Jennifer M. Granholm, Governor

Janet Olszewski, Director

REQUEST FOR PROPOSALS

FETAL ALCOHOL SPECTRUM DISORDERS

PREVENTION AND INTERVENTION GRANTS

Issued by:

Michigan Department of Community Health,

Division of Family and Community Health

Fetal Alcohol Spectrum Disorders Program

Re-issue date: Proposals Due by March 20, 2009 @ 5:00 PM

*Note: Proposals already received must not be re-submitted

MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
February 28, 2009
ANNOUNCEMENT OF REQUESTS FOR PROPOSALS FOR LOCAL

FASD PREVENTION AND INTERVENTION PROJECT FUNDING

This packet includes:

  • Grant Announcement ...... 2
  • Part I: General Information ...... 3
  • Part II: Review Process and Information ...... 10
  • Part III: Model Programs for FASD Prevention and Intervention ...... 10
  • Part IV: Application Information, Instructions, and Review Criteria ...... 19
  • References ...... 21
  • Appendix...... 22

GRANT ANNOUNCEMENT

The Michigan Department of Community Health, Division of Family and Community Health, FAS Program is pleased to announce the availability of funding for local FASD projects. These community-based projects have brought needed prevention and intervention services to local areas for nearly 10 years.

  • Proposals are due on or before March 20, 2009.
  • Up to 12 Grants will be awarded by Monday, April 20, 2009.
  • Funding is available for an initial planning period of 5 months followed by a noncompetitive option to provide services for 2 additional years.
  • Competitive proposals are being solicited for the initial planning period with requests for funding of up to $6,000 each. Current grantees are required to submit a proposal packet for the next funding cycle. The planning period will be April 20, 2009 through September 30, 2009. Grantees will be eligible to request additional funding for two option years:

Option Year 1 - October 1, 2009 through September 30, 2010 funded at $10,000.

Option Year 2 - October 1, 2010 through September 30, 2011 funded at $10,000.

The grant application forms are part of this document and additional or replacement forms may be obtained by email request to Debra Kimball at . Questions about the application may be addressed to Debra Kimball at the email address indicated or by calling 517-335-8379.

MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
February 20, 2009
APPLICATIONS FOR FASD PREVENTION AND INTERVENTION PROJECTS
PART I: GENERAL INFORMATION

INTRODUCTION

Fetal Alcohol Spectrum Disorders (FASD)is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The learning and life skills affected by prenatal exposure vary greatly among individuals, depending on factors such as the amount of alcohol exposure, the timing and pattern of exposure, as well as each individual’s current and past environment. Therefore, the services needed for individuals with FASD and their families vary based on what parts of the brain have been affected, the age or level of maturation of the person, the health or functioning of the family, and the overall environment in which the person is living.

FASD is a significant public health concern. While national survey data indicate that the percentage of women who abstain from alcohol use during pregnancy has increased slightly in recent years, 13% of women continue to use alcohol during pregnancy and approximately three percent of pregnant women report binge drinking (i.e. seven or more drinks per week or five or more drinks on any one occasion). Recent surveys have found risk factors for drinking during pregnancy to include: 1) pattern of alcohol use; 2) alcohol dependence;3) use of multiple substances; 4) having had a previous alcohol-exposed pregnancy; and 5) having a partner or family member who drinks heavily. Women who receive little or no prenatal care, are unemployed, are socially transient, or have lost children to foster or adoptive care because of neglect, abuse, or abandonment are also more likely to have high alcohol use patterns that could affect a pregnancy (Bertrand, J, et.al. 2004).

Best practice recommendations for prevention and intervention with FASD are outlined in reports from the Institute of Medicine and the Centers for Disease Control and Prevention. These reports served as guidelines to develop the proposed funding objectives for the MDCH FASD Program.

Copies of the reports can be accessed at:

CDC Report -

Institute of Medicine Report -

State Program Background. In 1999, the Michigan legislature allocated $200,000 of funding in the State budget for Fetal Alcohol Syndrome (FAS) initiatives. This funding led to the establishment of Michigan’s Fetal Alcohol Syndrome Program. The goal of the Program has been to reduce the number of children born in Michigan with FAS, to provide timely diagnosis, and to assist those that are diagnosed with needed support services. The original funds supported:

  • Centers of Excellence at five sites todiagnose and provide initial care planning for children and adults with FASD
  • Community outreach and education projects at twelve local sites
  • Training and consultation
  • Local prevention and intervention initiatives

A State FASD Taskforce was formed in 2005 to bring parents, providers, advocates and state government agencies together to address current issues around prevention and services for FASD. The vision of “coming together to address Fetal Alcohol Spectrum Disorders through awareness, prevention and access to services” marks significant progress in setting an aggressive agenda. The mission of the group is 1) to advocate for statewide prevention and treatment, 2) to bring together affected individuals, families and multidisciplinary professionals committed to increasing awareness of FASD and improving service delivery systems, and 3) to decrease these preventable disorders and enhance the quality of life for affected individuals and their families, thereby lessening the social and economic impact of FASD in Michigan.

