High Impact Philanthropy in the Downturn: Focus on Housing, Health, and Hunger (A Guide for Donors)

8/7/2019 High Impact Philanthropy in the Downturn: Focus on Housing, Health, and Hunger (A Guide for Donors)

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High Impact Philanthropyin the DownturnFocus on Housing, Health, and Hunger: A Guide for Donors

Th Cnt Hih Ipct PhinthpSchool of Social Pol icy & Pract ice | Univers ity of Pennsylvania

Nb 20


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THe CeNTer for HIgH ImPaCT PHIlaNTHroPyii

About the Authors

Katherina M. Rosqueta, MBA, is the oundin executie director o the Center or Hih Impact Philanthropy. Preious-

ly, she was a consultant at McKinsey & Company. Prior to joinin McKinsey, she worked in community deelopment,

nonproft manaement, and corporate and enture philanthropy.

Carol A. McLauhlin, MD, MPH, is the research director or lobal public health at the Center or Hih Impact Philan-

thropy. She is a primary care physician and public health specialist with experience in research, community enae-

ment, and proram implementation in the U.S. and the deelopin world.

Hilary J. Rhodes, PhD, is a senior analyst at Abt Associates, ormerly the senior analyst in education at the Center or

Hih Impact Philanthropy. Prior to joinin the Center, she was a doctoral ellow at the RAND Corporation.

The authors can be contacted at www.impact.upenn.edu or 215.573.7266.

About the Cente r for high impACt philAnthropy

The nonproft Center or Hih Impact Philanthropy was ounded in 2006 by Wharton alumni and is housed at the

Uniersity o Pennsylanias School o Social Policy & Practice. Our aim is to proide inormation and tools to help

philanthropists determine where their unds can hae the reatest impact in improin the lies o others. With

expertise in business, medicine, the law, and public and social policy, our team brins a multidisciplinary approach,

in-depth knowlede o research methods, and seasoned judment to the analysis o hih impact philanthropic op-

portunities.

sourCes of INformaTIoN

Field experience

Practitioner insihts

Perormance assessments

In-depth case studies

inFormed opinion

Expert opinion Stakeholder input

Policy analyses

research

Randomized controlled trials

and quasi-experimental studies

Modeled analyses

(e.., cost-eectieness)

Field

experience

inFormed

opinionresearch

most promising

To meet our oal o proidin smart, practical uidance to indiidual philanthropists, we synthesize the best aailableinormation rom three domains: research, inormed opinion, and feld experience. By considerin eidence rom

these three sources, we seek to leerae the strenths while minimizin the limitations o each. We beliee the most

promisin opportunities exist where the recommendations o these three domains oerlap.

our multi-perspeCtive, evidenCe- informed ApproACh


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HIgH ImPaCT PHIlaNTHroPy IN THe dowNTurNi

Table of ContentsWhy this , Why noW 1

opportunity 1: prevent foreClosures 3

Context 4

How Philanthropic Capital Can Change The Situation 6

2 Solution 1: Nonprofit Housing Counseling 6

2Solution 2: Outreach To At-Risk Homeowners 9

Taking Action 10

opportunity 2 : sustAin ACCess to primAry And preventive

heAlthCAre 13

Context 14


2 Solution 1: Community Health Centers 15

2 Solution 2: Targeted Prevention And Outreach 20

Taking Action 23

opportunity 3: ensure ACCess to food 27

Context 28


2 Solution 1: Emergency Food Providers 29

2 Solution 2: Benefits Access Programs 32

Taking Action 36

referenCes And endnotes (inCluding list of nonprofits) r- i

ACKnoWledgments ins ide bACK Cove r

2Model In Practice in this section


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THe CeNTer for HIgH ImPaCT PHIlaNTHroPyiv


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HIgH ImPaCT PHIlaNTHroPy IN THe dowNTurN

W A High

Impac Philanhopy in he Economic Downn

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cover or the ull list o individuals who contrib-

uted to our work.)

Three years ago, the Center for High Impact Philanthropy was founded to

provide analysis and decision-making tools to help philanthropists determine

where their funds can have the greatest impact in improving the lives of

others. Given the breadth and severity of the current economic downturn,

the question we needed to answer was clear: Where can individual donorsmake a significant difference in addressing the suffering caused by the

economic crisis?

Why this , Why noW


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[email protected].


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HIgH ImPaCT PHIlaNTHroPy IN THe dowNTurN3

opportunity 1

Prevent foreclosures through housing

counseling and outreach to at-risk

households

Nb 2009


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We lied in a home or 3 years and we lost it almost a year ao. It was the frst American Dream my

parents coulde accomplished but they did not know interest would risethey would not be able to pay

the mortae. So we moed in with our aunt. There are currently 12 o us in a one-room house, so do

the math.1

- evelyn, V Am H SIs Anybody Listening? A testament by Village Academy

High School students on the economic crisis

the Context

Refnancin could that hae been a actor? Im not 100% sure but that company sure as heck didnt

want to work with me. Youre not lookin or a ree handout, youre lookin or someone to ie you a

resh start Well, i the deal isnt reached they say by the end o the month, there will be a Sheris

sale. Now I know they initiated the stimulus packae to help people but it seems like you dont know

where to o to et that help.2

- Kenneth Kruse, - m

Te Faces o Foreclosure: People across the New Yorkregion tell their stories

An unprecedented number o people across the country ace losing their homes to oreclosure. However,

or many amilies like Evelyns and Keiths, eective housing counseling and targeted outreach can prevent

oreclosures enormous emotional, social, and economic toll. Such eorts now represent great bang or

philanthropic buck.


