[Federal Register Volume 60, Number 71 (Thursday, April 13, 1995)]
[Notices]
[Pages 18934-18937]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-9143]




[[Page 18933]]

_______________________________________________________________________

Part III





Department of Health and Human Services





_______________________________________________________________________



Public Health Service



_______________________________________________________________________



Bilingual/Bicultural Service Demonstration Projects in Minority Health; 
Availability of Funds and Request for Applications; Notice

  Federal Register / Vol. 60, No. 71 / Thursday, April 13, 1995 / 
Notices  

[[Page 18934]]


DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service


Office of the Assistant Secretary for Health; Notice on 
Availability of Funds and Request for Applications for Bilingual/
Bicultural Service Demonstration Projects in Minority Health

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

ACTION: Notice of availability of funds and request for applications 
for bilingual/bicultural service demonstration projects in minority 
health.

-----------------------------------------------------------------------

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

PURPOSE: To provide support to improve the ability of health care 
providers and other health care professionals to deliver linguistically 
and culturally competent health services to limited-English-proficient 
populations.

APPLICANT ELIGIBILITY: Eligible applicants are public and private 
nonprofit minority community-based organizations or health care 
facilities serving a targeted minority community.

ADDRESSES/CONTACTS: Applications must be prepared on 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, Office of Minority Health, 
Rockwall II Building, Suite 1000, 5515 Security Lane, Rockville, MD 
20852, (telephone 301/594-0758) or by Internet E-mail 
[email protected]. Completed applications are to be submitted 
to the same address.
    Technical assistance on the programmatic content for the Bilingual/
Bicultural Grants may be obtained from Ms. Nina Darling or Ms. Rizalina 
Galicinao. They can be reached at the Office of Minority Health, 
Rockwall II Building, Suite 1000, 5515 Security Lane, Rockville, MD 
20852, (telephone 301/594-0769) or by Internet E-mail 
[email protected] or [email protected].
    In addition, OMH Regional Minority Health Consultants (RMHCs) are 
available to provide technical assistance. A listing of the RMHCs and 
how they may be contacted is provided in the grant application kit. 
Applicants also can contact the OMH Resource Center (OMH/RC) at 1-800-
444-6472 for health information and generic information on preparing 
grant applications.

DEADLINE: To receive consideration, grant applications must be received 
by the Grants Management Office by May 15, 1995. Applications will be 
considered as meeting the deadline if they are either:
    (1) Received at the above address on or before the deadline date, 
or
    (2) Sent to the above address on or before the deadline date and 
received in time for orderly processing. Applicants should request a 
legibly dated U.S. Postal Service postmark or obtain a legibly dated 
receipt from a commercial carrier or U.S. Postal Service. Private 
metered postmarks shall not be acceptable as proof of timely mailing. 
Applications submitted by facsimile transmission (FAX) will not be 
accepted. Applications which do not meet the deadline will be 
considered late and will be returned to the applicant unread.

AVAILABILITY OF FUNDS: It is anticipated that in Fiscal Year 1995, the 
Office of Minority Health will have approximately $1.3 million 
available to support approximately 13 grants of up to $100,000 each 
under this program. At least three grants focusing on HIV/AIDS as a 
health problem will be funded under this announcement.

PERIOD OF SUPPORT: Support may be requested for a total project period 
not to exceed 3 years. Non competing continuation awards will be made 
subject to satisfactory performance and availability of funds.

