HRSA-20-047 Frequently Asked Questions

Objectives

We received multiple questions about clarifying the time determinations for the first three program objectives listed on p.2 of the NOFO:

The first objective requires an increase per year, while the second and third objectives require an increase over the duration of the project period.

For objectives 1-3 the expectation is that awardees will achieve at least the minimum rates of 95%, 85% and 80% respectively. If the awardee has already achieved the minimum rate for any of the objectives, the expectation is that they will continue to work towards increasing the rate.

Page 2, bullet 1 notes a 1% per year improvement and the next 2 bullets do not include the phrase per year. Please verify that the expectation is a 10 and 15 % increase, respectively, over the 4 year funding cycle
Is the screening and diagnostic increase goal from baseline per year or is it 10% by 2024?
Are all goals to be increased from baseline per year or is it 10% by 2024?
Is there a determination for which increase you will use for objectives 1-3?

For the objective “increase .... the number of infants that have completed a diagnostic audiological evaluation no later than 3 months of age” - does this mean the child needs to have had a diagnostic evaluation by 3 months of age OR have had a conclusive (permanent hearing loss yes/no) evaluation by 3 months of age? Sometimes a child has had a completed diagnostic evaluation, but the evaluation is inconclusive and the child needs to come back for another appointment.

This refers to the number of children who have had a diagnostic evaluation no later than 3 months of age; it does not refer to a conclusive diagnosis.

Is there a way that we can coordinate the way some of these measures (like the diagnosed by 3 months and enrolled in Part C, etc.) with the definitions used by CDC for the annual HSFS survey to insure consistency across programs?

The first three objectives align with the definitions used by CDC. CDC’s 2017 data will be used for baseline in reporting on these objectives.

What year should be used to set baseline data? 2017 was just finalized this spring and 2018 data will not be finalized until next year after the application.

Information on baseline data for the objectives can be found on p.2 of the NOFO. Data from the 2017 CDC Hearing Screening and Follow-up Survey will be used as baseline for the following objectives:

Data collected from the first year of the project will be used as baseline for the following objectives:

Increase by 1 percent from baseline per year, or achieve at least a 95 percent screening rate, whichever is less, the number of infants that completed a newborn hearing screen no later than 1 month of age.
Increase by 10 percent from baseline, or achieve a minimum rate of 85 percent, the number of infants that completed a diagnostic audiological evaluation no later than 3 months of age.
Increase by 15 percent from baseline, or achieve a minimum rate of 80 percent, the number of infants identified to be DHH that are enrolled in EI services no later than 6 months of age.
Increase by 20 percent from baseline the number of families enrolled in family-to-family support services by no later than 6 months of age.
Increase by 10 percent the number of families enrolled in DHH adult-to-family support services by no later than 9 months of age.
Increase by 10 percent the number of health professionals and service providers trained on key aspects of the EHDI Program.

In the measure family-to-family support, how is this defined? The NOFO has a definition for Family support but not family-to-family.

Family-to-family support consists of services and supports provided through a family-led organization or program.

Please define what you mean by the number of families "enrolled" in FTF support services?

This refers to the number of families utilizing services and supports from a family-led organization or program.

What mechanism will be used for reporting the data on the following measures to HRSA? Number of families enrolled in family-to-family support, number of families enrolled in DHH Adult to family support, and number of health professionals and service providers trained.

This data will be reported in DGIS Performance Reports and Non-Competing Continuation Progress Reports.

The objective to increase the number of families enrolled in DHH adult-family support services by 9 months of age - do you mean every child no matter their type/severity of hearing loss? So a non-deaf child still needs a HH mentor?

DHH adult-family support services are intended to mentor, support, and guide families and their children who are DHH.(p.13)

EHDI programs can refer children to Part C but they cannot control whether they enroll. Sometimes parents choose not to enroll in Part C and sometimes Part C programs don't follow through. Given this, should the goal for which EHDI programs are responsible be referral to part C instead of enrollment in Part C?

The objective on early intervention aligns with the expert guidelines developed by the Joint Commission on Infant referred to on page 1 of the NOFO, EHDI data collected by CDC, as well as the language in the Early Hearing Detection and Intervention Act of 2017 (PDF - 242 KB), Public Health Service Act, Title III, Section 399M (as added by P.L. 106-310, Sec. 702; as amended by P.L. 111-337 and P.L. 115-71. For the purposes of this NOFO, early intervention is not limited to Part C.

There are early intervention programs besides Part C do they count?

