national association of free and charitable clinics grant handbook

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PREFACE …………………………………………………………………………………………………………. 4 MY STORY – LOU HILL …………………………………………………………………………………… 5 DEMYSTIFYING GRANTS …………………………………………………………………….…………. 7 BEFORE YOU START ………………………………………………………………………………………. 9 GRANT RESEARCH ……………………………………………………………………………………… 16 KEY STAKEHOLDERS …………………………………………………………………………………… 22 GRANT ANATOMY ………………………………………………………………………………………… 24 ORGANIZATIONAL OVERVIEW ……………………………………………………………………. 28 STATEMENT OF NEED …………………………………………………………………………………. 30 PROJECT DESCRIPTION ……………………………………………………………………………… 32 OUTCOMES & EVALUATION ……………………………………………………………………….. 34 SUSTAINABILITY …………………………………………………………………………………………. 37 BUDGET ………………………………………………………………………………………………………. 40 ATTACHMENTS ……………………………………………………………………………………………. 42 NOW WHAT? ………………………………………………………………………………………………… 44

TABLE OF CONTENTS

NAFC Practical Grant Writing Handbook First Edition October 2014 Produced by the National Association of Free & Charitable Clinics

Written by Lou Hill, Executive Director, North Carolina Association of Free Clinics

Edited by Monise W. Quidley, CFRE, Development Director, NAFC

The National Association of Free & Charitable Clinics (NAFC) is the only nonprofit 501(C) 3 organization whose mission is solely focused on the issues and needs of the more than 1,200+ free clinics and the people they serve in the United States. Founded in 2001 and headquartered in the greater metro Washington, DC area, the NAFC is an effective advocate for the issues and concerns of Free and Charitable Clinics, their volunteer workforce of doctors, dentists, nurses, therapists, pharmacists, nurse practitioners, technicians and other health care professionals, and the patients served by free clinics in communities throughout the nation.

National Association of Free & Charitable Clinics 1800 Diagonal Road, Suite 600

Alexandria, VA 22314 Telephone Number: 703-647-7427 Website: www.nafcclinics.org

BUILDING A HEALTHY AMERICA, ONE PATIENT AT A TIME.

NAFC Practical Grant Writing Handbook – Preface

One of the most common misconceptions about how the United States will look after the full implementation of the Affordable Care Act (ACA) is that there will no longer be a need for our clinics to continue to provide charity care as a member of the safety net. In fact, many are surprised to hear that even after full implementation of the ACA, according to the Congressional Budget Office, there may be as many as 29 million people, including documented and undocumented and those who are eligible for Medicaid but reside in states that are not going to expand this program, who are still without access to health insurance. In the upcoming months and years, doctors, hospitals, navigators, states, clinics, and patients will be addressing the needs of the underserved with respect to affordability, accessibility and portability of primary, specialty, dental care and medication access. Free and Charitable Clinics will remain an important part of the country’s safety net, even after the implementation of the Affordable Care Act. Given this, clinics will continue to rely on the generosity of their foundations, corporations and donors in order to continue their important work of responding to the health care needs of their community. As more and more nonprofits and other entities compete for limited funding from corporations, foundations, and the government, producing this grant writing handbook is the NAFC’s way to help you, our member clinics prepare and submit well written grant proposals. It is our hope that this handbook will provide you with a practical, useful and educational tool that will help you to write a grant application that will not only receive funding but will also truly reflect the important work that you do on a daily basis. Nicole Lamoureux Busby Executive Director, NAFC

PREFACE

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NAFC Practical Grant Writing Handbook – My Story – Lou Hill

The National Association of Free & Charitable Clinics (NAFC) receives hundreds of questions every year about grant writing. Receiving grants are, after all, an important part of most clinics’ annual budget. Rather than refer to you to a general guide for grant writing, the NAFC wanted you to have a practical handbook to grant writing written by one of your own. Nearly twenty years ago, equipped with a brand-new English degree and little real life experience, I took my first job working under a grant program doing research. When the grant funds ended for my position, I had no job and no vision for what I wanted to be when I “grew up.” I spent time over the next year working temp jobs and helping my Dad with his business. What stands out to me now, is how incredibly bored I was during this time. The jobs were unremarkable and the work felt empty to me. One thing that became clear was that I wanted to do something meaningful. I wanted to go home every night and feel like I had made a difference in my community, in the lives of others, and for the common good. I did not know what that meant and decided that volunteering might help me find my calling. And then one day I experienced one of those destined moments that changed my life forever! A woman came into my Dad’s store and started talking about a new clinic in town that served people who did not have much money or health insurance. I was intrigued and asked if I could volunteer. I spent the next several months writing the clinic’s newsletter and helping out as much as I could. With no health insurance myself, I even became a patient for a short while. I did not plan on working in a free clinic. I didn’t even plan on working in healthcare. It chose me and I fell in love with it. When the Director of the clinic called and offered me a part-time job, I accepted it immediately even though I could have taken a full-time job with benefits that same week. I could not imagine doing anything else.

MY STORY – LOU HILL

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NAFC Practical Grant Writing Handbook – My Story – Lou Hill

Seventeen years later, I have worked in every non-clinical position there is at a not-for-profit medical clinic. I even went to graduate school and received a degree in public health administration so I could do more in the health clinic field. When I accepted my first position as an Executive Director, I thought I had reached my ultimate goal. Little did I know the hard work, long hours, heartache, and patience it takes to keep a clinic thriving? I learned by making mistakes, taking risks, and being willing to fail. I wrote some terrible grants and some pretty good grants. More than anything, I never gave up. I feel incredibly blessed to have been a part of this work.

