Application for Funding

Funding Opportunity Announced: Thursday, April 2, 2015Applications Due: Friday, May 1, 2015 at 4 pm ESTFrom: Beth Israel Deaconess Hospital-Milton, Milton, MAEncompassing the towns of: Milton, Randolph, Quincy, Braintree, Canton,

Dorchester, Mattapan, Hyde Park

For more information about Beth Israel Deaconess Hospital-Milton, please visit our website, www.bidmilton.org

One-time grants are available for $500 up to $1,500 to serve one or more communities within the service area of Beth Israel Deaconess Hospital-Milton (service area cities/towns stated above).

Applications must be received by Friday, May 1, 2015 at 4 pm EST, and funded projects must be completed no later than June 30, 2016.

Background Information

Beth Israel Deaconess Hospital-Milton (BID-Milton), formerly Milton Hospital, an affiliate of Beth Israel Deaconess Medical Center, cares for people of all ages in Milton, Quincy, Braintree, Randolph, Canton, Hyde Park, Mattapan, Dorchester and other local communities. Our services include general medical and surgical inpatient care, 24-hour emergency services and a complete complement of outpatient health services, including a new Center for Specialty Care. BID-Milton is committed to improving the health of our community by providing high quality, personalized health care with compassion, dignity and respect for patient rights in a cost effective and safe manner.

BID-Milton’s community benefits mission is to provide free or low-cost programs that address unmet health and wellness needs in the communities of Milton, Randolph, Quincy, Mattapan, Dorchester, Hyde Park, Braintree and Canton, in a manner shaped by community input, aligned with hospital resources, and guided by our mission.

Each year, we seek to meet the needs of our community with an organized effort of outreach programs, health educational opportunities, screenings and other means of support. Over the years, we have developed strong connections with many organizations and individuals in our community that have provided BID-Milton an avenue to share our services and skills. Our connections to seniors, families, students, professional health organizations and strong medical resources have resulted in many successful community health programs.

We continually seek new ways to reach out to our service area. In 2010, BID-Milton established its Community Health Walk. All proceeds from the walk are distributed in the form of mini-

grants to local organizations. A list of past grant recipients is included in this packet. This year’s walk, to be held on June 13, 2015, will again support community health initiatives.

BID-Milton’s 2015 Community Benefits goals are to:

1) Improve access to care that addresses the needs identified in our service population; 2) Engage community partners to focus chronic disease prevention and education efforts,

including congestive heart failure, diabetes and COPD (Chronic Obstructive Pulmonary Disease) to best impact vulnerable populations in our service area;

3) Collaborate with community partners to focus substance abuse prevention efforts on the general population;

4) Collaborate with community partners to enhance community knowledge of mental health as a primary health issue and promote available mental health resources and supports;

5) Enhance community resources on nutrition counseling and education;6) Support optimal use of transportation services available within our service area.

Among the many approaches BID-Milton will take to address these goals will be to provide financial support to organizations whose stated objectives are aligned with these goals. Therefore, grant applicants with projects that address any of the six goals stated above will be scored higher than those that do not address these objectives.

Applications for Funding

BID-Milton seeks applications from local service agencies, non-profit organizations, Boards of Health, coalitions, and community groups to help address the community health needs outlined in BID-Milton’s 2015 Community Benefits statement of goals (see bold headline above). Other hospitals or hospital-affiliated organizations may not apply for funding.

Applicants should submit proposals which use proven or promising, innovative practices to improve primary care, disease prevention and/or health promotion for vulnerable populations, with a focus on at least one of the following issue priorities:

1) Provide access to affordable, community-based medical and preventive services, particularly for seniors (access defined as health literacy, assistance with enrolling in insurance, outreach efforts or screenings);

2) Offer educational programs and/or screenings to address chronic disease prevention and education that impacts vulnerable populations;

3) Increase awareness of substance abuse as a growing health problem with a focus on education and prevention;

4) Enhance community knowledge of mental health as a primary health issue and promote available mental health resources and supports;

5) Develop programming that addresses health education around obesity and nutrition;

6) Improve access to care by promoting existing public transportation options.

All applications must be typed and must answer each the five questions described below. Responses to questions 1 through 5 may not exceed five pages and may not exceed the $1,500 budget request. The budget and cover sheet are not included in the 5-page limit. Administrative overhead may not exceed 10% of the total amount requested. Proposals that exceed the page limit or exceed the budget request will not be considered. Proposals will be evaluated against the

criteria listed below. All proposals must respond to each of the following questions. Proposals should be organized following the same order and numbering as the questions below:

1. 10 points: Provide a brief but clear abstract of the proposed program. (500 words or less)

2. 25 points: Describe how your proposal will improve access to care, chronic disease prevention, healthy nutrition choices, substance abuse and/or mental health education and treatment or support the use of transportation services for health related visits with a focus on one or more of BID-Milton’s 2015 Community Benefits goals.

