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Reducing the Burden of Injury: Advancing Prevention and Treatment
Before the widespread use of cooperative agreements in the mid-1990s, NCIPC awarded other types of grants to states that gave them more latitude in program development and implementation. There previously had been three general types of grants: capacity-building grants, 15 surveillance grants, and incentive grants for intervention projects (Hersey et al., 1995). In 1994, however, NCIPC made a policy decision to exercise greater participation in the building of state and local injury programs. Instead of awarding capacity building grants, NCIPC began to utilize the more focused cooperative agreements on the grounds that the agency's limited funds should be used to provide more guidance to states for introducing into practice, and monitoring the impact of, proven interventions like smoke detectors and bicycle helmets. During the same period, Congress began to earmark a large percentage of NCIPC's budget for program development and related activities at the state and community level. The overall impact of these changes was that NCIPC increasingly came to rely on cooperative agreements to carry out areas of emphasis defined by Congressionally earmarked appropriations.
Review and evaluation of cooperative agreements occur before and during the project. An RFP in the Federal Register announces the availability of funds. Each announcement culminates a mostly internal planning process to formulate and refine research priorities. Submitted proposals are reviewed by NCIPC according to published review criteria through ad hoc review panels.16 A new external review procedure, analogous to a time-limited NIH study section, has been introduced in lieu of the ad hoc review panel when there is insufficient internal expertise to review proposals (U.S. DHHS, 1994). Once an award is made, projects are subjected to annual reviews by NCIPC to ensure that milestones are being met. An evaluation component is routinely incorporated into the cooperative agreement once it begins. The evaluation typically asks, Did this project succeed at accomplishing its objectives? Evaluation criteria are often developed by NCIPC (as indicated earlier), and evaluation findings are required in the final report to NCIPC. Approximately 20–25 percent of submitted applications are approved.
Such grants were known as State and Community-Based Injury Control Programs. In FY 1994, these grants were distributed to 15 states and metropolitan areas (about $200,000–300,000 per grant) with the goal of developing, expanding, or improving injury control programs.
These panels, which are made up of CDC and other federal employees, rank proposals by merit and recommend funding. In about 20 percent of RFPs, a second review by a similarly constituted panel is invoked by the NCIPC director when more than one ad hoc review panel ranks proposals or when NCIPC's research priorities and/or geographic distribution requirements are not satisfied by the first review. To avoid conflict of interest, none of the reviewers for any of the review panels is from the NCIPC division supporting the cooperative agreement.