As you use this handbook, remember that someone who has been where you are wrote it. The NAFC wants you to have a practical guide to use when applying for grants – a manual written by someone with real experience writing grants for free and charitable clinic work. I hope this handbook is helpful to you and wish each of you success with your grant proposals! Lou Hill

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NAFC Practical Grant Writing Handbook – Demystifying Grants

When I tell people that I write grants, I often get responses about how hard it must be and how they could never do that. While I think that my English degree has certainly been put to good use, I don’t think that’s the sole reason I’ve been successful with grant writing. There is no substitute for quality writing but I could write the most well crafted proposal and if I haven’t given the funder what they’ve asked for, I still won’t be awarded the grant. So let’s start by demystifying the grant and talk about what a grant is and is not. A grant is for…

• New and innovative projects • Expansion of existing programs • Capital improvements or building campaigns • Specific program expense(s) • Capacity building to strengthen the organizational structure (i.e.

board development, strategic planning, adding staff, etc.) A grant is not for…

• General operating funds • Endowments or debt relief • Political or lobbying purposes • Individuals or for individual use • For-profit organizations • Immediately accessible

A word about grants for General Operating Support In the past, funders have been reluctant to award grants for general operating support in fear that organizations will become too dependent on that funding and not seeks funds elsewhere. There is some evidence that this mindset is shifting with more funders willing to consider grants for general operating support. They are still, however, few and far between and regardless will require evidence-based outcomes to show the value of your operation.

DEMYSTIFYING GRANTS

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NAFC Practical Grant Writing Handbook – Demystifying Grants

For those of you, who are not naturally gifted with writing, fear not. Grant writing is not about pretty, flowery prose. It is, for all intents and purposes, a formula. Each funder sets out a list of criteria/guidelines of what they are interested in funding. Your job is to match that criteria with your program/project and then write about it in easy to understand language, not jargon. Using good grammar is important. Spelling is important. Clear, concise, and compelling writing is extremely important. Focus on honing those skills, do your prep work and you will have a winning proposal. IT MAY BE HELPFUL TO Organize your thoughts Write an outline Eliminate the jargon Don’t embellish Be sure to include the human-interest aspect

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NAFC Practical Grant Writing Handbook – Before You Start

Have you ever painted a room in your house? How did you prepare for it? Did you spackle the walls? Tape the doors and windows? Buy the right brushes, rollers and paint for the surface? Or, did you just hope for the best and slap on whatever paint you had handy? Chances are you did at least one thing to prepare your room before you started painting. Grant writing is the same way. Understanding what the grant is for and aligning that with the funder’s priorities is the beginning of your prep work. This is where you look around your house and decide which room needs to be painted and then you buy the right type of paint for that particular room. To keep it simple, let’s break this into two parts: Know Your Organization and Know Your Funder. KNOW YOUR ORGANIZATION Start by assessing your clinic and determining what programs or projects would benefit the most from additional funding. By asking some important, yet basic, questions can help direct your efforts. Make sure that you include board members, paid staff and volunteers in these conversations in order to have the most informed answers. • Does the clinic have a stable financial base on which to build its

core programs? This is important because if you don’t have the funds for the basics, such as the power bill, then you may have grant funds for a specific project but end up doing the work in the dark. If your answer is no to this question, perhaps your efforts should be directed in finding capacity grant funding to strengthen your organizational infrastructure first.

BEFORE YOU START

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• What specific program needs does your clinic have? Usually you have a sense of what your clinic needs. If you’re not sure, listen to your volunteers, staff and most importantly, your patients. An easy way to do this is to conduct an annual patient survey. Ask them, “If you could change one thing about XYZ Clinic, what would it be?” But don’t leave the question open-ended. Give them multiple-choice responses and an option to be able to write in. For example, if your clinic is only open a couple nights a week, you may already know your patients would like it to be open for more hours, so list that as an option. In my experience, other popular patient requests are for more pharmacy hours and dental care. However, every clinic and community is different. By surveying your patients you are accomplishing two things:

1) You are identifying what patients perceive to be the greatest need and will respond to the most. This is especially critical if you ask them a program specific question such as “What types of activities would help you quit smoking?” Many a grant has been written by well-intentioned souls who believed if they built it, the patients would come. The reality is often a rude awakening, particularly if the grant requires patients to make significant behavioral changes. Ask them and then be willing to meet them where they are.

2) Patient survey information serves as excellent justification in the Statement of Need section in the grant. In addition to using national or state data, use real-time information about patient needs at your clinic. It shows the funder that you’ve taken the pulse of your organization and have a plan for success.

• Is the project aligned with the clinic’s mission? I get emails frequently from colleagues sharing new funding opportunities. Most of the time folks who just want to get the word out

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send these out in mass emails. Only about 10% of these grants ever make it to the proposal stage. Why? Because most of the Requests for Proposals (RFP’s) I receive are not aligned with the mission of my clinic. It is very tempting to go after every dollar that comes your way, but never forget that receiving grant dollars also comes with high expectations. If your mission is to provide health care for the underserved and the grant is to improve literacy, it’s probably not a good fit for your clinic. When reviewing RFP’s, it is important that you closely evaluate the time and effort required to complete a top-notch grant. Another important consideration is that if you actually receive the grant, you may not be able to complete the objectives or you may stretch your resources too thin trying to be something you’re not or do something that you can’t. Stay true to your core programs. As a safeguard, let your Board of Directors vote on any major departures from those services.

