NOFO: SAFE

C.1. Background

In 2013, 1,072 people in Illinois died of an opioid overdose.[1] In 2020, the number of fatal overdoses reached 2,000, and in 2022, surpassed 3,000.[2] The opioid overdose epidemic has accelerated nationwide.[3] 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 IDHS’ Substance Use, Prevention and Recovery (SUPR) division.

About IDHS/SUPR

The mission of IDHS/SUPR is to provide a recovery-oriented system of care along the continuum of prevention, intervention, treatment, and recovery support where individuals with substance use disorder (SUD), those in recovery, and those at risk are valued and treated with dignity and where stigma, accompanying attitudes, discrimination, and other barriers to recovery are eliminated. IDHS/SUPR is working to counteract systemic racism and inequity and to prioritize and maximize diversity throughout its service provision process. This work addresses existing institutionalized inequities, aims to create transformation, and operationalizes equity and racial and social justice. It also focuses on creating a culture of inclusivity for all, regardless of race, gender, religion, sexual orientation, or ability.

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 $14.24 million from the Illinois Opioid Remediation State Trust Fund (Fund) for harm reduction services, such as SAFE, for priority populations in accordance with the Illinois Opioid Allocation Agreement and the Fund allocation process. In April 2023, IDHS/SUPR 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 SUD in accordance with state-approved strategies and the scope of services provided by IDHS.

C.2. Need

The funds from the settlements will support prevention efforts in communities hardest hit by the opioid crisis and throughout the state. Fund distributions must be used equitably in service areas disproportionately affected by the opioid crisis as outlined in the Illinois Opioid Allocation Agreement, such as areas with the following characteristics:

• High opioid fatality rates, including
  • Counties other than Cook County with a crude rate of 1.8 or greater per 100,000 people and
  • Zip codes within Cook County with more than 100 overdoses (fatal and nonfatal) within the most recent year included in the Illinois Opioid Data Dashboard, http://idph.illinois.gov/opioiddatadashboard/
• Concentrated poverty, including
  • Counties other than Cook County with a poverty rate greater than twelve (12) percent and
  • Zip codes within Cook County with a poverty rate greater than twelve (12) percent, per the U.S. Census Bureau, https://www.census.gov/quickfacts/fact/map/IL/
• Concentrated firearm violence, including communities eligible for Reimagine Public Safety Act funding, https://www.dhs.state.il.us/page.aspx?item=144282
• Other conditions that hinder the communities from reaching their full potential for health and well-being, including counties other than Cook County with a crude nonfatal overdose rate of 4.0 or greater per 100,000 people, as listed in the Illinois Opioid Data Dashboard, http://idph.illinois.gov/opioiddatadashboard/

 

Harm reduction is one of five categories that form the basis of the State of Illinois Overdose Action Plan, underscoring the value of syringe services programs (SSPs), naloxone distribution and training, onsite access to basic wound care, and other harm reduction strategies.

• Integrating harm reduction into a wide variety of settings maximizes opportunities for connecting to individuals who are in need of services but too often lack access or opportunity. For example, Overdose Education and Naloxone Distribution (OEND) programs registered with the IDHS/SUPR Drug Overdose Prevention Program may order free Narcan (a form of naloxone) to distribute within their communities. The availability of naloxone at all Chicago Public Libraries is another example of Illinois’ commitment to reaching out to people in need of services.

 

Among other benefits, SAMHSA notes that harm reduction services can address the adverse consequences of substance use through the following:

• Reducing overdose deaths by increasing access to opioid overdose reversal medications and education
• Reducing transmission of infectious disease (e.g., HIV, viral hepatitis, bacterial and fungal infections) by providing sterile supplies and referrals to resources
• Increasing access to health care, social services, and treatment.
• Reducing stigma associated with substance use and co-occurring disorders
• Promoting hope and healing through active involvement of people with lived and living experience (PWLE) [4]

 

C.3. Funding Purpose and Scope of Services

A minimum of 14 organizations, at least one (1) in each of seven (7) health regions, will be awarded SAFE funding to reduce the adverse health, social, and economic consequences of substance use for persons in active use of substances within their community. To meet this goal, SAFE subrecipients shall accomplish the following objectives:

• Enhance and/or expand overdose prevention and harm reduction activities for persons in active use of substances.
• Engage persons who are in active use of substances in overdose prevention and harm reduction activities.
• Support distribution of opioid overdose reversal medication, safer drug use supplies, and harm/risk reduction information to individuals at risk of overdose.
• Facilitate overdose education and health education among community members generally and among persons in active use of substances specifically.
• Support individuals with referrals to services requested.
• Encourage individuals to take steps to reduce the negative personal and public health impacts of substance use.

