It is understood that evidence-based disease prevention and health promotion programs reduce the need for more costly medical interventions. Formula grants are available under the Older Americans Act.
Disease Prevention and Health Promotion Services
(OAA Title III-D)
Authorizing Legislation: Section 361 of the Older Americans Act (OAA) of 1965, as amended.
Background on Definition of Evidence-Based Programs
Evidence-based programs are now required for Title III-D-funded activities. This change followed a decade of progress by the aging services network to move efforts toward implementing disease prevention and health promotion programs that are based on scientific evidence and demonstrated to improve the health of older adults. The federal FY-2012 Congressional appropriations law included, for the first time, an evidence-based requirement. In response to the new requirement, ACL developed an evidence-based definition to support the transition.
Since October 1, 2016, Title III-D funds may only be spent on health promotion programs that meet the current, highest-level criteria definition.
How to Determine If a Program Meets Evidence-Based Requirements
There are two ways to assess whether Title III-D funds can be spent on a particular program (and as always, State Units on Aging may have additional state-specific Title III-D requirements):
- The program meets the requirements for ACL's Evidence-Based Definition (the ACL Definition is below)
- The program is considered to be an "evidence-based program" by any operating division of the U.S. Department of Health and Human Services (HHS) and is shown to be effective and appropriate for older adults:
- HHS has eleven divisions
- An HHS division has included the program on a registry of evidence-based programs, or has reviewed it and deemed it evidence-based
A number of federal registries of appropriate evidence-based programs are listed below under Resources.
ACL Definition of Evidence-Based Programs
As of October 1, 2016, all programs using Title III-D funds will have to meet these criteria (equivalent to the "highest-level" criteria of the former definition):
- Demonstrated through evaluation to be effective for improving the health and well-being or reducing disease, disability and/or injury among older adults; and
- Proven effective with older adult population, using Experimental or Quasi-Experimental Design;* and
- Research results published in a peer-review journal; and
- Fully translated** in one or more community site(s); and
- Includes developed dissemination products that are available to the public.
*Experimental designs use random assignment and a control group. Quasi-experimental designs do not use random assignment.
**For purposes of the Title III-D definitions, being “fully translated in one or more community sites” means that the evidence-based program in question has been carried out at the community level (with fidelity to the published research) at least once before. Sites should only consider programs that have been shown to be effective within a real-world community setting.
The Purpose of the Title III-D Program
Title III-D of the OAA was established in 1987. It provides grants to states and territories based on their share of the population aged 60 and older for programs that support healthy lifestyles and promote healthy behaviors. Evidence-based disease prevention and health promotion programs reduce the need for more costly medical interventions. Priority is given to serving older adults living in medically underserved areas of the state and those who are of greatest economic need.
- Frequently Asked Questions
- Why do we have an evidence-based requirement for OAA Title III-D?
While the aging network has been moving towards evidence-based disease prevention and health promotion programs for the last decade, FY-2012 Congressional appropriations included an evidence-based requirement for the first time. OAA Title III-D funding may be used only for programs and activities demonstrated to be evidence-based. The appropriations language pertaining to Title III-D is below:
Provided, that amounts appropriated under this heading may be used for grants to States under section 361* of the OAA only for disease prevention and health promotion programs and activities which have been demonstrated through rigorous evaluation to be evidence-based and effective . . .
*Section 361 is the main component of Title III-D of the OAA
- What is the amount of funding for Title III-D?
Older Americans Act funding for Disease Prevention and Health Promotion programs under Title III-D for the past several years:
- FY 2015: $19,730,530
- FY 2014: $19,732,154
- FY 2013: $19,731,329
- FY 2012: $20,944,340
- FY 2011: $20,983,948
- FY 2010: $21,026,000
- FY 2009: $21,026,000
- FY 2008: $20,026,142
- FY 2007: $21,355,796
- How can Older Americans Act Title III-D grantees afford to implement evidence-based programs given limited funding?
One source of funding may not be sufficient to meet all the disease prevention and health promotion needs of clients. Partnership and collaboration can extend the reach of health promotion programs. Many SUAs, Tribes, AAAs, and PSAs use Title III-D funding to leverage other funds. It is common practice to braid or blend funding streams to fund different components of the same activity in order to make a complete program. Depending on the health promotion program, funding sources may include: public health departments, hospitals, foundation giving, universities, Cooperative Extension System Offices (USDA), professional organizations (such as pharmacy, dental and dietetic associations), voluntary donations, private donors, Medicare, Medicaid, outpatient clinics, nonprofit organizations, federally-funded health centers, city parks and recreation departments, sliding scale co-pay, and others.
In addition to partnerships outside the Aging Services Network, some AAAs have pooled their Title III-D funding and implemented regional and/or statewide evidence-based programs. This can be an effective way to leverage moderate resources to provide training and licensing services to a broader geographic area.
- Can a portion of the Title III-D award be used for state administration?
State administration is based on the full Title III allocation and can be charged to any of the parts of Title III. As provided in OAA, Sec. 308(b), each state may determine the amount of Title III funds, including Title III-D, it will use for state plan administration activities up to 5% of its Title III allocation or $500,000, whichever amount is greater.
- Are there new reporting requirements for Older Americans Act Title IIID to reflect the evidence-based requirement?
