information 12.13.22 mRNA (PDF) 2. TDAP VIS 8.6.21 Spanish (PDF) 3. Pfizer Bivalent Booster VIS 12.8.22 (PDF) 4. NCHC General + MAP (PDF) 5. Moderna Bivalent Booster VIS 12.8.22 (PDF) 6. MAP General Locations [Vertical] 11.16.22 (PDF) 7. Influenza VIS 8.6.21 (PDF) 8. IMMOKALEE General + Immokalee MAP (PDF) 9. Symptoms of COVID-19_ (PDF) 10. Cover Letter Healthcare Network J.Ulmer (PDF) 11. BROCHURE General Eng-Span 8.20 (PDF) 12. 1OThings English 5.11.20 (PDF) 13. [linked] RPT 2022 08-30 CDC CCR Evaluation (PDF) 14. RPT 2022 02-28 CDC CCR Performance Measure (PDF) 15. RPT 2022 08-30 CDC CCR Performance Measure (PDF) 16. CRSP 2021 09-30 CDC Work Plan Rev (PDF) 17. NOFA 2021 03-25 CDC CCR (PDF) Packet Pg. 194 11.A 02/14/2023 COLLIER COUNTY Board of County Commissioners Item Number: I LA Doc ID: 24597 Item Summary: *** This item to be heard at 9:30 AM. *** Report to the Board of County Commissioners (Board) relative to the information and services being provided to the public through the COVID-19 Extra Mile Migrant Farmworker Community grant. (Maggie Lopez, Community and Human Services Interim Director) (Companion item to item l0A) Meeting Date: 02/14/2023 Prepared by: Title: Manager- Financial & Operational Support — Community & Human Services Name: Maggie Lopez 02/06/2023 5:45 PM Submitted by: Title: Manager - Federal/State Grants Operation — Community & Human Services Name: Kristi Sonntag 02/06/2023 5:45 PM Approved By: Review: Community & Human Services Kristi Sonntag CHS Review Operations & Veteran Services Jeff Newman Additional Reviewer Community & Human Services Maggie Lopez Additional Reviewer Public Services Department Todd Henry PSD Level 1 Reviewer Public Services Department Tanya Williams PSD Department Head Review Grants Erica Robinson Level 2 Grants Review County Attorney's Office Jeffrey A. Klatzkow Level 2 Attorney Review Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Community & Human Services Maggie Lopez Additional Reviewer Grants Therese Stanley Additional Reviewer County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Office of Management and Budget Christopher Johnson Additional Reviewer County Manager's Office Dan Rodriguez Level 4 County Manager Review Board of County Commissioners Geoffrey Willig Meeting Pending Completed 02/07/2023 8:07 AM Completed 02/07/2023 8:25 AM Completed 02/07/2023 8:30 AM Completed 02/07/2023 9:00 AM Completed 02/07/2023 9:32 AM Completed 02/07/2023 10:07 AM Completed 02/07/2023 10:55 AM Completed 02/07/2023 10:20 AM Completed 02/07/2023 10:25 AM Completed 02/07/2023 12:29 PM Completed 02/07/2023 3:30 PM Completed 02/07/2023 3:37 PM Completed 02/08/2023 1:58 PM 02/14/2023 9:00 AM Packet Pg. 195 How i Vacdo Understanding the virus that causes COVID-1c Coronaviruses, like the c causes COVID-19, are nE the crown -like spikes or surface, called spike pr These spike proteins ai targets for vaccines. What is rnRNA? Messenger RNA, or mRl genetic material that tel body how to make prot( What is in the vi The vaccine is made c wrapped in a coating delivery easy and kee from damaging it. How does the vaccine work? The mRNA in the vacc your cells how to mak of the spike protein. I exposed to the real vir your body will recogn know how to fight it o GETTING VACCINATED? For information about COVID-19 vaccine, visit: cdc.gov/coronavirus/vaccines it Pg. 196 Vaccine Information Statement ■ Tdap (8/6/21) ■ Spanish Translation • Distributed by the Immunization Action Coalition 11.A.2 �+in Spanish and Many vaccine information statements are Vacuna Tdap (tetanos, difteria, to See wwlw.mmunize.og/vsherlanguages. Estferina) ■ Lo que n ecesita saber sabre vacunas en hopanol y en muchos ■ sabre vacunas en es otros idiomas. Visite www.immunize.org/vis 1. `Por que es necesario vacunarse? Los adultos que no han recibido la vacuna Tdap deben recibir una dosis de la vacuna Tdap. La vacuna contra Tdap puede prevenir el tetanos, la difteria y la tos ferina (tetanus, diphteria and pertussis, Tdap). La difteria y la tos ferina se contagian de persona a persona. El tetanos entra en el cuerpo a traves de tortes o heridas. • El TETANOS (T) causa rigidez dolorosa de los mdsculos. El tetanos puede causar problemas graves de salud, como incapacidad para abrir la Boca, dificultad para tragar y respirar o la muerte. • La DIFTERIA (D) puede causar dificultad para respirar, insuficiencia cardiaca, paralisis o muerte. • La TOS FERINA (al?), tambien conocida como "coqueluche", puede causar tos violenta e incontrolable que dificulta respirar, comer o beber. La tos ferina puede ser extremadamente grave, especialmente en bebes y ninos pequehos, y causar neumonia, convulsiones, daho cerebral o muerte. En adolescentes y adultos, puede causar perdida de peso, perdida de control de la vejiga, desmayo y fracturas de costillas por la tos intensa. 2. Vacuna Tdap La vacuna Tdap es solo para ninos de 7 afios o mas, adolescentes y adultos. Los adolescentes deben recibir una sola dosis de la vacuna Tdap, de preferencia a los 11 o 12 anos. Las embarazadas deben recibir una dosis de Tdap durante cada embarazo, de preferencia en la primera parte del tercer trimestre, como ayuda para proteger al recien nacido contra la tos ferina. Los lactantes estan en mayor riesgo de tener complicaciones graves y potencialmente mortales de la tos ferina. Tdap VIS - Spanish (8/6/21) Ademas, los adultos deben recibir una dosis de refuerzo de las vacunas Tdap o Td (otra vacuna, que protege contra el tetanos y difteria, no contra la tos ferina) cada 10 anos, o despues de 5 anos en el caso de una herida o quemadura grave o contaminada. Las vacunas Tdap o Td se pueden aplicar al mismo tiempo que otras vacunas. 3. Hable con su proveedor de atencion medica Informe a su proveedor de vacunas si la persona que recibe la vacuna: • Ha tenido una reaction alergica despues de recibir una dosis previa de cualquier vacuna que proteja contra el tetanos, difteria o tos ferina, o si ha tenido cualquier alergia severa y potencialmente mortal • Ha tenido coma, disminucion del nivel de consciencia o convulsiones prolongadas en los 7 dias posteriores a una dosis previa de cualquier vacuna contra la tos ferina (DTP, Mal? o Tdap) • Tiene convulsiones u otro problema del sistema nervioso Alguna vez ha tenido el Guillain-Barre Syndrome (tambien llamado "GBS") Ha tenido dolor intenso o hinchazon despues de una dosis previa de cualquier vacuna que proteja contra el tetanos o la difteria En algunos casos, su proveedor de atencion medica podria decidir que se posponga la vacuna Tdap hasta una visita futura. �a a N co CO Cn a a 0 c a� E U 2 r a U.S. Department of Health and Human Services Centers for Disease Control and Prevention Packet Pg. 197 11.A.2 Se puede vacunar a personas con enfermedades leves, como el catarro comun. Las personas con enfermedad moderada o grave usualmente deben esperar hasta recuperarse antes de recibir la vacuna Tdap. Su proveedor de atencion medica puede proporcionarle mas informaci6n. 4. Riesgos de una reacci6n a la vacuna A veces ocurren dolor, enrojecimiento o hinchaz6n en el sitio donde se administr6 la inyecci6n, fiebre leve, dolor de cabeza, sensaci6n de cansancio, nausea, v6mito, diarrea o dolor estomacal despues de recibir la vacuna Tdap. En algunos casos, las personas se desmayan despues de procedimientos medicos, incluidas las vacunaciones. Informe a su proveedor de atencion medica si se siente mareado o si tiene cambios en la visi6n o zumbido en los oidos. Al igual que con cualquier medicina, hay probabilidades muy remotas de que una vacuna cause una reacci6n alergica grave, otra lesion grave o la muerte. 5. iQu6 hago si ocurre aigun problema grave? Podria ocurrir una reacci6n alergica despues de que la persona vacunada deje la clinica. Si observa signor de una reacci6n alergica grave (ronchas, hinchaz6n de la cara y garganta, dificultad para respirar, latidos rapidos, mareo o debilidad), flame al 9-1-1 y lleve a la persona al hospital mas cercano. Llame a su proveedor de atencion medica si hay otros signos que le preocupan. Las reacciones adversas se deben reportar al Vaccine Adverse Event Reporting System, VAERS (Sistema para reportar reacciones adversas a las vacunas). Es usual que el proveedor de atencion medica informe sobre ello, o tambien puede hacerlo usted mismo. Visite el sitio web de VAERS en www vaers.hhs.gov Spanish translation provided by the Immunization Action Coalition o flame al 1-800-822-7967. El VAERS es solo para informar sobre reacciones y el personal de VAERS no proporciona consejos medicos. 6. Programa nacional de compensaci6n por lesiones ocasionadas por vacunas El National Vaccine Injury Compensation Program, VICP (Programa nacional de compensaci6n por lesiones ocasionadas por vacunas) es un programa federal que se cre6 para compensar a las personas que podrian haber experimentado lesiones ocasionadas por ciertas vacunas. Las reclamaciones relativas a presuntas lesiones o fallecimientos debidos a la vacunaci6n tienen un limite de tiempo para su presentaci6n, que puede ser de tan solo dos afios. Visite el sitio web de VICP en www.hrsa.gov/vaccinecompensation o flame al 1-800-338-2382 para obtener informaci6n acerca del programa y de c6mo presentar una reclamaci6n. 7. i Mnde puedo obtener mas informaci6n? • Consulte a su proveedor de atencion medica. • Llame a su departamento de salud local o estatal. • Visite el sitio web de la Food and Drug Administration, FDA (Administraci6n de Alimentos y Medicamentos), para consultar los folletos informativos de las vacunas e informaci6n adicional en www.fda.gov/vaccines-blood-biologics/vaccines. • Comuniquese con los Centers for Disease Control and Prevention, CDC (Centros para el Control y Prevenci6n de Enfermedades): -Llame al 1-800-232-4636 (1-800-CDC-INFO) o - Visite el sitio web de los CDC en www.cdc.gov/vaccines. Vaccine Information Statement 42 U.S.C. § 300aa-26 OFFICEUSE r Tdap (Tetanus, Diphtheria, Pertussis) Vaccine 8i6i2021 ONLY �{ Packet Pg. 198 11.A.3 VACCINE INFORMATION FACT SHEET FOR RECIPIENTS AND CAREGIVERS ABOUT COMIRNATY (COVID-19 VACCINE, mRNA), THE PFIZER-BIONTECH COVID-19 VACCINE, AND THE PFIZER-BIONTECH COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5) TO PREVENT CORONAVIRUS DISEASE 2019 (COVID-19) FOR USE IN INDIVIDUALS 12 YEARS OF AGE AND OLDER FOR 12 YEARS OF AGE AND OLDER You are being offered either COMIRNATY (COVID-19 Vaccine, mRNA), the Pfizer-BioNTech COVID-19 Vaccine, or the Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5), hereafter referred to as the Pfizer-BioNTech COVID-19 Vaccine, Bivalent, to prevent Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2. This Vaccine Information Fact Sheet for Recipients and Caregivers comprises the Fact Sheet for the authorized Pfizer-BioNTech COVID-19 Vaccine and the Pfizer-BioNTech COVID-19 Vaccine, Bivalent, and also includes information about the U.S. Food and Drug Administration (FDA) -licensed vaccine, COMIRNATY (COVID-19 Vaccine, mRNA) for use in individuals 12 years of age and older'. The FDA -approved COMIRNATY (COVID-19 Vaccine, mRNA) and the Pfizer-BioNTech COVID-19 Vaccine authorized under Emergency Use Authorization (EUA) for individuals 12 years of age and older, when prepared according to their respective instructions for use, can be used interchangeably.2 COMIRNATY (COVID-19 Vaccine, mRNA) is an FDA -approved COVID-19 vaccine made by Pfizer for BioNTech. It is approved as a 2-dose series for prevention of COVID-19 in individuals 12 years of age and older. It is also authorized under EUA to provide: • a third primary series dose to individuals 12 years of age and older with certain kinds of immunocompromise. 1 You may receive this Vaccine Information Fact Sheet even if your child is 11 years old. Children who will turn from 11 years to 12 years of age between doses in the primary regimen may receive, for any dose in the primary regimen, either: (1) the Pfizer-BioNTech COVID-19 Vaccine authorized for use in individuals 5 through 11 years of age; or (2) COMIRNATY (COVID-19 Vaccine, mRNA) or the Pfizer- BioNTech COVID-19 Vaccine authorized for use in individuals 12 years of age and older. Z When prepared according to their respective instructions for use, the FDA -approved COMIRNATY (COVID-19 Vaccine, mRNA) and the EUA-authorized Pfizer-BioNTech COVID-19 Vaccine for individuals 12 years of age and older can be used interchangeably without presenting any safety or effectiveness concerns. Revised: 8 December 22 Packet Pg. 199 11.A.3 The Pfizer-BioNTech COVID-19 Vaccine has received EUA from FDA to provide: • a 2-dose primary series to individuals 12 years of age and older; and • a third primary series dose to individuals 12 years of age and older with certain kinds of immunocompromise. The Pfizer-BioNTech COVID-19 Vaccine, Bivalent has received EUA from FDA to provide either: • a single booster dose to individuals 12 years of age and older at least 2 months after completion of primary vaccination with any authorized or approved COVID-19 vaccine; or • a single booster dose to individuals 12 years of age and older at least 2 months after receipt of the most recent booster dose with any authorized or approved monovalent3 COVID-19 vaccine. This Vaccine Information Fact Sheet contains information to help you understand the risks and benefits of COMIRNATY (COVID-19 Vaccine, mRNA), the Pfizer-BioNTech COVID-19 Vaccine, and the Pfizer-BioNTech COVID-19 Vaccine, Bivalent, which you may receive because there is currently a pandemic of COVID-19. Talk to your vaccination provider if you have questions. This Fact Sheet may have been updated. For the most recent Fact Sheet, please see www.cvdvaccine.com. WHAT YOU NEED TO KNOW BEFORE YOU GET ANY OF THESE VACCINES WHAT IS COVID-19? COVID-19 disease is caused by a coronavirus called SARS-CoV-2. You can get COVID-19 through contact with another person who has the virus. It is predominantly a respiratory illness that can affect other organs. People with COVID-19 have had a wide range of symptoms reported, ranging from mild symptoms to severe illness leading to death. Symptoms may appear 2 to 14 days after exposure to the virus. Symptoms may include: fever or chills; cough; shortness of breath; fatigue; muscle or body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; nausea or vomiting; diarrhea. 3 Monovalent refers to any authorized or approved COVID-19 vaccine that contains or encodes the spike protein of only the Original SARS-CoV-2. Revised: 8 December 22 Packet Pg. 200 11.A.3 HOW ARE COMIRNATY (COVID-19 VACCINE, mRNA), THE PFIZER-BIONTECH COVID-19 VACCINE, AND THE PFIZER-BIONTECH COVID-19 VACCINE, BIVALENT RELATED? COMIRNATY (COVID-19 Vaccine, mRNA) and the Pfizer-BioNTech COVID-19 Vaccine, when prepared according to their respective instructions for use, can be used interchangeably. The Pfizer-BioNTech COVID-19 Vaccine, Bivalent is made in the same way as COMIRNATY and Pfizer-BioNTech COVID-19 Vaccine but it also contains an Omicron component to help prevent COVID-19 caused by the Omicron variant of SARS-CoV-2. For more information on EUA, see the "What is an Emergency Use Authorization (EUA)?" section at the end of this Fact Sheet. WHAT SHOULD YOU MENTION TO YOUR VACCINATION PROVIDER BEFORE YOU GET ANY OF THESE VACCINES? Tell the vaccination provider about all of your medical conditions, including if you: • have any allergies • have had myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the lining outside the heart) • have a fever • have a bleeding disorder or are on a blood thinner • are immunocompromised or are on a medicine that affects your immune system • are pregnant or plan to become pregnant • are breastfeeding • have received another COVID-19 vaccine • have ever fainted in association with an injection HOW ARE THESE VACCINES GIVEN? The Pfizer-BioNTech COVID-19 Vaccine, the Pfizer-BioNTech COVID-19 Vaccine, Bivalent, or COMIRNATY (COVID-19 Vaccine, mRNA) will be given to you as an injection into the muscle. Primary Series: The Pfizer-BioNTech COVID-19 Vaccine and COMIRNATY (COVID-19 Vaccine, mRNA) are given for the primary series. The vaccine is administered as a 2-dose series, 3 weeks apart. A third primary series dose may be administered at least 4 weeks after the second dose to individuals with certain kinds of immunocompromise. Booster Dose: Pfizer-BioNTech COVID-19 Vaccine, Bivalent is administered as a single booster dose at least 2 months after: • completion of primary vaccination with any authorized or approved COVID-19 vaccine; or • receipt of the most recent booster dose with any authorized or approved monovalent COVID-19 vaccine The vaccine may not protect everyone. Revised: 8 December 22 Packet Pg. 201 11.A.3 WHO SHOULD NOT GET COMIRNATY (COVID-19 VACCINE, mRNA), THE PFIZER-BIONTECH COVID-19 VACCINE, OR THE PFIZER-BIONTECH COVID-19 VACCINE, BIVALENT? You should not get any of these vaccines if you: • had a severe allergic reaction after a previous dose of COMIRNATY (COVID-19 Vaccine, mRNA) or the Pfizer-BioNTech COVID-19 Vaccine • had a severe allergic reaction to any ingredient in these vaccines. WHAT ARE THE INGREDIENTS IN THESE VACCINES? COMIRNATY (COVID-19 Vaccine, mRNA), Pfizer-BioNTech COVID-19 Vaccine, and Pfizer-BioNTech COVID-19 Vaccine, Bivalent include the following ingredients: • mRNA and lipids (((4-hydroxybutyl)azaned iyl)bis(hexane-6,1 -diyl)bis(2- hexyldecanoate), 2 [(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3-phosphocholine, and cholesterol). Pfizer-BioNTech COVID-19 Vaccine for individuals 12 years of age and older contains 1 of the following sets of additional ingredients; ask the vaccination provider which version is being administered: W potassium chloride, monobasic potassium phosphate, sodium chloride, dibasic sodium phosphate dihydrate, and sucrose • tromethamine, tromethamine hydrochloride, and sucrose Pfizer-BioNTech COVID-19 Vaccine, Bivalent for individuals 12 years of age and older contains the following additional ingredients: tromethamine, tromethamine hydrochloride, and sucrose COMIRNATY (COVID-19 Vaccine, mRNA) contains 1 of the following sets of additional ingredients; ask the vaccination provider which version is being administered: • potassium chloride, monobasic potassium phosphate, sodium chloride, dibasic •o sodium phosphate dihydrate, and sucrose • tromethamine, tromethamine hydrochloride, and sucrose HAVE THESE VACCINES BEEN USED BEFORE? In clinical trials, approximately 23,000 individuals 12 years of age and older have received at least 1 dose of Pfizer-BioNTech COVID-19 Vaccine. Millions of individuals have received the Pfizer-BioNTech COVID-19 Vaccine under EUA since December 11, 2020. In a clinical trial, approximately 300 individuals greater than 55 years of age received one dose of a bivalent vaccine that differs from the Pfizer-BioNTech COVID-19 Vaccine, Bivalent in that it contains a different Omicron component. LTA: I_%1_10 1=11111 34►14aI&K61ad:1=1yZ%[d811►1**2 COMIRNATY (COVID-19 Vaccine, mRNA) and the Pfizer-BioNTech COVID-19 Vaccine have been shown to prevent COVID-19. FDA has authorized Pfizer-BioNTech 4 Revised: 8 December 22 Packet Pg. 202 11.A.3 COVID-19 Vaccine, Bivalent to provide better protection against COVID-19 caused by the Omicron variant of SARS-CoV-2. The duration of protection against COVID-19 is currently unknown. WHAT ARE THE RISKS OF THESE VACCINES? There is a remote chance that these vaccines could cause a severe allergic reaction. A severe allergic reaction would usually occur within a few minutes to 1 hour after getting a dose. For this reason, your vaccination provider may ask you to stay at the place where you received your vaccine for monitoring after vaccination. Signs of a severe allergic reaction can include: • Difficulty breathing • Swelling of your face and throat • A fast heartbeat • A bad rash all over your body • Dizziness and weakness Myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) have occurred in some people who have received COMIRNATY (COVID-19 Vaccine, mRNA) or Pfizer-BioNTech COVID-19 Vaccine, more commonly in adolescent males and adult males under 40 years of age than among females and older males. In most of these people, symptoms began within a few days following receipt of the second dose of vaccine. The chance of having this occur is very low. You should seek medical attention right away if you have any of the following symptoms after receiving the vaccine: • Chest pain • Shortness of breath • Feelings of having a fast -beating, fluttering, or pounding heart Side effects that have been reported with these vaccines include: • Severe allergic reactions • Non -severe allergic reactions such as rash, itching, hives, or swelling of the face • Myocarditis (inflammation of the heart muscle) • Pericarditis (inflammation of the lining outside the heart) • Injection site pain • Tiredness • Headache • Muscle pain • Chills • Joint pain • Fever • Injection site swelling • Injection site redness • Nausea • Feeling unwell • Swollen lymph nodes (lymphadenopathy) 5 Revised: 8 December 22 Packet Pg. 203 11.A.3 • Decreased appetite • Diarrhea • Vomiting • Arm pain • Fainting in association with injection of the vaccine • Dizziness These may not be all the possible side effects of these vaccines. Serious and unexpected side effects may occur. The possible side effects of these vaccines are still being studied. WHAT SHOULD I DO ABOUT SIDE EFFECTS? If you experience a severe allergic reaction, call 9-1-1, or go to the nearest hospital. Call the vaccination provider or your healthcare provider if you have any side effects that bother you or do not go away. Report vaccine side effects to FDA/CDC Vaccine Adverse Event Reporting System (VAERS). The VAERS toll -free number is 1-800-822-7967 or report online to https://vaers.hhs.gov/reportevent.html. Please include either "COMIRNATY (COVID-19 Vaccine, mRNA)", "Pfizer-BioNTech COVID-19 Vaccine EUA", or "Pfizer-BioNTech COVID-19 Vaccine, Bivalent EUA" as appropriate, in the first line of box #18 of the report form. In addition, you can report side effects to Pfizer Inc. at the contact information provided below. Website Fax number Telephone number www.pfizersafetVreporting.com 1-866-635-8337 1-800-438-1985 You may also be given an option to enroll in v-safe. V-safe is a voluntary smartphone-based tool that uses text messaging and web surveys to check in with people who have been vaccinated to identify potential side effects after COVID-19 vaccination. V-safe asks questions that help CDC monitor the safety of COVID-19 vaccines. V-safe also provides second -dose reminders if needed and live telephone follow-up by CDC if participants report a significant health impact following COVID-19 vaccination. For more information on how to sign up, visit: www.cdc.gov/vsafe. WHAT IF I DECIDE NOT TO GET COMIRNATY (COVID-19 VACCINE, mRNA), THE PFIZER-BIONTECH COVID-19 VACCINE, OR THE PFIZER-BIONTECH COVID-19 VACCINE, BIVALENT? Under the EUA, it is your choice to receive or not receive any of these vaccines. Should you decide not to receive any of these vaccines, it will not change your standard medical care. Revised: 8 December 22 Packet Pg. 204 11.A.3 ARE OTHER CHOICES AVAILABLE FOR PREVENTING COVID-19 BESIDES COMIRNATY (COVID-19 VACCINE, mRNA), THE PFIZER-BIONTECH COVID-19 VACCINE, OR THE PFIZER-BIONTECH COVID-19 VACCINE, BIVALENT? For primary vaccination, another choice for preventing COVID-19 is SPIKEVAX (COVID-19 Vaccine, mRNA), an FDA -approved COVID-19 vaccine. Other vaccines to prevent COVID-19 may be available under EUA, including bivalent vaccines that contain an Omicron component of SARS-CoV-2. CAN I RECEIVE COMIRNATY (COVID-19 VACCINE, mRNA), PFIZER-BIONTECH COVID-19 VACCINE, OR THE PFIZER-BIONTECH COVID-19 VACCINE, BIVALENT AT THE SAME TIME AS OTHER VACCINES? Data have not yet been submitted to FDA on administration of COMIRNATY (COVID-19 Vaccine, mRNA), the Pfizer-BioNTech COVID-19 Vaccine, or the Pfizer-BioNTech COVID-19 Vaccine, Bivalent at the same time with other vaccines. If you are considering receiving COMIRNATY (COVID-19 Vaccine, mRNA), the Pfizer-BioNTech COVID-19 Vaccine, or the Pfizer-BioNTech COVID-19 Vaccine, Bivalent with other vaccines, discuss your options with your healthcare provider. WHAT IF I AM IMMUNOCOMPROMISED? If you are immunocompromised, you may receive a third primary series dose of Pfizer-BioNTech COVID-19 Vaccine or COMIRNATY (COVID-19 Vaccine, mRNA). Individuals 12 years of age and older may receive a booster dose with Pfizer-BioNTech COVID-19 Vaccine, Bivalent. Vaccinations may not provide full immunity to COVID-19 in people who are immunocom promised, and you should continue to maintain physical precautions to help prevent COVID-19. Your close contacts should be vaccinated as appropriate. WHAT IF I AM PREGNANT OR BREASTFEEDING? If you are pregnant or breastfeeding, discuss your options with your healthcare provider. WILL THESE VACCINES GIVE ME COVID-19? No. These vaccines do not contain SARS-CoV-2 and cannot give you COVID-19. KEEP YOUR VACCINATION CARD When you get your first COVID-19 vaccine, you will get a vaccination card. Remember to bring your card when you return. Revised: 8 December 22 Packet Pg. 205 11.A.3 ADDITIONAL INFORMATION If you have questions, visit the website or call the telephone number provided below. To access the most recent Fact Sheets, please scan the QR code provided below. Global website Telephone number www.cvdvaccine.com ■❑ • .r ❑■ 1-877-829-2619 Ria.] (1-877-VAX-CO19) HOWCAN I LEARN MORE? • Ask the vaccination provider. • Visit CDC at httas://www.cdc.aov/coronavirus/2019-ncov/index.html. • Visit FDA at https://www.fda.gov/emergency-preparedness-and-response/mcm- legal-regulatory-and-policy-framework/emergency-use-authorization. • Contact your local or state public health department. WHERE WILL MY VACCINATION INFORMATION BE RECORDED? The vaccination provider may include your vaccination information in your state/local jurisdiction's Immunization Information System (IIS) or other designated system. For more information about IISs visit: https://www.cdc.gov/vaccines/programs/iis/about.htm1. CAN I BE CHARGED AN ADMINISTRATION FEE FOR RECEIPT OF THESE COVID-19 VACCINES? No. At this time, the provider cannot charge you for a vaccine dose and you cannot be charged an out-of-pocket vaccine administration fee or any other fee if only receiving a COVID-19 vaccination. However, vaccination providers may seek appropriate reimbursement from a program or plan that covers COVID-19 vaccine administration fees for the vaccine recipient (private insurance, Medicare, Medicaid, Health Resources & Services Administration [HRSA] COVID-19 Uninsured Program for non-insured recipients). WHERE CAN I REPORT CASES OF SUSPECTED FRAUD? Individuals becoming aware of any potential violations of the CDC COVID-19 Vaccination Program requirements are encouraged to report them to the Office of the Inspector General, U.S. Department of Health and Human Services, at 1-800-HHS-TIPS or httas://TIPS.HHS.GOV. WHAT IS THE COUNTERMEASURES INJURY COMPENSATION PROGRAM? The Countermeasures Injury Compensation Program (CICP) is a federal program that may help pay for costs of medical care and other specific expenses of certain people who have been seriously injured by certain medicines or vaccines, including these vaccines. Generally, a claim must be submitted to the CICP within one (1) year from the Revised: 8 December 22 Packet Pg. 206 11.A.3 date of receiving the vaccine. To learn more about this program, visit www.hrsa.gov/cicp/ or call 1-855-266-2427. WHAT IS AN EMERGENCY USE AUTHORIZATION (EUA)? An EUA is a mechanism to facilitate the availability and use of medical products, including vaccines, during public health emergencies, such as the current COVID-19 pandemic. An EUA is supported by a Secretary of Health and Human Services (HHS) declaration that circumstances exist to justify the emergency use of drugs and biological products during the COVID-19 pandemic. A product authorized for emergency use has not undergone the same type of review by FDA as an FDA -approved product. FDA may issue an EUA when certain criteria are met, which includes that there are no adequate, approved, and available alternatives. In addition, the FDA decision is based on the totality of the scientific evidence available showing that the product may be effective to prevent COVID-19 during the COVID-19 pandemic and that the known and potential benefits of the product outweigh the known and potential risks of the product. All of these criteria must be met to allow for the product to be used during the COVID-19 pandemic. An EUA is in effect for the duration of the COVID-19 EUA declaration justifying emergency use of this product, unless terminated or revoked (after which the product may no longer be used). BIONT-CH Manufactured for BioNTech Manufacturing GmbH An der Goldgrube 12 55131 Mainz, Germany Pz Manufactured by Pfizer Inc., New York, NY 10017 LAB-1451-23.1 c Revised: 8 December 22 Scan to capture that this Fact Sheet was provided to vaccine recipient for the electronic medical records/immunization information systems. GDTI: 0886983000332 Revised: 8 December 22 Packet Pg. 207 '� l hea+,Ga�g nichais c �`ommunity P ttet� health center HEALTHCARE NETWORK'S NICHOLS COMMUNITY HEhLTH CENTER A comprehensive health center offering an array of services for patients of all ages, regardless of income, job or insurance status. A Sliding Fee Discount is available for eligible patients in need of financial assistance. SERVICES Pediatric care Adult and senior care Women's care Pediatric dental ■ Integrated behavioral health and traditional mental health services Drive-thru pharmacy Pediatric Convenient care SERVICIOS Aceptamos pacientes de todas las edades, independientemente de sus ingresos, trabajo o estado del seguro. ■ Cuidado de los ninos ■ Cuidado de adultos ■ Cuidado para la mujer ■ Cuidado dental para ninos ■ Salud mental integral y terapia tradicional Farmacia Cuidado pediatrico conveniente SEVIS YO Nou aksepte pasyan tout laj, kelkeswa revni, travay, oswa sitiyasyon. ■ Swen timoun yo ■ Swen you granmoun ak granmoun aje ■ Swen fanm yo ■ Swen dante you timoun yo ■ Sant sikoloji Famasi Pratik swen healthcare network Services are available in English, Spanish and Haitian Creole. Packet Pg. 208 11.A.4 �To Ft. Myers 13th Ave SW CHILDREN'S CARF WOMEN'S CARE CENTER FOR PSYCHOLOGY & WELLNESS ADULT & SENIOR CARE PEDIATRIC DENTAL CARE PEDIATRIC CONVENIENT CARE X-RAY & LAB PHARMACY SCAN for Directions -15th Ave SW Nichols Community Health Center Green Blvd 16th PL SW GOLDEN GATE n co O =a CD (n r+ cn 18th Ave SW 19th Ct SW 13th Ave SW 15th Ave SW 17th Ave SW 19th Ave SW Nichols Community Health Center 12655 Collier Blvd., Naples FL 34116 Q healthcare �i network 239.658.3000 1 HealthcareSWFL.org I Packet Pg. 209 11.A.5 VACCINE INFORMATION FACT SHEET FOR RECIPIENTS AND CAREGIVERS ABOUT SPIKEVAX (COVID-19 VACCINE, mRNA), MODERNA COVID-19 VACCINE, AND MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5) TO PREVENT CORONAVIRUS DISEASE 2019 (COVID-19) FOR 6 YEARS OF AGE AND OLDER You or your child are being offered either SPIKEVAX (COVID-19 Vaccine, mRNA), Moderna COVID-19 Vaccine, or Moderna COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5), hereafter referred to as Moderna COVID-19 Vaccine, Bivalent, to prevent Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2. This Vaccine Information Fact Sheet for Recipients and Caregivers comprises the Fact Sheet for the authorized Moderna COVID-19 Vaccine and the authorized Moderna COVID-19 Vaccine, Bivalent for use in individuals 6 years of age and older, and also includes information about the FDA -licensed vaccine, SPIKEVAX (COVID-19 Vaccine, mRNA) for use in individuals 12 years of age and older.' The FDA -approved SPIKEVAX (COVID-19 Vaccine, mRNA) and the Moderna COVID- 19 Vaccine authorized for Emergency Use Authorization (EUA) for individuals 12 years of age and older can be used interchangeably, when used according to their respective instructions for use.2 SPIKEVAX (COVID-19 Vaccine, mRNA) is an FDA -approved COVID-19 vaccine made by ModernaTX, Inc. It is approved as a two -dose series for prevention of COVID-19 in individuals 18 years of age and older. It is also authorized under EUA to provide: • a two -dose primary series to individuals 12 years through 17 years of age; and • a third primary series dose to individuals 12 years of age and older who have been determined to have certain kinds of immunocompromise. 1 You may receive this Fact Sheet even if your child is 5 years old. Children who will turn from 5 years to 6 years of age between doses in the primary series may receive, for any dose, either: (1) the Moderna COVID-19 Vaccine authorized for use in individuals 6 months through 5 years of age; or (2) Moderna COVID-19 Vaccine authorized for use in individuals 6 years through 11 years of age. Children who will turn from 11 years to 12 years of age between doses in the primary series may receive, for any dose in the primary series, either: (1) the Moderna COVID-19 Vaccine authorized for use in individuals 6 years through 11 years of age; or (2) Moderna COVID-19 Vaccine authorized for use in individuals 12 years of age and older; or (3) SPIKEVAX (COVID-19 Vaccine, mRNA). 2 FDA -approved SPIKEVAX (COVID-19 Vaccine, mRNA) and one presentation of the EUA-authorized Moderna COVID-19 Vaccine (supplied in vials with red caps and labels with a light blue border) can be used interchangeably for the primary series for individuals 12 years of age and older without presenting any safety or effectiveness concerns. Revised: Dec/8/2022 1 Packet Pg. 210 11.A.5 The Moderna COVID-19 Vaccine has received EUA from FDA to provide: • a two -dose primary series to individuals 6 years of age and older; and • a third primary series dose to individuals 6 years of age and older with certain kinds of immunocompromise. Moderna COVID-19 Vaccine, Bivalent has received EUA from FDA to provide either: • a single booster dose to individuals 6 years of age and older at least 2 months after completion of primary vaccination with any authorized or approved COVID-19 vaccine; or • a single booster dose to individuals 6 years of age and older at least 2 months after receipt of the most recent booster dose with any authorized or approved monovalent' COVID-19 vaccine. This Vaccine Information Fact Sheet contains information to help you understand the risks and benefits of SPIKEVAX (COVID-19 Vaccine, mRNA), Moderna COVID-19 Vaccine, and Moderna COVID-19 Vaccine, Bivalent, which you or your child may receive because there is currently a pandemic of COVID-19. Talk to the vaccination provider if you have questions. SPIKEVAX (COVID-19 Vaccine, mRNA), Moderna COVID-19 Vaccine, and Moderna COVID-19 Vaccine, Bivalent may not protect everyone. This Fact Sheet may have been updated. For the most recent Fact Sheet, please visit www.modematx.com/covidl9vaccine-eua. WHAT YOU NEED TO KNOW BEFORE YOU OR YOUR CHILD GET THIS VACCINE WHAT IS COVID-19? COVID-19 is caused by a coronavirus called SARS-CoV-2. This type of coronavirus has not been seen before. You can get COVID-19 through contact with another person who has the virus. It is predominantly a respiratory illness that can affect other organs. People with COVID- 19 have had a wide range of symptoms reported, ranging from mild symptoms to severe illness. Symptoms may appear 2 to 14 days after exposure to the virus. Symptoms may include: fever or chills; cough; shortness of breath; fatigue; muscle or body aches; headache; new loss of taste or smell; sore throat; congestion or runny nose; nausea or vomiting; diarrhea. s Monovalent refers to any authorized or approved COVID-19 vaccine that contains or encodes the spike protein of only the Original SARS-CoV-2. Revised: Dec/8/2022 Packet Pg. 211 11.A.5 HOW ARE SPIKEVAX (COVID-19 VACCINE, mRNA), MODERNA COVID-19 VACCINE, AND MODERNA COVID-19 VACCINE, BIVALENT RELATED? SPIKEVAX (COVID-19 Vaccine, mRNA) and Moderna COVID-19 Vaccine can be used interchangeably.4 Moderna COVID-19 Vaccine, Bivalent is made in the same way as SPIKEVAX and Moderna COVID-19 Vaccine, but it also contains an Omicron component to help prevent COVID-19 caused by the Omicron variant of SARS-CoV-2. For more information on EUA, see the "What is an Emergency Use Authorization (EUA)?" section at the end of this Fact Sheet. WHAT SHOULD YOU MENTION TO THE VACCINATION PROVIDER BEFORE YOU OR YOUR CHILD GET ANY OF THESE VACCINES? Tell the vaccination provider about all of your or your child's medical conditions, including if you or your child: • have any allergies • have had myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the lining outside the heart) • have a fever • have a bleeding disorder or are on a blood thinner • are immunocompromised or are on a medicine that affects your or your child's immune system • are pregnant or plan to become pregnant • are breastfeeding • have received another COVID-19 vaccine • have ever fainted in association with an injection WHO SHOULD NOT GET SPIKEVAX (COVID-19 VACCINE, mRNA), MODERNA COVID-19 VACCINE, OR MODERNA COVID-19 VACCINE, BIVALENT? You or your child should not get any of these vaccines if you or your child: • had a severe allergic reaction after a previous dose of SPIKEVAX (COVID-19 Vaccine, mRNA) or Moderna COVID-19 Vaccine • had a severe allergic reaction to any ingredient in these vaccines WHAT ARE THE INGREDIENTS IN THESE VACCINES? SPIKEVAX (COVID-19 Vaccine, mRNA), Moderna COVID-19 Vaccine, and Moderna COVID-19 Vaccine, Bivalent contain the following ingredients: messenger ribonucleic acid (mRNA), lipids (SM-102, polyethylene glycol [PEG] 2000 dimyristoyl glycerol [DMG], cholesterol, and 1,2-distearoyl-sn-glycero-3-phosphocholine [DSPC]), tromethamine, tromethamine hydrochloride, acetic acid, sodium acetate trihydrate, and sucrose. 4 FDA -approved SPIKEVAX (COVID-19 Vaccine, mRNA) and one presentation of the EUA-authorized Moderna COVID-19 Vaccine (supplied in vials with red caps and labels with a light blue border) can be used interchangeably for the primary series for individuals 12 years of age and older without presenting any safety or effectiveness concerns. Revised: Dec/8/2022 Packet Pg. 212 11.A.5 HOW ARE THESE VACCINES GIVEN? SPIKEVAX (COVID-19 Vaccine, mRNA), Moderna COVID-19 Vaccine, or Moderna COVID- 19 Vaccine, Bivalent will be given to you or your child as an injection into the muscle. Primary Series: SPIKEVAX (COVID-19 Vaccine, mRNA) and Moderna COVID-19 Vaccine are administered as a two -dose series, 1 month apart. A third primary series dose may be administered at least 1 month after the second dose to individuals with certain kinds of immunocompromise. Booster Dose: Moderna COVID-19 Vaccine, Bivalent is administered as a single booster dose at least 2 months after: • completion of primary vaccination with any authorized or approved COVID-19 vaccine; or • receipt of the most recent booster dose with any authorized or approved monovalent COVID-19 vaccine. HAVE THESE VACCINES BEEN USED BEFORE? Millions of individuals 18 years of age and older have received the Moderna COVID-19 Vaccine under EUA since December 18, 2020. In clinical trials, approximately 30,000 individuals 12 years of age and older, 4,000 individuals 6 years through 11 years of age, and 5,000 individuals 6 months through 5 years of age have received at least 1 dose of Moderna COVID-19 Vaccine. In a clinical trial, approximately 400 individuals 18 years of age and older received I dose of a bivalent vaccine that differs from the Moderna COVID-19 Vaccine, Bivalent in that it contains a different Omicron component. WHAT ARE THE BENEFITS OF THESE VACCINES? SPIKEVAX (COVID-19 Vaccine, mRNA) and Moderna COVID-19 Vaccine have been shown to prevent COVID-19. FDA has authorized Moderna COVID-19 Vaccine, Bivalent to provide better protection against COVID-19 caused by the Omicron variant of SARS-CoV-2. The duration of protection against COVID-19 is currently unknown. WHAT ARE THE RISKS OF THESE VACCINES? There is a remote chance that these vaccines could cause a severe allergic reaction. A severe allergic reaction would usually occur within a few minutes to one hour after getting a dose. For this reason, the vaccination provider may ask you or your child to stay at the place where you or your child received the vaccine for monitoring after vaccination. Signs of a severe allergic reaction can include: • Difficulty breathing • Swelling of your face and throat • A fast heartbeat • A bad rash all over your body • Dizziness and weakness Revised: Dec/8/2022 4 Packet Pg. 213 11.A.5 Myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the lining outside the heart) have occurred in some people who have received SPIKEVAX (COVID-19 Vaccine, mRNA) or Moderna COVID-19 Vaccine, more commonly in adult males under 40 years of age than among females and older males. In most of these people, symptoms began within a few days following receipt of the second dose of the vaccine. The chance of having this occur is very low. You should seek medical attention right away if you or your child have any of the following symptoms after receiving the vaccine: • Chest pain • Shortness of breath • Feelings of having a fast -beating, fluttering, or pounding heart Side effects that have been reported in clinical trials with these vaccines include: • Injection site reactions: pain, tenderness and swelling of the lymph nodes in the same arm of the injection, swelling (hardness), and redness • General side effects: fatigue, headache, muscle pain, joint pain, chills, nausea and vomiting, fever, and rash Side effects that have been reported during post -authorization use include: • Severe allergic reactions • Urticaria (itchy rash/hives) • Myocarditis (inflammation of the heart muscle) • Pericarditis (inflammation of the lining outside the heart) • Fainting in association with injection of the vaccine These may not be all the possible side effects of these vaccines. Serious and unexpected side effects may occur. The possible side effects of these vaccines are still being studied. WHAT SHOULD I DO ABOUT SIDE EFFECTS? If you or your child experience a severe allergic reaction, call 9-1-1, or go to the nearest hospital Call the vaccination provider or your or your child's healthcare provider if you or your child have any side effects that bother you or do not go away. Report vaccine side effects to FDA/CDC Vaccine Adverse Event Reporting System (VAERS). The VAERS toll -free number is 1-800-822-7967 or report online to hgps://vaers.hhs. og v/reportevent.html. Please include either "SPIKEVAX (COVID-19 Vaccine, mRNA)", "Moderna COVID-19 Vaccine EUA," or "Moderna COVID-19 Vaccine, Bivalent EUA", as appropriate, in the first line of box # 18 of the report form. In addition, you can report side effects to ModernaTX, Inc. at 1-866-MODERNA (1-866-663- 3762). You may also be given an option to enroll in v-safe. V-safe is a voluntary smartphone-based tool that uses text messaging and web surveys to check in with people who have been vaccinated to identify potential side effects after COVID-19 vaccination. V-safe asks questions that help CDC monitor the safety of COVID-19 vaccines. V-safe also provides dose reminders if needed and Revised: Dec/8/2022 Packet Pg. 214 11.A.5 live telephone follow-up by CDC if participants report a significant health impact following COVID-19 vaccination. For more information on how to sign up, visit: www.cdc.gov/vsafe. WHAT IF I DECIDE NOT TO GET OR NOT TO HAVE MY CHILD GET SPIKEVAX (COVID-19 VACCINE, mRNA), MODERNA COVID-19 VACCINE, OR MODERNA COVID-19 VACCINE, BIVALENT? Under the EUA, there is an option to accept or refuse receiving the vaccine. Should you decide not to receive, or for your child not to receive, any of these vaccines, it will not change the standard medical care. ARE OTHER CHOICES AVAILABLE FOR PREVENTING COVID-19 BESIDES SPIKEVAX (COVID-19 VACCINE, mRNA), MODERNA COVID-19 VACCINE, OR MODERNA COVID-19 VACCINE, BIVALENT? For primary vaccination in individuals 12 years of age and older, another choice for preventing COVID-19 is COMIRNATY (COVID-19 Vaccine, mRNA), an FDA -approved COVID-19 vaccine. For individuals 6 years of age and older, other vaccines to prevent COVID-19 may be available under EUA, including bivalent vaccines that contain an Omicron component of SARS- CoV-2. CAN I OR MY CHILD RECEIVE SPIKEVAX (COVID-19 VACCINE, mRNA), MODERNA COVID-19 VACCINE, OR MODERNA COVID-19 VACCINE, BIVALENT AT THE SAME TIME AS OTHER VACCINES? Data have not yet been submitted to FDA on administration of SPIKEVAX (COVID-19 Vaccine, mRNA), Moderna COVID-19 Vaccine, or Moderna COVID-19 Vaccine, Bivalent at the same time as other vaccines. If you are considering receiving or having your child receive SPIKEVAX (COVID-19 Vaccine, mRNA), Moderna COVID-19 Vaccine, or Moderna COVID- 19 Vaccine, Bivalent with other vaccines, discuss your options with your or your child's healthcare provider. WHAT IF I AM, OR MY CHILD IS, IMMUNOCOMPROMISED? If you are, or your child is, immunocompromised, you or your child may receive a third primary series dose of Moderna COVID-19 Vaccine or SPIKEVAX (COVID-19 Vaccine, mRNA). Individuals 6 years of age and older may receive a booster dose with Moderna COVID-19 Vaccine, Bivalent. Vaccinations may not provide full immunity to COVID-19 in people who are immunocompromised; therefore, you or your child should continue to maintain physical precautions to help prevent COVID-19. Your close contacts should be vaccinated as appropriate. WHAT ABOUT PREGNANCY OR BREASTFEEDING? If you are, or your child is, pregnant or breastfeeding, discuss the options with your healthcare provider. WILL THESE VACCINES GIVE ME OR MY CHILD COVID-19? No. These vaccines do not contain SARS-CoV-2 and cannot give you or your child COVID-19. Revised: Dec/8/2022 6 Packet Pg. 215 11.A.5 KEEP THE VACCINATION CARD When you, or your child, receive the first COVID-19 vaccine, you will get a vaccination card. Remember to bring the card when you return. ADDITIONAL INFORMATION If you have questions, visit the website or call the telephone number provided below. To access the most recent Fact Sheets, please scan the QR code provided below. Moderna COVID-19 Vaccine website Telephone number www.modematx.com/covidl9vaceine-eua 1-866-MODERNA (1-866-663-3762) 0 r 0 0 _ HOW CAN I LEARN MORE? • Ask the vaccination provider • Visit CDC at https://www.cdc.gov/coronavirus/2019-ncov/index.html • Visit FDA at httDs://www.fda.izov/emerizencv-preparedness-and-response/mcm-leizal- re ug latory-and-policy-framework/emergency-use-authorization • Contact your state or local public health department WHERE WILL VACCINATION INFORMATION BE RECORDED? The vaccination provider may include your or your child's vaccination information in your state/local jurisdiction's Immunization Information System (IIS) or other designated system. For more information about IISs, visit: https://www.cdc.gov/vaccines/programs/iis/about.html. CAN I BE CHARGED AN ADMINISTRATION FEE FOR RECEIPT OF THESE COVID-19 VACCINES? No. At this time, the provider cannot charge you for a vaccine dose and you cannot be charged an out-of-pocket vaccine administration fee or any other fee if only receiving a COVID-19 vaccination. However, vaccination providers may seek appropriate reimbursement from a program or plan that covers COVID-19 vaccine administration fees for the vaccine recipient (private insurance, Medicare, Medicaid, HRSA COVID-19 Uninsured Program for non-insured recipients). WHERE CAN I REPORT CASES OF SUSPECTED FRAUD? Individuals becoming aware of any potential violations of the CDC COVID-19 Vaccination Program requirements are encouraged to report them to the Office of the Inspector General, U.S. Department of Health and Human Services, at 1-800-HHS-TIPS or TIPS.HHS.GOV. WHAT IS THE COUNTERMEASURES INJURY COMPENSATION PROGRAM? The Countermeasures Injury Compensation Program (CICP) is a federal program that may help pay for costs of medical care and other specific expenses of certain people who have been Revised: Dec/8/2022 Packet Pg. 216 11.A.5 seriously injured by certain medicines or vaccines, including these vaccines. Generally, a claim must be submitted to the CICP within one (1) year from the date of receiving the vaccine. To learn more about this program, visit www.hrsa.gov/cicl/ or call 1-855-266-2427. WHAT IS AN EMERGENCY USE AUTHORIZATION (EUA)? An EUA is a mechanism to facilitate the availability and use of medical products, including vaccines, during public health emergencies, such as the current COVID-19 pandemic. An EUA is supported by a Secretary of Health and Human Services (HHS) declaration that circumstances exist to justify the emergency use of drugs and biological products during the COVID-19 pandemic. A product authorized for emergency use has not undergone the same type of review by FDA as an FDA approved product. FDA may issue an EUA when certain criteria are met, which includes that there are no adequate, approved, and available alternatives. In addition, the FDA decision is based on the totality of the scientific evidence available showing that the product may be effective to prevent COVID-19 during the COVID-19 pandemic and that the known and potential benefits of the product outweigh the known and potential risks of the product. All of these criteria must be met to allow for the product to be used during the COVID-19 pandemic. An EUA is in effect for the duration of the COVID-19 EUA declaration justifying emergency use of this product, unless terminated or revoked (after which the product may no longer be used). Moderna US, Inc. Cambridge, MA 02139 C2022 ModemaTX, Inc. All rights reserved. Patent(s): www.modernatx.com/patents Revised: Dec/8/2022 Revised: Dec/8/2022 "i Scan to capture that this Fact Sheet was provided to vaccine recipient for the electronic medical records/immunization information systems. GDTL 0886983000349 Packet Pg. 217 11.A.6 LOCATIONS �To Ft. Myers Immokalee Rd. 03 0 sas Vanderbilt Rd. C� 41 � > m O CD• � Y © li Pine Ridge Rd. o < J O +�. 