DV FVPSA ARP

The intent of this supplemental funding is to provide resources for states and territories, to provide access to COVID-19 vaccines for domestic violence survivors and their dependents including individuals from vulnerable and medically underserved communities. States and territories and subrecipients may use funds to address any barriers to vaccines that may be experienced by domestic violence survivors and their dependents.

The supplemental testing funding can be used for supplies and vaccine administration fees for administering the COVID-19 vaccine are outlined below but are not limited to:

•          Administration of a single-dose COVID-19 vaccine,

•          Administration of the first dose of a COVID-19 vaccine requiring a series of two or more doses,

•          Administration of the final dose of a COVID-19 vaccine requiring a series of two or more doses,

•          Administration of recommended booster dose of a COVID-19 vaccine, and

•          Other activities to support COVID-19 vaccine access or administration, including planning for implementation of a COVID-19 vaccine program, providing interpreters and translated materials for LEP individuals, procuring supplies to provide vaccines, training providers and staff on COVID-19 vaccine procedures, and reporting data on vaccine activities.

Allowable uses of funds may include, but are not limited to, the development and sharing of vaccine related outreach and education materials that are culturally competent or linguistically appropriate, conducting face-to-face outreach as appropriate, making phone calls or other virtual outreach to community members for education and assistance, providing information on the closest vaccine locations, organizing pop-up vaccination sites, making vaccine appointments for individuals, making vaccine reminder calls/texts, and arranging for transportation and childcare assistance to vaccine appointments, as needed, and using interpreters and translated materials for communications with LEP individuals.

The implementation of this supplemental funding is intended to build upon national vaccine education and outreach efforts (including the HHS-funded programs listed under technical assistance resources below), while tailoring approaches to meet the unique needs of the community. Further, this funding will directly support the increase in state, territorial, and local domestic violence workforce needed to implement this supplemental funding, support access to vaccines, and support coordination with the local health department, health centers or Indian Health Service (IHS) centers that will support addressing any barriers to vaccination for domestic violence survivors and their dependents, including individuals from vulnerable, underserved, rural and racial or ethnic specific communities.

Implementation efforts are expected to be coordinated with the local health department or IHS and may include, but are not limited to: vaccine promotion, information dissemination to survivors about how and where to get vaccinated, coordinating with existing vaccination sites and public health partners to identify isolated and/or vaccine hesitant populations, and increased community and individual patient literacy on benefits of broad vaccination and the safety of vaccines.

Mobile health units are an innovative model of health care delivery that could help alleviate health disparities among vulnerable populations and individuals with chronic diseases. The target populations of mobile health units include vulnerable communities such as the homeless, displaced populations, immigrant communities, migrant workers, the under-insured, and children. Historically, these populations and communities are often disconnected from traditional health care settings and require support in accessing health care.

Mobile health units travel to partnering locations and provide services on a recurring basis. For example, mobile health units across the country have successfully partnered with other agencies serving the homeless in the community, such as homeless shelters, faith-based organizations, and food banks. Access to services, engagement in care, and successful utilization of needed services may lead to measurable improvements in health care outcomes among homeless populations of individuals and families.

The FVPSA Program is providing supplemental testing funding to assist states and territories domestic violence shelters, domestic violence programs, culturally specific programs, and rural communities with establishing partnerships with health departments, hospitals, and IHS facilities to access mobile health units to mitigate the spread of COVID-19 for domestic violence survivors and their dependents.

Specifically, this supplemental funding is intended to assist states, territories, shelters, culturally specific organizations, and rural communities with establishing or maintaining contracts with existing mobile health units operated by hospitals, medical clinics, health centers, and public health nonprofit organizations. This funding is intended to provide resources for states, territories, shelters, domestic violence programs, and culturally specific organizations to have contractual agreements with mobile health units to make regular visits each week to shelter locations, program locations, or transitional housing locations. FVPSA grant recipients are not expected to purchase or operate their own mobile health units.

Partnerships with mobile health units can FVPSA recipients expand access for survivors and their dependents who are in rural parts of their state, or who are members of underserved communities by giving them greater flexibility to bring health care services even closer to survivors who may be isolated from health care.

In terms of access to mobile health units, the International Journal for Equity in Health states that there are an estimated 2,000 mobile clinics operating across the United States (US), serving 7 million people annually, (Attipoe-Dorcoo, S., Delgado, R., Gupta, A., Bennet, J., Oriol, N. E., & Jain, S. H. (2020). Mobile health clinic model in the COVID-19 pandemic: lessons learned and opportunities for policy changes and innovation. International journal for equity in health, 19(1), 73. https://doi.org/10.1186/s12939-020-01175-7).

Mobile health unit is defined “as a unit that is staffed by clinicians working for or on behalf of a health center, hospital, or medical association to provide medical or oral health services at one or more locations” (Yu, S., Hill, C., Ricks, M. L., Bennet, J., & Oriol, N. E. (2017). The scope and impact of mobile health clinics in the United States: a literature review. International journal for equity in health, 16(1), 178. https://doi.org/10.1186/s12939-017-0671-2).