Over the next five years the Taskforce is strategically focused to:

•Increase awareness of FASD and gain public and private support for decreasing the number of pregnant women who drink alcohol.

•Increase identification and diagnosis of individuals who have FASD.

•Determine and monitor the incidence and prevalence of FASD in Michigan.

•Improve the education system’s response to students who have FASD.

•Improve the justice system’s response to individuals who have FASD.

•Expand, increase the diversity of and strengthen the Task Force.

•Expand and improve timely lifelong service access and delivery statewide to individuals who have FASD and their families.

Specific barriers to services have been assessed across the state:

•Under-diagnosis/ misdiagnosis of FASD and co-occurring disorders

•Lack of understanding by providers that FASD is a disability

•Lack of services and treatment facilities

•Restrictions on eligibility for services, such as age or IQ

•Difficulty obtaining birth records and medical history in adoption

•Lack of financial resources for medical, mental, and respite care

•Lack of special education resources

•Little resources for child care when seeking substance abuse treatment

•Failure to recognize FASD variety of symptoms

•Ethnic and racial differences

•Parents in rural areas have geographic barrier

•Lack of transportation makes appropriate treatment and care difficult

•Lack of cohesive interaction among treatment systems

•Inadequate support for foster families or caregivers

Collaboration with foster care/adoption agencies to reach children most at risk has been recognized as a priority. Reaching women most at risk of an alcohol-exposed pregnancy involves collaboration with substance abuse treatment services. Success in education for children with FASD involves interaction with special education services to provide appropriate opportunities. Older children and adults with FASD are in need of mechanisms to deal with the criminal justice system.

Prevention Strategies. The 1996 Institute of Medicine report raised the awareness of the professional community to the fact that universal prevention approaches have limited value in reducing alcohol-exposed pregnancies. Approaches targeted at more at-risk groups show more promise for effecting behavior change to reduce FASD.

Universal prevention intervention strives to ensure that all members of society understand that drinking alcohol can have hazardous consequences, particularly during pregnancy. One of the basic techniques used in universal prevention is public education. Visits to family practitioners and to obstetrician gynecologists offer the opportunity for brief messages about the importance of responsible alcohol use and for providing general information about the risks of alcohol to the fetus.

Selective prevention interventions target people who are at greater risk for a particular outcome because they are members of a subgroup known to be at higher risk than the general population. These interventions involve different levels of targeting and intensity compared to universal preventive interventions. Targets of selective prevention for FASD include women who drink alcohol and are in the reproductive age range and their partners.

Physicians and other health care providers should be prepared to talk to women about their alcohol use, screen women for indication of alcohol abuse, conduct further assessments as necessary, and be prepared to offer brief interventions. If appropriate, referral for formal treatment of alcohol dependence should be made. There are studies showing that some pregnant women who drink moderately or heavily are amenable to interventions offered in conjunction with prenatal care.

Indicated prevention interventions target high-risk individuals. A small proportion of women within some populations give birth to most of the FAS children. The committee therefore considers the target for indicated prevention interventions to be a woman who engages in heavy drinking while pregnant or at risk for being pregnant, particularly a pregnant or preconceptional woman who drinks alcohol and who has already given birth to a child with an FASD. Indicated prevention of FASD includes treatment for alcohol abuse or dependence for a pregnant woman or for a woman highly likely to become pregnant. Because, in many cases, women do not seek obstetric services until delivery, any health care provider who comes in contact with women who abuse alcohol should consider brief intervention therapies and referral to more formal alcohol abuse treatment, if appropriate. Women of reproductive age who abuse alcohol should also be offered referral and access to birth control information and services.

Further information on selective and indicated approaches may be found at this website:

FASD Screening, Diagnosis and Linking. On the same website above there is a link to the 2004 CDC publication, FAS Guidelines for Referral and Diagnosis. This document provides the latest information on intervention and should be used for proposals seeking to provide linking services for individuals exposed to alcohol prenatally. The Michigan FASD Program supports five diagnostic centers that should be used for referral. A map and contact information is provided in Appendix G. Proposals for intervention should also include access to local screening of individuals for FASD. A screening tool used by the state program is also provided in Appendix H. Thus a comprehensive system includes case identification, screening, diagnosis, and linkage to services. Proposals may consider collaboration with the Department of Human Services Foster Care and Adoption Services to help identify children with FASD.

Diagnosis is never an endpoint for any individual with a developmental disability and his or her family. The FAS diagnosis and the diagnostic process are part of a continuum of care that identifies and facilitates appropriate health care, education, and community services. Service needs for any particular individual and his or her family can be quite individualistic. Thus intervention strategies must take into consideration a broad range of service systems and facilitate coordination for the family.

Intervention Strategies for Individuals Affected by FASD.Dr. Ann Streissguth reported in the 1996 FAS/E Secondary Disability Study at the University of Washington that the primary protective factors for the child with FASD were: living in a stable and nurturing home for over

72% of life and being diagnosed with FAS before age 6.During the toddler years children with FASD usually demonstrate developmental delays. As the child grows into school age the depth of the brain damage becomes more evident (Devries, J, 1998) In particular FAS significantly impairs information processing.

