BLUE HILLS COMMUNITY HEALTH ALLIANCE (CHNA 20) MULTI-YEAR GRANT INTRODUCTION The Blue Hills Community Health Alliance (CHNA 20) is pleased to offer a unique funding opportunity to qualifying organizations within its service area. Up to three (3) Multi-Year Grants will be awarded and will consist of a three-year award period beginning on April 17, 2015, with each award recipient being granted approximately $30,000 in Year One and $40,000 in Years Two and Three. CHNA 20 is one of 27 Community Health Network Areas across Massachusetts. The following communities comprise CHNA 20: Braintree, Canton, Cohasset, Hingham, Hull, Milton, Norwell, Norwood, Quincy, Randolph, Scituate, Sharon and Weymouth. The mission of CHNA 20 is to empower our communities to achieve their best quality of health and wellness through education and information while improving access to care and services. FUNDING OPPORTUNITY OVERVIEW In 2011, CHNA 20 conducted a Community Health Assessment which identified the coalition’s core health priority areas. New initiatives in 2013/2014 gave CHNA 20 an opportunity to further assess health needs in its thirteen town catchment. Through this process, clear gaps were identified between health resources and community needs. After careful review of the quantitative and qualitative data, it was determined that CHNA 20 could make the most impact funding broad-based, multi-year sustainable programs that would bridge these gaps. The new Multi-Year Grant is designed to increase linkages between community members and resources that improve access to care and services to impact overall health outcomes. This funding opportunity is intended for projects and initiatives that allow organizations the flexibility to create and pursue meaningful, data-driven change in one or more of CHNA 20’s priority areas of Chronic Disease & Wellness, Substance Abuse, and/or Mental/Behavioral Health. In addition, successful applicants will show consideration of the following: ●
Multi-disciplinary collaboration across sectors – The involvement of many different representatives from your community in shaping your project and contributing to project goals is an important component of this grant. Examples could be, but are not limited to, a school collaborating with a social service agency and a public health agency or a hospital collaborating with an educational organization and a youth empowerment program.
●
Targeted work with vulnerable populations. “Vulnerable” may be defined as low-income, high-risk for a particular health indicator, racially or ethnically marginalized, or experiencing barriers to services due to language or other significant socio-economic factor.
The Blue Hills Community Health Network Alliance (CHNA 20) funding source is through the Determination of Need Community Health Initiatives (DoN), which are required and overseen by the Massachusetts Department of Public Health. Our funders include: Dana-Farber Cancer Institute, South Shore Hospital, and Steward Health Care
1
●
Use of educational modalities, either as a primary function or complementary program component, to further progress toward access and improved community health. Preference for funding will be given to applications that show consideration of a prevention-oriented focus.
●
A sustainability plan to continue the work of the initiative beyond the three-year grant funding period.
NOTE: Linkages could be, but are not limited to, identifying and filling gaps in services, navigating health care systems or processes, or streamlining access to appropriate care.
The three-year funding period is crucial to the success of the Multi-Year Grant program. The time frame will be divided into three (3) phases, each lasting approximately one year, as follows:
PHASES** PHASE ONE: Capacity building and project planning Building of multi-sector collaborations Data collection Creating strategies
DURATION Lasting from date of funding until no later than 1 year from date of grant approval. PHASE ONE may overlap into PHASE TWO.
PHASE TWO: Project implementation Apply strategies Monitoring program Modifying, as needed Ex: Expanded community mobilization
Lasting from completion of Phase One
PHASE THREE: Evaluation and sustainability Outcome measures Sustainability plan
Beginning at least 1 year before end of funding and running through the completion of the grant period
PHASE TWO may overlap into PHASE THREE
**Funds will be distributed in 12 month increments regardless of grant’s phase.
2
IMPORTANT DATES AND INFORMATION SESSION Important Dates* Information Session Letter of intent due Invitation to submit full proposal comes from CHNA 20 Application due Grantees Notified Distribution of Funds
January 16 February 9 February 17 March 20 April 14 April 17
*CHNA 20 reserves the right to amend this RFA as necessary, including any of the above dates. Any change will be communicated immediately to the membership and to all grant applicants.
