2016 Tobacco Cessation

2016 Request for Proposals (RFP) Hawaiʻi Tobacco Prevention and Control Trust Fund Community Grants Program/ Tobacco Cessation Services for Priority Populations Online Application Deadline: Monday, April 4, 2016, 4:00 p.m. HST BACKGROUND

The source of funds for this Request for Proposals (RFP) is the Hawai‘i Tobacco Prevention and Control Trust Fund (Trust Fund). The Trust Fund was created by state law following a Master Settlement Agreement (MSA) between most US states and territories and the tobacco industry1. The Hawai‘i Community Foundation (HCF) has held and managed the Trust Fund on behalf of the Hawai‘i Department of Health (DOH) since 2000. Pursuant to the contract with the DOH, HCF implements a community grants program.

Tobacco use continues to be a serious public health problem in Hawai‘i, where roughly 1,400 deaths each year are attributable to smoking.2 Estimates of annual smoking-caused monetary costs in Hawai‘i include $526M in health care costs, $387M in lost productivity costs, and account for $141M of all Medicaid expenditures.3 Hawai‘i’s adult smoking prevalence rate in 2014 was 14.1% (about 155,200 adult smokers), a statistically significant decline since 20024. However, as stated by the Truth Initiative, tobacco is not an equal opportunity killer5. Despite the overall decline in tobacco use, certain groups in Hawai‘i still have disproportionate rates of tobacco use, and therefore disease and fatality, as evidenced by the Hawai‘i Behavioral Risk Factor Surveillance System (BRFSS)6, the Hawaii Youth Tobacco Survey7, and other surveys8. Those with higher smoking rates include Native Hawaiians, persons with mental health and/or substance abuse challenges, LGBT communities, and low socio-economic status populations9:  

Native Hawaiian – 27.0% Mental illness/substance abuse, examples: o Diagnosed depression – 27.1%

Hawai’i Revised Statutes 328L-2 (2010).

Campaign of Tobacco Free Kids (2015) - http://www.tobaccofreekids.org/facts_issues/toll_us/Hawai’i.

3 Campaign of Tobacco Free Kids (2015) - http://www.tobaccofreekids.org/facts_issues/toll_us/Hawai’i.

4 2014 Hawai‘i Behavioral Risk Factor Surveillance System (2014 BRFSS), accessible through the Hawai‘i Health Data Warehouse at http://www.hhdw.org/ under BRFSS Reports, Tobacco Use, Cessation.

5 The Truth Initiative (2016) - truthinitiativehttp://truthinitiative.org/topics/who-smokes.

6 2014 BRFSS, http://www.hhdw.org/ under BRFSS Reports, Tobacco Use, Cessation.

7 2013 Youth Tobacco Survey: http://hhdw.org/wp-content/uploads/YTS_Demographics_IND_00001.pdf 8 See, for example, Hawai‘i Health Data Warehouse - http://www.hhdw.org/.

9 2014 BRFSS, http://www.hhdw.org/ under BRFSS Reports, Tobacco Use, Cessation.

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o Heavy drinking - 29.4% Lesbian, Gay, Bisexual – 20.9% (Transgender data not available) Low socio-economic status, examples: o Annual income $10,000-$14,999 – 32.2% o No high school graduation – 28.6%

In addition, the statewide smoking rate for pregnant women during the last trimester of pregnancy was 8.1% in 2015.10 This has long-term consequences for the next generation because medical research has established that smoking during pregnancy causes significantly higher rates of premature birth, low birth weight, sudden infant death syndrome (SIDS), and attention deficit hyperactivity disorder (ADHD).11 Locally higher prevalence rates are consistent with national evidence and statements shared by the National Networks for Tobacco Control and Prevention12, the CDC13, and other sources indicating that vulnerable populations have higher rates of tobacco consumption:14       

Mental illness – 36% o 40% of all cigarettes are consumed by adults with mental illness and/or substance abuse disorders Native Hawaiian and Pacific Islander (nationally) – 42% (men), 27% (women) LGBT population – 33% Low income (below federal poverty rate) – 29% Medicaid population – 30% Homeless – 73% (2003 national data) Least educated – 41% (GED attained)

Improving cessation services for priority populations in Hawai‘i HCF’s community grants/cessation program is one component of a statewide comprehensive tobacco prevention, education, and cessation strategy to reduce and eliminate tobacco consumption and exposure to second-hand smoke in Hawai‘i. This strategy is based on the CDC’s four national goal areas for comprehensive tobacco control programs, which have been adopted by the State of Hawai‘i: 1. Prevent the initiation of tobacco use among all of Hawai‘i’s people; 2. Promote quitting tobacco and tobacco products among young people and adults; 3. Eliminate exposure to secondhand smoke; 4. Decrease tobacco related disparities among population groups.