BACKGROUND: The Office of Minority Health is the unit of the U.S. 
Department of Health and Human Services that coordinates Federal 
efforts to improve the health status of racial and ethnic minority 
populations, including American Indians, Alaska Natives, Asian 
Americans, Pacific Islanders, African Americans and Hispanics/Latinos. 
With the passage of the Disadvantaged Minority Health Improvement Act 
(Pub. L. 101-527), the OMH was established in legislation and given a 
broad mandate to advance efforts to improve minority health including 
supporting research, demonstrations and evaluations of new and 
innovative programs that increase understanding of disease risk factors 
and support improvement in information dissemination, education, 
prevention and service delivery to minority communities. The OMH was 
also directed to develop appropriate planning, logistical support, and 
technical assistance related to increasing the capabilities of health 
care providers and other health care professionals to address cultural 
and linguistic barriers to effective health care service delivery, and 
to increase access to effective health care for limited-English-
proficient minority populations [Pub. L. 101-527, section 1707(b)(7)].
    Social, cultural and linguistic barriers on the part of both 
providers and clients significantly affect the receipt of needed health 
care. Among the many factors contributing to the poor health status of 
limited-English-proficient minorities are:
     Inadequate number of health care providers and other 
health care professionals skilled in culturally competent and 
linguistically appropriate delivery of services;
     Scarcity of trained interpreters at the community level;
     Deficiency of knowledge about appropriate mechanisms to 
address language barriers in health care settings;
     A lack of culturally appropriate community health 
prevention programs;
     Absence of effective partnerships between major mainstream 
provider organizations and limited-English-proficient minority 
communities;
     Low economic status;
     Lack of health insurance; and
     Organizational barriers.
    This RFA specifically addresses the barriers that limited-English-
proficient minority populations face when trying to access health 
services.
    In the 1990 U.S. Census, language questions asked were (1) Whether 
respondents speak another language at home, (2) how well they speak 
English (for those who answered yes to the first question), and (3) 
which language they speak at home. The census data indicates that 31.8 
million persons ages 5 and above (13.8 percent of the total U.S. 
population counted by the 1990 census) spoke another language at home. 
Of those, 17.9 million people reported that they speak English very 
well. Almost 2 million people (1.8 million) do not speak English at 
all. An additional 4.8 million people do not speak English well.
    Large numbers of minorities in the United States are linguistically 
isolated--living in households in which no one 14 years old or over 
speaks English and no one who speaks a language other than English 
speaks English ``very well.'' The 1990 Census found 1,572,006 Asian and 
Pacific Islanders at least 5 years of age to be linguistically 
isolated. The percent of Asian and Pacific Islanders who are 
linguistically isolated varies by 

[[Page 18935]]
subgroup--ranging from 9.7% among Filipinos to 59.8% among Hmong. Among 
Pacific Islanders, Tongans had the highest proportion of persons who 
were linguistically isolated (18.7%). More than four million Hispanics 
are linguistically isolated (4,548,677 or 23.8%). Central Americans 
(40.3%) and Dominicans (39.6%) are the most likely to be linguistically 
isolated. Among Blacks, 282,147 (0.9%) are linguistically isolated. 
Among American Indians, Alaska Natives, 77,802 (4%) are linguistically 
isolated.

Definitions

    For purposes of this grant announcement, the following definitions 
are provided:
    (1) Minority Populations--As defined by the Office of Management 
and Budget (OMB) Circular No. 15, include: Asisan/Pacific Islanders, 
Blacks, Hispanics, and American Indian/Alaska Native.
    (2) Limited-English-Proficient Populations--individuals, as defined 
above (1), 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.
    (3) Minority Community-Based Organization--a public or private non-
profit community-based minority organization or a local affiliate of a 
national minority organization that has a governing board composed of 
51% or more racial/ethnic minority members, has a significant number of 
minorities in key program positions, has an established record of 
service to a racial and ethnic minority community.
    (4) Health Care Facilities--for purpose of this announcement, a 
health care facility is a public nonprofit facility that has an 
established record for providing a full range of health care services 
to a targeted racial and 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 care center, 
or a mental health center.
    (5) Community--a defined geographical area in which persons live, 
work, and recreate, characterized by: (a) formal and informal 
communication channels; (b) formal and informal leadership structures 
for the purpose of maintaining order and improving conditions; and (c) 
its capacity to serve as a focal point for addressing societal needs, 
including health needs. A community should be an appropriate catchment 
area in which to address a population's social and health needs.
    (6) Bilingual Direct Services--any activity that delivers person to 
person health care/health promotion services which is linguistically 
and culturally appropriate to limited-English-proficient clientele, 
including, for example, translation and interpreter services and health 
education course taught bilingually.
    (7) Cultural Competency--a set of interpersonal skills that allow 
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)
Potential Projects/Activities

    A broad range of approaches may be used to respond to this 
proposal. However, the projects should concentrate on activities to 
improve the ability of health care providers and other health care 
professionals to deliver linguistic and culturally competent health 
services to limited-English-proficient populations. A proposed program 
may include, but is not limited to:
     language and cultural competency training for health care 
professionals;
     bilingual health access or health promotion information in 
the native language of the target population(s);
     on-site interpretation services; and
     trainer development courses on cultural competency.

