[Federal Register: March 2, 1998 (Volume 63, Number 40)]
[Notices]               
[Page 10226-10229]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr02mr98-80]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

 
Office of Minority Health; Availability of Funds for Grants for 
the Bilingual/Bicultural Service Demonstration Grant Program

AGENCY: Office of the Secretary, Office of Minority Health.

ACTION: Notice of availability of funds and request for Applications 
for the Bilingual/Bicultural Service Demonstration Program.

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AUTHORITY: This program is authorized under section 1707(d)(1) of the 
Public Health Service Act, as amended by Public Law 101-527, the 
Disadvantaged Minority Health Improvement Act of 1990.

PURPOSE: The purpose of this Fiscal Year 1998 Bilingual/Bicultural 
Service Demonstration Grant Program is to:
    (1) Improve and expand the capacity for linguistic and cultural 
competence of health care professionals and paraprofessionals working 
with limited-English-proficient (LEP) minority communities and
    (2) Improve the accessibility and utilization of health care 
services among the LEP minority populations.
    These grants are intended to demonstrate the merit of programs that 
involve partnerships between minority community-based organizations and 
health care facilities in a collaborative effort to address cultural 
and linguistic barriers to effective health care service delivery and 
to increase access to effective health care for the LEP minority 
populations living in the United States.
    The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of Healthy People 
2000, a PHS-led national activity to reduce morbidity and mortality and 
to improve the quality of life. Potential applicants may obtain a copy 
of Healthy People 2000 which is available through the Government 
Printing Office, Washington, DC 20402-9325 or telephone (202) 783-8238 
(Full Report: Stock No. 017-001-00474-0). Another reference is the 
Healthy People 2000 Review--1997. One free copy may be obtained from 
the National Center for Health Statistics, 6525 Belcrest Road, Room 
1064, Hyattsville, MD 20782 or telephone (301) 436-8500. (DHHS 
Publication No. (PHS) 98-1256)

Background

    Large numbers of minorities in the United States are linguistically 
isolated. According to the 1990 U.S. Census, 31.8 million persons or 13 
percent of the total U.S. population (ages 5 and above) speak a 
language other than English at home. Almost 2 million people do not 
speak English at all and 4.8 million people do not speak English well. 
The 1990 U.S. Census also found that various minority populations and 
subgroups are linguistically isolated: Approximately 4 million 
Hispanics; approximately 1.6 million Asians and Pacific Islanders; 
approximately 282,000 Blacks; and approximately 77,000 Native Americans 
and Alaska Natives.
    Besides the social, cultural and linguistic barriers, which affect 
the delivery of adequate health care, there are other factors that 
contribute to the poor health status of LEP minority people. These 
factors include:

[[Page 10227]]

    <bullet> Inadequate number of health care providers and other 
health care professionals skilled in culturally competent and 
linguistically appropriate delivery of services;
    <bullet> Scarcity of trained interpreters at the community level;
    <bullet> Deficiency of knowledge about appropriate mechanisms to 
address language barriers in health care settings;
    <bullet> Absence of effective partnerships between major mainstream 
provider organizations and LEP minority communities;
    <bullet> Low economic status;
    <bullet> Lack of health insurance; and
    <bullet> Organizational barriers.
    Research has suggested that culture provides a unique concept of 
disease, risk factors, and preventive actions.\1\ It also has been 
indicated that definitions of health and illness are often culturally 
determined and therefore, the study of culture and tradition is a 
valuable tool in understanding the underlying motives for health 
behavior.\2\ The clients' understanding of the Western health care 
model, and the cultural ability to accept health education, influences 
their access to health care services and their compliance with health 
care advice.
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    \1\ Evans, P.E. (1988) Minorities and AIDS. Health Education 
Research, Vol. 3, No. 1, pp 113-115.
    \2\ Toumishey, H. (1993), Multicultural Health Care: An 
Introductory Course. In R. Masi, L. Mensah, & K. McLeod (eds.), 
Health and Cultures: Exploring the Relationships, pp 113-138. Mosaic 
Press, Ontario, Canada.
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    It is essential that health care providers, health care 
professionals and other staff become informed about their diverse 
clientele from a linguistic, cultural and medical perspective. These 
individuals should become culturally competent so they can encourage 
vulnerable LEP minority populations to access and receive appropriate 
health care with more knowledge and confidence.
    In FY 1993, the Office of Minority Health (OMH) launched the 
Bilingual/Bicultural Service Demonstration Grant Program to 
specifically address the barriers that LEP minority populations 
encounter when accessing health services.
    In FY 1998, the OMH continues to focus on health problem areas 
identified in the 1997 OMH Report to Congress. These health areas are: 
(1) Heart disease and stroke; (2) cancer; (3) chemical dependency; (4) 
diabetes; (5) homicide, suicide, and unintentional injuries; (6) infant 
mortality; and (7) HIV/AIDS. Flexibility for communities to define 
their own health problem priorities (e.g., asthma, sexually transmitted 
diseases (STDs), tuberculosis, female genital mutilation, immunization 
and tobacco use) is also encouraged.