 

To accomplish these objectives, SAFE subrecipients must provide harm reduction services (as defined for CHRPs in the Harm Reduction Framework) that are led and staffed by individuals representing and reflecting the community for individuals in active substance use within the community.

CHRP Criteria

CHRPs must meet the following criteria:

1. PWLE from the community must lead the planning and oversight, program development and evaluation, and resource/funding allocation for harm reduction initiatives, programs, and services. Additionally, if the organization participates in any research projects, PWLE must be co-investigators as part of the project.
2. Harm reduction services must reflect the needs of individuals in active use of substances, particularly opioids and stimulants, within the community. No person shall be denied service because of ongoing substance use. Not all core practices defined in Harm Reduction Framework are required, but those that align with the needs of the population should be provided.

 

Note: Harm reduction services may be integrated into a comprehensive, patient-centered continuum of care that meets the needs of the community served. However, the services must meet criteria 1 and 2.

Program activities should include one or both of the following:

• Focus on densely populated areas with high rates of opioid use, overdose, or overdose fatality.
• Address the unique challenges of rural communities, including geographic isolation, lack of healthcare resources, and limited transportation options, particularly for marginalized groups (e.g., individuals experiencing homelessness, indigenous communities, veterans).

 

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

Task 1. Fulfill Award Administration Requirements

SAFE subrecipients must fulfill obligations outlined in H.10. Reporting and Grants Administration Requirements, including:

a) Organizational needs assessment (ONA) survey.

b) Implementation and sustainability plan (ISP) development.

c) Equity and racial justice (ERJ) plan development.

d) Periodic performance reporting (PPR).

e) Program fiscal reporting (PFR).

f) Training and technical assistance (TTA) participation.

g) Organizational trauma-informed policies and procedures (TIPP) development.

 

Anticipated performance measures for these activities are detailed in Section C.4.

Task 2. Staff Program

SAFE subrecipients must establish and maintain program leadership and staffing to carry out program design, implementation, and data collection to meet grant program and reporting requirements. If new staff will be hired, interim staff must be available at the beginning of the period of performance.

Program staffing should align with CHRP recommendations requiring PWLE to do the following:

• Lead planning and oversight
• Be employed in direct service positions
• Serve in a membership role on the board of directors
• Actively contribute to program development and resource/funding allocation for harm reduction initiatives, programs, and services
• Be involved as co-investigators in any research projects related to SAFE

 

Please note: Program leadership must be supported by administrative, finance, and legal staff to ensure program operations comply with legislative and administrative requirements pursuant to the subaward agreement. It is expected that the level of effort required to provide this support to the program team is a minimum of one (1) FTE. This FTE may include more than one individual. For example, one individual may manage report submissions and one individual may handle invoices. In addition to the planned program staff, these resource allocations should be reflected in the budget personnel.

The following deliverables are required:

Task 2.a. Submit Organizational Chart and Staff List

SAFE subrecipients must submit a program organizational chart and list of names and email addresses of staff assigned to work on the program in any capacity (or designated to-be-hired), their roles, and matrixed supports.

Task 2.a.i. Performance Measure

Submit the organizational chart and staff list within fifteen (15) days from the beginning of the period of performance.

Task 2.b. Hire Staff

SAFE subrecipients must adequately staff program as described in the organizational chart.

Task 2.b.i. Performance Measure

Fully staff program within ninety (90) days from the beginning of the period of performance.

Task 3. Establish Community Partnerships

SAFE subrecipients must partner with organizations and establish processes, protocols, and mechanisms for warm hand-off referrals to appropriate treatment and recovery support services when requested and negotiated with the individual to meet their needs (e.g., HIV or viral hepatitis medical care, substance use treatment, mental health counseling or treatment). The following deliverable is required:

Task 3.a. Referrals and Linkages Plan

SAFE subrecipients must submit a Referrals and Linkages Plan (RLP) that includes the following:

• A list of referrals and linkages to entities/individuals providing trauma-informed and culturally relevant services that meet the needs of persons in active use of substances.
• Specific, written collaborative agreements (e.g., memorandums of understanding MOUs) between agencies so that gaps in services can be addressed.
• Written program/participant eligibility criteria that are shared with collaborative organizations to ensure appropriate referrals and linkages.
• Description of an individual needs assessment used to determine appropriateness for referral and linkages to internal services and appropriate referrals to collaborative agencies.
• Written up-to-date contact information for collaborative organizations (i.e., current staff names and telephone numbers).
• A system for tracking individuals referred to and then linked to internal and collaborative agencies.