Yes. For the purposes of this NOFO, early intervention is not limited to early intervention services provided through the Part C program; it can include any early intervention services specific to children who are DHH provided through public and/or private entities.

Regarding the first objective shown below, how should I address this in the context of our baseline is over 98%? Could I say “maintain or increase”?

Since your EHDI Program has already achieved the minimum screening rate of 95%, you should maintain or increase your screening rate.

Increase by 1 percent from baseline per year, or achieve at least a 95 percent screening rate, whichever is less, the number of infants that completed a newborn hearing screen no later than 1 month of age.

Which CDC formula, from the 2017 HSFS, shown below, do we use to answer: Increase by 10 percent from baseline, or achieve a minimum rate of 85 percent, the number of infants that completed a diagnostic audiological evaluation no later than 3 months of age.

Applicants should use this following formula from the 2017 HSFS to address Objective 2:“Percent Diagnosed Before 3 Months of Age among those Not Passing the Screen: (Number Total Diagnosed Before 3 Months of Age / Number Total Not Pass) * 100”

Percent Diagnosed Before 3 Months of Age among the Diagnosed: (Number Total Diagnosed Before 3 Months of Age / Number Total Diagnosed) * 100 OR
Percent Diagnosed Before 3 Months of Age among those Not Passing the Screen: (Number Total Diagnosed Before 3 Months of Age / Number Total Not Pass) * 100

Can you please include the numerator/denominators for the following objectives in the FAQ?

Objective	Measure
Increase by 1 percent from baseline per year, or achieve at least a 95 percent screening rate, whichever is less, the number of infants that completed a newborn hearing screen no later than 1 month of age.	# Screened for Hearing Loss / # Total Occurrent Births Reported to EHDI Program * 100
Increase by 10 percent from baseline, or achieve a minimum rate of 85 percent, the number of infants that completed a diagnostic audiological evaluation no later than 3 months of age.	# Total Diagnosed Before 3 Months of Age / # Total Not Pass * 100
Increase by 15 percent from baseline, or achieve a minimum rate of 80 percent, the number of infants identified to be DHH that are enrolled in EI services no later than 6 months of age.	# Total Enrolled in EI before 6 months of age (Part C and Non Part C) / # Total Enrolled in EI (Part C and Non-Part C) *100

For the objective (#2) it says that states will increase by 10 percent from baseline (2017), or achieve a minimum rate of 85 percent, the number of infants that complete a diagnostic audiological evaluation no later than 3 months of age. CDC site lists the percentage which includes normal hearing and hearing loss among those diagnosed, as well as a percentage for children diagnosed before 3 months of age among those not passing the screen (including cases of normal hearing and hearing loss). Which number are you using for the baseline?

Please use the following measurement for objective. 2: “Percent Diagnosed Before 3 Months of Age among those Not Passing the Screen: (# Total Diagnosed Before 3 Months of Age / # Total Not Pass) * 100”

Diagnosed by three months is different than having a diagnostic evaluation by three months. Is the numerator = had a diagnostic evaluation or is the numerator = found to have or not have permanent hearing loss by 3 months of age? I’ve always gone with the latter when reporting to the CDC.

Please see page 9 of the 2017 CDC EHDI Hearing Screening Follow Up Survey: Explanations (HSFS).

If an infant received a diagnosis and records of more than one diagnostic evaluation/testing appointment is available, only information from the appointment where an initial diagnosis of either permanent hearing loss or no hearing loss was made should be used when reporting diagnostic data in this section.

For Early Intervention, what are the numerators and denominators from the CDC website you want us to use and be judged on? CDC website has numerous numbers in their reports. If they are never referred for one reason or another, they are not going to be enrolled. If they are referred, but do not qualify for some reason, decline, move out of jurisdiction, etc. that also impacts enrollment.

The CDC uses this formula for early intervention enrollment before 6 months: # Total Enrolled in EI before 6 months of age (Part C and Non Part C) / # Total Enrolled in EI (Part C and Non-Part C) *100

Documented EI Services (p.17 of HSFS)

Total Enrolled in Part C EI Services

Total from Non-Part C EI Services Only

This is the total number of infants identified with a permanent hearing loss who were enrolled in Part C EI services.
Enrollment in Part C EI is defined as documentation of an infant with hearing loss with a signed Individual Family Services Plan (IFSP).
This is the total number of infants identified with a permanent hearing loss who were only enrolled in Non-Part C EI services.
Due to variability about eligibility and availability, it is the responsibility of jurisdiction to define what constitutes enrollment in non-Part C intervention services.
If an infant is receiving Part C EI, or both Part C and Non-Part C EI services, the infant should not be included in this section (i.e., they should be reported in the “Received Part C EI Services” section).