Eligible Applicants

    Public and private, nonprofit minority community-based 
organizations or health care facilities which serve a targeted LEP 
minority community. (See Definitions of Minority Community-Based 
Organizations and Health Care Facilities found in this announcement.) 
Eligibility is limited to: (1) Previously funded Bilingual/Bicultural 
Service Demonstration Program grant recipients; and (2) organizations 
which previously applied to the Bilingual/Bicultural Service 
Demonstration Program and were recommended for approval, but were not 
funded due to OMH budget limitations. This will allow previously funded 
grantees to build on efforts already initiated under this demonstration 
program. It also allows those organizations which designed projects 
judged to have merit in a previous objective review process, an 
opportunity to submit proposals which meet the requirements set forth 
in this announcement.
    A linkage must be in place between a minority community-based 
organization and a health care facility, one of which is the applicant 
organization, and documented in writing as specified under the project 
requirements described in this announcement.
    Currently funded OMH Bilingual/Bicultural Service Demonstration 
Program grantees (Managed Care) are not eligible to apply. National 
organizations, for-profit hospitals, universities and schools of higher 
learning are not eligible to apply. Applicants may apply to more than 
one OMH FY 98 grant program announcement; however, organizations will 
not receive funding for more than one OMH grant program concurrently.

Deadline

    To receive consideration, grant applications must be received by 
the OMH Grants Management Office 60 days after date of publication or 
by April 13, 1998. Applications will be considered as meeting the 
deadline if they are: (1) Received on or before the deadline date, or 
(2) postmarked on or before the deadline date and received in time for 
orderly processing. A legibly dated receipt from a commercial carrier 
or U.S. Postal Service will be accepted in lieu of a postmark. Private 
metered postmarks will not be accepted as proof of timely mailing. 
Applications submitted by facsimile transmission (FAX) or any other 
electronic format will not be accepted. Applications which do not meet 
the deadline will be considered late and will be returned to the 
applicant unread.

Addresses/Contacts

    Applications must be prepared using Form PHS 5161-1 (Revised July 
1992 and approved by OMB under control Number 0937-0189). Application 
kits and technical assistance on budget and business aspects of the 
application may be obtained from Ms. Carolyn A. Williams, Grants 
Management Officer, Division of Management Operations, Office of 
Minority Health, Rockwall II Building, Suite 1000, 5515 Security Lane, 
Rockville, Maryland 20852, telephone (301) 594-0758. Completed 
applications are to be submitted to the same address.
    Questions regarding programmatic information and/or requests for 
technical assistance in the preparation of grant applications should be 
directed to Ms. Cynthia H. Amis, Director, Division of Program 
Operations, Office of Minority Health, Rockwall II Building, Suite 
1000, 5515 Security Lane, Rockville, Maryland 20852, telephone number 
(301) 594-0769.
    Technical assistance is also available through the OMH Regional 
Minority Health Consultants (RMHCs). A listing of the RMHCs and how 
they may be contacted will be provided in the grant application kit. 
Additionally, applicants can contact the OMH Resource Center (OMHRC) at 
1-800-444-6472 for health information.

Availability of Funds

    Approximately $1.2 million is available for award in FY 1998. It is 
projected that awards of up to $100,000 total costs (direct and 
indirect) for a 12-month period will be made to approximately 10 to 12 
competing applicants. Of the total amount obligated, at least $460,000 
will be awarded to projects that include HIV/AIDS as one of the 
targeted health problem areas to be addressed.

Period of Support

    The start date for the Bilingual/Bicultural Service Demonstration 
Program grants is September 30, 1998. Support may be requested for a 
total project period not to exceed 3 years. Noncompeting continuation 
awards of up to $100,000 will be made subject to satisfactory 
performance and availability of funds.