• Does the clinic have the capacity for the proposed project? So you’ve done some footwork and figured out which program or project your clinic needs to start or expand upon…the next big question is, “Do you have the capacity to do it?” To be clear, I realize that new projects often involve building capacity with new staff members and systems. This question is more about the infrastructure to support that expansion. It goes back to that first question of having a stable financial base and takes it one step further by asking, do you have the administrative infrastructure to manage a new program? This might mean policies and procedures or it may mean financial oversight. Regardless of how you define it, it’s important that you plan for what will be required behind the scenes on the project, as it’s often things funders will not cover. Sometimes, if you’re lucky, a funder will also include 10% of administrative indirect program costs in addition to the awarded amount, but this financial perk is becoming more and more rare. More often than not, most funders expect the clinic to supply administrative oversight and cost as part of their in-kind contribution.

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• Who will be responsible for project implementation? This is tied in closely with the capacity question but is directly related to project activities as opposed to administrative oversight. If you are an Executive Director (ED), always ask yourself if taking on oversight of another project is the best use of your time. It is very common and very easy for Executive Directors to take on leadership of every new project. But with every new project taken on, something else may be neglected. In order to grow your clinic, to truly build its capacity, the Executive Director must have a broader vision than just the day-to-day operations or particular projects. This is not to say the ED isn’t involved. It just means that direct project oversight is delegated to a trustworthy team member who can report to the ED on the grant.

• What data exists or is needed to build a case for funding? If you don’t have a stockpile of data, the Patient Survey is a good place to start. It’s simple, easy to do and can be tailored to specific programs when necessary. More about Patient Surveys will be discussed in the chapter on Outcomes. Beyond the basic data of patient demographics and the number of visits, what information will you need to begin building your case for funding? If this is a grant that is tied to health outcomes, which is increasingly more common, then perhaps you will track specific health measures for a pre-defined cohort of patients. More detailed information for all data collection, including establishing patient cohorts, will be discussed in the Outcomes chapter. Data collection should always be considered an integral part of the grant from beginning to end because it is the sole way to demonstrate success.

TYPES OF FOUNDATIONS Just like our clinics, foundations come in all shapes and sizes. It’s important to understand what type of foundation you are working with prior to submitting a proposal. The following is a brief summary of types of foundations. For a more thorough overview, visit The Foundation Center’s

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website for their full Profile of the Funding Community (http://foundationcenter.org/getstarted/tutorials/ft_tutorial/profile.html). Private Family Foundations – • Generally started with an endowment in honor of a family member • Often the Board of Trustees is comprised of family members • May have a preset list of nonprofits funded based on family preferences

or greater discretion about how funds are disbursed Corporate Foundations – • Receive funds from their parent companies; but are legally separate

entities • Managed by a separate Board of Trustees • May only make grants to states where company is located or conducts

business • Often have specific priorities, guidelines or areas of interest Public Community Foundations – • Often support the specific geographic regions where they are located • Priorities typically focused around community needs • Receive funds from numerous sources and solicit endowments and donor

advised funds to build their portfolios • The Board of Trustees is usually comprised of community

leaders/members KNOW THE FUNDER Consider that, like your clinic, the Foundation you are applying to have a Board of Directors that, like your Board, has been charged with being a good steward of the organization’s resources. When the foundation’s Program Officer receives and vets your proposal, they are calculating whether your project will be the best use of the Foundation’s funds and how their Board will receive it. Understanding what makes each funder tick is invaluable and will help you craft your proposal to meet his or her needs. Just as you did with your clinic, ask some simple questions to decide which funder is a good fit for your project.

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• Does your clinic meet the funder’s eligibility criteria? It is important to learn the funder’s grant making philosophy, program/project interests and criteria. Every funder has different eligibility criteria that determines who is allowed to apply for their grants. Examples of eligibility restrictions are geographic preferences, priority issues, religious affiliation, academic oversight, the types of organizations that may apply, etc. Be sure to check the purpose of the grants offered, the timeline for submission and the funding cycle. Many funders will only accept proposals by their invitation. If you don’t meet the eligibility criteria, do not waste any additional time with that particular funder.

• Is the clinic/project a good fit for the priorities listed by the funder? This is the flip side to the question of whether or not the project is aligned with the clinic’s mission. Here, you are asking if the project is aligned with the funder’s mission. Each funder has defined priorities and guidelines established by their Board of Directors. Don’t try to fit a square peg into a round hole. If the funder’s guidelines don’t match what you’re trying to do, move on to another funder.

• What projects have been funded in the past and for how much? Most foundations, particularly larger foundations, have comprehensive websites and produce annual reports that list the projects and charities that have been funded the prior year. A web search may also reveal press releases or other pertinent information about specific grants the funder made to similar nonprofits. In the next chapter on Grant Research, there is valuable information on how to review the funder’s tax return to glean even more information.

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• Does your clinic’s board members or volunteers have any personal connection to the funder?

Someone with a personal connection may be able to give you additional insight on how to approach the funder and specific items to focus on in the grant proposal. A connection may even be able to help you to schedule a fact-finding visit with the foundation prior to submitting the proposal. Depending upon the relationship, your connection may be able to submit a letter of support to accompany the grant. How you use the connection will ultimately depend on their willingness to get involved on behalf of you and your clinic. Taking the time to sort through the relationship and determine how the connection can assist is definitely worth the effort. Other potential sources of information include local nonprofits that have previously received grants from the funder. Remember to build relationships with your peers. Contacting another local nonprofit that has already received funds from the grantor could be extremely helpful. Ask if they would be willing to share their experience with the grantor with you, especially the proposal process.

