Chronic Disease Risk Reduction

Grant Application

1. Program Description |
   Background |
   Chronic diseases account for roughly 75% of health care costs each year, more than $10 billion per year in Kansas. As states struggle to meet the staggering costs of health care, the most cost-effective interventions are frequently overlooked. Impressive achievements in population health are possible by reducing the prevalence of risk factors that underlie chronic disease and injury. |
   
   Tobacco Use. Tobacco use is the leading cause of preventable death and disease in Kansas. Annually, cigarette use alone causes approximately 3,800 deaths in Kansas, costing more than $927 million in medical expenditures and $863 million in lost productivity from an experienced workforce that dies prematurely (CDC SAMMEC). The risks of tobacco use extend beyond actual users. Nearly nine out of ten nonsmoking Americans are exposed to secondhand smoke, increasing their risk for lung cancer and heart disease. Additionally, youth continue to use tobacco at an alarming rate. Data from the 2009/2010 Kansas Youth Tobacco Survey (KYTS) reveal that 17.1% of high school students reported using cigarettes. The KYTS also indicates that 15.5% of high school male students in Kansas currently use smokeless tobacco. |
   
   Data compiled by the Centers for Disease Control and Prevention (CDC) show that smoking prevalence among youth and adults declines faster as spending for tobacco control programs is increased. This funding opportunity announcement solicits program grant applications from communities for the purpose of establishing or continuing tobacco control programs at the local level that are sustainable, accountable, and eventually comprehensive as recommended by CDC´s Best Practices for Comprehensive Tobacco Control Programs (October 2007). |
   
   Obesity. From 1992 to 2007, the prevalence of obesity in Kansas more than doubled from 13% to 29%. Currently, two-thirds (65%) of Kansas adults are either overweight or obese (KS BRFSS, 2010). More than 30% of the 700,000 children living in Kansas are overweight or at risk for becoming overweight. Healthcare costs related to obesity are excessive. In Kansas, an estimated $657 million is spent per year in total direct medical costs with Medicare and Medicaid expenditures of $138 million and $143 million, respectively (Finkelstein E. A, et al. Obesity Research. 2004:12(1):18-24). In 2005, obesity contributed to the deaths of 3,700 Kansans.
   
   | Physical Activity. Obese Kansans are less likely to participate in leisure time physical activity (61%) than normal weight or under-weight Kansans (44%), highlighting the relationship between obesity and physical activity (KS BRFSS, 2009). Fewer than 50% of Kansans in 2009 attained the recommended amount of physical activity per week (KS BRFSS, 2009). |
   
   Nutrition. Achieving healthy nutrition remains elusive for Kansans. In 2005-2006, 27% of Kansans reported that they never eat breakfast, a habit associated with poor nutritional intake (KDHE), and 81% fail to consume five or more fruits and vegetables each day (KS BRFSS, 2009). |
   
   This document is a request for proposals for local healthy community programs that include tobacco control and community physical activity, nutrition and obesity planning. It provides background and guidelines for developing a full proposal and submission instructions. This is a competitive grant process, meaning that grants will be awarded based upon the quality and clarity of the proposed activities and achievability of proposed outcomes. Please follow the directions carefully. Applications will be scored based on adherence to the request guidelines. |
   
   About the Kansas Tobacco Use Prevention Program (TUPP) |
   The Kansas Department of Health and Environment’s Tobacco Use Prevention Program (TUPP) was established in 1992 and is the lead state program for comprehensive tobacco prevention and control. TUPP incorporates CDC’s Best Practices for Comprehensive Tobacco Control Programs and uses approaches compatible with the Healthy People 2020 risk reduction strategies for tobacco use. A primary program function is to provide resources and technical assistance to community coalitions for development, enhancement, and evaluation of state and local initiatives to prevent morbidity and mortality from tobacco use. |
   