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fIgure 1: foreClosure raTes aCross THe CouNTrya NaTIoNal CrIsIs, CoNCeNTraTed PaIN

Source: Te Policy Map, a service o Te Reinvestment Fund

Estimated percent of mortgages to start foreclosure process or be seriously delinquent in the past 2 years

CHarT 1: reCord HIgH delINQueNCy & foreClosure raTes

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2009

Mortgage Foreclosure Inventory: United States (EOP, NSA, %)All Mortgages Not Current: U.S. (NSA, %)

Source: Mortgage Bankers Association8

legend

year: 2009

variable: Score

Insuicient Data

7 or less

8-11

12-14

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shaded by: Census Tract

source: HUD


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fIgure 2: How NoNProfITs work To PreveNT foreClosures

troubled

homeowners at risK

oF Foreclosure

OUTREACH

HOUSINg COUNSELINg &

HEARINg OR MEDIATION

SUPPORT

DECREASED ADMINISTRATIvE

PROCESSINg TIME

successFul worKouts:

Foreclosures prevented

target: Increase the

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hoW philAnth ropiC CApitAl CAn ChAnge the situAtion

solution 1 : nonprofit housing Counseling

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greaT BaNg for BuCk: NoNProfIT HousINg CouNselINg

Cost per impact: $300 $3,800 to help a homeowner at risk o oreclosure reach a successul loan

modiication with a servicer. Compare this to:

Costs to s: As much as $34,000 in municipal costs per foreclosure.12 Given that 9 million foreclosures

are anticipated over the next four years,13 the total bill to cities could reach $306 billion.14 The reduction inproperty values could reach $1.86 trillion.15

Costs to c: When a foreclosure occurs in a neighborhood, each neighboring home loses

an average of$7,200 in value.16 Neighborhood violent crime rises an estimated 2.33 percent with each

percentage point increase in that neighborhoods foreclosure rate. 17

Costs to i: Increased risk of homelessnes s, continued financial dist ress, increased rates of st ress and

mental illness; for children, loss in learning and development.


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model in practice:

Pntin c thh cti hin cnin

a : In conversations with unders and poli-

cymakers over the last several months, Consumer Credit

Counseling Services (CCCS) o Atlanta, soon to be known

as CredAbility, was cited as a nationally recognized leader

in eective housing counseling. It provides ace-to-ace

counseling in 30 locations in Georgia, Florida, Mississippi,

and Tennessee and over-the-phone counseling nationally,

24-hours a day in both English and Spanish. One o eight

nonproit credit counseling agencies responding to call-

ers o the national HOPE hotline, it answered more than

175,000 calls and provided housing counseling to 73,573

clients in 2008.18 In addition to oreclosure prevention as-sistance, it serves as a inancial emergency room, pro-

viding budget and credit counseling, money management

education and outreach, debt management plans, and

bankruptcy counseling and education.

i: 80% o CCCS clients were still in their homes

12 months ater their initial counseling session. 19 This

compares avorably with the industry comparison data o

23%, a reasonable benchmark and the best available ig-

ure against which to compare CCCSs results.20

c: CCCS o Atlanta reported a cost o $1 to $1.50

per minute or counseling with an average per client cost

o $208.21 Industrywide, the average cost per client coun-

seled is $431 and the median cost per client is $225,

based on a survey o HUD-approved counseling agencies,

including CCCS o Atlanta.22,23

c : We estimate that it costs CCCS o At-

lanta approximately $300 to keep one client in his or her

home and avoid uture oreclosure activity or a year. By

comparison, industrywide, the cost ranges rom $500 to

$3,800, based on the complexity o the case.24

We attribute several actors to CCCS o Atlantas strong

cost-per-impact proile:

Experience: Founded in 1964, it had a track record o

working with clients in inancial distress long beore the

current economic crisis.

Strong commitment to data-driven decisions and invest-

ment in data management systems, including its Early

Resolution Counseling Portal (ERCP), an online portaldeveloped in collaboration with servicers and the Ford

Foundation. ERCP acts as a bridge between the Early

Resolution platorm used by servicers or decision analy-

sis and CCCS counseling agencies terminals.

Strong, proessional culture relected in its knowledge

and working relationships with servicers.

For more detail on this model see High Impact Philanthro-

py in the Downturn: Additional Sources and Due Diligence,

available on our website: www.impact.upenn.edu.

To learn more about CCCS o Atlanta, visit its website:http://www.cccsatl.org/index.jsp. Alternatively, contact

Suzanne Boas, president, at [email protected]

or (404) 653-8809.

To learn how to identiy an eective housing counselor in

your local area, see our Taking Actionsection on p. 10.

Image by NeighborWorks America/Gregory Miller Photography


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model in practice:

linin tb hn t itnc thh tt, -nc cpin

a : General outreach activities (e.g., public

service announcements, bill inserts) can raise overall public

awareness. But in urban areas with a high concentration o

households at risk o oreclosure, a targeted door knock

campaign can be a cost-eective way to link borrowers with

housing counseling. The city o Philadelphia incorporatedsuch a campaign in its Residential Mortgage Foreclosure Di-

version Program. The city partnered with 15 local nonproits

to conduct door-to-door outreach to approximately 400 to

500 eligible homeowners a month.25,26 Representing the city,

trained nonproit sta received a list o at-risk, owner-oc-

cupied households. Households could receive up to 3 visits.

I representatives successully reached a homeowner, they

explained that help was available and urged the borrower

to call the city hotline to set up a ree housing counseling

session. The city is currently working with a oundation to

understand the impact and cost eectiveness o its eorts,

but the program has already been recognized nationally by

mayors such as Michael Bloomberg o New York and Antonio

Villaraigosa o Los Angeles.27

i: It will be some time beore rigorous studies are

available on programs created to respond to the current cri-

sis. In the meantime, we applied the success rates o one

o the Citys nonproit partners to estimate the potential im-

pact o a door-knock campaign. In a nonproit pilot o 117

households contacted, o which 94 were actually reached,

65%or 61 householdscalled the hotline immediately to

set up a housing counseling appointment.28 We dont know

the eects o the campaign isolated rom other aspects o

the program. In an early attempt to understand this, the city

observed a 12% increase in response rates by those coveredby the door-knock campaign versus those who were not. 29

c: An estimated $25 to $75 per household knocked,

that is, per name on the list.30 This is not the cost to the city,

but simply an estimate provided by a nonproit partner o its

costs to deploy sta as part o a city campaign. Cost includes

transportation, canvassers compensation, and cellphones.31

c : We estimated it cost $60 to $200 or

every homeowner who seeks help by scheduling a housing

counselor appointment, based on igures provided by the

nonproit pilot.32

In our conversations with those involved in outreach eorts,

two criteria emerged as central to the success o any door-

knock campaign. The irst is the availability o a good quality,

targeted list o at-risk households. The second is the avail-

ability o experienced canvassers who already have, or can

quickly gain, the necessary trust rom the low-income and

minority communities most at-risk o oreclosure.

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HIgH ImPaCT PHIlaNTHroPy IN THe dowNTurN 9


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model in practice (continued):

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For more details on this model see High Impact Philan-

thropy in the Downturn: Additional Sources and Due Dili-

gence, available on our website: www.impact.upenn.edu.

