NOFO: ANCHOR

C.1. Background 

In 2013, 1,072 people in Illinois died of an opioid overdose; by 2023, this number had more than doubled to 2,855. The state’s non-Hispanic Black population has the highest overdose fatality rate (69.3 percent), followed by non-Hispanic White population (17.7 percent). [1] To hold companies responsible for their roles in the opioid crisis, the Illinois Attorney General has engaged in multiple investigations, lawsuits, and settlements with opioid manufacturers, distributors, and chain pharmacies. The funds from the settlements will support recovery in communities hardest hit by the opioid crisis and throughout the State. 

The Illinois Office of Opioid Settlement Administration (OOSA) is the entity responsible for planning, administering, and managing fifty-five percent (55%) of the funds received from opioid settlements according to the Illinois Opioid Allocation Agreement and Executive Order 2022-19. The established processes ensure transparency and consideration of regional needs such as overdose rates, disparities created for specific populations, and resources to address opioid-related harms. OOSA is housed within the Department of Human Services Division of Behavioral Health and Recovery (IDHS/DBHR)  

About IDHS/DBHR 

The mission of IDHS/DBHR is to advance health and wellness for all people of Illinois through a comprehensive system of prevention, treatment, harm reduction, and recovery services. DBHR is responsible for ensuring that children, adolescents, and adults throughout Illinois have access to comprehensive substance use and mental health services. DBHR operates a statewide system that supports prevention, intervention, treatment, harm reduction, and recovery services for individuals, families, and communities through a combination of State and Federal funding. The system includes community-based mental health and substance use services delivered through partners and inpatient mental health services through twenty-seven (27) community hospitals with psychiatric units and seven (7) state-operated hospitals. DBHR is also responsible for regulating all substance use intervention and treatment providers in the State of Illinois to ensure safety and quality of care. 

DBHR focuses on improving outcomes, expanding access to care, reducing stigma, and providing coordinated care for people with behavioral health needs. It aims to create a more connected, responsive, and effective system of care through partnership with communities and providers.  

Funding Source 

The Office of the Illinois Attorney General has certified—and the Governor’s Opioid Overdose Prevention and Recovery Steering Committee has approved—the use of up to an estimated $3,000,000 over three (3) years from the Illinois Opioid Remediation State Trust Fund (Fund) for establishing ANCHOR in accordance with the Illinois Opioid Allocation Agreement and the Fund allocation process.  

In April 2023, IDHS/DBHR awarded Advocates for Human Potential, Inc. (AHP) a grant to serve as the RCCA. The RCCA administers subawards with organizations providing prevention, intervention, treatment, and harm reduction services for people with substance use disorders in accordance with State-approved strategies and the scope of services provided by IDHS.   

C.2. Need 

Up to five (5) organizations will be awarded funding to establish ANCHOR programs to reduce adolescent deaths from synthetic opioids by achieving the following objectives:

• Increase engagement of adolescents, particularly those who may be less motivated to seek help, and their families or caregivers, in the system of care.
• Increase access to evidence-based and innovative resources and programs, including harm reduction, treatment, and recovery supports, tailored for adolescents and their families.
• Reduce barriers to retention for adolescents and their families in the system of care.

To accomplish these objectives, ANCHOR subrecipients shall establish programs specifically tailored for the priority population, as defined in Section C.2., that can include the following:

• Comprehensive interventions including screening and/or crisis response, adolescent treatment services, and outreach and engagement initiatives
• Innovative approaches such as online recovery groups, recovery high schools, recovery groups for adolescents, and evidence-based family support interventions
• Telehealth services and training and technical assistance (TTA) to providers to support online activities
• Harm reduction education and programs for adolescents and their families as well as other people who interact with adolescents.

The tasks required and associated performance measures, standards, and potential metrics to be collected are as follows:

Task 1. Administer ANCHOR Program

Subrecipients shall fulfill obligations detailed in Section H.10. Reporting and Grants Administration Requirements, including the following:

• Attend an annual virtual kickoff meeting
• Complete an organizational needs assessment(ONA) survey
• Develop and update an implementation and sustainability plan (ISP), which informs the performance metrics used for program activities
• Develop and implement an equity and racial justice (ERJ) plan
• Complete quarterly periodic performance reports (PPRs)
• Complete monthly periodic financial reports (PFRs)
• Participate in TTA as prescribed
• Participate in project status meetings (PSMs) every other month
• Conduct data collection activities and complete monthly evaluation reporting (MER) and quarterly evaluation reporting (QER)
• Allocate or hire sufficient administrative and service staff

Anticipated performance measures for these activities are detailed in Section C.4. Deliverables and Performance Measures.