Task 3.a.i. Performance Measures

Submit the RLP within ninety (90) days from the beginning of the period of performance.

Task 4: Develop Data Collection Plan

SAFE subrecipients must prepare for the collection of data needed for grantee reporting. Data on how the needs of the population served are being met will be incorporated into the subrecipient’s external evaluation. The following deliverable is required:

Task 4.a. Data Collection Plan (DCP)

SAFE subrecipients must submit a DCP to guide and prepare for the collection of data needed for reporting. The DCP must detail systems for collecting data, including data on targeted outreach activities, referral data, and a mechanism for determining the number of individuals that access essential follow-up services.

Task 4.a.i. Performance Measures

Submit the DCP within sixty (60) days from the beginning of the period of performance.

Task 5:  Define Outreach Approach

SAFE subrecipients must demonstrate their commitment and capacity to meaningfully engage and include individuals who are historically/currently disproportionately impacted by criminalization and marginalization due to drug use, as well as other priority populations, such as individuals engaged in sex work; individuals experiencing homelessness; and individuals with reproductive, maternal, and child health needs. The following deliverable is required:

Task 5.a. Outreach Plan

SAFE subrecipients must develop an Outreach Plan for targeted public outreach and education on the following:

• Overdose risk prevention
• Treatment and recovery support services
• Reproductive health education
• Safer drug use services and supplies
• Sexually transmitted infections, such as HIV and viral hepatitis.
• Safe disposal of syringes
• Fentanyl, tranquilizers, and other drug trends associated with overdoses.
• Use of test strips for fentanyl and other drugs

Task 5.a.i. Performance Measures

Submit the Outreach Plan within ninety (90) days from the beginning of the period of performance.

Task 6: Promote Safer Practices

SAFE subrecipients must promote safer practices by describing how to reduce risk and providing risk reduction supplies and materials. The following deliverable is required:

Task 6.a. Provide Education and Support for Safer Practices

In response to the needs of the population served, SAFE subrecipients may do the following:

• Distribute sterile syringes through an SSP, which also includes collecting used syringes; offering drug-checking services, including distribution of test strips for fentanyl and other drugs; and providing safe disposal options. The SSP must operate on a needs-based distribution model.
• Directly distribute naloxone and conduct training and educational campaigns.
• Provide onsite access or immediate referral to basic wound care supplies and services in the community.
• Provide integrated reproductive health education, services, and supplies, as well as sexually transmitted infection screening, prevention, and treatment.

Task 6.a. Performance Measures

i. Initiate safer practice activities within one hundred twenty (120) days from the beginning of the period of performance.

ii. Support a minimum of eighty percent (80%) of safer practice activities based upon the ISP.

iii. Collect data and report on safer practice activities. The data should be summarized and reported as part of the monthly and quarterly PPR and external data collection activities.

Task 7. Facilitate Access to Safer Services and Supports

In addition to providing safer practice services listed in Task 6, SAFE subrecipients must carry out one or more of the following deliverables to facilitate access to safer settings, safer access to healthcare, and/or safer transitions to care.

Applicants should clearly identify which tasks they are proposing in their application narrative and in their budget personnel allocations. Applicants may propose Task 7.a., Task 7.b., Task 7.c., or any combination.

Task 7.a. Safer Settings

SAFE subrecipients who propose Task 7.a. must facilitate access to safe environments to find respite, learn about safer use practices, and receive supports that are trauma-informed and stigma-free.

This is expected to include:

• Social spaces that offer harm reduction services, are low barrier, and are led and maintained by the communities they serve.
• Hybrid recovery communities providing peer-delivered harm reduction and recovery support services.

Task 7.a. Performance Measures

i. Initiate safer setting activities within one hundred fifty (150) days from the beginning of the period of performance.

ii. Support a minimum of eighty percent (80%) of safer setting activities based upon the ISP.

iii. Collect data and report on safer setting activities. The data should be summarized and reported on as part of the monthly and quarterly PPR and external data collection activities.

Task 7.b. Safer Access to Healthcare

SAFE subrecipients who propose Task 7.b. must facilitate access to person-centered and non-stigmatizing healthcare that is trauma-informed, including access to U.S. Food and Drug Administration-approved medications to treat SUD. This is expected to include:

• Healthcare settings and providers directly informed by harm reduction principles, pillars, and the people they serve.
• Onsite or quick referral, low-barrier health services informed by lived experience with substance use.