3. 10 points: Describe the agencies that have agreed to work with you to implement your program and how these collaborations will enhance the effectiveness of your proposed project. Include the names of your key contacts within partner agencies.

4. 25 points: Describe (a) the targeted priority population (e.g., gender, age, race, ethnicity, socioeconomic status), (b) the geographic community that will be impacted by your program, and (c) the number of people your program will reach. Preference will be given to applications with the potential to impact the targeted priority population in accordance with the requested funding level. In addition, preference will be given to applications with a target population within one or more of BID-Milton’s service area, as stated at the beginning of this Application for Funding.

5. 20 points: Describe your goals and objectives and methods to evaluate success in reaching targeted outcomes. Preference will be given to applications that have SMART goals (Specific, Measurable, Attainable, Relevant, and Time-bound).

6. 10 points: Provide a budget for your program using the attached form. You must include line-item costs and a brief description of each line item, as well as evidence of other funding sources relevant to the project, including your own organization’s plan to provide funding, if any. Please include justification for any supplies/equipment expenses. Finally, please explain how partial funding could impact your project.

Budget

Applicants must use the attached budget template when outlining costs associated with the proposed project. Below is an example of how to complete the template.

Budget Example

Item Total Project Costs Other Funding Sources (Specify) Amount requested in application

Staff2 Youth Center Staff $300.00 $300.00

Consultant (youth training) $100.00 $100.00

Stipend (10 Peer Leaders, 10 training hours @ $8.00 per hour) $800.00 $800.00

Suppliespaper, markers, food for youth meetings $50.00 $50.00

Equipmenttape recorder and microphone $50.00 $50.00

Agency Overhead (may not exceed 10% of budget requested) $200.00 $200.00

Other expenses (list and explain)

Total $1500.00 $500.00 $1000.

Budget Justification Example: A group of ten peer leaders will work out of the youth center, overseen by the youth center staff, but an outside consultant will be invited to run a special session on HIV transmission with the peer leaders. For a stipend of $100 she will spend two hours training the youth and will be available for email consultation during the rest of the program. The tape recorder and tapes are to allow the peer leaders to gather input and feedback from other neighborhood youth about the ways that HIV is transmitted and about safe sex. This process will be tape-recorded so that the responses can be used in future training sessions. Markers, paper and other supplies will be purchased to enhance the presentations that the peer leaders will give to after-school programs throughout the year. Funding for the Youth Center Staff is provided by a grant from the neighborhood foundation, and agency overhead, including rent and administration, will be supported by Social Services, Inc. Grant Recipient Obligations

Evaluation and Reporting. A representative from the grant recipient organization must attend a Community Benefits Advisory Meeting held at BID-Milton after the project has been completed where a brief summary of the project must be presented. The exact date and time of the presentation will be determined at a later date.

In addition, each grant recipient must provide a final report within one month of the project’s completion (not to exceed three pages), due by Friday, July 31, 2016 which must include the following elements: · Project name, purpose, goals and objectives· Project participants and community collaborators· Project beneficiaries (targeted priority populations) and overall reach of project (number

of participants, geographic reach, etc.)· How funds were expended and for what purposes· Evaluation of project outcomes, linked to goals and objectives.· Recommendations and/or plans for future action

Final reports may, but are not required to, include copies of printed materials, media coverage, beneficiary testimonials, photographs, DVDs, etc. Reports should be mailed to Bob McCrystal, Director of Communications, Beth Israel Deaconess Hospital-Milton, Milton, MA 02186, or emailed to: robert_mccrystal@miltonhospital.org. Bob may be reached at (617) 313-1590.

Promotion. Grant recipients consent to allow BID-Milton to publicize their grant awards and projects. Such promotion may include website postings, fliers, photography/videography, news coverage, and distribution of project summary reports. BID-Milton will work with grant recipients to assure that privacy and confidentiality are appropriately safeguarded. Grantees are encouraged to acknowledge the support of BID-Milton in publicity/communications regarding the funded project/activity.

Walk Participation. Grant applicants are welcomed and encouraged to participate in BID-Milton’s Community Health Walk with a team of walkers to be held at the hospital on

Saturday, June 13 at 10 am. Walker registration forms may be downloaded at www.bidmilton.org.

Application submission

Applicants with questions or seeking clarification should contact Bob McCrystal, Director of Communications, Beth Israel Deaconess Hospital-Milton, via email at: robert_mccrystal@miltonhospital.org. The deadline for receipt of proposals is Friday, May 1, 2015 at 4 pm EST. Grant recipients will be notified in mid-May, 2015. Award announcements will be made public at the Community Health Walk on June 13, 2015.