Definitions

    For purposes of this grant announcement, the following definitions 
apply:
    Cultural Competency--A set of interpersonal skills that allow

[[Page 10228]]

individuals to increase their understanding and appreciation of 
cultural differences and similarities within, among and between groups. 
This requires a willingness and ability to draw on community-based 
values, traditions and customs, and to work with knowledgeable persons 
of and from the community in developing focused interventions, 
communications and other supports. (Orlandi, Mario A., 1992.)
    Health Care Facility--A public nonprofit facility that has an 
established record for providing comprehensive health care services to 
a targeted, LEP racial/ethnic minority community. Facilities providing 
only screening and referral activities are not included in this 
definition. A health care facility may be a hospital, outpatient 
medical facility, community health center, migrant health center, or a 
mental health center.
    Limited-English-Proficient Populations (LEP)--Individuals (as 
defined in Minority Populations below) with a primary language other 
than English who must communicate in that language if the individual is 
to have an equal opportunity to participate effectively in and benefit 
from any aid, service or benefit provided by the health provider.
    Minority Community-Based Organization--A public or private 
nonprofit community-based minority organization or a local affiliate of 
a national minority organization that has: A governing board composed 
of 51 percent or more racial/ethnic minority members, a significant 
number of minorities in key program positions, and an established 
record of service to a racial/ethnic minority community.
    Minority Populations--American Indian or Alaska Native, Asian, 
Black or African-American, Hispanic or Latino, and Native Hawaiian or 
other Pacific Islander. (Revision to the Standards for the 
Classification of Federal Data on Race and Ethnicity, Federal Register, 
Vol. 62, No. 210, pg. 58782, October 30, 1997.)

Project Requirements

    Each project funded under this demonstration grant is to:
    1. Address at least one, but no more than three, problem health 
areas identified in the Background section.
    2. Carry out activities to improve and expand the capacity of 
health care providers and other health care professionals to deliver 
linguistically and culturally competent health care services to the 
target population. Potential activities may include: Language and 
cultural competency training and curricula development, bilingual 
health access or health promotion information in the native language or 
on-site interpretation services. Traditional or innovative training 
models may include portable training products such as CD-ROMs, video 
tapes, or on-line distance based learning formats for continuing 
education.
    3. Carry out activities to improve access to health care for the 
LEP population. Potential activities may include those that will 
educate the target population on the importance of health promotion and 
disease prevention; enhance the ability of the target population to 
communicate their health care concerns to health care providers; and 
increase their understanding of health education information and 
improve compliance with health care treatments. The applicant may 
utilize culturally and/or linguistically appropriate informational or 
communication technologies, such as printed materials which may have 
pictorial messages, mass media, public service announcements and 
neighborhood outreach and electronic systems including kiosks as an 
educational tool; or forums, seminars or workshops to promote 
information exchange among the targeted LEP population and the health 
care professionals.
    4. Have an established, formal linkage between a minority 
community-based organization and a health care facility, one of which 
is the applicant, prior to submission of an application. The linkage 
must be confirmed by a signed agreement between the applicant and 
linkage organizations which specifies in detail the roles and resources 
that each entity will bring to the project, and states the duration and 
terms of the linkage. The document must be signed by individuals with 
the authority to represent the organizations (e.g., president, chief 
executive officer, executive director).

Use of Grant Funds

    Budgets of up to $100,000 total cost (direct and indirect) per year 
may be requested to cover costs of: Personnel, consultants, supplies 
(including screening and outreach supplies), equipment, and grant-
related travel. Funds may not be used for medical treatment, 
construction, building alterations, or renovations. All budget requests 
must be fully justified in terms of the proposed goals and objectives 
and include a computational explanation of how costs were determined.

Criteria for Evaluating Applications

    Review of Applications: Applications will be screened upon receipt. 
Those that are judged to be incomplete, nonresponsive to the 
announcement or nonconforming will be returned without comment. Each 
organization may submit no more than one proposal under this 
announcement. If an organization submits more than one proposal, all 
will be deemed ineligible and returned without comment. Accepted 
applications will be reviewed for technical merit in accordance with 
PHS policies. Applications will be evaluated by an Objective Review 
Panel chosen for their expertise in minority health and their 
understanding of the unique health problems and related issues 
confronted by the racial/ethnic minority populations in the United 
States.
    Applicants are advised to pay close attention to the specific 
program guidelines and general and supplemental instructions provided 
in the application kit.
    Application Review Criteria: The technical review of applications 
will consider the following generic factors:

Factor 1: Background (15%)

    Adequacy of: Demonstrated knowledge of the problem at the local 
level; demonstrated need within the proposed community and target 
population; demonstrated support and established linkage(s) in order to 
conduct the proposed model; and extent and documented outcome of past 
efforts and activities with the target population.

Factor 2: Goals and Objectives (15%)

    Merit of the objectives, their relevance to the program purpose and 
stated problem, and their attainability in the stated time frames.