7 5 ireen Blvd. O O Golden Gate Pkwy. 7th Ave. N. c � � a T 0 951 � 0 O W m Q- fC Q W Radio Rd. Davis Blvd. �7 00 >'-d 41 c � 0 Heritage Trail W U m Rattlesnake Hammock Rd. IMMOKALEE CHILDREN'S CARE • WOMEN'S CARE • CENTER FOR PSYCHOLOGY & WELLNESS ADULT & SENIOR CARE ADULT DENTAL CARE PEDIATRIC DENTAL CARE PEDIATRIC CONVENIENT CARE SPECIALTY CARE X-RAY & LAB PHARMACY NAPLES 0 12655 Collier Blvd., Naples FL 34116 at Nichols Community Health Center •••• •00 0 5450 YMCA Rd. #102, Naples, FL 34109 at Greater Naples YMCA 0 6350 Davis Blvd. #1001 Naples FL, 34104 0 1265 Creekside Pkwy. #208, Naples, FL 34108 at Arthrex Polaris Center © 1265 Creekside Pkwy. #206, Naples, FL 34108 at Arthrex Polaris Center 0 1890 SW Health Pkwy. #203, Naples FL 34109 at Gulf Coast Medical Arts Center 40 0 2355 Stanford Ct. #701 Naples, FL 34112 • • Temporarily Closed 0 1749 Heritage Trl., #801 Naples, FL 34112 •o 0 1441 Heritage Blvd., Immokalee, FL 34142 at Florida State University College of Medicine _•• m 1454 Madison Ave. W., Immokalee, FL 34142 at Marion E. Fether • *§1 • •0 508 North 9th St. #142, Immokalee, FL 34142 atiTech G? CORPORATE HEADQUARTERS 1454 Madison Ave. W., Immokalee, FL 34142 healthcare network 239.658.3000 HealthcareSWFL.org 0©00 Packet Pg. 218 11.A.7 Influenza (Flu) Vaccine (Inactivated or Recombinant): What you need to know 1. Why get vaccinated? Influenza vaccine can prevent influenza (flu). Flu is a contagious disease that spreads around the United States every year, usually between October and May. Anyone can get the flu, but it is more dangerous for some people. Infants and young children, people 65 years and older, pregnant people, and people with certain health conditions or a weakened immune system are at greatest risk of flu complications. Pneumonia, bronchitis, sinus infections, and ear infections are examples of flu -related complications. If you have a medical condition, such as heart disease, cancer, or diabetes, flu can make it worse. Many vaccine information statements are available in Spanish and other languages. See www.immunize.org/vis Hojas de informacion sobre vacunas estan disponibles en espanol y en muchos otros idiomas. Visite www.immunize.org/vis Even when the vaccine doesn't exactly match these viruses, it may still provide some protection. Influenza vaccine does not cause flu. Influenza vaccine may be given at the same time as other vaccines. 3. Talk with your health care provider Tell your vaccination provider if the person getting the vaccine: • Has had an allergic reaction after a previous dose of influenza vaccine, or has any severe, life - threatening allergies • Has ever had Guillain-Barre Syndrome (also Flu can cause fever and chills, sore throat, muscle called "GBS") aches, fatigue, cough, headache, and runny or stuffy nose. Some people may have vomiting and diarrhea, In some cases, your health care provider may decide though this is more common in children than adults. to postpone influenza vaccination until a future visit. In an average year, thousands of people in the Influenza vaccine can be administered at any United States die from flu, and many more are time during pregnancy. People who are or will be hospitalized. Flu vaccine prevents millions of pregnant during influenza season should receive illnesses and flu -related visits to the doctor each year. inactivated influenza vaccine. 2. Influenza vaccines CDC recommends everyone 6 months and older get vaccinated every flu season. Children 6 months through 8 years of age may need 2 doses during a single flu season. Everyone else needs only 1 dose each flu season. It takes about 2 weeks for protection to develop after vaccination. There are many flu viruses, and they are always changing. Each year a new flu vaccine is made to protect against the influenza viruses believed to be likely to cause disease in the upcoming flu season. People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting influenza vaccine. Your health care provider can give you more information. N cP 00 Cn M N c d S c as E M a U.S. Department of Health and Human Services Centers for Disease Control and Prevention Packet Pg. 219 11.A.7 4. Risks of a vaccine reaction • Soreness, redness, and swelling where the shot is given, fever, muscle aches, and headache can happen after influenza vaccination. • There may be a very small increased risk of Guillain-Barre Syndrome (GBS) after inactivated influenza vaccine (the flu shot). Young children who get the flu shot along with pneumococcal vaccine (PCV 13) and/or DTaP vaccine at the same time might be slightly more likely to have a seizure caused by fever. Tell your health care provider if a child who is getting flu vaccine has ever had a seizure. People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears. As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death. 5. What if there is a serious problem? An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness), call 9-1-1 and get the person to the nearest hospital. For other signs that concern you, call your health care provider. Adverse reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your health care provider will usually file this report, or you can do it yourself. Visit the VAERS website at wwwvaers.hhs.gov or call 1-800-822-7967. UAERS is only for reporting reactions, and UAERS staff members do not give medical advice. Vaccine Information Statement Inactivated Influenza Vaccine 6. The National Vaccine Injury Compensation Program The National Vaccine Injury Compensation Program (VICP) is a federal program that was created to compensate people who may have been injured by certain vaccines. Claims regarding alleged injury or death due to vaccination have a time limit for filing, which may be as short as two years. Visit the VICP website at www.hrsa.gov/vaccinecompensation or call 1-800-338-2382 to learn about the program and about filing a claim. 7. How can I learn more? • Ask your health care provider. • Call your local or state health department. • Visit the website of the Food and Drug Administration (FDA) for vaccine package inserts and additional information at www.fda.gov/vaccines-blood-biologics/vaccines. • Contact the Centers for Disease Control and Prevention (CDC): -Call 1-800-232-4636 (1-800-CDC-INFO) or -Visit CDC's website at www.cdc.gov/flu. 42 U.S.C. § 300aa-26 8/6/2021 OFFICE �. USE ONLY Packet Pg. 220 11.A.8 1L. L Healthcare Network offers an array of services to address the healthcare needs of every member of your family, regardless of income, job or insurance status. A Sliding Fee Discount is available for eligible patients in need of financial assistance. SERVICES ■ Pediatric care ■ Adult and senior care ■ Women's care ■ Dental care ■ Integrated behavioral health and traditional mental health services ■ Pharmacy ■ Telehealth SERVICIOS Aceptamos pacientes de todas las edades, independientemente de sus ingresos, trabajo o estado del seguro. ■ Cuidado de los nihos ■ Cuidado de adultos ■ Cuidado para la mujer ■ Cuidado dental ■ Salud mental integral y terapia tradicional Farmacia Telesalud healthcare network SEVIS YO Nou aksepte pasyan tout laj, kelkeswa revni, travay, oswa sitiyasyon asirans. ■ Swen timoun yo ■ Swen you granmoun ak granmoun aje ■ Swen fanm yo ■ Swen dante ■ Sant sikoloji 0 Famasi 0 Telesante is Packet Pg. 221 IMMOKALEE 0 1441 Heritage Blvd., Immokalee, FL 34142 at Florida State University College of Medicine 000 0 1454 Madison Ave. W., Immokalee, FL 34142 at Marion E. Fether lee © 508 North 9th St. #142, Immokalee, FL 34142 atiTech • CORPORATE HEADQUARTERS & 1454 Madison Ave. W., Immokalee, FL 34142 11.A.8 CHILDREN'S CARE WOMEN'S CARE • CENTER FOR PSYCHOLOGY & WELLNESS ADULT & SENIOR CARE ADULT DENTAL CARE S PEDIATRIC DENTAL CARE JYEIaALI Y CAHE X-RAY & LAB PHARMACY healthcare ri network 239.658.3000 1 HealthcareSWFL.org I Packet Pg. 222 https://www.cdc.gov/coronavi rus/2019-ncov/symptoms-testing/sym ptoms.htm l ,,Symptoms of COVID-�O Know the symptoms of COVID-19, which can include the following: If you are experiencing any of these symptoms, get tested for COVID-19. Symptoms can range from mild to severe and appear 2-14 days after you are exposed to the virus that causes COVID-19. Seek medical care immediately if you or someone you know has Emergency Warning Signs of COVIDA 9: Trouble breathing Persistent pain or pressure in the chest New confusion Difficulty waking or staying awake Pale, gray, or blue -colored skin, lips, or nail beds, depending on skin tone This is not a list of all possible symptoms. Please call your healthcare provider for any other symptoms that are severe or concerning to you. T 0 0 U) E 0 Q. E CO c d E 0 cdc.gov/coronavirus Packet Pg. 223 healthcare &A network January 23, 2022 Collier County Board of Commissioners 3299 Tamiami Trail East, Suite 303 Naples, FL 34112 Re: Support Healthcare Network Community Health Workers (CHWs) Dear Board of Commissioners: 1454 Madison Avenue W lmmokalee, Florida 34142 P 239.658,3000 www.healtheareswfl.org Healthcare Network would like to request your assistance in protecting the health of our community's most vulnerable residents by supporting our Community Health Worker (CHW) Program the "Extra Mile". This grant has supported more people in Immokalee such as migrant farmworkers and other vulnerable communities than any other funding source we have received to date. CHWs allow us to build trust in at -risk and underserved communities throughout Collier County by delivering culturally and language -appropriate information about critical health matters to improve chronic disease control, mental health, quality of care and unnecessary hospitalizations. The multicultural team consists of registered nurses, licensed practical nurses, medical assistants, and individuals with experience in public health and health education. To reach those living in remote areas our CHWs employ several tactics including door-to-door outreach, community collaborations and participating in community events. CHWs work to: • Improve access to health care services. • Increase health and screenings. • Enhance communication between community members and health providers. • Increase use of health care services. • Improve adherence to health recommendations. • Reduce need for emergency and specialty services. • Help families connect with local resources for physical and mental health, food, and housing assistance. • Advocate for underserved individuals or communities to receive services and resources to address health needs. PROVIDING QUALITY HEALTHCARE FOR ALL SINCE 1977 Packet Pg. 224 The attached materials were and are currently used for educational purposes only. Our team works to raise awareness and inform people about options and at no time are community members advised to receive care or follow CDC guidelines such as getting vaccinated and wearing a mask. Educational resources include: • Map General Location — Map of all Healthcare Network locations • Brochure General Eng-Span — Overview of Healthcare Network services • Pfizer Bivalent Booster VIS - Vaccine and information fact sheet, benefits and risks of vaccine • NCHC General+ Map — Services available at Nichols Community Health Center • Bifold Sliding Fee Scale — Explains a discount is available to those who may not have insurance or ability to pay for care. • TDAP VIS English — What is TDAP, benefits and risks of vaccine • 10 Things English — How to manage COVID-19 Symptoms • Updated COVID Information - • Immokalee General + Immokalee Map - Services available in Immokalee • Moderna Bivalent Booster - Vaccine and information fact sheet, benefits and risks of vaccine • TDAP VIS Spanish - Vaccine and information fact sheet, benefits and risks of vaccine • COVID-19 Symptoms — Lists symptoms of COVID- 19 • Influenza VIS - Vaccine and information fact sheet, benefits and risks of vaccine • Updated COVID Information mRNA How mRNA COVID-19 vaccine works Healthcare Network CHW's fill an important role in our community. They work in at -risk communities like Immokalee and Golden Gate to break down barriers that prevent people from finding and using health and social systems. We humbly request your continued support of our CHW program and The Extra Mile Grant, which allows us to reach our most vulnerable families living in Collier County. Sincerely, Jamie Ulmer President & Chief Executive Officer Healthcare Network Packet Pg. 225 L O O d c 0 o E o a N A N O A V O p y O0� Wag Q ¢ a �aE-W W a O U J� 11 LOUNR•0 N Q N O N A N N 'JO N N m :2 6 C 0' U S y TTT1111 Z Q in EO Q O 2 _ Z a El U N N N O lC0 O O N Q N U T O. J N N 'Nm 6 2 '� ^ W e .o 2 W c d •g N J W p O U a w o=892 9om22 J .E crn Z W�9 m ccLL¢ pEpU -•N m m 0 Q w U 6 2 m U d .,a.N S< E" C N I'I N m O C 'Np O N 0 y.0 C N U N N _ O J. N N N V W Q Q 0- co m 0 N N N 0 J 0 N o Q a N OQO``C �C,0-: ■ t' r 0 o 0 �' y ZC7JU' oC,.a " W W W y 9 2 -m 0 `W Z~zz yom—°aom 1 III 111 ? Z m m o E L _ o - a N N O .p NO Ea C N J N ti Z U N L d •m d c� N r� o E cNi �a a n o m E R w w N N N N O N O N O a ? w N L N C d U c a E 'u1 a s is U a a a n a c c myNN$ Lj ¢o a•`co v ooc Y T O U U U y cO o w DE d W N W N J o 0 3 d rn 0 �° d E O Q Q Q Q Q IL N U 6 a Z E m � Z a1 $ 0. E J ■ ■ ■ ■ ■ ■ ■ 1-1 C Z J J //## O Q W O 0 00 ao w'W Z w z J LU rI Q 2 u w vo ��' ►1 _ y 0 O r1) LU $d ma �"gU,�E c 6Ni� a`� z~ U I U T U1 = l0 Q- .T W Q Q W W Z s LL � vv C ,� a U > c a ��_� m Vl m m$ O m IL Q O p = E C �OwO sLLm_a OlC U ///// �� 2 V>- m ca a Q C) m s ate. �i N U W Q 0�` r cc o J Q2Z C ?` O y a N = - U t O m -O d m m m m m y a N E cmi y m N E O T.6,m m `ma U E T tOJ U.9 « N C A O :EW N L F at6i an d o@ E o W '� 3 0 N 0 a §= m E 6�i o O a r o m m Co 0 0 0 0 ■ ■ 10 THINGS YOU CAN DO TO MANAGE YOUR COVID-19 SYMPTOMS AT HOME I COVID-19 1 If you have possible or confirmed COVID-19 1® Stay home except to get medical care. Monitor your symptoms carefully. If your symptoms get worse, call your healthcare provider immediately. ® Get rest and stay hydrated. If you have a medical appointment, call the healthcare provider ahead of time and tell them that you have or may have COVID-19. 5. For medical emergencies, call 911 and notify the dispatch personnel that you have or may have COVID-19. qAq 6. Cover your cough and sneezes with a tissue or use the inside of your elbow. %. Wash your hands often with soap and water for at least 20 seconds or clean your hands with an alcohol -based hand sanitizer that contains at least 60% alcohol. 8. As much as possible, stay in a specific room and away from other people in your home. Also, you should use a separate bathroom, if available. If you need to be around other people in or outside of the home, wear a mask. 9. Avoid sharing personal items with other people in your household, like dishes, towels, and bedding. 10. Clean all surfaces that are touched often, like counters, tabletops, and doorknobs. Use household cleaning sprays or wipes according to the label instructions. cdc.gov/coronavirus CS325556-A 1 07/16/2021 Packet Pg. 228 Performance Measures - Collier County NOFO: Component: Current Submission Export Date & Time: Status: DP21-2109 Component 6/6/2022 12:55 PM (GMT-04:00) Eastern Daylight Time A In Progress (America/New York) Measure CB1: # of CHWs successfully completing state/local/tribal public health -led COVID-19 response training efforts as determined by relevant public health -led entities, e.g., skills related to contact tracing, vaccine and treatment equity, appropriate use and care of PPE, and sufficient documentation of relevant data collection efforts. Type Short Term Measure Narrative 6 CHWs will be hired and each will complete relevant initial COVID-19 response training Setting Federally Qualified Health Centers CHW training records (classes attended; shadowing experiences documented; CHW evaluations of each training session or shadowing Data Source experience; pre- and post -training subject matter knowledge evaluations completed by CHWs Measurements Year Performance Period Date Collected Numerator/Count Sub -measurement Type: Value Notes Recruiting 6 CHWs; 3 hired and onboarding in March Year Period 1 1/31/2022 0 2022; 3 1 will be hired before end of March 2022. Measure CB3: # and type of organizations/entities that are integrating CHWs to support state/local public health -led COVID-19 response efforts. Type Long Term Measure Narrative Strengthen existing relationships and develop new relationships with organizations/entities that help support COVID-19 response efforts Setting Hospitals, multi -unit family housing, outpatient clinics, schools, health clinics, FQHCs, community centers, community based organizations Page 1 of 4 1 Packet Pg. 229 List of organizations (key contacts, frequency of interaction, type of Data Source interactions, referrals) Measurements Year Performance Period Date Collected Numerator/Count Sub -measurement Type: Value Notes Current: 6 organizations (Coalition of Immokalee Workers, Mision Peniel, RCMA, Guadalupe Year period 1 2/28/2022 6 Non-profit organizations/NGO Center, Grace Place, St. 1 Vincent de Paul). Adding 6 more collaborating/integrating organizations before 8/31 /2022. Measure CB4: # and type of messages developed and disseminated. Type Intermediate Measure Narrative CHWs will educate individuals, groups and media audiences regarding CHW role, resources and opportunities for involvement Setting Multi -unit family housing, outpatient clinics, schools, health clinics, FQHCs, community centers, community based organizations CHW documentation of home visits, group presentations and media Data Source interviews Measurements Year Performance Period Date Collected Numerator/Count Sub -measurement Type: Value Notes CHWs are being hired; once onboard and trained (April), they will begin home canvassing/visits, group presentations and Year Period 1 2/28/2022 0 The CHWs' role in delivering media interviews 1 services and conducting activities in extra mile communities. Target, per CHW: 20 home visits/month, 1 group presentation/month and 1 media interview in 6 months. Page 2 of 4 1 Packet Pg. 230 Measure CB5: # of individuals within communities and/or clinical settings reached through messaging and education, including those at highest risk for poor health outcomes, including those resulting from COVID-19, among populations of focus within communities. Type Intermediate Measure Narrative CHWs will educate individuals in populations of focus Setting Multi -unit family housing, community centers, community based organizations Data Source CHW documentation of individual interactions/screenings Measurements Year Performance Period Date Collected Numerator/Count Sub -measurement Type: Value Notes Once CHWs are hired and trained (April), they will conduct home visits to Year Period 1 2/28/2022 0 educate about COVID-19 and screen for SDOH. Goal for each CHW: 20 home visits/per month Measure CB6: # of patients referred for individual, specific named health and social conditions that increase the risk for COVID-19 for patients at highest risk for poor health outcomes, within clinical and/or community settings. Document referrals for any of the following specific named conditions: housing and shelter; food; healthcare; mental health and addictions; employment and income; clothing and household; childcare and parenting; government and legal. Type Short Term Measure Narrative # of patients referred to primary care (Healthcare Network or other) and to other named conditions. Setting Multi -unit family housing, community centers, community based organizations Interview summaries/SDOH screening questionnaires collected by CHWs on iPads/tablets in the field (home visits, health fairs with Page 3 of 4 1 Packet Pg. 231 Data Source collaborating organizations) and uploaded to Healthcare Network's secure database. Measurements Year Performance Period Date Collected Numerator/Count Sub -measurement Type: Value Notes Once CHWs are hired and trained (April), they will conduct home visits and participate in health fairs with Year collaborating 1 Period 1 2/28/2022 0 Tracking, referral, healthcare access organizations to educate about primary health care , screen for SDOH and make appropriate referrals. Goal per CHW: 10 referrals/month. Page 4 of 4 1 Packet Pg. 232 Performance Measures - Collier County NOFO: Component: Current Export Date & Time: Submission Status: DP21-2109 Component 10/26/2022 10:04 AM (GMT-04:00) Eastern Daylight Time A In Progress (America/New York) Measure CB1: # of CHWs successfully completing state/local/tribal public health -led COVID-19 response training efforts as determined by relevant public health -led entities, e.g., skills related to contact tracing, vaccine and treatment equity, appropriate use and care of PPE, and sufficient documentation of relevant data collection efforts. Type Short Term Measure Narrative 6 CHWs will be hired and each will complete relevant initial COVID-19 response training Setting Federally Qualified Health Centers CHW training records (classes attended; shadowing experiences documented; CHW evaluations of each training session or shadowing Data Source experience; pre- and post -training subject matter knowledge evaluations completed by CHWs Measurements Year Performance Date Numerator/Count Sub -measurement Type: Value Notes Period Collected Recruiting 6 CHWs; 3 hired and onboarding in March Year Period 1 1/31/2022 0 2022; 3 1 will be hired before end of March 2022. Hired, Year Period 2 8/30/2022 6 onboarded 1 and trained 6 CHWs. Performance Year L Roadmap Activity Status Roadmap Prevention Status Year 1 Year 1 Page 1 of 6 1 Packet Pg. 233 Measure CB3: # and type of organizations/entities that are integrating CHWs to support state/local public health -led COVID-19 response efforts. Type Long Term Measure Narrative Strengthen existing relationships and develop new relationships with organizations/entities that help support COVID-19 response efforts Setting Hospitals, multi -unit family housing, outpatient clinics, schools, health clinics, FQHCs, community centers, community based organizations List of organizations (key contacts, frequency of interaction, type of Data Source interactions, referrals) Measurements Year Performance Date Numerator/Count Sub -measurement Type: Value Notes Period Collected Current: 6 organizations (Coalition of Immokalee Workers, Mision Peniel, RCMA, Guadalupe Year period 1 2/28/2022 6 Non-profit organizations/NGO Center, Grace Place, St. 1 Vincent de Paul). Adding 6 more collaborating/integrating organizations before 8/31 /2022. Added 4 additional collaborating/integrating organizations: Year Pace Center for 1 Period 2 8/30/2022 4 Non-profit organizations/NGO Girls-Immokalee, ChenMed Foundation, Robert's Center - Collier County Senior Food Center in Immokalee Manantial de Vida Church (Golden Gate); Bethel Church Year Period 2 8/30/2022 4 Religious entities (Immokalee); St. Agnes 1 Catholic Church (Naples/Golden Gate); Everglades Community Church, Everglades City Performance Year Roadmap Activity Status Roadmap Prevention Status Year 1 Year 1 Year 1 Page 2 of 6 1 Packet Pg. 234 Measure CB4: # and type of messages developed and disseminated to educate organizations and care teams on the critical role CHWs play in delivering services and managing the spread of COVID-19 among priority populations within communities. Type Intermediate Measure Narrative CHWs will educate groups and media audiences regarding CHW role, resources and opportunities for involvement Setting Multi -unit family housing, outpatient clinics, schools, health clinics, FQHCs, community centers, community based organizations CHW documentation of home visits, group presentations and media Data Source interviews Measurements Year Performance Period Date Collected Numerator/Count Sub -measurement Type: Value Notes CHWs are being hired; once onboard and trained (April), they will begin home canvassing/visits, group presentations and Year Period 1 2/28/2022 0 The CHWs' role in delivering media interviews 1 services and conducting activities in extra mile communities. Target, per CHW: 20 home visits/month, 1 group presentation/month and 1 media interview in 6 months. CHWs made presentations about the CHW's role in delivering services and conducting activities to Healthcare Network (HCN) departments including chronic care management, pharmacy, specialty care, pediatrics, family care, behavioral health and Page 3 of 6 1 Packet Pg. 235 women's health. Education was also provided externally to the Year Period 2 8/30/2022 20 The CHWs' role in delivering Florida Department of I services and conducting activities Health community health department, St. Vincent de Paul, Catholic Charities, Chen Med Foundation, Pulte Foundation, Robert's Center -Collier County Senior Food Center, Boys & Girls Club of Collier County, Pace Center for Girls, Everglades Community Church, Unity Church, Golden Gate Community Center, Bethel Church and Manantial de Vida Church. Performance Year Roadmap Activity Status Roadmap Prevention Status Year 1 Year 1 Measure CB5: # of individuals within communities and/or clinical settings reached through messaging and education, including those at highest risk for poor health outcomes, including those resulting from COVID-19, among populations of focus within communities. Type Intermediate Measure Narrative CHWs will educate individuals in populations of focus Setting Multi -unit family housing, community centers, community based organizations Data Source CHW documentation of individual interactions/screenings Measurements Year Performance Period Date Collected Numerator/Count Sub -measurement Type: Value Notes Once CHWs are hired and trained (April), they will conduct home visits to Yearl educate about Page 4 of 6 1 Packet Pg. 236 I Period 1 2/28/2022 0 COVID-19 and screen for SDOH. Goal for each CHW: 20 home visits/per month From April to August, CHWs attended twice/three times weekly COVID-19 testing events and staffing health fairs in "Extra Mile" communities, Year assessing health 1 Period 2 8/30/2022 500 status (500 SDOH screening surveys), educating about COVID-19 (including vaccines), and making appropriate referrals for medical/dental/mental health and support services. Pcrformancc Year Roadmap Activity Status Roadmap Prevention Status Year 1 Year 1 Measure CB6: # of patients referred/connected to services for individual, specific named health and social conditions that increase the risk for COVID-19 for patients at highest risk for poor health outcomes, within clinical and/or community settings. Type Short Term Measure Narrative # of patients referred to primary care (Healthcare Network or other) and to other named conditions. Setting Multi -unit family housing, community centers, community based organizations Interview summaries/SDOH screening questionnaires collected by CHWs on iPads/tablets in the field (home visits, health fairs with Data Source collaborating organizations) and uploaded to Healthcare Network's secure database. Measurements Year Performance Period Date Collected Numerator/Count Sub -measurement Type: Value Notes Once CHWs are hired and trained (April), they will conduct home visits and Page 5 of 6 1 Packet Pg. 237 participate in health fairs with Year collaborating 1 Period 1 2/28/2022 0 Tracking, referral, healthcare access organizations to educate about primary health care , screen for SDOH and make appropriate referrals. Goal per CHW: 10 referrals/month. Year Period 2 8/30/2022 20 Diabetes management 20 1 Year 1 Period 2 8/30/2022 20 Hypertension management 20 Year Period 2 8/30/2022 5 Housing and shelter (including Home 5 1 Energy Assistance LIHEAP) Year Period 2 8/30/2022 30 Food (including food banks, SNAP, 37 (exceeded 1 WIC) goal) Performance Year Roadmap Activity Status Roadmap Prevention Status Year 1 Year 1 Year 1 Year 1 Year 1 ti M uO N as L N a� a� c E L 0 a U U U 0 U 0 M 00 O N N O N H d r C G1 E t t� 10 Q Page 6 of 6 1 Packet Pg. 238 Year 1: 8/31/2021- 8/30/2022 Strategy 1: Train Identify an( collaborate with community -wide efforts to ensure comprehensive acquisition of relevant knowledge, roles, and skills by CHWs so they are prepared to successfully engage with existing state and/or local public health -led actions to manage COVID-19 among priority populations within communities. Outcome: Increased skills/capacity/roles of CHWs to provide services and support for COVID-19 public health response efforts among priority populations. Objectives Tasks Timeline: Establish Community -Based Educational Feedback Begin Recruiting Community Healthcare Providers, Agencies, and Stakeholders for Opportunities Through the Coalition involvement by identifying and contacting key leaders in communities 9/1/2021 Coalition with existing HCN clinics: Immokalee and Golden Gate. Hold Recurring Bi-Monthly Coalition Meetings to educate on CHWs work and updates, and provide opportunities for community stakeholders to give feedback 11/30/2021; Ongoin; and assist in identifying unmet needs and additional resources. Establish Internal Training and Hold recurring Bi-Weekly Trainings for CHWs with Partners in Health to monitor Education Procedures program progress, successes, and weakness, and to train on current clinical and 10/15/2021; Ongoin, community issues for the COVID-19 response. Onboarding Training for new CHWs, including 1-day Human Resources new employee orientation and 1-day training about programs and services offered by 12/31/2021 Healthcare Network, including sliding fee scale. Field Training for new CHWs - Onboarding will conclude with 2-week hands-on 12/31/2021 training by shadowing experienced CHWs in the community. Partners in Health 3-5 Day Promotora Training Workshop for CHWs: Understanding Social Determinants of Health, General COVID-19 Knowledge, 1/31/2022 Communication Strategies, Navigating Challenging Household Visits, the Accompaniment Concept and the Psycho- Social Support Strategies. Strategy 2: Deploy Integrate CHWs into organizations and care teams to support the public health response to COVID-19 among priority populations within communities. Develop and disseminate messaging that educates organizations and care teams on the critical role CHWs play in delivering services and managing the spread of COVID-19 among priority populations within communities. Outcome: Increased workforce of CHWs delivering services to manage the spread of COVID-19. Objectives Tasks Timeline Expand the CHW Workforce Begin recruitment in Extra Mile Communities to add 6 new CHWs to the existing 9/1/2021 teams of 12 CHWs that are currently located in Immokalee & Golden Gate. 6 new CHWs will be fully onboarded. 12/31/2021 Integrate CHWs into the clinical As clients are enrolled or referred, a caseload of households will be assigned to care teams each CHW to assess their needs and help them navigate through and or access the 9/1/2021; Ongoing health services available. a� r a c L E E 0 U Lm L0 3 E M u_ m c� x LU ti aD uO Iq N m c �a a L 0 U U 0 cM o� 0 N 0 N IL Cn U c d E t U c� r Q Packet Pg. 239 Develop an ongoing program to give CHWs opportunities to shadow Healthcare Network clinicians and attend clinical meetings, as appropriate, to learn clinic processes and procedures, as well as to provide CHWs opportunities to share 10/30/2021; Ongoin; experiences from the community, leading to coordinated patient case management and support. CHWs and DOH -Collier County will coordinate their COVID testing and vaccination schedules, with CHWs assisting with translation and registration at DOH events, as 10/30/2021; Ongoin; needed; and CHWs will provide referrals to healthcare and social support services for community members who have tested positive for COVID-19. Coalition will collaborate with local healthcare providers to develop and implement consistent referral procedures for agencies and medical providers to 12/31/2021 refer community members for CHW-case-management, as well as for CHWs to refer clients to providers for applicable social support and other services. Promote CHW engagement in Extra Mile Communities Begin Recruiting Community Medical Providers, Agencies, and Stakeholders for Coalition involvement by identifying and contacting key leaders in Extra Mile 4/1/2022 Communities where CHW involvement has not yet been established, to include (but not limited to): Lely, Everglades City, Goodland, Copeland, Chokoloskee. Begin canvassing and promoting in Extra Mile Communities to disseminate educational materials regarding CHW role, resources, and opportunities for 4/2/2022 involvement. Strategy 3: Engage Coordinate and/or promote opportunities, such as messaging/education, within community and clinical settings to facilitate the engagemen of CHWs in addressing the needs of those at highest risk for poor health outcomes, including those resulting from COVID-19. Initiate and develop and/or utilize systems to document engagement of CHWs in the care, support, and follow-up across clinical and community settings of priority populations at highest risk for poor health outcomes, including those resulting from COVID-19 Outcome: Increased utilization of community resources and clinical services for those at highest risk for poor health outcomes among priority populations within the community. Objectives Tasks Timeline Address Social Determinants of CHWs will refer clients to COVID-19 resources when appropriate and address Health and Barriers to Needs barriers to linking with resources, such as transportation access. 9/1/2021; Ongoing CHWs will identify clients without a primary care physician and will make necessary referrals to primary care physicians, and address barriers to linking with 9/1/2021; Ongoing the healthcare provider and facilitating the new patient appointment. CHWs will identify social service needs of clients and make referrals for service 10/30/2021; Ongoin providers such as: housing, food, and utilies assistance. Promote equitable access to Healthcare Network and CHWs will conduct COVID-19 testing events in COVID-19 testing and underserved neighborhoods where needs are identified. Testing events will be 9/1/2021; Ongoing vaccination convenient for the populations in terms of location, time and day of week (evenings and weekends, for example). a� a c 'L^ V E E 0 U L m L0 E L M u_ m c� x w ti as u0 N m c �a d L 0 U 0 U 0 M d) 0 N O N a N U c d E t U M r Q Packet Pg. 240 To educate and build trust CHWs will schedule meetings with the local organizations and religious leaders (church pastors and other organized groups). 9/1/2021: Ongoing CHWs will launch door-to-door canvassing in Extra Mile communities to provide vaccine education and provide assistance to connect those interested with the 6/1/2022 vaccine through scheduling, transportation, and language assistance. The Coalition will reach out to coordinate with Growers to increase availability of vaccination at migrant farm worker sites. 6/1/2022 Document and Evaluate 6 Additional tablets will be purchased, for CHW documentation. 10/31/2021 Program Outputs and Impacts New data collection platform will be implemented, to increase capacity for data tracking. 11/30/2021 Program team members will be trained on new data collection system. 12/15/2021 Submit finalized Evaluation and Performance Measurement Plan, including Data Management Plan to the CDC 2/28/2022 Submit Annual Performance Report (APR) to the CDC 4/30/2022 CHWs will collect client data during houshold visits and interactions (such as at a food distribution event) to track project outputs. Data collection will be Supervised by Healthcare Network and will be supported and advised by Partners in Health. PIH will bring on a data clerk and additional academic colloborators to the team to facilitate reporting and the evaluation of Ongoing program impacts Output data will include: Household demographics, number of client visits conducted, services provided, number of COVID tests and vaccinations, existing primary care provider relationship status and referrals made. A third party evaluator will be contracted to review data correlated to program impact on the communities. COVID-19 statistics for the County are collected by the Department of Health. 11/30/2021 Impact data to be evaluated will include: Pre- and post- activation and engagement scores; COVID-19 positivity rates; COVID-19 hospitalization rates; COVID-19 mortality rates. Packet Pg. 241 CENTERS FOR DISEASET"' CONTROL AND PREVENTION Centers for Disease Control and Prevention NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION Community Health Workers for COVID Response and Resilient Communities (CCR) CDC-RFA-DP21-2109 05/24/2021 w U U U 0 U N M O Packet Pg. 242 Table of Contents A. Funding Opportunity Description...............................................................................................3 B. Award Information....................................................................................................................28 C. Eligibility Information..............................................................................................................30 D. Required Registrations..............................................................................................................31 E. Review and Selection Process...................................................................................................42 F. Award Administration Information...........................................................................................49 G. Agency Contacts.......................................................................................................................56 H. Other Information.....................................................................................................................57 I. Glossary......................................................................................................................................58 Part I. Overview Applicants must go to the synopsis page of this announcement at www. rg ants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- DP21-2109. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes. A. Federal Agency Name: Centers for Disease Control and Prevention (CDC) B. Notice of Funding Opportunity (NOFO) Title: Community Health Workers for COVID Response and Resilient Communities (CCR) C. Announcement Type: New - Type 1: This announcement is only for non -research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at hgps://www.gpo. og v/fdsys/pkg/CFR-2007-title42-voll/pdf/CFR-2007-title42-voll-sec52- 2.pdf. Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs. og v/ohrp/regulations-and-policy/regulations/45-cfr- 46/index.html (See section 45 CFR 46.102(d)). D. Agency Notice of Funding Opportunity Number: CDC-RFA-DP21-2109 E. Assistance Listings Number: 93.495 F. Dates: 1. Due Date for Letter of Intent (LOI): 03/25/2021 Not Applicable LOI is not required or requested. Page 1 of 64 Packet Pg. 243 2. Due Date for Applications: 05/24/2021 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov. 3. Due Date for Informational Conference Call: Date: March 31, 2021 Time: 3:30 pm - 4:30 pm U.S. Eastern Standard Time Conference Number: 800-369-3192 Participant Code: 5479788 Join via Computer: https://adobeconnect.cdc.gov/rOer4cleiiemc/ Potential applicants may also submit questions via email at: nccdphp chw(c-r�,cdc.gov The following website will contain pre -and post -conference call information, including questions and answers submitted by potential applicants: Community Health Workers for Covid Response and Resilient Communities I CDC F. Executive Summary: Summary Paragraph The Coronavirus Aid, Relief, and Economic Security ("CARES") Act of 2020 allocated funds to w the Centers for Disease Control and Prevention (CDC) to states, localities, territories, tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes. CDC LO announces the availability of funds to achieve the goal of the CARES Act in preventing COVID- N 19 and protecting the American people from related public health impacts. This Notice of v Funding Opportunity (NOFO) supports this work through training and deployment of c� community health workers (CHWs) to response efforts and by building and strengthening c community resilience to fight COVID-19 through addressing existing health disparities. v Ln N Program strategies include integrating CHWs into organizations and care teams and c strengthening relevant CHW knowledge, roles, and skills to prepare them to successfully engage N with existing state and/or local public health -led actions to manage COVID-19 among priority N populations. Priority populations are those with increased prevalence of COVID-19 and are U_ disproportionately impacted by long-standing health disparities related to sociodemographic Z characteristics, geographic regions, and economic strata. Examples include, racial and ethnic minority groups, persons who are economically disadvantaged, justice -involved, experiencing z homelessness, or have certain underlying medical conditions that increase COVID-19 risk. a. Eligible Applicants: Open Competition b. NOFO Type: G (Grant) c. Approximate Number of Awards Page 2 of 64 Packet Pg. 244 70 d. Total Period of Performance Funding: $ 300,000,000 e. Average One Year Award Amount: $ 1,000,000 Over a three-year period of performance, CDC will award approximately $100 million each budget year for three years with the average award varying. These grants will range approximately from $350,000 - $3 million per year depending on the size and scope of activity. The range of funds is broad to accommodate a varied number of organizations based on capacity and a range of catchment areas whose resource needs will vary. Approximate average one-year award amounts for each component are: Component A (Capacity Building): $600K Component B (Implementation Ready): $2M Component C (Innovation — demonstration projects): $2M f. Total Period of Performance Length: 3 g. Estimated Award Date: August 01, 2021 h. Cost Sharing and / or Matching Requirements: No Part I1. Full Text A. Funding Opportunity Description 1. Background a. Overview The novel Coronavirus Disease 2019 (COVID-19) has impacted communities nation-wide, v including all states, localities, and territorial jurisdictions. Public health crises, such as COVID- c 19, exacerbate existing health disparities and inequities in the social determinants of health c� (SDOH), conditions in which people are born, live, learn, work, play, worship, and N age. Black/African Americans, Hispanics/Latinos, and American Indian/Alaska Native o populations have higher rates of unemployment; are more likely to work in essential, low-income N positions that do not allow telework; live in communities with higher rates of environmental N hazards; and do not have health insurance or paid sick leave through employers. Racial and o ethnic minority groups, economically disadvantaged persons, justice -involved, people z experiencing homelessness, and people who use drugs and/or have certain underlying medical conditions are also at risk. All of these factors increase risk of exposure to COVID-19, while E limiting ability to stay home or access care when sick. Racial and ethnic minority groups also experience higher incidence of severe heart disease, diabetes, obesity, and smoking, all shown to Q increase the risk of severe illness from COVID-19. Furthermore, distrust of medical and governmental entities and longstanding disparities in vaccine coverage may impact achievement of high COVID-19 vaccination rates, once vaccines are widely available in these population groups. Along with CDC's strategies for ending the COVID-19 pandemic, focused investments are Page 3 of 64 Packet Pg. 245 needed to decrease disparities among the populations outlined above. Initiatives that promote health equity in all policies and reduce inequities should be pursued and evaluated for effective and targeted systems' changes across relevant sectors. Overwhelming evidence demonstrates that health is highly influenced by SDOHs such as intergenerational wealth, high quality education, stable and fulfilling employment opportunities, affordable housing, access to healthful foods, commercial tobacco -free policies, and safe green spaces for physical activity. Through partnerships around community health assessment and planning efforts, federal, state, local, tribal, and territorial governments have invested in long-range policy and environmental change plans to improve SDOHs in communities with the poorest health outcomes. CHWs are well -positioned to reach communities, especially those disproportionately impacted by COVID-19. CHW interventions can improve uptake and access to health care services, improve communication between community members and health providers, reduce the need for emergency and specialty services, and improve adherence to health recommendations. While CHW administered interventions have a demonstrated impact, barriers to increased intervention implementation exist (e.g. insufficient numbers of trained individuals to meet existing needs; lack of funding/reimbursement; poor integration of CHWs in multidisciplinary care teams, in the health care delivery system, or in community organizations addressing the social determinants of health; and limited communication technology). CHWs can improve access to COVID-19 related services (e.g. testing, contact tracing, health 2 behavior education) and management of other underlying medical conditions that increase risk of severe COVID-19 illness and adverse outcomes. Through this initiative, CDC can highlight the x integral role of CHWs in increasing resiliency, and response efforts in the hardest hit w communities across the nation, especially during emergency crises by supporting three components in this NOFO: Component A focuses on building capacity for CHW efforts;LO Component B focuses on enhancing and expanding existing CHW efforts; and Component C `= focuses on developing innovative approaches to strengthening the use of CHWs. U b. Statutory Authorities U This program is authorized under the Coronavirus Aid, Relief, and Economic Security Act v ("CARES Act"), Public Law 116-136 and under the Public Health Service Act 42 U.S.C. N 301(a). o c. Healthy People 2030 This funding opportunity focuses on COVID-19 response and community resilience addressing Healthy People 2030 goals including emergency preparedness: https://health.gov/healthypeople/objectives-and-data/browse- objectives/emergencyspreparedness and vaccination: https://health.gov/healthypeople/objectives- and-data/browse-objectives/vaccnation. For further information, please see https://health.gov/healthypeople/objectives-and-data/browse- obj ectives. d. Other National Public Health Priorities and Strategies The COVID-19 pandemic requires a coordinated public health response; recipients should consider the following in their proposed work: Page 4 of 64 Packet Pg. 246 Topics (e.g. social determinants of health) related to health conditions associated with increased risk of COVID-19 illness and poorer outcomes. https://www. cdc. gov/coronavirus/2019-ncov/need-extra-precautions/people-with- medical-conditions.html Centers for Disease Control and Prevention (2020). Community Preventive Services Task Force. The Community Guide. Retrieved from The Guide to Community Preventive Services (The Community Guide). • Health Resources and Services Administration (2020). Coronavirus-Related Supplemental Funding Allowable Uses Technical Assistance Resource. https://bphc.hrsa.gov/emergency-response/coronavirus-info/supplemental-funding uses e. Relevant Work This NOFO will leverage previous work funded by the CDC with various public and private partners to implement and evaluate the effectiveness of different approaches for building the public health infrastructure to respond to COVID-19, particularly: Centers for Disease Control and Prevention (2020). Public Health Crisis Response NOFO. https://www.cdc.gov/cpr/readiness/funding-covid.htm Centers for Disease Control and Prevention (2020). CDC COVID-19 Funding for Tribes. hLtps://www.cdc.gov/tribal/cooperative-agreements/covidm 19.html?deliveMName=USCDC 289-DM25904 Centers for Disease Control and Prevention (2020). COVID-19 Financial Resources. Retrieved from Financial Resources I CDC. 2. CDC Project Description a. Approach LO Bold indicates period of performance outcome. `= CDC-RFA-DP21-2109: Community Health Workers for COVID Response and Resilient U Communities (CCR) NOFO Logic Model c� c c.� Scale up Community Health Worker (CHW) actions across the nation to support COVID-19 N response efforts in those communities hit hardest by COVID-19 and among populations that are c at high risk for COVID-19 exposure, infection, and outcomes (priority populations). N CDC-RFA-DP21-2109: Community Health Workers for COVID Response and Resilient Communities (CCR) NOFO Logic Model Proposed High Level Strategies Short Term Outcomes: Year 1 Outcomes Intermediate Outcomes: Year 2 Long Term:>Year 3 Page 5 of 64 Packet Pg. 247 Train Community Health Workers to ensure comprehensive acquisition and reinforcement of relevant knowledge, roles, and skills to support the COVID- 19 public health response to manage outbreaks and community spread. Deploy Community Health to Support the COVID-19 Public Health Response to manage outbreaks and spread of COVID-19 among priority populations within communities. Engage Community Health Workers to Help Build and Strengthen Community Resilience to mitigate the impact of COVID- 19 by improving the overall health of priority populations within communities. Increased skills/capacity/roles of CHWs to provide services and support for COVID-19 public health response efforts among priority populations within communities. Increased workforce of CHWs delivering services to manage the spread of COVID-19. Increased utilization of community resources and clinical services for those at highest risk for poor health outcomes among priority populations within communities. Increased reach of CHW- influenced mitigation efforts among priority populations within communities. Continued promotion and integration of CHWs into existing workforce among priority populations within communities. Increased provision of community resources and clinical services to those at highest risk for poor health outcomes among priority populations within communities. Decreased impact of COVID-19 on those at risk (priority populations) and settings. Increased community resilience to respond to COVID-19 and future public health emergencies. IMPACT I Decreased health disparities I Increased health equity Page 6 of 64 Packet Pg. 248 i. Purpose This new grant will address 1) disparities in access to COVID-19 related services, e.g., testing, contact tracing, immunization services etc., and 2) health outcomes and factors that increase risk of severe COVID-19 illness (e.g., chronic diseases, smoking, pregnancy) and poorer outcomes (e.g. health and mental health care access, access to healthy food, health insurance, etc.) which have been exacerbated by COVID-19 by scaling up and sustaining a nation-wide program of CHWs who will support COVID-19 response and prevention in populations at high risk and communities hit hardest by COVID-19. ii. Outcomes Applicants are expected to focus on those outcomes that align with the three high-level strategy LO categories, i.e. Train, Deploy, and Engage. N Short term outcomes: o_ c.