Information Session All potential applicants AND potential collaborators are encouraged to attend an informational session with CHNA 20 to assist in defining the scope of proposed projects and begin the process of forming multi-sector collaborative relationships. The Multi-Year Grant Informational Session will be held on: January 16, 2015 9:30 am to 11:30 am Department of Public Health, Metrowest Office 5 Randolph Street (in room known as the “Fishbowl�) Canton Questions and answers from the Information Session will be posted to the www.CHNA20.org website within 5 business days.
3
LETTER OF INTENT Interested applicants MUST submit a Letter of Intent (Template provided/Attachment A). Submitting this documentation confirms eligibility and provides applicants with the opportunity to present a brief overview of their projects to CHNA 20. Approved Letters of Intent will be notified on February 17. Only approved applicants will be invited to move forward with the completion of a full application for the Multi-Year Grant. Organizations applying for the CHNA 20 Multi-Year Grant will meet all of the following eligibility criteria:
Must be located within, and primarily serve, one or more communities in the CHNA 20 service areas of Braintree, Canton, Cohasset, Hingham, Hull, Milton, Norwell, Norwood, Randolph, Quincy, Scituate, Sharon, and/or Weymouth. Must be a non-profit organization with valid 501c(3) or 509(a) status Must be able to show one or two examples of funded projects your organization has managed.
The Letter of Intent is limited to no more than three (3) pages in 12 point font, and should include:
Description of the idea or project
Indication of how the project connects to one or more of CHNA 20's priority areas in improving community health: Chronic Disease and Wellness, Substance Abuse, or Mental Health
Indication of how the project addresses the overarching goal of improving community health linkages and outcomes through increased access to care, services and/or information
Identification of potential collaborative organizations who will be instrumental in the success of the project
PLEASE NOTE: The final equitable allocation of funds will be determined by the CHNA 20 Grant Review Committee. Only one Multi-Year Grant will be awarded to any given lead agency within the CHNA 20 service area. If funded, organizations applying as the lead agency for the Multi-Year Grant cannot receive new funding from any other CHNA 20 grant program for the duration of the MultiYear Grant period.
Please submit your Letter of Intent electronically by 5:00 p.m. on February 9, 2015: chna20@baystatecs.org, CHNA 20 Program Manager
4
Letter of Intent Attachment A Please use 12-point font in this document. Please include all the items listed below: 1. General Information Organization Name: Organization Address: Are you a 501c (3) or 509 (a)?
Yes
No
Tax ID Number of Organization OR Of Organization’s Fiscal Sponsor: Fiscal Sponsor: Contact Person: Phone: Email: Names of Collaborating Partners
(at least 2)
2. Eligibility a. List CHNA 20 towns that will be served: b. In 75 words or less, please name one or two examples of funded projects your organization has managed?
3. Narrative: No more than three (3) pages and should include: ●
Description of the idea or project
●
Indication of how the project connects to one or more of CHNA 20's priority areas in improving community health: Chronic Disease and Wellness, Substance Abuse, or Mental Health
●
Indication of how the project addresses the overarching goal of improving community health linkages and outcomes through increased access to care, services and/or information
●
Identification of potential collaborative organizations who will be instrumental in the success of the project 5
MULTI-YEAR GRANT APPLICATION Organizations submitting successful Letters of Intent will be invited to move forward with the completion of a full application for the Multi-Year Grant. The Multi-Year Grant application must be completed in full and submitted no later than 5:00 p.m. on March 20, 2015.
APPLICATION INSTRUCTIONS: Required elements include: ● ● ● ● ● ● ● ● ●
Cover Sheet (template provided) Proposal Narrative Community Collaborations Worksheet (Attachment B/ template provided) Letters of Understanding for Key Collaborators (Attachment B1 / template provided) Project Workplan (Attachments C1, 2,3 / template provided) Budget Justification Worksheet (Attachment D/ template provided) Affirmation of Understanding (Attachment E/template provided) Signature Page (template provided) Certificate of Tax-Exempt Status (A current IRS letter confirming the tax exempt status: 501c (3), 509(a) of the lead organization, group or fiscal sponsor)
All applications must be typed. Please use no smaller than 12-point font. Collectively, responses to the narrative may not exceed 2000 words. The narrative word count does NOT include the cover sheet, Community Collaborations worksheet, Letters of Collaborative Agreement, project workplan, budget worksheet, signature page, and certificate of tax-exempt status. All application materials should be submitted electronically as a single file, with the exception of the certificate of tax-exempt status, which can be sent as a separate attachment. Please submit all required materials by 5:00 p.m. on March 20, 2015 to: chna20@baystatecs.org, Arlene Goldstein, CHNA 20 Program Manager GRANT RECIPIENT OBLIGATIONS ●
CHNA 20 will provide guidance and evaluation support to grant recipients in addition to the grant award. This support is being provided in order to ensure maximum success of grant awardees.
