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FAQ: Catalyst for Infant Health Equity (HRSA-22-066)

Single State or City Application

How would HRSA respond to several Healthy Start programs in a single state or city applying for this NOFO?
The purpose of this new program is to support the implementation of existing action plans that apply data-driven policy and innovative systems strategies to reduce infant mortality (IM) disparities in a specific county/jurisdiction. For the purpose of the Catalyst for Infant Health Equity NOFO, “jurisdiction” refers to tribal areas; the District of Columbia; municipalities including in Puerto Rico; and similar geographical areas found within the U.S. Virgin Islands, the U.S.-affiliated Pacific Islands and Freely Associated States. Accordingly, a city within a county or that encompasses multiple counties can submit an application for the city. HRSA will not accept an application targeting the whole state.

Area of Service

Can an applicant apply for serving more than one county or jurisdiction?
For the purpose of the Catalyst for Infant Health Equity NOFO, “jurisdiction” refers to tribal areas; the District of Columbia; municipalities including in Puerto Rico; and similar geographical areas found within the U.S.-affiliated Pacific Islands and Freely Associated States. Embedded in the definition of municipalities are cities, boroughs, towns, and districts. Applicants may submit an application for more than one county if they are under the same borough, town, city, or district.

New York City has Healthy Start programs in each of the five counties or boroughs, but policies for all five are set by New York City Department of Health and Mental Hygiene. Would a collaboration of these programs be considered, assuming that there is demonstrated need?
Yes, as these boroughs are part of the same city.

Will HRSA fund more than one project in the same county/jurisdiction?
No.

Action Plan

What will qualify as an existing action plan? Does the action plan need review or approval by the applicant’s board of directors or leadership?
For the purposes of this NOFO, applicants are to have an action plan that is as fully formed as possible and has stakeholder buy-in. Applicants will be reviewed based on the degree to which the action plan is thorough, defensible, and provides actionable steps that will reduce infant mortality. Buy-in will be a factor reviewers may use in determining/considering the degree to which the plan is actionable.

If a community has done its own plan, not funded through the Infant Healthy Equity supplement, will it be reviewed and scored on an equal basis?
Preference will not be given to any existing Healthy Start recipient or organization that received Infant Health Equity funds. HRSA will assess applicants based on their responses to the review criteria.

What does HRSA mean by existing action plans?
HRSA expects applicants will have developed an action plan with strategies to reduce infant mortality and improve infant health equity. In some cases, a state, municipality, or organization may have an action plan that addresses maternal and child health broadly. Applicants may submit a portion of that plan that focuses on a particular county with high disparities in infant mortality. It is also acceptable to submit a sub-section of an existing plan that focuses on a specific social determinant of health domain related to infant health equity and not include the sections of the plan that focus on direct service delivery.

Does the organization need to have a public action plan to be eligible to apply?
No. The Catalyst NOFO does not require eligible applicants to have publicly available infant mortality action plans.

My state/tribe has developed a strategy to address infant mortality. Can I use it as my action plan?
Yes. As long as the strategy includes all of the required components outlined in the NOFO.

My organization has an existing action plan that is not from the Healthy People 2030. Can I still apply?
Yes. Successful award recipients will be expected to implement policy and systems strategies in their action plan from at least one of the Healthy People 2030 social determinants of health domains, and focus on an objective(s) within that domain that can affect birth outcomes and contribute to reducing the IM disparity in the target county/jurisdiction.

Will HRSA accept an action plan that the applicant developed in collaboration with other partners in the state/county/jurisdiction?
Yes. Applicants may submit an action plan developed in collaboration with partners throughout the applicant’s state, tribe, municipality, county, or jurisdiction. For the purposes of this NOFO, “jurisdiction” refers to tribal areas; the District of Columbia; municipalities including in Puerto Rico; and similar geographical areas found within the U.S. Virgin Islands, the U.S.-affiliated Pacific Islands, and Freely Associated States.

Is there a required format/template for the action plan?
No. HRSA does not require a specific format for the action plan.

This grant funding is for five years. Are recipients expected to implement the action plan during the first year of the grant?
Catalyst recipients are expected to implement the action plan in the first through the fifth year of the grant. Since successful applicants will have an action plan, it is expected that they will begin implementing that plan in the first year.

Are tribes and tribal organizations funded through this NOFO allowed to focus their action plan activities on addressing historical trauma?
Applicants may use Catalyst funding to implement an action plan containing specific policies and systems changes to reduce racial/ethnic disparities in IM in a county/jurisdiction. Action plan activities must address the “upstream” factors or environmental, social, and economic conditions, and/or structural (institutions and policies) or systemic barriers that contribute to disparities in infant mortality in a county/jurisdiction.

Collaboration and Partnership

If my organization already has a Community Action Network (CAN), do I need to find or develop a partnership with cross-sector state and/or local partners?
No. The Community Action Network may serve as the partnership so long as it includes cross-sector state and/or local partners.

Is there a minimum or maximum number of strategic partners required?
No. HRSA expects Catalyst award recipients to engage cross-sector state and/or local partners (including the State Title V Maternal and Child Health Block Grant Program), community members, and individuals with lived experience to implement program components.