Organizational Linkages

    Project goals should promote access to direct services for limited-
English-proficient minority populations by providing continuity of 
support to clients for outreach, referral and treatment. Linkages must 
be established between minority community based organizations and 
appropriate health care facilities. The minority community-based 
organizations and the health care facilities must reach out and work 
with each other to ensure that limited-English-proficient persons are 
in receipt of appropriate health care services. Thus, the applicant, 
either the minority community-based organization or the health care 
facility must have an established linkage with the other organization 
prior to submitting an application.

Application Process

    Applicants should pay particular attention to the general and 
supplemental instructions provided in the application kit to ensure 
that their applications are responsive to each of the concerns under 
the following headings:

Background

    Provide a description of the problem to be addressed; clearly 
identify the scope of the problem including linguistic/cultural 
barriers; the limited-English-proficient minority target group(s) 
affected; health issues; and the pertinent geographic area/subarea. 
Provide documentation supporting the serving of at least 40 percent or 
more persons with limited-English proficiency.
    Cite the capability and experience of the organization to provide 
linguistic and culturally competent health care services.

Goal(s) and Objective(s)

    Clearly state the goal(s) of the project. Provide a list of 
specific, time-phased, measurable objective(s), including target dates.

Methodology

    A project management plan must be included which delineates project 
activities specifying responsible parties, methods to be used, 
timelines, and anticipated outcomes. Project activities must be linked 
to goal(s) and objective(s). Indicate the organization's capability to 
collaborate with other health care providers and health care 
professionals to effectively reach the target population. Describe the 
linkage between the organization and the applicable minority community-
based organization/health care facility.

Personnel/Management

    Describe duties, reporting channels, requisite qualifications, and 
related experience of personnel who will be responsible for carrying 
out the project. Resumes and curriculum vitae of key personnel must be 
provided. Describe management capability and experience of proposed 
grantee organization.

Evaluation

    Specify the approach and provide an example of data collection 
instruments that will be used to measure accomplishment of objectives; 
the evaluation should include both process and outcome measures. 
Provide a concise analysis of how the project will result in a 
sustained impact on reducing the problem of access to bilingual/
bicultural health care services. Provide 

[[Page 18936]]
information on how the project will be sustained beyond the funding 
period and the degree that the project can be replicated.

Budget

    Budgets of up to $100,000 total direct and indirect costs per year 
may be requested to cover: The cost of personnel, consultants, support 
services, materials, and travel. The project budget must include travel 
for one project staff member to meet with the OMH Bilingual/Bicultural 
Program Director in Washington, D.C. Funds may not be used for 
construction, building alterations or renovations. Also, funds may not 
be used to purchase equipment except as may be acceptably justified in 
relation to conducting the project activities.
    All budget requests must be fully justified in terms of the goals 
and objectives proposed and include a computational explanation of how 
costs were determined.
    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. Applications 
judged to be complete, conforming, and responsive will be reviewed for 
technical merit in accordance with PHS policies.
    Applications will be evaluated by Federal and non-Federal reviewers 
chosen for their expertise in minority health and their understanding 
of the unique health problems and related issues confronted by limited-
English-proficient racial and ethnic populations in the United States.
    Applicants are advised to pay special attention to developing 
clearly defined goals and objectives for their projects, as well as 
providing well-developed study and evaluation designs for the 
measurement of project objectives. Both formative and summative 
evaluations will be required of the grantee, as well as analysis of how 
the project can be improved to reach the desired outcomes. Applicants 
should also pay specific attention to the program guidelines, and the 
general and supplemental instructions provided in the application kit.
    Review Criteria: Applications will be reviewed and evaluated for 
evidence of consistency with the requirements of this announcement. Of 
specific importance will be the following criteria under the listed 
headings. (An indication of the quantitative weight appears in 
parentheses after each heading):

Background (25%)

     Clarity, specificity, depth and coherence of the described 
need(s) and problem(s) of the target-population(s) which includes 
linguistic/cultural barriers.
     Strength and specificity of the capability of the 
organization to provide linguistically and culturally competent health 
care services for the target population;
     Degree to which the organization is committed to linkage 
with the applicable minority community-base organization/health care 
facility;
     The validity of the documentation supporting the 
percentage of limited-English-proficient persons the project will 
serve;
     Extent and outcomes of past efforts/activities with the 
proposed target community; and
     Specificity of data on the intended target group.