The statewide strategy is implemented through a coordinated effort between DOH’s Tobacco Prevention and Education Program, public health advocates, private and non-profit organizations, policy makers, and various communities throughout our state. Their coordinated effort has been guided by the State’s Tobacco Use Prevention and Control Five-Year Strategic Plan (“Strategic Plan”). The design of this 2016 cessation grant RFP is based on the

Early Childhood Indicator Report: Hawai‘i State and Counties. Health, page 7. He, S.J. & Pobutsky, A. (2015). University of Hawai‘i, Center on the Family.

11 For example, see “The Mystery of Risk: Drugs, Alcohol, Pregnancy, and the Vulnerable Child” by Dr. Ira J. Chasnoff, MD, pp. 37-38, NTI Upstream (2010).

12 National Networks for Tobacco Control and Prevention - http://clinicians.org/national-networks-for-tobacco-control-and-prevention/ 13 Centers for Disease Control and Prevention, Current Cigarettes Smoking Among Adults in 2014 http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm#national.

14 Prevalence rates from “Achieving Health Equity in Tobacco Control”, December 8, 2015, a joint report by the American Lung Association, American Cancer Society, Smoking Cessation Leadership Center, and many other agencies, citing numerous data sources.

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anticipated goals and strategies of the next Five-Year Strategic Plan (2016 through 2020), which is being finalized at the time of publication of this RFP. During the planning process for the 2016-2020 Strategic Plan, community input favored higher concentration of cessation grant resources on services to priority populations15 that have the highest smoking prevalence rates, including the following:     

Native Hawaiians Persons with mental illness and/or substance abuse disorder Lesbian, Gay, Bisexual, Transgender communities (LGBT) Persons of low socio-economic status (Low SES)16 In addition, this RFP includes pregnant smokers as a priority population due to the high risk of harm to the fetus.

Through this RFP, HCF seeks to reduce smoking rates in these priority populations while also building on lessons learned from the current cessation grant program, which will expire on June 30, 2016. The 2012-2016 program design was based on extensive available research from national sources that identified evidence-based programs and technologies that can help tobacco users quit.17 For example, research showed that:   

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The first step in becoming tobacco-free is making a quit attempt.18 Being ready to quit is a significant predictor of successful quitting.19 With the use of behavioral interventions (e.g. counseling20) and pharmaceutical interventions (Nicotine replacement therapies and/or pharmacotherapies) tobacco users who can make a quit attempt, even if for a short period of time like 24-hours, have a higher probability of sustained abstinence (e.g. quitting tobacco in the long term).21 Intensive interventions22 for tobacco dependence have higher success at quit attempts than brief interventions.

Hawai‘i smokers who want to quit smoking can also get help from the Hawai‘i Tobacco Quitline. The Quitline provides free cessation counseling services through a toll-free telephone line (1-800-Quit-Now) or online (www.hawaiiquitline.org). By design, the Quitline and the current cessation grant program are meant to be complementary. The cessation grant program is intended to provide free in-person services for individuals from

Priority populations are population groups that experience tobacco-related disparities, defined as “differences in patterns, prevention and treatment of tobacco use; differences in risk, incidence, morbidity, mortality, and burden of tobacco-related illness that exist among special population groups in the United States; and related difference in capacity and infrastructure, access to resources and secondhand smoke exposure.” Fagan P, King G, Lawrence D, Petrucci SA, et al. (2004), “Eliminating Tobacco-Related Disparities: Directions for Future Research.” American Journal of Public Health 94(2): 211-217.

16 Socio-economic status: “A composite measure that typically incorporates economic, social, and work status. Economic status is measured by income. Social status is measured by education, and work status is measured by occupation. Each status is considered an indicator.” CDC, NCHHSTP Social Determinants of Health, Definitions webpage - http://www.cdc.gov/nchhstp/socialdeterminants/definitions.html 17 Institute of Medicine for National Academies (2016), http://sites.nationalacademies.org/Tobacco/SmokingCessation/TOBACCO_051286 18 Fiore MC, Jaén CR, Baker TB, et al., Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

19 Id. 20 Counseling may involve individual and group formats which are both effective in tobacco use treatment.

21 2011 Professional Data Analysts, Cessation Grants Aggregate Evaluation Report to HCF 22 According to the Public Health Service, Treating Tobacco Use and Dependence: 2008 Update, the more intense the intervention, the greater the rate of abstinence. Interventions may be intensified by increasing the length of the individual intervention sessions and/or the number of intervention sessions.

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priority populations, while the Quitline provides free telephone and online services to all interested smokers in all communities statewide. Both programs provide services to individual smokers and can distribute free FDA-approved nicotine replacement therapies to eligible smokers. Both programs are required to participate in a joint program evaluation conducted by Professional Data Analysts, Inc. (PDA), an external evaluator. For the evaluation of the cessation grant program, results through June 30, 2015 showed a number of successes that contributed to smoking reduction in our state.23 The Quitline has shown similar success.