   About the Kansas Physical Activity and Nutrition Program (PAN) |
   The mission of the Kansas Department of Health and Environment´s Physical Activity and Nutrition Program is to increase the number of Kansas residents who have the knowledge, motivation and opportunity to make lifestyle choices that promote healthy eating and physical activity. PAN´s mission is facilitated through state-level leadership and coordination that reaches into communities across the state. |
   
   
2. Program Purpose |
   Chronic Disease Risk Reduction (CDRR) Grant overview |
   The purpose of this community grant program is to provide funding and technical assistance to communities to address chronic disease risk reduction through evidence-based strategies that impact tobacco use, physical activity, and nutrition. Examples of these strategies can be found in the American Journal of Preventive Medicine´s “The Guide to Community Preventive Services: Tobacco, Obesity, Physical Activity, Nutrition” and “The Community Health Promotion Handbook: Action Guides to Improve Community Health.” The grant program is structured to promote community program progress in four distinct stages:
   
   1.   An initial planning phase;
   2.   Capacity building;
   3.   Implementation;
   4.   Sustainability and maintenance.
   
   Currently, tobacco prevention and control is supported through all program progress phases. Physical activity, nutrition and obesity control programming is supported through the capacity building phase. Each phase of the program requires the grantee to demonstrate increasingly comprehensive activities with associated short-term outcomes before advancing to the next phase |
   
   
3. Specific Program Information |
   Program Progress Phases
   Separate funding is available at one of four tobacco control program progress phases and for one of two obesity control program progress phases. Applicants must apply for tobacco programming to be eligible to apply for obesity programming. All applications must include tobacco control activities, while obesity control activities are optional. Grantees are expected to advance sequentially and consistently through the progress phases, completing the requirements of each phase before advancing to the next. If necessary, a grantee may have a lapse in funding for one year. After the lapsed year, the grantee may re-apply at the highest phase attained or may choose to re-apply at a previous phase. A grantee may not advance phases during a lapse period. The program phases and estimated maximum lengths are outlined below. A grantee may petition to remain in a phase longer than the maximum when circumstances provide a compelling rationale. In such cases, a separate petition document will be required in addition to the grantee´s application. |
   
   Planning (2 years maximum): Grant funds support completion of an approved community assessment tool, establishment of a functional tobacco prevention coalition, preparation for future participation in the Youth Tobacco Survey (YTS), and attendance at three state trainings. At least 0.25 FTE (a minimum of 10 hours per week) must be dedicated to grant implementation. |
   
   Capacity Building (3 years maximum): Grant funds support maintenance of a functioning coalition that meets at least quarterly, a concentrated focus of activities and outcomes on one tobacco prevention and control program goal with integrated disparate population activities, participation in the state level YTS if selected, and attendance at three state trainings. If also applying for obesity control funding, applicants must focus physical activity and nutrition activities and outcomes on one community sector. At least 0.25 FTE (a minimum of 10 hours per week) must be dedicated to grant implementation. |
   
   Implementation (5 years maximum): Grant funds support continued focus on the program goal selected during Capacity Building with the addition of activities and outcomes for the remaining two tobacco program goals, quarterly coalition meetings, participation in the county and state level YTS if selected, and attendance at three state trainings. At least .5 FTE (a minimum of 20 hours per week) must be dedicated to grant implementation. |
   
   Sustainability (5 years maximum): Grant funds provide for a functioning coalition, program activities and outcomes generation in all three tobacco prevention and control program goals, participation in the county and state level YTS if selected, attendance at three state trainings, and funding replacement activities. Grantee is responsible for seeking external funding, to enhance CDRR funds for sustaining and growing the local program with a 5 year goal of generating a match equivalent of two-thirds of the Sustainability Year 1 CDRR budget. To achieve this goal, grantees should aim to increase the match by 27% each year. Technical assistance will be provided to grantees to support their external funding applications. At least .5 (a minimum of 20 hours per week) FTE must be dedicated to grant implementation. |
   