●
A representative from both the grant recipient organization and any collaborating organizations will be required to become members of the Blue Hills Community Health Alliance and attend a minimum of two meetings per year of funding.
●
Grant recipients will be required to submit mid-year and annual reports to CHNA 20. Dates and templates will be provided to recipients at the time of the award. Recipients will also be required to deliver a brief presentation about their project at a CHNA 20 meeting.
●
Grant recipients consent to allow CHNA 20 to publicize their grant award and projects.
●
Grantees are required to acknowledge the support of CHNA 20 in funded project publicity/communication. 6
CHNA20 MULTI-YEAR GRANT COVER SHEET PROJECT TITLE: 2 -3 sentence description of the proposed project.
NAME OF LEAD APPLICANT: EXECUTIVE DIRECTOR/PRINCIPAL: Address, city, state, zip: ___________________________________________________________________________________ Phone: (
)
Fax: (
)
Fax: (
)
Email: Email: GRANT PROPOSAL CONTACT: Address, city, state, zip: Phone: (
)
Email: COLLABORATIVE PARTNERS: ___________________________________________________________________________________ ___________________________________________________________________________________ _________________________________________________________________________________ ___________________________________________________________________________________ Amount of Funding Requested: $______________________________________________________ Geographic Area Served by Project:____________________________________________________ NAME OF FISCAL CONTACT PERSON: Address, city, state, zip: ___________________________________________________________________________________ Phone: (
)
Fax: (
)
Email: Note: If your group has a fiscal agent/conduit other than the applicant named above, please provide the name and complete contact information of the fiscal agent/conduit:
7
PROPOSAL NARRATIVE Project Overview and Sustainability 1. Project Overview (1500 word maximum) Please describe your proposed project. The following bullet points may be used as general guidelines to assist you in writing a thorough description.
What is the problem you plan to address through this project? How does it relate to one or more of CHNA 20's priority areas: Mental Health, Substance Abuse, or Chronic Disease and Wellness?
What evidence/data can you provide of the problem and its impact(s) on the community you intend to serve?
What is the long-term data-driven change you plan to achieve through this project? Is it change in knowledge, behavior, systems/policy, or a combination of two or more of these areas? Based on your desired long-term change, what goals can you identify as benchmarks for success throughout the three year grant period? What outcomes will you seek to accomplish in each phase?
Who will the project serve? (Population, demographics, geographic community, etc.) Please be sure to specify the CHNA 20 cities and towns impacted by this project. How many people do you estimate can be reached through your efforts?
Identify collaborative organizations that will be instrumental in this project. Explain their collaborative role in this project. Required for submission and to assist you in building collaborations a Community Collaboration Worksheet template (Attachment B) is provided on page 9 of this document.
Please summarize the key activities you plan to engage in to achieve your results.
How will these activities create or strengthen linkages between community members and resources that improve access to care or services? Required for submission and to assist you in project planning there is a 3 phase Project Workplan Template (Attachments C 1-3) provided on pages 10-12 of this document.
How do you intend to track and evaluate your progress towards project goals throughout the 3year time period? What outcome measures will be used? How will you define your project’s success?