Would enrollment in the state’s CYSHCN program before six months of age be considered “Non-Part C Early Intervention?

For the purposes of this NOFO early intervention is not limited to early intervention services provided through Part C. It can include any early intervention services specific to children who are DHH provided through public and/or private entity. Due to variability about eligibility and availability, it is the responsibility of the jurisdiction to define what constitutes enrollment in non-Part C intervention services (p.17 of HSFS).

If a child is enrolled in Part C before six months, but it is unknown whether or not they’re receiving hearing related services, does it count as receiving services?

Enrollment in Part C EI is defined as documentation of an infant with hearing loss with a signed Individual Family Services Plan (IFSP) (p. 17 of HSFS).

What is being counted as an enrollment for family-to-family support or DHH adult-to-family support services? What are the definitions? How many times must you provide some sort of support to be counted?

A “family-to-family support program” consists of services and supports provided in response to the needs of a given family through a family-led organization or program. Types of support and services provided will be based on the capacity of the family-led organization or program and may include, but are not be limited to direct parent-to-parent support, information, education, technical assistance, training, and referral. Please see p. 11 in HRSA-20-051.

A “DHH adult consumer-to-family support program” consists of services and supports provided by a trained DHH adult who has the knowledge and skills to mentor, support, and guide families and their children who are DHH in culturally and linguistically sensitive ways and to serve as communication/language and social role models and mentors. Please see p. 11 in HRSA-20-051.

The NOFO does not define enrollment for family-to-family support or DHH adult-to-family support services. Applicants are asked on p.18 of the NOFO to “e. describe the data collection strategy to collect, analyze and track data to measure process and impact/outcomes. Explain how the data will be used to inform program development and service delivery.”

In addition to reporting on family enrollment rates, applicants may also report the number of families offered or referred to family-to-family support program services, and the number of families offered or referred to DHH adult consumer-to-family support program services.

Can you offer additional information on DHH adult consumer-to-family support services? Do agencies who offer this traditionally offer training and/or conduct background checks?

In the HRSA-20-051 Family Leadership in Language and Learning Center (FL3) NOFO, there is a definition for DHH adult consumer-to-family support program. The DHH adult consumer-to-family support program consists of services and supports provided by a trained DHH adult who has the knowledge and skills to mentor, support, and guide families and their children who are DHH in culturally and linguistically sensitive ways and to serve as communication/language and social role models and mentors.

States and territories may determine the training requirements for D/HH adults to serve with DHH adult consumer-to-family support programs.

If there are 10 families that are offered adult to family support services out of those five enroll and five do not if they’re not interested, do we determine five out of the five interested enrolled so that is 100% enrollment or is that 50% because it was 5 out of the 10?

If there are 10 families with a child who has been identified to be deaf or hard of hearing, and 8 of these families are offered or referred to DHH adult consumer-to-family support services and 5 are enrolled in these services, then the formula would be calculated as 5 enrolled families out of 10 total families, or 50% enrollment rate.

You may also report in your Noncompeting Continuation progress reports the number of families that were offered or referred to DHH adult consumer-to-family support services. For example, if there are 10 families with a child who has been identified to be deaf or hard of hearing, and 8 of these families are offered or referred to DHH adult consumer-to-family support services, and 5 are enrolled in these services, then the formula would be calculated as 8 referred/offered families out of 10 total families, or 80% offer/referral rate.

Is family-to-family support adequate for this NOFO or are we required to also have an adult to family mentor?

Recipients are expected to increase by 20 percent from baseline the number of families enrolled in family-to-family support services by no later than 6 months of age, as well as increase by 10% the number of families enrolled in DHH adult-to-family support services by no later than 9 months of age (p.2 of NOFO).

Are the 90% of infants identified annually in our own state that are hard of hearing vs, deaf- do we need to have a trained adult hard of hearing mentor for them? For the metric of DHH-mentor before 9 months, we don’t have hard of hearing mentors, just deaf mentors.

All families of children who are identified as deaf or hard of hearing should be offered the opportunity to receive or are referred to receive deaf or hard of hearing adult consumer-to-family support services.

For the deaf adult mentor do we have to provide the service or refer those services?

The NOFO does not specify who provides those services.

Are there certification standards for Deaf Adult Mentors?

