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Sustaining the Work or Initiative:


Example 2 - MPCA REACH 2010 Project: Reducing Cardiovascular Disease and Diabetes Among Urban Ethnic Minorities

MPCA REACH 2010 Grant: Reducing Cardiovascular Disease and Diabetes Among Ethnic Minorities in Urban Kansas City, Missouri

Modified from the Kansas City - Chronic Disease Coalition's REACH 2010 grant application

1. Background and deciding whether the initiative needs to be sustained

As a REACH 2010 Phase I grantee, the Missouri Primary Care Association (MPCA) brought together multiple organizations in the Kansas City, Missouri area to address disparities in health care access and long term health outcomes among African American and Hispanic persons. Morbidity and mortality due to cardiovascular disease, diabetes, and related disorders are disproportionately high among many racial and ethnic minorities in contrast with Caucasians in the U.S. This holds true of the African American and Hispanic populations in Kansas City, Missouri, as well. The newly formed Kansas City Chronic Disease Coalition (KC-CDC) applied for Phase II of the REACH 2010 in July 2001 in order to provide a funding base for implementation of an extensive action plan to reduce CVD and diabetes in 11 zip codes in predominantly African American and Hispanic urban areas of Kansas City. Many of the partners within KC-CDC have already been working to reduce disparities in health by eliminating barriers to health care and creating prevention programs within their separate organizations and communities. These partners, along with many local community members, support the long-term creation of a community-based plan to reduce cardiovascular disease and diabetes.

2. Clarifying goals and contexts

KC-CDC's vision is to create an organization that promotes health for all persons in Kansas City. Since CVD and diabetes are diseases that reflect behavioral choices over long periods of time (and possible genetic predisposition), KC-CDC estimated that the Kansas City Coalition and the environmental changes it facilitates would need to be sustained for a minimum of 15 years in order to significantly change health risk factors. Ideally, programs and policies enacted will be in place indefinitely with the ongoing support of the community. Changes in residents' levels of physical activity and food choices must be permanently modified; and preventive services be made available and used to bring about long-term changes in health risk and protection. As goals are met such as for promoting physical activity, the Coalition may set new goals, such as reducing risk for HIV/AIDS among community members. The overall focus will continue to be the health of all Kansas City residents.

The initial structure of KC-CDC was built around the Missouri Primary Care Association as the CCO and three community health centers. State and local health departments, national and local health care organizations, related city agencies, and community-based development groups were recruited and subsequently joined the coalition. While leadership was predominantly provided by MPCA during the planning phase, leadership has begun to emerge from health center and local health department staff who are involved in the coalition and will be encouraged as the coalition grows and begins to implement the action plan. In Phase II of the grant, KC-CDC has proposed the need for ongoing financial support for a full-time coordinator, 80% time assistant project director, three half-time positions through the health centers, and part time clerical support, in addition to financial support for the implementation and promotion of programming related to the coalition's action plan. Successful funding through the CDC REACH 2010 initiative will provide much of the anticipated financial support for three years along with inkind support from various sources. It is difficult to know if the financial needs for KC-CDC itself will grow or diminish over time. Many programs will hopefully grow and expand and new goals will be undertaken, but other outside organizations with similar or complementary objectives working with the KC-CDC will be encouraged to shoulder the financial responsibility. A strategic plan to share financial responsibilities for implementation of the action plan with other organizations and to enlist the ongoing support of local foundations and corporations is crucial to the initiative's sustainability.

The organizations making up the KC-CDC bring an assortment of assets and resources to the work of reducing disparities in health outcomes associated with diabetes and cardiovascular diseases. While the coalition was initially formed in response to the REACH 2010 grant opportunity and initial implementation of the action plan will be primarily supported by REACH 2010 grant funds, each organization is already committed to reducing disparities in health All coalition members bring leadership experience, health related services, and relationships with multiple organizations and community members. Each will contribute to the effort in different ways. Samuel U. Rodgers and Swope Parkway clinics will designate a half-time person to help develop the program within their respective health centers and service areas. These persons will help to ensure fuller access to needed preventive health services and prevention programs. The Kansas City Parks and Recreation Department will continue to develop and implement a program on Healthy Habits, a program focused on children from age 5 to 14 that teaches lifelong healthy eating and exercise habits. In conjunction with the Parks and Recreation, The University of Missouri Medical School is in the process of developing a community-based education program for adults to promote healthy eating and physical activity. The Missouri Department of Health and Kansas City Health Department will provide surveillance information and data. They will provide the statistical support to help interpret the data for public presentation and professional communications. The American Diabetes Association and the American Heart Association will help with the development and availability of printed materials for the educational offerings. They will also keep the group advised of changes occurring in the National Standards of Care.