To learn more about Philadelphias Residential Mortgage

Foreclosure Diversion Pilot Program, contact Terry Gil-

len, executive director, Redevelopment Authority, City oPhiladelphia, at (215) 209-8720, [email protected] or

Laura Taylor, contract administrator, City o Philadelphia at

(215) 686-9711, [email protected].


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greaT BaNg for BuCk: How your dollars Could HelP

For $300 $3,800, eective housing counseling can help a homeowner at risk o oreclosure reach a

successul loan modiication with a servicer. Examples o how philanthropists can make this model more

eective and eicient include:

$15,000 to $20,000 will enable housing counselors like CCCS of Atlanta to recruit, hire, train, and provide

necessary resources (e.g., computers, desks, and office supplies) for a new housing counselor, who will wo rk

with 800 to 1,000 clients per year.33

$15,000 will enable counseling agencies to purchase early resolution portal software. Right now, servicer

capacity to process loan modifications remains a severe bottleneck. Such data exchange systems can alleviate

servicers overload and expedite the loan modification process.

In addition, funding targeted outreach and community education ensures that more troubled borrowers connect

with available, effective housing counseling.

We offer these not as a menu but rather simply to provide you with examples of the types of unmet needs we

heard from leaders in foreclosure prevention.

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[email protected]


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opportunity 2

Sustain access to primary and preventive

healthcare through support of community

health centers and targeted outreach

Nb 2009

Image provided by Nurse-Family Partnership


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Since sales at the Sebrin, Fla.-area car dealership where Christopher Pye works hae dwindled, so hae

the commissions that were 40% o his income in ood times. Barely able to aord his $850 monthly

mortae and pay or roceries, he says somethin had to ie: his two youn sons annual medical

checkups. Its just a little too expensie riht now, says Mr. Pye, 32-years old, who says he cant aord

to hae his amily on the company health plan or to pay up ront or the isits. This month, Mr. Pye is

cancelin his own insurance, hopin the $56 hell sae in weekly premiums will pay or the exams o his

boys, aes 3 and 4, later.1

By supporting community health centers, donors can help amilies like the Pyes stay healthy and avoid the

more serious health problems that come rom oregoing care. In addition, existing nonprot models provide

cost-eective programs targeting amilies who are especially vulnerable.

the Context


19/52


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solution 1 : inCreAse ACCess to Comprehensive primAry And

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greaT BaNg for BuCk: CommuNITy HealTH CeNTers

Average cost:$560 / or access to comprehensive primary care8

representative impacts:

For : significantly better health outcomes, such as 11% lower rate of low birth weight infants and

8% higher rates of blood pressure control (compared with national average) despite serving communities at

higher risk for both9

For : an estimated $10 billion to $18 billion saved by averting more costly hospital- or ER-based care 10

For : for every $1 million invested, $6 million in direct and indirect economic benefits

through job creation and local business stimulus11


20/52


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comprehensive primary care:

Well checkupsTreatment when sick

Complete care during pregnancy

Immunizations and checkups or children

Dental care and prescription drugs

Mental health and substance abuse care

supportive services to help

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stay healthy:

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Social workers

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Transportation and mobile units

fIgure 1: CommuNITy HealTH CeNTers make PrImary Care aCCessIBle

[T]he community health center model has proven

effective not only in increasing access to care, but

improving health outcomes for the often higher-

risk populations they serve.

Te Institute o Medicine 8


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22/52


enhncin tch t n nin n h-t-ch pptin

Many people in need o care, especially the newly unin-

sured, are unaware o the services at CHCs and how to

get access to them. Private philanthropy can help by sup-

porting community outreach workers and support person-

nel who ensure that amilies in need know about and can

obtain clinic services.

For example, Community Healthcare Network(CHN) o NewYork estimates that our out o ive people who could use

its services do not come in. Instead, they oten end up in

emergency rooms when their health deteriorates. Com-

munity health educators and skilled call center/custom-

er service sta can overcome access barriers and help the

newly uninsured get the care they need.

A community outreach educator provides inormation

about a clinics services to those at greatest risk or being

uninsured, and delivers health programs in areas such as

nutrition and sexual health to teenagers in high schools.

Well-trained support sta, such as call center personnel,

answer calls, link patients to the services they need (e.g.,

doctor visits, case management, translation, transporta-

tion), and provide answers to basic health questions. For

some CHCs, mobile units help reach rural amilies spread

out over large distances or engage urban teenagers who

would rarely come to a clinic. Quality inormation and

communication on irst contact with the CHC mean more

amilies get the care they need and take advantage o the

eective CHC model.

For more details on these models see High Impact Phi-

lanthropy in the Downturn: Additional Sources and Due

Diligence on our website www.impact.upenn.edu.

models in practice:

Incin cnit hth cnt (CHC) cpcit t t in n

Escalating unemployment rates mean community health

centers see more uninsured and underinsured pa-

tients. This demand comes at a time when essential und-

ing rom state grants and public insurance is threatened

by state budget shortalls. In order to bring more quality

care to more people, CHCs need additional sta, inra-

structure, and systems. Philanthropic support can bridge

the gap between public unding and the cost o providing

CHCs core services to the growing number in need.

CHCs like Salud Family Health Centers in Colorado have ex-

perienced a steady increase in demand or services, most-

ly rom the newly uninsured. In 2008, ity-two percent o

its patients were uninsured and eligible or sliding-scale

payment based on amily size and amily income. As ed-

eral and state grants cover only a small portion o costs

or uninsured patients, there is an increasing gap between

the cost o services provided and unds to cover those

costs.

Private philanthropic capital can expand a core program

such as dental health services that are currently under-

unded. Examples o core sta that are needed are nurses,

doctors, pharmacists, and health educators.

In addition to human capital, CHCs need capacity invest-

ments in systems that increase their quality and ei-

ciency. For example, Clinica Sierra Vista in Fresno, Cali.,an area hard hit by the recession, seeks to expand its

electronic patient registry and tracking program. By creat-

ing an interace between patient records, lab reports, and

clinic visits, these programs help clinic sta understand

who needs what tests, who is doing ine on their own, and

who needs more help. For chronic illnesses such as dia-

betes and asthma, as well as outreach eorts or breast

and cervical cancer, such systems can help CHCs target

their limited resources to where they can do the most

good. They are particularly needed or outreach to mobile

or migrant populations to ensure that patients receive ap-

propriate screening and ollow-up care. -m Image provided by Clinica Sierra Vista


23/52


Nine-year-old Michael was carried into the dental clinic o the Community HealthCenter o Southeast Kansas (CHCSEK) in Pittsburg, Kansas, with a high temperature and an abscessed

tooth. He hadnt eaten solid ood in weeks. There was no dentist in the community that accepted Medicaid.