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NAFC Practical Grant Writing Handbook – Grant Research

For those new to grant writing, there is a tendency to research grants using general search terms on the web or by using very expensive foundation search engine subscriptions. The problem with this is the results are often for very large, national foundations that may or may not include access to health care as one of their priorities. Competition for grants from these foundations is extreme and the rejection can be discouraging. If you are just starting out with grant writing, your best bet is to use local resources, free searches and especially word of mouth to identify potential sources of funding. Local grants are often much smaller, but are also a great way to hone your writing skills with a simple, one page request. It generally requires fewer attachments. PAID RESOURCES • Grantstation – You can receive a drastically reduced rate with a NAFC

membership • The Foundation Center – Subscription offers in-depth information on

funders and ability to sort by funding interests and geographic area. With a subscription, you are also able to save your favorites for later review

FREE RESOURCES • Foundation Annual Reports, websites • Any past history your organization has with the foundation • Other non-profits in your community • NAFC – Newsletter and Grantstation briefs • Other clinics • The Foundation Center

o Identify foundations in your geographic area o 990 Review

GRANT RESEARCH

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Figure 1: The Foundation Center 990 Search Page

Figure 2: Search results for "CVS" from 990 Search Page

For example, search for “CVS” under “Organization Name”

for a list of all 990’s associated with CVS

Look for the most recent 990 to start but if you have time, go through a couple years to see

trends in giving

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990 REVIEW

KEY THINGS TO LOOK FOR… Part I, Line 25, Page 1 – Contributions, Gifts & Grants Paid

Figure 3: Page 1 of the CVS Caremark Charitable Trust 2012 990

This is the amount paid out in grants in 2012

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Part III, Line 6, Page 2 – Total Net Assets at Year-End

Figure 4: Total Net Assets

Part VIII, Line 1 – Officers & Trustees

Figure 5: Officers &

Trustees

If you’re not familiar with the foundation at all, this helps give you an idea of their size. Foundations can have anywhere from $10,000 in net assets to billions. Keep in mind that what is granted is only the interest off of these assets.

It never hurts to know the names and positions of the Board and Staff at major foundations. Share this list with your Board to see if there are any connections. This will also help you see how their Board is structured. For example with family foundations, their board is often comprised of a group of relatives.

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Part XV, Line 2 (all) – The 4 W’s: Who, What, Where, and When?

Figure 6: WHO: Foundation Employees & Divisions (FOR EXAMPLE ONLY)

Figure 7: WHAT: Funding Priorities (FOR EXAMPLE ONLY)

Figure 8: WHERE AND WHEN: Grant Submission Requirements (FOR EXAMPLE ONLY)

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Part XV, Line 3a, Attachment 11 – Grants Paid Out or Approved Figure 9: Grants Paid Out

This section of the 990 provides you with information on who works there, what regions they represent, what their funding priorities are and how to submit the application. In this case, the foundation does online applications and screens applicants for eligibility before they can complete the full application.

In the case of our example, CVS Caremark Charitable Trust, there are a large number of grantees. For smaller foundations, the list may only be a page. This is one of the most important parts of the 990 to review because it reveals not only what they fund, but also their funding range. This is important to know so that you don’t ask for $25,000 when they only give grants of $5,000.

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NAFC Practical Grant Writing Handbook – Key Stakeholders

Stakeholders are individuals or groups who have a vested interest and concern in the success of your organization. Stakeholders can affect or be affected by the organizations actions, objectives and policies. While all of us know that patients, volunteers and donors are stakeholders, it’s often easy to leave out important partners. As you develop a master list of stakeholders, have your board review it to insure you don’t leave anyone out. This is particularly important if a specific group sponsors the grant. In the case of the CVS grant, leaving out the NAFC would be a major red flag for CVS since the NAFC was responsible for securing the grant funding for its members. Be very thorough in making your list and update it annually. WHO ARE THEY? • Patients including their families and/or spouses • Volunteers/Board of Directors • Donors • In-Kind Donors – Hospital, physicians, etc. • Monetary – Include specific names for larger funders or those with key

roles such as county government • Community Partners • Other community organizations • Vendors/Suppliers • National Association of Free & Charitable Clinics • State Association

WHY ARE THEY IMPORTANT? • Reason for being • Capacity • Return on Investment • Critical Services • Program and General operating funds

KEY STAKEHOLDERS

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NAFC Practical Grant Writing Handbook – Key Stakeholders

• Resource Sharing • Leveraging Resources • Advocacy • Purchasing Discounts • Funding Opportunities

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NAFC Practical Grant Writing Handbook – Grant Anatomy

Most grant applications ask the same set of questions with very little variation. Grant anatomy typically includes:

• Project/Executive Summary – Use key statements from larger narrative This summary usually comes after your cover letter. It helps the grantor to understand quickly what you are seeking. This summary should only be a couple of key sentences touching on the main points of your proposal. This summary should be brief. The executive summary should be clear, concise, compelling and well written to impress the reader. Explain what your clinic does and its mission and include specific details of the proposed program/project to get the reader involved, enticing them to read more.

• Organizational Overview In this section give a short history of the clinic, state its mission, vision and values, the population it serves and provide a detailed overview of your track record in achieving your mission to date. In a few paragraphs explain what your clinic does, and why the funder can trust you to use the requested funds responsibly and effectively. Be detailed even if you know the funder or you have received funds from them before.

