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REQUEST TA

One way that SPHARC serves as a resource is by providing technical assistance (TA) to support states, particularly Title V Maternal and Child Health (MCH) programs, to learn how to implement or adapt a specific practice to improve systems of care for children and youth with ASD/DD in their state. TA can include intensive one-on-one support from SPHARC staff on a specific topic or skill, creating collaborative cross-state learning opportunities, planning and hosting webinars, and supporting in-person site visits or other trainings.

Mentorship/Site Visit Technical Assistance

*For current Health Resources & Services Administration’s (HRSA) Innovation in Care Integration for Children and Youth with ASD/DD grant recipients ONLY

General Technical Assistance

States and jurisdictions can request more general TA from SPHARC on topics related to ASD/DD. Requests will be reviewed on a rolling basis and SPHARC staff will do their best to fulfill these requests. Please note, completion of general TA requests are not guaranteed and will depend on SPHARC staff and funding availability.

What can you expect from SPHARC?

Coordination support to connect the entity to the program representative or other expert providing the technical assistance, as needed
Ongoing assistance from staff to guide the technical assistance process
Facilitated check in calls to plan/coordinate technical assistance and follow up
Information and resources about best practices

Approval Procedure
State grantees and states/jurisdictions requesting TA are required to complete and submit all sections of the form. AMCHP requests that forms be submitted by July 1, 2023. Requests can still be submitted after this date and will be considered only if there are remaining funds on a first come basis.

Please Note: You will receive notification of receipt of your form within 1-2 business days following submission. If you have not received notification in that time frame, contact the team at spharc@amchp.org.

Due to limited funding, requests will be considered on the following criteria:

Readiness/Impact
Extent to which grantee identifies how technical assistance is related to HRSA implementation needs or grant objectives and improving systems of care for children and youth with ASD/DD. (for mentorship/site visit TA only).
Extent to which entity identifies resources and infrastructure to receive technical assistance.
Extent to which entity addresses the added value of receipt of technical assistance.
Extent to which entity identifies and offers effective ways to overcome barriers to receiving the technical assistance.
Project Plan
Identifies a mentor and practice the grantee wishes to implement or improve. (for mentorship/site visit TA only).
Extent to which the grantee describes a feasible, flexible plan to receive mentorship and implement lessons learned from the technical assistance. (for mentorship/site visit TA only).
Extent to which entity includes an achievable timeline.
Budget
Extent to which the requested funding amount is reasonable, and the budget provides itemized costs and cost calculations.
Commitment
Entity commits to carrying out the activities outlined in their request.

State or jurisdiction(Required)

Name of person submitting request(Required)

Organization or agency(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number(Required)

Email address(Required)

Technical Assistance Overview

Goal: What is the main goal(s)/objective(s) of the TA you are requesting?(Required)

Need: What need or gap will the TA help fill?(Required)

Proposed Plan/Activity

Briefly outline your request/proposed plan for TA. Include who will be responsible for carrying out major roles and existing infrastructure to support this work. Please also address as applicable: 1) Topics/specific type of TA and/or mentorship you hope to receive (including format – site visit, meeting, other); 2) What you plan to do differently after receiving this TA; 3) How this TA will contribute to improving systems of care for children with ASD/DD and their families; and 4) General timeline.(Required)

Expected Benefits

Summarize the impact this technical assistance will have for your work and how it will lead to positive health outcomes for children/youth with ASD/DD. Include rationale for why you are requesting this particular mentorship/technical assistance.(Required)

Obstacles

Identify challenges you might experience in carrying out the work, and how these obstacles will be mitigated. If applicable, state how AMCHP could help you address those barriers.(Required)

Budget

List the overall amount requested, including itemized expenses and how costs were calculated.(Required)

Commitment

I affirm that I (and applicable key staff) am/are committed to providing any needed coordination/support to receive the technical assistance. I further affirm that I have secured any required approval to receive this technical assistance and move forward the outlined activities prior to submission of this form.(Required)

Yes

Electronic signature(Required)

Today's date(Required)

Comments

This field is for validation purposes and should be left unchanged.

For current Health Resources & Services Administration’s (HRSA) Innovation in Care Integration for Children and Youth with ASD/DD grant recipients ONLY

Current HRSA state autism grantees can request the mentorship/site visit technical assistance (TA). While only current grantees can request this TA, the technical assistance can be provided by a current or former grantee. Technical assistance must be completed by August 31, 2023, and a short evaluation submitted by September 15, 2023. AMCHP will provide the evaluation template, which will include a summary of technical assistance activities, and results/action steps.

State or jurisdiction(Required)

Name of person submitting request(Required)

Organization or agency(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number(Required)

Email address(Required)

Technical Assistance/Mentorship Overview

Goal: What is the main goal(s)/objective(s) of the practice/project the TA will support?(Required)

Desired mentor/TA provider: What is the name of the state, organization, or individual you seek TA from?(Required)

Proposed Plan/Activity

Briefly outline your proposed plan for the technical assistance visit and how it fits into the overall plan/timeline to implement the practice. Include who will be responsible for carrying out major roles and existing infrastructure to support this work. Please also address: 1) Topics/specific type of TA and/or mentorship you hope to receive (including format – site visit, meeting, other); 2) What you plan to implement in your state overall; 3) How this TA specifically links to the goals/objectives or needs identified in your HRSA grant; and 4) General timeline.(Required)

Expected Benefits

Summarize the impact this technical assistance will have for your work, including how it will help you to better meet grant objectives and lead to positive health outcomes for children/youth with ASD/DD. Include rationale for why you are requesting this particular mentorship/technical assistance.(Required)

Obstacles

Identify challenges you might experience in carrying out the work, and how these obstacles will be mitigated. If applicable, state how AMCHP could help you address those barriers.(Required)

Budget

List the overall amount requested, including itemized expenses and how costs were calculated.(Required)

Commitment

By submitting this request form, I affirm that I (and applicable key staff) am/are committed to providing any needed coordination/support to receive the technical assistance. I further affirm that I have secured any required approval to receive this technical assistance and move forward the outlined activities prior to submission of this form.(Required)

Yes

Electronic signature(Required)

Today's date(Required)

Phone

This field is for validation purposes and should be left unchanged.