However, despite these successes and the long-term decline in the statewide prevalence rate, the continued persistence of higher prevalence rates in priority populations indicates that the national standardized interventions do not always work. Cessation providers have found, for example, for some priority populations, it is harder to persuade smokers to be ready to quit, more counseling interventions are necessary, relapses are more common, and family or support group approaches can be more effective than one-on-one counseling. The community input for the 20162020 Strategic Plan recognized these differences and encouraged the use of innovative cessation strategies that are better suited to the needs and circumstances of those priority populations. To be effective, innovative strategies should be derived from standardized evidence-based interventions but adapted to fit the unique circumstances of individual smokers in these specific populations. Therefore, a major goal of this RFP is to encourage such innovation and adaptation.

Each smoker is unique and so are his or her motivations to quit. Thus, a successful grantee’s tobacco treatment specialists and other staff may need to carefully assess the circumstances and needs of each individual smoker, and then be prepared to select the most appropriate counseling and intervention approach from a variety of available options. This may be particularly important when the smoker comes from more than one priority group. Grantees will be expected to share their “toolbox” of strategies and innovations, including successes and challenges, with other grantees through regular grantee gatherings and networks during the grant term. For program evaluation, HCF and the program evaluator will work with grantees to develop effective and accurate methods to measure successful outcomes for innovative strategies, and to allow for learning, adjustment, and improvement in strategies throughout the term of the grant.

Innovations and adaptations are encouraged in the following areas: 

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Integrating tobacco screening and cessation services into the grantee’s existing client services, with all staff having client contact being trained in motivational interviewing, brief intervention, and other basic tobacco cessation services.

Utilizing partnership relationships with organizations that have trust and credibility with priority populations but do not have tobacco cessation services or expertise, so that the grantee and its partners serve the same individual smoker together to provide appropriate smoking cessation services as part of a comprehensive, patient-centered service team. (Partnership relationships can be supported by subcontracts from the grantee where appropriate.)

Increasing access to cessation services for smokers from priority populations who live in remote areas with no public transportation by providing regular outreach services to locations closer to their residences, or through partnership relationships with organizations that can do such outreach.

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4,622 (estimated) interventions provided in the first 30 months of the grant period.

Reach was strong at 1.3%, similar to the 1 to 2% average reach for quitlines nationally.

Counseling time: a median of an hour and a half of counseling across two sessions.

84% of survey respondents reported being very or mostly satisfied with services received.

82% of enrolled tobacco users quit for at least 24 hours between enrollment and a seven month follow-up survey.

29% of enrolled tobacco users were quit for the last 30 days at the time of a seven month follow-up survey.

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Increasing access to cessation services for non-English speaking smokers from priority populations by providing bilingual/bicultural cessation staff, interpreters, translated written materials, and other language access services, or through partnership relationships with organizations that have such language capacity.

Increasing access to cessation services for Native Hawaiian smokers by providing culturally appropriate outreach and counseling services through bicultural cessation staff, or through partnership relationships with organizations that have capacity to provide such services.

Increasing access to cessation services for smokers with mental health and/or substance abuse challenges by training staff about mental health, substance abuse, and effective strategies to serve those populations, or through partnership relationships with organizations that already effectively serve those populations.

Using appropriate incentives to encourage smokers to participate in cessation services.

Providing staff training and public education information about the risks of electronic smoking devices (ecigarettes).

Improving utilization of available insurance coverage from private health insurers and Medicaid for tobacco screening and cessation services, in order to achieve long-term tobacco program sustainability.24 Adopting workplace no smoking policies at all grantee and partner facilities to set a good example for clients and staff.

Adopting evening and weekend office hours for cessation services to increase access for working smokers.

PURPOSE To align with federal and state goals for tobacco prevention and control and to reduce tobacco use prevalence and consumption, reduce tobacco-related morbidity and mortality and decrease tobacco related disparities, the HCF community grants program announces the availability of funds for cessation programs that: 

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Reach and address priority populations in Hawai‘i as defined in this RFP using innovative strategies adapted from best practices and other evidence-based methods to help people quit smoking. Some examples of best practices and other evidence-based methods targeted to certain priority populations are listed as potential resources for applicants in Appendix 1.

Help tobacco users in priority populations to become ready to quit including, where appropriate, engagement with the smoker’s family members and support groups.

Provide intensive interventions and NRTs to tobacco users when they are ready to quit, and provide renewed interventions and NRTs to tobacco users who have relapsed but are again ready to quit.

Provide interventions that are adapted to the needs and circumstances of the priority populations based on available best practice25 or evidence based programming for tobacco cessation.

Establish tobacco screening and referral partnerships with agencies in the same service area serving the same priority populations in order to increase access to services, as appropriate.

Work in collaboration with the Hawai‘i Tobacco Quitline to provide comprehensive cessation services for all people of Hawai‘i.

Grant Expectations

Private health insurance and Medicaid may provide some coverage for tobacco screening, cessation interventions, and NRTs. Applicants who have billing systems that are able to access these coverages to generate revenue can provide even more cessation services and NRTs to more smokers, in addition to grant-funded cessation services.

25 Centers for Disease Control and Prevention: http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm; Public Health Service Treating Tobacco Use and Dependence Clinical Practice Guidelines (2008), Hawaii Department of Health Tobacco Prevention and Education Program.