The school nurse contacted the nearby CHCSEK clinic and was told to bring Michael to the center right

away. Crying and rightened when he arrived, Michael was bundled into blankets and comorted while thedentist examined him. It was evident that Michael had been enduring an enormous amount o pain or

weeks and he was within hours o having to be hospitalized. Michael was given a large dose o antibiotics

and the tooth was extracted. Michaels ace immediately lit up with relie despite his d iscomort due to the

inection.

The health center continues to provide care or the extensive decay persisting throughout Michaels mouth.

When sta went to Michaels school a ew months later to screen 700 other children, he took the hands o

CHCSEK sta, led them into his classroom and announced These are my riends and they will help you.

Adapted rom U.S. Department o Health and Human Services. (2008, June). Health Centers: Americas Primary Care Saety Net,

Relections on Success, 2002-2007.Rockville, MD.tp://tp.hrsa.gov/bphc/HRSA_HealthCenterProgramReport.pd

c o m m u n i t y h e a l t h i n a c t i o n


24/52


solution 2: su pport tArgeted prevention And heAlth eduCAtion

progrAms for esp eCiAlly vulnerAble p opulAtions

F m (.. mm

), m

. Hm -

m -

m

, - m .

Exm m :

m- m

m -

m m

m

m m

, x

P . M

m -

. Y, mm

m f

, m m -m

. M m

mm . S

m m,25 ,26 ,27

.28

I Model in Practice - x,

xm - m -

m -m, -m m

. T m

2 . N-Fm P (NFP)

- mm

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,

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.

greaT BaNg for BuCk: TargeTed PreveNTIoN aNd HealTH eduCaTIoNPrograms

a 5

example community education and prevention

After five years, an investment of $10 per person per year in -

directed at physical activity, healthy eating, and reduction in smoking

$5.60 , taking into account only reductions in healthcare costs and not

including improvements in productivity, school achievement, or quality of life.23

example targeted home-based support

Nurse-Family Partnership (a nurse visitation program for first-time moms): a 2005 cost-benefit analysis by

RAND found that , $5.70, providing a net benefit to

society of over $34,148 per high-risk family served. 24


25/52


model in practice:

H-b pntin: Hpin it-ti pnt cc

a : Pioneered by the nonproit Nurse-

Family Partnership (NFP), this program targets low-income

mothers pregnant with their irst child. Participating moth-

ers are partnered with a registered nurse early in preg-

nancy and receive in-home support and guidance through

their childs second birthday. Support rom nurse home

visitors begins with education or the women and their

amilies about healthy pregnancy practices such as good

nutrition, regular and early prenatal checkups, and quit-

ting smoking. It then progresses to coaching parents in

providing care or their newborn, inant, and toddler, plan-

ning uture pregnancies, and developing skills to reach

education and work goals.

Registered nurses receive more than 60 hours o train-

ing in the NFP model, meet with supervisors on a regular

basis, and come together as teams or case conerences

to learn rom one another and ensure the highest standard

o care.

i: Evidence rom more than thirty years o re-

search and three randomized controlled trials substanti-

ates signiicant beneits or both mother and baby. They

include:29

48% decrease in child abuse and neglect

56% reduction in ER visits or accidents and poisoning

67% reduction in behavioral and intellectual problems

at age 6

59% reduction in arrests by the time child is age 15

83% increase in labor orce participation by the mother

c-: In addition, studies have ound the program

provides an excellent return on investment or society.

RAND researchers ound that or every one dollar invest-

ed, the program returned $5.70, providing a net beneit to

society o over $34,148 per high-risk amily served. 30 The

best returns were achieved by targeting the program to

Image provided by Nurse-Family Partnership


26/52


amilies at highest risk as the return on investment (ROI)

was less or lower-risk amilies. Societal savings came

rom increased tax revenues rom increased employment,decreased welare costs, lower criminal justice costs, and

reduced costs or healthcare and other social services.

(See Chart : Nurse-Faily Partnership: Mon-

etary beneits to society.)

r : While the Obama administration

has expressed support or the expansion o nurse home

visitation programs, states hard hit by the recession have

had to cut unding or these programs. For example, Detroit

and surrounding counties in Michigan cut state unding to

their well-established NFP program as o July 1, 2009.

Such unding cuts provide a high leverage opportunityor private philanthropy to step in and keep the programs

running, especially as there are ederal dollars available

to match local unds. In general, private philanthropy can

support activities that will enhance the impact o existing

programs and enable the replication o the model in more

communities o need. Private philanthropists can increase

the impact and capacity at current sites by providing undsor nurses, nursing practice consultants, inormation sys-

tems or tracking outcomes, and training and oversight to

ensure implementation idelity.



gence available on our website: www.impact.upenn.edu.

To learn more about NFP, visit its website: www.nurseam-

ilypartnership.org or contact Scott Shirai, chie develop-

ment oicer, at [email protected]

or (303) 327-4246.

CHarT 2: Nurse-famIly ParTNersHIP: moNeTary BeNefITs To soCIeTy

S: 25 RAND C S3

$ $10,000 $20,000 $30,000 $40,000 $50,000

net present value dollars per child 2003

HIgHER RISK FAMILIES

LOWER RISK FAMILIES

Beneit

Cost

Cost

Beneit

increased participant income

savings to government

reduction in tangible crime losses

cost

model in practice (continued):


27/52


solution 1: h f

T 7,2 U S

mm m

m mm-

. mm -

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: hp://ndahealhcene.ha.gov

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H C (FQHC) FQHC--.

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. C, C, S H Dm M

m

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m. T f -

m m

m m .

2. U W M U-

W 2-- -

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tAKing ACtion

TIPs for assessINg CommuNITy HealTH CeNTers

alk to health center leadership

A m m

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28/52


A , m -

m m mm

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m .

I x , xm -

CHC

. T xm m m

CHC m.

solution 2: h f -

N-Fm P Pm,

S S, m ,

.@m.