   Maintenance (on-going): For grantees achieving sustainability, grant funds may be requested to provide for county and state-level data collection as requested, conference attendance and program marketing. At least .5 (a minimum of 20 hours per week) FTE must be dedicated to grant implementation. Maintenance grantees must be willing to serve as a “Mentor” to additional CDRR grantees as needed. When needed, Mentors will be assigned to another grantee in the same CDRR region. Mentors will not be assigned more than two grantees to coach in any one year. |
   
   
4. Funding |
   Grant funds may NOT be used to: |
   
   • provide meals;
   • provide direct services, individual or group cessation services;
   • provide direct patient care;
   • provide personal health services medications (NRT therapy);
   • provide patient rehabilitation;
   • supplant existing funding from Federal, State, or private sources;
   • directly enforce policies;
   • pay for an internship
   • provide incentives and promotional items
   • provide staff time for direct classroom instruction of students of any age;
   • lobby government entities; or
   • defray other costs associated with the treatment of diseases.
   
   Eligibility |
   Eligible applicants are local health agencies who are expected to serve as project lead on behalf of the community. A local health department may designate a partner organization to serve as the lead agency. If a partner organization is to serve as the lead agency, the application must include a letter from the local health department stating that it has designated another agency to be the applicant and include a letter from the designee indicating consent to do so. A consortium of counties may apply together under one application. |
   
   Match |
   All applicants applying for Planning, Capacity Building, and Implementation grants must provide a minimum of 25% match for every dollar awarded. The 25% match may be in cash, in-kind, or a combination of both from county and/or public and private sources. Sources of in-kind match may include: school programs, Safe and Drug Free Schools funds, Kansas Healthy Schools, Safe Routes to School, Sunflower Foundation Trails grant, Kansas Department of Transportation Enhancement grant and others as determined by program director. Local funds that support existing evidence-based cessation program services and local funds provided for enforcement activities may also serve as local match. To lead a program towards sustainability, the match should increase each year. Please see the following diagram as an example of incremental increases in match goals: |
   
   

   Match Requirements
   Progress Phases	Percentage of Total Match (minimum)	Percentage Total Match to be Cash (minimum)	Percentage of Total Program Cost that is Cash Match (minimum)
   Planning	25%	0	$0
   Capacity Building	25%	0	$0
   Implementation	25%	0	$0
   Sustainability (Year 1)	25%	0	$0
   Sustainability (Year 2)	32%	22%	7%
   Sustainability (Year 3)	40%	38%	15%
   Sustainability (Year 4)	51%	51%	25%
   Sustainability (Year 5)	65%	62%	40%

   
   

   SUSTAINABILITY EXAMPLE
   Progress Phase	CDRR Grant Funds	Match Amount	CASH Match Amount (minimum)*	Total Program Cost
   Sustainability (Year 1)	$37,500	$12,500	$0	$50,000
   Sustainability (Year 2)	$34,000	$16,000	$3,520	$50,000
   Sustainability (Year 3)	$30,000	$20,000	$7,600	$50,000
   Sustainability (Year 4)	$25,500	$24,500	$12,494	$50,000
   Sustainability (Year 5)	$17,500	$32,500	$20,150	$50,000
   Maintenance	$17,500	$32,500	$20,150	$50,000

   *NOTE: Only a percentage of total match funds are cash amount (see table above). The remaining percentage of total match funds can be in-kind donations as listed previously. |
   
   

Reporting Requirements
All applicants must complete mid-year and final reports. A “CDRR Activity Evaluation” form for each activity should be attached to the mid and final year reports. Forms for this purpose are provided by KDHE and include the “Reporting Form” and the “Affidavit of Expenditure.” Additionally, the grantee will be required to participate in two formal site visits taking place in the first and third quarters of the fiscal year. Revisions to the first grant application, if required, are due before receipt of the first disbursement of grant funds.

The Final Report and Affidavit of Expenditure for the period of July 1, 2012 – June 30, 2013 will be due no later than July 15, 2013. When submitting your Final Report, send one copy to your Outreach Coordinator and email a second copy to Kshaughnessy@kdheks.gov.