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If a grant is awarded, it will be finalized through a document entitled “Grant Terms and Agreement” or GTA. Grantees will be expected to: 1. Perform the scope of work as described in the proposal and/or negotiated at the time of the award.

2. Fully implement the work plan included as part of the proposal and/or negotiated at the time of the award.

3. Share performance information with HCF and, as appropriate, with other grantees.

4. Consistently meet established benchmarks and SMART objectives as described in Appendices 2 and 3 and defined in the work plan included as part of the proposal and/or negotiated at the time of the award.

5. Participate in HCF site visits, grantee gatherings, and trainings.

6. Coordinate with any HCF media campaigns if programs have a media component.

7. Offer/refer clients to the Hawai‘i Tobacco Quitline, as appropriate.

8. Accept referrals of clients from the Hawai‘i Tobacco Quitline, as appropriate.

9. Have not less than two FTE paid staff positions at all times during the grant term that are responsible to deliver the services described in the GTA and work plan (preferably with Tobacco Treatment Specialist certification), or an alternative staffing plan that assures that grant services will be provided at all times during the grant term. Alternative plans can include staff positions provided under a partnership agreement.

10. Submit progress reports to HCF (such as update on the work plan, narrative and financial reports) consistent with the timeline developed by HCF and a final report within thirty days of the grant end date.

11. Cooperate with and implement the evaluation designed for this RFP to assess processes and outcomes achieved by each funded program and the initiative as a whole as measured by the benchmarks and SMART objectives. Specifically, the grantee will be expected to: a. During the first 3 months of the first grant year, work with the program evaluator to develop logic models based on the work plans for the proposed services, which will provide the basis for evaluation protocols and requirements during the grant term. b. Collect and submit data electronically on a quarterly basis using evaluation protocols and participate in other evaluation activities as described below. c. Review evaluation reports and other data as necessary to assess strengths and opportunities for improvement. d. Attend evaluation training sessions and telephone calls to ensure quality evaluation data. e. Make appropriate adjustments and develop solutions to areas for improvement identified in the evaluation, as necessary. f. During the grant term, allocate between 5 to 10% of budgeted personnel expenses to participation in evaluation-related activities under the guidance of HCF’s contracted evaluator.

Program Evaluation The purpose of the evaluation is to assess grantee performance for the purposes of program improvement and accountability. Additionally, the evaluation aims to help document successes and lessons learned related to the innovations and adaptations carried out by grantees. Please note that intensive interventions and innovations and adaptations will be evaluated differently (see definitions in the following section). This is because intensive interventions have a large body of literature that allows the evaluator to specify the evaluation in great detail, while evaluations of innovations and adaptations will be customized to the activities that each grantee will be conducting.

However, all evaluations will collect three kinds of data: program data, process data, and outcome data.

1. Program data will include a logic model of the program that incorporates all of the activities the program plans to implement, including activities related to both intensive interventions and innovations and adaptations. The grantee can expect to participate in a phone call or site visit to create the logic model, and use the model with the evaluator throughout the course of the funding period.

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2. Process data includes information about the services your grant provides and how services are provided.

Process data differs depending on whether the funded activity is an intensive intervention or an innovation and adaption. a. Process data for the intensive interventions will be collected by program staff using instruments developed by the evaluator, and will include information such as the number of tobacco users served, participant characteristics, and program use. Please see Appendix 2 for more information about the benchmarks for intensive interventions. b. Process data for the innovations and adaptations may include but may not be limited to the SMART objectives outlined in Appendix 3 and may be collected by the program’s own internal tracking or through interviews with the evaluator.

3. Outcome data includes the changes you expect to see as a result of your activities. As with the process data above, outcome data differs depending on whether the funded activity is an intensive intervention or an innovation and adaptation. a. Outcome data for the intensive interventions will be collected by the evaluator via a 7-month follow-up survey and will include the proportion of participants who attempt to quit and who quit tobacco. Please see Appendix 2 for more information about the benchmarks for intensive interventions. b. Outcome data for the innovations and adaptations may include but may not be limited to the SMART objectives outlined in Appendix 3 and may be collected by the program’s own internal tracking or through interviews with the evaluator.

Key Definitions  Benchmarks: Evidence-based performance measures for grantees that will be established for intensive interventions. See Appendix 2 for more information.  Best Practice: Refers to methodologies, policies and procedures that provide guidance based on past experiences and evaluation, and are proven to be effective. (For example see the CDC Best Practice Guides in Appendix 1.)  Cessation services: Includes the full range of services to help a smoker quit smoking, for example: o Outreach to smokers and their families or support groups, to provide educational information about the harms of smoking, the benefits of quitting, and the availability of help to quit smoking; o Regular screening of clients for tobacco use during an intake process followed by brief intervention for those who screen positive; o Appropriate engagement with smokers to encourage them to try quitting; o For smokers who are ready to try quitting, referral to trained, qualified cessation counselors to provide intensive interventions and nicotine replacement therapies; o Multiple service interactions with smokers who need multiple quit attempts to become tobacco-free; o Participation in data collection, data tracking, and evaluation of services in order to learn, improve, and ultimately increase the numbers of smokers who quit smoking.