Early accomplishments include the development of the Coalition, its action plan, and community and systems changes to date. During the Phase I of the grant, the coalition was developed. Organizations were added to the coalition during the year. Many of these groups had not worked together before. A major accomplishment was the establishment of relationships through which partner organizations can support each other in their projects. Those joining in the common effort set turf issues aside. Second, the KC-CDC developed a comprehensive Community Action Plan. The Plan identifies 30 priority changes to be sought among 98 total community and systems changes. Working with the Kansas City, Missouri City Council, the KC-CDC was able to facilitate alignment with the newly created Kansas City Health Commission. This alignment will enable the KC-CDC to have visibility and authority in the Kansas City Area as it implements the Community Action Plan (CAP).

3. Creating a business plan to anticipate needed resources

The CAP is seen as a strong base from which to launch a comprehensive network of programs, new policies and policy changes, and modified practices that will transform environments and behaviors such that the health of African Americans and Hispanics in Kansas City will improve. A budget (at the end of this document) was created to anticipate what resources would be necessary to accomplish the initiative's goals and maintain its staff and materials needs.


4. Specific goals for generating financial resources and sustaining programs and practices

As part of the REACH 2010 grant requirement and the already identified need for long term intervention, ten strategies were identified to ensure the long-term sustainability of the Coalition. First, staff positions and other resources will be shared with other organizations that are working to accomplish related goals. For example, the creation of a full-time position for a coalition liaison to work with the Mayor's Health Commission will be partially funded by the City. Similarly, the Kansas City Health Department has suggested that the KC-CDC utilize its space for staff and projects. Second, the Coalition will petition the Kansas City Missouri City Council to include funding for KC-CDC staff and programming in the city's yearly budget. The Coalition has already developed a relationship with Councilwoman Mary Williams Neal, who is acting as an advocate for the KC-CDC to city government. Third, to encourage buy-in, other organizations based in the community (e.g., local schools, faith organizations, Boys and Girls Clubs) will be asked to provide locations for rotating KC-CDC meetings and for related programs established as part of the intervention. Fourth, over time, as many of the coalition's activities will be integrated with other organizations' services, they will be asked to incorporate them into their budgets. Fifth, local faith communities will be encouraged to adopt nutrition and cooking demonstrations as part of their educational programming, emphasizing both spiritual and physical health. Similarly, the Local Investment Commission's (LINC) Caring Communities school-based programs could permanently incorporate educational programming about the link between diet and physical activity and the prevalence of chronic diseases.

Sixth, additional grants and in-kind support will be solicited. The Coalition will seek out grants from local foundations, including the Ewing Marion Kaufmann Foundation, Kemper Foundation, Greater Kansas City Community Foundation, and the Hall (Hallmark Cards) Family Foundation. Matching grants will also be sought from relevant national grantmakers such as the Robert Wood Johnson Foundation. Seventh, large Kansas City metro-based corporations, including Halls, Sutherlands, Sprint, Bayer, Blue Cross and Blue Shield, Aventi Pharmaceuticals and H&R Block, will be approached as potential corporate supporters. Eighth, in-kind support will be solicited for printing, supplies, social marketing of health practices, advertising for events, and new programming. For example, we will use already created educational materials from local affiliates of national organizations such as the American Heart Association and the American Diabetes Association. Ninth, although the KC-CDC will initially rely on many volunteers, as it becomes more established and its programs more developed, student internships will be sought from local universities. For example, we anticipate including students from the University of Missouri at Kansas City, the University of Kansas, KU Medical Center, Avila College, Rockhurst University, William Jewel College, and various metropolitan community colleges. Similarly, high school students from affected neighborhoods might be involved as interns in data collection and program implementation. Finally, fundraising events and endowments may also be considered as possible ways to promote sustainability after the coalition is well established and connected to local financial supporters.


5. Outlining an action plan for specific tactics

KC-CDC's immediate efforts to promote sustainability of the initiative--and the environmental changes it facilitates--will concentrate on several strategies: a) applying for appropriate grants, b) organizing in-kind support from local businesses and organizations, and c) working to gain the support of the city council and Mayor's Health Commission for implementation of the priority elements of the Community Action Plan.


Budget Narrative Justification

A. Personnel Salaries -

     Total: $139,859 Salaries

Name Position Months % Effort Salary Requested Fringe Benefits Totals
Joseph Pierle Project Director 12 months 10% 8,925 2,410 11,335
Kathy Smith Ass. Project Dir. 12 months 80% 36,000 9,720 45,720
Coordinator KC-CDC Coordinator 12 months 100% 42,000 11,340 53,340
Brenda Frank Office Manager 12 months 5% 3,200 864 4,064
Accountant/Grants Man.   12 months   20,000 5,400 25,400
Totals       110,125 29,734 139,859


B. Travel
Grants Budget
In-kind
   Local Travel
10,740
-
   Out of State CDC Workshops
7,364
-
   Total Travel
$18,104
C. Equipment
   Sub-Totals
6,660
5,700
   Total Equipment
$12,360
D. Supplies
   Sub-Totals
12,100
18,700
   Total Supplies
$30,800
 