� • TRAIN: Increased skills/capacity/roles of CHWs to provide services and support for v COVID-19 public health response efforts among priority populations within v communities. N • DEPLOY: Increased workforce of CHWs delivering services to manage the spread of c COVID-19. N • ENGAGE: Increased utilization of community resources and clinical services for those N at highest risk for poor health outcomes among priority populations within communities. iii. Strategies and Activities COMPONENT A: CAPACITY BUILDING Applicants applying for Component A funding must address the four required strategies identified in bold and also select one additional strategy from the menu of strategies targeting Capacity Building efforts. TRAIN: Strategy CB1 (Required): Identify and collaborate with community -wide efforts to ensure comprehensive acquisition of relevant knowledge, roles, and skills by CHWs so they are prepared to successfully engage with existing state and/or local public Page 7 of 64 Packet Pg. 249 health -led actions to manage COVID-19 among priority populations within communities. • Strategy C132: Align training opportunities for CHWs with the primary actions of state and/or local public health led efforts to address the underlying conditions and/or environments that increase the risk and severity of COVID-19 infections among priority populations within communities. DEPLOY: Strategy CB3 (Required): Integrate CHWs into organizations and care teams to support the public health response to COVID-19 among priority populations within communities. Strategy C134: Develop and disseminate messaging that educates organizations and care teams on the critical role CHWs play in delivering services and managing the spread of COVID-19 among priority populations within communities. ENGAGE: Strategy C115 (Required): Coordinate and/or promote opportunities, such as messaging/education, within communities and clinical settings to facilitate the a_ a� engagement of CHWs in addressing the needs of those at highest risk for poor health outcomes, including those resulting from COVID-19. 2 Strategy CB6 (Required) Year 1 : Initiate and develop and/or utilize systems to w document engagement of CHWs in the care, support, and follow-up across clinical and community settings of priority populations at highest risk for poor health LO outcomes, including those resulting from COVID-19. (Required) Year 2: Facilitate N engagement of CHWs in the care, support, and follow-up across clinical and community settings of priority populations at highest risk for poor health outcomes, including those resulting from COVID-19. v c Strategy CBT Establish and strengthen partnerships between CHWs and State Medicaid v un agencies, relevant state or local coalitions, initiatives, professional organizations, N providers, and health systems that provide resources and support for deploying CHWs to 0 engage with priority populations at highest risk for poor health outcomes, including those o resulting from COVID-19 by addressing social determinants of health (e.g. those with Q underlying health conditions, with decreased access to care or lacking access to routine o and usual care, challenges with having social needs met, food insecurity, housing Z insecurity and homelessness, etc.) c COMPONENT B: IMPLEMENTATION READY Applicants applying for Component B funding must address the four required strategies identified in bold and also select two additional strategies from the menu of strategies targeting Implementation Ready efforts. TRAIN: Page 8 of 64 Packet Pg. 250 Strategy IRI (Required): Identify and collaborate with community -wide efforts to ensure comprehensive acquisition of relevant knowledge, roles, and skills by CHWs so they are prepared to successfully engage with existing state and/or local public health -led actions to manage COVID-19 among priority populations within communities. Strategy IR2: Ensure appropriate training opportunities to disseminate messaging for CHWs focused on reaching those with underlying conditions and/or environments that increase the risk and severity of COVID-19 infections among priority populations in order to strengthen infrastructure critical to identification of infection, appropriate follow- up, including contact tracing, and treatment among priority populations within communities. Strategy IR3: Align training opportunities for CHWs with the primary actions of state and/or local public health led efforts to address the underlying conditions and/or environments that increase the risk and severity of COVID-19 infections among priority populations within communities. DEPLOY: Strategy IR4 (Required): Integrate CHWs into organizations and care teams to support the public health response to COVID-19 among priority populations within communities. Strategy IR5: Integrate CHWs into public health emergency preparedness and vaccine deployment planning, e.g. inclusion in planning and coordination with Immunization and Public Health Preparedness Programs; existing vaccine infrastructure; and vaccine providers in the community to increase access to new and existing vaccination programs in priority populations within communities. ENGAGE: v c.� c • Strategy IR6 (Required): Coordinate and/or promote opportunities, such as v messaging/education within communities and clinical settings to facilitate the N engagement of CHWs in addressing the needs of those at highest risk for poor c health outcomes, including those resulting from COVID-19. c • Strategy IR7 (Required): Facilitate engagement of CHWs in the care, support, and Q follow-up across clinical and community settings of priority populations at highest o risk for poor health outcomes, including those resulting from COVID-19. z COMPONENT C: INNOVATION - DEMONSTRATION PROJECTS The demonstration project should identify an approach that employs policy, systems or environmental changes, is innovative and will train, deploy, and engage CHWs to further address health disparities and social inequities exacerbated by COVID-19 within the catchment area identified in the recipient's Component B application. The demonstration projects should each uniquely focus on improving selected conditions of the socioecological environment (e.g., community interventions intending to reduce toxic and chronic stress, Page 9 of 64 Packet Pg. 251 strategies that enhance community resilience; strategies that address reimbursement or other sustainable funding; strategies that increase income, housing and/or food security and support recovery from other unintended negative consequences of COVID-19 mitigation strategies; engaging employers in identifying and adopting policies that protect worker health and safety; engaging owners/overseers of multi -unit housing to identify and adopt policies that protect worker and tenant health from COVID-19 and conditions that increase COVID-19 risk). This is an opportunity to demonstrate how CHWs can incorporate interventions addressing social determinants of health, and be an integral part of innovative approaches, such as technology, payment models, communication campaigns, new ways to link to social services and/or provide "wrap -around" services, or other services that will improve health outcomes among those at greatest risk for severe COVID-19 disease. Requirements for the demonstration project include the following: The demonstration project must address at least 1 of the 3 overarching strategies of the NOFO: train, deploy, and/or engage; o This proposed project must be distinctly different from what the applicants is proposing in Component B; it is not meant to be an expansion of a Component B effort. It is an opportunity to test an innovative approach that accelerates impact to ameliorate effects of COVID-19 through the use of CHWs and builds more resilient communities. • CHWs must be an integral part of the demonstration project; • The project must be implemented in communities or populations at risk for poor health outcomes as a result of COVID-19 that the applicant has identified for Component B. • The demonstration project must be aligned with the outcome(s) as described in the logic model. • The demonstration project must include a rigorous evaluation to assess the project's impact, outcomes, and effectiveness and develop recommendations for v sustainability. The applicant should plan to initiate evaluation in Year 1, continue data v c collection in Year 2, and complete and submit all data to CDC immediately upon v completion of Year 3. N M Performance measures related to Train, Deploy, and Engagement efforts for Component C and o the impact on COVID-19 may be proposed by recipients based on activities conducted and N finalized in collaboration with CDC and Evaluation/Technical Assistance partners, awarded through a separate NOFO. Performance measures will be reported annually, and CDC and z Evaluation/Technical Assistance partners will manage and analyze the data to identify recipient; program improvements, respond to broader technical assistance needs, and report to E stakeholders. 1. Collaborations a. With other CDC programs and CDC -funded organizations: Required Collaborations: Recipients are required to collaborate with other CDC -funded programs that are currently implementing activities to mitigate the spread of COVID-19 infection in their respective communities and address certain underlying medical conditions that increase risk of exposure to Page 10 of 64 Packet Pg. 252 COVID-19. These collaborations are especially essential for implementing both the training and deployment strategies of this NOFO; applicants must include letters of support to document these collaborations. Letters must be dated within 45 days of the application due date. These letters must state the role of organizations and specify how they will help the applicant achieve the goals and outcomes of the NOFO. Applicants must file the letter of support, as appropriate, name the file "CHW_LOS_Applicant Name ", and upload it as a PDF file at www. rg ants.g�ov. This will ensure that proposed activities are complementary with other CDC funded programs operating in the same area and avoid duplication of efforts. State- and/or local - level CDC funded programs to advance efforts to mitigate the spread of COVID-19 infection include: • Epidemiology and Laboratory Capacity Program: https://www. cdc. gov/ncezid/dpei/epidemiology-laboratory-capacity.html • State (and jurisdictional) Immunization Program: https://www.cdc.gov/vaccines/imz- managers/awardee-imz-websites.html • Supporting Tribal Public Health Capacity in Coronavirus Preparedness and Response Program: https://www.cdc.gov/tribal/documents/cooperative-agreements/COVID-19- Funding-for-Tribes-Grant-Recipients-OT20-2004-508.pdf • Tribal Public Health Capacity Building and Quality Improvement Program: https://www.cdc. gov/tribal/cooperative-agreements/tribal-capacity-building-OT 18- 1803.html • Cooperative Agreement for Emergency Response: Public Health Crisis Response and Z COVID-19 Crisis Response Cooperative Agreement Components A and B Supplemental x Funding Program: htt2s://www.cdc.gov/cpr/readiness/funding-covid.htm W • Racial and Ethnic Approaches to Community Health (REACH) Flu Vaccine Supplement. LO DP18-1813. https://www.cdc.gov/nccdphp/dnpao/state-local- N programs/reach/current programs/index.html. o_ Encouraged Collaborations: Recipients are also highly encouraged to collaborate with other CDC -funded programs that focus c on population health approaches to reduce health disparities and address the social determinants v un of health that contribute to them such as injury prevention, mental health promotion, sexually N transmitted disease and chronic disease prevention. These collaborations are especially essential c T.- for implementing the strengthening community resilience strategies of this NOFO. This will c ensure proposed activities are complementary with other CDC -funded programs operating in the Q same area and avoid duplication of efforts. n b. With organizations not funded by CDC: Required Collaborations: • Recipients are required to appropriately align their work with other national, state or nongovernmental programs that support CHWs to promote healthy communities including State Medicaid agencies. • Recipients are also required to collaborate, through formalized partnerships, supported by detail specific service agreements, with medical (e.g., Community Health Centers (CHCs), private providers, health insurers and health systems) and essential support service providers to maximize reach, increase coordination and collaboration, and support Page 11 of 64 Packet Pg. 253 the provision of essential services in respective communities. These collaborations are essential for the successful implementation of all three NOFO strategies. Letters of support with a firm commitment from partners should be included in the application. Applicants should submit letters of support from organizations that will have a role in helping to achieve the NOFO activities and outcomes. Letters must be dated within 45 days of the application due date. These letters must state the role of organizations and specify how they will help the applicant achieve the goals and outcomes of the NOFO. Applicants must file the letter of support, as appropriate, name the file "CHW LOS Applicant Name ", and upload it as a PDF file at www.grants.gov. Community Coalition The recipients are required to either establish a new or expand an existing community coalition to serve as a formal arrangement for cooperation and collaboration among stakeholder groups to work together to achieve the short-term, intermediate, and long-term outcomes of this NOFO. Applicants should describe the proposed or existing coalition within the project narrative. Recipients will collaborate with the coalition to develop and carry out the program action plan to train and deploy CHWs to support the COVID-19 public health response as well as to build and strengthen resilience to mitigate the impact of COVID-19 by improving the overall health of priority populations in key communities. The community coalition proposed by the recipient should have diverse and multi -sector representation and, at a minimum, should include the: • Recipient • Community Health Worker Network Representation • Healthcare organization representative (who provides services for the priority population) • Local public health department representation • Community representation The community coalition should: • Demonstrate ability to leverage partnerships across settings and sectors to address key contributors to health disparities within their community (e.g., social determinants of health) • Meaningfully engage and incorporate input from those who represent the proposed priority population(s) • Use Community Based Participatory Approaches (http://ctb.ku.edu/en/table-of-contents /analyze/where-to-start/participatory-approaches/main) in their planning approach • Reflect the composition of the proposed priority population • Demonstrate a history of success in working together with partners on issues relating to health or other disparities. • Demonstrate effectiveness and progress in mobilizing partners to assist in implementation of local evidence -based or practice -based improvements that are culturally tailored to the priority population(s) Page 12 of 64 Packet Pg. 254 Encouraged Collaborations: Recipients are also encouraged to establish strategic partnerships with the following types of organizations: state- and jurisdictional -recipients of other relevant Federal programs (e.g., the Health Resources and Services Administration's State Office of Rural Health programs or Maternal and Child Health Bureau, the Centers for Medicare and Medicaid Services, and State - Medicaid Offices) and their recipients; local public health departments (for state recipients); local health insurers; American Indian/Alaska Native tribal governments and/or tribally designated organizations; non -CDC funded Community Based Organizations; faith -based organizations; local chambers of commerce or large employers, community advocates and other stakeholders with vested interests in reducing health disparities and the social determinants of health that contribute to them. 2. Target Populations Applicants must identify and focus on populations with increased risk for or prevalence of E E COVID-19 or who are at increased risk for poor health outcomes from COVID-19 because they G U are also disproportionately impacted by long-standing health disparities as described in the Executive Summary and Background sections of this announcement. Applicants must c demonstrate that the proposed catchment area(s) reflect a) the burden of COVID-19 infection rates and/or COVID-19 mortality rates and b) populations disproportionally affected by COVID- a 19 infections; particularly those affected by poverty. Catchment areas are defined in this NOFO a as a county, metropolitan statistical area(s) or a group of contiguous counties. These catchment areas must have significant COVID-19 disease burden, evidence of disproportionate health disparities as evidenced by poverty rates, and sufficient combined populations to allow the w strategies supported by this NOFO to reach significant numbers of people (see components below for information on population size). Applicants must describe the population selected, CD including relevant health disparities, and how the selected interventions will improve health and N contribute to a more resilient community better able to address threats such as COVID-19. U U Applicants must use the following two resources to document a) poverty rates and b) COVID-19 c cases and/or mortality rates: U un • Poverty rates may be found at M https://www.census.gov/library/visualizations/interactive/2014-2018-poverty-rate-by- o conty.html. N u 0 N • COVID-19 cases and/or deaths (county level) can be found at https:Hcovid.cdc.gov/covid-data-tracker/#couniy-view. -view. The two COVID-related data points that can be used are: 0 7 Day total reported cases per 100,000 population 0 7 Day total reported deaths per 100,000 population Applicants should include the time period for the 7 day total for cases and/or deaths from the CDC COVID Data Tracker. Additional guidance on the two COVID-related data points can be found at: Community Health Workers for Covid Response and Resilient Communities I CDC Applicants addressing racial and ethnic populations should address the inclusion of subpopulations within the identified target population that can benefit from the program strategies listed in this announcement. These subpopulations can include groups such as older Page 13 of 64 Packet Pg. 255 people, people with low socioeconomic status, ethnic minorities, economically disadvantaged persons, justice -involved , people experiencing homelessness, or those who traditionally do not access health care on a routine basis such as people with mental health or substance abuse disorders, non-English speaking populations, Lesbian, Gay, Bisexual, and Transgender (LGBT) populations, persons with disabilities, or other populations who may otherwise be missed by the program. In addition, applicants will be expected to provide specific activities to address the underlying health and social inequities that put many of these subpopulations at increased risk of getting sick, having more severe illness and dying from COVID-19 and other communicable and non -communicable conditions. a. Health Disparities CDC recognizes that social and economic opportunities, health behavior, and the physical environment in which people live greatly impact health outcomes. Health disparities represent preventable differences in the burden of disease, disability, injury or violence, or in opportunities to achieve optimal health. Applicants must describe the population(s) selected, including relevant health disparities, and how selected interventions will improve health and reduce or eliminate one or more identified health disparities. This announcement provides the opportunity to incorporate interventions to address health -related social needs, (e.g., housing instability and poor quality, food insecurity, insufficient utility resources, interpersonal violence, insufficient transportation, and inadequate educational resources) for the priority populations described in the background section. This is an opportunity to demonstrate how increased awareness of available community services, navigation assistance to access services, and partner alignment to ensure that available services support community needs can positively impact health in these communities; which should all be addressed in the proposed activities. iv. Funding Strategy Applicants must demonstrate that the proposed catchment area(s) reflect a) the disproportionate N burden of COVID-19 infection rates/COVID-19 mortality rates and b) populations v disproportionally affected by COVID-19 infections; particularly those affected by v poverty. Catchment areas are defined in this NOFO as a county, metropolitan statistical area(s), C c.� or a group of contiguous counties. These catchment areas must have significant COVID-19 N disease burden, evidence of disproportionate health disparities as evidenced by poverty rates, and o sufficient combined populations to allow the strategies supported by this NOFO to reach significant numbers of people. N Applicants must use the following two resources to document a) poverty rates and b) COVID-19 cases and/or mortality rates: Poverty rates may be found at httDs://www. census. izov/librarv/visualizations/interactive/2014-2018-Doverty-rate-bv- county.html. COVID-19 cases and/or deaths (county level) can be found at hlt2s://covid.cdc.gov/covid-data-tracker/#couniy-view. -view. The two COVID-related data points that can be used are: 0 7 Day total reported cases per 100,000 population 0 7 Day total reported deaths per 100,000 population Page 14 of 64 Packet Pg. 256 Applicants should include the time period for the 7 day total for cases and/or deaths from the CDC COVID Data Tracker. Additional guidance on the two COVID-related data points can be found at: Communitv Health Workers for Covid Response and Resilient Communities I CDC Component A focuses on organizations that have some experience with CHWs and want to build capacity by expanding training and oversight plans that will lead to the increased deployment of CHWs which will result in improved health outcomes. These organizations must have approximately one year of experience in implementing a CHW program in their catchment area. The experiences of this program may have been limited in scope, i.e., focusing on a single or a few disease concerns, providing advice and guidance to direct community members to appropriate clinical services. We expect to fund approximately 35 applicants. Applications for this component will reflect services addressing a catchment area, as defined in this NOFO, as a county, metropolitan statistical area(s), or a group of counties: • up to 50,000 population, applicants may apply for up to $350K. • For 50,000 to 200,000 population, applicants may apply for up to $600K. • For 200,000+ population, applicants may apply for up to $1M. Component B focuses on expanding deployment of CHWs in organizations with substantial (approximately 3 years) experience currently utilizing CHWs that want to amplify activities to address COVID-19 within communities resulting in improved health outcomes; we expect to fund approximately 35 applicants. Applications for this component will reflect services addressing a catchment area, as defined in this NOFO, as a county, metropolitan statistical area(s), or a group of counties: • up to 200,000 population, applicants may apply for up to $1 M. N • For 200,000 to 600,000 population, applicants may apply for up to $2M • For 600,000+ population, applicants may apply for up to $3M. v c Component C focuses on policy, systems or environmental changes, is innovative and will train, N deploy, and engage CHWs to further address health disparities and social inequities exacerbated o by COVID-19 within the catchment area identified in the recipient's Component B application. N Only applicants that are approved and funded for Component B will be considered for N Component C funding. We expect to fund approximately 5 recipients for Component C for up to $2M each. 0 b. Evaluation and Performance Measurement i. CDC Evaluation and Performance Measurement Strategy Evaluation and performance measurement help demonstrate program accomplishments and strengthen the evidence for strategy implementation. CDC, in collaboration with identified Evaluation and Technical Assistance (TA) partners, will work individually and collectively with recipients to track the implementation of recipient strategies and activities and assess progress in achieving NOFO outcomes within the three-year period of performance. Both process and outcome evaluation will seek to answer the following questions: Page 15 of 64 Packet Pg. 257 Approach: 1. To what extent has the recipient's implementation approach resulted in achieving the desired outcomes? Effectiveness: 1. To what extent has the recipient increased the reach of Component A and B strategies to prevent and control COVID-19 infections and strengthen community resilience? 2. To what extent has implementation of Category A and B strategies led to improved health outcomes among the identified priority population(s)? Recipients must collaborate with CDC and Evaluation/Technical Assistance partners and are strongly encouraged to submit at least two success stories per year with impacts using the NCCDPHP Success Stories Application. Information on this application is located in the Resources section of this document. CDC and Evaluation/Technical Assistance (TA) partners will implement an evaluation approach that consists of (1) ongoing monitoring and evaluation of progress through the collection and reporting of performance measures by recipients, (2) a CDC - and Evaluation/TA partner -led comprehensive evaluation, and (3) recipient -led evaluations, with support from CDC and Evaluation/TA partners, as appropriate. Performance measures developed for this NOFO correspond to the high-level broad strategy categories and outcomes described in the logic model. All measures are broadly stated and may be refined with recipients, CDC, and Evaluation/TA partners, based on activities proposed and recipient needs. CDC and the Evaluation/TA partners, as appropriate, will work with recipients on operationalizing and further defining each performance measure and guidance will be provided prior to the first year of expected recipient reporting. Performance measures will be reported semi-annually by all recipients to CDC and the v Evaluation/TA partners, who will also manage and analyze the data to identify recipient program v improvements, respond to broader technical assistance needs, and to report to stakeholders. CDC v and the Evaluation/TA partners will analyze recipient submitted performance measure data and develop aggregate performance measure reports to be disseminated to recipients and other key M stakeholders, including federal partners, non -funded partners, and policy makers, as appropriate. o These aggregate findings may also be presented during site visits and recipient meetings. In N addition to performance measures reported by recipients, CDC will track all outcome measures Q (not listed in required recipient table for reporting) that are relevant to the program through p national data sets or the comprehensive evaluation activities. As part of the comprehensive z evaluation activities, a subset of NOFO recipients will be selected who will be required to work a collaboratively with CDC and the Evaluation/TA partners to report more in-depth narratives of activities over the course of the NOFO. For the CDC- and Evaluation/TA partner -led comprehensive evaluation activities, CDC will lead the design, data collection, analysis, and reporting. Recipients will be expected to participate in evaluation activities such as surveys, interviews, case studies, and other data collection efforts to ensure there is a robust evaluation of the evidence -driven, community tailored/adapted efforts of the role CHWs play in leading, supporting, and collaborating with a wide variety of stakeholders Page 16 of 64 Packet Pg. 258 to improve the health of the community. An appropriate level of guidance and support, including one on one outreach, small peer -to -peer learning and sharing opportunities, webinars, learning collaboratives, electronic resources, and virtual engagements to showcase successes and brainstorm the resolution of potential challenges will be provided to the recipients. These connections among recipients, CDC and the Evaluation/TA partners are critical to the programmatic success and effective and meaningful evaluation of this grant. CDC and the Evaluation/TA partners will use finding from these evaluation efforts to refine technical assistance and, in turn, maximize and sustain program outcomes. For recipient -led evaluations, CDC and Evaluation/TA partners will be available to work closely, where appropriate, with recipients to develop, refine, and implement evaluation plans that they can use to make program improvements and demonstrate the outcomes and impact of their programs. CDC, Evaluation/TA partners, and recipients will only collect data that will be analyzed and used. CDC will provide recipients with performance measure reporting templates, and potentially evaluation plan and reporting templates. CDC and Evaluation/TA partners will provide ongoing TA on program implementation efforts, recipient -led evaluation, and recipient performance measure reporting. Evaluation TA will be provided using a customized approach to ensure that the tools and services provided best meet the needs of the recipients. All evaluation findings produced by CDC, the Evaluation TA providers, and recipients will contribute to: (1) program and quality improvement of program efforts; (2) practice -based evidence; (3) documentation and sharing of lessons learned to support replication and scaling up of these program strategies and/or (4) future funding opportunities to expand upon these successes. The data CDC collects for performance measurement and evaluation are directly related to theLO implementation of the strategy and/or the desired outcome indicated in the logic model. Data `= being collected are strictly related to the implementation of the NOFO strategies and shall be used for assessing and reporting progress and for other pertinent implementation improvement v actions. All performance measure data will be collected via secure data systems. Recipients will 0 report their performance measure data semi-annually via the data system and will have access to Ln their data only. Over the 3-year performance period, data will be secured with limited access to M authorized CDC program and evaluation staff. CDC will publish summative reports on o individual and aggregate performance measure data. o Applications involving public health data collection or generation must include a Data Management Plan (DMP) as part of their evaluation and performance measurement plan unless CDC has stated that CDC will take on the responsibility of creating the DMP. The DMP describes plans for the applicant's assurance of the quality of the public health data through the data's lifecycle and any plans to deposit data in a repository to preserve and to make the data accessible in a timely manner. See web link for additional information: https://www.cdc.gov/grants/additionalrequirements/ar-25.html Short-term measures reported by recipients are described in the table below. Recipients will report one level of measures: Page 17 of 64 Packet Pg. 259 short-term outcomes measures for each required strategy and for each additional strategy selected The tables below align with the logic model and shows the alignment among the overarching high level strategy categories, i.e. TRAIN, DEPLOY, and ENGAGE, along with the specific strategies, outcomes, and performance measures for Component A and Component B. Table 1. Component A: Capacity Building -- Strategies, Outcomes, and Performance Measures Community Health Workers for COVID-19 Response and Resilient Communities (CCR) Table 1. Component A: Capacity Building -- Strategies, Outcomes, and Performance Measures Short-term Outcomes itegies (Component A Applicants are aired to address the four strategies cated in BOLD and must also ct one additional strategy from any of the areas (train/deploy) in the menu of tegies targeting capacity building (CB) its within this table. TRAIN Increased skills/capacity/roles rategy CB1 (Required): Identify and of CHWs to llaborate with community -wide efforts to provide services sure comprehensive acquisition of and support for .evant knowledge, roles, and skills by COVID-19 public IWs so they are prepared to successfully health response gage with existing state and/or local efforts among blic health -led actions to manage priority )VID-19 among priority populations* populations thin communities. within communities. leasures (Recipients will port short-term measures igned with all required ,ategies in BOLD and e one additional strategy lected.) te: All measures are )adly stated and will be fined with recipients and >C based on activities leasure (Required): # of HWs successfully )mpleting state/local ublic health -led OVID-19 response ,aining efforts as Aermined by relevant ublic health -led entities, g., skills related to ►ntact tracing, to use and care PPE, and sufficient cumentation of levant data collection Page 18 of 64 Packet Pg. 260 Increased Measure: # and type of skills/capacity/roles health conditions and/or of CHWs to provide social service needs for services and support which CHWs are provided for COVID-19 training and/or certification public health to deliver among priority Strategy CB2: Align training opportunities response efforts populations* within for CHWs with the primary actions of state among priority communities, e.g. Lifestyle and/or local public health led efforts to populations* within interventions and address the underlying conditions and/or communities. strategies, hypertension environments that increase the risk and management, diabetes severity of COVID-19 infections among management, arthritis priority populations* within communities. management, improving physical activity, improving healthy eating, tracking, referral, and connection of individuals to available social services to address identified needs. DEPLOY Increased Measure (Required): # Strategy CB3 (Required): Integrate CHWs workforce of and type of into organizations and care teams to CHWs delivering organizations/entities support the public health response to services to manage that are integrating COVIDI9 among priority populations* the spread of CHWs to support within communities. COVID-19. state/local public health - led COVID-19 response efforts. Strategy CB4: Develop and disseminate Increased workforce Measure: # and type of messaging that educates organizations and of CHWs delivering messages developed and care teams on the critical role CHWs play in services to manage disseminated delivering services and managing the spread the spread of of COVID-19 among priority populations* COVID-19. within communities. ENGAGE Strategy CB5 (Required): Coordinate Increased Measure (Required): # of and/or promote opportunities, such as utilization of individuals within messaging/education, within communities community communities and/or Page 19 of 64 X W I - CD LO N o_ U U U c U Ln N M 0 N 0 N Q u_ 0 z c as E z Q Packet Pg. 261 and clinical settings to facilitate the engagement of CHWs in addressing the needs of those at highest risk for poor health outcomes, including those resulting from COVID-19. resources and clinical services for those at highest risk for poor health outcomes among priority populations* within communities. clinical settings reached through messaging and education, including those at highest risk for poor health outcomes, including those resulting from COVID-19, among priority populations* within communities. Increased Measure (required): # of utilization of patients referred for community individual, specific Strategy CB6 (Required): Year 1: Initiate resources and named health and social and develop and/or utilize systems to clinical services for conditions that increase document engagement of CHWs in the those at highest the risk for COVID-19 care, support, and follow-up across clinical risk for poor health for patients at highest and community settings of priority outcomes among risk for poor health populations* at highest risk for poor health priority outcomes, within clinical outcomes, including those resulting from populations* and/or community COVIDI9. within settings. Document Year 2: (Required): Facilitate engagement communities. referrals for any of the of CHWs in the care, support, and follow- following specific named up across clinical and community settings conditions: housing and of priority populations* at highest risk for shelter; food; healthcare; poor health outcomes, including those mental health and resulting from COVID-19. addictions; employment and income; clothing and household; childcare and parenting; government and legal. Strategy C137: Establish and strengthen Increased utilization Measure: # and type of partnerships between CHWs and State of community partnerships established Medicaid agencies, relevant state or local resources and with traditional and coalitions, initiatives, clinical services for nontraditional partners, professional organizations, providers, and those at highest risk such as, faith -based health systems that provide resources and for poor health organizations, businesses, support for deploying CHWs to engage with outcomes among hospital systems, housing priority populations* at highest risk for poor priority populations* and community health outcomes, including those resulting within communities. development entities, and from COVID-19 by addressing social others for the purposes of determinants of health (e.g. those with providing support for those underlying health conditions, with decreased at highest risk for poor access to care or lacking access to routine and health outcomes, including usual care, challenges with having social those resulting from needs met, food insecurity, housing COVID-19, among priority Page 20 of 64 as a r c ca a x w ti aD LO o_ U U U c U Ln N M 0 N O N a_ 0 z c a) z ns Q Packet Pg. 262 insecurity, and homelessness, etc). populations* within communities. * Priority populations are those with increased prevalence of COVID-19 and are disproportionately impacted by long-standing health disparities related to sociodemographic characteristics, geographic regions, and economic strata. Examples include, racial and ethnic minorities, persons who are economically disadvantaged, justice -involved, experiencing homelessness, and/or have certain underlying medical conditions that increase COVID-19 risk Table 2. Component B: Implementation Ready -- Strategies, Outcomes, and Performance Measures Community Health Workers for COVID-19 Response and Resilient Communities (CCR) Table 2. Component B: Implementation Ready --Strategies, Outcomes, and Performance Measures Strategies (Component B Applicants Short-term are required to address the four Outcomes strategies indicated in BOLD and must also select two additional strategies from any of the two areas (train/deploy) in the menu of strategies targeting Implementation Ready (IR) efforts within this table). TRAIN Short-term Measures (Recipients will report short-term measures aligned with all required strategies in BOLD and the two additional strategies selected). Note: All measures are broadly stated and will be refined with recipients and CDC based on activities proposed. Increased Measure (Required): # of CHWs utilization of successfully completing state/local rategy IR1 (Required): Identify community public health -led COVIDI9 response d collaborate with community- resources training efforts as determined by de efforts to ensure and clinical relevant public health -led entities, e.g. mprehensive acquisition of services for skills related to contact tracing, .evant knowledge, roles, and those at appropriate use and care of PPE, and ills by CHWs so they are highest risk sufficient documentation of relevant epared to successfully engage for poor data collection efforts. th existing state and/or local health blic health -led actions to outcomes mage COVID-19 among priority among priority pulations* within communities. populations communities. Page 21 of 64 Packet Pg. 263 Increased Measure: # of individuals within specific Strategy IR2: Ensure appropriate utilization of media distribution areas, inside stated training opportunities to disseminate community catchment areas that have been reached by messaging for CHWs focused on resources and critical messaging, as determined by reaching those with underlying clinical relevant public health -led entities, to conditions and/or environments that services for identification of infection, appropriate increase the risk and severity of those at follow-up, including contact tracing, and COVID-19 infections among priority highest risk treatment. populations in order to strengthen for poor infrastructure critical to identification health of infection, appropriate follow-up, outcomes including contact tracing, and among treatment among priority priority populations* within communities. populations* within communities. Increased utilization of Measure: # and type of health conditions community and/or social service needs for which Strategy IR3: Align training resources and clinical CHWs are provided training and/or opportunities for CHWs with the services for certification to deliver among priority primary actions of state and/or local those athihest populations* within communities, e.g. public health led efforts to address g risk Lifestyle interventions and strategies, the underlying conditions and/or for poor hypertension management, diabetes environments that increase the risk health management, arthritis management, and severity of COVID-19 infections improving physical activity, improving amongpriority populations* within p y p p outcomes health eating, tracking,referral and y g' ' communities. among connection of individuals to available priority social services to address identified needs. populations* within communities. DEPLOY Strategy IR4 (Required): Integrate Increased Measure (Required): # and type of CHWs into Organizations and workforce of organizations/entities that are Care Teams to support the public CHWs integrating CHWs to support state/local health response to COVID-19 delivering public health -led COVID-19 response among priority populations* services to efforts. within communities. manage the spread of COVID-19. Strategy IR5: Integrate CHWs into Increased Measure: # and types of vaccine public health emergency workforce of deployment plans in which CHWs are Page 22 of 64 X w t as LO o_ U U U c U un N M 0 N O N u_ 0 z c a) z ns Q Packet Pg. 264 -paredness and vaccine ployment planning, e.g. inclusion planning and coordination with munization and Public Health -paredness Programs; existing ccine infrastructure; and vaccine )viders in the community to ;rease access to new and existing ccination programs in priority pulations* within communities. rategy IR6 (Required): iordinate and/or promote portunities, such as -ssaging/education, within mmunities and clinical settings facilitate the engagement of IWs in addressing the needs of )se at highest risk for poor alth outcomes, including those iultiniz from COVID-19. CHWs delivering services to manage the spread of COVID-19. ENGAGE utilization of community resources and clinical services for those at highest risk for poor health outcomes among priority populations* communities. utilization of community itegy IR7. (Required): resources ilitate engagement of CHWs in and clinical care, support, and follow-up services forthose )ss clinical and community at ings of priority populations* at highest risk lest risk for poor health for poor -omes, including those resulting health n COVID-19. outcomes among priority populations* included in the planning and design; deployment of plan components; ethical distribution of initial COVID-19 vaccine supplies to vaccine providers in accordance with state, local, and federal regulations; and/or dissemination to identified individuals/populations. easure (Required): # of individuals thin communities and/or clinical ttings reached through messaging and .ucation, including those at highest ►k for poor health outcomes, including ose resulting from COVID-19, among ,iority populations* within Measure (required): # of patients referred for individual, specific named health and social conditions that increase the risk for COVID-19 for patients at highest risk for poor health outcomes, within clinical and/or community settings. Document referrals for any of the following specific named conditions: housing and shelter; food; healthcare; mental health and addictions; employment and income; clothing and household; childcare and parenting; government and legal. Page 23 of 64 Packet Pg. 265 communities. * Priority populations are those with increased prevalence of COVID-19 and are disproportionately impacted by long-standing health disparities related to sociodemographic characteristics, geographic regions, and economic strata. Examples include, racial and ethnic minorities, persons who are economically disadvantaged, justice -involved, experiencing homelessness, and/or have certain underlying medical conditions that increase COVID-19 risk. ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe: • How the applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement. • How key program partners will participate in the evaluation and performance measurement planning processes. • Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant) • Plans for updating the Data Management Plan (DMP) as new pertinent information becomes available. If applicable, throughout the lifecycle of the project. Updates to CD DMP should be provided in annual progress reports. The DMP should provide a N description of the data that will be produced using these NOFO funds; access to data; data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data c preservation plans. For more information about CDC's policy on the DMP, see https://www.cdc.aov/grants/additionalrequirements/ar-25.html. N M Where the applicant chooses to, or is expected to, take on specific evaluation studies, the o applicant should be directed to: N • Describe the type of evaluations (i.e., process, outcome, or both). • Describe key evaluation questions to be addressed by these evaluations. • Describe other information (e.g., measures, data sources). Recipients will be required to submit a more detailed Evaluation and Performance Measurement plan, including a DMP, if applicable, within the first 6 months of award, as described in the Reporting Section of this NOFO. With support from CDC, recipients will be required to submit a more detailed Evaluation and Performance Measurement Plan, including a Data Management Plan (DMP), within the first 6 months of receiving the award, as described in the Reporting Section of this NOFO. CDC will review and approve the recipient's monitoring and evaluation plan to ensure that it is appropriate Page 24 of 64 Packet Pg. 266 for the activities to be undertaken as part of the agreement and for compliance with the monitoring and evaluation guidance established by CDC or other guidance otherwise applicable to this cooperative agreement. CDC recommends that at least 10% of total annual funds be allocated for evaluation, per Best Practices for Comprehensive Tobacco Control Programs. Applicants are required to submit a plan for Performance Measurement Data Collection and Use. A detailed plan for Performance Measurement Data Collection and Use will be due within 6 months of receiving the award. CDC will provide additional templates and guidance for developing the Performance Measurement Data Collection and Use plan. Any anticipated issue with data collection should be highlighted in the plan, along with options to remedy it. Additionally, the plan should address how the information generated by the performance measures will be used for program improvement by the recipient. c. Organizational Capacity of Recipients to Implement the Approach Core Capacity for All Applicants Upon receipt of award all recipients must be able to implement this program in the state, locality, territory or tribal area in which they operate and are located. To ensure that recipients are able to execute CDC program requirements and meet period of performance outcomes, applicants must: describe relevant experience to implement the activities and achieve the project outcomes, describe experience and capacity to implement the evaluation plan, provide a staffing plan with clearly defined staff roles (including contractual staff if applicable) and resumes of key staff, and ensure a project management structure sufficient to achieve the project outcomes. This information must be described in the project narrative. Applicants must name the staffing plan file "Component [A, B or C] Staffing Plan" and upload to www. rg ants.gov Applicants must name the resumes "Component [A, B or C] Resumes" and upload to www. rg ants.gov. Key capacity requirements include: • Leadership and management to plan and supervise the project and improve outcomes. v U • Readiness and ability to begin implementation and data collection within 1 month of c award. v N • Budget management and administration capacity to establish financial procedures and c track, monitor, and report expenditures. N 0 • Contract management to manage the required procurement efforts, including the ability to Q write, award, and monitor contracts. 