Goals and Objectives (15%)

     Relevance of the proposed goals and objectives to this 
announcement and the OMH mission;
     Merit of the proposed objectives, including their 
measurability and relevance to the stated project goals, and soundness/
attainability of the time frame specified; and
     Soundness/attainability of proposed impacts/results/
products.

Methodology (25%)

     Strength of the work plan and specific activities 
proposed, including their scope and relevance to each of the stated 
objectives and projected outcomes;
     The degree to which the linguistic and cultural competence 
skills will provide the health care providers and health care 
professionals with the ability to increase outreach effectiveness to 
the target population(s);
     Evidence that the organization has the established 
linkages with appropriate health care facilities to provide continuity 
of support to clients for outreach, referral and treatment; and
     Clearly defined project timeline, Gantt Chart or Pert 
Chart is included as it relates to project planning, implementation, 
and program evaluation.

Personnel/Management (15%)

     Strength of proposed grantee organization's management 
capability;
     Adequacy of qualifications, experience, linguistic and 
cultural competence of proposed personnel;
     Evidence that the proposed staff can effectively outreach 
and work with the targeted community; and
     Evidence of clear lines of authority and accountability 
among proposed staff, volunteers, managers, and collaborators.

Evaluation (20%)

     The strength of the evaluation plan: includes formative 
and summative evaluation designs; the likelihood that the proposed 
objectives can be measured; and the linguistic and cultural competence 
of the project can be assessed;
     Clarity and specificity of proposed qualitative and 
quantitative measures of project accomplishments;
     Soundness of proposed data analysis and reporting methods;
     Evidence that a project can be replicated;
     Evidence that the proposed implementation plan and bring 
about the desired outcome(s); and
     If the proposed project provides direct services, 
likelihood that services will be sustained beyond the expiration of the 
3 year funding period.

Budget/Financial Plan (0%)

    The budget items will be commented on, but not rated by the review 
panel.
     Evidence that required budget items are consistent with 
stated goals and are appropriate to the level of effort required.
    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/ratings of review 
panels as well as program balance which includes geographic and race/
ethnicity distribution, and health problem areas having the greatest 
impact on minority health in terms of causes of death. Preference will 
be given to applicants who have received grants under the Bilingual/
Bicultural Program.
    Supplementary Information: This announcement for Fiscal Year 1995 
Bilingual/Bicultural Service Demonstration Grants focuses on the six 
health problems identified by the Secretary's Task Force on Black and 
Minority Health as having the greatest impact on minority health in 
terms of causes of death: (1) Cancer; (2) cardiovascular disease and 
stroke; (3) chemical dependency; (4) diabetes; (5) homicides; and (6) 
infant mortality. Additional areas of concern under this announcement 
include HIV infection, 

[[Page 18937]]
access to and financing of health care, health professions personnel 
development, data collection and analysis, and surveillance. Proposals 
should include strategies that will address these problems in a 
culturally competent and linguistically appropriate manner.
    These health priorities also are addressed in the Health Objectives 
for the Nation, Healthy People 2000, which the Public Health Service 
(PHS) is committed to achieving. Potential applicants may obtain a copy 
of Healthy People 2000 (Full Report: Stock No. 017-001-00474-0) or 
Healthy People 2000 (Summary Report: Stock No. 017-001-00473-1) through 
the Superintendent of Documents, Government Printing Office, 
Washington, DC 20402-9325 (telephone: 202/783-3238).
    State Reviews: E.O. 12372 sets up a system for state and local 
government review of proposed Federal assistance applications.
    Applicants [other than federally-recognized Indian tribal 
governments] should contact their State Single Point of Contact (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. All comments from a state 
office must be received within 60 days after the application deadline 
by the Office of Minority Health's Grants Management Officer. A list of 
addresses of the SPOCs is enclosed with the application kit material.
    Provision of Smoke-Free Workplace and Non-Use of Tobacco Products 
by Recipients of PHS Grants: The Public Health Service strongly 
encourages all grant recipients to provide a smoke-free workplace and 
to promote the non-use 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 
the following information to the head of the appropriate state and 
local health agencies in the area(s) to be impacted no later than the 
Federal application receipt due date: (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.
    The Catalog of Federal Domestic Assistance number is 93.105.

    Dated: March 23, 1995.
Clay E. Simpson, Jr.,
Acting Deputy Assistant Secretary for Minority Health.
[FR Doc. 95-9143 Filed 4-12-95; 8:45 am]
BILLING CODE 4160-17-M