Task 7.b. Performance Measures

i. Initiate safer access to healthcare activities within one hundred fifty (150) days from the beginning of the period of performance.

ii. Support a minimum of eighty percent (80%) of safer practice activities based on the ISP.

iii. Collect data and report on safer practice activities. The data should be summarized and reported on as part of the monthly and quarterly PPR and external data collection activities.

Task 7.c. Safer Transitions to Care

SAFE subrecipients who propose Task 7.c. must provide connections and access to harm reduction-informed and trauma-informed care and services, as requested. Examples include:

• Referral and linkage to HIV, viral hepatitis, sexually transmitted disease, and tuberculosis prevention; hepatitis A virus and hepatitis B virus vaccination, treatment, and care services (including antiretroviral therapy for hepatitis C virus); pre-exposure and post-exposure prophylaxis for HIV; and prevention of mother-to-child transmission.
• Referral/linkage to and provision of evidence-based SUD treatment, including medication assisted recovery, such as use of methadone, buprenorphine, or naltrexone to treat opioid use disorder (OUD).
• Referral to medical care, mental health services, and other support services.
• Onsite or immediate referral to accessible nutritional assistance, clothing, temporary shelter, and housing.

Task 7.c. Performance Measures

i. Initiate safer transition to care activities within one hundred fifty (150) days from the beginning of the period of performance.

ii. Support a minimum of eighty percent (80%) of safer transition to care activities based upon the ISP.

iii. Collect data and report on safer transition to care activities. The data should be summarized and reported on as part of the monthly and quarterly PPR and external data collection activities.

C.4. Deliverables and Performance Measures

The following table details (a) the deliverables required according to the scope of services and (b) associated performance measures, standards, and potential metrics (subject to change) 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 described in the Implementation and Sustainability Plan (ISP).

Deliverables		Performance Measures	Standards	Metrics
T1	Fulfill award administration requirements	(a) Complete ONA survey	100%	ONA survey completed (30 days after distribution)
		(b) Complete ISP	100%	ISP submitted (45 days)
		(c) Develop ERJ Plan	100%	ERJ organizational assessment completed (90 days) ERJ Plan drafted (120 days) ERJ Plan finalized (180 days)
		(d) Complete PPR	100%	Activities and services metrics reported (15th of each month, 15th following each quarter unless otherwise prescribed)
		(e) Complete PFR	100%	Fiscal performance reported (15th of each month; monthly and quarterly reports)
		(f) Participate in TTA	75%	# Bimonthly cohort meetings (initiated within 30 days) # Bimonthly individual  meetings (initiated within 30 days) # TTA sessions attended (quarterly or as prescribed)
		(g) Develop TIPP	100%	TIPP developed (180 days)
T2	Staff Program	(a) Submit organizational chart and staff list	100%	Organizational chart and staff list submitted (15 days)
		(b) Hire staff	Fully staffed	# FTE hired (90 days)
T3	Establish Community Partnerships	(a) Develop RLP	100%	RLP submitted (90 days)
T4	Develop Data Collection Plan	(a) Develop DCP	100%	DCP submitted (60 days)
T5	Define Outreach Approach	(a) Develop Outreach Plan	100%	Outreach Plan submitted (90 days)
T6	Promote Safer Practices	(a) Provide education and support on safer practices	80%	Services initiated (120 days) Services delivered (80%) Services reported: # service sites (by location/type) # service encounters (by demographics) # educational materials distributed (by type) # participants engaged (by service) #/type of safer substance use supplies distributed # participants trained in overdose prevention and response # naloxone kits distributed (by recipient type) # drug checking services provided to participants
T7	Facilitate Access to Safer Services and Support (Applicants may propose Task 7.a., Task 7.b., Task 7.c., or any combination)	a)      Safer settings	80%	Services initiated (150 days) Services delivered (80%) Services reported: # low-barrier social spaces offering harm reduction services # participants and peers in hybrid recovery community
		b) Safer access to healthcare	80%	Services initiated (150 days) Services delivered (80%) Services reported: # collaborations with healthcare settings # providers trained on harm reduction principles and pillars # onsite (or quick referral to) low-barrier health services informed by lived experience with substance use
		(c) Safer transitions to care	80%	Services initiated (150 days) Services delivered (80%) Services reported: # participants referred and linked to treatment/housing # participants receiving onsite or referrals (by type)

 

 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, et. al. and “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 (15) percent 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 Rate” in the budget workbook and in the application.

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 Illinois Department of Human Services 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.