0 z • Data management to design collection and evaluation strategies to produce useful data that demonstrate impact, program improvement, and sustainability E z • Partnership development and coordination to leverage resources and maximize the reach 2 and impact of CHW interventions within the state, locality, territory, or tribal area. Q • Evaluation and performance monitoring to implement the evaluation plan and maintain programmatic quality, consistency, and fidelity. • Knowledge and awareness of CDC -funded programs or other federally funded programs, that support the ongoing COVID-19 response in the jurisdiction they are proposing to serve and how they plan to work and align their activities with the program. These Page 25 of 64 Packet Pg. 267 programs, must include, at a minimum, the CDC Epidemiology, Lab and Capacity (ELC) cooperative agreement, the Public Health Emergency Preparedness (PHEP) cooperative agreement and the Emergency Response: Public Health Crisis Response cooperative agreement. • Experience convening and/or supporting a community coalition to achieve program goals. For the engage community resilience to COVID-19 strategy, applicants must describe in the project narrative their expertise and credibility working with CDC or other federal programs supporting this work (e.g., National Diabetes Prevention Program, Prescription Drug Overdose Program, Wisewoman). The work proposed should align with these already funded projects. • Applicants for Component A must have approximately one year of experience in implementing a CHW program in their catchment area. The experiences of this program may have been limited in scope, i.e., focusing on a single or few disease concerns, providing advice and guidance to direct community members to appropriate clinical services. Components B: Enhanced Organizational Capacity Requirements for Implementation Ready (IR). Applicants for Component B must have approximately three years of experience in w implementing a CHW program in their catchment area. The experiences of this program, however, have been broad in scope and provided appropriate education and assistance to M community members from CHWs for a wide variety of concerns, including health and N social services. Component B applicants must describe their history and experience in a) engaging CHWs to identify and enroll eligible community members in applicable health U U and social service programs, b) engaging CHWs to coordinate health care by providing U appropriate referral and follow-up services, c) engaging CHWs to act as an advocate for v those community members needing language assistance or support with health systems N and d) working with health care payers in the public and private health systems to c incorporate CHWs into teams of care professionals. Component B applicants must N describe their quality assurance program, and the results of their ongoing evaluation or N quality improvement efforts to identify priority needs and the actions they have taken to meet those needs, as well as evidence of documented improvement in the health status of Z the community served. Established expertise and credible working relationships with health care organizations/systems documented by letters of support, interagency agreements, or MOUs. These could include: federally qualified health centers, private health care provider systems, Accountable Care Organizations, hospitals. Applicants must name these files "Component [A, B or C] [Letters of Support, Interagency Agreements, MOUs]" and upload to www.grants.gov. • Technical and technological infrastructure to support rapid recruitment, selection, hiring, training and deployment of CHWs for the work of this grant. Page 26 of 64 Packet Pg. 268 • Readiness and ability to begin implementation and data collection within 1 month of award. • Description of having met any state, NGO or other CHW certification requirements as appropriate. • Existing training infrastructure that is multimodal and includes virtual modules (instructional design expert, online learning platforms and tools). • Accomplishments working with a community coalition of partnerships. • Advanced infrastructure for leveraging existing partnerships. Component C: Innovation - Demonstration Projects • Readiness and ability to begin implementation of the demonstration project and data collection within 1 month of award. • Describes their relationship(s) with existing partners that will be engaged to implement the demonstration project. • Additional capacity to evaluate the impact and effectiveness of the demonstration project to build community resilience. d. Work Plan Applicants should provide a detailed work plan for the first year of the project and a high-level work plan for the subsequent years. The work plan should include evidence -based strategies and activities to achieve all outcomes listed in the logic model. All applicants must propose a comprehensive work plan to include activities designed to achieve the short- and intermediate- term outcomes specified in this NOFO and that are aligned with the v following three high-level strategy categories: • TRAIN CHWs to ensure comprehensive acquisition and reinforcement of relevant knowledge, roles, and skills to support the COVID-19 public health response to manage N outbreaks and community spread. o • DEPL0YCHWs to manage outbreaks and spread of COVID-19 among priority populations within communities. • ENGAGE CHWs to help build and strengthen community resilience to mitigate the impact of COVID-19 by improving the overall health of priority populations within communities. CDC will provide feedback and technical assistance to recipients to finalize the work plan post - award. Applicants must name this file "Component [A, B or C] Work Plan" and upload to www.grants.gov. e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and recipients, site visits, and recipient reporting (including work plans, performance, and financial reporting). Page 27 of 64 Packet Pg. 269 Consistent with applicable grants regulations and policies, CDC expects the following to be included in post -award monitoring for grants and cooperative agreements: • Tracking recipient progress in achieving the desired outcomes. • Ensuring the adequacy of recipient systems that underlie and generate data reports. • Creating an environment that fosters integrity in program performance and results. Monitoring may also include the following activities deemed necessary to monitor the award: • Ensuring that work plans are feasible based on the budget and consistent with the intent of the award. • Ensuring that recipients are performing at a sufficient level to achieve outcomes within stated timeframes. • Working with recipients on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets. • Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels. Monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high -risk recipients. Failure to participate in the monitoring and reporting activities could result in the restriction of funds. Satisfactory progress for this NOFO would include: (a) meeting all deadlines for reporting N performance measures, (b) working with recipients of DP21-2110 to evaluate impact, and (c) appropriate and timely response to requests from CDC staff supporting this NOFO. v f. CDC Program Support to Recipients v N/A N M O B. Award Information 1. Funding Instrument Type: G (Grant) 2. Award Mechanism: Activity Code: U58 3. Fiscal Year: 2021 Estimated Total Funding: $ 300,000,000 4. Approximate Total Fiscal Year Funding: Page 28 of 64 Packet Pg. 270 $ 100,000,000 This amount is subject to the availability of funds. 5. Approximate Period of Performance Funding: $ 300,000,000 This amount represents approximate funding provided through the CARES Act over a three-year period of performance ($100 million per budget period for three budget periods) for formula - based awards. This amount could increase during the period of performance. 6. Total Period of Performance Length: 3 year(s) 7. Expected Number of Awards: 70 8. Approximate Average Award: $ 1,000,000 Per Budget Period Over a three-year period of performance, CDC will award approximately $100 million each budget year for three years with the average award varying. These grants will range approximately from $350,000 - $3 million per year depending on the size and scope of activity. The range of funds is broad to accommodate a varied number of organizations based on capacity and a range of catchment areas whose resource needs will vary. Approximate average one-year award amounts for each component are: Component A (Capacity Building): $600K c.� Component B (Implementation Ready): $2M v Component C (Innovation — demonstration projects): $2M c c.� 9. Award Ceiling: N $ 5,000,000 0 Per Budget Period N N The ceiling may increase based on availability of funds. Q u_ 10. Award Floor: z $ 350,000 Per Budget Period E 11. Estimated Award Date: August 01, 2021 Throughout the project period, CDC will continue the award based on the availability of funds, the evidence of satisfactory progress by the recipient (as documented in required reports), and the determination that continued funding is in the best interest of the federal government. The total number of years for which federal support has been approved (project period) will be shown in the "Notice of Award." This information does not constitute a commitment by the federal Page 29 of 64 Packet Pg. 271 government to fund the entire period. The total period of performance comprises the initial competitive segment and any subsequent non-competitive continuation award(s). 12. Budget Period Length: 12 month(s) 13. Direct Assistance Direct Assistance (DA) is not available through this NOFO. If you are successful and receive a Notice of Award, in accepting the award, you agree that the award and any activities thereunder are subject to all provisions of 45 CFR Part 75, currently in effect or implemented during the period of the award, other Department regulations and policies in effect at the time of the award, and applicable statutory provisions. C. Eligibility Information 1. Eligible Applicants Eligibility Category: 00 (State governments) 01 (County governments) 07 (Native American tribal governments (Federally recognized)) 25 (Others (see text field entitled "Additional Information on Eligibility" for clarification)) 11 (Native American tribal organizations (other than Federally recognized tribal governments)) Additional Eligibility Category: Government Organizations: State (includes the District of Columbia) Local governments or their bona fide agents Territorial governments or their bona fide agents in the Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau American Indian or Alaska Native tribal governments (federally recognized or state -recognized) American Indian or Alaska native tribally designated organizations 2. Additional Information on Eligibility As authorized by the Coronavirus Aid, Relief, and Economic Security Act ("CARES ACT"; Public Law 116-136), eligibility is limited to those listed above as well as those listed in Additional Information on Eligibility and include: • American Indian/Alaska Native Urban Indian Centers Page 30 of 64 Packet Pg. 272 • Health Service Providers to tribes Applicants may apply for Component A only, or Component B only, but not both. If an applicant applies for both Component A AND Component B, CDC will determine the application to be non -responsive and it will not receive further review. Only Component B applicants may also apply for Component C. Only applicants that are approved and funded for Component B will be considered for Component C funding. The Component C application must be submitted at the same time as the Component B application. No awards for Component C will be made to Component A applicants. If applying for Component C, three elements are required for submission: a) a separate proposal not to exceed four pages clearly describing the proposed innovation for the demonstration including rationale, approach, expected impact, and evaluation; b) a budget narrative; and c) a workplan. A minimum of 3 eligible tribal entities (i.e., tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes) across Components A, B, and C will be funded. For non -tribal applicants, we will fund at least one application in each of the 10 HHS rem with a maximum of 3 awards per state. If a state applies and identifies a particular county(ies) as their catchment area, they must submit a letter from appropriate county -level government confirming the county's agreement with the application. A locality may apply separately or may join with other localities meeting COVID- w 19 and poverty requirements and submit an application for a single responsibility for all financial and reporting requirements. A locality joining with other localities for the application must LO submit a letter from appropriate county -level government confirming the county's agreement N with the application. Applicants must file the letter, as appropriate, name the file "CHW_County v Agreement_ApplicantName', and upload it as a PDF file at www. rg ants.gov. c� c.� APPLICANTS MUST CLEARLY STATE WHICH COMPONENT(S) THEY ARE v APPLYING FOR IN THEIR PROJECT ABSTRACT. N 3. Justification for Less than Maximum Competition c 4. Cost Sharing or Matching N Cost Sharing / Matching Requirement: No 0 5. Maintenance of Effort Maintenance of effort is not required for this program D. Required Registrations 1. Required Registrations An organization must be registered at the three following locations before it can submit an application for funding at www. rg ants.gov. a. Data Universal Numbering System: All applicant organizations must obtain a Data Page 31 of 64 Packet Pg. 273 Universal Numbering System (DUNS) number. A DUNS number is a unique nine -digit identification number provided by Dun & Bradstreet (D&B). It will be used as the Universal Identifier when applying for federal awards or cooperative agreements. The applicant organization may request a DUNS number by telephone at 1-866-705-5711 (toll free) or internet at http:// fedgov.dnb. com/ webform/ displayHomePage.do. The DUNS number will be provided at no charge. If funds are awarded to an applicant organization that includes sub -recipients, those sub - recipients must provide their DUNS numbers before accepting any funds. b. System for Award Management (SAM): The SAM is the primary registrant database for the federal government and the repository into which an entity must submit information required to conduct business as a recipient. All applicant organizations must register with SAM, and will be assigned a SAM number. All information relevant to the SAM number must be current at all times during which the applicant has an application under consideration for funding by CDC. If an award is made, the SAM information must be maintained until a final financial report is submitted or the final payment is received, whichever is later. The SAM registration process can require 10 or more business days, and registration must be renewed annually. Additional information about registration procedures may be found at https://www.sam.gov/index.html. c. Grants.gov: The first step in submitting an application online is registering your organization atwww. rg ants.gov, the official HHS E-grant Web site. Registration information is located at the "Applicant Registration" option atwww. rg ants.gov. All applicant organizations must register at www. rg ants.gov. The one-time registration process usually takes not more than five days to complete. Applicants should start the registration process as early as possible. Step System Requirements Duration Follow Up 1. Click on http:// fedgov.dnb.com/ webform 2. Select Begin DUNS To confirm that you search/request process have been issued a Data 3. Select your country or new DUNS number Universal territory and follow the check online at 1 Number instructions to obtain your 1-2 Business Days (http:// System DUNS 9-digit # fedgov.dnb.com/ (DUNS) . Request appropriate staff ebform) or call 1- ember(s) to obtain DUNS 866-705-5711 umber, verify & update information under DUNS umber Page 32 of 64 Packet Pg. 274 System for Award Management (SAM) formerly 1. Retrieve organizations DUNS number 2. Go to htt2s://www.sam.gov/SAM3-5 Business Days but up o 2 weeks and must be or SAM Customer Service Contact https://fsd.g ov/ and designate an E-Biz POC Central (note CCR username will not renewed once a year home.do Calls: 866- Contractor work in SAM and you will 606-8220 06-82 Registration need to have an active SAM (CCR) account before you can register on grants.gov) 1. Set up an individual account in Grants.gov using organization new DUNS umber to become an authorized organization representative Same day but can take 8 (AOR) weeks to be fully early! Log 2. Once the account is set up egistered and approved in into into grants.gov and 3 Grants.gov the E-BIZ POC will be he system (note, check AOR status notified via email applicants MUST obtain a until it shows you 3. Log into grants.gov using DUNS number and SAM have been approved he password the E-BIZ POC account before applying received and create new on grants.gov) assword 4. This authorizes the AOR to submit applications on behalf of the organization 2. Request Application Package Applicants may access the application package at www. rg ants.gov. 3. Application Package Applicants must download the SF-424, Application for Federal Assistance, package associated with this funding opportunity at www.grants.gov. 4. Submission Dates and Times If the application is not submitted by the deadline published in the NOFO, it will not be processed. Office of Grants Services (OGS) personnel will notify the applicant that their application did not meet the deadline. The applicant must receive pre -approval to submit a paper application (see Other Submission Requirements section for additional details). If the applicant is authorized to submit a paper application, it must be received by the deadline provided by OGS. a. Letter of Intent Deadline (must be emailed or postmarked by) Page 33 of 64 Packet Pg. 275 03/25/2021 LOI is not required or requested. b. Application Deadline Number Of Days from Publication 60 05/24/2021 11:59 pm U.S. Eastern Standard Time, at www.grants.gov. If Grants.gov is inoperable and cannot receive applications, and circumstances preclude advance notification of an extension, then applications must be submitted by the first business day on which grants.gov operations resume. Due Date for Information Conference Call Date: March 31, 2021 Time: 3:30 pm - 4:30 pm U.S. Eastern Standard Time Conference Number: 800-369-3192 Participant Code: 5479788 Join via Computer: https:Hadobeconnect.cdc.2ov/r0er4cleiieme Potential applicants may also submit questions via email at: nccdphp chw(d),cdc.gov The following website will contain pre -and post -conference call information, including questions a and answers submitted by potential applicants: Community Health Workers for Covid Response N and Resilient Communities I CDC c.� 5. Pre -Award Assessments v c.� Risk Assessment Questionnaire Requirement v CDC is required to conduct pre -award risk assessments to determine the risk an applicant poses N to meeting federal programmatic and administrative requirements by taking into account issues o such as financial instability, insufficient management systems, non-compliance with award N conditions, the charging of unallowable costs, and inexperience. The risk assessment will include N an evaluation of the applicant's CDC Risk Questionnaire, located U_ at hgps://www.cdc.gov/grants/documents/PPMR-G-CDC-Risk-Questionnaire.pdf, as well as a z review of the applicant's history in all available systems; including OMB -designated repositories of government -wide eligibility and financial integrity systems (see 45 CFR 75.205(a)), and other E sources of historical information. These systems include, but are not limited to: FAPIIS (https://www.fapiis.govo, including past performance on federal contracts as per Duncan Hunter Q National Defense Authorization Act of 2009; Do Not Pay list; and System for Award Management (SAM) exclusions. CDC requires all applicants to complete the Risk Questionnaire, OMB Control Number 0920- 1132 annually. This questionnaire, which is located at https://www.cdc.gov/grants/documents/PPMR-G-CDC-Risk-Questionngire.pdf, along with Page 34 of 64 Packet Pg. 276 supporting documentation must be submitted with your application by the closing date of the Notice of Funding Opportunity Announcement. If your organization has completed CDC's Risk Questionnaire within the past 12 months of the closing date of this NOFO, then you must submit a copy of that questionnaire, or submit a letter signed by the authorized organization representative to include the original submission date, organization's EIN and DUNS. When uploading supporting documentation for the Risk Questionnaire into this application package, clearly label the documents for easy identification of the type of documentation. For example, a copy of Procurement policy submitted in response to the questionnaire may be labeled using the following format: Risk Questionnaire Supporting Documents _ Procurement M Policy. L Duplication of Efforts r Applicants are responsible for reporting if this application will result in programmatic, budgetary, or commitment overlap with another application or award (i.e. grant, cooperative E E agreement, or contract) submitted to another funding source in the same fiscal G U year. Programmatic overlap occurs when (1) substantially the same project is proposed in more a - than one application or is submitted to two or more funding sources for review and funding c consideration or (2) a specific objective and the project design for accomplishing the objective are the same or closely related in two or more applications or awards, regardless of the funding a source. Budgetary overlap occurs when duplicate or equivalent budgetary items (e.g., a equipment, salaries) are requested in an application but already are provided by another source. Commitment overlap occurs when an individual's time commitment exceeds 100 2 percent, whether or not salary support is requested in the application. Overlap, whether w programmatic, budgetary, or commitment of an individual's effort greater than 100 percent, is not permitted. Any overlap will be resolved by the CDC with the applicant and the PD/PI prior M to award. N Report Submission: The applicant must upload the report in Grants.gov under "Other v Attachment Forms." The document should be labeled: "Report on Programmatic, Budgetary, v and Commitment Overlap." v 6. Content and Form of Application Submission N M Applicants are required to include all of the following documents with their application package c at www. rg ants.gov. o N 7. Letter of Intent 0 Is a LOI: Z Not Applicable LOI is not requested or required as part of the application for this NOFO. E z� 8. Table of Contents Q (There is no page limit. The table of contents is not included in the project narrative page limit.): The applicant must provide, as a separate attachment, the "Table of Contents" for the entire submission package. Provide a detailed table of contents for the entire submission package that includes all of the documents in the application and headings in the "Project Narrative" section. Name the file Page 35 of 64 Packet Pg. 277 "Table of Contents" and upload it as a PDF file under "Other Attachment Forms" at www. - rg ants.gov. 9. Project Abstract Summary A project abstract is included on the mandatory documents list and must be submitted at www.grants.gov. The project abstract must be a self-contained, brief summary of the proposed project including the purpose and outcomes. This summary must not include any proprietary or confidential information. Applicants must enter the summary in the "Project Abstract Summary" text box at www. rg ants.gov. Q Applicants must clearly state which component(s) they are applying for in their Project Abstract. ca L 10. Project Narrative r Multi -component NOFOs may have a maximum of 15 pages for the "base" (subsections of the 3 Project Description that the components share with each other, which may include target E population, inclusion, collaboration, etc.); and up to 4 additional pages per component for c U Project Narrative subsections that are specific to each component. Y L Text should be single spaced, 12 point font, 1-inch margins, and number all pages. Page limits 3 include work plan; content beyond specified limits may not be reviewed. E L M Applicants should use the federal plain language guidelines and Clear Communication Index to a respond to this Notice of Funding Opportunity Announcement. Note that recipients should also use these tools when creating public communication materials supported by this NOFO. Failure to follow the guidance and format may negatively impact scoring of the application. w Component A applicants can submit a project narrative that is up to 20 pages long. The work LO plan and budget narrative are included in the 20 pages. N Component B applicants can submit a project narrative that is up to 20 pages long. The work v plan and budget narrative are included in the 20 pages. U c U Applicants applying for both Component B and Component C can submit a project narrative for N Component B that is up to 20 pages long (including the Component B work plan and budget c narrative) and a separate Component C proposal, not to exceed 4 pages, clearly describing the N proposed innovation for the demonstration project including rationale, approach, expected N impact and evaluation, budget narrative, and work plan. Pages in the narrative exceeding these limits may not be reviewed. a. Background Applicants must provide a description of relevant background information that includes the context of the problem (See CDC Background). b. Approach i. Purpose Applicants must describe in 2-3 sentences specifically how their application will address the problem as described in the CDC Background section. Page 36 of 64 Packet Pg. 278 ii. Outcomes Applicants must clearly identify the outcomes they expect to achieve by the end of the period of performance. Outcomes are the results that the program intends to achieve. All outcomes must indicate the intended direction of change (e.g., increase, decrease, maintain). (See the logic model in the Approach section of the CDC Project Description.) iii. Strategies and Activities Applicants must provide a clear and concise description of the strategies and activities they will use to achieve the period of performance outcomes. Applicants must select existing evidence - based strategies that meet their needs, or describe in the Applicant Evaluation and Performance Measurement Plan how these strategies will be evaluated over the course of the period of performance. (See CDC Project Description: Strategies and Activities section.) 1. Collaborations Applicants must describe how they will collaborate with programs and organizations either internal or external to CDC. Applicants must address the Collaboration requirements as described in the CDC Project Description. 2. Target Populations and Health Disparities Z Applicants must describe the specific target population(s) in their jurisdiction and explain how x such a target will achieve the goals of the award and/or alleviate health disparities. The w applicants must also address how they will include specific populations that can benefit from theCD program that is described in the Approach section. Applicants must address the Target N Populations and Health Disparities requirements as described in the CDC Project Description. c.� c. Applicant Evaluation and Performance Measurement Plan c� Applicants must provide an evaluation and performance measurement plan that demonstrates v how the recipient will fulfill the requirements described in the CDC Evaluation and Performance u, Measurement and Project Description sections of this NOFO. At a minimum, the plan must M describe: How applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement. The Paperwork Reduction Act of 1995 (PRA): Applicants are advised that any activities involving information collections (e.g., surveys, questionnaires, applications, audits, data requests, reporting, recordkeeping and disclosure requirements) from 10 or more individuals or non -Federal entities, including State and local governmental agencies, and funded or sponsored by the Federal Government are subject to review and approval by the Office of Management and Budget. For further information about CDC's requirements under PRA see https://www.cdc.gov/od/science/integrity/reducePublicBurden/. • How key program partners will participate in the evaluation and performance measurement planning processes. Page 37 of 64 Packet Pg. 279 • Available data sources, feasibility of collecting appropriate evaluation and performance data, data management plan (DMP), and other relevant data information (e.g., performance measures proposed by the applicant). Where the applicant chooses to, or is expected to, take on specific evaluation studies, they should be directed to: • Describe the type of evaluations (i.e., process, outcome, or both). • Describe key evaluation questions to be addressed by these evaluations. • Describe other information (e.g., measures, data sources). Recipients will be required to submit a more detailed Evaluation and Performance Measurement plan (including the DMP elements) within the first 6 months of award, as described in the Reporting Section of this NOFO. d. Organizational Capacity of Applicants to Implement the Approach Applicants must address the organizational capacity requirements as described in the CDC Project Description. 11. Work Plan (Included in the Project Narrative's page limit) Applicants must prepare a work plan consistent with the CDC Project Description Work Plan section. The work plan integrates and delineates more specifically how the recipient plans to carry out achieving the period of performance outcomes, strategies and activities, evaluation and performance measurement. 12. Budget Narrative 0 Applicants must submit an itemized budget narrative. When developing the budget narrative, N applicants must consider whether the proposed budget is reasonable and consistent with the v purpose, outcomes, and program strategy outlined in the project narrative. The budget must c include: v N • Salaries and wages o • Fringe benefits N 0 • Consultant costs N • Equipment • Supplies Z • Travel as • Other categories E • Contractual costs • Total Direct costs Q • Total Indirect costs Indirect costs could include the cost of collecting, managing, sharing and preserving data. Indirect costs on grants awarded to foreign organizations and foreign public entities and performed fully outside of the territorial limits of the U.S. may be paid to support the costs of Page 38 of 64 Packet Pg. 280 compliance with federal requirements at a fixed rate of eight percent of MTDC exclusive of tuition and related fees, direct expenditures for equipment, and subawards in excess of $25,000. Negotiated indirect costs may be paid to the American University, Beirut, and the World Health Organization. If applicable and consistent with the cited statutory authority for this announcement, applicant entities may use funds for activities as they relate to the intent of this NOFO to meet national standards or seek health department accreditation through the Public Health Accreditation Board (see: http://www.phaboard.org). Applicant entities to whom this provision applies include state, local, territorial governments (including the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau), or their bona fide agents, political subdivisions of states (in consultation with states), federally recognized or state -recognized American Indian or Alaska Native tribal governments, and American Indian or Alaska Native tribally designated organizations. Activities include those that enable a public health organization to deliver public health services such as activities that ensure a capable and qualified workforce, up-to-date information systems, and the capability to assess and respond to public health needs. Use of these funds must focus on achieving a minimum of one national standard that supports the intent of the NOFO. Proposed activities must be included in the budget narrative and must indicate which standards will be addressed. Vital records data, including births and deaths, are used to inform public health program and w policy decisions. If applicable and consistent with the cited statutory authority for this NOFO, applicant entities are encouraged to collaborate with and support their jurisdiction's vital records CD office (VRO) to improve vital records data timeliness, quality and access, and to advance public N health goals. Recipients may, for example, use funds to support efforts to build VRO capacity through partnerships; provide technical and/or financial assistance to improve vital records v timeliness, quality or access; or support vital records improvement efforts, as approved by CDC. c c.� un Applicants must name this file "Budget Narrative" and upload it as a PDF file M 0 at www. rg ants.gov. If requesting indirect costs in the budget, a copy of the indirect cost -rate agreement is required. If the indirect costs are requested, include a copy of the current negotiated federal indirect cost rate agreement or a cost allocation plan approval letter for those Recipients under such a plan. Applicants must name this file "Indirect Cost Rate" and upload it at www.grants.gov. 13. Pilot Program for Enhancement of Employee Whistleblowers Protections Pilot Program for Enhancement of Employee Whistleblower Protections: All applicants will be subject to a term and condition that applies the terms of 48 Code of Federal Regulations (CFR) section 3.908 to the award and requires that recipients inform their employees in writing (in the predominant native language of the workforce) of employee whistleblower rights and protections under 41 U.S.C. 4712. Page 39 of 64 Packet Pg. 281 13a. Funds Tracking Proper fiscal oversight is critical to maintaining public trust in the stewardship of federal funds. Effective October 1, 2013, a new HHS policy on subaccounts requires the CDC to set up payment subaccounts within the Payment Management System (PMS) for all new grant awards. Funds awarded in support of approved activities and drawdown instructions will be identified on the Notice of Award in a newly established PMS subaccount (P subaccount). Recipients will be required to draw down funds from award -specific accounts in the PMS. Ultimately, the subaccounts will provide recipients and CDC a more detailed and precise understanding of financial transactions. The successful applicant will be required to track funds by P-accounts/sub accounts for each project/cooperative agreement awarded. Applicants are encouraged to demonstrate a record of fiscal responsibility and the ability to provide sufficient and effective oversight. Financial management systems must meet the requirements as described 45 CFR 75 which include, but are not limited to, the following: • Records that identify adequately the source and application of funds for federally - funded activities. • Effective control over, and accountability for, all funds, property, and other assets • Comparison of expenditures with budget amounts for each Federal award. • Written procedures to implement payment requirements. • Written procedures for determining cost allowability. • Written procedures for financial reporting and monitoring. 13b. Copyright Interests Provisions x This provision is intended to ensure that the public has access to the results and accomplishments w of public health activities funded by CDC. Pursuant to applicable grant regulations and CDC's CD Public Access Policy, Recipient agrees to submit into the National Institutes of Health (NIH) N Manuscript Submission (NIHMS) system an electronic version of the final, peer -reviewed manuscript of any such work developed under this award upon acceptance for publication, to be v made publicly available no later than 12 months after the official date of publication. Also at the v time of submission, Recipient and/or the Recipient's submitting author must specify the date the final manuscript will be publicly accessible through PubMed Central (PMC). Recipient and/or N Recipient's submitting author must also post the manuscript through PMC within twelve (12) c months of the publisher's official date of final publication; however the author is strongly N encouraged to make the subject manuscript available as soon as possible. The recipient must N obtain prior approval from the CDC for any exception to this provision. The author's final, peer -reviewed manuscript is defined as the final version accepted for journal publication, and includes all modifications from the publishing peer review process, and all graphics and supplemental material associated with the article. Recipient and its submitting authors working under this award are responsible for ensuring that any publishing or copyright agreements concerning submitted articles reserve adequate right to fully comply with this provision and the license reserved by CDC. The manuscript will be hosted in both PMC and the CDC Stacks institutional repository system. In progress reports for this award, recipient must identify publications subject to the CDC Public Access Policy by using the applicable NIHMS identification number for up to three (3) months after the publication date and the PubMed Central identification number (PMCID) thereafter. Page 40 of 64 Packet Pg. 282 13c. Data Management Plan As identified in the Evaluation and Performance Measurement section, applications involving data collection or generation must include a Data Management Plan (DMP) as part of their evaluation and performance measurement plan unless CDC has stated that CDC will take on the responsibility of creating the DMP. The DMP describes plans for assurance of the quality of the public health data through the data's lifecycle and plans to deposit the data in a repository to preserve and to make the data accessible in a timely manner. See web link for additional information: https://www.cdc.gov/grants/additionalrequirements/ar-25.htm1 14. Funding Restrictions Restrictions that must be considered while planning the programs and writing the budget are: • Recipients may not use funds for research. • Recipients may not use funds for clinical care except as allowed by law. • Recipients may use funds only for reasonable program purposes, including personnel, travel, supplies, and services. • Generally, recipients may not use funds to purchase furniture or equipment. Any such proposed spending must be clearly identified in the budget. • Reimbursement of pre -award costs generally is not allowed, unless the CDC provides written approval to the recipient. • Other than for normal and recognized executive -legislative relationships, no funds may be used for: ■ publicity or propaganda purposes, for the preparation, distribution, or use ; of any material designed to support or defeat the enactment of legislation w before any legislative body a ■ the salary or expenses of any grant or contract recipient, or agent acting N for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, v or Executive order proposed or pending before any legislative body v c • See Additional Requirement (AR) for detailed guidance on this prohibition Ln andadditional guidance on lobbying for CDC recipients. M • The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project outcomes and not merely serve N as a conduit for an award to another party or provider who is ineligible. Q 15. Other Submission Requirements a. Electronic Submission: Applications must be submitted electronically by using the forms and instructions posted for this notice of funding opportunity atwww. grants. gov. Applicants can complete the application package using Workspace, which allows forms to be filled out online or offline. All application attachments must be submitted using a PDF file format. Instructions and training for using Workspace can be found at www.grants.gov under the "Workspace Overview" option. b. Tracking Number: Applications submitted through www. rg ants.goyare time/date stamped electronically and assigned a tracking number. The applicant's Authorized Organization Representative (AOR) will be sent an e-mail notice of receipt whenwww. rg ants.goyreceives the Page 41 of 64 Packet Pg. 283 application. The tracking number documents that the application has been submitted and initiates the required electronic validation process before the application is made available to CDC. c. Validation Process: Application submission is not concluded until the validation process is completed successfully. After the application package is submitted, the applicant will receive a "submission receipt" e-mail generated by www. rg ants.gov. A second e-mail message to applicants will then be generated bywww..ra�nts.gov that will either validate or reject the submitted application package. This validation process may take as long as two business days. Applicants are strongly encouraged to check the status of their application to ensure that submission of their package has been completed and no submission errors have occurred. Applicants also are strongly encouraged to allocate ample time for filing to guarantee that their application can be submitted and validated by the deadline published in the NOFO. Non- validated applications will not be accepted after the published application deadline date. If you do not receive a "validation" e-mail within two business days of application submission, please contact www. rg ants.gov. For instructions on how to track your application, refer to the e- mail message generated at the time of application submission or the Grants.gov Online User Guide. https://www. ram. o�p/html/help/index.htm?callingApp=custom#t=GetStarted%2FGetStart ed.htm d. Technical Difficulties: If technical difficulties are encountered at www.grants.gov, applicants should contact Customer Service atwww. grants. gov. The www. rg ants.goyContact Center is available 24 hours a day, 7 days a week, except federal holidays. The Contact Center is available by phone at 1-800-518-4726 or by e-mail at supporWgrants•gov. Application submissions sent by e-mail or fax, or on CDs or thumb drives will not be accepted. Please note thatwww. grants. goyis managed by HHS. e. Paper Submission: If technical difficulties are encountered at www.grants.gov, applicants W should call thewww. rg ants.goyContact Center at 1-800-518-4726 or e-mail them v at support(c�,rg ants.gov for assistance. After consulting with the Contact Center, if the technical v difficulties remain unresolved and electronic submission is not possible, applicants may e-mail CDC GMO/GMS, before the deadline, and request permission to submit a paper application. M 0 Such requests are handled on a case -by -case basis. An applicant's request for permission to submit a paper application must: 1. Include the www.grants.gov case number assigned to the inquiry 2. Describe the difficulties that prevent electronic submission and the efforts taken with the www. rg ants.goyContact Center to submit electronically; and 3. Be received via e-mail to the GMS/GMO listed below at least three calendar days before the application deadline. Paper applications submitted without prior approval will not be considered. If a paper application is authorized, OGS will advise the applicant of specific instructions for submitting the application (e.g., original and two hard copies of the application by U.S. mail or express delivery service). E. Review and Selection Process Page 42 of 64 Packet Pg. 284 1. Review and Selection Process: Applications will be reviewed in three phases a. Phase 1 Review All applications will be initially reviewed for eligibility and completeness by the Office of Grants Services. Complete applications will be reviewed for responsiveness by Grants Management Officials and Program Officials. Non -responsive applications will not advance to Phase II review. Applicants will be notified that their applications did not meet eligibility and/or published submission requirements. b. Phase II Review A review panel will evaluate complete, eligible applications in accordance with the criteria below. i. Approach ii. Evaluation and Performance Measurement iii. Applicant's Organizational Capacity to Implement the Approach Not more than thirty days after the Phase II review is completed, applicants will be notified electronically if their application does not meet eligibility or published submission requirements. i. Component A: Approach Maximum Points: 45 Purpose and Outcomes (20 points) — The extent to which the applicant: 1. Describes the catchment area and provides quality information reflecting a) the burden of COVID-19 infection rates and/or COVID-19 mortality rates and b) poverty rates in the populations disproportionally affected by COVID-19 infections. (5 points) 2. Describes how they will work with CHWs to reach and serve the communities described in the catchment area. (5 points) 3. Provides a clear, concise statement of the community problem(s) and how CHWs are integral to the project. (5 points) 4. Provides a clear description of how they intend to train, deploy, and engage CHWs to support COVID-19 response and prevention in described catchment area. (5 points) Strategies and Activities (25 points)- The extent to which the applicant: 5. Proposes activities that are aligned with existing COVID-19 response activities, including other CDC -funded programs, and ensures there is no duplication of effort. (5 points) 6. Proposes work that will be done in the required and optional strategy areas that are aligned with the outcomes presented in the logic model. (5 points) 7. Describes how they will ❑ collaborate ❑ with other federally funded programs, community partners, and coalitions who are addressing COVID-19, to carry out the work of the grant. ❑ Letters of support are provided. ❑ If applicant identifies a particular county(ies) Page 43 of 64 Packet Pg. 285 as their catchment area, or is a state intending to work in a specific county(ies), a letter(s) from appropriate county -level government confirming the county's agreement with the application is included. (5 points) 8. Provides a work plan that is aligned with the strategies and activities described in the NOFO and includes a description of specific tasks that are reasonable and feasible, with realistic completion dates, to accomplish the outcomes as stated in the NOFO. (10 points) ii. Component A: Evaluation and Performance Maximum Points: 25 Measurement The extent to which the applicant: 1. Dedicates at least 10% of funds to support evaluation (5 points) 2. Commits to work with the recipient(s) of the Evaluation TA NOFO to refine evaluation plans and performance measures and facilitate the national evaluation. (5 points) 3. Describes how CHWs and key partners will be engaged in the evaluation and performance measurement planning processes. (5 points) 4. Describes potentially available data sources for the performance measures. (5 points) 5. Describes plans to submit ❑at least two success stories per year with impacts using the 2 NCCDPHP Success Stories Application. (5 points) w as LO iii. Component A: Applicant's Organizational Capacity to N Maximum Points: 30 Implement the Approach v The extent to which the applicant: c.� 1. Describes their relevant experience (approximately 1 year) working with CHWs and v provides examples of CHW-related projects and accomplishments they've N achieved. (10 points) M 0 2. Describes ❑ a staffing plan that includes ❑ roles, responsibilities, and qualifications of all staff, including evaluation staff, who will have a role in implementing program strategies and achieving outcomes. ❑ Contractual staff and/or organizations should be included in the staffing plan, as applicable. Resumes for ❑key staff, including key contractual staff, are included. ❑ (5 points) 3. Describes day-to-day responsibility for key tasks including leadership of project, budget management, contract management, implementation of activities and tasks, monitoring progress, data collection and management, preparation of reports, partnership development and coordination, evaluation and performance monitoring, and communication with partners and CDC. Describes readiness and ability to begin implementation within 1 month of award. (10 points) Page 44 of 64 Packet Pg. 286 4. Describes their relationship and accomplishments with existing coalition(s) and other CDC -funded programs with which they will partner to implement the activities outlined in their workplan and address COVID-19 response and prevention response efforts? (5 points) Budget Maximum Points: 0 Though not scored, applicants must assure their proposed budget(s) align with the proposed work plan and adhere to CDC fiscal policy. i. Approach Maximum Points: 35 Component B: Approach Purpose and Outcomes (15 ❑points) — The extent to which the applicant: ❑ 1. Describes the catchment area and provides quality information reflecting a) the burden of COVID-19 infection rates and/or COVID-19 mortality rates and b) poverty rates in the populations disproportionally affected by COVID-19 infections. (5 points) 2. Describes how they will work with CHWs to reach and serve the communities described in the catchment area. (5 points) 3. Provides a clear, concise statement of the community problem(s) and how CHWs are integral to the project. (2 points) 4. Provides a clear description of how they intend to train, deploy, and engage CHWs to support COVID-19 response and prevention in described catchment area. (3 points) Strategies and Activities (20 points)- The extent to which the applicant: 5. Proposes activities that are aligned with existing COVID-19 response activities, including other CDC -funded programs, and ensures there is no duplication of effort. (5 points) 6. Proposes work that will be done in the required and optional strategy areas that are aligned with the outcomes presented in the logic model. (5 points) 7. Describes how they will ❑ collaborate ❑ with other federally funded programs, community partners, and coalitions who are addressing COVID-19, to carry out the work of the grant. ❑ Letters of support are provided. ❑ If applicant identifies a particular county(ies) as their catchment area, or is a state intending to work in specific county(ies), a letter(s) from appropriate county -level government confirming the county's agreement with the application is included. (5 points) 8. Provides a work plan that is aligned with the strategies and activities described in the NOFO and includes a description of specific tasks that are reasonable and feasible, with realistic completion dates, to accomplish the outcomes as stated in the NOFO. (5 points) ii. Evaluation and Performance Measurement Maximum Points: 25 Page 45 of 64 Packet Pg. 287 Component B: Evaluation and Performance Measurement The extent to which the applicant: 1. Dedicates at least 10% of funds to support evaluation (5 points) 2. Commits to work with the recipient(s) of the Evaluation TA NOFO to refine evaluation plans and performance measures and facilitate the national evaluation. (5 points) 3. Describes how CHWs and key partners will be engaged in the evaluation and performance measurement planning processes. (5 points) 4. Describes potentially available data sources for the performance measures. (5 points) 5. Describes plans to submit ❑at least two success stories per year with impacts using the NCCDPHP Success Stories Application. (5 points) iii. Applicant's Organizational Capacity to Implement the Maximum Points: 40 Approach Component B: Applicant's Organizational Capacity to Implement Approach The extent to which the applicant: 1. Describes their relevant experience (approximately 3 years) working with CHWs and provides examples of CHW-related projects and accomplishments they've achieved. (10 points) 2. Describes ❑ a staffing plan that includes ❑ roles, responsibilities, and qualifications of all x staff, including evaluation staff, who will have a role in implementing program strategies w and achieving outcomes. ❑ Contractual staff and/or organizations should be included in the CD staffing plan, as applicable. Resumes for[] key staff, including key contractual staff, are N included. ❑ (5 points) a; 3. Describes day-to-day responsibility for key tasks including leadership of project, budget v management, contract management, implementation of activities and tasks, monitoring c progress, data collection and management, preparation of reports, partnership development c� and coordination, evaluation and performance monitoring, and communication with partners N and CDC. Describes readiness and ability to begin implementation within 1 month of award. o (5 points) N 4. Describes their relationship and accomplishments with existing coalition(s) and other CDC -funded programs with which they will partner to implement the activities outlined in their workplan and address COVID-19 response and prevention response efforts (10 points) 5. Describe their expertise and credible working relationships with health care organizations/systems documented by ❑ letters of support/MOUs/MOAs. ❑ These could include: []federally qualified health centers, private health care provider systems, Accountable Care Organizations, hospitals. ❑ (5 points) 6. Demonstrates technical and technological infrastructure to support rapid recruitment, selection, hiring, training, and deployment of CHWs for the work of this grant. (5 points) Budget Maximum Points: 0 Page 46 of 64 Packet Pg. 288 Component B: Budget Though not scored, applicants must assure their proposed budget(s) align with the proposed work plan and adhere to CDC fiscal policy. Component C: Approach Maximum Points: 40 The extent to which the applicant: 1. Provides the rationale for the project through a clear, concise statement of the community problem(s) and how ❑ the ❑ innovative approach(es) that ❑ they propose ❑ involving ❑ CHWs n are ❑ foundational in building community resilience. (10 points) M r c 2. Provides a proposal that clearly ❑ describes ❑ the ❑ approach and expected outcome(s) of the demonstration project, ❑ how innovation can address the issue, ❑ tangible ❑ activities ❑ that r will be employed ❑ to accomplish those ❑ expected outcomes, ❑ and how they will be 3 achieved within 2 years. ❑ (10 ❑ points) E 3. Clearly describes the ❑ critical role ❑ CHWs ❑ will play ❑ in ❑ implementing ❑ and evaluating the demonstration❑project. ❑(5 points) Y L 4. ❑ Provides a clear description in their proposal of how they intend to ❑ use innovation and 3 CHWs to address ❑ at least one of the high-level strategies in the NOFO (train, E deploy, ❑ or❑ engage). ❑ (5 points) ❑ Ui 2 5. Describes how they will work with ❑new and/or ❑existing programs, community partners, and coalitions to carry out the ❑ innovative strategies and activities proposed for the demonstration project. ❑ Letters of support will strengthen the application. ❑ (5 points) w 6. Provides a work plan that is aligned with the ❑ proposal ❑and includes a description of LO specific tasks that are reasonable ❑ and ❑ feasible ❑ to ❑ implement the demonstration proj ect N and clearly identifies CHW role(s) ❑ and responsibilities in implementing and evaluating the demonstration project. ❑ ❑ (5 points) Component C: Evaluation and Performance Measurement Maximum Points: 35 c The extent to which the applicant: N 1. Ensures ❑ at least 10% of funds are budgeted to support evaluation. (5 points) o 2. Provides a thorough evaluation plan that Eldescribes Elkey evaluation questions ❑ and N potential data sources ❑ to ❑ determine the impact and effectiveness of the demonstration proj ect ❑ on building community resilience. 