In a grant proposal that includes a partnership arrangement with other organizations, a grantee and the partner organizations could each provide different components of a full range of services so long as all component services are coordinated to serve smokers effectively.  Innovations and Adaptations: Activities other than the provision of intensive interventions (described below) that will be conducted to meet the objectives of this RFP. Note that innovations and adaptations may be related to intensive interventions (e.g. incorporating tailored counseling approaches for specific 7

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populations), as well as other areas described earlier in the proposal, such as recruitment, screening, referral and cost-sharing.

Intensive intervention: Four or more sessions (individual or group), at least 10 minutes each, with someone formally trained in tobacco cessation accompanied by discussion about and/or use of applicable nicotine replacement therapy and/or pharmaceutical quit smoking aids.

Priority populations: Tobacco users (including persons using e-cigarettes or other electronic smoking devices) who are or who self-identify as one or more of the following: o Native Hawaiian o Persons with mental illness and/or substance abuse disorder o Lesbian, Gay, Bisexual, Transgender o Low socio-economic status (Low SES) o Pregnant women Quit Attempt: Abstinence from tobacco use for at least 24-hours sometime between enrollment in the program and the seven month follow-up survey. This is a benchmark for intensive interventions.

Quit Rate: Abstinence from tobacco use for thirty (30) days prior to being surveyed seven months after enrolling in the cessation program. The community grants evaluation design adopts the calculation for quit rates designed by the North American Quitline Consortium (NAQC) which suggests that only those participants who respond to a survey be used to calculate quit rates. In general, this produces higher quit rates than alternate calculation methods. This is a benchmark for intensive interventions.

SMART Objectives: Performance measures for grantees that will be established for activities related to innovation and adaptation. See Appendix 3 for more information.

Training, Technical Assistance and Support to Grantees As part of an awarded grant, grantees will receive training, technical assistance, and support with respect to:  Training: o Tobacco Treatment Specialist certification (TTS) o Motivational interviewing and brief intervention skills o Providing cessation services for priority populations o Counseling on electronic smoking devices (E-cigarettes)  Technical assistance: o Implementation of program evaluation (i.e. assistance with the evaluation tools) o Use of the evaluation results (i.e. assistance with interpreting and using evaluation report findings)  Other support: o Regular grantee gatherings to provide updates on cessation services, to share successes and challenges to improve services, and to learn from evaluation results. o Coordination of grant activities with the Department of Health, the Coalition for a Tobacco-free Hawaii, and other tobacco control stakeholders. o Access to and assistance on how to use current population-based survey data from the Department of Health. o Support for grantees’ local communications, media, and public education efforts, coordinated with the HCF Tobacco Trust Fund’s communications vendor.

ELIGIBILITY To be eligible for funding under this RFP:

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1. The applicant must be a non-profit organization with a 501(c)(3) tax-exempt status, or submit a proposal using a fiscal sponsorship organization. The fiscal sponsor must have a 501(c)(3) status and be accountable for compliance with fiscal and programmatic requirements (see fillable Fiscal Sponsor Acknowledgement/Agreement template on HCF website).

2. The applicant must have a history of successful programmatic implementation and experienced personnel.

Funding will not be provided for start-up organizations.

Timeline Submission of proposals for the community grants/cessation program will be online. Anticipated RFP launch date is February 22, 2016. Your organization must first establish an online account with Hawaii Community Foundation to access the online application. Please go to: http://www.hawaiicommunityfoundation.org/grants/grants/grant/hawaiitobacco-prevention-control-trust-fund-cessation to request an account or, if you already have an account, to access the online application. Note: If you are requesting an account, it may take a few days for you to receive the account information. It’s highly recommended you request your account early to allow adequate time to complete the application by the submission deadline.

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Deadline: submit your proposal online by 4:00pm HST on Monday, April 4, 2016.

Notification of awards will be sent by early June, 2016 with an initial notification by email.

First payment will be mailed upon the finalization of grant terms and agreement requirements.

Initial meetings with the program evaluator to discuss evaluation design and data collection tools to occur within one month of grant award.

Proposal Review and Award Process Proposals will be reviewed by a review team comprised of HCF staff and external individuals selected for their expertise, skills, and knowledge related to the focus of this RFP who do not have any controlling or financial interest in any of the entities submitting proposals. The review team will analyze the merits of each proposal and make recommendations to HCF. HCF will make the final decision on all grant awards. The strongest proposals will be those that address all the criteria listed below and provide supporting documentation (see Application Instructions).

Any items missing from the on-line submission will delay review and may result in denial.

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Grants will be awarded for a three-year period with a maximum grant award of $150,000 per year (maximum of $450,000 over three years). However, larger grant awards may be considered for applications proposing cessation strategies that are scalable to serve more smokers through partnership sub-contract arrangements for coordinated cessation outreach, screening, referral and treatment, or to cover more than one island or more than one priority population. Continuation of the grant for each year of the three-year grant term will depend on the grantee demonstrating adequate progress in the grant work plan. HCF reserves the right in its sole discretion to discontinue grant funding if progress is unsatisfactory.

