Grant Writing: SAMHSA and Beyond Steve Estrine, CEO Heidi Arthur, VP SAE and Associates
SAE Who We Are > Behavioral health program specialists Populations with Serious Mental Illness and Co-Occurring Disorders Youth with SED, Juvenile Justice, Child Welfare Criminal Justice Older Adults HIV/AIDS Veteran s Services > Over $120 million in Grant Awards since 2007 SAMHSA, VA, ACF, DOL, DOJ, CDC, HRSA, etc
SAE Behavioral Health Consulting Services > Program Development and Grant Writing > Strengthening Organizational Operations Expert analysis of organizational operations to maximize efficiency, correct challenges, and improve desired outcomes > Developing External Partnerships Assist clients in developing partnerships with organizations and agencies that will expand their visibility and reach
Session Overview PBHCI opportunity Managing a grant writing project Program development: Crafting your story Writing tips and techniques
SAMHSA Primary Behavioral Health Care Integration (PBHCI)
OVERVIEW OF PBHCI Purpose: coordinated and integrated services via colocated primary and specialty care services in community-based mental and behavioral health settings. Goal: improved for adults with serious mental illnesses (SMI) who have or are at risk for co-occurring primary care conditions and chronic diseases Objective: triple aim--improving health for those with SMI; enhancing the consumer s experience of care; and reducing/controlling cost of care.
Key Considerations June 8 application deadline 32 awards $400,000/year or $1.6 in total per applicant Eligibility is limited to Qualified Community Mental Health Programs (CMHC)
Core Requirements On site primary care services Medically necessary referrals Health home services: Comprehensive care management Care coordination and health promotion Comprehensive transitional care from inpatient to other settings, including appropriate follow-up Individual and family support, which includes authorized representatives Referral to community and social support services, including appropriate follow-up
Target Population > Adults with SMI who have or are at risk for co-occurring chronic conditions > Minimum Numbers: 200 clients in Year 1 375 clients in Year 2 475 clients in Year 3, and 600 clients in Year 4 and beyond
Prevention and Health Promotion Goals At least 10% of the total grant award must be used for developing preventive and health promotion services. > A continuum of preventive and health promotion services made available based on screening and assessment > Approaches that promote peer leadership and recovery support > A range of interventions: Tobacco cessation Nutrition Health education Health literacy Self help and self management
HIT Requirements > No more than 15% of the total grant award may be may be used for facility modifications and health information technology > Must be prepared to achieve Meaningful Use standards by the end of the 4 year period: Submit at least 40% of prescriptions electronically (as allowable given state-specific laws regarding the use of e- prescriptions for controlled substances); Receive structured lab results electronically; Share a standard continuity of care record between behavioral health providers and physical health providers; and Participate in the regional extension center program.
Data Collection Requirements No more than 20% of the total grant award may be used for data collection, performance measurement and performance assessment, >Blood pressure quarterly >Body Mass Index quarterly >Waist circumference quarterly >Breath CO quarterly >Plasma Glucose (fasting) and/or HgbA1c annually >Lipid profile (HDL, LDL, triglycerides) annually >National Outcome Measures every 6 months >Quarterly Performance Reports
Sustainability Utilize 3 rd party and other revenue to the extent possible Use grant funds to support services to: individuals who are ineligible for public health insurance programs, individuals for whom coverage has been formally determined to be unaffordable, or for services that are not sufficiently covered by an individual s health insurance plan (co-pay or other cost sharing requirements are acceptable) Must facilitate the health insurance application and enrollment process for those who are eligible Must be prepared to develop a comprehensive sustainability plan in Year 2 of the grant
Feasibility Analysis > Licensed by your state to provide mental health services? > Primary care integration plan for the mental health service delivery setting? > Capacity/reach to achieve required numbers? > EHR readiness to ensure Meaningful Use by the end of the project? > Sustainability plan?
Critical Considerations > Available timeframes > Required activities vs. available funds > Required services within transformation environment > Required service volume > Making it work Co-location does not ensure coordination or collaboration Care access does not ensure care engagement
MANAGING THE PROJECT
Government Grants are an Investment According to an evaluation conducted by the Federal Grantsmanship Network, preparation of a federal grant application takes over 70 hours, and the commitment was over double that number of hours (over 140 hours) for winning applications.