Additional Grant Recipient Responsibilities

• Meet with Outreach Coordinator in first and third quarters for a site visit.
• Provide agenda for Outreach Coordinator two weeks prior to each coalition meeting date. Provide minutes to Outreach Coordinator after the meeting.
• Inform Outreach Coordinator of ongoing grant activities including but not limited to media campaigns, youth events, coalition meetings, etc.
• Follow reporting and evaluation guidelines.
• Submit all media for prior approval to CDRR Communications Coordinator two weeks prior to media placement deadlines.
• Provide quarterly fiscal report and information requested at quarterly site visits.
• Grantee or a coalition member must be present at all bi-monthly technical assistance calls
• Share activity successes with other grantees
• Submit quarterly fiscal reports to Outreach Coordinator during site visit
• Attend three trainings from the state approved workshop list



KDHE’s Responsibility to Grant Recipient

• Presence at coalition meetings and other events if requested.
• Provide assistance during the grant writing process.
• Provide technical assistance for evaluation and media.
• Schedule first and third quarter site visits to check progress with grant activities.
• Guidance through processes that require state agency oversight (Internal Review Board (IRB), media approval, etc.).
• Provide technical assistance with finding alternative funding sources in Sustainability Phase.

 

Application Format and Instructions
The Proposal Template is to be used for all application content and materials. Applications that do not follow the instructed format may be considered non-responsive.

Below are instructions and guidelines for each section of the template. Please direct questions about adapting the template format for specific applications to the Outreach Coordinators.

1. Cover Sheet – The cover sheet requires information about the organization submitting the proposal including contact information for the legal applicant, project contact, fiscal contact, etc.
   
   
2. Executive Summary – The Executive Summary should include the essential elements of the proposal and give the reviewers a brief, yet complete overview of the project. Briefly describe key concepts contained in the main body of the proposal: the need for and rationale behind the program, goals, major program activities, organizational capacity, and grant amount requested.
   
   Grant Writing Tip: The Executive Summary should be written last after working through the program activities and evaluation forms and budget forms.
   
   
3. Community Profile Form – The Community Profile Form requires the applicant to describe the community to be served. This description must include population demographic information, identified disparate population(s) and the most recent CHANGE Tool Action Plan (not applicable to Planning Grantees). In the absence of a CHANGE Tool Action Plan, applicants may attach the results of a previously approved community assessment or write a narrative describing community needs and strengths as well as anticipated barriers to proposed activities. All grantees are expected to complete the CHANGE Tool. Applicants operating under a community assessment plan that is less than five years old may delay implementation of the CHANGE tool until after the five year anniversary of their last assessment.
   
   
4. Program Description
1. Program Activities and Evaluation
1. Planning Phase
   Planning Phase applicants are required to provide evidence of community readiness for chronic disease risk reduction. Three tables (Connection Map, Identifying Linkages, and Types and Levels of Partnerships) are provided to guide applicants through the process of identifying community connections, priorities, linkages and potential partnerships.
   
   Applicants for a Planning Phase grant are required to accomplish the following activities/outputs within their grant period:
   
   
1. Establish a chronic disease risk reduction coalition that meets at least quarterly.
2. Complete the CHANGE Tool and submit results.
       (1)  Planning phase applicants: attach a CDRR Activity Evaluation form for your CHANGE Tool assessment.
3. Attend the annual CDRR Summit.
4. Select a primary goal area for capacity building in tobacco.
5. Select a sector for capacity building in obesity, if applying for obesity control funds.
   
   If funding allows, consideration may be given to extending the planning phase for applicants who encounter mitigating difficulties, but demonstrate sufficient progress toward activity completion and evidence of ability and potential.


2. Capacity/Implementation/Sustainability Phase
   All applicants at Capacity, Implementation and Sustainability must complete the following activities:
   1. Administer the Youth Tobacco Survey (YTS) if selected
   2. Write a quarterly letter to the area´s state representative(s) and state senator(s) to inform them of program goals and accomplishments. Letters must be approved by the KDHE Communications Coordinator prior to sending.
   3. Promote the Kansas Tobacco Quitline.
   