• Statement of Need

This is the “meat” of your proposal. You must convince the funder that what you propose to do is important and that your clinic is the right one to do it. Assume that the reader of your proposal doesn’t know much about the issue or subject matter. Don’t use jargon. Explain why the issue is important, and what research you’ve done to learn about the possible solutions. The statement of need should include both stories and factual data, and be matched to the interests of the grantor. The goal is to

GRANT ANATOMY

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convince the grantor that your project solves a crucial societal problem, and that they should be completely interested in supporting it.

• Program/Project Description The program/project description should describe the problem the program/project will address, its goals, overall objectives and the plan. Key items to include are the program/project’s location, the length of the program/project, objectives, staffing and administration, as well as any evaluation to date. It is important to use plain English, so that any reader is able to comprehend.

• Outcomes and Evaluation Perhaps the most critical part of the grant, this section shows how you plan to “move the needle”. What are you going to do to prove you’ve addressed the needs you’ve identified. Outcomes relate to your objectives, you want to have a significant impact but still be credible. Be careful not to overstate how much the program/project can claim or measure. If the need is to increase access to care, then perhaps you will show an increase in the number of new patients or visits. More and more funders are looking for outcomes that go beyond just increasing volume and actually show improvement in patient health. The proposal should include a plan for determining the degree to which objectives are met. Explain who will be doing the evaluation, how they were chosen (list credentials) and clearly state the evaluation criteria. Be realistic and use an evaluation plan that is either already in place or can easily be implemented. Using the same outcomes metrics for more than one grant is often helpful in reducing the total number of metrics you collect.

• Goals and Objectives

Here is where you explain exactly what your clinic plans to do about the problem. State what you ultimately hope to accomplish with the project and spell out specific results or outcomes you expect to

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accomplish. Think of goals as general and broad outcomes and objectives as the specific steps you’ll take to reach/get those outcomes.

• Sustainability This is the section that will give the funder a clear explanation of how the clinic will be able to keep the program/project going financially. Have you gotten committed funds from other sources? Or have you asked other sources? Most funders don’t want to be the only source of support for a program or project. Be sure to mention in-kind contributions you expect (i.e. meeting space or equipment). You are responding to the question of; how do you plan to fund this project into future? In detail describe your plan for securing additional funding.

• Budget How much will your program initiative/project cost? Attach a short budget showing expected expenses and income. The expenses portion should include personnel expenses, direct project expenses, and administrative or overhead expense. Income should include earned income and contributed income. It is important to show specific project budget not the whole operating budget.

WRITING THE NARRATIVE

• Be concise • Be clear • Be specific • Be compelling • Don’t use We, I, Our if possible • Repeat Critical Points • Use only relevant (local), factual data to build your case

Using national data in conjunction with the local data in some cases may bolster your narrative.

• Show leveraging power through partnerships

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• Proofread and then proofread it again and then give it to someone else to proofread, preferably someone that isn’t so familiar with your program/project.

Keep in mind as you are writing a grant that each funder will receive many applications for many different types of projects. While you may eat, sleep and breathe the work at your clinic, the funder does not and it’s critical that you present your proposal clearly. Sometimes it can be difficult to tell if it’s clear because you are so familiar with it. It can be very helpful to have someone outside of the clinic and not familiar with your programs to read your grant and see if it makes sense to them.

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NAFC Practical Grant Writing Handbook – Organizational Overview

This is your chance to showcase your clinic’s best attributes by writing about who you are and what you do. Drill down on what your clinic does and why it is so important using only a few sentences to set the tone. EXAMPLE XYZ Clinic is a comprehensive medical and pharmacy home for the uninsured of XYZ County. The majority of patients served suffer from one or more chronic diseases that affect their heart, lungs, metabolism, and even their ability to move. Without XYZ, these individuals face an uncertain future with poor quality of life and limited access, if any, to healthcare. Eligibility Guidelines

• Geography – Do patients have to live in a specific geographic area in order to be eligible for clinic services? Is the clinic located in the right geographic area?

• Insurance status – This is particularly important in the era of the Affordable Care Act (ACA). Funders are curious and concerned about how clinics fit within the context of this very complex legislation. It is not necessary to go into great detail but may help, for example, to note that patients who may be eligible for insurance subsidies in the federal marketplace are referred to a community partner for navigation services. How your individual clinic is managing changes under the ACA will depend on your state, your clinic structure and your patient mix.

• Income guidelines – Give a context if referring to Federal Poverty Levels. If you write that your clinic serves individuals with household incomes less than 200% of the federal poverty level, follow it up with an example such as a family of four can make up to $47,700 before taxes and be eligible for clinic services.

ORGANIZATIONAL OVERVIEW

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NAFC Practical Grant Writing Handbook – Organizational Overview

Put a Face on the Services • Age • Race • Gender • Household Income • Employment Status • Any other unique attributes about your patients

EXAMPLE In order to become a patient of XYZ Clinic, patients must go through the enrollment process and meet the following eligibility criteria: resident of XYZ County, no private or government health insurance and household income less than 200% of federal poverty levels. Patient incomes are lower than ever with the number of patients with household incomes less than $15,000 increasing 12% in the past two years to a record high of 90%. With poverty and unemployment consistently in the double digits, there is nowhere else for them to go. Demographically the program serves slightly more men than women; 60% of patients are Caucasian, 28% Latino, 9% African American and 3% other. Nearly 90% of patients are over the age of 30 and a full third are employed.