The grant term is expected to begin in July 1, 2016 and run to June 30, 2019. Grant payments are contingent on the availability of funds from the Trust Fund.

A total of two million dollars ($2M) has been budgeted in calendar year CY 2016 for this cessation grant program and an additional $2M is expected to be budgeted in each of CY 2017 and CY 2018, subject to availability of funds.

CRITERIA FOR PROPOSAL REVIEW 9

The strongest proposals will be those that meet all or most of the following criteria.       

Organization can demonstrate that it has a good history of successful programmatic implementation, strong operational and fiscal administration, and experienced personnel who can effectively lead and oversee cessation services provided under the grant.

Organization can demonstrate that it has substantial relevant experience in smoking cessation services or related public health services addressing addiction and behavioral change.

Organization can demonstrate a clear strategy to reduce smoking in its service area by providing effective cessation services to individual smokers in one or more priority populations.

There is a clear rationale for the strategy that is tied to known best practices or other evidence-based methods to help people quit smoking or become ready to quit smoking, and is designed to address the needs and circumstances of individual smokers in one or more priority populations.

Organization can demonstrate that its cessation services are high quality and that it has the capacity to deliver cessation services under the grant, including the evaluation requirements.

Organization has the capacity to administer the grant and support its employees who will deliver the cessation services.

Organization has strong partnerships with other service providers in its service area that will support the creation of tobacco outreach, screening, brief intervention, and referral protocols to increase utilization of the organization’s cessation services.

TOBACCO CESSATION GRANTS WILL NOT FUND THE FOLLOWING  Capital improvements, including capital campaigns, construction or renovations (minor capital improvements to implement programs are allowable).  Establishment of or operating funds for a statewide quitline  Debt reduction or third-party reimbursement.

ONLINE SUBMISSION Applications must be submitted online at: https://nexus.hawaiicommunityfoundation.org/nonprofit, which will be accessible by February 22, 2016. (Or click on “NONPROFIT GATEWAY” at the bottom right of the HCF homepage).

If you are a new user, click “New User Registration;” the registration process may take up to 2 days so please register early!

APPLICATION INSTRUCTIONS  Only complete applications will be accepted.  If you are a fiscally sponsored project or organization, please create your own online account. You can enter the name and information for your Fiscal Sponsor on your application.  The online application has fillable boxes with character limits. The character counts in MS Word do not match the character counts in the application. If you cut and paste your work into the application, please be sure your text fits the space provided.  We recognize the significance of diacritical markings in written Hawaiian as pronunciation guides; however, the online application system is unable to accept diacriticals. Please do not include these in your narrative as it may cause errors in the way the online system processes your proposal.  HCF will make final award decisions based on a full review of complete proposals submitted, as well as fund availability. Projects selected for funding are anticipated to receive grants with an award period beginning on July 1, 2016. Please consider this timeline when providing your project start date.

NARRATIVE SUBMISSION The following character counts are approximate to the specified page lengths based on single-spacing in Arial 12point font with 1 inch margins.

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Organizational Performance Questions for Proposed Cessation Grant Services 1. For your organization as a whole, please describe the community your organization serves, including who you serve, the geographic areas you serve, and the needs you are working to address or the opportunities you are working to provide. What priority populations are served and how are they served by your organization? (max 4,000 characters = 1 page) 2. How does your organization assess or learn about the community’s needs related to tobacco cessation services? (for example consumer feedback, community forums, data tracking, etc.). (max 2,000 characters = 1/2 page) 3. What tobacco cessation programs, services or activities are your organization already providing? How does your organization determine which cessation programs, services or activities to implement? In other words, of all the things your organization could do to achieve its desired results in tobacco cessation, why have you chosen the programs, services or activities that you offer? (If your organization is not doing tobacco cessation work at this time, then describe the programs, services or activities your organization is using to address addiction or other behavioral change public health issues in the community.) (max 4,000 characters = 1 page) 4. Please describe what your organization achieved in tobacco cessation over the “past year” (either fiscal or calendar year is acceptable). Specifically, how much did your organization achieve and what difference did your efforts make for the community you serve? (If your organization is not doing tobacco cessation work at this time, then describe what your organization achieved through its services addressing addiction or other behavioral change public health issues in the community.) (max 3,000 characters = 3/4 page) 5. How has your organization measured results in its tobacco cessation services (if any) to date? Please describe what data you collect, how and how often it is collected, and how you analyze and use this information to make decisions. If possible, please include a description of how your organization measures the quality of its tobacco cessation activities, i.e., how well it performed the services it provided (for example customer satisfaction, performance against standards or industry benchmarks, level of participation, etc.). (If your organization is not doing tobacco cessation work at this time, then describe how your organization measures results in its services addressing addiction or other behavioral change public health issues in the community.) (max 3,000 characters = 3/4 page) 6. Which priority populations will receive cessation services from your organization (and any partner organizations) under your proposal, and where they are located. (max 2,000 characters = 1/2 page) 7. Please describe your scope of work including the major strategies you would implement and your rationale for doing so. How will you and your partner organizations provide cessation services (both intensive interventions and/or innovations and adaptations) to the priority populations listed in #6? If you will use innovative strategies or adaptations, how are they related to known best practices or other evidence-based methods? How will you provide services to individual smokers who come from more than one priority population? How will your organization work with partner organizations, if any, to increase access and effectiveness? (max 8,000 characters = 2 pages) 8. For the staff who will be managing and delivering cessation services under your proposal, please describe their experience, knowledge and background related to tobacco control and prevention. How many are TTS certified? What do you anticipate will be their training and professional development needs to better serve smokers from priority populations during the grant term? How is the work of these staff members integrated with other services provided by your organization? Please describe how your organization will allocate time to comply with the evaluation and work with HCF’s contracted evaluator. (max 4,000 characters = 1 page)