   Applicants applying at Capacity Building in Tobacco will conduct activities in only one of the following 3 tobacco goal areas: 1) preventing initiation of tobacco use among young people, 2) eliminating non-smokers exposure to secondhand smoke and 3) promoting quitting among adults and young people. Implementation and Sustainability applicants must conduct activities in all 3 tobacco goal areas. Applicants must apply for tobacco programming to be eligible to apply for obesity programming.
   
   Applicants applying for Capacity Building in Obesity (Physical Activity and Nutrition) will select a specific community sector (community-at-large, community organization, worksite, school or healthcare) in which to conduct activities. Currently, the CDRR grant program supports obesity prevention and control activities only at the Planning and Capacity Building phase. Plans for expansion of this component of the program are contingent on additional funding.
   
   For each activity selected, applicants will be guided through describing their activity and building an evaluation plan. The CDRR Activity Evaluation form may be reproduced as necessary for all proposed activities. Instructions for completing each section of the form are below.
   
   Evaluation Plans:
   

   Attach a CDRR Activity Evaluation form for each proposed activity.

    

   Evaluation Plan templates and examples are provided in the appendix. Though the format of the activity evaluation forms has changed, the content should be similar to the examples. Technical assistance is available to applicants to tailor evaluation methods for specific community settings. Please contact your Outreach Coordinator to request a consultation with an epidemiologist.

   
   CDRR Activity Evaluation:
   
   • Outcome Selection: Select the short-term outcomes for the proposed program by referencing the attached appendix of outcomes. These outcomes are taken from Key Outcome Indicators for Evaluating Comprehensive Tobacco Control Programs (CDC, 2005) and CDC´s Recommended community strategies and measurements to prevent obesity in the United States: Implementation and measurement guide (2009). In order to focus the evaluation each activity must have one selected short-term outcome.
     
     
   • Program Activities and Outputs: Select which CHANGE Sector the activity will target and which strategy applies to the proposed activity. For each activity, provide an Activity Name (e.g., “After School Program”), and Action Steps (sequential steps you will take to meet your objective). Qualitatively describe the activity in the Activity Narrative. Applications will be scored based on how well the proposed activities fit the community needs identified by community assessment plan produced by the CHANGE Tool or other community assessment.
     
     Grant Writing Tip: Use your CHANGE Tool Community Action Plan (or other community assessment) to justify your activities. State how these activities will meet local needs.
     
     
   • SMART Objectives are specific, measurable, attainable, realistic and time-bound. See examples.
     
     
   • Target Population and Target Group: Effective community-based interventions target a specific population of people (Target Population) through an intermediary such as a specific group of schools, local businesses, hospitals, health clinics or some other community-based organization (Target Group). In as much detail as possible, describe the activity´s Target Population (location, characteristics, size, etc.) and the Target Group (location, characteristics, size, etc.) you will work with to impact the Target Population. Provide brief sources for the numbers you report and include any disparate population information relevant to your Target Population/Group.
     
     Grant Writing Tip: Process indicators should come from your Action Steps. Impact indicators should be related to your objective. See examples.
     
     
2. Staffing Plan and Budget Justification
   Complete the Staffing Plan Form in the CDRR Budget document. List the Position Name for each proposed staff member, the staff member’s name and credentials, and provide a brief explanation of the scope of duties for this position related to the program. The staffing plan should reflect the organizational capacity to complete the program activities and evaluation through an appropriate amount of FTE. Minimum FTE requirements as specified for each progress phase must be dedicated to the program. Grant funds for staffing are to be used for grant coordination and activity implementation through local health educators/outreach workers. No more than 10% of administrators’ salaries may be funded by CDRR. Please insert a Résumé Form for each person named in the staffing plan.
   
   Complete an Employee Salary Calculation on the Salary Worksheet for each staff person to be paid by grant funds. Supplantation of existing resources for staff salaries is prohibited. In the case that existing staff is to be paid from grant funds, the applicant must demonstrate avoidance of supplantation in the Budget Justification.
   