No. The reporting requirements for Title III-D have not changed. At this time, the State Program Report (SPR) requires SUAs to report on: persons served; Title III expenditures; total service expenditures; program income received; number of providers; and number of AAAs providing direct service provision. View the AoA Program Results and Evaluation resources.
- If an Area Agency on Aging feels it does not have the expertise to conduct Title III-D programs that meet the new evidence-based requirements, can the State Unit on Aging take their allocation and give it to another AAA who is able to meet the new requirements?
In the event an Area Agency on Aging is unable to meet the new Title III-D requirements after receiving the funds via the Intrastate Funding Formula (IFF), States must follow their own written policy regarding programmatic compliance and reclamation of funds. ACL regional offices are able to assist states and AAAs with identifying and/or implementing disease prevention health promotion programs that meet the new requirements.
States are required to deliver Title III-D funding via the approved interstate funding formula.
Note: Some states may have a separate section of the IFF for Title III-D funding that goes to "medically underserved areas" rather than to all AAAs. Please consult with your state on questions related to the IFF.
- What funding can be used to support Disease Prevention and Health Promotion activities that do not meet the evidence-based criteria?
OAA Title III-B funds can be used as well as administration funds. Using the example of a health fair, some communities have obtained donated services and/or found volunteers for activities such as informational booths, walk-a-thons, and exercise demonstrations. By inviting local organizations to host a booth, give a presentation or offer a demonstration, they receive free marketing and in return provide a health fair activity free of charge. These activities could include: presentations on healthy diets and grocery shopping tips by a nutritionist paid by a local grocery store; healthy cooking demonstration hosted by a local restaurant; benefits of stretching demo by a local gym instructor; presentation on building healthy relationships by a local therapist, psychiatrist, psychologist or psychotherapist; alternative medicines demo by a local acupuncturist, massage therapist or herbalist; bicycle and pedestrian safety demo by a local partner of the National Bicycle Safety Network; back health demo by a local chiropractor; CPR and first aid demonstration by local EMTs; dental care presentation by a local dentist or dental hygienist; and skin cancer prevention demonstration hosted by a local dermatologist.
- What, if any, supporting documentation should SUAs or AAAs provide to substantiate that they are meeting the new OAA Title III-D requirements?
AoA does not require prior approval or documentation to be submitted regarding evidence-based health promotion programs. However, AAAs and SUAs may want to retain documentation of the evidence supporting their chosen Title III-D health promotion program(s) for their own records. AAAs should work with their SUAs in meeting the requirement.
- Is an “evidence-based program” the same as an “evidence-based service/practice?”
No. While the terms “evidence-based program” and “evidence-based service/practice” are often used interchangeably, the field distinguishes services/practices from programs. Evidence-based services/practices can be part of an evidence-based program, but the reverse is not always true. Title III-D funds are required to be used on evidence-based programs.
Specifically, evidence-based services/practices refer to strategies or activities used by evidence-based programs as part of their larger intervention. For example, evidence-based self-management programs (such as diabetes prevention programs or pain management programs) may incorporate similar evidence-based practices such as blood pressure screenings or glucose checks, even though the outcome goals of these programs may be very different.
Evidence-based programs refer to organized and typically multi-component interventions with clearly identified linkages between core components of the program and expected outcomes for an identified target population. For example, an evidence-based falls prevention program could involve educational enrichment classes, as well as one or more evidence-based services (for example, strength and balance building exercises and/or a home environmental assessment component). In order to meet the highest-level definition for Title III-D funds, such programs must also have methods available to guide their dissemination in the community, such as materials and training.
Understanding and Finding Evidence-Based Programs
Toolkit on Evidence-Based Programming for Seniors (Community Research Center for Senior Health)
A comprehensive guide on finding and implementing evidence-based programs in a community setting.
National Council on Aging Evidence-Based Program Resources
Guides to understanding, implementing, and building a business case for evidence-based programs.
Evidence-Based Leadership Council
This organization represents a small but notable group of evidence-based programs that are shown to improve older adult health.
NCOA Cost Chart of Highest Level Evidence-Based Programs
In 2012 ACL and the National Council on Aging (NCOA) developed a chart with some commonly used programs meeting highest-level criteria, with associated costs.
Note: Programs do NOT need to be included on this chart to meet ACL’s highest-level criteria.
Federal Registries of Evidence-Based Programs
Numerous federal agencies have registries of evidence-based programs that are suitable to use for older adults:
ACL also maintains a small registry of evidence-based programs that have been assessed by the Office of Performance and Evaluation’s Aging and Disability Evidence-Based Programs and Practices (ADEPP) process:
Note: Programs do NOT need to be on the ADEPP list to be considered highest level evidence-based.
Webinar on the Evidence-Based Requirement: MOVING ON UP! OAA Title III-D Funds—Disease Prevention and Health Promotion Webinar on the Evidence-Based Requirement. (June 4, 2014): Recording Slides (PDF, 1.80MB) | Audio (MP3, 11.9MB) | Transcripts (DOCX, 110KB)
Evidence-Based Programs 101 Webinar: Presenters from the Texas A&M’s School of Rural Public Health share what programs are available, why they're important, how to find the right one for your organization, and how to measure success