1111 ❑ (10 ❑ points) 0 z 3. Describes additional ❑ experienced ❑staff (not identified in Component B) or❑experienced contracted organization identified to ❑ lead evaluation of the demonstration project. ❑ (5 E points) ❑ 4. Commits to work with the recipient(s) of the Evaluation TA NOFO to refine evaluation Q plans and performance measures, and ❑ finalize ❑ appropriate data sources. ❑ (5 points) ❑ 5. Describe how CHWs and key partners will be engaged in the evaluation and performance measurement planning processes ❑ and how recommendations for sustainability of such efforts will be incorporated into the evaluation plan. (5 points) ❑ Page 47 of 64 Packet Pg. 289 6. Describes clear monitoring and evaluation procedures and how evaluation and performance measurement will be incorporated into planning, implementing, and reporting of project activities and ❑outcomes and enable continuous program quality improvement and inform sustainability planning. ❑ (5 points) Component C: Applicant's Organizational Capacity to Maximum Points: 25 Implement Approach The extent to which the applicant: 1. Describes a staffing plan that is separate from Component B, inclusive of any contracts as applicable, for the demonstration project including roles and responsibilities and qualifications. El Resumes for ❑key staff, including contract staff if applicable, are included. (5 []points) 2. Describes day-to-day responsibility for key tasks including leadership of the demonstration project, budget management, contract management, ❑implementation of activities and tasks, monitoring progress, data collection and management , preparation of reports, ❑partnership development and coordination, and evaluation and performance monitoring, and communication with partners and CDC. (5 points) 3. Demonstrates readiness and ability to begin implementation[] of the demonstration project within 1 month of award. (10 points) 4. Describes their relationship with existing ❑partners that will be engaged to implement the demonstration project. ❑ (5 points) Component C: Budget Maximum Points: 0 Though not scored, applicants must assure their proposed budget(s) align with the proposed work plan and adhere to CDC fiscal policy. c. Phase III Review • Applications for Components A and B will be funded separately. Only one application per organization will be considered for either Component A or Component B. CDC may fund out of rank order to ensure geographical representation in each of the 10 HHS regions, COVID-19 infection rates, and/or poverty rates are being addressed, as well as ensuring applicants are reaching larger numbers of the target population and that a minimum of 3 eligible tribal entities (i.e., tribes, tribal organizations, urban Indian health organizations, or health service providers to tribes) across Components A, B, and C are funded. • For Component C, CDC may fund out of rank order to ensure that innovative approaches are not duplicative and that demonstration projects are geographically dispersed. • CDC will provide justification for any decision to fund out of rank order. Review of risk posed by applicants. Prior to making a Federal award, CDC is required by 31 U.S.C. 3321 and 41 U.S.C. 2313 to review information available through any OMB -designated repositories of government -wide Page 48 of 64 Packet Pg. 290 eligibility qualification or financial integrity information as appropriate. See also suspension and debarment requirements at 2 CFR parts 180 and 376. In accordance 41 U.S.C. 2313, CDC is required to review the non-public segment of the OMB - designated integrity and performance system accessible through SAM (currently the Federal Recipient Performance and Integrity Information System (FAPIIS)) prior to making a Federal award where the Federal share is expected to exceed the simplified acquisition threshold, defined in 41 U.S.C. 134, over the period of performance. At a minimum, the information in the system for a prior Federal award recipient must demonstrate a satisfactory record of executing programs or activities under Federal grants, cooperative agreements, or procurement awards; and integrity and business ethics. CDC may make a Federal award to a recipient who does not fully meet these standards, if it is determined that the information is not relevant to the current Federal award under consideration or there are specific conditions that can appropriately mitigate the effects of the non -Federal entity's risk in accordance with 45 CFR §75.207. CDC's framework for evaluating the risks posed by an applicant may incorporate results of the evaluation of the applicant's eligibility or the quality of its application. If it is determined that a Federal award will be made, special conditions that correspond to the degree of risk assessed may be applied to the Federal award. The evaluation criteria is described in this Notice of Funding Opportunity. In evaluating risks posed by applicants, CDC will use a risk -based approach and may consider any items such as the following: (1) Financial stability; (2) Quality of management systems and ability to meet the management standards prescribed in this part; (3) History of performance. The applicant's record in managing Federal awards, if it is a prior recipient of Federal awards, including timeliness of compliance with applicable reporting v requirements, conformance to the terms and conditions of previous Federal awards, and if v applicable, the extent to which any previously awarded amounts will be expended prior to future v awards; N (4) Reports and findings from audits performed under subpart F 45 CFR 75 or the reports and o findings of any other available audits; and N (5) The applicant's ability to effectively implement statutory, regulatory, or other requirements imposed on non -Federal entities. CDC must comply with the guidelines on government -wide suspension and debarment in 2 CFR part 180, and require non -Federal entities to comply with these provisions. These provisions restrict Federal awards, subawards and contracts with certain parties that are debarred, suspended or otherwise excluded from or ineligible for participation in Federal programs or activities. 2. Announcement and Anticipated Award Dates Successful applicants can anticipate notice of funding by August 1, 2021. F. Award Administration Information Page 49 of 64 Packet Pg. 291 1. Award Notices Recipients will receive an electronic copy of the Notice of Award (NOA) from CDC OGS. The NOA shall be the only binding, authorizing document between the recipient and CDC. The NOA will be signed by an authorized GMO and emailed to the Recipient Business Officer listed in application and the Program Director. Any applicant awarded funds in response to this Notice of Funding Opportunity will be subject to the DUNS, SAM Registration, and Federal Funding Accountability And Transparency Act Of 2006 (FFATA) requirements. Unsuccessful applicants will receive notification of these results by e-mail with delivery receipt or by U.S. mail. r c If you are successful and receive a Notice of Award, in accepting the award, you agree that the award and any activities thereunder are subject to all provisions of 45 CFR part 75, currently in E effect or implemented during the period of the award, other Department regulations and policies ci in effect at the time of the award, and applicable statutory provisions. Y L O 2. Administrative and National Policy Requirements Recipients must comply with the administrative and public policy requirements outlined in 45 a CFR Part 75 and the HHS Grants Policy Statement, as appropriate. a Brief descriptions of relevant provisions are available at http://www.cdc.gov/grants/additionalrequirements/index.html#ui-id-17. x w The HHS Grants Policy Statement is available at hqp://www.hhs.gov/sites/default/files/ rg ants/ rg ants/policies-regulations/hhsgps107.pdf. LO N A recipient of a grant or cooperative agreement awarded by the Department of Health and Human Services (HHS) with funds made available under the Coronavirus Preparedness and v Response Supplemental Appropriations Act, 2020 (P.L. 116-123); the Coronavirus Aid, Relief, v and Economic Security Act, 2020 (the "CARES Act") (P.L. 116-136); and/or the Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139) agrees, as applicable to N the award, to: 1) comply with existing and/or future directives and guidance from the Secretary c regarding control of the spread of COVID-19; 2) in consultation and coordination with HHS, N provide, commensurate with the condition of the individual, COVID-19 patient care regardless 40 N of the individual's home jurisdiction and/or appropriate public health measures (e.g., social distancing, home isolation); and 3) assist the United States Government in the implementation z and enforcement of federal orders related to quarantine and isolation. In addition, to the extent applicable, Recipient will comply with Section 18115 of the CARES Act, with respect to the reporting to the HHS Secretary of results of tests intended to detect SARS—CoV-2 or to diagnose a possible case of COVID-19. Such reporting shall be in accordance with guidance and direction from HHS and/or CDC. Further, consistent with the full scope of applicable grant regulations (45 C.F.R. 75.322), the purpose of this award, and the underlying funding, the recipient is expected to provide to CDC copies of and/or access to COVID-19 data collected with these funds, including but not limited Page 50 of 64 Packet Pg. 292 to data related to COVID-19 testing. CDC will specify in further guidance and directives what is encompassed by this requirement. This award is contingent upon agreement by the recipient to comply with existing and future guidance from the HHS Secretary regarding control of the spread of COVID-19. In addition, recipient is expected to flow down these terms to any subaward, to the extent applicable to activities set out in such subaward The full text of the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards, 45 CFR 75, can be found at: hops://www.ecfr.gov/cgi-bin/text- idx?node=pt45.1.75 3. Reporting Reporting provides continuous program monitoring and identifies successes and challenges that recipients encounter throughout the project period. Also, reporting is a requirement for recipients who want to apply for yearly continuation of funding. Reporting helps CDC and recipients because it: • Helps target support to recipients; • Provides CDC with periodic data to monitor recipient progress toward meeting the Notice of Funding Opportunity outcomes and overall performance; • Allows CDC to track performance measures and evaluation findings for continuous quality and program improvement throughout the period of performance and to determine applicability of evidence -based approaches to different populations, settings, and contexts; and • Enables CDC to assess the overall effectiveness and influence of the NOFO. The table below summarizes required and optional reports. All required reports must be sent electronically to GMS listed in the "Agency Contacts" section of the NOFO copying the CDC Project Officer. Report When? Required? Recipient Evaluation and Performance Measurement Plan, including Data 6 months into award Yes Management Plan (DMP) No later than 120 days before end of Annual Performance Report (APR) budget period. Serves as yearly Yes continuation application. Data on Performance Measures Semi-annually Yes Federal Financial Reporting Forms 90 days after the end of the budget Yes period. 90 days after end of period of Final Performance and Financial Report erformance. Yes Page 51 of 64 Packet Pg. 293 Payment Management System (PMS) Quarterly reports due January 30; yes Reporting April 30; July 30; and October 30. a. Recipient Evaluation and Performance Measurement Plan (required) With support from CDC, recipients must elaborate on their initial applicant evaluation and performance measurement plan. This plan must be no more than 20 pages; recipients must submit the plan 6 months into the award. HHS/CDC will review and approve the recipient's monitoring and evaluation plan to ensure that it is appropriate for the activities to be undertaken n as part of the agreement, for compliance with the monitoring and evaluation guidance established by HHS/CDC, or other guidance otherwise applicable to this Agreement. L c� Recipient Evaluation and Performance Measurement Plan (required): This plan should provide r additional detail on the following: E Performance Measurement c U • Performance measures and targets Y • The frequency that performance data are to be collected. 3 • How performance data will be reported. E a_ • How quality of performance data will be assured. • How performance measurement will yield findings to demonstrate progress towards achieving NOFO goals (e.g., reaching target populations or achieving expected outcomes). w • Dissemination channels and audiences. LO • Other information requested as determined by the CDC program. N Evaluation U U • The types of evaluations to be conducted (e.g. process or outcome evaluations). c • The frequency that evaluations will be conducted. N • How evaluation reports will be published on a publically available website. o • How evaluation findings will be used to ensure continuous quality and program improvement. N • How evaluation will yield findings to demonstrate the value of the NOFO (e.g., effect on improving public health outcomes, effectiveness of NOFO, cost-effectiveness or cost -benefit). z • Dissemination channels and audiences. E HHS/CDC or its designee will also undertake monitoring and evaluation of the defined activities within the agreement. The recipient must ensure reasonable access by HHS/CDC or its designee Q to all necessary sites, documentation, individuals and information to monitor, evaluate and verify the appropriate implementation the activities and use of HHS/CDC funding under this Agreement. b. Annual Performance Report (APR) (required) Page 52 of 64 Packet Pg. 294 The recipient must submit the APR via www.Grantsolutions.gov no later than120 days prior to the end of the budget period. This report must not exceed 45 pages excluding administrative reporting. Attachments are not allowed, but web links are allowed. This report must include the following: • Performance Measures: Recipients must report on performance measures for each budget period and update measures, if needed. • Evaluation Results: Recipients must report evaluation results for the work completed to date (including findings from process or outcome evaluations). • Work Plan: Recipients must update work plan each budget period to reflect any changes in period of performance outcomes, activities, timeline, etc. • Successes o Recipients must report progress on completing activities and progress towards achieving the period of performance outcomes described in the logic model and work plan. o Recipients must describe any additional successes (e.g. identified through evaluation results or lessons learned) achieved in the past year. o Recipients must describe success stories. • Challenges o Recipients must describe any challenges that hindered or might hinder their ability to complete the work plan activities and achieve the period of performance outcomes. o Recipients must describe any additional challenges (e.g., identified through c.� evaluation results or lessons learned) encountered in the past year. v c.� • CDC Program Support to Recipients u� o Recipients must describe how CDC could help them overcome challenges to M complete activities in the work plan and achieving period of performance o outcomes. o • Administrative Reporting (No page limit) o SF-424A Budget Information -Non -Construction Programs. o Budget Narrative — Must use the format outlined in "Content and Form of Application Submission, Budget Narrative" section. o Indirect Cost Rate Agreement. The recipient must submit the Annual Performance Report via https://www.grantsolutions.gov 120 days prior to the end of the budget period. c. Performance Measure Reporting (optional) Page 53 of 64 Packet Pg. 295 CDC programs may require more frequent reporting of performance measures than annually in the APR. If this is the case, CDC programs must specify reporting ftequency, data fields, and format for recipients at the beginning of the award period. Performance measures should be reported semi-annually. CDC and the Evaluation/TA partners will specify data fields and format at the beginning of the award period. d. Federal Financial Reporting (FFR) (required) The annual FFR form (SF-425) is required and must be submitted 90 days after the end of the budget period through the Payment Management System (PMS). The report must include only those funds authorized and disbursed during the timeframe covered by the report. The final FFR must indicate the exact balance of unobligated funds, and may not reflect any unliquidated obligations. There must be no discrepancies between the final FFR expenditure data and the Payment Management System's (PMS) cash transaction data. Failure to submit the required information by the due date may adversely affect the future funding of the project. If the information cannot be provided by the due date, recipients are required to submit a letter of explanation to OGS and include the date by which the Grants Officer will receive information. e. Final Performance and Financial Report (required) The Final Performance Report is due 90 days after the end of the period of performance. The Final FFR is due 90 days after the end of the period of performance and must be submitted through the Payment Management System (PMS). CDC programs must indicate that this report should not exceed 40 pages. This report covers the entire period of performance and can include information previously reported in APRs. At a minimum, this report must include the following: • Performance Measures — Recipients must report final performance data for all process and outcome performance measures. • Evaluation Results — Recipients must report final evaluation results for the period N of performance for any evaluations conducted. • Impact/Results/Success Stories — Recipients must use their performance measure v results and their evaluation findings to describe the effects or results of the work c completed over the period of performance, and can include some success stories. c� • A final Data Management Plan that includes the location of the data collected N during the funded period, for example, repository name and link data set(s) o • Additional forms as described in the Notice of Award (e.g., Equipment Inventory c Report, Final Invention Statement). N No additional information is required, other than what is listed above. 4. Federal Funding Accountability and Transparency Act of 2006 (FFATA) Federal Funding Accountability and Transparency Act of 2006 (FFATA), P.L. 109-282, as amended by section 6202 of P.L. 110-252 requires full disclosure of all entities and organizations receiving Federal funds including awards, contracts, loans, other assistance, and payments through a single publicly accessible Web site, hqp://www.USASpending_gov. Compliance with this law is primarily the responsibility of the Federal agency. However, two elements of the law require information to be collected and reported by applicants: 1) information on executive compensation when not already reported through the SAM, and 2) similar information on all sub-awards/subcontracts/consortiums over $25,000. Page 54 of 64 Packet Pg. 296 For the full text of the requirements under the FFATA and HHS guidelines, go to: • https://www.gpo. og v/fds@pkg/PLAW-109publ282/pdf/PLAW-109publ282.pdf, • hLtps://www.fsrs.gov/documents/ffata legislation_ 110_252.pdf • http://www.hhs.gov/ rg ants/ rg ants/ rg ants-policies-regulations/index.html#FFATA. 5. Reporting of Foreign Taxes (International/Foreign projects only) A. Valued Added Tax (VAT) and Customs Duties — Customs and import duties, consular fees, customs surtax, valued added taxes, and other related charges are hereby authorized as an allowable cost for costs incurred for non -host governmental entities operating where no applicable tax exemption exists. This waiver does not apply to countries where a bilateral agreement (or similar legal document) is already in place providing applicable tax exemptions and it is not applicable to Ministries of Health. Successful applicants will receive information on VAT requirements via their Notice of Award. B. The U.S. Department of State requires that agencies collect and report information on the amount of taxes assessed, reimbursed and not reimbursed by a foreign government against commodities financed with funds appropriated by the U.S. Department of State, Foreign Operations and Related Programs Appropriations Act (SFOAA) ("United States foreign assistance funds"). Outlined below are the specifics of this requirement: 1) Annual Report: The recipient must submit a report on or before November 16 for each foreign 2 country on the amount of foreign taxes charged, as of September 30 of the same year, by a w foreign government on commodity purchase transactions valued at 500 USD or more financed with United States foreign assistance funds under this grant during the prior United States fiscal LO year (October 1 — September 30), and the amount reimbursed and unreimbursed by the foreign N government. [Reports are required even if the recipient did not pay any taxes during the reporting period.] v c 2) Quarterly Report: The recipient must quarterly submit a report on the amount of foreign taxes v charged by a foreign government on commodity purchase transactions valued at 500 USD or N more financed with United States foreign assistance funds under this grant. This report shall be o submitted no later than two weeks following the end of each quarter: April 15, July 15, October c 15 and January 15. N 3) Terms: For purposes of this clause: "Commodity" means any material, article, supplies, goods, or equipment; "Foreign government" includes any foreign government entity; "Foreign taxes" means value-added taxes and custom duties assessed by a foreign government on a commodity. It does not include foreign sales taxes. 4) Where: Submit the reports to the Director and Deputy Director of the CDC office in the country(ies) in which you are carrying out the activities associated with this cooperative agreement. In countries where there is no CDC office, send reports to VATreporting@cdc.gov. 5) Contents of Reports: The reports must contain: Page 55 of 64 Packet Pg. 297 a. recipient name; b. contact name with phone, fax, and e-mail; c. agreement number(s) if reporting by agreement(s); d. reporting period; e. amount of foreign taxes assessed by each foreign government; f. amount of any foreign taxes reimbursed by each foreign government; g. amount of foreign taxes unreimbursed by each foreign government. 6) Subagreements. The recipient must include this reporting requirement in all applicable subgrants and other subagreements. 6. Termination ° U CDC may impose other enforcement actions in accordance with 45 CFR 75.371- Remedies for Y Noncompliance, as appropriate. 3 The Federal award may be terminated in whole or in part as follows: E U_ (1) By the HHS awarding agency or pass -through entity, if the non -Federal entity fails to comply a� with the terms and conditions of the award; L (2) By the HHS awarding agency or pass -through entity for cause; w (3) By the HHS awarding agency or pass -through entity with the consent of the non -Federal entity, in which case the two parties must agree upon the termination conditions, including the LO effective date and, in the case of partial termination, the portion to be terminated; or `= (4) By the non -Federal entity upon sending to the HHS awarding agency or pass -through entity U U written notification setting forth the reasons for such termination, the effective date, and, in the U case of partial termination, the portion to be terminated. However, if the HHS awarding agency v or pass -through entity determines in the case of partial termination that the reduced or modifiedLn N portion of the Federal award or subaward will not accomplish the purposes for which the Federal c award was made, the HHS awarding agency or pass -through entity may terminate the Federal N award in its entirety. N G. Agency Contacts CDC encourages inquiries concerning this NOFO. Program Office Contact For programmatic technical assistance, contact: First Name: Stacy Last Name: De Jesus Project Officer Page 56 of 64 Packet Pg. 298 Department of Health and Human Services Centers for Disease Control and Prevention Address: Telephone: Email: NCCDPHP_CHW@cdc.gov Grants Management Office Information For financial, awards management, or budget assistance, contact: First Name: Rhonda Last Name: Latimer Grants Management Specialist Department of Health and Human Services Office of Grants Services Address: 2939 Flowers Rd. South KOGR Bldg, VANDE Rm 211, MS TV-2 Atlanta, GA 30341 Telephone: Email: itol@cdc.gov For assistance with submission difficulties related to www. rg ants.gov, contact the Contact Center by phone at 1-800-518-4726. Hours of Operation: 24 hours a day, 7 days a week, except on federal holidays. CDC Telecommunications for persons with hearing loss is available at: TTY 1-888-232-6348 H. Other Information Following is a list of acceptable attachments applicants can upload as PDF files as part of their application at www.grants.gov. Applicants may not attach documents other than those listed; if other documents are attached, applications will not be reviewed. • Project Abstract • Project Narrative • Budget Narrative • Report on Programmatic, Budgetary and Commitment Overlap • Table of Contents for Entire Submission For international NOFOs: Page 57 of 64 Packet Pg. 299 • SF424 • SF424A • Funding Preference Deliverables Optional attachments, as determined by CDC programs: Memorandum of Agreement (MOA) Memorandum of Understanding (MOU) Bona Fide Agent status documentation, if applicable Indirect Cost Rate, if applicable Position descriptions Letters of Support Required Attachments: • Resumes/CVs • Letters of Support • Staffing plan, can include position descriptions Other Optional attachments • County agreement letter I. Glossary Activities: The actual events or actions that take place as a part of the program. LO N Administrative and National Policy Requirements, Additional Requirements(ARs): Administrative requirements found in 45 CFR Part 75 and other requirements mandated by v statute or CDC policy. All ARs are listed in the Template for CDC programs. CDC programs v must indicate which ARs are relevant to the NOFO; recipients must comply with the ARs listed C in the NOFO. To view brief descriptions of relevant provisions, see http:// www.cdc.gov/ grants / N additional requirements/ index.html. Note that 2 CFR 200 supersedes the administrative o requirements (A-110 & A-102), cost principles (A-21, A-87 & A-122) and audit requirements N (A-50, A-89 & A-133). N Approved but Unfunded: Approved but unfunded refers to applications recommended for approval during the objective review process; however, they were not recommended for funding z by the program office and/or the grants management office. Assistance Listings: A government -wide compendium published by the General Services Administration (available on-line in searchable format as well as in printable format as a .pdf file) that describes domestic assistance programs administered by the Federal Government. Q Assistance Listings Number: A unique number assigned to each program and NOFO throughout its lifecycle that enables data and funding tracking and transparency. Page 58 of 64 Packet Pg. 300 Award: Financial assistance that provides support or stimulation to accomplish a public purpose. Awards include grants and other agreements (e.g., cooperative agreements) in the form of money, or property in lieu of money, by the federal government to an eligible applicant. Budget Period or Budget Year: The duration of each individual funding period within the period of performance. Traditionally, budget periods are 12 months or 1 year. Carryover: Unobligated federal funds remaining at the end of any budget period that, with the approval of the GMO or under an automatic authority, may be carried over to another budget period to cover allowable costs of that budget period either as an offset or additional authorization. Obligated but liquidated funds are not considered carryover. Continuous Quality Improvement: A system that seeks to improve the provision of services with an emphasis on future results. Contracts: An award instrument used to acquire (by purchase, lease, or barter) property or services for the direct benefit or use of the Federal Government. Cooperative Agreement: A financial assistance award with the same kind of interagency relationship as a grant except that it provides for substantial involvement by the federal agency funding the award. Substantial involvement means that the recipient can expect federal programmatic collaboration or participation in carrying out the effort under the award. Cost Sharing or Matching: Refers to program costs not borne by the Federal Government but by the recipients. It may include the value of allowable third -party, in -kind contributions, as well as expenditures by the recipient. Direct Assistance: A financial assistance mechanism, which must be specifically authorized by statute, whereby goods or services are provided to recipients in lieu of cash. DA generally CD involves the assignment of federal personnel or the provision of equipment or supplies, such as N vaccines. DA is primarily used to support payroll and travel expenses of CDC employees assigned to state, tribal, local, and territorial (STLT) health agencies that are recipients of grants v and cooperative agreements. Most legislative authorities that provide financial assistance to c STLT health agencies allow for the use of DA. http:// www.cdc.gov c� /grants/additionalrequirements /index.html. cV, M DUNS: The Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number is a CD nine -digit number assigned by Dun and Bradstreet Information Services. When applying for N Federal awards or cooperative agreements, all applicant organizations must obtain a DUNS Q number as the Universal Identifier. DUNS number assignment is free. If requested by telephone, O a DUNS number will be provided immediately at no charge. If requested via the Internet, z obtaining a DUNS number may take one to two days at no charge. If an organization does not a know its DUNS number or needs to register for one, visit Dun & Bradstreet at z http://fedgov.dnb.com/ webform/displayHomePage.do. Evaluation (program evaluation): The systematic collection of information about the activities, characteristics, and outcomes of programs (which may include interventions, policies, and specific projects) to make judgments about that program, improve program effectiveness, and/or inform decisions about future program development. Page 59 of 64 Packet Pg. 301 Evaluation Plan: A written document describing the overall approach that will be used to guide an evaluation, including why the evaluation is being conducted, how the findings will likely be used, and the design and data collection sources and methods. The plan specifies what will be done, how it will be done, who will do it, and when it will be done. The NOFO evaluation plan is used to describe how the recipient and/or CDC will determine whether activities are implemented appropriately and outcomes are achieved. Federal Funding Accountability and Transparency Act of 2006 (FFATA): Requires that information about federal awards, including awards, contracts, loans, and other assistance and payments, be available to the public on a single website at www.USAspending.gov. Fiscal Year: The year for which budget dollars are allocated annually. The federal fiscal year starts October 1 and ends September 30. Grant: A legal instrument used by the federal government to transfer anything of value to a recipient for public support or stimulation authorized by statute. Financial assistance may be money or property. The definition does not include a federal procurement subject to the Federal Acquisition Regulation; technical assistance (which provides services instead of money); or assistance in the form of revenue sharing, loans, loan guarantees, interest subsidies, insurance, or direct payments of any kind to a person or persons. The main difference between a grant and a cooperative agreement is that in a grant there is no anticipated substantial programmatic involvement by the federal government under the award. Grants.gov: A "storefront" web portal for electronic data collection (forms and reports) for federal grant -making agencies at www. _rg ants.gov. Grants Management Officer (GMO): The individual designated to serve as the HHS official responsible for the business management aspects of a particular grant(s) or CD cooperative agreement(s). The GMO serves as the counterpart to the business officer of the N recipient organization. In this capacity, the GMO is responsible for all business management matters associated with the review, negotiation, award, and administration of grants and v interprets grants administration policies and provisions. The GMO works closely with the c program or project officer who is responsible for the scientific, technical, and programmatic c� aspects of the grant. N M Grants Management Specialist (GMS): A federal staff member who oversees the business and o other non -programmatic aspects of one or more grants and/or cooperative agreements. These N activities include, but are not limited to, evaluating grant applications for administrative content Q and compliance with regulations and guidelines, negotiating grants, providing consultation and p technical assistance to recipients, post -award administration and closing out grants. Z Health Disparities: Differences in health outcomes and their determinants among segments of the population as defined by social, demographic, environmental, or geographic category. Health Equity: Striving for the highest possible standard of health for all people and giving special attention to the needs of those at greatest risk of poor health, based on social conditions. Health Inequities: Systematic, unfair, and avoidable differences in health outcomes and their determinants between segments of the population, such as by socioeconomic status (SES), demographics, or geography. Page 60 of 64 Packet Pg. 302 Healthy People 2030: National health objectives aimed at improving the health of all Americans by encouraging collaboration across sectors, guiding people toward making informed health decisions, and measuring the effects of prevention activities. Inclusion: Both the meaningful involvement of a community's members in all stages of the program process and the maximum involvement of the target population that the intervention will benefit. Inclusion ensures that the views, perspectives, and needs of affected communities, care providers, and key partners are considered. @ Indirect Costs: Costs that are incurred for common or joint objectives and not readily and n specifically identifiable with a particular sponsored project, program, or activity; nevertheless, these costs are necessary to the operations of the organization. For example, the costs of operating and maintaining facilities, depreciation, and administrative salaries generally are considered indirect costs. Letter of Intent (LOI): A preliminary, non -binding indication of an organization's intent to E submit an application. 0 0 U L Lobbying: Direct lobbying includes any attempt to influence legislation, appropriations, Y regulations, administrative actions, executive orders (legislation or other orders), or other similar 3 deliberations at any level of government through communication that directly expresses a view E on proposed or pending legislation or other orders, and which is directed to staff members or ,M other employees of a legislative body, government officials, or employees who participate in formulating legislation or other orders. Grass roots lobbying includes efforts directed at inducing or encouraging members of the public to contact their elected representatives at the federal, state, x or local levels to urge support of, or opposition to, proposed or pending legislative proposals. w Logic Model: A visual representation showing the sequence of related events connecting the activities of a program with the programs' desired outcomes and results. N Maintenance of Effort: A requirement contained in authorizing legislation, or applicable v regulations that a recipient must agree to contribute and maintain a specified level of financial U effort from its own resources or other non -government sources to be eligible to receive federal v grant funds. This requirement is typically given in terms of meeting a previous base -year dollar un amount. Memorandum of Understanding (MOU) or Memorandum of Agreement(MOA): N M Document that describes a bilateral or multilateral agreement between parties expressing a convergence of will between the parties, indicating an intended common line of action. It is often N used in cases where the parties either do not imply a legal commitment or cannot create a legally Q enforceable agreement. p z Nonprofit Organization: Any corporation, trust, association, cooperative, or other organization that is operated primarily for scientific, educational, service, charitable, or similar purposes in the E public interest; is not organized for profit; and uses net proceeds to maintain, improve, or expand the operations of the organization. Nonprofit organizations include institutions of higher Q educations, hospitals, and tribal organizations (that is, Indian entities other than federally recognized Indian tribal governments). Notice of Award (NoA): The official document, signed (or the electronic equivalent of signature) by a Grants Management Officer that: (1) notifies the recipient of the award of a grant; (2) contains or references all the terms and conditions of the grant and Federal funding limits and Page 61 of 64 Packet Pg. 303 obligations; and (3) provides the documentary basis for recording the obligation of Federal funds in the HHS accounting system. Objective Review: A process that involves the thorough and consistent examination of applications based on an unbiased evaluation of scientific or technical merit or other relevant aspects of the proposal. The review is intended to provide advice to the persons responsible for making award decisions. Outcome: The results of program operations or activities; the effects triggered by the program. For example, increased knowledge, changed attitudes or beliefs, reduced tobacco use, reduced morbidity and mortality. Performance Measurement: The ongoing monitoring and reporting of program accomplishments, particularly progress toward pre -established goals, typically conducted by program or agency management. Performance measurement may address the type or level of program activities conducted (process), the direct products and services delivered by a program (outputs), or the results of those products and services (outcomes). A "program" may be any activity, project, function, or policy that has an identifiable purpose or set of objectives. Period of performance —formerly known as the project period - : The time during which the recipient may incur obligations to carry out the work authorized under the Federal award. The start and end dates of the period of performance must be included in the Federal award. Period of Performance Outcome: An outcome that will occur by the end of the NOFO's funding period Plain Writing Act of 2010: The Plain Writing Act of 2010 requires that federal agencies use w clear communication that the public can understand and use. NOFOs must be written in clear, CD LO consistent language so that any reader can understand expectations and intended outcomes of the funded program. CDC programs should use NOFO plain writing tips when writing N NOFOs. Program Strategies: Strategies are groupings of related activities, usually expressed as v general headers (e.g., Partnerships, Assessment, Policy) or as brief statements (e.g., Form partnerships, Conduct assessments, Formulate policies). v Program Official: Person responsible for developing the NOFO; can be either a project officer, N program manager, branch chief, division leader, policy official, center leader, or similar staff o member. N Public Health Accreditation Board (PHAB): A nonprofit organization that works to promote and protect the health of the public by advancing the quality and performance of public health departments in the U.S. through national public health department accreditation hllp://www.phaboard.org. Social Determinants of Health: Conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality - of -life outcomes and risks. Statute: An act of the legislature; a particular law enacted and established by the will of the legislative department of government, expressed with the requisite formalities. In foreign or civil law any particular municipal law or usage, though resting for its authority on judicial decisions, or the practice of nations. Page 62 of 64 Packet Pg. 304 Statutory Authority: Authority provided by legal statute that establishes a federal financial assistance program or award. System for Award Management (SAM): The primary vendor database for the U.S. federal government. SAM validates applicant information and electronically shares secure and encrypted data with federal agencies' finance offices to facilitate paperless payments through Electronic Funds Transfer (EFT). SAM stores organizational information, allowing www. ra�nts.gov to verify identity and pre -fill organizational information on grant applications. Technical Assistance: Advice, assistance, or training pertaining to program development, implementation, maintenance, or evaluation that is provided by the funding agency. Work Plan: The summary of period of performance outcomes, strategies and activities, personnel and/or partners who will complete the activities, and the timeline for completion. The work plan will outline the details of all necessary activities that will be supported through the approved budget. Community Health Worker - A community health worker is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. [accessed from www.apha.org 12/14/2020] Bona Fide Agent - ❑ a bona fide agent is an agency/organization identified as eligible to submit an application in lieu of a state application. If applying as a bona fide agent, a legal, binding agreement from the state, tribal, territorial, or local government as documentation of the status is required. Attach with "Other Attachment Forms" when submitting via grants. gov. Innovation - Novel combinations or uses of preexisting efforts [programs, tools, ideas, etc.] toLn enable or enhance the solution to a need[] N HHS Regions - The Department of Health and Human Services Office of Intergovernmental and v External Affairs hosts 10 Regional Offices in various cities across the United States. These v offices each oversee a geographic area, or region, across multiple states and are maintained to u, ensure that the Department is able to remain in close contact with state, local, or tribal partners M and to ensure HHS programs and policies address the needs of individuals and communities across the country. For details on each region or Regional Office, visit Regional Offices I N HHS.gov Q References/Resources 1. Centers for Disease Control and Prevention (2019). CHW Forum: Community Health Worker Forum: Engaging Community Health Workers in the Development of a Statewide Infrastructure for Sustainability. Retrieved fromhttDs://www.cdc.i!ov/diabetes/nroLrams/stateandlocal/resources/chw- forum.html 2. Department of Health and Human Services (HHS, 2020. Healthy People 2030. Emergency Preparedness. Retrieved from https://health.gov/healthypeople/objectives- and-data/browse-objectives/emergency-preparedness Page 63 of 64 Packet Pg. 305 3. Department of Health and Human Services (HHS, 2020). Compendium of Federal Datasets Addressiniz Health Disparities 4. HRSA 2019-2020 Health Equity Report: Special Feature on Housing and Health Inequalities. Retrieved from https://www.hrsa.gov/sites/default/files/hrsa/health- eguity/HRSA-health-equity-report.pdf 5. National Stakeholder Strategy for Achieving Health Equity. Retrieved from https://sph.umd.edu/sites/default/files/files/NSS_SummM0405_1 .pdf a� 6. National Association of Community Health Workers (2020). See New report on sustainable financing for CHWs. 7. World Health Organization (2018). WHO launches new guideline on health policy and system support to optimize community health worker programmes. Retrieved from hgps://www.who.int/hrh/communily/guideline-health-support-optimize-hw- programmes/en/ 3 8. Centers for Disease Control and Prevention (2020). Resources for Community Health E Workers, Community Health Representatives and Promotores de la Salud. Retrieved c0 from Resources for Community Health Workers, Community Health Representatives, and Promotores de la Salud I CDC. L 9. NCCDPHP Success Stories Application: This online application provides a step-by-step 3 template for awardees as they develop their success stories. Awardees can use the E application to create stories for their own needs or choose to submit the story to CDC for a_ consideration in the online library. helps://nccd.cdc.gov/NCCDSuccessStories/ 10. The application is supported by the Success Stories Development Guide. This Word document guides users through the sections of the NCCDPHP Success Stories application w and helps them prepare a story for submission: https://nccd.cdc.gov/NCCDSuccessStories/pdfs/Success_ Stories_Developme LO nt Guide.docx N 11. Centers for Disease Control and Prevention (2020), National Center for Health Statistics. Health Disparities: Race and Hispanic Origin. Retrieved from COVID-19 Provisional v Counts - Health Disparities (cdc.gov). c 12. People at Increased Risk and Other People Who Need to Take Extra Precautions: Do ILn v need to Take Extra Precautions Aizainst COVID-19 1 CDC N Page 64 of 64 M O Packet Pg. 306 DP21-2109: Community Health Workers for COVID Response and Resilient Communities Annual Evaluation Report for Collier County Program Year 1: 8/31/2021-8/30/2022 Executive Summary Evaluation Results • CHWs are gaining knowledge and skills to serve community members (clients) in Extra Mile, at-risk communities. Gaps are being identified and addressed. • Community partners/stakeholders are appreciative of the CHW outreach into the community, connecting clients to medical and other services. • Some in the community find CHWs to be valuable partners but there is a need to continue to communicate about the role of CHWs and their impact on a vulnerable population. • Community members/clients are favorable about the work of CHWs. The Haitian-Creole speaking population acknowledged hesitancy about COVID-19 testing and vaccinations because of their faith, yet their interplay with the CHW played a pivotal role in their health care decisions. • Client success stories speak to the positive im pact CHWs are having on the quality of life for many living in Extra Mile communities where services are limited and barriers exist such as technology and transportation. How Results are Being Used Program evaluation results are providing direction for Year 2, including: • Additional training, guidance and one-on-one support for CHWs to feel confident and competent in their roles; more self-care services for CHWs will be implemented. • If/when CHWs leave the team, make concerted efforts to recruit a new CHW fro m an Extra Mile community— they will be more accepted by clients, and will know the needs and the resources available. • Continuing to expand community engagement and partnerships, with greater involvement and improved information sharing strategies being developed. • More marketing/communication tactics (messages and methods) in targeted Extra Mile communities about CHWs and their role, not only to increase understanding but also to make CHWs feels supported. Lessons Learned • It is critical to more fully engage CHWs in setting annual goals and objectives, and in planning and implementing outreach efforts. Year 1 plans may have been too aggressive as they were developed before CHWs were in their roles. For example, a comprehensive analysis of data collected from clients has not been completed. • Continue efforts to better understand culture and language barriers in reaching out to clients and in developing evaluation tools, such as surveys and focus group questionnaires. • Marketing messages and methods about CHWs and their roles need to be refined for greater impact in the targeted communities. Train: Strategy CB1 Description This strategy addresses measures the level of change in the knowledge of the six CHWs as they participated in onboarding, orientation and training on specifics about CHW roles, as well as health issues, unique needs of the community and referrals to resources. Process/Outcome Questions As the process, HCN and PIH developed and utilized pre-tests and post-tests for the orientation and training sessions, as well as an evaluation tool to give HCN and PIH leaders a guide for understanding the level of knowledge, competency and level comfort of CHWs to perform home visits and provide education and services at health fairs and COVID-19 testing events. Outcomes were measures of change in subject matter knowledge for pre and post-tests, and observation of CHWs performing their roles with confidence and competence. Methods After each training, reports were created to summarize pre- and post-test scores and identify areas of additional training and education. In recent weeks, post -training debriefing by HCN and PIH provided real-time opportunities to enhance the training experience for CHWs. The CHW shadowing evaluation tool was used to provide immediate constructive feedback and guidance to CHWs to improve their performance in connecting with, identifying needs/concerns and effectively providing education to clients in home visits, health fairs and COVID-19 testing events. Key Evaluation Findings While they may know the concepts and content, some CHWs do not always test well, which speaks to a difference in knowledge/skill assimilation, requiring additional personal follow up and coaching. Deploy: Strategy CB3 Description This strategy’s evaluation examined the question “What were the levels of integration of CHWs into organizations and entities supporting COVID-19 response efforts?”