Description of Services • Use bullet points • Include community partners in descriptions

EXAMPLE (partial excerpt): • Mental Health

o Case management by 0.5 FTE Peer Support Specialist provided in-kind by local Behavioral Health agency

o Psychiatric counseling and medication management • Dental Care

o Primarily limited to emergency extractions twice a month by volunteer dentist

o Limited pilot program with farm worker patients o Fledgling hygiene program with dental hygiene students

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NAFC Practical Grant Writing Handbook – Statement of Need

When writing the statement of need, it’s easier to break it down into a series of easy to answer questions:

• WHO? – Reiterate who your clinic serves briefly • WHAT? – Clearly state the problem including cites based evidence

of LOCAL severity. Use internal, patient driven data if possible.

• WHERE? – Where is the need located and where is the service provided?

• WHEN? – How long has this been an issue and how long has your organization been addressing it?

• WHY? – What IMPACT will your clinic addressing this issue make? Why are you the right organization to tackle this problem?

EXAMPLE The proposed project will expand the partnership between ABC Hospital and XYZ Clinic to include Community Care and the Department of Social Services in order to create a new Medicaid family practice. The practice will operate under ABC Hospital, but will be housed in currently unutilized space at XYZ Clinic in order to reduce overhead costs and increase resource sharing between the two. The primary goal of this project is to create new medical homes for Medicaid recipients and the uninsured of XYZ County, while simultaneously creating new jobs and keeping important revenue within the county. In December 2009 alone, sixty-two Medicaid recipients were forced to find a Medicaid provider outside of XYZ County due to practice closure, physician retirement and lack of physicians in the county accepting new patients (Source: Department of Social Services). This is an average for most months of 2009 and does not account for any patients who simply have gone without care because they do not realize they qualify for Medicaid. Given the cost of a new patient visit, return visits, chronic care case

STATEMENT OF NEED

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NAFC Practical Grant Writing Handbook – Statement of Need

management and transportation, more than $1 million of Medicaid revenue goes to providers out of the county (please see below): Medical Home Access Program Medicaid Revenue Savings

New Patient Visits (62/months @ $129/visit) $ 95,976 Chronic Care Follow-Up Visits (75% of patients @ $99/visit) $ 662,904 Basic Follow-Up Visit (25% of patients bi-monthly @ $56/visit) $ 62,496 Access Medical Home Enrollment Fees (75% of patients @ $5 per pt/month) $ 33,480 Transportation (8,556 visits @ $20/visit) $ 171,120 Total Savings $ 1,025,976

USING PATIENT SURVEYS

• Pick a minimum number to survey – 100 is a good sample • Keep it simple – less than a page and 10 multiple choice questions • Easy way to establish quantifiable needs and impact of your clinic

EXAMPLE Because of widespread lay-offs and loss of unemployment benefits the number of XYZ Clinic patients has grown from 100 unduplicated patients in 2007 to 1,000 in 2012. In a 2013 randomized survey, 60% of patients surveyed have been a patient at XYZ Clinic for more than a year and 85% consider XYZ as their medical home. In addition since becoming a patient at XYZ, 75% report fewer emergency room visits, 92% fewer hospitalizations and 74% of patients. USING FOCUS GROUPS A focus group is a form of qualitative research in which a diverse group of people are assembled and asked about their perceptions, opinions, beliefs and attitudes towards a designated topic. Using a focus group may help you gain a clearer understanding about your clinic, program or project. It will help you learn more about the groups or community opinions and needs.

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NAFC Practical Grant Writing Handbook – Project Description

KNOW OUTCOMES AND BUDGET FIRST It can be very tempting to write out the project description first and build your proposal from there. While it is important to have a general idea of how the project will work, identifying your outcomes and your budget needs FIRST, will allow you to be very thorough in your description and timeline implementation. The saying “Start with the end in mind” is very true when writing grants. Determine what you want to accomplish first through your outcomes measurements and then work backwards by developing a budget and then your project description.

FOCUS ON THE PROGRAM BEING FUNDED Clinic programs are often inter-woven and overlapping, which can make writing separate descriptions for each of them, challenging. When writing your grant, stay very focused on the project at hand. The Organizational Overview section of the grant is the place to list other clinic programs. It is fine to mention them in the Project Description narrative but only in context with the proposal. HAVE AN IMPLEMENTATION TIMELINE Even if the grant application doesn’t specifically ask for a timeline, it is good practice to develop one and distribute it to the staff members that will be responsible for particular items. This helps avoid confusion once the grant is received and the project gets underway. It will also help bolster your chance for achieving your goals. DESCRIBE YOUR PARTNERS AND THEIR ROLE Community partnerships, particularly those that leverage additional resources for the proposed project, are a critical part of the Project Description. This shows the funder that you are collaborating within your community in order to maximize your funds. Make sure you are specific and provide quantitative value and volume of any cash or in-kind contributions.

PROJECT DESCRIPTION

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NAFC Practical Grant Writing Handbook – Project Description

For example, ABC Hospital donated more than 1,000 x-rays valued at $500,000 in 2013. Towards the end of the Project Description, you can start to transition by leading into outcomes by mentioning the shift from A to B. For example, “Expanding the clinic’s services will reduce wait time by x% and increase operating hours by x%.”

