The following grant sample proposes developing a countywide pediatric-asthma network that will help educate health-care providers, parents, and children about asthma management, using National Institutes of Health (NIH) materials. It also would provide intensive case management for low-income children who have moderate to severe asthma. The goal would be to reduce morbidity and mortality associated with pediatric asthma.

1. Executive Summary

The County Pediatric Asthma Network (CPAN) is a consortium of individuals from area health-care institutions and related agencies who, since 1993, have collaborated to improve pediatric asthma management among children. With pilot funding from 1996 to 1998, CPAN provided education for more than 5,800 physicians, nurses, school personnel, parents, and others who care for children with asthma, and intensively case-managed fifty children (ages five to nineteen) from low-income families.

The pilot project resulted in statistically significant changes: CPAN findings for 1997 indicate measurable improvements in knowledge about asthma, changes in behavior, and clinical outcomes for children. School personnel, children, and physicians increased their knowledge about asthma significantly as indicated on pre-education and posteducation tests. Children in the program significantly improved their use of metered-dose inhalers and other treatments. Perhaps the most dramatic improvement came in the clinical area, where the number of hospitalizations in one year fell from twenty to eight among the thirty-four youth who completed a full year of intervention; the number of days hospitalized dropped from fifty-seven to eighteen; and the number of school days missed went from 718 to 612.

These results were the motivation behind a recent CPAN long-range strategic plan developed with the assistance of the Direction Center. The plan calls for formalizing and strengthening the collaborative partnership, increasing public and health-care provider awareness and knowledge about asthma and asthma management, strengthening and expanding services to reach more and younger children from low-income families, and increasing research activities and dissemination of findings.

CPAN requests the assistance of the community foundation in formalizing and expanding the collaborative partnership to ensure that more lowincome families that have infants or children with asthma will benefit from CPAN services.

2. Purpose

A. Needs/Problem Statement

Asthma is the most prevalent chronic pediatric disease, affecting approximately 4.9 million children and adolescents in the United States. The prevalence of asthma in the pediatric age group is increasing more than in any other age group as evidenced by a 56-percent rise from 1982 to 1991. Over this same period, the prevalence of asthma in those under eighteen years of age rose from 4 percent to 6.3 percent (National Center for Health Statistics, 1982–91).

Asthma is the most frequent reason for hospitalization due to chronic disease in children and teens, with an estimated annual cost of $712 million for treating asthma in those under eighteen years of age. That figure increases to $1.3 billion when parents' missed work days and outpatient visits and medications are added. In addition, asthma is the leading cause of school absenteeism, with ten million school days lost annually (American Lung Association of Michigan, 1994).

Asthma more commonly affects minorities, and with greater mortality, too. African-Americans have a prevalence of asthma that is 22-percent greater than whites, while age-adjusted asthma mortality data show that death rates in African-Americans are three times greater than in whites. Asthma also more commonly afflicts those in urban settings and those from poor households (Centers for Disease Control, 1986–90).

Eighty-three percent of the county's half-million population live in urban settings. In 1989, the county had 8,599 children and adolescents with asthma. Of these children, we can expect 7,149 to be from an urban area, 1,092 to be of minority background, and 791 to be from low-income families (United States Census Bureau, 1990). About 2,700 of the nearly 8,600 children have moderate-to-severe asthma. At least 2,400 live in households where they breathe secondhand smoke. These children are all at great risk. The estimated annual pediatric asthma costs in the county alone exceed $2.5 million.

ABC Children's Hospital, the regional tertiary and primary-care pediatric hospital and one of four hospitals that admit children in City, admitted 404 children with the diagnosis of asthma in 1996. Their illness generated a total of 1,141 hospital days and $1,276,895 in hospital charges, or an average of $3,161 per child. Of the 404 admitted children, 50.7 percent received Medicaid insurance and 2.3 percent were private pay (ABC Children's Hospital data, 1996). Finally, of those admitted children for whom ethnic data were available, 29.6 percent were of minority ethnicity.