The NOFO does not specify any professional certification standards for Deaf Adult Mentors.

HRSA received multiple questions about increasing by 10 percent the number of health professionals and service providers trained on key aspects of the EHDI Program.

How do you plan to figure the percentage for health professionals and service providers being educated? How do you know it was 10%? As per Page 18 there is no guidance on numerator or denominator we need to use, correct? Do you have recommendations or requirements about which professionals are included?
The NOFO, p. 18 says, “describe the data collection strategy to collect, analyze and track data to measure process and impact/outcomes. Explain how the data will be used to inform program development and service delivery”. To clarify, with regard to educating 10% of the health professionals, we are to decide how to measure this as per p. 18? There is no guidance or numerator/denominator we need to use, correct?
What are we to use as the baseline – 10% of all health professionals in the state? Should we include pediatrics, family medicine, audiology, ENT, others? Are we to contact each licensing board and get what their totals are? Which ones?

Using data collected from year 1 as baseline data (p.2 of NOFO), recipients must increase by 10 percent the number of health professionals and service providers trained on key aspects of the EDHI program. Per the NOFO (p.18, first bullet), applicants must describe the data collection strategy to collect, analyze and track data to measure process and impact/outcomes. The data collection strategy should address the methodology for establishing the baseline. The applicant should propose data collection strategy including the methodology for establishing the baseline, including the numerator and denominator. The NOFO does not define which health professionals or service providers should be included.

Expanding Screening Up to Age 3

Is there a policy statement from AAP, JCIH, or similar organization regarding hearing screening for children under 3 years of age?

The reauthorization of the EHDI Act of 2017, which amended the Public Health Service Act, expands the target population for hearing screening beyond newborns to include young children up to the age of 3.

Can you please elaborate on the screenings up to 3 years of age? Is the expectation to collect data on all screenings up to age 3, or is there a new schedule for screenings that will be need to occur beyond 1 month? Will specific data points need to be reported?

Recipients will be expected to develop a state/territory plan to expand infrastructure, including data collection and reporting, for hearing screening for children up to age 3 by the end of year 2. (p. 10)

This question refers to p. 12 of the NOFO, Section B.1.b: Does this mean that after a child has passed NBHS, we need to continue to track them and make sure they have additional screenings before pre-school enrollment, or we track children who have either not been screened or who have failed and need a diagnostic up to age 3?

This particular bullet in the NOFO is about educating providers on the importance of hearing screening for young children up to age 3, even if they passed the newborn screening, in order to identify later onset hearing loss in early childhood.

Budget

How will unused funds from the line item designated under the 25% for family engagement and support activities be tracked and used?

The use of funds for family engagement and support activities are tracked and reported in recipients’ budget narrative and progress reports. The unobligated balance reflects unused federal funds.

The expectation is that there will be no unused funds; however, in the event that you have unused funds, you should discuss plans for the use of the potential unobligated balance with your Project Officer and Grants Management Specialist before the budget period expires.

If our state budget offices will not allow us to use "Family Support/Engagement" as a line item (because there isn't an accounting line item code in our internal processes for that), can we break those costs out in the budget narrative as you've requested?

Yes, the budget narrative is intended to capture the breakout of costs in each line item of the budget. You can either use personnel or contractual to describe your activities and deliverables for the family engagement requirement. The personnel cost category allows for key personnel to contribute to the programmatic development or execution of a project or program in a substantive, measurable way; whether or not they receive salaries or compensation under the grant. The narrative should provide information about key personnel assigned to the family support requirement if your plan to accomplish this within your organization instead of a contract.

I have a question regarding the statement in the NOFO about funding not being in the 2020 Presidential budget. Didn’t the passage of the EHDI reauthorization act of 2017 require funding be implemented?

The 2017 EHDI reauthorization provided for the continuation of the program and provided an appropriations amount. Actual annual funding is decided through the congressional appropriations process. The FY 2020 President’s Budget does not request funding for this program. This program notice is subject to the appropriation of funds, and is a contingency action taken to ensure that, should funds become available for this purpose, HRSA can process applications and award funds in a timely manner. (p.7)

Would DHH mentors be considered consultants for which we cannot pay fringe?

The DHH mentor would be considered a consultant if he/she is not employed by the state EHDI program.

Optional Needs Assessment

Is there an expectation that all states that apply and are awarded the money for the Optional Needs Assessment will have to work with one entity or will the states have the flexibility to hire their own entity, if needed?