(33) 327-4246 hp://www.

neamilypanehip.og/conen/index.

cm?eacion=howMap&navID=17

T m m 2

NFP m -

m mm

,

. I ,

NFP m

m.

m , m-

m m

. W CHC, mm

mm m m-

/ m

mm

mm.

greaT BaNg for BuCk: How your dollars Could HelP

For less than $600 per person per year, CHCs deliver impressive health outcomes (see page 15.)

examples oF how philanthropists can extend this model to more people and/or improve

the eFFiciency oF existing chcs:

$35,000 would allow Salud Family Health Centers to equip a dental exam room with X-ray equipment and

instruments, and $150,000 will cover a dental team comprised of a dentist and a hygienist, making it possible

for an additional 2,000 patients to receive a year of standard dental care. 34

$45,000 will cover a typical performance tracking program, including personnel and computer expenses, at one

ofClinica Sierra Vistas health centers, to track patients and provide appropriate follow-up.35 Such programs

allow CHCs to target their limited resources to where they can make the most difference in patient care.

AtCommunity Healthcare Network, an investment of $35,000 will fund a community health educator who can

provide important health information (e.g., substance abuse prevention, child nutrition, HIV prevention), as well

as guide community members to appropriate clinic services. In addition to providing health education to at-risk

communities, one additional outreach worker could also mean, conservatively, that three to five new patients

each week, or an additional 150 to 250 patients each year, would take advantage of clinic ser vices.36

We offer these not as a menu but rather simply to provide you with examples of the types of unmet needs we

heard from leaders of CHCs across the country.


29/52


TIPs for assessINg good ouTreaCH

Programs

W mm, , m,

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expin t ip cc n

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aitin c ptnhip

n th cnt, tt, ntin

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,

:

Pimay Cae Aociaion (PCA). E

PCA mm mm-

-

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PCA : hp://bphc.ha.gov/echni-

calaiance/pcadiecoy.hm.

Pblic healh inie x m

mm m. T

mm

z

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: www.nnphi.og/home/ecion/2/

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NGO

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-

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hp://www.phny.og/index.php ,

x

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CHC :

T Naional Aociaion o Commniy Healh

Cene m -

CHC

m m. A-

m m CHC

: hp://www.

nachc.com.


30/52



31/52


opportunity 3

Ensure access to food by supporting

emergency food providers and linking

eligible families to benets such as SNAP

(formerly, food stamps)

Nb 2009


32/52


H mm, , m

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m m m . I 27,

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the Context

We are able to show quite precisely that because

people cant afford to pay for housing, health care,

transportation, child care, other basic expenses, as

well as all the food they need, they are forced to

frequently ration food.3

Joel Berg, author o All You Can Eat:

How Hungry Is America

Since losin her job, it has become impossible or Sarah Hammer to make ends meet. Eery day, she

takes her two dauhters to Boston Medical Center or their seere asthma. Their heat and lihts had been

cut o. To make sure the irls were ettin their nebulizer treatments, her landlord was lettin her run an

electric cord rom the basement, and the neihbors were lettin the irls bathe at their apartment to aoid

their asthma rom bein triered by cold showers. To pay the rent, the amily had cut back as ar as they

could on ood.1

Shoring up existing networks o emergency ood providers and linking eligible amilies to benets can prevent

a amily like Sarah Hammers rom going hungry. Making sure amilies have access to nutritious ood, in

particular, can help prevent lost productivity and health problems or adults and irreversible losses in

cognitive skills and development in children.


T mm

m

.

solution 1:e F p: Ex

-

m-

. F x

m .

H, m-

z ,

, m

. T

,

.

solution 2: bf a p: C

m. Sm m,

SNAP (Sm N A P-

m, m m),

. O (..,

) /

x (.., LIHEAP L-Im

E A Pm

), m

.


33/52


E

m . H,

m.

M m m,

z. B

, m,

m,

. U, m

m ,

m , m

m , -

. W

-

, mm m x

m

.

F m SNAP -

x,

. A , SNAP m

m -

m

. H,

m . F x

SNAP, m

$.78 m

, -

.4 E ,

SNAP m x-

m m m m

m .

solution 1 : emergenCy food providers

greaT BaNg for BuCk: emergeNCy food ProvIders usINg HIgHlyeffICIeNT sourCINg aNd dIsTrIBuTIoN sTraTegIes

Cost per impact:As little as $16 $37 k8

Choice and/or bulk purchasing models (see Model in Practicesections that follow) represent a particularly

efficient and effective strategy for emergency food providers. By comparison, the US Department of Agriculture

(USDA) estimates that it costs a family of four on a low to moderate budget $150 to $220 to purchase enough

food to feed themselves for a week.9

However, the choice model is a relatively recent innovation, and a typical food bank can spend $150 or more

to feed a family of four for a week. Philanthropists can help local providers become more efficient by funding

regional networks that provide logistics and bulk purchasing capabilities, making monetary donations instead

of food donations, and supporting providers efforts to incorporate other aspects of the choice model into their

operations.

Em , -

, m

. C, ,

m

m. F

m

5, 29% 38% m

.6 I m

US C M Dm 28, 2

m

m.7

Source: Olsen, E., Almeida, M. (2009, July 29). A Year o Struggle at a Food

Bank. Retrieved August 6, 2009, rom http://video.nytimes.com/vid-

eo/2009/07/29/us/1247463625625/a-year-o-struggle-at-a-ood-bank.html


34/52


P -

m . W

m m m m

. T

m m . T

m m

. I Model in Practice , -

m, -

m m. I aking Ac-

tion 36,

.

model in practice:

wt Nt, wnt Nt chic piin nc

a : In the choice model, ood banks pur-

chase ood at signiicantly discounted wholesale prices,

ar more cheaply than the general public can. Food banks

then allow clients to select their own ood rom super-

market-style displays. This approach diers signiicantly

rom that used by most ood pantries, where volunteers

pre-sort ood into identical boxes that are then distributed

to clients regardless o client needs. The choice model

has been pioneered by Feeding America West Michigan

Food Bank (ormerly Second Harvest Gleaners Food Bank

o West Michigan, Inc.), the regions nonproit clearing-

house or ood since 1981. In its implementation o the

model, West Michigan reers to it as the Waste Not, Want

Not program.

i: The model has helped increase West Michigans

distribution rom 8.3 million pounds o ood in 1994 to

22 million pounds in 2008. Using this model, the ood

bank expects to distribute 24.5 million pounds by the end

o 2009, providing ood to 400,000 needy people annu-

ally. Compared with traditional practices, it wastes hal

as much ood, drops the cost o addressing hunger, and

ensures that people are ed according to their needs.10

c: 15 cents per pound to acquire and distribute

ood.11

c : We estimate that it costs between $16

to $20 to eed a amily o our or a week. We calculated

this estimate based on ood provider and US Department

o Agriculture estimates o per person average daily con-

sumption and nonproit-reported costs.