. The population of focus for this question are the community partners and stakeholders that work with CHWs, including the Collier County Community Health Coalition (CCCHC). Process/Outcome Questions Process measures included indicators on the number of meetings with community partners/stakeholders and the CCCHC. CCCHC members were asked via survey to indicate their meeting frequency, involvement, and usefulness of the meetings and material provided. Outcome measures utilized a mixed-methods approach in which quantitative and qualitative instruments were used to collect data on stakeholders’ perception of the CHW and their work in the community. CCCHC members were asked via survey to indicate activities/partnerships that have resulted from the meetings in addition to future programmatic needs. In addition, six community partners were interviewed about the role of the CHW in the community and their collaborations. Specifically, partners were asked to indicate perceived strengths, weaknesses, opportunities, and threats to the CHW program. Evaluation Methods With input from the CCCHC, a stakeholder survey was developed to assess CCCHC members perception of the bi-weekly meetings they hold on the CHW program. A total of 8 participants completed the 10-question survey that was distributed via e-mail to CCCHC members from June 20 to July 1, 2022. Data were analyzed in Qualtrics by Dr. Goldfarb and presented as a report to the Healthcare Network and CCCHC (attached). With input from the CCCHC, an interview guide was developed to assess community partners’ perception of the CHW program in the community. Six community partners were given separate interviews via Zoom in August 2022, all of which were led by Dr. Goldfarb. Audio files were transcribed by Collier County and thematic analyses completed by Dr. Goldfarb and presented as a report to HCN and CCCHC (attached). Key Evaluation Findings The CCCHC stakeholder survey found that most members reported attending meetings regularly, participating often/always, and stated that the meetings were very useful to them. Almost all of the respondents indicated that the meetings are very valuable to their work and that they often/always use the material presented. Respondents have indicated that the meetings have led to additional collaborations, partnerships, and shared resources. The meetings have also led to more streamlined planning and coordinating of community activities. Respondents stated that it has been most helpful to hear about the CHW outreach efforts and collaborating with others about the work plan, activities, and addressing health care gaps. In future meetings, respondents indicated a desire to identify new communities to reach out to, determine exact figures on the community’s unmet needs, and discuss health education material (ensuring that the material is in three languages: Spanish, Creole, and English). These findings will be used by HCN to tailor future meetings to meet the needs of CCCHC members. The community partner interview report found that they were highly appreciative of the services provided by HCN and the collaborations that they have formed with the organization. The HCN CHW team was praised for its leadership, partnerships, and proactive collaborations with other agencies to serve the needs of community members. The stakeholders had a clear understanding of the services provided by the team. They stated that the team has improved community health through activities related to COVID-19 as well as other health care services such as physicals, health education sessions, or referrals. The CHWs were consistently described by stakeholders as being well-trained, prepared, and professional. It was stated that the team’s diversity and reliability allowed them to build the community’s trust, alongside the high quality of care that HCN provides. Related to the potential challenges that the team may face in the present or future, the transiency of the community members, need for additional staff and funding, and leadership changes were stated. Related to potential opportunities, stakeholders mentioned the growth of community needs and greater outreach services for the team to consider expanding upon. Areas of improvement for the team include greater community awareness of their service provision to all members, greater mental health education and specialty care resources, and being open to change and more internal dialogue. These findings will be used by HCN in future program activities for Year 2 to meet community partner needs. Deploy: Strategy CB4 Description This strategy’s evaluation examined the question “How well were messages received by the population of focus?”. The population of focus for this question are the community members and CHWs in Collier County. Process/Outcome Questions Process measures included indicators on the number of community members served by the CHWs. Outcome measures utilized a mixed-methods approach in which quantitative and qualitative instruments were used to collect data on the CHW and community members’ perception of the CHW program’s impact on the community. CHWs were asked via a focus group about how they felt their work was perceived by the community and how the work can be improved. Community members were asked via a survey and two focus groups to indicate awareness of the CHW program and increased knowledge of topics presented by CHWs. Evaluation Methods A focus group guide was developed to assess CHWs perception of the program. A total of 6 CHWs were present for a focus group conducted via Zoom by Dr. Goldfarb on August 30, 2022. The audio file was transcribed using a third-party service (GMR transcription) and thematic analyses completed by Dr. Goldfarb. The results were presented as a report to the Healthcare Network and CCCHC (attached). In addition, a focus group guide was developed to assess community members’ perception of the CHW program. Two in-person focus groups were conducted, one led in Spanish by Mr. Roggiero on September 2, 2022 and one led in Haitian Creole by Dr. Beauchamp on September 6, 2022. The Spanish audio file was translated and transcribed by a third-party service (GMR transcription) while the Haitian Creole audio file was translated and transcribed by a team member. Thematic analyses for both focus groups were completed by Dr. Goldfarb and presented as separated reports to Healthcare Network and CCCHC (attached). Lastly, a survey was also developed to assess increased knowledge and awareness of the CHW program and materials. A total of 56 participants completed the 14-question survey that was distributed via iPad at CHW events from August 16-30, 2022. Data were analyzed in Qualtrics by Dr. Goldfarb and presented as a report to the Healthcare Network and CCCHC (attached). All instruments were developed with input from the CCCHC. Key Evaluation Findings The CHW focus group found that the most helpful training/resources/information provided by the CHW program involved role-play, shadowing, or contained medical tra ining. Those sessions that were deemed unhelpful involved repetitive trainings. Many suggestions were given for future sessions related to CHW self-care, cultural competency, home visits, clinical care, collaboration with partners, and an internal time/pla ce to dialogue. Barriers identified in the CHW role/program included transportation and group dynamics. Within the community, CHWs identified barriers related to the lack of awareness of the CHW role, CHW discomfort with the community outside of Immokalee, and a lack of community knowledge/education. The CHWs identified several opportunities to address the barriers identified including marketing of the CHW role and program, community education/literacy sessions, staff assistance with applications, and more engagement with community leaders. These findings will be used by Healthcare Network to tailor future activities and priorities for the CHW program. The community members in the Spanish-speaking focus group felt that the CHWs had demonstrated knowledge and a strong presence in the community for providing services and referrals to care. They also appreciated that the CHWs spoke the same language as them. Barriers identified to receiving CHW services by other community members included transportation, missing work, and a lack of interest in or knowledge of the services. Community members had limited suggestions for program improvement. Rather, they hoped that CHWs would continue to provide more information to the community through campaigns and handouts . The community members in the Creole-speaking focus group felt that the CHWs had demonstrated kindness and trusted them to provide health information and services to them. They also appreciated that the CHWs spoke the same language as them. Barriers identified to receiving CHW services by other community members included a lack of knowledge of the information/services due to negligence or work and a need for further assistance in hospital care. Community members suggested increasing home visits, providing more information on COVID treatment and protocols, hiring more CHWs to assist, and providing more incentives/money to address these barriers. The community member survey found that most respondents encountered CHWs primarily through COVID testing events in the past three months. Respondents primarily received information from CHWs related to how to stop the spread of COVID and COVID testing. Over 80% of respondents from almost every topic found the educational materials provided by the CHW on that topic to be extremely or very effective. Moreover, 90% or more of respondents from every topic stated that they strongly agree or agree that the information provided by the CHW increased their knowledge of that topic. Fifty percent or more of respondents for the following topics stated that they have always or often talked to others about: How to stop the spread of COVID, COVID testing, COVID vaccination, and access to dental care. Of importance, over half of respondents from every topic stated that the community health worker has led them to seek more information on that topic. All of these findings will be used by HCN in future program activities for Year 2 to meet community member needs. Engage: Strategy CB5 Description This strategy’s evaluation examined the question “What level of change/impact resulted from messages delivered to populations of focus?”. The population of focus for this question are the community members and CHWs in Collier County. Process/Outcome Questions Process measures included indicators on the number of community members served by the CHWs. Outcome measures utilized a mixed-methods approach in which quantitative and qualitative instruments were used to collect data on the CHW and community members’ perception of the CHW program’s impact on the community. CHWs were asked via a focus group about how they felt their work was perceived by the community and how the work can be improved. Community members were asked via a survey and two focus groups to indicate awareness of the CHW program and increased knowledge of topics presented by CHWs. Evaluation Methods CB5 utilized the same evaluation methods presented in CB4. Key Evaluation Findings The CHW focus group found that the CHWs felt the work they did was important to the community as demonstrated in their stories of the most significant change they have made in the community as a CHW. They felt that their team diversity and departmental collaboration were strengths to the CHW program. These findings will be used by HCN to tailor future activities and priorities for the CHW program. The community members in the Spanish-speaking focus group responded favorably to the work of the CHWs. Related to COVID-19, there remains hesitancy to receive services. However, one community member felt the knowledge received by the CHW allowed him to receive services and provide information to others . The community members in the Creole-speaking focus group also responded favorably to the work of the CHWs. Regarding COVID-19, community members expressed a hesitancy to receive services and acknowledged that their faith (and its interplay with the CHW) played a pivotal role in their health care decisions. The community member survey found that 50% or more of respondents stated that they received a referral by the CHW to get a service or treatment for the following topics: COVID testing, COVID vaccination, access to dental care, and access to pharmacy/prescriptions. Of respondents from every top ic who received a CHW referral, 50% or more of respondents went on to get that service. Moreover, 50% or more of respondents who received that service stated that it was helpful for every topic, with the exception of access to medical care . All of these findings will be used by HCN in future program activities for Year 2. Engage: Strategy CB6 Description This strategy’s evaluation focused on Social Determinants of Health (SDOH) screening and client case management data. The population of focus for this question are the community members (clients) in Extra Mile communities in Collier County. Process/Outcome Questions Process measures included indicators on the feedback from clients on the referrals made and services provided to clients testing positive for COVID-19 or identified with underlying health conditions related to a PRAPARE survey or a health screening (blood pressure, blood sugar). Outcome measures utilized a mixed-methods approach in which quantitative and qualitative data was collected on clients, including health conditions and referrals made to medical and others services. Evaluation Methods PRAPARE data and case management summaries are captured in databases and stored in a centralized, secure file. Each week, CHWs identify and share “success stories” of client cases. Key Evaluation Findings A comprehensive analysis of data collected from clients will be conducted in Year 2. In the meantime, many clients report to CHWs a higher quality of life and appreciate the referrals to medical and other services. CHWs continue to follow and report out on clients receiving case management, sharing “success stories” which are shared internally with the Outreach team and others at HCN, as well as through social media and other external communications, including newsletters. Challenges Several of the greatest challenges were : involving CHWs in the goal setting and program evaluation; time constraints to complete components of the evaluation plan; language/cultural competency of staff/evaluation team for focus group and other research; creating and implementing a plan for data analysis of PRAPARE and case management reports. Lessons Learned CHWs will be more actively involved in setting annual goals, advising on marketing/communication strategies and supporting program evaluation efforts. Also, it is critical to gather more community and stakeholder input into evaluation instrument development (e.g., changing opening question for Haitian Creole focus group). Dissemination Evaluation results for CB3 to CB5 were delivere d to HCN from the evaluators as reports (see attachments). Reports were disseminated by Healthcare Network to members of the Collier County Community Health Coalition (CCCHC). The information has also been presented at the bi-weekly CCCHC meetings for feedback. Additional communications with stakeholders, community leaders and the general public will be planned for Year 2. Attachments The following reports were developed and disseminated to members of the Collier County Community Health Coalition and are attached for review: • Collier County Community Health Coalition (CCCHC) Stakeholder Survey Report • Collier County Stakeholder Interview Report • Collier County Community Member Survey Report • Collier County Community Member Focus Group Report – Spanish • Collier County Community Member Focus Group Report – Haitian Creole • Collier County Community Health Worker Focus Group Report Collier County Community Health Coalition (CCCHC) Stakeholder Survey Re port Collier County Community Health Coalition Stakeholder Survey Report Participant Characteristics A total of 8 participants completed a stakeholder survey given to the Collier County Community Health Coalition (CCCHC) in June of 2022. Participants were asked to identify the entity with which they are associated. The type of entities identified include the following: health care organization (n=5; 62.5%), community-based organization (n=1; 12.5%), faith-based organization (n=1; 12.5%), and other (n=1; 12.5%). The ‘other’ respondent specified ‘NGO’ as his/her/their entity. Survey Measures and Questions The survey was developed by Drs. Samantha Goldfarb and Jeff Harman (with input from the CCCHC) and administered through Qualtrics from June 20, 2022 to July 1, 2022. Respondents were asked the following close-ended questions: 1) How frequently have you attended the Collier County Community Health Coalition (CCCHC) meetings in the past six months or since you have joined/been invited to attend? 2) Please rate the usefulness of CCCHC meetings in allowing you to develop partnerships. 3) Please choose the response that best indicates your level of involvement in the CCCHC meetings. 4) Please choose the response that best indicated your agreement about the content presented in the CCCHC meetings. 5) How frequently have you utilized the material and information presented at these meetings? Respondents were also asked the following open-ended questions: 1) Please briefly describe activities or partnerships that have resulted from the meetings (if any). 2) What material or information did you find most helpful at the meetings? 3) What kind of material or information (that hasn’t been shared already) would be helpful to receive at the meetings? 4) Are there ways that the meetings may be structured differently to better support your programmatic needs? 5) Is there anything else you would like to add about the meetings themselves and/or the partnerships that have resulted from the meetings? For the results section, any “not applicable” or blank response to a survey question was not included in the analysis. Frequency of Meeting Attendance For the CCCHC meetings, respondents were asked to report how often they attended the meetings on a four-point scale ranging from “1- Rarely (less than half of all meetings)” to “4- Always (all meetings)” in Collier County Community Health Coalition (CCCHC) Stakeholder Survey Re port which “frequent” is defined as any rating ranging from “3- Often (more than half of all meetings)” to “4- Always (all meetings)”. • Over half of the respondents reported frequently attending the meetings (n=5; 62.5%). Usefulness of Meetings Respondents were asked to rate the usefulness of CCCHC meetings in allowing them to develop partnerships. The response options included: “1- Not at all useful”, “2- Slightly useful”, “3- Moderately useful”, “4- Very useful”, and “5-Extremely useful”. • The majority of respondents rated the meetings as very or extremely useful (n=6; 75%). • The remaining two respondents rated the meetings as moderately useful (n=2; 25%). Level of Involvement in Meetings Respondents were asked to indicate their level of involvement in the CCCHC meetings. The responses included the following options: “1- I make significant contributions to these meetings.”, “2- make some contributions to these meetings.”, “3- I only attend these meetings on an informational basis as I believe it is part of what others expect of me.”, “4- Not applicable.”, and “5- Other: please specify”. Being “involved” is defined by choosing response option 1 or 2. • Over half of respondents reported being involved in the meetings (n=5; 62.5%). Content Provided at Meetings Respondents were asked to indicate their level of agreement about the content presented at the CCCHC meetings. The response options were: “1- I feel the content is very valuable to my work.”, “2- I feel the content is somewhat valuable to my work.”, “3- I do not feel the content is valuable to my work.”, or “4- Other: please specify.” • Almost all of respondents indicated that the content presented in the CCCHC meetings was very valuable to their work (n = 6; 85.71%). • One respondent indicated that the content was somewhat valuable to his/her/their work (n=1; 14.3%). Frequency of Using Material/Information Provided at Meetings Respondents were asked to indicate the frequency with which they have utilized the material and information presented at the meetings. The response options included: “1- Never”, “2- Rarely”, “3- Sometimes”, “4-Often”, or “5- Always”. Collier County Community Health Coalition (CCCHC) Stakeholder Survey Re port • Almost all of respondents (n=7; 87.5%) reported using the material/information provided at meetings often or always. Activities or Partnerships Resulting from Meetings When asked to describe the activities or partnerships that have resulted from the meetings, respondents stated the following: • “Additional collaborations and shared resources.” • “Ongoing partnerships and coordination between PIH and other groups.” • “We incorporate health care staff with our food distribution to provide information, schedules and answer questions the community has throughout our walkup distribution time every Friday.” • “Planning and review of different activities such as community outreach, testing, CHWs training, workplan review etc.” Material/Information Most Helpful at Meetings When asked about the material or information that has been most helpful at meetings, respondents stated the following: • “The CHW outreach efforts.” • “Updates about CHW community outreach and success stories.” • “Coordination of events; discussion around remaining needs.” • “Networking, sharing of ideas and resources, identifying needs and gaps in health care services.” • “Workplan, activities schedule (testing, canvassing, etc.).” • “Survey.” Material/Information Desired for Future Meetings When asked about material or information that would be helpful to receive at the meetings, respondents stated the following: • “New underserved neighborhoods to reach out to.” • “Exact figures on unmet needs in the community.” • “Just more of the same and any community handouts or info to post in 3 languages: Spanish, Creole and English.” • “Feels the materials shared so far are very helpful.” • “Health education.” Meeting Structure to Support Programmatic Needs When asked if there are ways that the meetings could be structured differently to better support programmatic needs, respondents stated the following: Collier County Community Health Coalition (CCCHC) Stakeholder Survey Re port • “Maybe less updates and more goal settings for each quarter. The work does change often, but finding ways for all attending to collaborate.” • “Yes.” • “The biweekly schedule works great. Having agenda shared ahead of time when possible would be great.” Others felt the meetings worked well as they were: • “Continue to engage all participants in the discussions.” • “Not that I can think of now.” • “I appreciate the zoom meetings.” Additional Comments/Suggestions about Meetings or Partnerships When asked if there was anything respondents would like to add about the meetings themselves or the partnerships that have resulted, they stated the following: • “It would be good to know how the other CHW teams receiving grants are progressing on their goals & plans.” • “Active, regular participation of all partners should be encouraged.” Others expressed no concerns or shared encouragement: • “Not right now.” • “Thank you for all you are doing!” Summary In summary, most respondents reported attending meetings regularly, participating often/always, and finding the meetings to be very useful to them. Importantly, almost all of respondents indicated that the meetings are very valuable to their work and that they often/always use the material presented. Respondents have indicated that the meetings have led to additional collaborations, partnerships, and shared resources. The meetings have also led to more streamlined planning and coordinating of community activities. Respondents stated that it has been most helpful to hear about the CHW outreach efforts and networking/sharing/collaborating with others about the work plan, activities, and addressing health care gaps. In future meetings, respondents indicated a desire to identify new communities to reach out to, determine exact figures on the community’s unmet needs, and discuss health education material (ensuring that the material is in three languages: Spanish, Creole, and English). One respondent requested that fewer updates be given at the meetings in favor of more goal setting for each quarter. Another respondent requested that an agenda be distributed prior to each meeting (when possible). Regarding additional comments and suggestions for improvement, one respondent would like to know how other CHW teams receiving grants have progressed on their goals and plans. Another respondent wanted to ensure that active, regular participation was encouraged. Collier County Community Partner Stakeholder Interview Report Collier County Community Partner Stakeholder Interview Report Participant Characteristics A total of 6 community stakeholders completed an interview in August of 2022. Stakeholders were selected based on availability from a list of community partner names and organizations given by Healthcare Network. Those interviewed included individuals from local non-profit organizations that Healthcare Network works with to serve community members in Collier County. Interview Measure and Questions The interview was developed by Drs. Samantha Goldfarb and Jeff Harman (with input from the CCCHC) and administered through the Zoom platform by Dr. Goldfarb from August 15-22, 2022.The interviews were transcribed via a third party and thematic analyses were conducted by Dr. Goldfarb. Stakeholders were asked the following open-ended questions: 1. How did you first get connected with the Healthcare Network’s Outreach Team – Community Health Workers (hereafter Outreach Team)? 2. How do you feel that your involvement in or partnership with the Outreach Team has impacted you and your organization? a. How about the community? b. Related to COVID-19? c. Related to other health issues? d. Related to social supports to improve population health/health equity? 3. What do you think are the biggest strengths of the Outreach Team? 4. What do you think the Outreach Team could improve on? 5. What do you think the biggest challenges are for the Outreach Team presently or in the future? 6. What do you think the biggest opportunities are for the Outreach Team presently or in the future? 7. This next question will apply if you have been able to attend one of the Collier County Community Health Coalition (CCCHC) meetings. How do you think information from the CCCHC meetings can be used to further improve the needs of the community? 8. Is there anything else you would like to add about the Outreach Team and your role with them? Overall Praise of Healthcare Network An important theme to emerge from the interviews were stakeholders’ praise of the Healthcare Network organization overall, especially in improving access to care for vulnerable populations: • “I just think it's a great partnership and collaboration, and I think it's extremely beneficial to this community and has been for years.” • “…we've been partners for many, many years.” • “…we had just so many organizations that we came together as one, and the goal that we set for ourselves is: OK, we want to be the driving force behind all these disparities that we have in this community, health being one of them, keeping their underlying conditions in check, having the Collier County Community Partner Stakeholder Interview Report availability for them. Letting them know that, just because you're poor, just because you come from another country, just because you work in the fields, that does not deter you from getting good healthcare.” • “…having that access to care that Healthcare Network provides, not only for the homeless, but for other poor folks or people who are insured, all of those things are great value.” • “We are all working towards the same goal, providing some education and some resources for people to get help in dealing with COVID and the sensitive thing was in different languages; that was not always provided by the Department of Health.” Strength of Healthcare Network Outreach Team: Proactive about Partnerships A major theme (and strength) that was identified from the stakeholder interviews was how proactive the Healthcare Network Outreach Team is in engaging and partnering with other community agencies: • “I know when I came on board they reached out with me to want to introduce themselves to the new CEO at [Organization] and to offer additional opportunities for us to partner together.” • “We just built a new center and there were about six members of their staff came out to visit, and we explained what we do and offered a collaboration with them because we now have a medical room. Then, they also invited us to reciprocate and come out to their open house, which was just a couple of weeks ago, which we did, so we know their staff well.” • “I'm disappointed that a lot of my homeless people are not receptive to getting connected, but that's their issue, that's not Healthcare Network’s issue. Many of these folks have problems with transportation, they have problems with cost of prescriptions, they have a lot of issues that get in the way. Many of them are suffering from addictions and those sort of things. So, they're not necessarily a population that's easy to serve, but Healthcare Network has been working with us. I have to say that Julie’s intervention or outreach or her connection to us was pivotal for us getting the healthcare we have received so far and I'm hoping that our partnership and our connection will get even better.” Strength of Healthcare Network Outreach Team: Collaborative Action through Leadership An additional theme that was identified from the stakeholder interviews was how Healthcare Network’s leadership has facilitated collaborations between the Outreach Team and community partners that has led to active engagement with the community: • “I was at their open house for their new CEO and I met some additional staff members all over there, and we had toured the facility, the new facility, maybe in April. We are now going to bus our parents in our program over there on field trips so that they become comfortable with actually using that facility because I believe that we are a great partner and we're working to assist the same population. Then when I was just at this open house, they shared additional information on how they're training people to move into medical fields which is really important for us, because we also have a high school program, and so we're going to bring their HR team in to do some training, and share some information associated with opportunities to go to work there with our high school seniors.” Collier County Community Partner Stakeholder Interview Report • “Their leadership is so willing to adapt to whatever we ask, so again just the bus rolling in here for our backpack event--and it was literally 100 degrees, it was hot--they were here in the morning. There's always a great team that's here, and I think that comes from leadership.” • “…that's another thing that I wanted to mention here-- as far as how it related to health issues, was the mental health part, because we saw a lot of our families not being able to pay their rent, not having food. So, the grants that we were fortunate to have, they were specifically for Immokalee. And then we did incentives. We said to Julie, ‘OK, we want to start really getting out to these folks, but we need to come up with an idea.’ So I asked our donor, ‘Can we give out incentives for getting the vaccines?’ and they said, ‘Of course, you do what you have to do.’ So, we gave out gift cards and that was kind of the motivation for my community to come out and say ‘OK.’ ‘But you really have to go through all of these booths and you really have to try to get information on COVID. We're not going to force you to get the vaccine, but at least get all this information.’ And our first health fair was a great success. We really did get a lot of families to get the vaccine, the first vaccine, and then emphasize: ‘You got to come back.’ Julie, the next one was at 21 days later, they were back here to make sure that we were going to do the second dose. So, working with the community and relating to the COVID was specifically: have access to the vaccines, and not only did they not say: ‘OK we can only do it from this time to this time.’ It was a Saturday, it was even a Sunday, Julie even reached out to us and said ‘should we do a Sunday?’ So, for them to even say: ‘let's do this when it's more convenient for farmworkers to have access,’ was even just, I was really proud that we didn't have to offer that information, that Julie brought that up to us.” • “But, just combating the inequities was a challenge and I think we have a lot of work to do, but through Healthcare Network, they’re such a great partner. And I know that you can count on them for anything. And Julie, I’ll tell Julie: ‘I had an idea, what you think?’ and she's like ‘OK, let's do it.’” • “And Julie does the same thing, she really just, we give her an idea and she thinks about it, and she runs with it.” • “…one of the things Julie did was set up an outreach type or mini health fair that came to us and we got several number of people that we got registered for primary health care.” [Interview #5] • “…we were identified as a spot that had every week gathering with 350 to 450 people coming to our walk-up food distribution, so that was a natural spot because we created a courtyard where it was safe for people to walk. And it was a natural spot for community health workers to begin to talk directly with the residents that all of us sought to serve at that crucial time, the most vulnerable, that had suspicion, but not a lot of facts, had mixed messaging coming, and not always messaging in their language. For the community health workers that was really a strong focus: ‘let’s pull these wonderful resources together and make it accessible language wise’, not just in print, because not all our residents and community members can read. So we made sure we had boots on the ground, people actually talking with community residents. So that's how we got started in a very formal informal way, and had people coming on campus, every Friday afternoon, talking and setting up a table if needed, and talk about Just to what would work best, since we all had the same valuable information and resources for that vulnerable population.” COVID-19 Service Provision The following theme represents stakeholders’ perception or description of the Healthcare Network Outreach Team’s activities related to COVID-19: • “…they've been on campus several times during COVID to assist people with COVID information testing and vaccines both. I think they do a great job, but the information they provide is very clear, which was not always the case going through COVID.” Collier County Community Partner Stakeholder Interview Report • “Very supportive with any of our needs, whether it's testing, or information just whenever and wherever needed.” • “I think that when COVID-19 started, we were all dumbfounded, we didn’t know what it was going to bring to our community, and as that went on, we knew the dangers and what impact it was going to bring. So, I think that by bringing this information, we were able to help many of our listeners in our community gather the information needed to live a healthier life and protect themselves from the virus.” • “I said I was going to call… Julie, we need to do something. We just can't wait for everybody to open up. We need to do something and provide services to come to them because they can't come to you guys. We make an effort to come. So anyway, Julie was on board, Dr. Rosado was on board, and let me tell you, Healthcare Network… boom, immediately says ‘Yes, we'll do it.’ They had their COVID team, they had the community outreach team, they had everything in place, and it just took off from there.” • “We all just came up and we did our first health fair in December of 2020. Julie brought her team out, and just set it up, and the first, we had one in December, and it was a success. But we still had some issues with misinformation. What our community believed and didn't believe, and then of course, the access to our essential workers who were the farmworkers that were still going on the bus, that were still coming home really late, and not have any access to healthcare.” • “So, it greatly benefited our organization, not only the parents, but our staff as well, and with all this misinformation, and all of this going around, they were there to help to just ease and give out the correct information, as they were getting it from the CDC. Also, with the community, it was open to everyone.” • “This is obviously tied to COVID. We've learned to work together. We've kept communication open. There were times when the community health workers built the bridge for us to make sure that funding went to the people in need, the people that tested positive, and we're told, you know, the best way to get through this is to quarantine, and we are there and the community health workers were there to receive the questions ‘What am I going to do about my rent?’, ‘What about getting food on the table?’ And so knowing that we had funds available with a very efficient, but very streamlined process, providing funds for people that we were dealing with COVID and needed to quarantine to help prevent the spread. We connected, they helped fill intake forms for us that we then followed up on. They provided information, with the hotline for people that tested positive for COVID, and wondered ‘Now what?’, they told people ‘If you need assistance so that you can quarantine, call us.’” Provision of Other Health Services The following theme represents stakeholders’ perception or description of the Healthcare Network Outreach Team’s activities related to other health services they provide, such as physicals, health education, referrals, etc.: • “…we've been very pleased with how they adapt the physicals for back to school. That was the first time they had done that not at their site, and it went very well for us. It was a real resource for our parents not to have to go someplace and be ready to go to school.” • “They came out and did a community presentation at our center as well for families.” • “Well, they come in regularly and discuss different matters, different issues, viruses, strains, the different strains and how to protect yourself. So, I think that is something good that our community can take from this source of information, from the radio station. So, I believe that we are doing a good job working, in collaboration, with the clinic, to provide that information to our listeners.” Collier County Community Partner Stakeholder Interview Report • “…because we brought more awareness to the community, specifically, we serve over 900 children in our community. So, not only did it help the organization do the flu shots, have COVID testing, have the vaccines available to our families, and being accessible.” • “A lot of them didn't even know that they had high blood pressure, they did not even know. So, whoever was diagnosed with higher than normal, we gave these to the Healthcare Network, and they were giving them out to anybody that had a higher rate, and to keep checking it into go see a doctor. So, we got a lot of referrals, over 500 referrals, and from just the community to go look for, to get more help for their underlying conditions.” • “I just began working with case management with Healthcare Network. I have one lady who's receiving behavioral assistance, I've had a couple incidences where they've helped with dental, so, the comprehensive nature of the Healthcare Network has been very good.” Community Health Worker s: Well-Trained, Diverse, Prepared Of those interviewed, a primary theme to emerge from stakeholders related to the community health workers themselves. In particular, the team was praised for being well-trained and prepared in serving the community members and their needs: • “…their team was trained really well.” • “They seem really—very—prepared, and the outreach team has a really good understanding of the services that are available and are working hard, I think, to connect with community partners to make sure that they can get the word out.” • “One of the things I’ve seen is the team has different cultures, different races and your able to target not just one group, one culture, but your able to reach out and touch everyone. And I think by having that, we don’t leave nobody out of the loop, and everyone is informed of what health issues is affecting our community.” • “Huge, huge. Really built that bridge to accessibility, and accurate information. I would say that Immokalee did well, thanks to healthcare workers who would be the volunteers or workers at the testing and vaccine sites. Because it takes a lot of people power to put those up. So they were there, there was a real reliability. I know it's hard to sustain the kind of work, you know, sometimes, that people are asked to do. But there was always a rotation of people, you know, new people coming up, and intentional training that took place.” • “Their relatability to the community. They speak the language, they listen. At least that's the goal is to speak with people, not just to give them answers, but to listen to what their concerns are. They are continually getting new information or new training from what I understand.” Community Health Worker s: Professionalism Almost all of the stakeholders interviewed praised the community health workers for their professionalism, as demonstrated below: • “Right after they announced-- the government--announced that vaccines were available for children, they came onto campus, and we had protesters that were across the street associated not with them, but just with children being vaccinated. Their team did not rise to the occasion. They were very respectful and continued to work with the families that were interested. It could have been a situation where if teams weren't prepared for that, it could have become antagonistic. Their team could have been uncomfortable, they maybe would have wanted to Collier County Community Partner Stakeholder Interview Report leave, they maybe would have made our families feel uncomfortable for seeking information, and none of those things happen, so very professional team.” • “If we pick up the phone we know where if someone is not available, we're gonna get a callback.” • “They’re going out to their community, it’s not like they’re sitting at their office trying to pass out information, they are going out, I actually can say, door-to-door giving out information.” • “…they were convenient with the hours, they were very sensitive to our farmworker population, they provided materials in English and if they needed a other languages, and we had they had translators.” • “…it has been absolutely important for you all to realize how professional, how competent, but also how compassionate, they have been with my population. My population isn't always the most attractive group of people because of all kinds of issues and yet their feedback I get from my homeless people is very positive. They feel heard, and they feel supported, and they feel that they’re being kindly treated.” • “So community health workers really helped navigate some of those physical resources of food, diapers and hygiene needs during that quarantine time and it was a delight to work with them, they would come to the mission, we talked, and it was just delightful. They were always there.” Community Health Worker s: Trustworthy, Quality Care In addition to their professionalism, stakeholders praised the community health worker team for their ability to gain the community’s trust and provide high quality care to community members: • “I think the staff across the board is so friendly, that they do a wonderful job of putting people at ease no matter what your background is, no matter what your language is, that I think that families, when they do go there, feel very comfortable, they're not uncomfortable going to the clinic, l which you think a lot of times when you may be an immigrant from another country you don't know what our medical care looks like or what that's gonna be about, ‘Am I gonna have to fill out a lot of forms?’, ‘Is there going to be somebody that can help me?’ and they do a really good job with that.” • “We’re located in Immokalee, Florida which is a very needy community and where multiple services are needed by our families. We know we can reach out to them when we have a need for a family. We've taken students there; we've taken families there.” • “…one thing that I think helps us is once you have listeners, once you have a following, people rely, people kind of trust you, so I think that by opening the doors, they can trust the health department because they believe in us.” • “There is such good healthcare coming from Healthcare Network. That’s how we refer everyone to because of the customer service that you have, and because of how welcome your team makes our families feel.” • “I think it has developed a level of trust that may not have been there with regards to healthcare, and access to healthcare. I think trust is huge. Huge. There's a familiarity now, so now the healthcare workers aren't on site every Friday as much as they used to be, the needs are different, but when they are I can just see a familiarity, a pat on the arm like ‘hey, good to see you how you've been?’ and so there's a comfort there too and there's a trust.” Potential Challenges for Healthcare Network Outreach Team Collier County Community Partner Stakeholder Interview Report Stakeholders were asked if they identified the Healthcare Network Outreach Team as having any potential challenges in the present or future. The following four areas were proposed: 1) Transiency of community • “I would think the biggest challenge would be reaching the migrant families as they come and go, and they're in the camps and located sporadically throughout the community… to finding those families that need the services the most.” 2) Additional staff to prevent burnout • “I really would like to see more people because I saw how they work, I saw those hours, and how tired they were, and how still, they were there presently, healthy, regardless of how whatever they were going through with life, they were there presently, helping, ensuring, giving their 150% to help our families.” • “I think that just challenges are that I think we needed more personnel to help. And Julie, I mean, she stretched her team to the capacity that she could, but I think that's the only thing, it's more funding for them to spread out and not be as so thin with staff.” 3) Funding to provide more health care services • “…they need more money. Again, so much care requires lab work, requires X-rays, scanning, radiology, requires, as I say, specialization, prescriptions to be able to --doctor will prescribe medications-- and if my people don't have the money to get them then those medications are worthless. So, making sure that they have more tools, more monies, to help with this population, to me is vital.” 