During its pilot, CPAN provided asthma-management education for more than 4,000 parents, teachers and school personnel, health-care providers, and children with asthma, which proved valuable, statistically successful, and cost efficient. Staff also case-managed fifty children ranging in age from five years to nineteen years with very successful results, particularly in the areas of reduced hospitalization, improved overall health as evidenced by a reduction in school-days missed, and improved asthma-management behaviors, particularly among the children, though also among some parents.

CPAN plans to continue its educational outreach and seeks funding to add fifty children per year to its case-management roster (100 children in 2003, 150 in 2004, and 200 in 2005). All qualifying children will be from low-income families (using WIC standards for poverty). Qualifying age range will be expanded to include children younger than age five and their families. More than 50 percent of program participants have been of minority ethnic background, predominately African-American; it is anticipated that this involvement with the ethnic community will continue at the same or greater level.

B. Goals and Objectives

CPAN has two overarching goals: 1) to educate those caring for children with asthma — the physicians, nurses, school personnel, parents, and the children themselves — using National Institutes of Health (NIH) materials; and 2) to intensively case-manage low-income children with moderate to severe asthma. Achieving these goals will reduce morbidity and mortality associated with pediatric asthma.

Achieving the first goal consumes approximately 25 percent of CPAN's resources; accomplishing the latter requires the remaining 75 percent. CPAN believes it can best accomplish its two primary goals by implementing its long-range strategic plan. The plan outlines several goals and specific objectives; however, only those goals for which funding is sought from the community foundation are described below:

Goal 1: Formalize and expand partnerships and collaborations with other agencies that interact with the same population. Establish adequate staffing and communication channels to ensure formal, long-term partnerships that are in the best interest of the children served.

Objectives

  • Maintain and strengthen linkages between and among CPAN, the County Health Department, City Public Schools, area hospitals and clinics, neighborhood organizations, home health-care agencies, pharmaceutical companies, the American Lung Association of State, State University, health-maintenance organizations, private practices, visiting-nurse services, area pharmacies, and family members of children with asthma.

  • Expand beyond these partners to other agencies and school districts. The City and City Public Schools, among others, have expressed a strong interest in using CPAN's resources, both to in-service their personnel and for the case management of their students.

  • Create and increase executive director staff to 0.5 full-time employees (FTE), 0.5 FTE, and 1 FTE for 2003, 2004, and 2005, respectively. The executive director will be expected to oversee the entire operation, including deployment of resources (including the CPAN Speakers' Bureau), maintaining the service and educational missions, seeking future sources of revenue, and contracting with institutions and third-party payors.

  • Create and increase medical social-worker staff to 1 FTE, 1.5 FTE, and 2 FTEs for 2003, 2004, and 2005, respectively. The use of a medical social-work intern for the past six months has proved invaluable. A social-assessment tool is being developed by CPAN to identify those families at highest risk.

  • Create and increase clerical/data support staff to 0.5 FTE, 0.5 FTE, and 1 FTE for 2003, 2004, and 2005, respectively. As the casemanagement and data collection — for research purposes — increases, so does the importance of these positions.

  • Goal 2: Reduce pediatric-asthma morbidity and mortality within a targeted urban, low-income population with moderate-to-severe asthma through case-managed intervention.

    Objectives

  • Increase the case-managed population to 100 children per year, 150 children per year, and 200 children per year for 2003, 2004, and 2005, respectively.

  • Establish protocols for identifying qualifying infants and toddlers for the program and share protocols with area practitioners, social service agencies, and others who can refer preschool-age children to program. By the end of year one at least twenty-five infants/toddlers will be enrolled in the program; by the end of year two, at least one-third of participants will be under age five.

  • Increase nursing staff to 2 FTEs, 3 FTEs, and 4 FTEs for 2003, 2004, and 2005, respectively. (The current CPAN budget allows for 1 FTE through June 30, 2004.) A priority in this objective is a nurse educator with a specialty in infant/toddler asthma management.

  • Achieve measurable outcomes within this targeted population:reduce school absences by 20 percent, reduce hospital admissions by 50 percent, reduce days hospitalized by 50 percent, and reduce emergency-department visits by 20 percent.