12




For more inormation and a detailed guide on how to es-

tablish a Waste Not/Want Not or choice model pantry

in your community, visit: www.endhungerinamerica.org/

EndHunger.pd.

To learn more about Feeding America West Michigan Food

Bank, contact John Arnold, executive director, Feeding

America West Michigan Food Bank, at (616) 784-3250,

x206 or [email protected]. You can visit their web-

site at: www.wmgleaners.org.

Image provided by Feeding America West Michigan Food Bank


35/52


model in practice:

ain bth hn n ntitin thh ip tch n piin

tti

a : By employing a multi-pronged ap-

proach to emergency ood provision, emergency ood

providers can help meet heightened demand while also

making healthy ood more accessible to those in need. For

example, Philabundance, the largest hunger relie organi-

zation in the ten-county region surrounding Philadelphia,

has responded to the downturn by:

Delivering resh produce to hard-hit neighborhoods

where residents select perishable items right o the

truck. Philabundance has doubled the number o its

year-round Fresh for Alldelivery sites rom six to twelve

in response to increased demand.

Implementing the Emergency Food Responsesystem, a

toll-ree hotline or individuals seeking inormation about

ood assistance

Introducing pick-up points beyond established pantries

or one-time emergency ood box with three days worth

o ood or a amily o ive

Partnering with St. Josephs University and the Mayors

Oice o Community Service to pilot choice model o

distribution as pioneered by the Feeding America West

Michigan Food Bank (see previousModel in Practiceon p

30) .

These represent promising strategies that other ood

banks can adopt.

i: Provides approximately 65,000 people per week

with ive pounds o ood to supplement what they obtain

rom other sources, or enough ood to cover the weekly

consumption needs o 9,000 to 15,000 people. 13 In 2008,

Philabundance distributed 17 million pounds o ood

within its ten-county service area and exported six mil-

lion pounds o additional ood, primarily produce, to oodbanks in the Feeding America network.14

c: 28 cents per pound to acquire and distribute ood,

well below the wholesale rate o $1.50 per pound, because

o signiicantly discounted prices rom the ood industry.

The organization also receives some ood at no cost rom

distributors or whom it is cheaper to give away ood than

to dispose o it in landills at $65 per palette.15

c : We estimate that it costs between $30

and $37 to eed a amily o our or a week. 16 Although this

is twice the cost o the Waste Not/Want Not or choice

model pioneered by West Michigan, it is still signiicant-

ly lower than the USDA estimate o $150 to $220 or a

amily o our on a low to moderate budget to purchase

enough ood to eed themselves or a week17 and there-

ore represents a useul benchmark or eiciency or do-

nors interested in supporting their local agents who may

not have existing inrastructure to implement the choice

model at this time.




To learn more about Philabundance, contact Martha M.

Buccino, senior vice president and chie development o-

icer at (215) 339-0900 x 30, or Mbuccino@philabun-

dance.org. Visit its website at: www.philabundance.org.

Image provided by Philabundance


36/52


Em -

. H, ,

m m

. SNAP (Sm-

N A Pm, m

m) m

m .

T mj

. I 26,

SNAP -m

m 57%. F

, 34%.8 C -

: x- m, m -

, ,

,

m ( ) ,

, m

m .

I Models in Practice xm 34 36,

m -

m . T m-

.

einc n ipct n icinc

pbic bnit p

S m m

m

. T

m , , -

m m. H

m -

m m

m .

T SNAP

m m -.9 A US Dm A

C B P P

m m , m-

.2 I ,

m M.m m

M Z SNAP

m 3 m xm

m ,

mm m m (See Chart 1:

Fiscal Econoic Bang or Buck).2

O m -

m

solution 2: ACCess to snAp ( food stAmps) And other

publiC benefits

greaT BaNg for BuCk: BeNefITs aCCess Programs

Cost per impact:Estimated $70 $230 in

beneits prorams that help maintain household access to basic essentials such as ood22

Some programs such as SNAP specifically target food and nutrition. Others serve as work supports (e.g.,

childcare subsidies) and/or help with other urgent expenses such as heating bills. Such assistance helps preventstrapped families from rationing food.

Access barriers differ by benefit program and population. These differences account for some of the range in our

cost per impact estimates. However, all these estimates compare f avorably with the median and average costs

observed across the 19 USDA-funded outreach efforts for food stamps (SNAP) in 2002. The median cost to

successfully enroll a client in food stamps was $776 (with an average of $1,558 and a range of $126 to more

than $4,000).23


37/52


m m .

W z

m, 26 C

B P P -

m m Am (.., 44%

3 m)

m .24

A note on reported ROI or benets access programs

I , m -

m m m

,

m . H,

SNAP m

, ROI m

m . W

m, m

$.4 $ SNAP

m .25 I ,

$2 $3 m

SNAP , m $5 $22

m m m

. W m m m

m m m-

(see Great Bang or Buck, page

), SNAP m

m m

j m m m (see below: Chart 1: Fiscal Econoic Bang or

Buck). T m -

m

SNAP. T, Models in Practice, -

m m ( m

m,

www.impac.penn.ed).

F m -

-

m , mm

m

29 3.

Nnpit tin t cnnctin

iib ii t bnit

I m x , m-

z

-

m -

, m

CHarT 1: esTImaTed fIsCal eCoNomIC BaNg for BuCk

$0.00 $0.20 $0.40 $0.60 $0.80 $1.00 $1.20 $1.40 $1.60 $1.80 $2.00

one year change in real gdp For a given $1 reduction in

Federal tax revenue or $1 increase in spending

t

e ui f

i

g

p

r -

a

n- -

e

mk

c

mk b

a

tax cut or spending increase

Source: Zandi, M. (July 24, 2008).2


38/52


models in practice:

ocin bi t bnit nnt th in p

a : Launched in 2004 by the national

nonproit Seedco, EarnBeneits helps the working poor

gain access to beneits. Currently operating in six cit-

ies (Atlanta, Baltimore, Bualo, Memphis, New York, and

Louisville) and soon in Tulsa, EarnBeneits partners with

local community organizations to assist clients through

three stages o the enrollment process: outreach, eli-

gibility screening and application, and ongoing beneits

management. At partner sites and through its website,

EarnBeneits provides user-riendly materials that inorm

low-wage workers about available beneits and their eligi-

bility. Proessional counselors provide on-site, one-on-one

help, guiding clients through application processes and

later ollowing up to provide assistance with recertiication

as well as suggestions or additional beneits or which

clients may be eligible.