E. Contractual    
Swope Parkway Health Center (example)  
   Method of Selection Single feasible source 9/30/2001 to 9/29/2002  
   Scope of Work Implementation of Community Action Plan  
   Budget One-half salary for the KC-CDC lead
$25,000
  Fringe @27%
$ 6,750
  Travel
$ 3,250
  Program cost:
$25,000
   Subtotals
60,000
12,000
   Total for Swope Parkway
$72,000
Sam Rodgers Health Center
   Subtotals
60,000
12,000
   Total for Sam Rodgers
$72,000
Cabot Westside Center
   Subtotals
60,000
12,000
   Total for Cabot Westside
$72,000
Missouri Dept of Health
   Subtotals
40,000
30,000
   Total for Missouri DOH
$70,000
KCMO Dept of Health
   Subtotals
40,000
12,000
   Total for KCMO DOH
$52,000
Kansas City Parks & Recreation
   Subtotals
45,000
12,000
   Total for Swope Parkway
$57,000
   Sub-Totals
$305,000
$90,000
Contractual Totals
$395,000
 
F. Evaluation/Consulting    
KU Work Group on Health Promotion and Community Development (example)  
   Method of Selection Single feasible source  
   Period of Performance September 30, 2001 to September 29, 2002  
   Scope of Work Provide project evaluation using on-line documentation system. Provide training and related materials for staff to conduct on-line documentation and retrieval of reports information. Provide technical assistance to project on matters related to on-line documentation/evaluation, provide a second party verification check on documentation entries and elicit additional information from site staff that supports project documentation efforts. Assist with development and management of project's web site.  
   Sub-Totals
55,000
12,000
   Total for KU WG
$67,000
Dr. Jasjit Ahluwalia - KU Medical Center
   Sub-Totals
10,000
2,000
   Total for Dr. Ahluwalia
$12,000
Dr. Ross Brownson - St. Louis University
   Sub-Totals
10,000
5,000
   Total for Dr. Brownson
$15,000
 
   Sub-Total
$75,000
$19,000
   Total for Evaluation/Consulting
$94,000
 
G. Other
 
Grant Budget
In-kind
IRB - Administrative cost associated with process and overseeing required IRB related protocols and procedure to support program operations.
20,000
-
Postage/telecommunications/other - To support both the Jefferson City and Kansas City-based operations.
4,200
1,200
Office space - Jeff City ($500 per month)
6,000
3,600
Office space - Kansas City
6,000
12,000
 
Special projects - mini-grants    
Seton Center -    
Support for outreach services to African-American populations served through the Seton Center community-based clinic in zip code 64127
10,000
5,000
Kansas City Free Health Center -
Support for outreach, alignment of program implementation and operations related to KC-CDC community changes outlined in the CAP with a focus on residents living in zip code 644110
10,000
5,000
Black Health Care Coalition -
Administrative support to assist the Kansas City's Black Health Care Coalition in using their in-place networks to promote community changes through the KC-CDC Action Plan process.
10,000
5,000
Concerned Clergy -    
Administrative support to assist the Concerned Clergy in the development and extension of faith-based health programs. Mini-grants to the churches to help defray cost of implementation of the KC-CDC Action Plan    
   Administrative Cost
10,000
2,000
   faith-based programs 20 x $ 2,000
40,000
40,000
   Total
50,000
42,000
Coalition for Hispanic Organization -
Coalition of Hispanic organizations in Kansas City area. Will work with the Health and Social Services Committee to develop programs within Hispanic community with the KC-CDC Action Plan
10,000
5,000
Neighborhood groups-
This project component employs this model to assist local groups in implementing one or more of the community changes outlined in the KC-CDC Action Plan. 15 x @ 3,000
45,000
45,000
Health agencies (e.g. Am Heart Assn) 3 X $ 5,000
15,000
30,000
Emerging partnerships 8 @ $ 5,000
40,000
40,000
Media promotions contractual work -    
Will support cost to agencies and media representatives to assist with media promotions, making full use of print, electronic and on-line outreach. It is anticipated that these funds will be used to provide support for support for a wide range of media initiatives rather that to 1-2 organizations, with a heavy emphasis on funds being used to generate in-kind match of media services, in exchange for actual funds provided through the project.
90,000
125,000
Special Projects - Report Cards -
Cost for 4 reports card initiatives during year one. Expenses would include cost for printing and preparation of report card materials and mailing cost. Four report carts @ $4000 each
16,000
10,000
 
   Sub-Totals
$332,200
$328,800
   Total Other Costs
$661,000
 
Proposal Subtotals (grant and in-kind)
$888,923
$461,400
 
Full Proposal Budget
$1,350,323