2. Project Sustainability (500 word maximum) Please describe your vision of sustainability for the proposed project: ●
How can this project continue to impact your community beyond the three-year award period? What systems, policies, or programs will need to be in place prior to the end of the award period in order to successfully transition the project to a sustainable model? Please identify 3-5 key activities you will undertake during the three-year award period to ensure that those systems, policies, or programs are implemented. Please identify any challenges you foresee in sustaining the project beyond the three-year award period, as well as any potential solutions you may have identified. 8
COMMUNITY COLLABORATIONS WORKSHEET: (Attachment B) The template is intended to assist you in developing collaborations and identifying broad-based community support for you project. Collaborating Agency
Representative Name
Contact Information
Example of Collaborative Activity
Ex.: John Q. Public Educational Program
John Q. Public
888-888-8888 johnq@public.com
Co-chair collaborator’s meetings on health literacy in K-12
9
BLUE HILLS COMMUNITY HEALTH ALLIANCE (CHNA 20) Template: Letter of Understanding for Key Collaborators (Attachment B1) In order to demonstrate the value of your planned collaborative activities, CHNA 20 strongly recommends submitting a completed Letter of Understanding from a minimum of two (2) key collaborative external organizations attachments to your completed grant application. Please note that these Letters of Understanding are to be submitted IN ADDITION TO the collaboration worksheet(s) included within the RFA packet. Letter of Understanding: Affirmation of Collaborative Commitment This letter covers the entirety of the CHNA 20 Multi-Year Grant funding period, from April 2015 through April 2018. Lead Agency: (Your organization's name here) Lead Agency Contact Person: Collaborative Partner: (Your collaborator's organization) Collaborative Partner Contact Person: (Collaborative Partner Agency) is pleased to submit this letter of understanding affirming our commitment to participate in (Lead Agency's) programmatic efforts in fulfillment of the CHNA 20 Multi-Year Grant. Our collaborative relationship is the result of (what factors led you to form this partnership?). Our role in this collaboration will include the following activities: 
Please list, in bulleted format, no fewer than 3 specific activities your organization plans to participate in as a direct support to the lead agency's efforts. These can include financial resources, personnel duties, and in-kind contributions.
We hereby affirm our understanding that our collaborative relationship will be sustained throughout the 3 year time period covered by CHNA 20 funding, and that any withdrawal of our collaborative commitment to the project or change in role will need to be submitted in writing to both the Lead Agency and to CHNA 20. We further affirm our understanding that we may be asked to provide documentation, signatures, or other written materials in service to the annual reporting requirements the Lead Agency will fulfill each year, and offer our commitment to complete these requests to the best of our ability. (Signature of Collaborative Partner Contact Person) (Title and Contact information)
10
PROJECT WORKPLAN TEMPLATE (Attachment C1) This template is intended to assist you in planning your project implementation over the threeyear award period. Please complete each section of the template to the best of your ability, providing no fewer than three (3) key activities per phase. Project Name: Overall Project Goal: PHASE ONE Goal (s):
PHASE ONE (Capacity building and project planning) Activity
Desired Outcome
Outcome Measurement
Assessment Method
11
PROJECT WORKPLAN TEMPLATE (Attachment C2) PHASE TWO Goal (s): PHASE TWO (Core Project Implementation) Activity
Desired Outcome
Outcome Measurement
Assessment Method
12
PROJECT WORKPLAN TEMPLATE (Attachment C3) PHASE THREE Goal(s):
PHASE THREE (Evaluation and Sustainability) Activity
Desired Outcome
Outcome Measurement
Assessment Method
13
To assist your understanding, below is a PHASE ONE EXAMPLE of the PROJECT WORKPLAN TEMPLATE Project Name: Improved Access to Preventative Health Care for New Immigrants Overall Project Goal: Members of our community who have been in the United States for fewer than 3 years will show increased well check-ups and preventive health care activities. Phase One Objective: Change in knowledge for our target population through educational and informational activities.
Activity
Desired Outcome
Outcome Measurement
Assessment Method
Meeting with representative leaders from the immigrant community
Gain support of influential immigrant community members to create a Task Force
Participation of these community members on task force to raise awareness of preventive health care resources
Collection of attendance from task force meetings and action steps
Culturally targeted community focus groups(s) to raise awareness and assess knowledge
Community informed about available preventive health and wellness services and assess perception of need
Measure level of awareness and perception based on focus group conversations
Answers to focus group questions and conversations
(Specific) number of printed materials distributed to community members by Task Force members
Task Force member’s inventory distributed materials after determined period of time
Creation of culturally Raise awareness of competent prevention community resources materials preventative resources based on assessed needs
14
BLUE HILLS COMMUNITY HEALTH ALLIANCE (CHNA 20) MULTI-YEAR GRANT BUDGET JUSTIFICATION TEMPLATE (ATTACHMENT D) Please list and explain all project costs to be funded on this page. Please provide a 1 paragraph budget explanation that provides further clarity, detail and justification of all costs. Include other sources of funding, if applicable. Amount requested in this application
Item
Other funding Sources
Sources and amounts of in-kind support
Total Program/Project Costs
Personnel Coordinator Other personnel
Fringe benefits Printing & Supplies Equipment Subcontractors Consultant(s) Administration (may not exceed 10% of budget requested) Other expenses (list and explain)
Total
$
$
$
$
*Special note: CHNA 20 COMMUNITY Grants are not made directly to individuals, nor are they made for; general marketing and promotional videos; endowments; independent research; seed money, advertisements, sponsorships, or fund raising events; or for lobbying or other items.