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9. How does your organization as a whole financially support its overall activities and infrastructure? Please describe your organization’s typical sources of income or revenue. Please describe any additional sources of income (other than this grant) that will support the proposed tobacco cessation services.

Please include any information on revenue from medical insurance, Medicare, or Medicaid reimbursement. (max 2,000 characters = 1/2 page)

REQUIRED FORMS - ATTACHMENTS TO BE UPLOADED WITH THE APPLICATION Proposals missing any of the required forms will be administratively denied.

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Program Budget Form (download template) Program Matrix Form (download template) One-page board or leadership group list with professional affiliations Financial Statements (audited, if available) for the two most recently completed fiscal years Organization’s current and previous year’s board-approved Operating Budget If applicable, documentation of any partnership arrangement described in your proposal (supporting letter, MOU, etc.)

7. If using a Fiscal Sponsor, please also attach the following documents: a. Fiscal Sponsor’s Board of Directors Resolution authorizing project fiscal sponsorship* b. Fiscal Sponsor’s Agreement* c. Fiscal Sponsor’s Board of Directors list d. Fiscal Sponsor’s operating budget for the current and previous fiscal years *Please see HCF website for sample Fiscal Sponsor materials at: http://www.hawaiicommunityfoundation.org/grants/fiscal-sponsor-materials .

DEADLINE Submit your application by clicking the “Submit” button at the end of the application no later than 4:00 p.m. HST, on Monday, April 4, 2016.

QUESTIONS ABOUT THIS RFP Please visit the Tobacco Cessation Grant Program page of our website (http://www.hawaiicommunityfoundation.org/grants/open-applications) for a list of FAQs and to view a pre-recorded informational webinar on the RFP (to be posted by early March, 2016).

If you have additional questions about the RFP or the Tobacco Cessation Grant Program you may contact: Larissa Kick at 808-566-5565 or lkick@hcf-hawaii.org or Tom Matsuda at 808-566-5549 or tmatsuda@hcfhawaii.org. Neighbor Islands may call our toll-free number at 1-888-731-3863.

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APPENDIX 1 Resource List: (This is a partial list only, to provide a general introduction to available resources.)

General: CDC Best Practices for Comprehensive Tobacco Control Programs. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2014. http://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2014/comprehensive.pdf Tobacco –related health equity generally: Best Practices User Guide: Health Equity in Tobacco Prevention and Control. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2015. (This Guide includes a comprehensive list of references for tobacco prevention and control services for priority populations. For copies of the Guide, go to www.cdc.gov/tobacco or call toll-free 1-800-232-4636.)

Vulnerable populations: http://smokingcessationleadership.ucsf.edu/vulnerable-populations For Hawai‘i data on tobacco use by priority populations, see Tobacco Use Prevention & Control Tracker, http://www.hawaiihealthmatters.org/index.php?module=Trackers&func=display&tid=1007 Native Hawaiian: Culturally informed smoking cessation strategies for Native Hawaiians: http://www.ncbi.nlm.nih.gov/pubmed/19301474 (abstract). (Older study).

Culturally informed smoking cessation strategies for Native Hawaiians. Informa Healthcare, Nicotine & Tobacco Research, Volume 10, No. 4 (April 2008), 671-681.

Tobacco Use, Prevention and Control: Implications for Native Hawaiian Communities. ‘Imi Hale – Native Hawaiian Cancer Awareness, Research & Training Network (2001). For this and other Native Hawaiian cessation resources, see: http://www.imihale.org/education_materials.htm Mental Health: Smoking Cessation for Persons with Mental Illnesses, A Toolkit for Mental Health Providers (2009): http://www.integration.samhsa.gov/Smoking_Cessation_for_Persons_with_MI.pdf Tobacco Use & Mental Illness: https://quitday.org/support/mental-health/ Data on tobacco use and mental health: http://www.bhthechange.org/ Psychiatric Settings: Best practices toolkit for psychiatric settings - http://www.integration.samhsa.gov/pbhci-learning-community/TobaccoFree_Living_in_Psychiatric_Settings_Toolkit.pdf Learning about Living Healthy manual (treatment for smokers with mental health problems) http://www.nysmokefree.com/ConfCalls/CCNYSDownloads/UMDNJLearningAboutHealthyLiving.pdf