The supplemental testing funds can be used to establish or maintain contracts with mobile health units for regularly scheduled visits or on-call visits to domestic violence programs, culturally specific organizations, or rural communities to mitigate the spread of COVID-19. Additional allowable uses of funds are outlined below but are not limited to:

•          COVID-19 testing and vaccine administration;

•          Preventative health services to mitigate the spread of COVID-19 such as vaccines, primary health care, or behavioral health services; and

•          Operational costs or supply costs associated with the operation of mobile health units to partner with domestic violence shelters, programs, culturally specific organizations, or rural communities.

The supplemental testing funds can be used for COVID-19 workforce related expansions and supports, or to reimburse subrecipients for such costs and for costs that include but are not limited to:

•          Planning for implementation of a COVID-19 testing program, COVID-19 mitigation program, or mobile health units access program;

•          Training providers and staff on COVID-19 testing procedures, COVID-19 mitigation activities, or mobile health unit coordination activities;

•          Hiring culturally-competent and linguistically-appropriate providers and staff to carry out COVID-19 testing procedures, COVID-19 mitigation activities, or mobile health unit coordination activities;

•          Reporting data to HHS on COVID-19 testing activities, COVID-19 mitigation activities, or mobile health unit coordination activities; and

•          Expenses to secure and maintain adequate personnel to carry out COVID-19 testing, COVID-19 mitigation activities, or mobile health unit coordination activities; may be considered allowable costs under applicable HHS regulations if the activity generating the expense and/or the expenses are necessary to secure and maintain adequate personnel. Please review HHS regulations 45 CFR § part 75 “Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards,” Subpart E—Cost Principles, https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-75/subpart-E?toc=1. These requirements apply to all FVPSA grant recipients, and any subrecipients. All FVPSA grant recipients should thoroughly review these regulations before developing your proposed budget. Such expenses may include:

·         Hiring bonuses and retention payments,

·         Childcare,

·         Transportation subsidies, and

·         Other fringe or personal benefits authorized by HHS regulations (45 CFR part 75).

The purpose of these allowable workforce capacity building expenses are to ensure the continuity of domestic violence services in local communities by allowing supplement funding to be used to sustain an advocacy workforce to prevent, prepare for, and respond to the needs of domestic violence survivors impacted by the COVID-19 public health emergency. A sustainable workforce is needed to operate COVID-19 testing programs, COVID-19 mitigation programs, or mobile health units access programs; and to coordinate partnerships with health departments for each local program to keep families healthy and safe during the COVID-19 public health emergency.

PARTNERSHIPS

The impact of experiencing domestic violence has lifelong, health related consequences for survivors, including chronic pain, traumatic brain injury, digestive problems, reproductive and maternal health concerns, and the potential loss of a medical home. Housing instability and homelessness exacerbate this problem. Health care providers, working in partnership with states, territories, domestic violence service providers, and culturally specific organizations, represent important opportunities for mitigating the spread of COVID-19 through integrated health and community-based supports for families that face particular barriers at the intersection of domestic violence, homelessness, and health care.

A consortium of community partners and health care providers enables domestic violence programs, culturally specific organizations, and rural communities to support the safety and health needs of domestic violence survivors and increases health supports to mitigate the spread of COVID-19.

Partnership Resources:

•          CDC Community coalition-based COVID-19 Prevention and Response provides guidance on using a whole-community approach to prepare for COVID-19 among people experiencing homelessness, https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/unsheltered-homelessness.html#coalition.

•          The FVPSA-funded National Health Resource Center on Domestic Violence has developed two resources that can help states, territories, shelters, programs, and health care providers build and sustain strong partnerships.

•          A step-by-step online guide for community health centers on building partnerships with Domestic Violence (DV) and Sexual Assault (SA) advocacy, addressing violence in health centers, and promoting prevention: IPVHealthPartners.org.

•          An online toolkit for health care providers and DV advocates to prepare a clinical practice to address domestic and sexual violence, including screening instruments, sample scripts for providers, patient and provider educational resources: IPVHealth.org.

Partnering organizations may include entities such as:

•          Community-based organizations (including faith-based organizations and social service organizations),

•          Local chapters of national medical/health associations,

•          Local health departments,

•          IHS,

•          HRSA-funded health centers,

•          Health centers and other community-based health providers,

•          Culturally specific community-based organizations,

•          Philanthropic organizations,

•          Local municipal entities, such as fire departments and Emergency Medical Services,

•          Social service providers (e.g., food banks, community transportation, childcare),

•          Runaway and homeless youth programs, and

•          Community Action Coalitions, Chambers of Commerce, Health Equity Councils, and other community groups.

Partnering with Health Departments

Health departments can facilitate the development of important partnerships with health care providers and officials to increase COVID-19 health services coordination. The CDC has contact information on state and territorial health departments that can be accessed through the following website link, https://www.cdc.gov/publichealthgateway/healthdirectories/healthdepartments.html