Factor 3: Methodology (35%)

    Appropriateness of proposed approach and specific activities for 
each objective. Logic and sequencing of the planned approaches in 
relation to the objectives and program evaluation. Soundness of the 
established linkages.

Factor 4: Evaluation (20%)

    Thoroughness, feasibility and appropriateness of the evaluation 
design, and data collection and analysis procedures. Potential for 
replication of the project for similar target populations and 
communities.

Factor 5: Management Plan (15%)

    Applicant organization's capability to manage and evaluate the 
project as determined by: The qualification of

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proposed staff or requirements for ``to be hired'' staff; proposed 
staff level of effort; management experience of the lead agency; and 
experience of each member of the linkage as it relates to its defined 
roles and the project.

Award Criteria

    Funding decisions will be determined by the Deputy Assistant 
Secretary of Minority Health, Office of Minority Health, and will take 
under consideration: The recommendations and ratings of the review 
panel, geographic and racial/ethnic distribution, and health problem 
areas having the greatest impact on minority health. Consistent with 
the Congressional intent of Public Law 101-527, section 1707(c)(3), 
consideration will be given to projects targeting Asian, American 
Samoan, and other Pacific Islander populations. Consideration will also 
be given to projects proposed to be implemented in Empowerment Zones 
and Enterprise Communities.

Reporting and Other Requirements

General Reporting Requirements

    A successful applicant under this notice will submit: (1) Annual 
progress report; (2) an annual Financial Status Report, and (3) a final 
progress report and Financial Status Report in the format established 
by the Office of Minority Health, in accordance with provisions of the 
general regulations which apply under ``Monitoring and Reporting 
Program Performance,'' 45 CFR part 74, subpart J, with the exception of 
State and local governments to which 45 CFR part 92, subpart C 
reporting requirements apply.

Provision of Smoke-Free Workplace and Nonuse of Tobacco Products by 
Recipients of PHS Grants

    Ths Public Health Service strongly encourages all grant recipients 
to provide a smoke-free workplace and to promote the nonuse of all 
tobacco products. In addition, Public Law 103-227, the Pro-Children Act 
of 1994, prohibits smoking in certain facilities (or in some cases, any 
portion of a facility) in which regular or routine education, library, 
day care, health care or early childhood development services are 
provided to children.

Public Health System Reporting Requirements

    This program is subject to Public Health Systems Reporting 
Requirements. Under these requirements, a community-based 
nongovernmental applicant must prepare and submit a Public Health 
System Impact Statement (PHSIS). The PHSIS is intended to provide 
information to State and local health officials to keep them apprised 
of proposed health services grant applications submitted by community-
based nongovernmental organizations within their jurisdictions.
    Community-based, nongovernmental applicants are required to submit, 
no later than the Federal due date for receipt of the application, the 
following information to the head of the appropriate state and local 
health agencies in the area(s) to be impacted: (a) A copy of the face 
page of the applications (SF 424), (b) a summary of the project 
(PHSIS), not to exceed one page, which provides: (1) A description of 
the population to be served, (2) a summary of the services to be 
provided, (3) a description of the coordination planned with the 
appropriate State or local health agencies. Copies of the letters 
forwarding the PHSIS to these authorities must be contained in the 
application materials submitted to the Office of Minority Health.

State Reviews

    This program is subject to the requirements of Executive Order 
12372 which allows States the option of setting up a system for 
reviewing applications from within their States for assistance under 
certain Federal programs. The application kit to be made available 
under this notice will contain a listing of States which have chosen to 
set up a review system and will include a State Single Point of Contact 
(SPOC) in the State for review. Applicants (other than federally 
recognized Indian tribes) should contact their SPOCs as early as 
possible to alert them to the prospective applications and receive any 
necessary instructions on the State process. For proposed projects 
serving more than one State, the applicant is advised to contact the 
SPOC of each affected State. The due date for State process 
recommendations is 60 days after the application deadline by the Office 
of Minority Health's Grants Management Officer. The Office of Minority 
Health does not guarantee that it will accommodate or explain its 
responses to State process recommendations received after that date. 
(See ``Intergovernmental Review of Federal Programs,'' Executive Order 
12372, and 45 CFR part 100 for a description of the review process and 
requirements.)

OMB Catalog of Federal Domestic Assistance

    The OMB Catalog of Federal Domestic Assistance Number for the 
Bilingual and Bicultural Service Demonstration Program is 93.105.
Clay E. Simpson, Jr.,
Deputy Assistant Secretary for Minority Health.
[FR Doc. 98-5233 Filed 2-27-98; 8:45 am]
BILLING CODE 4160-17-M