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APPENDIX 1, continued

Pregnant Women: DIMENSIONS: Tobacco Free Toolkit for Healthcare Providers, Supplement for Priority Populations: Pregnant and Postpartum. Behavioral Health & Wellness Program, University of Colorado Anschutz Medical Campus School of Medicine (May 2015). Website: www.bhwellness.org

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APPENDIX 2 – Benchmarks for Intensive Interventions The following benchmark categories apply to intensive interventions provided during the grant period. Benchmarks are based on evidence-based practices. For intensive interventions, it is expected that grantees would participate in the evaluation to collect all the data described below. However, criteria for success (e.g., the exact number of people your grant intends to serve) is not predetermined. Applicants should indicate in the proposal their criteria for success for each benchmark category below, and a rationale for why that criteria was chosen, especially if it differs from the standard, evidence-based criteria. Applicants’ criteria for success may change over time as activities become established, so a criteria for success for each benchmark should developed for each year of the grant. Benchmarks may also be renegotiated with HCF as needed and deemed appropriate. Benchmarks are primarily used for program improvement purposes; however, HCF may elect to use the information for future funding decisions.

1. Number served: This is defined as the number of tobacco users who receive at least some intensive counseling services. The criteria for success should consider the funding amount, who is being served, and the percent of time and budget devoted to intensive interventions. We encourage you to calculate a cost per enrollee as part of your planning process.26 We also encourage you to consider how the tobacco users you plan to serve will impact your program’s ability to produce a quit rate.27 2. Priority populations: This is defined as the percent of participants who meet the priority population criteria outlined on page 8 of the RFP. The previous funding cycle included a benchmark that 80% of participants were from a priority population, and this was achieved by all grantees.

3. Program satisfaction: This is defined as the percent of participants who are very or mostly satisfied with the services they received. We consider 80% satisfaction to reflect strong program satisfaction, and this was achieved by most grantees in the previous funding cycle.

4. Medication use: This is defined as the percent of participants who report using stop-smoking medication between enrollment and the follow-up survey. The previous funding cycle included a 75% benchmark for stop-smoking medication use, and this was achieved by most grantees.

5. 24 hour quit attempt: This is defined as the percent of participants who are able to quit using tobacco for at least 24 hours sometime between enrollment and the follow-up survey. The previous funding cycle included a 90% benchmark for 24-hour quit attempts, and this was achieved by most grantees.

6. 30-day abstinence quit rate: This is defined as the percent of participants who are able to quit using tobacco during the 30 days prior to the follow-up survey. The previous funding cycle included a 30% benchmark for 30-day abstinence, and this was achieved by most grantees.

The last grant round included a benchmark of 150 enrollees per year, which amounted to $500 per enrollee, given the total funding amount during that round. For this round, the cost per enrollee is the total dollars your project wishes to allocate to intensive interventions, divided by the number of persons you wish to serve. Based on this initial calculation, you may wish to adjust your dollar amount or numbers served. While $500 per enrollee was typical in the last funding cycle, it is important to consider that certain kinds of interventions, or reaching certain groups may be more expensive and require a higher cost per enrollee.

27 We estimate that a project would need to serve about 160 people with intensive services over the course of the grant to calculate a quit rate that could be used for internal purposes. If a program wishes to publicize its quit rate, about 315 or more enrollees would need to be served.

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APPENDIX 3 – SMART Objectives for Innovations and Adaptations

A SMART objective is Specific, Measurable, Attainable, Relevant, and Timely. The resources included in Appendix 1 provide more information about SMART objectives. The SMART objectives are separate from the benchmarks because they are used to measure innovations rather than evidence-based practices. SMART objectives might include things like the number of partnerships developed, the number of brief interventions provided, or appropriate indicators of increased access.

Applicants should develop SMART objectives for their major innovative/adaptive activities. Each SMART objectives should include a criteria for success (such as the exact number of partnerships developed or partners recruited). We rely on the grantee to develop the SMART objective that will best reflect the activities they have planned.

Additionally, a separate SMART objective should developed for each year of the grant because it is possible that criteria for success will change over time as an activity is developed, implemented, and mastered. SMART objectives are primarily used for program improvement purposes; however, HCF may elect to use the information for future funding decisions.

The SMART objectives should be developed for major activities, for each year of the grant. Categories for SMART objectives may include but are not limited to: 1.

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Moving tobacco users along the stages of change Family-based intervention strategies Systems change for tobacco screening Systems change for tobacco cessation Systems change for payment from private health insurers and Medicaid Partnerships Increasing access among priority populations based on geographic location Increasing access to cessation services via expanded hours of operation Increasing access among non-English-speaking tobacco users Increasing access for priority populations (Native Hawaiian, mental health and substance use disorders, LGBT, low income, Medicaid, homeless, less educated) Use of incentives E-cigarette counseling Workplace no-smoking policies Referral to the Hawaii Tobacco Quitline Other objectives that reflect other innovation/adaptation activities

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