15
BLUE HILLS COMMUNITY HEALTH ALLIANCE (CHNA 20)
Affirmation of Understanding: Multi-Year Grant Reporting (Attachment E) I hereby affirm that I understand that I will be required to complete the following activities as part of my responsibilities pertaining to the potential receipt of funds through the CHNA 20 Multi-Year Grant:
Mid-year reports (to be completed in each of the 3 years)
Annual reports (to be completed at the end of each of the 3 years)
A comprehensive final report (to be compiled after the completion of the 3-year term)
Written evaluations of technical assistance provided by CHNA 20 (to be submitted at CHNA 20's request)
I understand that further detailed instructions and deadlines for submission of each of these required reports will be provided to me 1) upon acceptance of my proposal for funding by CHNA 20; and 2) no later than six (6) weeks prior to the deadline for submission of any given report. I further affirm my understanding that all reporting materials will also be made available to me electronically via the CHNA 20 website, and that instructions for accessing such materials will be provided to me by CHNA 20 at such time as the materials become available for use. (Signature of Lead Agency contact person) (Title and contact information)
16
BLUE HILLS COMMUNITY HEALTH ALLIANCE (CHNA 20) MULTI-YEAR GRANT SIGNATURE PAGE and POST AWARD EXPECTATIONS/OBLIGATIONS I certify that the information in this application is accurate and true to the best of my knowledge and that the grant our agency may receive from CHNA 20 will be used in accordance with granting guidelines as indicated in this application
E-Signature: Title: Date:
CHNA PARTICIPATION: A representative from both the grant recipient organization and any collaborating organizations will be required to become members of the Blue Hills Community Health Alliance and attend a minimum of two meetings per year of funding.
REPORTING: Grant recipients will be required to submit mid-year and annual reports to CHNA 20. Dates and templates will be provided to recipients at the time of the award. Recipients will also be required to deliver a brief presentation about their project at a CHNA 20 meeting.
PROMOTION AND FUNDING ACKNOWLEDGMENT: Grant recipients consent to allow CHNA 20 to publicize their grant awards and projects. Such promotion may include names, website postings, fliers, photography, videography, news coverage, and distribution of project summary reports. Grant recipients will be notified in advance of promotional activities involving their organizations and programs. CHNA 20 will work with grant recipients to ensure that privacy and confidentiality are appropriately safeguarded. Grantees are asked to acknowledge the support of CHNA 20, in publicity/communications regarding the funded project/activity.
For additional information please email, Arlene Goldstein, CHNA 20 Program Manager at CHNA20@baystatecs.org The Blue Hills Community Health Network Alliance (CHNA 20) funding source is through the Determination of Need Community Health Initiatives (DoN), which are required and overseen by the Massachusetts Department of Public Health. Our funders include: Dana-Farber Cancer Institute, South Shore Hospital, and Steward Health Care
17
COMMUNITY GRANT APPLICATION CHECKLIST
Please check all items once you have included them in your application. Please note: all items listed below are required.
Coversheet Proposal narrative Project Overview (1500 words maximum) Project Sustainability (500 words maximum) Community Collaborations Worksheet Letter(s) of Understanding for Key Collaborators Phases One through Three Project Workplan Templates Grant budget/ form (provided), including:
Line-item costs and a brief description of each line item Evidence of other funding sources relevant to the project, if applicable
Affirmation of Understanding Signature Page and Post Award Expectations/Obligations Page Documentation of Tax Exempt Status or, if applicable, verification of designated Fiscal Agent and 501(c)3 or 509(a) of that agent Electronic copy submitted with all sections included in one document (pdf format preferred) Please do not attach additional documents or letters of support Proposals must be submitted electronically in PDF format to Arlene Goldstein at CHNA20@baystatecs.org with CHNA 20 Multi-Year Grant Application 2015 in the “SUBJECT” line. All proposals must be received by 5:00 PM EST March 20, 2015. No late submissions will be accepted.
18