Please type and submit proposals to:Bob McCrystal, Director of Communications, Beth Israel Deaconess Hospital-MiltonBy mail/in person: Beth Israel Deaconess Hospital-Milton,

c/o Bob McCrystal, Public Relations199 Reedsdale Road, Milton, MA 02186

By fax: 617-313-1562By email: robert_mccrystal@miltonhospital.org

Congratulations to our Past Community Health Walk

Grant Winners!

Bird Street Community Center, Dorchester (2011)"Gender Specific Health/Wellness"

Braintree Public Schools (2011)"Braintree Bans Bullying"

Braintree Public Schools (2012)“Braintree Youth Cardiovascular Health Education Project”

Canton Public Schools (2010)"Adventure Programming: Adventure Fitness and Fun for Everyone"

Canton Public School’s Health Services Dept. of Nursing (2013)“Community Cardiovascular Connection”

Cooperative Elder Services (2012)“Fall Prevention & Chronic Disease Management”

Father Bill's & Mainspring, Quincy (2011)"Feet First" Health Clinics for Homeless Men and Women

Girl Power, Milton (2014)Adolescent Female Running and Empowerment Group

Healthworks Community Fitness, Dorchester (2013)“Fitspiration: Health Inspiration Meets Perspiration”

Interfaith Social Services, Quincy (2014)“Memories Workshop”

Kit Clark Senior Services, Inc., Dorchester (2010)"Fit-4-Life"

Milton Community Food Pantry, Inc. (2011)"Community Cookbook"

Milton Early Childhood Alliance (2010)"Dealing with Children's Health Issues"

Milton Public Schools (2010 and 2011)"Wellness Intervention for Milton Students"

Milton High School (2013 and 2014)“Good Decision Making and Healthy Choices”

Point-Webster Middle School, Quincy (2012 and 2013)“Point Webster Middle School Positive and Safe Climate Proposal”

Point-Webster Middle School, Quincy (2014)“Substance Abuse Prevention”

Randolph Public Schools (2010)"Eat Healthy; Get Active"

Randolph Senior Center (2014)Haitian Health Promotion Group

Roosevelt School, Hyde Park (2014)“Eat Smart, Stay Smart”

Simon Fireman Community Center, Randolph (2014)“Healthy Bodies, Minds, Spirits”

South Shore YMCA, Quincy (2011)"CATCH Kids Club"

Town of Milton Board of Health (2012)“Smoke or Chew Tobacco is Not for You”

Town of Milton Board of Health (2014)“Alcohol and Substance Abuse Prevention”

Town of Milton Youth Office (2010)"Walk and Talk with Your Elected Officials"

Yoga Woga, Randolph (2012)“Geriatric Chair Yoga and Children’s Yoga for Randolph Senior Center and Randolph Elementary Students”

BID-Milton Mini-Grant 2015 Cover Sheet

PROJECT TITLE: ______________________________________________________________________________

1-2 SENTENCE DESCRIPTION OF THE PROPOSED PROJECT:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

APPLICANT ORGANIZATION OR GROUP: _______________________________________________________

EXECUTIVE DIRECTOR/PRINCIPAL: ___________________________________________________________

ADDRESS: ___________________________________________________________________________________

CITY:_________________________________________________ STATE:___________ ZIP:________________

PHONE: (___________)______________________ FAX: (___________)_________________________

EMAIL: ______________________________________________________________________________________

PROJECT DIRECTOR/ CONTACT: _______________________________________________________________

ADDRESS: ___________________________________________________________________________________

CITY:_________________________________________________ STATE:___________ ZIP:________________

PHONE: (___________)______________________ FAX: (___________)_________________________

EMAIL: ______________________________________________________________________________________

COLLABORATIVE PARTNERS: ________________________________________________________________

_____________________________________________________________________________________________

AMOUNT OF FUNDING REQUESTED: $_________________________________________________________

GEOGRAPHIC AREA SERVED BY PROJECT: _____________________________________________________

_____________________________________________________________________________________________

NAME OF FISCAL CONTACT PERSON: __________________________________________________________

ADDRESS: ___________________________________________________________________________________

CITY:_________________________________________________ STATE:___________ ZIP:________________

PHONE: (___________)______________________ FAX: (___________)_________________________

EMAIL: ______________________________________________________________________________________

NOTE: If your group has a fiscal agent/conduit other than the applicant named above, please complete the following information.

Name of fiscal agent/conduit: _____________________________________________________________________

Grant Budget Form

Item Total Project Costs Other Funding Sources Amount requested in application

Staff

Supplies

Equipment

Administration(may not exceed 10% of budget requested)

Other expenses (list and explain)

Total $ $ $

Grant Budget Narrative

Please list and explain all project costs to be funded on this page. Be sure to include justification of all line items included in your proposal and identification of other sources of funding, including your own organization’s plan to provide funding, if any. Finally, please explain how partial funding could impact your project.