4) Leadership changes and ensuring open dialogue with internal team members to build trust • “I think one of the challenges that Healthcare Network is facing or has faced is when there was a turnover of leadership. And that's always going to affect that, and just how you deal with human dynamics of those community health workers, too. That's a challenge. Is how to sustain the strength and the value of this kind of outreach values there. And just so that, how do you keep everyone on the same page? Two, let's build trust. Let's not try to answer everyone's questions. You know, be resourceful more than ‘I have all the answers.’” Potential Opportunities for Healthcare Network Outreach Team Stakeholders were asked if they identified the Healthcare Network team as having any potential opportunities in the present or future. Two areas of opportunity were proposed: 1) Growth of community needs and sustaining/expanding the capacity to provide services • “I don't know what their staffing plan is, or what their capacity is over there. But I know right now they're so accommodating that you just feel that as it continues to grow that those will be challenges that they have, is maintaining that.” • “I just would think growth would be an opportunity for them to reach more—be able to provide more services.” Collier County Community Partner Stakeholder Interview Report • “But to really spread the information in the community so they're not the only ones handing it out. I think the opportunities would be to talk with businesses and just say who they are and what they're trying to do and ask ‘Can we post some things on your little bulletin board?’ or to the pharmacy, ‘if you're aware of people that need to talk to someone, not only necessarily for medical issues, we're here, you know, we are listening ear’, to build those bridges, to engage more of the community, there is an opportunity, there is always an opportunity to engage more, don’t just stay within your own your own organization. Get out there. Go to some doors of community members 'cause that is where the people, the community people will go. Whether it's the grocery stores, the laundromat is a valuable resource. For spreading communication and just going where the people are.” 2) Greater reach to provide services in the fields through pop-up clinics • “I know they were not directly to the fields, and did some work out there, some testing, and so forth, but I don't think it was done with every single of crew leader or grower here in Immokalee, I think that's a big opportunity for this next season…my vision, my goal as a community leader…be engaged directly in the fields. And have like a pop-up clinic there, and just be there available once a month, twice a month. Anybody has underlying conditions or they don't feel good? Just go quickly, get checked there. That's kind of the opportunity I see that we could probably focus on for the next coming years.” o “I wanted just to push a little bit so that we could do pop-up clinics, either in the camps --which I know they've done but particularly in the fields cause their parents leave at 5:00 AM they don't get back to 7:30 PM and they work during peak season, it's seven days a week—so, they might not have that healthcare access, to be able to see a doctor, go all the way to Naples if there's an emergency, or so forth.” Areas of Improvement for Healthcare Network Stakeholders were asked if there were any areas of improvement for Healthcare Network Outreach team. The following four areas were proposed: 1) Greater awareness that services are available for all community members (not just low- income) and the billing process • “…when I first heard about them the assumption was that only low income families could go there, and I know that their services are available to everyone. That might be something that they could expand on, in an effort to broaden who they’re assisting, and maybe even what their billing is.” 2) Need for mental health education • “I think that we do need more mental health education. We have parents that have anxiety that we've found out through COVID, depression, and I think that's something that we as a society and as community leaders need to ensure that we do that.” 3) Need for specialty care resources • “…not only primary care, but also getting them to specialists, getting them prescriptions. Because my population is primarily the chronically homeless, who have no money, except for when they panhandle or whatever other things they do in order to get money. So, again, it's Collier County Community Partner Stakeholder Interview Report not only getting them seen by primary health care, which I'm doing with the Healthcare Network, they have had a couple grants that they're able to help a little bit with medications.” 4) Being open to change in order to have greater internal communication • “But I think to keep sustaining this kind of work I think there has to be an ongoing openness to what's new. Have you heard just the feedback among each other? What are some of the concerns and to kind of reel those in? … And just to keep that communication among themselves open and intentional that, you know, it's not just one person that wants credit for this, or whatever, but to really be willing to share what their concerns are having open… So just really intentional time together to process experience.” Input about Collier County Community Health Coalition (CCCHC) Meetings Of those interviewed, only one stakeholder had participated in the Collier County Community Health Coalition (CCCHC) meetings. When asked for input on how the information from the CCCHC meetings can be used to further improve the needs of the community, the respondent stated the following: • “Yes, I think getting the message out there to where not just those who attend the meetings could have it, if there's a way to have a short synopsis of what went on. And here's what we'd like to do, could you help us engage in this way in the coming week or in this month or something? I haven't attended all of them and I don't know what was communicated. In the ones I didn't attend, it's not that I wasn't interested, it’s just I'm in transition.” Summary In summary, the stakeholders interviewed were highly appreciative of the services provided by the Healthcare Network and the collaborations that they have formed with the organization. Of importance, the Healthcare Network Outreach team was praised for its leadership, partnerships, and proactive collaborations with other agencies to serve the needs of community members. The stakeholders had a clear understanding of the services provided by the Healthcare Network Outreach Team. They outlined how the Outreach Team has improved community health through activities related to COVID-19 as well as other health care services such as physicals, health education sessions, or referrals. The community health workers were consistently described by stakeholders as being well- trained, prepared, and professional. It was stated that the team’s diversity and reliability allowed them to build the community’s trust, alongside the high quality of care that the Healthcare Network provides. Related to the potential challenges that the Healthcare Network Outreach team may face in the present or future, the transiency of the community members, need for additional staff and funding, and leadership changes were stated. Related to potential opportunities, stakeholders mentioned the growth of community needs and greater outreach services for the Outreach Team to consider expanding upon. Areas of improvement for the Healthcare Network Outreach Team include greater community awareness of service provision for all members, greater mental health education and specialty care resources, and being open to change and more internal dialogue. Collier County Community Partner Stakeholder Interview Report In conclusion, all stakeholders expressed an immense gratitude for the work that is being done by the Healthcare Network Outreach Team and the impact it is having on the community. Collier County Community Member Survey Report Collier County Community Member Survey Report Participant Characteristics A total of 66 participants completed a community member survey given at Community Health Worker events to residents of Collier County, Florida from August 17, 2022 to August 30, 2022. The survey was developed with translation in English, Spanish, and Haitian Creole and participants were encouraged to choose their primary language to complete the survey. Respondents may have had technical assistance completing the survey from community health workers, as needed. Of the 66 participants, 37 (56.1%) completed it in English, 23 (34.9%) completed it in Spanish, and 6 (9.1%) completed it in Haitian Creole. When asked about the resident’s zip code, most respondents wrote 34142 (33, 70.21%). Other zip codes included: 34104 (2 respondents), 34109 (2 respondents), 34116 (2 respondents), 34120 (2 respondents), 33936 (1 respondent), 34019 (1 respondent), 34113 (1 respondent), 34117 (1 respondent), and 34135 (1 respondent). Survey Measures and Questions The survey was developed by Drs. Samantha Goldfarb and Jeff Harman (with input from the Collier County Community Health Coalition) and administered through Qualtrics from August 17, 2022 to August 30, 2022. Community health workers distributed the survey at their events and would assist participants in completing it, as needed. After reading their rights as participants and providing consent to continue the survey, respondents answered the following questions: 1.What is your zip code? 2.A community health worker is someone who aims to provide education and help people receive any health services they may need. Please specify if you have connected with a community health worker at any of the following in the past three months (Yes/No): •Response options: Your home, Health fair, COVID testing event, Community event, Church, Health clinic, Resource/information line (phone call), Media (radio) 3.If you connected with a community health worker, what did you receive education on? Please check all that apply. •Response options: How to stop the spread of COVID, COVID testing, COVID vaccination, Access to medical care, Access to dental care, Access to pharmacy/ prescriptions, Access to behavioral/mental health care, Role of community health worker, Other (please specify) 4.Please rate how effective the education materials were at raising your awareness of [selections from Question 3]: •Response options: Extremely effective, Very effective, Moderately effective, Slightly effective, Not effective at all 5.Please rate the extent to which you agree with the following statement: As a result of the community health worker connecting with me, I have an increased knowledge of [selections from Question 3]: •Response options: Strongly agree, Agree, Disagree, Strongly disagree 6.As a result of the community health worker connecting with you, how often have you talked to others about [selections from Question 3]: •Response options: Always, Often, Sometimes, Rarely, Never Collier County Community Member Survey Report 7. Has the community health worker led you to seek more information about [selections from Question 3]: • Response options: Yes, No 8. Did you receive a referral by the community health worker to get a service or treatment for [selections from Question 3]: • Response options: Yes, No 9. Did you go get this service as a result of the referral? [based on selections of ‘Yes’ from Question 8] • Response options: Yes, No 10. Did you find this service/treatment helpful? [based on selections of ‘Yes’ from Question 9] • Response options: Yes. No 11. Overall, what did you find most helpful about the community health worker or information he/she/they presented? 12. What can the community health worker do to improve this experience? 13. Please provide any additional comments about your experiences with the community health worker. 14. Would you be willing to have someone from our organization contact you in the future about other opportunities to provide input? [Yes/No. If ‘Yes’, asked to provide Name/Phone Number/E-mail] Place of Community Health Worker (CHW) Encounter Respondents were asked, “A community health worker is someone who aims to provide education and help people receive any health services they may need. Please specify if you have connected with a community health worker at any of the following in the past three months:” Respondents were asked to choose ‘Yes’ or ‘No’ to each of the following response options: “Your home”, “Health fair”, “COVID testing event”, “Community event”, “Church”, “Health clinic”, “Resource/information line (phone call)”, “Media (radio)”. The results are as follows, with respondents checking all topics that apply: • Your home: 13 (31.0%) of 42 respondents selected “Yes”, they had encountered a CHW at their home in the past three months. • Health fair: 14 (35.0%) of 40 respondents selected “Yes”, they had encountered a CHW at a health fair in the past three months. • COVID testing event: 36 (81.8%) of 44 respondents selected “Yes”, they had encountered a CHW at a COVID testing event in the past three months. • Community event: 11 (28.2%) of 39 respondents selected “Yes”, they had encountered a CHW at a community event in the past three months. • Church: 5 (13.2%) of 38 respondents selected “Yes”, they had encountered a CHW at church in the past three months. • Health clinic: 13 (34.2%) of 38 respondents selected “Yes”, they had encountered a CHW at a health clinic in the past three months. • Resource/information line (phone call): 10 (27.8%) of 36 respondents selected “Yes”, they had encountered a CHW through a resource/information line, or phone call in the past three months. • Media (radio): 5 (14.7%) of 34 respondents selected “Yes”, they had encountered a CHW through the media, or radio in the past three months. In sum, respondents encountered CHWs primarily through COVID testing events in the past three months. Collier County Community Member Survey Report Information Received from CHW Respondents were asked, “If you connected with a community health worker, what did you receive education on? Please check all that apply.” The response options to check included, “How to stop the spread of COVID”, “COVID testing”, “COVID vaccination”, “Access to medical care”, “Access to dental care”, “Access to pharmacy/prescriptions”, “Access to behavioral/mental health care”, “Role of community health worker”, and “Other: please specify”. The results are as follows, with percentages based on denominator of total 45 respondents who answered this question: • How to stop the spread of COVID: 39 (86.7%) respondents selected this topic. • COVID testing: 38 (84.4%) respondents selected this topic. • COVID vaccination: 23 (51.1%) respondents selected this topic. • Access to medical care: 15 (33.3%) respondents selected this topic. • Access to dental care: 7 (15.6%) respondents selected this topic. • Access to pharmacy/prescriptions: 5 (11.1%) respondents selected this topic. • Access to behavioral/mental health care: 3 (6.7%) respondents selected this topic. • Role of community health worker: 10 (22.2%) respondents selected this topic. • Other, please specify: 3 (6.7%) respondents selected this topic. When asked to specify, 1 respondent stated “I have never had contact” in Spanish. In sum, respondents primarily received information from CHWs related to how to stop the spread of COVID and COVID testing. Effectiveness of Information by CHW Respondents were asked, “Please rate how effective the education materials were at raising your awareness of:” with each of the selections respondents chose from Question 3 being listed. Respondents were asked to rate each selection on a scale from “Extremely effective” to “Not effective at all”. The results are as follows: • How to stop the spread of COVID: Of 38 respondents, 13 (34.2%) stated it was extremely effective, 19 (50.0%) stated it was very effective, 5 (13.2%) stated it was moderately effective, and 1 (2.6%) stated it was slightly effective. Therefore, 84.2% of respondents found this topic extremely or very effective. • COVID testing: Of 34 respondents, 9 (26.5%) stated it was extremely effective, 21 (61.8%) stated it was very effective, and 4 (11.8%) stated it was moderately effective. Therefore, 88.3% of respondents found this topic extremely or very effective. • COVID vaccination: Of 18 respondents, 5 (27.8%) stated it was extremely effective and 13 (72.2%) stated it was very effective. Therefore, 100% of respondents found this topic extremely or very effective. • Access to medical care: Of 13 respondents, 1 (7.7%) stated it was extremely effective, 5 (38.5%) stated it was very effective, 3 (23.1%) stated it was moderately effective, 2 (15.4%) stated it was slightly effective, and 2 (15.4%) stated it was not at all effective. Therefore, 46.2% of respondents found this topic extremely or very effective. Collier County Community Member Survey Report • Access to dental care: Of 5 respondents, 4 (80.0%) stated it was very effective and 1 (20.0%) stated it was moderately effective. Therefore, 80% of respondents found this topic very effective. • Access to pharmacy/prescriptions: Of 3 respondents, 3 (100%) stated it was very effective. Therefore, 100% of respondents found this topic very effective. • Access to behavioral/mental health care: Of 1 (100%) respondent, he/she/they found this topic very effective. • Role of community health worker: Of 8 respondents, 2 (25.0%) stated it was extremely effective, 2 (25.0%) stated it was very effective, 3 (37.5%) stated it was moderately effective, and 1 (12.5%) stated it was slightly effective. Therefore, 50% of respondents found this topic extremely or very effective. • Other, please specify: Of 1 (100%) respondent, he/she/they found this topic slightly effective. In sum, 80% or more of respondents 1 from almost every topic found the educational materials provided by the CHW on that topic to be extremely or very effective. Of note, the access to care topics (dental, pharmacy, behavioral) were rated as “very effective” but not “extremely effective”, which indicates a potential area for improvement. The topics that did not meet these criteria were education about the role of the community health worker, access to medical care, and the ‘Other’ category. Increased Knowledge of Information by CHW Respondents were asked, “Please rate the extent to which you agree with the following statement: As a result of the community health worker connecting with me, I have an increased knowledge of:” with each of the selections respondents chose from Question 3 being listed. Respondents were asked to rate their level of agreement with each selection from “Strongly agree” to “Strongly disagree.” The results are as follows: • How to stop the spread of COVID: Of 38 respondents, 14 (36.8%) stated they strongly agree and 24 (63.2%) stated they agree that the CHW increased their knowledge on this topic. Therefore, 100% of respondents stated that they strongly agree or agree that the CHW increased their knowledge of this topic. • COVID testing: Of 34 respondents, 10 (29.4%) stated they strongly agree and 24 (70.6%) stated they agree that the CHW increased their knowledge on this topic. Therefore, 100% of respondents stated that they strongly agree or agree that the CHW increased their knowledge of this topic. • COVID vaccination: Of 16 respondents, 5 (31.2%) stated they strongly agree and 11 (68.8%) stated they agree that the CHW increased their knowledge on this topic. Therefore, 100% of respondents stated that they strongly agree or agree that the CHW increased their knowledge of this topic. • Access to medical care: Of 12 respondents, 1 (8.3%) stated they strongly agree, 10 (83.3%) stated they agree, and 1 (8.3%) stated they disagree that the CHW increased their knowledge on this topic. Therefore, 91.6% of respondents stated that they strongly agree or agree that the CHW increased their knowledge of this topic. • Access to dental care: Of 4 respondents, 1 (25.0%) stated they strongly agree and 3 (75.0%) stated they agree that the CHW increased their knowledge on this topic. Therefore, 100% of 1 Denominator varies and is based on total number respondents who answered each topic. Collier County Community Member Survey Report respondents stated that they strongly agree or agree that the CHW increased their knowledge of this topic. • Access to pharmacy/prescriptions: Of 3 respondents, 1 (33.3%) stated they strongly agree and 2 (66.7%) stated they agree that the CHW increased their knowledge on this topic. Therefore, 100% of respondents stated that they strongly agree or agree that the CHW increased their knowledge of this topic. • Access to behavioral/mental health care: Of 1 (100%) respondent, he/she/they stated that they agree that the CHW increased their knowledge of this topic. • Role of community health worker: Of 8 respondents, 4 (50.0%) stated they strongly agree and 4 (50.0%) stated they agree that the CHW increased their knowledge on this topic. Therefore, 100% of respondents stated that they strongly agree or agree that the CHW increased their knowledge of this topic. • Other, please specify: Of 1 (100%) respondent, he/she/they stated that they disagree that the CHW increased their knowledge of this topic. In sum, 100% of respondents1 from every topic (except access to medical care with over 90%) stated that they strongly agree or agree that the information provided by the CHW increased their knowledge of that topic. One respondent in the ‘Other’ category stated that they disagree, but no response was listed. Information from CHW Communicated to Others Respondents were asked, “As a result of the community health worker connecting with you, how often have you talked to others about:” with each of the selections respondents chose from Question 3 being listed. Respondents were asked to rate their level of agreement with each selection from “Always” to “Never”. The results are as follows: • How to stop the spread of COVID: Of 38 respondents, 7 (18.4%) stated always, 13 (34.2%) stated often, 11 (29.0%) stated sometimes, 5 (13.2%) stated rarely, and 2 (5.3%) stated never have they talked to others about the topic. Therefore, 52.6% of respondents stated that they have always or often talked to others about this topic. • COVID testing: Of 32 respondents, 5 (15.6%) stated always, 13 (40.6%) stated often, 8 (25.0%) stated sometimes, 4 (12.5%) stated rarely, and 2 (6.3%) stated never have they talked to others about the topic. Therefore, 56.2% of respondents stated that they have always or often talked to others about this topic. • COVID vaccination: Of 14 respondents, 3 (21.4%) stated always, 5 (35.7%) stated often, 3 (21.4%) stated sometimes, and 3 (21.4%) stated rarely have they talked to others about the topic. Therefore, 57.1% of respondents stated that they have always or often talked to others about this topic. • Access to medical care: Of 11 respondents, 1 (9.1%) stated always, 3 (27.3%) stated often, 4 (36.4%) stated sometimes, and 3 (27.3%) stated never have they talked to others about the topic. Therefore, 36.4% of respondents stated that they have always or often talked to others about this topic. • Access to dental care: Of 4 respondents, 1 (25.0%) stated always, 1 (25.0%) stated often, 1 (25.0%) stated sometimes, and 1 (25.0%) stated rarely have they talked to others about the topic. 1 Denominator varies and is based on total number respondents who answered each topic. Collier County Community Member Survey Report Therefore, 50% of respondents stated that they have always or often talked to others about this topic. • Access to pharmacy/prescriptions: Of 3 respondents, 1 (33.3%) stated always, 1 (33.3%) stated sometimes, and 1 (33.3%) stated rarely have they talked to others about the topic. Therefore, 33.3% of respondents stated that they have always or often talked to others about this topic. • Access to behavioral/mental health care: Of 1 (100%) respondent, he/she/they stated that they have never talked to others about this topic. • Role of community health worker: Of 7 respondents, 3 (42.9%) stated always, 1 (14.3%) stated sometimes, 2 (28.6%) stated rarely, and 1 (14.3%) stated never have they talked to others about the topic. Therefore, 42.9% of respondents stated that they have always or often talked to others about this topic. • Other, please specify: Of 1 (100%) respondent, he/she/they stated that they have never talked to others about this topic. In sum, 50% or more of respondents1 stated that they have always or often talked to others about the following topics: How to stop the spread of COVID, COVID testing, COVID vaccination, and access to dental care. Information-Seeking Resulting from CHW Encounter Respondents were asked, “Has the community health worker led you to seek more information about:” with each of the selections they chose from Question 3 being listed. Response options were “Yes” or No”. The results are as follows: • How to stop the spread of COVID: 27 (77.1%) of 35 respondents selected ‘Yes’ they sought more information on this topic. • COVID testing: 25 (83.3%) of 30 respondents selected ‘Yes’ they sought more information on this topic. • COVID vaccination: 12 (63.2%) of 19 respondents selected ‘Yes’ they sought more information on this topic. • Access to medical care: 7 (70%) of 10 respondents selected ‘Yes’ they sought more information on this topic. • Access to dental care: 3 (75%) of 4 respondents selected ‘Yes’ they sought more information on this topic. • Access to pharmacy/prescriptions: 3 (100%) of 3 respondents selected ‘Yes’ they sought more information on this topic. • Access to behavioral/mental health care: 1 (100%) of 1 respondent selected ‘Yes’ they sought more information on this topic. • Role of community health worker: 7 (87.5%) of 8 respondents selected ‘Yes’ they sought more information on this topic. • Other, please specify: No respondents answered this selection. In sum, 60% or more of respondents1 from every topic stated that the community health worker has led them to seek more information on that topic. 1 Denominator varies and is based on total number respondents who answered each topic. Collier County Community Member Survey Report Referral by CHW for Service or Treatment Respondents were asked, “Did you receive a referral by the community health worker to get a service or treatment for:” each of the selections they chose from Question 3. Response options were “Yes” or No”. The results are as follows: • How to stop the spread of COVID: 14 (40%) of 35 respondents selected ‘Yes’ they received a referral to get a service or treatment for this topic. • COVID testing: 18 (58.1%) of 31 respondents selected ‘Yes’ they received a referral to get a service or treatment for this topic. • COVID vaccination: 13 (65%) of 20 respondents selected ‘Yes’ they received a referral to get a service or treatment for this topic. • Access to medical care: 5 (45.5%) of 11 respondents selected ‘Yes’ they received a referral to get a service or treatment for this topic. • Access to dental care: 2 (50%) of 4 respondents selected ‘Yes’ they received a referral to get a service or treatment for this topic. • Access to pharmacy/prescriptions: 2 (100%) of 2 respondents selected ‘Yes’ they received a referral to get a service or treatment for this topic. • Access to behavioral/mental health care: 0 (0%) of 1 respondent selected ‘Yes’ they received a referral to get a service or treatment for this topic. • Role of community health worker: 2 (33.3%) of 6 respondents selected ‘Yes’ they received a referral to get a service or treatment for this topic. • Other, please specify: No respondents answered this selection. In sum, 50% or more of respondents 1 stated that received a referral by the CHW to get a service or treatment for the following topics: COVID testing, COVID vaccination, access to dental care, and access to pharmacy/prescriptions. Service Receipt based on CHW Referral Respondents were asked, “Did you go get this service as a result of the referral?” based on each of the selections that they chose ‘Yes’ from in Question 8. Response options were “Yes” or No”. The results are as follows: • How to stop the spread of COVID: 9 (75%) of 12 respondents selected ‘Yes’ they received a service for this topic based on the CHW referral. • COVID testing: 12 (75%) of 16 respondents selected ‘Yes’ they received a service for this topic based on the CHW referral. • COVID vaccination: 8 (66.7%) of 12 respondents selected ‘Yes’ they received a service for this topic based on the CHW referral. • Access to medical care: 4 (100%) of 4 respondents selected ‘Yes’ they received a service for this topic based on the CHW referral. • Access to dental care: 2 (100%) of 2 respondents selected ‘Yes’ they received a service for this topic based on the CHW referral. 1 Denominator varies and is based on total number respondents who answered each topic. Collier County Community Member Survey Report • Access to pharmacy/prescriptions: 2 (100%) of 2 respondents selected ‘Yes’ they received a service for this topic based on the CHW referral. • Access to behavioral/mental health care: No respondents answered this selection. • Role of community health worker: 1 (50%) of 2 respondents selected ‘Yes’ they received a service for this topic based on the CHW referral. • Other, please specify: No respondents answered this selection. In sum, 50% or more of respondents 1 who stated that they received a referral from the CHW went on to get that service for every topic. Service Satisfaction (if Service Received) Respondents were asked, “Did you find this service/treatment helpful?” based on each of the selections that they chose ‘Yes’ from in Question 9. Response options were “Yes” or No”. The results are as follows: • How to stop the spread of COVID: 8 (88.9%) of 9 respondents selected ‘Yes’, the service they received was helpful. 1 respondent (11.1%) selected ‘No’, the service they received was not helpful. • COVID testing: 12 (100%) of 12 respondents selected ‘Yes’, the service they received was helpful. • COVID vaccination: 8 (100%) of 8 respondents selected ‘Yes’, the service they received was helpful. • Access to medical care: 1 (25%) of 4 respondents selected ‘Yes’, the service they received was helpful. 2 respondents (50%) selected ‘No’, the service they received was not helpful, while 1 respondent selected ‘Not applicable’. • Access to dental care: 1 (100%) of 1 respondent selected ‘Yes’, the service they received was helpful. • Access to pharmacy/prescriptions: 1 (50%) of 2 respondents selected ‘Yes’, the service they received was helpful. 1 (50%) respondent selected ‘Not applicable’. • Access to behavioral/mental health care: No respondents answered this selection. • Role of community health worker: 1 (100%) of 1 respondent selected ‘Yes’, the service they received was helpful. • Other, please specify: No respondents answered this selection. In sum, 50% or more of respondents1 stated that the service they received based on the CHW referral was helpful for every topic, with the exception of access to medical care. Comments about CHW/Information Presented Respondents were asked, “Overall, what did you find most helpful about the community health worker or information he/she/they presented?” This question was open-ended and comments were translated to English, as needed. 1 Denominator varies and is based on total number respondents who answered each topic. Collier County Community Member Survey Report The following themes emerged based on respondents’ comments: • COVID-Specific (n=18) o Information (n=9):  “To provide more info to stop the spread of COVID”  “Information about COVID”, “COVID information”  “Educate us how to protect ourselves from COVID”  “Very helpful information about vaccines and testing”  “The information over the vaccine was very effective. There are people who don’t want it but it’s important and they are insisting that the vaccine is important.”  “All of the educational information helped me learned how to take care of myself and stop the spread of COVID. These testing sites give me peace of mind.”  “COVID pamphlet” o Testing (n=8):  “Providing covid testing, PPE, info”  “Convenient Testing and accessible to the community”  “Free covid testing”  “Free test and walking education about COVID”  “Testing kits”  “Very informative beneficial rapid test”  “Schedule for COVID testing”  “Helping us getting COVID test” o Location (n=1):  “Knowing where testing locations and vaccinations are located” • “Information”/ “Resources” (n=3) • Satisfaction with care (n=3) o “Everything is good” o “Everything can be used” o “Continue the help that exists” • Service assistance that is free, close, culturally competent (n=3) o “Helping us service close to us” o “Helps for people like who’s don’t have money” o “Helpful everything is free / we have people speak us in our language” • CHW is informative and willing to help (n=2) o “Willingness to help” o “Informative and answered all questions” Comments about CHW Opportunities for Improvement Respondents were asked, “What can the community health worker do to improve this experience?” This question was open-ended, and comments were translated to English, as needed. The following themes emerged based on respondents’ comments: • “Nothing” / “Everything is good” (n=19) o “Continue to put more information as it comes out and continue to provide testing” o “Continue providing these services and keeping up to date with information” • Expand services / supplies (n=6) o “Expand urgent care services mobile units” o “Health access like blood pressure and sugar” o “Have more health service in the event” o “Provide vaccinations at testing events” o “To always have supplies available” Collier County Community Member Survey Report o “Provide water for patients while waiting for results and having chairs for people to wait” • Expand awareness of CHW in community (n=3) o “Make yourself known” o “Visit the areas” o “They should be more in the community” • Quicker response / Additional staff (n=2) o “More faster” o “Need staff” • Provide incentives (n=1) o “Incentive to get tested” Additional Comments Respondents were asked, “Please provide any additional comments about your experiences with the community health worker.” This question was open-ended, and comments were translated to English, as needed. The respondents’ comments are below (“N/A”, “none” comments excluded): Suggestions: • “More health service we need in the community” • “More education and media capsule for the activities event” • “Provide education in our language” [original comment written in English] Praise: • “I like that the group is still remaining very involved in the community. Even though there are people who don’t think COVID is a big deal anymore, I find that these events are very important to Immokalee” • “Thanks to the workers we are able to be tested” • “All the community health workers were very helpful and knowledgeable about the information given to me” • “Excellent” Summary In summary, most respondents encountered CHWs primarily through COVID testing events in the past three months. Respondents primarily received information from CHWs related to how to stop the spread of COVID and COVID testing. Over 80% of respondents from almost every topic found the educational materials provided by the CHW on that topic to be extremely or very effective. Moreover, 90% or more of respondents from every topic stated that they strongly agree or agree that the information provided by the CHW increased their knowledge of that topic. Fifty percent or more of respondents for the following topics stated that they have always or often talked to others about: How to stop the spread of COVID, COVID testing, COVID vaccination, and access to dental care. Of importance, over half of respondents from every topic stated that the community health worker has led them to seek more information on that topic. Fifty percent or more of respondents stated that received a referral by the CHW to get a service or treatment for the following topics: COVID testing, COVID vaccination, access to dental care, and access Collier County Community Member Survey Report to pharmacy/prescriptions. Of respondents from every topic who received a CHW referral, 50% or more of respondents went on to get that service. Moreover, 50% or more of respondents who received that service stated that it was helpful for every topic, with the exception of access to medical care. Comments related to the CHW were overwhelmingly positive, with community members expressing gratitude for COVID-specific information, testing, and vaccination events. When asked to comment on opportunities for improvement, some suggested expansion of services/supplies and greater awareness of the CHW in the community. Overall, community members expressed satisfaction with the CHW and information/services provided. Collier County Community Member Focus Group Report - Spanish Collier County Spanish-Speaking Community Member Focus Group Report Participant Characteristics A total of 2 community members attended a focus group conducted at Amigos de Cristo church in Immokalee, Florida on September 2, 2022. Community members were selected because they reside in Collier County and have received health information or services from a Community Health Worker (CHW) as funded through the Centers for Disease Control and Prevention’s Collier County Extra Mile Grant. Those interviewed included community members who spoke Spanish. Focus Group Measure and Questions The focus group guide was developed by Drs. Samantha Goldfarb and Jeff Harman (with input from the Collier County Community Health Coalition) and administered at Amigos de Cristo church and moderated by Jean Paul Roggiero on September 2, 2022. Mr. Roggiero completed the focus group in Spanish as it is the primary language of the 2 community members. The audio file was then sent to a third-party service (GMR transcription) for translation and transcription from Spanish to English in order for Dr. Goldfarb to conduct thematic analysis and reporting. For the purposes of this report, names have been deidentified and multiple speakers in a discussion are referred to as Speaker 1 followed by Speaker 2, 3, etc. Of importance, Speaker 1 in one context is not the same speaker as Speaker 1 in another context. Community members were asked the following open-ended questions, after an opening and icebreaker session: 1. What were your thoughts when first meeting the community health worker? 2. What mattered most in your decision to get information or services from the community health worker? a. What kind of information or services provided by the community health worker did you think were the most helpful? 3. From your point of view, describe a story that represents the most significant change that has resulted because of the community health worker. 4. Aside from the information or services that you received from the community health worker right away, how did your experience with the community health worker affect you afterward? This can include, but is not limited to, how you now feel about your physical health, mental health, and/or your thoughts about the importance of health and well-being. 5. Community health workers hope to reach as many community members as possible and help them to receive the health care information or services they need. What things do you think may be preventing the community health workers from reaching more community members? a. What would you suggest on how to get the message out to the community? 6. Is there information or services that you did not receive from the community health worker that you wanted or needed? 7. Are there other resources in the community that you use to receive health care information and services? a. Are there ways that a community health worker can connect with these resources to better assist you? Collier County Community Member Focus Group Report - Spanish 8. What do you think are some of the biggest problems for the community getting health care information and services? a. Are there ways that a community health worker can help with this problem? 9. What advice would you give to community health workers about the information or services they provide? Most Significant Change Methodology Community members were asked to identify the Most Significant Change (MSC) they have identified in receiving services from a community health worker thus far and explain their rationale in Question 3. Question 3 was adapted from “The ‘Most Significant Change’ (MSC) Technique: A Guide to its Use” by Rick Davies and Jess Dart.1 The MSC technique aims to collect stories from the field so staff and stakeholders may better understand a project’s impact. The goal is for these stories to be discussed in- depth by team members to assess overall project impact. MSC is used as program evaluation and monitoring approach for complex interventions, such as the work a CHW provides. When asked to provide stories of the MSC th at has resulted from the community health worker, community members stated: • “At work, everything was over, there was no work, we were struggling with the disease, but by taking care of ourselves everything is going to get better, it is getting better.” • “Just that, the work went down a lot, the economy, the food, sometimes it was spoiled, but they helped us in many ways like giving us help for the children. On the one hand that was good but on the other hand, it was bad because the government raised the price of things; they gave us the money for the children but the things in the house went up in price even though they gave us the help. To this day it is still going up and work is going down; salaries are still the same.” COVID Testing/Vaccine : Hesitancy When asked about their thoughts when first meeting the CHW and the activities, in general, community members stated a hesitancy to receive COVID information, testing, vaccine. • “The first time I had doubts about the vaccine because they said a lot of things, but I got it and everything was fine, I never got COVID. Everything was fine with the services, I got the vaccines and everything.” • “My reaction and my thoughts were very negative, on everything, on the tests, the vaccines. To date with the vaccines.” One of the two community members mentioned faith as a contributor to their hesitancy to receive services: • “In that, it was not real because if you believe in God, only God knows what is going to happen, and as long as you are in God's hands you are free from all evil.” 1 Available online at MSC_finalextra_single (mande.co.uk) Collier County Community Member Focus Group Report - Spanish COVID Testing/Vaccine: Knowledge When asked about the information provided by the CHW program that was helpful, one of the two community members responded favorably throughout the session to receiving COVID resources and vaccinations: • “I think getting all the vaccinations, taking good care of yourself so you don’t get that disease.” • “…it helped me a lot because they explained to me what could happen, they did the tests and all that. They helped us to take care of ourselves too.” • [When asked if they gave the information to others in their community:] “Yes, I did tell them about that so that they would take care of themselves.” Community Health Worker Program Strengths When asked if the community health workers helped the community members receive the information/ services they need, both responded favorably to the program and two themes emerged: 1) CHWs have demonstrated knowledge and presence in the community for service provision and referral to care • “What you're doing right now, coming to the utilities, setting up everywhere, helping people. That's very good… Yes, like right now they are helping COVID by giving information, I think that helps a lot of people because many people are very closed and do not go to the clinics to get tested, others do not have the means or do not know how to do it because many people do not speak the same language and there is no adequate staff to help them with the language.” • “What happened is that they were already closing that day. They told me, ‘You can go to such and such a place, to the medical center here, in Immokalee, they will take care of you there.’ And yes, I went and they took very good care of me.” • “No, everything was fine. I have gone to several places where there are booths and they have given me all the services. As [pronoun] says, they give information; once they did HIV tests, blood tests, and eye tests, they did tests for everything.” • “Do what you are already doing, go to various sites and people can get to where you are.” 2) CHWs share the same language as the community • “Yes, I think it helps more in that way. I have encountered people who do not speak Spanish or English and sometimes they speak other dialects and do not understand, you have to explain to them so that they understand because not many speak the same language.” • “I also believe the same thing [pronoun] says. I have worked with people who do not speak perfect Spanish and it is hard to communicate with them. I think what [pronoun] says is very true.” Barriers to Receiving CHW Program Services Community members were asked to identify barriers to receiving services from the CHW program. Three main themes emerged: Collier County Community Member Focus Group Report - Spanish 1) Transportation • “Sometimes it's transportation, sometimes there's no way to get there or they live too far away. Or laziness.” • Moderator: “If I may, when you say transportation, do you mean transportation to get from home to –“ o Speaker 1: “To the place where the services are. For example, I live in the Village, the clinic is on the other side. WIC is on the other side; the other doctors are on the other side; I need transportation because it's an hour's walk.” o Moderator: “So, you think one thing would be to help with transportation for people to medical or social appointments, right? That would be an important thing to evaluate.” o Speaker 1: “Yes.” 2) Missing work • “Sometimes you just don't want to miss work. Those are the only obstacles, but you can find the time; it's important for your health. 3) Lack of interest in or knowledge of CHW services • “When you see them here in town and all that is when you approach them, but there are a lot of people who are not interested and don't go… You are doing everything in your power, but sometimes people are humble and do not understand, do not want to approach or accept the reality that COVID is a deadly disease.” Suggestions for CHW Program Community members were asked if they had any recommendations for CHWs to improve or expand services to the community. The main theme to emerge was for CHWs to continue to provide information to the community: • “They should continue giving information to the people because sometimes we are very poor people who do not understand the reasons, and with more information, people will learn.” • “The same thing [pronoun] said.” One of the community members suggested continuing the campaigns and providing handouts to increase awareness: • “Let them continue doing what they are already doing, the campaigns to help, that is very good. It is the only way to reach people in need.” • “I believe that by handing out papers with information; there will be people who see the information, are interested in it, and maybe they will come to receive more information.” Other Sources of Care When asked where community members receive services outside of the CHW program, one stated that they go to the county hospital and the other stated that they go to WIC and a neighboring clinic. • “Well besides you I think at a county hospital.” • “There is other information like at the WIC, next to the WIC there is another little office where they test you for HIV; at the clinic, private doctors; there are several private doctors. Sometimes they even send pamphlets from the school.” Collier County Community Member Focus Group Report - Spanish Summary In sum, the community members responded favorably to the work of the CHWs. Related to COVID-19, there remains hesitancy to receive services. However, one community member felt the knowledge received by the CHW allowed him to receive services and provide information to others. The community members felt that the CHWs had demonstrated knowledge and a strong presence in the community for providing services and referrals to care. They also appreciated that the CHWs spoke the same language as them. Barriers identified to receiving CHW services by other community members included transportation, missing work, and a lack of interest in or knowledge of the services. Community members had limited suggestions for program improvement. Rather, they hoped that CHWs would continue to provide more information to the community through campaigns and handouts. When asked where they received care outside of the CHW program, they stated a county hospital and WIC (with a neighboring clinic). In conclusion, the community members seemed pleased with the CHWs and the services they provide to the community. Collier County Community Member Focus Group Report – Creole Collier County Haitian Creole-Speaking Community Member Focus Group Report Participant Characteristics A total of 5 community members attended a focus group conducted at the Coalition of Immokalee Workers office in Immokalee, Florida on September 6, 2022. Community members were selected because they reside in Collier County and have received health information or services from a Community Health Worker (CHW) as funded through the Centers for Disease Control and Prevention’s Collier County Extra Mile Grant. Interviewees included community members who spoke Haitian Creole. Focus Group Measure and Questions The focus group guide was developed by Drs. Samantha Goldfarb and Jeff Harman (with input from the Collier County Community Health Coalition) and administered at the Coalition of Immokalee Workers office and moderated by Dr. Jude Beauchamp on September 6, 2022. Dr. Beauchamp completed the focus group in Creole as it is the primary language of the 5 community members. The audio file was then translated and transcribed by a third-party colleague who is fluent in Creole in order for Dr. Goldfarb to conduct thematic analysis and reporting. For the purposes of this report, names have been deidentified and multiple speakers in a discussion are referred to as Speaker 1 followed by Speaker 2, 3, etc. Of importance, Speaker 1 in one context is not the same speaker as Speaker 1 in another context. Community members were asked the following open-ended questions, after an opening and icebreaker session: 1. What were your thoughts when first meeting the community health worker? 2. What mattered most in your decision to get information or services from the community health worker? a. What kind of information or services provided by the community health worker did you think were the most helpful? 