Frequently Asked Questions
- Does the lead agency have to be located within the geographic area to be served by the project?
ANSWER: The lead (fiduciary) agency must be located within the geographic area served by the project. The rationale for this requirement is to ensure mutual identification, appreciation and understanding of community needs within the geographic area and to assure more timely accessibility and accountability as well as responsiveness of the fiduciary organization to issues related to the project that may arise within the community. The RFA clearly states that the fiduciary agent or 501c3 is more than just the receiver of funds. The Eligible Applicant section states: "It includes responsibility for overseeing fiscal and programmatic services." Toward this goal, it is prudent for the fiduciary organization to reside in the same community as the target population. Therefore, for example, a state health department or a university proposing to work with a community outside its geographic location would not be an eligible applicant.
- Is the local health department an eligible applicant? In South Carolina all local health departments are legally part of the state health department.
ANSWER: Local health departments are eligible. In the Eligible Applicants' section, it states that eligible recipients must: a) be a public agency, b) have been in the community 5 years, and c) be able to make arrangements to provide for uninsured people.
- The geographic area to be targeted by the project includes a rural county and a county designated as an MSA (they are contiguous). What are the urban/rural distinctions made in the FRN? In other words, how is rural is being defined? How should the project be classified, as urban or rural?
What counts as rural? If a county contains a metropolitan statistical area, but the remainder of the county is rural, is the county considered to be an urban county?
ANSWER: It is perfectly reasonable to target overlapping areas that may have both rural and urban residents. The eligibility criteria were set to ensure a minimum threshold, population size. The specific labeling of the target area will not impact the applicant's eligibility.
- How large a geographic area would be considered to be too large? Some rural counties have high stroke rates but small population numbers, and it might take 3-4 of them combined to obtain the 60,000 suggested minimum population for the contiguous geographic area.
ANSWER: Applicants may target multiple, contiguous counties or health service areas in order to obtain the minimum population size as long as it constitutes a community-focused proposal. However, State-wide targeting is discouraged.
- What literature references are available for the "enabling ring" concept?
ANSWER: The Enabling Ring Concept was specifically developed as a part of the Stroke Belt Elimination Initiative (SBEI).1 An Enabling Ring is formed at the community level when necessary resources are identified, sourced, allocated and coordinated in a manner that permits formation of a 'ring of collaborative activities' encircling the priority condition and priority risk factor (stroke and hypertension, respectively; see figure below).
Enabling Ring Model for Collaboration (Click here)
The Enabling Ring concept is based on 2 core principles. The first core principle is ring vaccination (a.k.a. surveillance-containment).2,3,4,5,6 This is a traditional way to control an outbreak of a communicable disease within a community using strategic administration of vaccine. This principle has received substantial attention in the context of the recent health policy debate as regards smallpox. The ring of individuals surrounding each known index case and known contact(s) are identified, vaccinated and monitored in an effort to prevent further spread of disease. The ring vaccination core principle is adapted and applied in the SBEI at the community level to prevent and control spread of excessively high prevalence rates for stroke-and hypertension-related risk factors and conditions.
The second core principle is enabling-factor identification.7,8,9,10 Those elements pre-existing within a community or that need to be imported in order to fill key gaps are identified during a community-level ecological assessment that is done as an early step in strategic planning. Necessary enabling factors are then sourced, allocated and coordinated in an effort to effectively manage health-related challenges within the community.
- Pg 43 - The SBCAT will be required to coordinate with the SBRAT to avoid multiple contacts from multiple communities. Does the Lead Agency ever work with the SBRAT?
ANSWER: The Lead Agency will be a significant member of the SBCAT and as such, the Lead Agency representative will work with the SBRAT. The degree of the working relationship will be defined by the nature and scope of the defined project goals and objectives. The Lead Agency Representative and the SBCAT Coordinator will work collaboratively with the SBRAT Coordinator and the SBRAT to identify and connect with regional resources and activities that may enhance the likelihood of the SBCAT achieving its objectives and desired outcomes.
- 7. Is it correct that interventions are not to be initiated until after the initial baseline data is collected, which would be in month 6?
ANSWER: It is anticipated that no intervention activity will take place until after the baseline assessments are conducted. It may take up to 6 months for the baseline assessment to be completed; however, depending upon circumstances, this could be sooner. This approach assures opportunity to obtain pre-intervention community measures for comparison with post intervention measures. This also allows time for programmatic refinement of specific project objectives and agreement on performance measures and desired outcomes before implementation.
References
1U.S. Department of Health and Human Services. Stroke Belt Elimination Initiative: Community-Focused Initiative To Reduce the Burden of Stroke. 2004. CFDA No.: 93.004. Available from: http://www.omhrc.gov/omh/whatsnew/2pgwhatsnew/special242.htm and http://www.omhrc.gov/omh/whatsnew/2pgwhatsnew/funding716index.htm.
2Kretzschmar M, van den Hof S, Wallinga J, van Wijngaarden J. Ring vaccination and smallpox control. Emerg Infect Dis. 2004 May; 10(5):832-841. Available from: http://www.cdc.gov/ncidod/EID/vol10no5/03-0419.htm.
3U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. The CDC Smallpox Response Plan and Guideline. Executive Summary plus Sections A through F. General Strategy and Priority Activities for Smallpox Outbreak Containment: Ring Vaccination. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/files/sections-i-iv.pdf; page 4; also see http://www.bt.cdc.gov/agent/smallpox/response-plan/.
4Bozzette SA, Boer R, Bhatnagar V, Brower JL, Keeler EB, Morton SC, Stoto MA. A model for a smallpox-vaccination policy. N Engl J Med. 2003 Jan 30;348(5):416-25. Epub 2002 Dec 19.
5Foege WH, Millar JD, Lane JM. Selective epidemiologic control in smallpox eradication. Am J Epidemiol. 1971 Oct;94(4):311-5.
6Henderson DA. The eradication of smallpox. In: Maxcy-Rosenau Public Health and Preventive Medicine. 11th ed. Chapter 4. Diseases transmitted from person to person. Last JM (ed.). Appleton-Century-Crofts. New York, NY. 1980:104.
7van Servellen G, Chang B, Garcia L, Lombardi E. Individual and system level factors associated with treatment nonadherence in human immunodeficiency virus-infected men and women. AIDS Patient Care STDS. 2002 Jun;16(6):269-81.
8Gallagher TC, Geling O, Comite F. Use of multiple providers for regular care and women's receipt of hormone replacement therapy counseling. Med Care. 2001 Oct;39(10):1086-96.
9Levy SR, Anderson EE, Issel LM, Willis MA, Dancy BL, Jacobson KM, Fleming SG, Copper ES, Berrios NM, Sciammarella E, Ochoa M, Hebert-Beirne J. Using multilevel, multisource needs assessment data for planning community interventions. Health Promot Pract. 2004 Jan;5(1):59-68.
10Health Promotion Planning: An Educational and Ecological Approach. Third Ed. Green LW and Kreuter MW (eds.). Chap. 5. Educational and ecological assessment of factors affecting health-related behavior and environments. Mayfield Publishing Co. Mountainview, CA. 1999:167-171.
Stroke Belt Elimination Initiative
U.S. Department of Health and Human Services
Enabling Ring Reference materials
By: Greg Morosco (NHLBI), Rob Fulwood (NHLBI), and Larry E. Fields (OS/OPHS)