  • C. Timeline

    All objectives are established for the course of the next three years (2003–2005); most timeframes for completion are included in the objectives. CPAN is currently seeking funding from a number of sources to establish itself as a well-known, successful provider of asthma management for children from low-income families. Funding for the next three years is necessary until CPAN develops the linkages necessary to obtain government or insurance funding.

    D. Partners

    Since its inception as a pilot project, CPAN has enjoyed great interinstitutional and interdisciplinary collaboration. Indeed, CPAN consists of individuals from all four (now three) acute-care hospitals in City as well as staff from the American Lung Association of State, the County Health Department, State University, Health Organization, private practices, and visitingnurse services. Physicians, nurses, respiratory therapists, social workers, pharmacologists, managed-care providers, educators, and family members of children with asthma are included in CPAN's membership.

    Among its strongest and most consistent collaborators have been: 1) the Local Children's Hospital and Health Organization, which has supplied CPAN with health-care professional expertise, direction, and clerical support; 2) The American Lung Association of State, which has supplied CPAN with expertise, clerical support, and physical space; 3) Hospital Health Services, which has supplied CPAN with administrative and accounting expertise and a home; and 4) The City Public Schools, which has partnered with CPAN to educate City Public School personnel — principals, classroom, and physical-education teachers, school nurses, and school secretaries — to learn the optimal asthma care for their students.

    As CPAN seeks to expand its services, new potential partners have been identified. Among those that have expressed an interest in participation are the County Intermediate School District, the City A Public Schools, City B Public Schools, City C Public Schools, and City D Public Schools.

    E. Similar Programs/Agencies

    There are no programs or agencies similar to CPAN in County and only a handful of such programs in the nation. In fact, at a recent convention for health-care professionals who specialize in asthma management, the City program was highlighted for several of its features: its broad partnerships, which cross the entire spectrum of health-care providers in the community; its focus on research, education, treatment, and evaluation; and its statistically significant results achieved in a relatively brief time.

    It is the vision of CPAN's Board to become the “Region's model organization for asthma care, offering education, professional expertise, and advocacy resources to control this serious illness. Through stronger collaboration with institutions of higher education and health care, CPAN will improve the lives of infants, children, and adolescents with asthma,” and to “become a nationwide model making its experience in research, education, and treatment available for replication by any and all interested professionals and organizations” (Long-Range Strategic Plan).

    F. Constituent Involvement

    Collaborating partners' specific contributions are described above. Individually, school personnel, health-care professionals, and parents of children with asthma frequently share specific problems related to the management of asthma for review and assistance from CPAN staff; however, most overall planning for services is done by the CPAN Board of Directors. The board at this time is composed primarily of health-care providers and representatives from other partner organizations, such as schools. Another goal of the long-range strategic plan is to diversify and broaden board membership to reflect community constituencies and represent program participants.

    G. Staff Qualifications

    Current staff are licensed medical practitioners. CPAN seeks to hire an executive director with a background in social services and/or health care to establish cross-partner communication linkages and quality-assurance procedures, and to establish and strengthen new linkages with other agencies that work with the same population group. Further, this person must be knowledgeable about managed care and insurance providers as he or she will be required to negotiate with these providers and with Medicaid to approve CPAN for reimbursement.

    The nurse educator to be hired under the grant proposal will have a specialty in infant and toddler asthma management and treatment and will report directly to the Respiratory Department Manager at ABC's Health Services, as well as to the CPAN Medical Director and the CPAN board. He or she must be a registered nurse (RN) or registered respiratory therapist (RRT), with a bachelor's degree in nursing or related field necessary and a master's preferred. Past experience in community health, case management, and patient advocacy are important criteria.

    CPAN will make every effort to recruit and hire qualified minority candidates for these positions.

    H. Long-Term Funding Strategies

    Once CPAN has an executive director, the organization can begin the lengthy process of identifying insurance and managed-care agencies and developing and presenting contracts for care. Sharing CPAN's clinical and behavioral outcomes with these organizations will be critical; naturally, it will enhance CPAN's position to have more than one year's data, significant as the year's data are. The executive director will also be charged with identifying a contact within Medicaid and exploring the feasibility of a proposal to the government for Medicaid reimbursement.