   Complete the Budget Justification Form included in the template. Provide line item budget with justification consistent with selected goals and outcomes, planned activities, and time frame of the project, ending July 30, 2012.
   
   
5. Budget
   Funds may be used for salary, travel, registration fees, supplies, advertising (requires prior approval from TUPP Communication Coordinator to ensure statewide coordination), consultation, facility rental, equipment rental, speakers/presenters, educational materials, and other reasonable costs associated with the program’s activities.
   
   Funds may not be used to replace existing agency funding sources, provide inpatient services, purchase capital equipment, or purchase food. Communities are encouraged to get partner contributions for food, which may be used as matching funds. The Kansas Department of Health and Environment funds cannot be used to supplant existing funding. Applicants may not use these funds to supplant funds from Federal, State or private sources.
   
   Matching funds may be cash, in-kind or donated services or a combination of these made directly or through donations from private entities. Cash matches are required to increase yearly for programs in the Sustainability Phase. Please consult the regional Outreach Coordinator for assistance in determining the amount of cash match required for a specific program. The applicant must document all costs used to satisfy the matching requirements. Program resources may be used for consultants, staff, survey design and implementation, data analysis, or other expenses associated with surveillance and evaluation efforts to fulfill the match requirement.
   
   
6. Program Coalition Membership Form – Please complete the Program Coalition Membership Form and have each participant sign to indicate their support for the grant application. Sectors of community support are provided as a guideline to composition of an optimal community coalition for chronic disease risk reduction. Applicants are encouraged, but are not required to have an organization represented in every sector, however, applicants should include all sectors with direct relevance to selected goals and outcomes. Each sector may have multiple participants. A minimum of five active sectors are required for the coalition to be considered functional.
   
   

Review Procedures

Grant applications will be reviewed by a team of outside consultants and state program staff. Each regional Outreach Coordinator will present the grant applications from his/her region to the team for consideration. Applicants will benefit in the review process by working closely with the regional Outreach Coordinator to refine the application prior to submission to ensure that the Outreach Coordinator can present the application strongly. Outreach Coordinators will not score grants from their assigned region during the review process.

Applications will be initially reviewed by state program staff for completeness and responsiveness. Incomplete applications and applications that are non-responsive will not advance through the review process. Applicants will be notified if the application did not meet submission requirements.

Applications will be reviewed by at least three review team members and scored as follows:


A. Community Profile Community Demographics: CHANGE Tool Status: Community Action Plan or Community Assessment Findings: B. Program Description Outcome Selection Program Activities Program Outputs Impact Evaluation Staffing Plan C. Budget and Budget Justification

25 points 5 points 10 points 10 points 75 points 15 points 20 points 10 points 20 points 10 points Reviewed, but not scored




Funding preference will be given to those applications in Capacity Building, Implementation and Sustainability with highest scores. Planning Grants will be scored separately to eliminate competition barriers for new applicants.

Anticipated Award Announcement Date – Awards will be announced approximately June 1, 2012.

Award Administration Information – Successful applicants will receive a Letter of Award and Grant Contract from the Kansas Department of Health and Environment. The first disbursement of grant funds may be expected on or before July 31, 2012. Any requested revisions to program activities, evaluation, and/or budgets must be completed before the first disbursement of grant funds. Grant activities will be expected to start on July 1, 2012 and continue through June 30, 2013.

Unsuccessful applicants will receive notification of the result of the application review by mail.



Required forms:

CDRR Application, includes Cover Sheet, Executive Summary and Community Profile
| CDRR Activity Evaluation
| CDRR Budget, includes Budget Justification, Salary Worksheet and Staffing Plan
| CDRR Detailed Budget
| CDRR Coalition Members
| CDRR Planning Phase Forms
|

 

Evaluation Examples:

Evaluation, Impact, Process Examples
|
|

 

Reference Documents:

MAPPS Intervention Table, Short Term Outcome Indicator List, Program Phases
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