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 10, 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** DURATION

PHASE ONE: Capacity building and project planning Building of multi-sector collaborations Data collection Creating strategies

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 TWO may overlap into PHASE THREE

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

**Funds will be distributed in 12 month increments regardless of grant’s phase.

2

IMPORTANT DATES AND INFORMATION SESSION

Important Dates*

Information Session January 16 Letter of intent due February 6Invitation to submit full proposal comes from CHNA 20 February 13Application due March 20Grantees Notified April 3Distribution of Funds April 10

*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, 20159:30 am to 11:30 amDepartment of Public Health, Metrowest Office5 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 13. 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 cannotreceive new funding from any other CHNA 20 grant program for the duration of the Multi-Year Grant period.

Please submit your Letter of Intent electronically by 5:00 p.m. on February 6, 2015:chna20@baystatecs.org, CHNA 20 Program Manager

4

Letter of IntentAttachment 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 OROf Organization’s FiscalSponsor:

Fiscal Sponsor:

Contact Person:

Phone:

Email:

Names of Collaborating Partners (at least 2)

2. Eligibilitya. 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

MULTI-YEAR GRANT APPLICATION

5

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 13, 2015.

APPLICATION INSTRUCTIONS:

Required elements include:

● Cover Sheet (template provided)● Proposal Narrative ● Community Collaborations Worksheet (template provided)● Letters of Collaborative Agreement ● Project Workplan (template provided)● Budget Worksheet (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 13, 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: ( )Email: Email:

GRANT PROPOSAL CONTACT: Address, city, state, zip:

Phone: ( ) Fax: ( )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:

PROPOSAL NARRATIVE

7

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 3-year 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

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 888-888-8888johnq@public.com

Co-chair collaborator’s meetings on health literacy in K-12

9

PROJECT WORKPLAN TEMPLATE(Attachment C1)

This template is intended to assist you in planning your project implementation over the three-year 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

PROJECT WORKPLAN TEMPLATE (Attachment C2)

PHASE TWO Goal (s):

PHASE TWO (Core Project Implementation)

10

Activity Desired Outcome Outcome Measurement

Assessment Method

PROJECT WORKPLAN TEMPLATE (Attachment C3)

PHASE THREE Goal(s):

PHASE THREE (Evaluation and Sustainability)

Activity Desired Outcome Outcome Measurement

Assessment Method

11

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 ImmigrantsOverall 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 informed Measure level of Answers to focus group

12

community focus groups(s) to raise awareness and assess knowledge

about available preventive health and wellness services and assess perception of need

awareness and perception based on focus group conversations

questions and conversations

Creation of culturally competent prevention resources materials based on assessed needs

Raise awareness of community preventative resources

(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

13

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 (in the space below the grid) that provides further clarity, detail and justification of all costs. Include other sources of funding, if applicable.

Item Amount requested in

this application

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.

14

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

15

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 Collaborative Agreement

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

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 13, 2015. No late submissions will be accepted.

16