Task 2. Plan ANCHOR Program

A subrecipient seeking to establish ANCHOR shall provide the following deliverables:

Task 2.a. Assess Current Needs and Services

The subrecipient shall assess the needs of adolescents and their families/caregivers within and around the targeted community. The assessment shall evaluate health disparities and the related social and economic inequities that impact access to and need for services, as well as availability of the following:

• Intervention, screening, and treatment services specifically designed for adolescents and their families/caregivers at accessible clinical sites.
• Programs that engage adolescents and their families/caregivers in treatment.
• Online recovery groups, recovery high schools, and recovery groups for adolescents.
• Harm reduction education and programs for adolescents and their families/caregivers, educators, and other people who interact with adolescents.
• Evidence-based family support interventions.
• Training for providers to engage and support adolescents and their families/caregivers in telehealth and other online services.

Task 2.a. Performance Measure

The subrecipient shall submit, within sixty (60) days from the beginning of the period of performance, a comprehensive needs assessment report in the communities where ANCHOR services will be provided.

Task 2.b. ANCHOR

The subrecipient shall, based on the results of the comprehensive needs assessment, plan program activities and services to address identified gaps. ANCHOR services shall incorporate evidence-based or promising practices to support the provision of accessible services in at least one of the following categories. Each category includes examples of potential program activities.

Screening and/or Crisis Response

• Screening services designed specifically for adolescents and their families/caregivers
• A dedicated, adolescent-focused, 24/7 helpline or text-based support service
• Naloxone distribution and training for adolescents, families/caregivers, and community members

Treatment

• Adolescent-appropriate, in-person treatment that meets the standard of care for OUD and PUD including opioids
• Telehealth counseling
• Education, outreach, and other support to reduce barriers to care
• Teaching adolescents and families/caregivers about the need for and benefits of treatment
• Promoting availability of treatment sites
• Facilitating meeting appointments (e.g., transportation assistance)
• Alleviating concerns about confidentiality and stigma surrounding OUD and treatment
• Education, outreach, and other support to reduce barriers to care
  • Teaching adolescents and families/caregivers about the need for and benefits of treatment
  • Promoting availability of treatment sites
  • Facilitating meeting appointments (e.g., transportation assistance)
  • Alleviating concerns about confidentiality and stigma surrounding OUD and treatment

Youth Recovery Supports

• Online or in-person recovery groups, recovery high schools, and other innovative approaches to serving and supporting adolescents
• A Youth Advisory Council of adolescents with lived experience or interest in substance use prevention and recovery services to provide input on service design, outreach strategies, and quality improvement, as well as review and advise on ANCHOR activities
• Coordinated wraparound services (e.g., access to transitional/supportive housing for unstably housed youth and food security) to address social determinants of health affecting youth and families/caregivers impacted by OUD and PUD including opioids
• Harm reduction education for adolescents, including guidance on the following:
  • Opioid overdose reversal medications and their use
  • Sterile supplies for reducing transmission of infectious disease (e.g., HIV, viral hepatitis, bacterial and fungal infections)
  • Accessible health care, social services, and treatment services

Family/Caregiver Support

• Innovative and evidence-based family support interventions
• Harm reduction education for families and caregivers, guidance shall include information on the following:
  • The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Harm Reduction Framework
  • Opioid overdose reversal medications and their use
  • Sterile supplies for reducing transmission of infectious disease (e.g., HIV, viral hepatitis, bacterial and fungal infections)
  • Available health care, social services, and treatment
• Peer-led parent/caregiver support groups
• Educational workshops for families/caregivers to reduce stigma and increase supportive parenting strategies

Workforce Development

• TTA opportunities for providers, clinicians, social workers, and support staff, which shall include the following topics:
  • Screening, intervention, treatment, medication-assisted recovery, harm reduction, and other services
  • Engaging adolescents and their families/caregivers
• Development of a simulation-based educational intervention to increase knowledge of adolescent care among addiction medicine, pediatric, and other relevant providers
• Harm reduction education for educators and other people who interact with adolescents that aligns with and includes the following topics:
  • Opioid overdose reversal medications and their use
  • Sterile supplies for reducing transmission of infectious disease (e.g., HIV, viral hepatitis, bacterial and fungal infections)
  • Available health care, social services, and treatment

The subrecipient shall provide support for their proposed use of evidence-based, promising, and innovative practices for each of the above services categories. The subrecipient shall detail its commitment and plan to meaningfully engage adolescents who are most impacted by OUD and PUD including opioids, particularly those who may be reluctant to seek help, and retain them in ANCHOR services.