The NOFO does not specify that that recipients work with an entity to complete the Optional Needs Assessment Project. Applicants must submit a plan, budget, and budget narrative for a 1-year targeted needs assessment on the educational needs of health care professionals and service providers who interact at the time of diagnosis so they can clearly articulate care and service options, as well as provide quality care and support to the impacted infants and families. Should you chose to apply for this optional project, the plan and budget should be included in Attachments 7–15 (p.16 of NOFO).

If we apply for the Optional Needs Assessment funding will there be technical assistance to make sure people or recipients are measuring the same thing the same way?

If the Optional Needs Assessment project is funded, technical assistance will be provided. The NOFO does not specify how states should conduct the needs assessment.

Progress Report

HRSA received several questions about the dates of coverage for the progress report.

The progress report should the project period of the current award, that is, April 1, 2017 – March 31, 2020.

How long would you recommend I make my annual report? Is the annual report counted separately than the application?

The NOFO does not specify the length of the progress report. The progress report should include a brief presentation of the accomplishments, in relation to the objectives of the program during the current period of performance (p.21 of NOFO).

The progress report is counted as part of the page limit. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support required in the Application Guide and this NOFO (p.9 of NOFO).

Other

You mention sustainability should be beyond federal funding. Can we discuss using MCH Title V funding for sustainability even though it is federal funding?

We encourage applicants to explore all sources of funding beyond the specific federal funding designated for this program.

Is the state required to work with all of the HRSA funded resource centers?

As described in the NOFO, HRSA expects EHDI Program recipients to do the following:

Per Review Criterion 2, applications will be reviewed for the strength, completeness, and feasibility of the applicant’s proposed plans to work with HRSA-20-051 (FL3 Center), HRSA-20-48 (EHDI NTRC), HRSA-16-190 (Pediatric Audiology Competitive Supplement to LEND), and HRSA-18-069 (NRC-PFCMH) recipients. (p.25)

Collaborate, as appropriate, with the HRSA-16-190 (Pediatric Audiology Competitive Supplement to Leadership Education in Neurodevelopmental and Related Disabilities (LEND)) recipients, the HRSA-18-069 (National Resource Center for Patient/Family-Centered Medical Home (NRC-PFCMH) recipient, and any relevant future recipients to engage and educate health professionals and service providers to help reach program goals. (p.12)
Consult with the HRSA-20-051 recipient (the Family Leadership in Language and Learning (FL3 Center) for resources, technical assistance, training, education, QI and evaluation to strengthen the infrastructure and capacity for family engagement and family support in the state/territory. (p.13)
Work with the HRSA-20-048 program recipient (the EHDI National Technical Resource Center (NTRC)) to implement the various initiatives that are listed in this NOFO and outlined in the work plan. (p.14)

Does the state have to include plans on how they will reach all of the activities listed in the program description?

Applications will be evaluated based on the strength, completeness, and feasibility of the applicant’s proposed methods to address the stated needs and meet each of the previously described program goals, objectives, requirements, and expectations listed in the Purpose and Program Description sections in the NOFO. For a more detailed description of the review criteria, please see p.24-27 of the NOFO.

Per the NOFO, p. 11, Item 6, must we choose goals for the entire four years or can we focus on a couple of them for the first year or two and then choose a different set the last two years? For example provide an outreach and then switch to outreach underserved.

The NOFO asks that applicants identify a minimum of two areas for improvement to address throughout the 4-year period based on identified needs (p.11 of NOFO). Applicants are free to address additional areas for shorter periods.

There is no mention of how many letters of support are needed. I would assume three?

The NOFO does not specify the number of letters to include in the application.

The “commitment to the project/program” has to be something tangible like staff or in-kind services? We don’t do “in-kind” with anyone, at least to my understanding of in-kind, which I thought was services rendered in lieu or money.

Information regarding letters of support can be found on p. 22 of the NOFO, “Include any other documents that are relevant to the application, including letters of support. Letters of support must be dated and specifically indicate a commitment to the project/program (in-kind services, dollars, staff, space, equipment, etc.).”

For the EHDI annual meeting when you state a “family leader” must attend the meeting do you mean a leader in the local FBO that you are providing funding to or a family member within your jurisdiction that has a child that is DHH?

The NOFO does not provide a specific definition of a family leader.

For more information about family leaders and understanding family leadership, there are a number resources that may be helpful:

1) National Center for Family Professional Partnerships

2) Association of Maternal and Child Health Programs

3) Family Leadership in Language and Learning

Date Last Reviewed:

October 2021

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