3. From your point of view, describe a story that represents the most significant change that has resulted because of the community health worker. 4. Aside from the information or services that you received from the community health worker right away, how did your experience with the community health worker affect you afterward? This can include, but is not limited to, how you now feel about your physical health, mental health, and/or your thoughts about the importance of health and well-being. 5. Community health workers hope to reach as many community members as possible and help them to receive the health care information or services they need. What things do you think may be preventing the community health workers from reaching more community members? a. What would you suggest on how to get the message out to the community? 6. Is there information or services that you did not receive from the community health worker that you wanted or needed? 7. Are there other resources in the community that you use to receive health care information and services? a. Are there ways that a community health worker can connect with these resources to better assist you? Collier County Community Member Focus Group Report – Creole 8. What do you think are some of the biggest problems for the community getting health care information and services? a. Are there ways that a community health worker can help with this problem? 9. What advice would you give to community health workers about the information or services they provide? COVID Testing/Vaccine : Hesitancy, Faith, Knowledge When asked about their thoughts when first meeting the CHW and the activities, in general, community members stated a hesitancy to receive COVID information, testing, vaccine. Many community members stated that their faith (and its interplay with the CHW) played a pivotal role in their decisions to receive COVID services (or not). Related to their faith and COVID, community members stated: • “I didn't want to get the vaccine. I heard people talking bad about the vaccine then I saw a young lady who was next and she told me that you should get the vaccine and it’s not the job that’s pushing her to get the vaccine. My job encouraged me to get it but I did not want to get it but they said that I had to get it because if I have children at home I would have to get it to protect the other children in the house and that's why I got it, and when I did get it I prayed over it so that God would fix everything that's not good with it.” • “What happened to me with COVID just until now like, leave people. I have one of my children who is in [location] and she was infected and she went to go take a test and she got COVID and she said she was infected and at that same spot. I never thought about putting doctors first, I always put God first and doctors second because God always has the first spot and at that same spot I put my knees on the floor and pray to God that ‘God, you gave me this child and… she's telling me she's infected and what are you going to do for us’ and when I prayed to God I prayed to God and God talked to me and He came and got medicine and any remedies that people told me to make I made and she never went to the hospital she only went to go take the test and she was positive for the test after three weeks she went back to do the test again and she was good and she told God ‘Thank you for that’ and when she went back to the hospital she went to consult and they said she was normal.” • “Something that I wanted to say someone else already said because by the grace of God my family was protected and all this sickness passed all of us. I am not sick my kids are not sick, and I tell God ‘thank you’ by the grace of God.” • “What I want to say about the vaccine when I was going to get my vaccine after a certain amount of time whenever my arm was hurting, I told God thank you.” Related to the interplay between the CHW and the community members’ faith: • “Since COVID-19 when it first started it was a surprise to us but during if I did have it I would suffer the [CHW] worker came and they looked like a vigil not Jesus Christ but some who looked bigger than a regular person. I would have to talk to them correctly and what they tell me I would have to accept because they are the ones bringing information to me. I had to just accept what they were telling me.” • “Not only COVID are they talking about but that's what they [the CHWs] work with and if you did need other information you can ask them for it but the principle of the conversation was COVID and how to keep working and how to protect yourself to not get it. I am not saying to be negligent and not get information… you can protect yourself how you want to protect yourself and whatever you get is what you get and the only thing that can stop you from not getting this sickness is …God can only stop a sickness from coming onto you and people can't stop a sickness from Collier County Community Member Focus Group Report – Creole coming to you when you ever you see the co-worker come near you know that they came to help you with deliverance anyways.” • “The only thing that would be better is if God came with them [the CHWs] when they were trying to help us everything that they were supposed to do…” COVID Testing/Vaccine: Knowledge On receiving COVID resources and vaccinations from the CHW, community members stated: • “…when they finish giving you the information, they had me sit for a couple of minutes so that they can monitor and pain I had and if I felt like my head was spinning, I felt like everything was good.” • “All the services that they gave me helped me. The masks helped me and the items they gave me to rub on my hands helped me. They also gave me gloves. Everything they gave me helped me and everything they did with me, it helped me because I didn't pay money for it, and I thank God for that night thank you as well.” Community Health Worker Program Strengths When asked if the community health workers helped the community members receive the information/ services they need, community members responded favorably to the program and two themes emerged: 1) CHWs have demonstrated kindness and are trusted sources in the community for health education and service provision • “When I first interacted with a community member, they showed me good and served me nice and treated me good in God’s name.” • “I just saw that these people came to do something that was good for me I knew what they were.” • “They treat people good. They always tell you this is how you should treat your body and even your house and how to clean it and how to kill germs, just how you can live better and prevent the disease.” • “The information that the community workers gave me was a kid in school and the kid goes to school and the kid goes to school to learn and what they learned they had to apply them, and they will see them in an exam. Same thing goes for the community workers they sat down with me they explained to me, and I came to my house, and this is what they were giving, and I accepted everything they were telling me and now I understood more about the sickness.” • “Well, there's some things that someone already said and sometimes when you hear the community workers tell you something it's things that make you protect yourself more. It's like when you put your hand in the water on the floor and you don't wash your hands after they let you know that, you know, after anything you touch you use alcohol and they gave you alcohol gloves and stuff.” • “You just asked if I'm sick and I'm suffering and I have help moving forward, and I know that help can help me and come up with a solution for that disease that is moving throughout the community and Immokalee. I know that they are coming with the solution for people and me being patient and I'm just going to wait for that solution that the workers are going to bring to me.” • “I am satisfied with the information and services that or given to me.” Collier County Community Member Focus Group Report – Creole 2) CHWs share the same language as the community • “The one thing I can say in the community, there are a lot of people who don't speak English and including me I don't speak English. When I go to the hospital, I find somebody who speaks Creole with me, I feel happy because they helped me more in what I'm trying to do but if my child isn't here to help me and I find a community worker there to help me I find it more helpful and I appreciate it or I wish there were more Haitians and that they sent more Haitians who speak my language not saying that we don't try hard for us to understand some words do you understand but it would make me make more of an effort if I had more community workers to come help us in the community.” Barriers to Receiving CHW Program Services, Health Care Community members were asked to identify barriers to receiving services from the CHW program. Two main themes emerged: 1) Lack of knowledge of CHW information/services due to missing work, negligence • “What I was going to say is I see that these people are people who work a lot, and they give a lot of concern. There are some people who show negligence and you can talk to them and they show negligence and they don't want to actually learn anything, but the bigger thing that everything you were telling me before is now I see it and this person is in their little job and the reason why they don't want to learn anything is from negligence and afterwards now that I see everything clearly now you’re going to need those people but the community workers are here for that this is their job to help.” 2) Need CHW assistance in receiving hospital care, getting timely appointments • “Another barrier that we have is that we need since we're only just talking to each other barriers that we see there are people who come and go to the hospital to get better and make themselves healthy and there's people who don't know how to read or write or don't know something and when they get there after they get your ID and your name they put it on the computer and they give you a book so that you can do it yourself I've been to the hospital in I see that this happens there's people that ask you for help but if there was a community worker there to help it would be better for people.” • “…there are people who even if they are suffering from a problem they go to the hospital or the clinic and when they arrive at their consultation, they give you an appointment with the date far away and the person has an urgent problem and cannot wait they go to the emergency room.” Suggestions for CHW Program Community members were asked if they had any recommendations for CHWs to improve or expand services to the community. The following suggestions were identified: 1) Home visits • “From a house standpoint, if the community workers would be able to come because there are older people who aren't able to make their appointment and they also forget their appointment and when they call they say that, ‘they gave you this date, this time, this month’ and they say that they don't remember and they said they sent another after… but if there was a community worker that passed by their house to be able to give them their appointments so that they remember.” Collier County Community Member Focus Group Report – Creole 2) More information on COVID treatment and isolation protocols • “Let me start to respond the information that they should give us that they didn't give us. If I'm sick and I have COVID-19 and I go to my house to bring medicine to me, I don't see anything and I was sick and now I'm healed and to be healed he gave me these medicines or these things I think that everything that was given to me satisfied me and there was nothing else that I needed.” 3) More CHWs to assist • “…would like to see more people get doing services for people poor health. When there's more people helping with health, it's better for the community. I might have a problem and the problem is very bad and takes about two hours but if it's only two people and there's no other people and somebody else has a problem there's nobody else to help them but when there's a lot of people it's better so they can help… people in the community.” 4) More incentives/money for community participation • “…be able to give people more money and resolve the problems because there are problems and the two illusions are there, we just can't reach the solution. If the solution is there if it's worth money then we can fix it with money then and we can use the young women, young men to help us more in the community so that they can give us more information and the community workers need to learn and do everything that they do well. Communication is important so that you can see which person it's needed for, if not… there's always going to be more people in this society who get sickness. We need to invest money into young men so that they can be better and put gas in their car if they're going all the way to Fort Myers or all the way to Naples so that they can talk to the right people so that they can fix the problems and come up with the solutions.” Summary In sum, the community members responded favorably to the work of the CHWs. In regards to COVID-19, community members expressed a hesitancy to receive services and acknowledged that their faith (and its interplay with the CHW) played a pivotal role in their health care decisions. The community members felt that the CHWs had demonstrated kindness and trusted them to provide health information and services to them. They also appreciated that the CHWs spoke the same language as them. Barriers identified to receiving CHW services by other community members included a lack of knowledge of the information/services due to negligence or work and a need for further assistance in hospital care. Community members suggested increasing home visits, providing more information on COVID treatment and protocols, hiring more CHWs to assist, and providing more incentives/money to address these barriers. In conclusion, the community members seemed pleased with the CHWs and the services they provide to the community. 1 Collier County Community Health Worker Focus Group Report Collier County Community Health Worker (CHW) Focus Group Report Participant Characteristics A total of 6 community health workers completed a focus group on August 30, 2022. Community Health Workers (CHWs) were selected because they were fully funded from the Centers for Disease Control and Prevention (CDC) Collier County Extra Mile Grant. Those interviewed included CHWs who provide health education, services, and outreach to community members in Collier County. Focus Group Measure and Questions The focus group guide was developed by Drs. Samantha Goldfarb and Jeff Harman (with input from the Collier County Community Health Coalition) and administered through the Zoom platform by Dr. Goldfarb on August 30, 2022. All six CHWs participated in the same room, while virtually Dr. Goldfarb served as moderator and Dr. Harman served as notetaker. The audio file was sent to GMR transcription, a third- party service for transcription. Dr. Goldfarb completed the thematic analyses for reporting. For the purposes of this report, names have been deidentified and multiple speakers in a discussion are referred to as Speaker 1 followed by Speaker 2, 3, etc. Of importance, Speaker 1 in one context is not the same speaker as Speaker 1 in another context. CHWs were asked the following open-ended questions, after an opening and icebreaker session: 1. From your point of view, describe a story that epitomizes the most significant change you have made as a community health worker in Collier County. a. Why was this story significant for you? b. How has working with the Healthcare Network Outreach Team and/or coordinators contributed to this? 2. What are the strengths of the community health worker program? a. What kind of resources, information or training provided by the program do you think are the most helpful in serving as a community health worker? b. What future specific resources, information or training could be provided in the to further enhance your role as a community health worker? 3. What are some of the barriers you encounter in the community health worker program? a. Are there any resources, information, or training provided by the program that have not been helpful in serving as a community health worker? b. Are there any resources, information, or training that you wish had been provided by the program (or would like to be provided in the future) in serving as a community health worker? 4. In what ways do you feel knowledgeable or comfortable with the community you serve? [Prompt: This can include but is not limited to how much you can relate to community members.] a. Are there any areas where you do not feel knowledgeable or comfortable? b. What are some of the barriers you encounter from the community in serving as a community health worker? c. What may assist you in overcoming these barriers? 5. Are there any factors/barriers that you think may be preventing community members from receiving care from the community health worker program? 2 Collier County Community Health Worker Focus Group Report a. What might be some mitigating approaches to address these factors/barriers? [Prompt: This includes suggestions you might have to alleviate the factors/barriers you have identified.] 6. What do you think are some opportunities for the community health worker program presently or in the future? 7. In what ways has serving as a community health worker affected you? This can include, but is not limited to, how you now feel about your physical health, mental health, and/or your attitudes towards your community, health care, etc. 8. Suppose that you were in charge and could make one change that would make the community health worker program better. What would you do? 9. What advice, knowledge, or information would you like to share with other community health workers across the country? Most Significant Change Methodology CHWs were asked to identify the Most Significant Change (MSC) they have identified in their role thus far and explain their rationale in Question 1. Question 1 was adapted from “The ‘Most Significant Change’ (MSC) Technique: A Guide to its Use” by Rick Davies and Jess Dart.1 The MSC technique collects stories from the field so stakeholders may better understand a project’s impact. The goal is for these stories to be discussed in-depth by team members to assess overall project impact. MSC is used as program evaluation and monitoring approach for complex interventions, such as the work a CHW provides. When asked to provide stories of the MSC they have encountered so far, CHWs stated: • “Today we were canvassing in Farm Worker Village. We are going door to door, then I came to look at a Haitian woman, but she was pregnant. She told me she came from Chile to come as an immigrant. She was pregnant. She wanted to go to a clinic and everything. She took a paper, and then I told her to talk to my supervisor and tell him what the [inaudible] said. Then she said, ‘Yeah.’ And after that point, they got word out to people who don’t have insurance and who don’t have papers. We followed up, and then she came here to us.” [referring to services for prenatal care] • “I guess for me it would be we had an event one weekend at a church, and we were doing blood pressure and blood sugar screenings. An older man came, and he had a really high blood sugar screening to the point where the machine couldn’t take the number, so we had advised him to go to the ER. He had previously told us that I don’t think he was taking his medications or had been to the clinic for a while…. So, we advised him to go the ER, and he did. And we followed up with him, and we were able to get him an appointment with the clinic and were able to get his medications back up. But for me, that was sort of significant because it was just a random screening we had that day, so just with that connection we were able to make him affiliated with the Healthcare Network.” • “I was asked to go with [Name] to go visit a patient that chronic care has been working with to kind of situate him into a new living environment because he’s newly blind, so it’s kind of hard for him to maneuver around his house. And he even cooks by himself in his house. It’s kind of hard for him to know where things are. And something that really spoke to me and was significant for me was that we got to help him get more comfortable in where he is, and we even bought him furniture. That was really significant for me because a lot of people in multiple places around here, they don’t get the help that they need sometimes. And mostly sometimes they don’t ask for it because they’re strong people in their family, so them asking for help sometimes seems weak. But I felt that it was really significant for him to ask for the help that he needed so that he can continue to live his life the way he wants to. And through us helping him to his appointments and to have a better way of living. He’s been able to go to his eye doctor’s appointments, and there’s even a possible chance that he might be able to see again because they were able to help him.” 1 Available online at MSC_finalextra_single (mande.co.uk) 3 Collier County Community Health Worker Focus Group Report Most Significant Change: Contribution of CHW, Program When asked about how the CHW or program contributed to the MSC, the CHWs stated the following: 1) Team diversity, knowledge, familiarity with culture • “I would say in our team specifically, we’re very diverse. I mean, we all speak one to two languages, and we all have different skillsets. For example, I am working towards [education], so that gives me a certain knowledge. [Name]’s gonna go into medical school, so that gives [pronoun] knowledge, too. And we have nurses in the group. So, we can feed off of each other and ask each other for help in anything that we need. I think that’s a big strength.” • “Yeah, I agree. All of us on the team have some type of medical background, whether it’s doctors from their own country, or people who come into the United States and are now medical assistants, or nurses, or even one guy is a phlebotomist as well.” • “…when we go outside to do the testing, and when we do the fair, too, the big event where we do the blood pressure and blood sugar, everything like that, and sometimes we have the doctor with the glasses, the consultation is free. Sometimes the people don’t have anything like that to go to the clinic, and they don’t speak English, Spanish. They speak only Creole, and they don’t know how to go in the schedule to talk when they go to the clinic. And when we [were] outside we speak Creole, Spanish, and English. We understand very well, and we talk to them. That’s free. They don’t have to pay…” 2) Departmental collaboration • “I feel like whenever our outreach team is able to work with other departments, it kind of solidifies our role in the community and how we can help everyone else. And each department doesn’t have to do the follow-ups by themselves because we’re able to have the time to be able to go out into the community and show that Healthcare Network has a presence, not only in the clinic but also in the community, to keep following up with them.” CHW Training, Resources, and Information: Strengths When asked about the most helpful training, resources, and information provided by the CHW program, the CHWs stated the following: 1) Shadowing • “So, I guess for me what was helpful was when they put me to shadow someone directly because I feel like that’s some of the best on-the-job training. I was able to see how they do their work and what they need to do before the events. It’s just the shadowing a coworker for me that’s just very helpful.” • “Probably shadowing, like [Name], because the PIH [Partners in Health] helps us to relax about the training.” 2) Medical training • “We also have even medical background training, medical-based trainings. For example, last month we had a training on how to take people’s blood pressures and blood sugar, glucose training just so in case we needed to know how, we can. We could let them know with further education how their readings looked, if it was within range or a little bit past range. Those trainings help us help the community.” • “Sometimes we do the trainings, like [Name] said, blood pressure and vital signs because first of all, some people don’t know how to take vital signs. It’s good for me because I do have a family, but if something happened to them I know how to take care of them.” 4 Collier County Community Health Worker Focus Group Report 3) Role-play • “We had multiple trainings throughout the months, and some of the trainings that I feel that we do that are the most important are when we have to role-play. In some of the trainings we role- play so that we know when different situations occur how to talk to the patients or how to de- escalate certain situations. We also go over how a home visit should go or certain precautions that we should take, safety measures for ourselves as well. I think those play a really important part in the learning aspect we have.” CHW Training, Resources, and Information: Opportunities When asked about the training, resources, and information provided by the CHW program that was not helpful, the CHWs stated the following: 1) Repetition of training • “I feel like sometimes some of the trainings are repetitive. Sometimes the trainings are kind of constant, and they’re always refreshers of what we’ve already done or have already been through. And so, it feels like it’s not really helpful in the case of the stuff that we actually need. Because if we’re just gonna do trainings on de-escalation, it feels like we’ve already been there, done that. I’ve already learned this.” When asked about the trainings, information and resources that were not provided by the CHW program but would be helpful, the CHWs stated the following: 1) Resources for CHW self-care • “I would say maybe more promoting our own health and wellness. I know we had maybe a short training or reading on stress management, but kind of beyond that because what we do and what we see is a lot, the people that we help in this community especially. So, I think maybe ways to promote our mental health, physical health trainings or self-care management would be nice for us as Community Health Workers.” • “I feel like there should also be information brought to us about what things are in our community that are able to help us. In schools they have the food pyramid so that kids know food groups that they should be eating. I feel like there should be stuff like that for us reciprocated as well like nutritional facts that we should uphold, sleeping schedules, just stuff that’s important as adults for us to keep in mind. Especially since we work at a medical facility, it’s important for us to know what’s our normal blood pressure rating or what’s our normal glucose. We should also be screened as well medically, physically. We should always try to upkeep that as well.” • “I’d say maybe my mental health, sometimes it’s not the best. Sometimes this job can get stressful. Even with the weather here in Florida, there’s been days where it’s terribly hot or it’s always raining. Also, we have had difficult interactions with people in the community, so that can also make us feel a little bit more stressed. So, it has affected my mental health. And as for physical health, I guess just seeing what’s going on in the community and my blood sugar readings and stuff, it makes me not want to be as sick as some of the people in the community. I’d better take better care of myself physically.” 2) Home visit training • “We need more training about the house visits, how to go to the patient’s house, because sometimes when you go to someone’s house, maybe they’re scared to open the door. Maybe the day we come in and the time, maybe some people are working at night. Maybe they were sleeping. They don’t hear the bell. Maybe we come too early or too late, something like that. So, I think we need more training about that, about the house visits.” 5 Collier County Community Health Worker Focus Group Report 3) Cultural competency training • “I think we should get training specifically on what communities we go to because, for example, Immokalee is very different from, let’s say, Everglades where it’s predominantly Caucasian people. And Immokalee is mostly Haitian Creole and Spanish people. I feel like it’s even different the way that we’re supposed to talk to them because even our cultures are different. Maybe just for the Everglades because we have instances where they’re kind of hostile towards us. So, to better educate us about the differences between us as community helpers and the community members of Everglades.” 4) Basic clinical training • “More medical-based training. Not all of us have the clearance to do certain medical things, but to be able to know how to do certain things are important for us just in case the person who usually does it isn’t around or just for us to continue a basic medical knowledge, like to know what parameters are for glucose readings, or blood pressure, or even just some basic things we do just to have further education for people… It’s hard if we don’t know the information how to relay it back to somebody who does speak those languages. So, we’re just translating instead of actually understanding so that we can help them understand as well. They’re giving us technical terms, and we need to translate it back to layman’s terms so that they understand what we’re saying sometimes, so there’s also a bridge in comprehension, not just language.” 5) CHW member directory/resource for greater community awareness • Speaker 1: “I think a training or a resource that would be more helpful for all of us is if other community members or businesses would have a better collaboration for all of us to have, because I feel like whenever we go to either certain businesses or certain stores or even places where a lot of community are, sometimes they’re apprehensive about us being there or –“ o Speaker 2: “Or sometimes, like [Name] said, when we go to businesses, sometimes they often only have a point of contact that’s one of our leads, so if we go there it’s like, ‘What are you doing here? We don’t know who you are.’ So, maybe if they knew all of us –“ o Speaker 1: “All of us, yeah. Because our lead is not always with the people who go canvassing, so sometimes it’s hard for us to be like, “Yeah, we’re with this person,” when maybe they know either one, our senior lead, or our other lead. We don’t know which person they know. We don’t know whose name to give. They should know all of us.” 6) Designated time/place for internal team dialogue • “I feel like as a Community Health Worker there should be facets for us to be able to either express our opinions on how things are going, just maybe sometimes a group share about how we feel certain areas we’re going to are working out for us, or even for our aspect somewhere that’s kind of a safe space for us so we can be able to do good either mentally, physically.” Barriers to CHW Role/Program CHWs were asked to identify barriers to their role as a CHW or within the CHW program. Two main themes emerged: 1) Transportation • “I know I’ve had some issues in the past with transportation. We recently split into two teams, one team in Immokalee and one in Naples. And the team in Immokalee does have the business van or the van that we use for events that are far away, but I know Naples doesn’t. And they’re struggling right now when we get to those events here in Immokalee because they’re also cutting back on the travel expenses that they can request. So, it’s been kind of a gray area 6 Collier County Community Health Worker Focus Group Report between our two teams and the transportation that we need to get first hour from the Everglades and the second hour a way to both Immokalee and Naples.” 2) Internal group dynamics and fragmented teams • “I think another barrier that we have within the group alone is what I notice as a therapy aspect. Some people will be in a specific position for the reason they are in it, but I feel like sometimes people kind of self-appoint themselves to things that they might not be able to know how to do or shouldn’t be doing because somebody else is probably more skilled in doing it in the first place. So, sometimes we’ve had that problem where one person thinks that they can do everything or multiple people think that they can do everything, and that’s not the case. Sometimes one person should just take the reins and be able to lead everyone.” • “…since we’re split up into two teams now, the Naples team doesn’t really have that much coverage to be able to go out and canvas for the whole day in certain places. And then, we’re the Immokalee team. We don’t go with them. So, if they’re the ones canvassing, we’re kinda left out a little bit to not know where things are in that area. It’s a little uncomfortable for our team and their team since when they come here they might not know where something is in Immokalee, and vice versa.” Barriers Encountered by CHW in Community CHWs were asked to identify barriers encountered in the community as a CHW. The following themes emerged: 1) Lack of community awareness of CHW role (to build community trust and ensure CHW safety) • “…people don’t really know about our community outreach work. Because we can do a survey and say, ‘Do you talk with the CHW?’ People are gonna say, ‘No, what is that?’ I think we need something to do to educate the people and the community to know about us, like we’re doing [inaudible] where they should know it better.” • “For me, the barrier is if when we do the canvassing, for example… we were going to Everglades City. When we’re going over there not a lot of people open the door, and they have a gun on it, they have the sign, ‘Don’t Enter.’ And that’s a bad experience for us, a very bad experience for us. I think for me, before we go there maybe, like [Name] said, one or two leads can go there and talk to them. For example, tomorrow the community outreach is coming to the city to do the canvassing to talk to them about how to protect yourself from the COVID-19, flu, something like that. But when we come in just like that, they don’t know nothing. They’re scared. They don’t open the door. And they have a big dog or a lot of things.” 2) Lack of community knowledge/education • “From the community, I feel there’s a sense of understanding. Sometimes they might not understand what we’re trying to present to them or there’s a lack of knowledge on what we’re trying to explain to them. But sometimes people are from other countries, and they don’t finish schooling because they can’t afford to finish schooling. And so, sometimes people don’t know how to read or write, and that’s kind of a barrier sometimes for us. There’s also instances where we have people who, at a mental capacity, they aren’t really all there as well. Sometimes we have that barrier. There [are] also social aspects. Sometimes people, if they see someone trying to get help medically, they think, ‘Oh, there’s something wrong with that person.’ There’s kind of a stigma sometimes on getting the help that they need. I think that’s also a barrier within our community.” 3) CHW discomfort with community outside of Immokalee • “…I’m especially comfortable in this community, in particular, because most of the people here either speak Spanish or Creole, and I can speak Spanish. I feel like I can relate to some of the 7 Collier County Community Health Worker Focus Group Report patients we see, and I kind of know what they might be going through as a family because my folks are similar. So, as for Immokalee, I’m very comfortable. But let’s say, for example, Everglades, we’ve only been there a couple of times. And their culture seems very different, so I find it difficult to relate to them as a community. Maybe getting more info on how they live their life over there would help make me feel more knowledgeable.” • “Yeah, I agree with [Name]. I feel like I’m really comfortable in Immokalee. If I have to tell a patient either where we’re located or where we’re gonna have a testing event, I can direct them to that place. But I feel like, as [Name] said, a place like the Everglades where I can’t tell someone where the park is there and I can’t tell them where the nearest grocery store is, it’s kind of hard to build that sense of community there when we don’t really know that much about them. And a lot of them are standoffish. They don’t really want us to be there, so it’s a little bit harder. But at least we try to keep going back so that they see us more often and know that we’re in their community and we’ll be here, we’ll be around.” • “I agree with [Name] and [Name]. Since I’ve come to the United States, in Immokalee I feel comfortable. And when we do canvassing, the testing, it makes me feel very comfortable because the families are Haitian and speak Creole. Not all of them speak Spanish or English. When I talk to them, I talk to them in my language, in Creole. I can understand everything.” Opportunities for CHW Role/Program CHWs were asked if they had suggestions to address the barriers identified in the community and as a CHW/program. Four areas of opportunity were proposed: 1) Marketing of CHW role and program. This opportunity includes greater engagement with the Marketing team, fewer delays in media posting of events, and expansion of marketing to a wider audience. • Speaker 1: “We need to be promoting the program more. So, I don’t know if there are any resources, if we are able to provide more –“ o Speaker 2: “Publicity.” o Speaker 1: “Yeah, more publicity about the Community Health Worker to get people to know more about us so when we are outside they will know we can knock on their doors, because they don’t know what we are, and they don’t open the door to us. So, I think we need to do more to get people to know about the program.” o Speaker 2: “Yeah. Like what you said, [Name] – I don’t know if you were there when we had the meeting with the marketing team, but when we talked about it, it was kind of to learn how we could help them promote the Healthcare Network as a program, not so much about how we could get the word out about us and the programs and what we do. Maybe in the future we could get some – I don’t know if they can become a little bit more in the media when it comes to what we – and we could start hosting stuff. Because I know, even for the Hispanic community, everyone’s on Facebook. So, if they could even just know when we’re having events or where we’re going to be canvassing, I think they could reach a lot more people that way.” • Speaker 1: “I think that we’re not reaching the mass of the audience that we could be. Like what [Name] was saying, when we did have that meeting with marketing, it was more for us to give them stories to make them look better instead of us being able to post our schedule, when we’ll be out, or important things that the community should know that we’re doing. But they kind of post on their timetable and not when we actually need it to be posted.” o Speaker 2: “And they would post, for example, a flyer for an event. I don’t know why, but at some points they would post it after the fact. I didn’t think that was useful at all because if it was after the event happened, people don’t know.” o Speaker 1: “Yeah, and I feel like we’re only on one radio station, and it’s just a Hispanic radio station. We’re not also on a Haitian radio station. And so, we’re only reaching one group of people through other things. We’re not reaching both aspects of the 8 Collier County Community Health Worker Focus Group Report people who are in our community.” o Speaker 2: “And I think it’s a Christian radio station, too, so that even narrows the [inaudible].” o Speaker 1: “Yeah. Especially with people who want to get the vaccine from us, they’re not hearing it. Because a lot of people, depending on their religion or faith, don’t want to get the vaccine based on that alone. So, it kind of makes the people who come out to our events even smaller. If we had more places for us to be able to share what we’re doing it would be more productive for all of us. We’d reach more people.” • “I feel like if we’re able to spread more about what we’re doing and where we’re going to be instead of marketing after the fact, after the event’s over, sometimes the next day. It’s kind of counterproductive. It’s not really working towards anything that we’re trying to do for the community.” 2) Community health education/literacy sessions • Speaker 1: “To break certain barriers like the comprehension and reading or writing, I feel like it’s important to have people who speak the same language as the person and that we can break it down to them as far as possible. Some people stop going to school in sixth grade, seventh grade. They didn’t even make it to high school. It’s important for us to be able to – because if we’re trying to explain hypertension, a normal person doesn’t really know what hypertension is, even trying to explain what hypertension causes or what it does. Some people don’t know that it’s the certain way the valves of your heart are beating that causes the hypertension, so it’s important for us to break it down for them so that they understand more.” o Speaker 2: “I think like how [Name] said, I think it would be cool if we could maybe just, even if it’s once a month or it’s every couple months, go to our tiny communities, for example, Farm Worker Village or [inaudible] and maybe host a small meeting, an informational type of session with the people of that community just to kind of go over all those medical terms and educate them on these things that are important to them so they can learn from it. That way our conversations would go smoother and they would have an understanding of what we’re talking about.” o Speaker 1: “I feel like not only medical terms is something we should go over but also medications because sometimes people go to their primary care doctor, and they get a list of medications to take, but they don’t know what those medications do or when to take them or what it’s for. So, I think that’s also important for us to be able to relay. I definitely agree with what [Name] said to have an information session with people in these communities where we’re only just letting them know what certain terms mean, how this affects them, or what it means to them in their population or their specific group or ethnicity.” 3) Greater staff assistance with applications • “I think some opportunities that we would be able to have is more to be able to help people fill out applications for assistance. I do know that we have people on our team who are able to fill out certain applications for people. Like if we see pregnant mothers, sometimes people don’t know about WIC. That helps the community. And so, it would be really beneficial for us to be able to help them apply for either WIC or Medicaid, or Medicare for elderly. That would be really important if we can eventually move into that opportunity aspect.” 4) More engagement with community leaders • Speaker 1: “I think something that would be really cool for us as a team would be if we could get more involved with important meetings for our county. For example, we can go through – what is it called?” o Speaker 2: “Chamber of Commerce?” o Speaker 1: “Chamber of Commerce and even school district meetings. So, maybe if it was just one of us representing the team just to kind of get our word out because who knows the community better than us if we’re out there all day? And even some of us are part of the community, so maybe we could get involved with their, I don’t know –“ 9 Collier County Community Health Worker Focus Group Report Suggestions for CHW Program When asked if they could make one change to make the CHW program, the CHWs gave the following suggestions: 1) More incentives for community participation in CHW activities • “I think we should give more things to people that they can come more to the fairs within the community because when we are in the community of people, if they find something that they benefit, I think they will refer other people to come here. Because I know my people, but [inaudible] for the Haitian people. If someone is coming, and they give you something or some advantage or some benefit, you’re gonna tell other people to come here to us. Then we can pass them the message, and then the people can get healthy, too.” • “Yesterday we had something to do to go outside and give the flyer out about September 6th. We’re doing the program, and we are giving a gift card for $50.00. They’re so happy. They’re very happy because we’re going to give them more things. We give more things than that because, like [Name] said, we give some prizes, or we give the kit for Corona to do it at home, something like that, and we can sometimes give gloves and masks. But they just get more because when you say, ‘If you get the vaccine or if you want a ticket, we’re gonna give you $50.00 to go shopping,’ and that’s more things. That’s motivation. If we do something, they’re all coming more to do that.” • “That’s for people who don’t have any insurance or have any Medicaid. That’s why they’re scared to come into the clinic. When we say we give outside a free program, and if they come into the clinic we have a prize for it, they can qualify to get the next chance, they’re so very happy. Because they don’t know how to come to the clinic to ask for it because they don’t speak Creole or English. They just speak Spanish, and we help them.” 2) Self-improvement day for CHWs • “I have written down a self-improvement day or designate a time for that because we all have different skills. And like [Name] had mentioned, there’s sometimes people who want to take all the roles and kind of work on it themselves. But maybe there’s a time when we can all share, like, ‘Oh, I think I could help you with this,’ or maybe we could brainstorm on how to improve our team. Maybe have a designated time for that because there are moments where multiple people are out in the office maybe helping people out in the community or having meetings here at the… building. So, maybe having a time when we’re all together and kind of just sharing how we can improve our team.” 3) Clear communication of internal roles and leadership hierarchy • “I think something that would help all of us is if we all understood our roles better correctly. Sometimes now we have moments where one person is saying to do one thing, but then another person is saying, ‘No, I want you to do this instead.’ So, sometimes we don’t have that clear level of who’s in charge. That’s a really important thing that I feel like we should have because there are moments where there are four people, and all four people think that they’re in charge. I feel like it breaks down the morale of everybody else’s working. It feels like, ‘Well, if those four people are in charge, then why can’t I be in charge, too?’ You know, it breaks down the purpose of what we’re there for. So, the people who are in charge should be the people who are in charge. And sometimes the people who are in charge are also a little too lenient. They should be, not strict, but follow what they should be doing. Sometimes it can be counterproductive for you to tell one person one thing, and then you were telling another person something completely different. That’s important.” 10 Collier County Community Health Worker Focus Group Report Advice to CHWs Nationwide When asked if they had any advice to provide to CHWs across the United States, two themes were identified: 1) Patience and consistency • “Something that I would say advice-wise to other community workers is probably to be patient because people aren’t going to come to you the first time around. You have to be patient and also be consistent with what you’re doing because just a simple home visit might turn into that patient, every time they see you they’ll say hi to you. So, being consistent and continuing to go to their house or whenever you see them, that’s something that is important to build trust. I would say just to be patient and consistent.” • “I would say you have to be patient because sometimes when you go to their house to visit someone, they just don’t open the door. Yeah, you have to be patient. You have to keep doing your thing, your work. Keep focusing on your work and be patient, and eventually you will see why it is important to do the work.” • “For me, like [Names] said, we have to be patient because when we are going to a house for a visit, it’s very hard. They won’t open the door to come outside. You talk to them, and sometimes the conversation is too long. But you have to be patient for that because we have to understand what they said, and they have time for you to answer, too, for them.” 2) Know your limits • “I would say maybe know your limits as a Community Health Worker. It’s hard to see sometimes what people go through. It’s great that we do have multiple resources for them, but it’s important to know that we can’t help them with every little thing and to kind of just not beat yourself up about it and drain yourself. You know the community best and what they need, but then again, we can’t do everything and touch every necessity or every need that they have in their lives. So, I guess just know your limits.” Summary In sum, the CHWs felt the work they did was important to the community as demonstrated in the MSC technique. They felt that their team diversity and departmental collaboration were strengths to the CHW program. When asked about the training, resources, and information provided by the CHW program, the CHWs stated that the most helpful sessions involved role-play, shadowing, or contained medical training. Those sessions that were deemed unhelpful involved repetitive trainings. Many suggestions were given for future trainings, resources, and information related to CHW self-care, cultural competency, home visits, clinical care, collaboration with partners, and an internal time/place to dialogue. Barriers identified in the CHW role/program included transportation and group dynamics/fragmented teams. Within the community, CHWs identified barriers related to the lack of awareness of the CHW role, discomfort with the community outside of Immokalee, and a lack of community knowledge/education. The CHWs identified several opportunities to address the barriers identified including marketing of the CHW role and program, community education/literacy sessions, staff assistance with applications, and more engagement with community leaders. When asked if they would make one change to improve the CHW program, the CHWs identified greater incentives for community members’ participation, clear communication of internal roles, and a self-improvement day for CHWs.