Services requiring licensure by IDHS shall adhere to standards established by 77 Ill. Admin. Code Sec. 2060. Services shall be culturally and linguistically appropriate for the individuals, families, and community served.

Task 2.b. Performance Measure

The subrecipient shall submit, within ninety (90) days from the beginning of the period of performance, an ANCHOR Implementation Plan. The subrecipient shall include literature and/or treatment models that support service modalities, what and to whom services and training will be provided, when services and training will be launched, and how youth and families/caregivers will be engaged in services.

Task 2.c. Establish Partnerships/Collaborative Agreements

The subrecipient shall establish partnerships and/or collaborative agreements (e.g., memorandum of understanding [MOU]) with organizations serving adolescents and their families/caregivers, such as schools, public libraries, healthcare providers, child welfare agencies and the foster care system, residential centers for youth, and law enforcement.

Task 2.c. Performance Measure

The subrecipient shall submit evidence of signed MOUs with partner agencies within ninety (90) days of the commencement of the period of performance.

Task 2.d. Develop Data Collection Plan

Subrecipients shall prepare for the collection of evaluation data needed for process and outcomes reporting. This shall include, but not be limited to, data on program implementation; aggregate data on individuals, families, or caregivers served; outreach and engagement activities provided; service provision details; patient satisfaction; patient outcomes; and TTA outcomes. Additionally, the subrecipient shall work with an external evaluator to identify additional outcome indicators for the subrecipient scope of services, to be included in their data collection plan (DCP).

The DCP shall specify how the subrecipient will collect data on the reach of their services, such that it aligns with their priority populations defined in the needs assessment.

Task 2.d. Performance Measure

The subrecipient shall submit a DCP within 120 days of the commencement of the period of performance.

Task 2.e. Develop Quality Assurance and Quality Control Plans

Subrecipients shall maintain current Quality Assurance and Quality Control Plans that include, among other things, annual reviews of program policies and procedures, ongoing assessment of outcomes, and implementation of process improvement plans.

Task 2.e. Performance Measure

The subrecipient shall submit Quality Assurance and Quality Control Plans within 120 days of the commencement of the period of performance.

Task 3. Implement ANCHOR Program

The subrecipient shall acquire appropriate resources to establish and deliver program services as defined in the submitted ANCHOR Implementation Plan, within the specified timeframe, and in accordance with all Federal and State licensing, privacy, security, and confidentiality laws, rules, or regulations. The subrecipient shall participate in monitoring and evaluation of services.

Task 3.a. Establish Services and Activities

The subrecipient shall offer and coordinate ANCHOR program services and activities for adolescents, their families/caregivers, and providers in accordance with the ANCHOR Implementation Plan.

When establishing services and activities, the subrecipient shall do the following:

• Consider the whole person, identifying and addressing co-occurring substance use and mental disorders, such as mood, anxiety, and eating disorders
• Consider positive and negative familial/caregiver dynamics
• Promote a safe, trauma-informed, and caring environment
• Recognize cultural expectations to help improve engagement and retention

Task 3.a. Performance Measures

The subrecipient shall establish ANCHOR services provided to adolescents and their families/caregivers within 180 days of the commencement of the period of performance.

Task 3.b. Engage and Retain Adolescents and Their Families/Caregivers

The subrecipient shall engage adolescents and their families/caregivers in the system of care through outreach activities . In proposing outreach activities, the subrecipient shall prioritize adolescents who may be less motivated to seek help.

Task 3.b. Performance Measure

The subrecipient shall report the number and type of outreach and engagement activities, the number of adolescents and families/caregivers initiating services or who are referred to ANCHOR partners, and the duration of adolescent and family/caregiver participation in ANCHOR services.

Task 4. Monitor ANCHOR Program

The subrecipient shall monitor ANCHOR program implementation throughout the period of performance. The subrecipient shall collect data and conduct quality assurance and control activities in accordance with the DCP, quality assurance plan (QAP), and quality control plan (QCP).

Task 4.a. Performance Measure

The subrecipient shall collect data and conduct quality control activities in accordance with the data collection and quality control plans and report progress on the PPR.

C.4. Deliverables and Performance Measures 

The following tables detail (a) the deliverables required according to the scope of services and (b) associated performance measures, standards, and potential metrics to be collected by task. Time periods refer to the days from the beginning of the period of performance, unless otherwise specified. Standards for activities refer to percentages of those activities described in the ISP. 