i: From January 2005 through June 2009, Earn-

Beneits has screened 75,580 people to determine their

eligibility or beneits, enrolling 46,405 in at least one ad-

ditional beneit program. In total, it has enrolled its clients

in more than 57,961 beneit programs.27

c: Costs all into three broad categories: technol-

ogy and technical assistance ($150,000 or year one;

$50,000 annually or subsequent years), program man-

agement ($100,000 or year one; $30,000 to $50,000

annually or subsequent years); and counseling($50,000

annually or a proessional counselor; $20,000 annually

or an AmeriCorps member).28

c : On average, $215 to successully en-

roll a new client in at least one beneit program, with a

potential range o $125 to $800, depending on the com-

plexity o a clients situation and the cost o counseling

(i.e., proessional vs. AmeriCorps).29

To learn more about EarnBeneits, visit its website: http://

www.earnbeneits.org. Alternatively, contact Michelle Hen-

ry, senior program manager or asset building, Seedco, at

(212) 204-1337 or [email protected].

, -

m . W m

, m

m :

Sm mx

-. S

m m

m m

m j

m

F m m

C -

.

S -

I , f

, m m

m .

T m -

m. F xm, SNAP

m m m

m m m

mm - , m

m , m m. T

Models in Practice -

m-

- . A

, m m

m m

m m 9 USDA-

m (SNAP).

B m 22,

m m $776 $,558,

$26 m $4,.26



39/52


a : Currently, only about a third o the

elderly eligible or SNAP receive them.30 A complex enroll-

ment process, involving multiple orms and oten requiring

numerous accompanying documents and in-person inter-

views, presents barriers to many eligible clients, but es-

pecially the elderly poor. Beneits Data Trust (BDT) has re-

cently pioneered an approach to overcome these barriers

and is seeing impressive early results. Using an approach

modeled on successul credit card marketing programs,

BDT obtains lists rom government and private organiza-

tions and cross reerences them to identiy seniors who

are eligible but not receiving beneits. It then contactseligible individuals through direct mail and automated,

prerecorded telephone calls. Through its call center, BDT

assists those it contacts by illing out applications elec-

tronically and submitting them to the appropriate agency.

A client usually can complete up to three applications

during a 30-minute call. Since BDT representatives keep

detailed electronic logs o their contact with clients, any

representative can provide prompt service when a client

calls in. Tracking also supports BDTs eorts to assess

and analyze its perormance. In addition to assisting with

SNAP enrollment, BDT helps low-income seniors gain ac-

cess to Low Income Home Energy Assistance Program (LI-

HEAP) and drug beneits.

i: Screened 11,000 clients and completed 6,166

applications, yielding 4,471 new beneits accessed be-

tween September 2008 and January 2009. These enroll-

ments all helped people 65 and over.31

c: $300,000 to cover computers and phones, sala-

ries and beneits or call center representatives, program-

ming or beneits, and direct mail costs.32

c : An estimated $67 per newly enrolled

client. This number is decreasing as BDT enrolls more cli-

ents, leveraging economies o scale.33

To learn more about Beneits Data Trust, visit its website

at: http://www.bdtrust.org. Alternatively, contact Michelle

Raymond, development director, at (215) 207-9106 or

[email protected].

Ipin tt-i cc thh b pbic-pit ptnhip

a : For many programs, processes and

eligibility or enrollment dier by state. The Ohio Ben-

eit Bank (OBB) is one o nine state eorts by the Work

Supports Initiative, a public-private partnership to connect

low-and moderate-income amilies with work supports,

The Ohio Beneit Bank (OBB) is a public-private partner-

ship o the Ohio Governors Oice o Faith-Based and

Community Initiatives, Ohio Association o Second Harvest

Foodbanks, oundations, and other aith-based, nonproit,

governmental, and private-sector organizations. Its web-

based service reduces complex tax and beneit orms to

simple questions written at a 4th-grade level. A network

o community-based nonproit partners (e.g., churches,

legal aid services, and ood pantries) oers the web-based

service, and a corps o trained volunteers assist clients

with entering answers to questions. The service uses the

answers to assess a persons eligibility or about 20 ben-

eits across our categories: ood,medical, tax assistance,

and other supports (e.g.,childcare and home energy as-

sistance). The counselor then helps the client complete

and submit the appropriate applications.

i: Since its inception in 2006, OBB has trained

more than 5,300 volunteer counselors who help clients

at nearly 1,200 sites in all o Ohios 88 counties. OBB

has screened more than 88,000 people and completed

32,000 beneit applications. Based on assumptions made

by OBB, the screenings are estimated to have producedmore than 22,000 new enrollments in public beneit pro-

grams.34

c: Costs or launching an eort in a new state all

into three broad categories: initial investment in technolo-

gy and technical assistance ($950,000 to $1,600,000 or

year one);ongoing operational support (estimated at 35%

uin cit c tin tchniq t pi bnit t th n

models in practice: (continued):


40/52


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models in practice: (continued):

Ipin tt-i cc thh b pbic-pit ptnhip (cnt)

o technology costs, or $330,000 to $560,000 annually);

and civic engagement and counseling eorts ($600,000

to $650,000 annually).35

c : Between $170 to $230 or a state with

a program and client population similar to that served by

OBB. State demographics and geography, state-speciic

technology requirements, and relationships with civic en-

gagement partners (e.g., community colleges) are exam-

ples o actors that can inluence both the cost and impact

o a new program.36

To learn more about Ohio Beneit Bank, go to its web-

site at: http://www.obb.ohio.gov. To learn more about the

Work Supports Initiative, go to: http://www.mdcinc.org or

contact Ralph Gildehaus, senior ellow at MDC, the North

Carolina-based nonproit ounder and managing partner o

the Work Supports Initiative, at (919) 251-8818.

For more details on these models see High Impact Philanthropy

in the Downturn: Additional Sources and Due Diligence aailable on our website: www.impact.upenn.edu.