Effective parenting is important to maximizing the abilities of a child to learn and adapt to society. Early intervention is crucial to reducing the secondary disabilities often associated with older children and adults. Parenting issues involve effective communication, creating structure and ritual in their environment, developing ways of transitioning that reduce the fear of change, providing supervision for safety and advocating for access to services. Because parenting becomes a consuming process, parents need education about effective strategies and support.

Secondary disabilities can be prevented or lessened by better understanding and appropriate interventions.The most prevalent secondary disability is mental health problems such as ADHD, clinical depression, and attempted suicide. Disrupted School Experience(suspension or expulsion or drop out), is experienced by many children of school age. Common school problems include: not paying attention; incomplete homework; can't get along with peers; disruptive in class; disobeying school rules; talking back to the teacher; fighting; and truancy.Trouble with the law (involvement with police, charged or convicted of crime), is also common in children age 12 and over.Inappropriate Sexual Behaviormay also be common in those who age 12 and over, and especially adult males with FASD.Alcohol or drug problems may also be found in age 12 and over.Most adults with FASD are not living independently and have problems with employment.

GRANT PURPOSE

This RFP seeks competitive proposals for local FASD projects that will deliver services to families in a local jurisdiction. Recognizing that both prevention and linking to services are important parts of a system of care for FASD, this funding offers the opportunity for a local jurisdiction to select what type of service will fit their community needs and abilities.

The programs are to achieve one of three goals:

  1. FASD Prevention: Decrease the incidence of FASD by eliminating alcohol consumption by pregnant women.
  2. FASD Screening, Diagnosis and Linking:Increase the identification of individuals exposed to alcohol during pregnancy, provide diagnostic evaluations and linking with specific resources based on the individual need.
  3. Intervention Strategies for IndividualsAffected byFASD:Improve the functioning and quality of life of children, youth or adults with an FASD and their families.

The applicant must choose either FASD prevention, FASD screening anddiagnosis, or intervention strategies as a purpose that they want to pursue. An applicant cannot choose more than one. The request for proposals for these three programs will be described separately below.

The initial planning phase of this grant will be led by the department staff and follow common strategic planning steps, including expansion of a needs assessment, action plan with objectives, evaluation plan and implementation plan. Projects must have their implementation plan approved in order to have option year funding awarded. Technical assistance and training will be provided to facilitate skill building in FASD interventions and to accomplish the planning phase.
ELIGIBLE APPLICANTS

Organizations providing the services listed below, within the state of Michigan are invited to submit proposals. The organizations must be local government organizations, federally recognized tribes, or private non-profit organizations with a 501C-3 status.Applicants must have the authority to change the relevant policies and procedures of the service delivery organization or program of interest. These subcontracts are NOT designed to support academic research.

FASD Prevention

  • Preconception or prenatal care programs
  • WIC programs (for pregnant women)
  • Alcohol or substance abuse treatment programs (outpatient and especially residential)
  • Programs that provide services to women likely to have an alcohol-exposed pregnancy (e.g., mental health services, criminal justice system, low income health centers, home visitation services to high risk women, and others)

FASD Screening, Diagnosis and Linking

  • Developmental disabilities programs
  • Behavioral health or mental health programs
  • Programs serving youth in child welfare or juvenile justice
  • Programs demonstrating they are serving children and youth likely to have a higher prevalence of FASD

Strategies for Intervention with Children, Youth and Adults with FASD

  • Programs demonstrating they are serving children, youth and/or adults with a FASD
  • Developmental disabilities programs
  • Behavioral health or mental health programs
  • Programs serving youth in child welfare or juvenile justice
  • Programs serving adults in Corrections
TARGET POPULATIONS TO BE SERVED

This RFP seeks proposals for services designed to either prevent FASD in at-risk women or to link individuals with FASD to appropriate community services in Michigan or to intervene more strategically with individual with FASD. The applicant must document local need in a particular geographic area.

Because the FASD Program desires to improve the identification of the most at-risk populations, priority for funding will be given to agencies that provide services to women who drink at high levels or are alcohol dependent, and/or to provide diagnostic and linking to services for children in foster care or adoption, or older youth and adults with a diagnosed FASD.

Data from NSDUH/SAMHSA indicates that 27.8% of underage females are currently using alcohol. Older teens and college age females are another target population for preconception FASD prevention activities.

Older youth and adults already determined to have a FASD may be considered a target population for the purpose of linking to services, to support independent living, to support and educate parents/caregivers and/or to work with the justice system to promote more equitable treatment.

FUNDING LIMIT AND DURATION OF FUNDING

This grant will provide funding of up to $6,000 for planning to provide local services for prevention of alcohol exposed pregnancies and/or diagnosis and intervention for children with FASD. Grantees that have a successful planning period will be eligible to take part in a noncompetitive application for 2 option years of direct service. No local match is required for this application, but is recommended to improve sustainability of efforts when the grant is concluded.