Task 1. Administer ANCHOR Program 

See Section H.10. Reporting and Grants Administration Requirements for detailed descriptions of Task 1 activities. 

Task 2. Plan Anchor Program 

Task 3. Implement ANCHOR Program 

Task 4. Monitor ANCHOR Program 

C.5. Funding Details 

The following sections discuss allowable and unallowable costs for this funding opportunity. Please refer to 2 CFR § 200 – “Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards,” Part 200 Subpart E – Cost Principles to determine the appropriateness of costs. 

Allowable Costs 

Allowable costs are those that are necessary and reasonable based on the activity contained in the statement of work (SOW), are justified in the Budget Narrative, and are allowable under 2 CFR §§ 200.400-476. It is expected that administrative costs, both direct and indirect, will represent a small portion of the overall program budget. Any budget deemed to include inappropriate or excessive administrative costs will not be approved. Program budgets and narratives must detail how all proposed expenditures are necessary for program implementation. 

Unallowable Costs 

Refer to 2 CFR § 200 –Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Part 200 Subpart E – Cost Principles to determine the appropriateness of costs. In addition, and specific to this grant, the following costs will be unallowable without specific prior written approval: 

• Entertainment costs, except where specific costs that might otherwise be considered entertainment have a programmatic purpose and are authorized in the approved budget (2 CFR § 200.438) 

• Capital expenditures for general purpose equipment, including any vehicle regardless of cost, buildings, and land (2 CFR §  200.439) 

• Capital expenditures for improvements to land, buildings, or equipment that materially increase their value or useful life (2 CFR §  200.439) 

• Food and other goods or services for personal use of the grantee’s employees, contractors, or consultants unless authorized as per diem under the Illinois Governor’s Travel Control Board (2 CFR § 200.445) 

• Deposits for items, services, or space 

• Dues to societies, organizations, or federations 

• Meetings or conventions, unless directly related to the program and approved in advance by the RCCA 

• Alcoholic beverages 

• Cash payments to intended recipients of services 

• Purchase or repair of vehicles 

• Lobbying, political contributions, or compensation of a government body 

• Fundraising 

• Bad debt, fines, or penalties 

• Personal-use items, including expenses related to personal use of vehicles 

• Unallowable relocation expenses 

• Related-party transactions 

• Any other costs not approved in the plan and budget 

Indirect Cost Rate 

To charge indirect costs to this grant, the applicant organization must: (1) have a federal annually negotiated indirect cost rate agreement (NICRA), or (2) elect to use the de minimis rate and specify what percentage (up to fifteen percent [15%] of modified total direct costs) the applicant chooses. See 2 CFR § 200.414. 

Indirect Cost Rate Election 

• Federally Negotiated Rate: Organizations that receive direct federal funding may have an indirect cost rate that was negotiated with a federal cognizant agency. The organization must provide a copy of the federal NICRA. Organizations must notify the RCCA of any changes to their previously established NICRA no later than six (6) months after the close of the organization’s fiscal year. 

• De minimis Rate: An organization may elect a de minimis rate of up to fifteen percent (15%)  of modified total direct cost (MTDC).** Once established, the de minimis rate may be used indefinitely. If programs elect to use the de minimis rate, it is critical that program budgets accurately calculate the MTDC base. 

Please see regulation 2 CFR § 200.1 below and note the exclusions to MTDC. 

**2 CFR § 200.1, Modified Total Direct Costs, means “all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and up to the first $50,000 of each subaward (regardless of the period of performance of the subawards under the award). MTDC excludes equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs, and the portion of each subaward in excess of $50,000. Other items may only be excluded when necessary to avoid a serious inequity in the distribution of indirect costs and with the approval of the cognizant agency for indirect costs.” 

“No Rate”  

Subrecipients have discretion not to request payment for indirect costs. Subrecipients that elect not to claim indirect costs cannot be reimbursed for indirect costs. The organization must record an election of “No Indirect Costs” in the Budget Workbook linked in Section J. Mandatory Forms 

C.6. Authorizing Statutes and Regulations 

Subrecipients are required to adhere to the requirements outlined in the following: 

• Grant Accountability and Transparency Act (GATA), 30 ILCS 708  

• Illinois Administrative Code, Government Contracts, Title 44, Part 7000  

• Grantmaking, Procurement, and Property Management, and federal regulations under Grants and Agreements, 2 CFR § 200, et al. 

• The requirements and policies outlined in the IDHS Division of Substance Use Prevention and Recovery Contractual Policy Manual  

• Any other federal or state statutes, regulations, or policies specified in the subaward agreement or its attachments.