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NAFC Practical Grant Writing Handbook – Outcomes & Evaluation

Outcomes are the most important part of your grant proposal because you are essentially developing a report card for yourself on which your funder will grade you. When you write this section, you are telling your funder you are going to improve some measure in your clinic over a specified time frame. Be very realistic when setting your goals, understanding that 100% is never an achievable goal. If you’re not sure of what outcomes to use, the patient survey tool can be a helpful way to establish baseline measures to build on. By pre-planning for measurement and reporting, you are setting the stage for success. Once you have some established outcomes for specific programs (i.e. 65% of hypertensive patients will achieve BP control of less than 140/90), use them for other grants. It is not necessary to create new outcomes for every grant.

THE DIFFERENCE BETWEEN OUTPUTS AND OUTCOMES… QUANTITY VS. QUALITY Outputs are a count, a quantitative value of a service your clinic provides. Examples include the number of unduplicated patients, the number of medical visits and the number of prescriptions. EXAMPLE

OUTCOMES & EVALUATION

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Outcomes are qualitative measures that typically reflect improvement in patient health and quality of care. These measurements are becoming increasingly important to funders. For clinics that do not have electronic medical records the necessary reports, there are standardized methods to choosing smaller size patient cohort to track throughout the year. EXAMPLE

Diabetic patients with HgbA1C less than 7 35%

Diabetic patients with HgbA1C greater than 7 show improvement 65% Diabetic patients with HgbA1C less than 9 70% Diabetic patients who receive education 80% Diabetic patients who received an annual foot exam 65% Diabetic patients who received a retinal exam

70%

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S.M.A.R.T. OUTCOMES S: SPECIFIC Who is impacted?

• What is the intervention that will bring about the change? M: MEASURABLE

Are there evaluation tools (surveys, observations, etc.) or other evidence than can provide needed information?

• How much change is expected or what is the quantifiable result? A: ACHIEVABLE

• Can outcome be attained within the time frame and available resources?

• Can outcome be achieved with the intervention given the scope of the problem?

• Is the outcome a “stretch”? R: RELEVANT

• Does the outcome matter or make a difference? • What is the strength of the linkage between the outcome and the

impact? T: TIME BOUND

• What is the time frame for achieving the outcome?

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NAFC Practical Grant Writing Handbook – Sustainability

What the grant asks…

Describe how your project/program will sustain itself after the funding ends

What the funder is really asking…

• Is this funding just a quick fix or is this a longer-term solution? • Will this project end with the funding and leave those community

needs unmet yet again? • What work has your board and your organization done to plan for

its future? • Is there a fundraising plan? • How has the clinic diversified its funding base so that sole support

for the project isn't dependent on one funder? • How does the Affordable Care Act (ACA) affect sustainability? • Will our contribution have a lasting impact?

TYPICAL ANSWERS The Vague Response

Medication assistance has been an ongoing project started in 2000. Each year, additional sources of funding have been sought and secured. Additional sources of funding are currently being investigated. As previously noted, support from community sources has resulted in a 17% increase in revenue.

The Specific Response

Medication assistance has been an integral part of XYZ Clinic’s programming since 2000. Multiple funders including ABC Foundation and ABC Church have provided $XXXX for the program over the last X years. An additional $ in funding from DEF Foundation and DEF business are pending. Community support is expected to increase by 15% through the annual campaign and increased media presence

SUSTAINABILITY

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THE BEST ANSWERS The best answers focus on:

• How the benefit to the patients will be sustained • How the program will be integrated into existing programs and

services • Capacity building within the clinic to promote long-term

sustainability with all of its programs • Detail how the clinic will sustain the health improvements first,

instead of focusing only on the funding. This could include things such as:

o Systems changes within the clinic that create a better system of care

o Greater staff and/or volunteer involvement o Improved communication or communication plan about the

value of the project to clinic staff, volunteers and donors • Detail a fundraising plan that shows:

o Diversity of funding sources o Avenues of earned income

WHAT NOT TO SAY

• Our clinic will apply again next year for this funding – Foundations need to know that you aren’t solely dependent on them for funding. Show them that you’ve got a development plan with identified ways to sustain new programs

• Our clinic will not be able to continue the program and will shut it down – When your clinic is awarded a grant, the funder has made an investment into your organization and they want to see it grow and thrive beyond the life of the grant. Any indication that your organization does not have a plan for continuation is a sure way not to get funded

• We don’t know – The truth is (and funders know this) you may not completely know how you’re going to fully fund every program in the coming years. However, you do know aspects to your budget

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and are able to make estimates based on historical trends in giving. Use what you do know to make your most educated projection.

• We are going to pray about it – I was the Director for a faith-based clinic for many years and understand the importance and value of prayer. I spent countless hours praying for the well being of our clinic and our patients. However, when you are writing a grant, you are essentially building a business case with actionable steps. Those steps are the footwork behind your prayers and need to be explained fully to funders.

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NAFC Practical Grant Writing Handbook – Budget

IMPORTANT BUDGET POINTS

• Make sure the numbers match and the calculations are correct • Don’t overlap your grants – use a spreadsheet or QuickBooks to

separate by class • Keep it simple • Plan expense tracking procedures based on:

o Will the grant be paid as lump sum or reimbursement? o Will they require you to provide invoices with expense

documentation? • And, again, because it can’t be said enough….