    While these processes are put in place to ensure future funding, CPAN must continue to seek corporate and individual support. The executive director is important to this process as well and will be asked to identify potential donors, share our clinical-outcomes data, and solicit interim and permanent funding to expand services.

    CPAN is also seeking funding from national and local foundations and from Local Hospital Health's Community Benefit Fund.

    3. Evaluation

    A. Defining and Measuring Success

    Previous studies of asthma have cited improvements in educational, behavioral, or clinical outcomes when using educational interventions. CPAN is the first such study in the nation to demonstrate all three among its participating children. The children, their parents, school personnel, and primary-care physicians were taught about the effects, triggers, medications, equipment care and techniques, and management plans of asthma. These outcomes are provided below. Those that are statistically significant are indicated in italics.

    Education Outcomes

    Behavior Outcomes

    Clinical Outcomes

    The difference CPAN makes in the quality and duration of these children's lives is the measure of the program's success. CPAN, therefore, will continue to collect data with the use of group-specific pre-education and posteducation tests, prestudy and poststudy behavioral criteria, and measurement of clinical outcomes.

    B. Dissemination

    Results of the 1998 study have been compiled for presentation at the annual Academy of Allergy, Asthma, and Immunology and American Thoracic Society meetings. In addition, CPAN is preparing the data for sharing with area health-care professionals and the community.

    C. Constituent Involvement

    Constituents participate as members of pretest and posttest and study groups. CPAN staff have learned a great deal from their constituents. Clients of the program have been candid with CPAN about how to work in their neighborhoods and how to work with diverse populations. As a result, CPAN has twice modified its enrollment form to be easier to complete and more sensitive to constituent issues and has shaped its methods of approaching and assessing families based on the advice of early program participants.

    The most common request of CPAN from constituents is to expand the program to encompass younger children; in fact, many program participants have younger siblings with asthma. Clients also require that staff reorder their asthma lessons to deal with more immediate problems. In many cases, staff work with clients to establish priorities before beginning educational plans.

    4. Budget Form and Narrative

    A. Grant Budget Form

    A. Organizational fiscal year: July 1 through June 30

    B. Time period this budget covers: Jan. 1, 2003–Dec. 31, 2005

    C. Expenses: include a description and the total amount for each of the budget categories, in this order:

    Amount Requested from the Local Foundation

    Total Project Expenses (2003, 2004, and 2005)

    Salaries

    $169,293

    $626,642

    Payroll Taxes

    Fringe Benefits

    $42,323

    $156,660

    Consultants and Professional Fees

    $21,750

    Insurance

    Travel

    $4,836

    $10,881

    Equipment (Office)

    $4,500

    Supplies (Office)

    $2,300

    Printing and Copying

    $15,000

    Telephone and Fax

    $1,500

    Postage and Delivery

    $1,750

    Rent

    $18,000

    Utilities

    Maintenance

    Evaluation

    Marketing

    $1,000

    Other (specify)

    Reference materials for library

    $1,000

    Peak low meters for each enrolled child

    $3,600

    Spacer systems for each enrolled child

    $2,700

    Professional development

    $1,500

    $3,000

    TOTAL EXPENSES

    $217,952

    $870,283

    D. Revenue: include a description and the total amount for each of the following budget categories, in this order; please indicate which sources of revenue are committed and which are pending.

    Committed 2003-2005

    Pending 2003-2005

    1. Grants/Contracts/Contributions

    Local Government

    State Government

    Federal Government

    Foundations

    QRS Fdn.

    $50,000

    ABC Fdn.

    $150,000

    The City Foundation

    $217,952

    LMN

    $24,451*

    $90,000

    Family Foundation

    $20,000*

    Health Department

    $75,000*

    $100,000

    Corporations

    Individuals

    2. Earned Income

    Events

    Publications and Products

    3. Membership Income

    4. In-Kind Support

    $120,505

    5. Other (specify)

    TOTAL REVENUE

    $239,956

    $607,952

    *Committed only for 2003

    B. Explanation

    CPAN's request of the Community Foundation is for three years' funding for the following:

    Staffing

    Adequate staffing is critical to achieving CPAN's objectives and goals for improving the health and outcomes of low-income children with asthma.