Expenditure of Funds

Can funds be utilized to pay for Social Determinants of Health (SDOH) efforts and facilitation of services in the community? For example, food insecurity, transportation, housing assistance, etc.
No, the Catalyst for Infant Health Equity is authorized by Healthy Start legislation. Currently, this legislation does not allow us the flexibility to use grant funds as benefits. Applicants cannot make economic transfers to individuals or to organizations that make economic transfers, such as paying for housing, groceries, or utilities such as heating. Such activities are considered benefits and are not allowed under the Healthy Start legislative authority.

Grant funds may be used to support structural changes necessary for the development and delivery of resources and services related to social determinants of health. Development and implementation of specific policy changes that address infant health equity are also an appropriate use of funds.

What would be appropriate expenditures of funds or inappropriate expenditures in regards to changing systems and policies?
An example of appropriate allowable expenditures of funds for the Catalyst Program includes payment of salaries and benefits for staff, supplies and equipment, data collection, and evaluation activities. An example of un-allowable use of funds is using funds to buy homes or pay rent for unhoused individuals.

Can funds be used to support colocation of services, such as co-locating WIC in a health care setting?
Navigation services in which services such as nutrition support or case management are delivered in a health care setting are an appropriate use of funds.

May funded organizations combine Catalyst funding with other sources of funding to implement action plan activities?
Yes. There are no restrictions on use of non-federal funding to support implementation of action plan activities. Catalyst grant recipients may accept and use external funds to support implementation of their program components.

Target Population

Can an organization apply for this grant if its target population includes non-Hispanic Whites and/or Hispanics?
Yes. Eligible applicants include any domestic public or private entity. Domestic faith-based and community-based organizations, tribes, and tribal organizations are also eligible to apply for these funds.

Excess Infant Deaths/Data

What number constitutes a large number of excess infant deaths?
Excess infant deaths are those that occur due to higher mortality rates relative to non-Hispanic White infants, and can be referred to as deaths attributable to disparity or deaths that need to be prevented to achieve equity in infant mortality rates. Excess deaths are calculated by multiplying excess death rates by the number of births (e.g., [Black IM rate – White IM rate] X Black births). This definition is in the Catalyst NOFO glossary. HRSA’s analysis of excess infant deaths shows that counties with the highest excess infant deaths have ≥15 Black and/or ≥4 AI/AN excess infant deaths per year - at least 1.5 times the county-level average for their respective populations. Higher numbers of excess infant deaths demonstrate higher need.

Where can I get the data needed to calculate excess annual deaths?
Infant mortality statistics by race/ethnicity for counties with population sizes of 250,000 or more are available on CDC Wonder. If technical assistance is needed in calculating excess infant deaths for your target county/jurisdiction, applicants may contact MCHB at infanthealthequity@hrsa.gov.

What year of data will HRSA accept?
HRSA expects current IM data; 2019 is the most recent year of Linked Birth/Infant Death Data available nationally. Multiple years of data may be combined to produce reliable infant mortality rates (e.g., 3 or 5 year rates).

Definitions

How does HRSA define policy and systems change?
Policy and systems change are defined as structural interventions that improve conditions, such as educational and employment opportunity, to promote equity across a range of health outcomes.

How does HRSA define “individuals with lived experience”?
For the purpose of the Catalyst NOFO, individuals with lived experience are participants of program services and activities that exist to reduce IM.

How does this program differ from the Healthy Start Initiative?
The purpose of the HS program is to reduce the rate of infant mortality and improve perinatal outcomes by using a community-based approach to service delivery and facilitating access to a comprehensive approach to women’s health care. HS works to reduce the disparity in health status between the general population and individuals who are members of racial or ethnic minority groups. The Catalyst for Infant Health Equity is a new HRSA-funded program that will support implementation of existing action plans that address public policies, systemic racism and discrimination, and/or institutional practices. The goals of the Catalyst for Infant Health Equity program are twofold: 1) to continue reducing overall infant mortality (IM) rates in the United States, and 2) to decrease and ultimately eliminate disparities in IM across racial/ethnic groups by achieving steeper declines for groups with the highest rates.

Can you clarify or give examples of tools and training that the organization is expected to provide to the network?
Recipients are expected to offer the type of tools and trainings for the network that will support policy and system changes that address root causes of, and contributors to, disparities in IM.

Healthy People 2030 Objectives, Data Collection, and Evaluation

Should I include Healthy People 2030 objectives in my application?
Yes. Applicants are expected to implement policy and systems strategies in their action plan from at least one of the five Healthy People 2030 SDOH domains included on pages 1 and 2 of the NOFO.

Are funded organizations allowed to address more than one of the five domains related to social determinants of health?
Yes. Catalyst recipients will be expected to implement policy and systems strategies in their action plan from at least one of the SDOH domains highlighted in the NOFO, and focus on an objective(s) within that SDOH domain that can affect birth outcomes and contribute to reducing the IM disparity seen in the target county/jurisdiction. Additional social or structural determinants that contribute to IM disparities but are not listed may be addressed in the action plan’s policy and systems strategies, such as: racism, discrimination, and bias; supportive economic policy (e.g., paid parental leave, living wages); housing programs and policies; culturally respectful and equitable health care; among others.

Am I expected to collect data on Healthy People 2030 objectives during this grant?
Catalyst recipients are expected to collect and report data on performance measures as part of their annual progress report. This includes plans for establishing baseline data and targets. See Catalyst performance measures.

Will my organization be allowed to sub-contract for the outcome evaluation?
Yes, sub-contracts under this award for evaluation and other program activities are allowable.

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