HHS/AoA Supplemental Grant: Empowering Older Adults Through Evidence-Based Health Prevention Programs

Background
In 2003, the Department of Health and Human Services (HHS), under the leadership of AoA, launched a multi-year grant program involving the Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ), Health Resources Services Administration (HRSA), the National Institute on Aging (NIA), the Centers for Medicare and Medicaid Services (CMS), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Atlantic Philanthropies, the John A. Hartford and Robert Wood Johnson Foundations and a variety of other private foundations to promote the deployment of evidence-based disease and disability prevention programs through community-based aging services provider organizations. The goal of the 2003 initiative was to develop the knowledge, experience and national infrastructure necessary to support the nationwide implementation of such programs and to broaden AoA’s role in working with the HHS science and health agencies to facilitate the rapid translation of research findings into practice at the community-level. To accomplish this goal, AoA partnered with AHRQ, CDC, CMS, HRSA and over 30 private foundations to strengthen the capacity of its Aging Network to deliver evidence-based prevention programs at the community level, leading with the CDSMP.

This initiative expanded with cooperative agreement awards to 16 states in 2006 and 8 awards to states in 2007. To date, there are 24 AoA funded states operating (Evidence-Based Disease Prevention) EBDP projects with $50 million invested by AoA and its partners. The infrastructure for delivering evidence-based programs includes 1,200 community-based delivery sites; a national training and certification programs; a national technical assistance center on evidence-based prevention programs for the elderly; local program training materials, guides and marketing materials; quality assurance mechanisms and fidelity protocols; and a variety of technologies including an AHRQ-sponsored Knowledge Transfer Program to support rapid diffusion.

Current Announcement
In 2009, the goal of this initiative has largely been realized, and HHS now stands ready to
take the initiative by supporting the efforts of the original AoA FY 2006 state grantees.
FY 2006 AoA Evidence-Based Disease Prevention grantees will compete for a 1-year supplemental funding opportunity. The purpose of this announcement is to provide funding to assist states’ efforts in fulfilling the original scope of work in the FY 2006 announcement. The original scope of work included funding to help States establish public/private partnerships as well as develop the statewide systems necessary
to support the on-going implementation of evidence-based programs that have been proven effective at empowering older people to take more control of their health and reduce their risks of disease and disability. Under this announcement, partnership activities should continue to grow at both the State and community level. Collaborations with aging and State health departments on the provision of policy leadership and on-going support for local partnerships involving non-profit aging services providers, area agencies on aging, health organizations, the business sector, and other potential partners from the private and public sectors will continue to be strengthen by this funding opportunity. In concert with the original FY 2006 grant announcement, a major expectation of this competitive supplement is to deliver high quality evidence-based programs that maintain fidelity to both the original design and to the research outcomes associated with the evidence-based models being deployed and to reach the maximum number of at-risk older adults who can benefit from the programs. This expectation reflects both the design and implementation of efficient and well-managed programs, and the need to find and commit funds from other public and private sources to these programs (as has occurred at the national level).

Program Description
In keeping with the original scope of work in the FY 2006 grant announcement, competitive supplemental applications must propose, at a minimum, how they will continue to implement the Stanford University Chronic Disease Self-Management Program (CDSMP) self-care model in their projects’ selected geographic areas. The
programs selected under the original FY 2006 grant announcement fit into one or more of the following subject areas:
• Chronic Disease Self-Care (i.e., chronic diseases generally or specific ones such
as diabetes, hypertension, heart disease, arthritis, etc.)
• Physical Activity (see Cress ME et al. (2004). “Physical Activity Programs and Behavior Counseling in Older Adult Populations,” Medicine & Science in Sports & Exercise, 36(11): 1997-2003.)
• Fall Prevention
• Nutrition and Diet (including the role of nutrition in the maintenance of healthy and appropriate body weight and control of chronic diseases, etc.)
• Mental Health and/or Substance Abuse Prevention (including early intervention for depression, anxiety, alcohol misuse or edication misuse In keeping with the original scope of the FY 2006 grant announcement, applicants should outline how continuation funds will ensure the following:
• Lead organizations at the community level have the organizational capacity and commitment necessary to mobilize public/private partnerships and implement an evidence-based prevention program.
• Local programs continue to reach and retain older adults who are at high risk for the specific diseases or disabilities that are the focus of the selected intervention.
• Strong partnerships are formed with appropriate public and private organizations
from aging, public health, health care and other sectors.
• Programs are implemented with fidelity to both the original design and research
outcomes associated with the selected evidence-based program with as few adaptations as necessary to address local conditions and the unique needs of the target population. Any adaptations that are made must not compromise the effectiveness of the original evidence-based program.
• Information and monitoring systems are provided to track on-going fidelity to the original evidence-based design and research outcomes and to conduct routine formative evaluations, including measuring participant/client satisfaction to enable continual program improvements and to provide accountability.

As in the original FY 2006 grant announcement, the applicant should ensure its proposal demonstrates that no organization, except the local health department as described below,
fulfills more than one of the three required partnership roles:

• A research organization, such as an institution of higher learning, to assist with translating the evidence-based model into a program, maintaining fidelity to the evidence-based intervention, and assisting in the training, evaluation, cost assessment, and other technical aspects of the program.

• A Local Health Department which, in addition to serving as the health partner, may have the capacity to perform the roles described for the “Research Organization,” or assist in the implementation of services.

• An Aging and Disability Resource Center (ADRC) which can help clients access the disease and disability prevention programs and help clients address current or future long-term care issues. ADRCs are not available in all places, but as they are established, they should become partners in evidence-based disease and disability prevention programs

• Other community organizations that may assist in meeting program goals including, but not limited to: local foundations, charitable organizations, professional associations, USDA Extension Service programs, community organizations not currently receiving Older Americans Act funds, mental health agencies, and many others.