MAKE SURE THE NUMBERS MATCH

EXAMPLE OF CLASS BUDGET

Expenses Org

Budget CVS Women's Health

United Way WNCF Unrestricted Total

Salaries & Benefits 300,000$ 25,000$ 10,000$ 50,000$ 150,000$ 65,000$ 300,000$ Dues & Subscriptions 2,000$ -‐$ -‐$ -‐$ -‐$ 2,000$ 2,000$ Professional Development & Travel 4,000$ -‐$ -‐$ -‐$ 2,000$ 2,000$ 4,000$ Facility Expense (Rent, Housekeeping, etc) 20,000$ -‐$ 2,000$ 5,000$ 5,000$ 8,000$ 20,000$ Liability Insurance 10,000$ 1,000$ 1,000$ 2,000$ 6,000$ 10,000$ Licenses & Permits 1,000$ 500$ -‐$ -‐$ 500$ -‐$ 1,000$ Maintenance/Repairs 2,000$ -‐$ -‐$ -‐$ -‐$ 2,000$ 2,000$ Program Supplies 15,000$ 5,000$ 3,000$ 2,000$ 5,000$ -‐$ 15,000$ Office Supplies 3,000$ 1,000$ 500$ 1,000$ 500$ 3,000$ Postage 1,000$ 500$ -‐$ -‐$ -‐$ 500$ 1,000$ Printing 500$ -‐$ -‐$ -‐$ 500$ -‐$ 500$ Professional Fees 8,000$ -‐$ -‐$ -‐$ -‐$ 8,000$ 8,000$ Service Contracts 6,000$ -‐$ 2,000$ 2,000$ 2,000$ -‐$ 6,000$ Telephone & Internet 5,000$ -‐$ 500$ 500$ 500$ 3,500$ 5,000$ Volunteer Expense 2,000$ -‐$ -‐$ -‐$ 2,000$ -‐$ 2,000$ Bank Service Charges & Interest Expense 500$ -‐$ -‐$ -‐$ -‐$ 500$ 500$ Capital Equipment 2,000$ 2,000$ -‐$ -‐$ -‐$ -‐$ 2,000$ Fundraising Expense 1,000$ -‐$ -‐$ -‐$ -‐$ 1,000$ 1,000$

Total Expenses 383,000$ 35,000$ 19,000$ 60,500$ 169,500$ 99,000$ 383,000$

EXAMPLE OF BUDGET NARRATIVE • Pharmacist ($45/hour @ 10 hours week + FICA) - $25,190

To provide chronic disease medication management and targeted health education

• Pharmacy Medications & Supplies - $7,000

BUDGET

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NAFC Practical Grant Writing Handbook – Budget

Labels and vials for patient medications Medications

• Computers and Scanners - $2,000 Two new computers and scanning equipment to allow for

electronic documentation of prescription pick-ups • Continuing Education - $810

Continuing education for clinical staff directly related to chronic disease

Total Request - $35,000

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NAFC Practical Grant Writing Handbook – Attachments

The attachments are often the afterthought of grant writing. If you’ve waited until the last minute and finished the grant but realize you don’t have the attachments ready, it can be easy to miss the deadline. Establish a hard copy and electronic file with the following to avoid having to search multiple places:

• IRS Determination Letter • Annual Audit • 990 • Organizational Budget • Program/Project Budget • Board of Directors List with affiliations • Organizational Chart

Other potential documents if allowed:

• Annual Report • Fact Sheet • Videos • Photos • Letters of Support

Please note that ALL attachments should be clearly labeled and in PDF form if sent electronically. LETTERS OF SUPPORT

• Choose only partners relevant to the grant proposal • Always include letters of commitment if the partner will be playing a

key role in the grant • Get letters early, preferably as soon as you’ve received the grant

opportunity and decided on a plan of action

ATTACHMENTS

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NAFC Practical Grant Writing Handbook – Attachments

• Develop a support letter template and send with your request to make it easy for your partners to complete

PUTTING IT ALL TOGETHER Put everything together with your cover sheet (not always a requirement) and a cover letter. You may need to have your Executive Director sign the cover letter. You do not need a fancy binder, but it should all be neatly typed and error free. Make a copy for your files. Follow all instructions as indicated (i.e. some foundations request more than one copy, some may request receiving it both electronically as well as a hard copy.) You may hand-deliver if possible, but however, when you get it to them, be sure to get a receipt when available.

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NAFC Practical Grant Writing Handbook – Now What?

The proposal has been submitted and you are waiting for the response.

1. Generally most grantors will indicate how long the review period may take. Depending upon the grantor that can be anywhere from three weeks to three months, so don’t spend any money yet.

2. You may receive the final decision by telephone call, email or an official letter.

THE DECISION IS IN:

YOUR REQUEST IS GRANTED

It’s time to Celebrate!!!

Send a thank you note, regurgitating/highlighting key elements outlined in the grant.

Read the terms of the agreement and sign; and immediately return any documents as requested. Make a copy for your files.

Begin setting your program/project into motion. Place any required reports or timelines due in your tickler file.

Set up the method to track your activity and spending as related to the grant.

NOW WHAT?

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NAFC Practical Grant Writing Handbook – Now What?

YOUR REQUEST WAS DENIED

Take a look at the initial guidelines, and depending on the description you may be able to request support again, in a year, for something else, see and place it in your tickler system.

This may also be an opportunity for you to call, write or email the person that signed the denial and request a debriefing session. Ask up front for a short period of time (five or ten minutes). If a debriefing session is permitted, use this time wisely to ask the Program Director or their designee poignant questions regarding your submission and perhaps how you may have missed the mark. This information will be helpful for your next proposal submitted to them and any future proposal you may write.

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national association of free and charitable clinics grant handbook

Documents