Your Application Team > A leader/convener > Development Department Representative > Clinical advisor(s) staff and consumer > Evaluator > Finance > Administrator > Decider
Tools to Coordinate Proposal Process > Program planning worksheet/logic model > Project work plan > Application Guide
Program Planning Guide Top five local health needs for SMI cohort: Key sub-groups to explore: Current approach to SMI care delivery in targeted community: Gap in health care delivery system that, if addressed by these required service, will yield improved health for this SMI population: Agency s Existing Capacity/Strengths to provide this assistance: Challenges/weaknesses: Potential Partners for strategic alignment/reinforcement: Plan for co-located primary care: Evidence Based Practices Plan for Health Home services: Plan for Health Promotion Array: Plan for identifying, engaging, and conducting follow-up with targeted population Plan for Evaluator Plan for Sustainability Plan to meet Meaningful Use requirement how has this evolved? Key Partners Staffing Plan//Identified Key Staff/ Bios for PBHCI Budget
Project Workplan Program Planning Content Draft Review Draft 1 Review Draft 2 Audit/Score Review Final Draft Submission Planned Planning Worksheet Complete Draft Due Peer Review Complete Draft Due Peer Review Complete Draft Due Peer Review Complete Review Complete Draft Due Admin Review Complete
Document Application Guide Budget Information Form Use SF-424A - Fill out Sections B, C, and E of the SF-424A. Respons ible Party RFP Page # Face Page - SF-424 34 Abstract (no longer than 35 lines) Include project name, population(s) to be served (demographics and clinical characteristics), strategies/interventions, project goals and measurable objectives, including the number of people to be served annually and throughout the lifetime of the project, etc. In the first five lines or less of your abstract, write a summary of your project that can be used, if your project is funded, in publications, reporting to Congress, or press releases. SAE 35 and 20 Table of Contents 35 and 20 35 and 20 (A sample budget and justification is included in Appendix J page 52 of this document.) Project Narrative (no longer than 30 pages) SAE 35 and 20 Section A: Population of Focus and Statement of Need SAE 25/26 Section B: Proposed Evidence- Based Service/Practice SAE 26 Section C: Proposed Implementation Approach SAE 26-28 Section D: Staff and Organizational Experience SAE 28 Section E: Performance Assessment and Data Project Evaluator 29 Section F: Sustainability SAE 30 Supporting Documentation (no page limits) 35 and 20/21 Section G: Literature Citations SAE 30 Section H: Budget Justification, Existing Resources, Other Support 30 Section I: Biographical Sketches and Job Descriptions biographical sketch for the Project Director and other key positions. Each sketch should be 2 pages or less. Job descriptions should be no longer than 1 page each. 30 (also page 51)
Project Organization > Determine key elements of the planned approach from the outset > Craft your story > Assess each team member s strengths and availability; assign roles and responsibilities > Determine timeframes; adjust as necessary
Proposal Development Process > Outline the proposal > Extract key requirements and priorities to guide plan development > Assign team roles > Determine resources, gather source materials, identify gaps and plan information gathering > Assess who needs to review and when > Allow for an RFP audit and an independent scoring review by someone outside of the team
DEVELOPING THE PROGRAM: Crafting Your Story
Make Your Proposal Stand Out > Determine what your strengths are and what makes your approach unique > Promote your assets > Minimize your challenges > Craft a compelling, readable proposal
Getting Started: What is the Story Going to Be? > Assess organizational/program strengths relative to the funder s priorities > Identify opportunities to reinforce these advantages > Check-in to ensure that everyone is on the same page; will reduce inconsistencies which can create time-consuming problems later > Leverage partnerships
Key Considerations > Logically integrate needs, goals and approach within: organization s service array community system of care (including recovery supports) > The staffing plan and budget bring the plan into focus
Elements of a Good Story > Characters the target population, your agency, your partners > A setting your unique local community > A conflict the critical and compelling needs and the gap in care that you propose to address > A story arc how your project will actually work > A satisfying ending the required outcomes your program will achieve
Highlight your Strengths > Overwhelming local needs > Critically underserved population > Amazing array of comprehensive services in house and/or via strong partnerships > Integrated care capacity > Consumer engagement or consumer driven services > Person-centered, culturally competent approach > Evidence-based services > Strong IT capacity and data regarding prior outcomes
Know Your Challenges > Wealthy local area > Lack of service array for targeted population > Limited capacity to meet linguistic and cultural needs of the targeted population > Small numbers > Limited data > Lack of prior outcomes > Strong competitors
PROPOSAL WRITING TIPS
Write for the reviewer: Understand the Review Process Make the proposal easy, clear, and logical to read; follow the bullets Seek opportunities to score points in every section e.g. cultural competence Imagine likely concerns, reactions, biases Calibrate number of pages/section based on the points allocated
Using Headers: An Example Describe the Evidence-Based Practice (EBP) that will be used and justify its use for your population of focus, your proposed program, and the intent of this RFA. Describe how the proposed practice will address the following issues in the population(s) of focus, while retaining fidelity to the chosen practice: demographics (race, ethnicity, religion, gender, age geography, and socioeconomic status; language and literacy; sexual identity (sexual orientation and gender identity); and disability
Needs Section 10 points
Evidence Based Interventions 10 points > Utilizing dually trained physicians (a physician trained in both psychiatric and physical medicine who manages all care) > Physical medicine on-site consultation (Physical medicine clinician provides consultation and care within psychiatric clinic or inpatient setting) > Collaborative care (Frequent communication between mental and physical health care teams) > Case manager (Often a registered nurse who coordinates transportation and appointments, monitors health status and treatment adherence) > Facilitated referral to primary care (Psychiatric care team facilitates access to primary care team)
Implementation 30 points > Describe plans for each of the required health home services relate to goals and objectives and disparities within population > Describe plan to meet Meaningful Use Standards > Plan for identification, recruitment, and retention current and planned > Consumer/peer participation > Role of partners
Experience 15 points Tailor organizational boilerplate to highlight fit with the goals of the program and to avoid unsupported platitudes Elicit organizational details to highlight links to the community and to the target population Highlight connections to grassroots providers and to local community providers--be creative and specific Highlight staff and partners with stellar backgrounds-- get specific, incl. trainers
Performance and Assessment Data 20 points Choose an evaluator with SAMHSA expertise, when possible: should have expertise with programs serving those with SMI should be involved in the plan development early on Should write the plan once the draft is in the refinement stage to ensure consistency
Sustainability Business plan for this health home: Partnerships with FQHCs and Hospitals Leveraging expected, new, and/or existing Medicaid coverage that will supplement grantrequired activities (e.g. coverage for care coordination, billable medical services) Appendix N template
Tips for Easy Points Add recognized national experts as trainers Include key staff whose cultural/linguistic expertise matches the target population Incorporate strong consumer participation Address cultural aspects of the target population in every section highlight subpopulations to enhance readability
Contact Information Steve Estrine, PhD. Founder and CEO Heidi Arthur, LMSW Vice President SAE and Associates New York, NY Phone: 212.684.4480 harthur@saeandassoc.com sestrine@saeandassoc.com