    Cost for full staffing is calculated on market-rate salaries and includes payroll taxes. The Community Foundation is asked in this request for decreasing amounts over the next three years to support a 0.5-FTE executive director: $25,000 in 2003, $20,000 in 2004, and $15,000 in 2005. The person hired in this position will be responsible, with assistance from the board of directors, for establishing contracts with Medicaid and other insurance payors and for seeking alternate sources of funding until the position is self-sustaining. Base salary for this position is $50,000/year.

    Also included in the grant request is three-years' salary for a nurse/ asthma educator with a specialty in early pediatrics (infants and toddlers). CPAN plans to add this position first and to increase nursing staff by another FTE nurse/educator in 2004 and two nurse/educators in 2005 (total four new positions by the end of the grant period). Base salary for each FTE is $17 per hour or approximately $35,500 per year. Currently, CPAN's only nurse educator is supported by a grant from the Local Foundation, for which CPAN intends to apply annually.

    Staffing positions not requested of the grant include a clerical/datamanagement coordinator @ $25,709/year (beginning half-time and increasing to full-time by 2005), and a medical social worker at $16 per hour or approximately $33,200 annually (beginning with one FTE and increasing to two FTE by 2005). A medical director's services are donated by Local Children's Hospital at a value of $75 per hour for 200 hours per year.

    All positions assume a 3-percent cost-of-living increase annually. Fringe benefits include FICA, health insurance, disability, workers' compensation, etc., and are calculated at 25 percent of salaries.

    Professional Fees

    Professional fees are donated by the partners and include meeting expenses for the advisory council ($1,000 per year), administrative oversight provided by hospital's Health Services ($35 per hour for 100 hours in 2003, 150 hours in 2004, and 200 hours in 2005), and accounting services at $1,000 per year for three years.

    Travel

    Local travel is mandatory for the case managers/nurse educators. Mileage for the funded position of early-pediatric nurse educator is requested of the grant at $0.31/mile, 100 miles per week × 52 weeks. Mileage not included in the grant is calculated by the same formula and applicable to the current nurse educator and additional nurse educators as they are hired.

    Office Supplies and Equipment

    Office equipment includes computer hardware and software for the executive director and is not requested of the grant; supplies also are not requested.

    Office Services

    Copying and duplication is important to ensure seamless communications and to share information with parents and others charged with the care of children with asthma. This service is not charged to the grant request. Telephone and fax charges are expected to increase with the addition of another line at participants' request. This increase is not reflected in the grant request. Postage costs are estimated based on past experience.

    Rent

    Space for staff and program equipment is donated by the partners and is calculated at a rate of $12 per square foot for 400 square feet in 2003, 500 square feet in 2004, and 600 square feet in 2005. Utilities and maintenance are included in the cost per square foot.

    Evaluation

    Evaluation is ongoing and integral to the program. It is not calculated separately.

    Marketing

    CPAN plans a quarterly newsletter for participants and will seek the estimated $1,000-per-year cost for producing the newsletter from other grant sources.

    Reference Library

    CPAN hopes in year three to establish a small reference library for staff, other health-care professionals, and program participants at an estimated one-time cost of $1,000.

    Health-Care Supplies

    CPAN provides each child with a new peak flow meter (approximately $20 each with 20 percent allocated for loss) and a spacer system (approximately $15 each with 20 percent allocated for loss) upon enrollment. CPAN is seeking assistance with these costs or donated supplies from pharmaceutical companies and manufacturers.

    Professional Development

    It is important to remain abreast of changes in asthma treatment methods, educational information, and asthma management techniques, and to attend meetings of professional affiliations. Therefore, CPAN requests of the grant half of the $3,000 allocated for professional development over three years, to ensure that the executive director and early-pediatric nurse/ educator attend appropriate educational or networking conferences and seminars.

    C. Other Requests

    CPAN completed its long-range strategic plan in July, 2002, and immediately contracted with a local fundraising expert to assist it in establishing funding for formalizing the partnerships and expanding outreach and participation opportunities to children under five. Since then, CPAN has submitted requests on the invitation of John Doe to the ABC and XYZ foundations. Those requests are expected to be decided by the end of 2002. Plans also call for an application to the LMN Foundation and, pending responses from larger foundations, requests of several smaller foundations.

    In addition, CPAN successfully applied for a hospital Health Community Benefits grant, which will provide $75,000 from October 15, 2002 to October 14, 2003 and may be renewable each year thereafter. It has also recently received a one-year $20,000 grant from the private Foundation at hospital's Health Services and a $48,903 grant from the LMN Foundation, which covers half of this year's and half of 2003's salary for the current nurse educator. CPAN intends to continue to apply to LMN for funding as needed when the current grant expires in July, 2002. An application for special-program assistance to purchase new bedding for children in the program was made to one of the trustees of the private Foundation.

    D. Priority Items

    If the entire amount cannot be granted, CPAN requests that the Community Foundation consider one of two alternatives: First, that it grant first-year funding and perhaps a portion of the second-year funding request to enable CPAN to begin formalizing its partnerships and expanding services.

    Alternately, CPAN most urgently needs an executive director who can oversee daily management, communications, fundraising, marketing/public relations, and data-gathering activities and ensure quality control across the partnering organizations.

    5. Organization Information

    A. History

    CPAN was founded in 1993 as a consortium of individuals from area health-care institutions and related agencies who sought to collaborate to improve pediatric asthma management. Pilot funding came from the Community Foundation, Hospital Foundation, Corporate Foundation, Private Foundation, ABC Hospital, and XYZ Memorial Medical Center.

    In addition to providing successful public education about asthma management to more than 5,800 parents, children with asthma, school personnel, and health-care practitioners and providing asthma case management for as many as ninety-three children from low-income families in 2002, CPAN began community and professional awareness programs, data analysis and outcomes, a professional certification project, and patient educational resources.

    Results from its 2002 program indicate significant success in most objectives and demonstrated the need to formalize the partnership so that CPAN can expand its services.

    B. Mission and Goals

    The mission of ABC County Pediatric Asthma Network is “to improve the lives of all infants, children, and adolescents with asthma by providing educational and professional expertise.” Goals in support of this mission were developed during long-range strategic planning and include:

  • Stabilizing and strengthening the organization

  • Increasing public awareness of CPAN and its programs

  • Strengthening and expanding services

  • Expanding and strengthening working relationships with agencies that serve urban, ethnic-minority children

  • Stabilizing and broadening funding

  • Increasing research activities and dissemination

  • C. Current Programs, Activities, and Accomplishments

    Current programs, activities, and accomplishments are described in the proposal narrative. Selected additional planned activities include:

  • Diversifying community representation on the CPAN Board of Directors and in its membership

  • Establishing an advisory panel or ad-hoc focus groups composed of customers, providers, and community representatives

  • Creating an organizational marketing plan

  • Developing and providing certification standard for educators and health-care professionals

  • Increasing access to insurance coverage and inclusion in managed care

  • Developing and implementing a CPAN patient/practitioner-satisfaction evaluation program

  • Disseminating the results of outcome-management programs through community and national professional media

  • D. Organizational Chart

    The current partnership structure does not lend itself to the traditional organizational chart. Such a chart has not been developed and awaits adequate staffing.

    Attachments:

    Previous grants made to CPAN were handled by Hospital's Health Services, which acted as fiduciary agent. CPAN, therefore, cannot submit an audited financial report with this request. If the Community Foundation requests, it will supply an audited financial statement from the agent.

    The following sample was submitted to the Kresge Foundation for its capital challenge program. Most foundations periodically examine and refine their program areas. The Kresge Foundation is in the process of altering the challenge grant program by the end of 2007. Be sure to check the Web site for current guidelines and priorities. Speak directly with a program officer prior to submitting your proposal.

    3. NARRATIVE

    Organizational Information

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