41/52


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organiZation where they worK website page no.

o 1: p F

c c

c s

(cccs) a (k

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counselin aailable at

30 locations in georia,

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aailable nationally

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National www.nw.org 10

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Colorado www.saludclinic.org 18

c s v Fresno, Kern, Inyo

counties, Caliornia

www.clinicasierravista.org 18

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nk (chn)

New York City, New York www.chnnyc.org 18

c h

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Southeast Kansas www.chcsek.org 19

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u w Worldwide www.211.org 23

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list of nonprofits


44/52

THe CeNTer for HIgH ImPaCT PHIlaNTHroPyRef-ii

organiZation where they worK website page no.

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West Michigan www.wmleaners.or 30

p Delaware valley www.philabundance.org 31

ebf Atlanta, Baltimore, Bualo,

Memphis, New York,

Louisille, Tulsa

www.earnbenefts.org 34

bf d t

(bdt)

Philadelphia, Pennsylania www.bdtrust.org 35

o bf bk

(obb)

Ohio www.obb.ohio.gov 35

bf bk Pennsylania, Florida,

District o Columbia,

Maryland, Mississippi,

Kansas, Arkansas

www.thebeneftbank.com 35

mdc, i North Carolina www.mdcinc.org 36

F a National www.eedingamerica.org 37

list of nonprofits (Continued)


45/52

HIgH ImPaCT PHIlaNTHroPy IN THe dowNTurNRef-i

VMA Cmm. (29, J 6). Is anybody listening? A testament by Village Academy High School students on the

economic crisis. R Sm 7, 29, m ://..m//mmm.

2

Km, M., B, J., C, F.R., Fm, K., H, C., H, D. (29, M 7). T : P N Y . New York imes. R Sm 7, 29, m ://.m.m/

/29/5/7//-j/2957_FORECLOSURE.m.

3 L, P., I, J. (28, A). Te impact o the mortgage crisis on children and their education . W, DC: F F.

R J 28, 29, m ://../~/m/F///28/4_m__/4_m_

_..

4 E, B., OC, K., D, S., P, S. W. (28, A 5). Foreclosure to homelessness: Te orgotten victims o the

subprime crisis: A national call to action. W, DC: N C Hm. R J 28, 29, m

://../m/FHmA528..

5 C R L. (29, M). Soaring spillover: Accelerating oreclosures to cost neighbors $502 Billion in 2009 alone.

R M , 29, m ://../m-/-/--3-9..

6 Imm, D., Sm, G. (26, Nm). T m -m m m. Housing

Studies, 2(6), 85-866.

7 A, W.C., D, M. (25, M ). Collateral damage: Te municipal impact o todays mortgage oreclosure boom.

Hm P F. R A , 29, m ://.995.///A_D_S_

S_V..

8 M B A. (29). N : S 29. R O 9, 29, m ://

.m./PD.x?_=EC-38-RP-I. N: 3.6% --j

m MBA N D S. M

m .

9 S R 5.

RERm. (29, S 7). FC announces new enorcement actions in continuing crackdown on mortgage relie services scams .

R Sm 7, 29, m ://.m.m/29/9/7/f---m---

---m---m-ID6.m.

F M. (25). Foreclosure avoidance research. R M 9, 29, m ://.m.m//m//

__25..

2 S R 7.

3 S R 5.

4 T (.., $36 ) mxmm m (.., $34,)

A m m x (.., 9 m) j C

R L.

5 S R 5.

6 S R 5.

7 S R 6.

8 CCCS A. (29, J 2). Consumer credit counseling service o greater Atlanta helps record number o people in 2008.

R J 5, 29, m ://../mRm/RD.j?=83

9 Cm C C S. (29, J 7). Using technology solutions to improve outcomes in oreclosure prevention:

A presentation to Kat Rosqueta and Hilary Rhodes, Te University o Pennsylvania. A, GA.

2 H, C., m, J., R, C. (28, Sm). Te state o the housing counseling industry. U.S. Dm H

U Dm. R M 9, 29, m ://../P/PDF/_..

2 P mm M C, Ex V P C O O CCCS A, J 7, 29.

22 S R 2.

opportunity 1 : referenCes And endnotes


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THe CeNTer for HIgH ImPaCT PHIlaNTHroPyRef-iv

23 F m A A m m , HUD- . T

m m. F, , . S,

(.., m , ). T, m m

. F, m

; m m. I m

, m $45 $862 .

24 S R 2.

25 L 5 : ACHIEVE, ACORN, C P Cmm C, D Cmm S/Dx

H, H P NAC, L CDC, N K CDC, N CDC, N S C A, P

Umm Pj (PUP), GPUAC - S Hm/S N - W O L, S CDC, S

M NAC, T P CDC, U Cmm S P, W P NAC

26 P mm C , O 6, 29 Nm 3, 29.

27 T U S C M. (29, J 29). USCM, A, m m

m . U.S. Mayor Newspaper. R O 27, 29, m ://m./

m/m/6_29_9/6_ACORN.; T, G. (29, J ).Mayors laud Acorn anti-oreclosure eorts.

R J 2, 29, m ://..m///69/M__A___.m.

28 ACORN. (29). R R: H P M R F A C. R J , 29

m ://../m/ACORN_R/29/R__R_R..

29 Ex G Nm 29.

3 C ACORN , A J 29.

3 S R 3.

32 P --m . S : .m..

m.

33 S R 2.

opportunity 2: referenCes And endnotes

Fm, V. (28, Sm 22). Consumers cut health spending, as economic downturn takes toll. R A 26, 29,

m ://.j.m//SB22249875666845.m.

2 A, J. Z., Wm, J. S., S, E. C., G, J. A., Z, A. M. (2, O 25). Um

U S.Journal o the American Medical Association, 284(6), 26-269.

3 Hmm, D. U., W, E., T, D., W, S. (25, F). I j .

Health Aairs, W5, 63-73.

4 C, S. (29, J ). U.S. initial jobless claims decreased last week . R J , 29, m ://.m.m/

/?=2668=QQRSN.

5 L.. (29). Health: Key health acts. R J 2, 29, m ://..//.

6 Gm . P., K, R. G. (29, J/A). H m : H m Am

2? Health Aairs, 28(4), 573-577.

7 Fm USA. (29, J). Te clock is ticking: More Americans losing health insurance coverage. R J 24, 29, m ://

.m.///-m/--..

8 U.S. Dm H Hm S, H R S Am. (28) Te health center program:

2007 national aggregate UDS data. R J 2, 29, m ://..//27/R//SSmmR.

m.

9 U.S. Dm H Hm S, H R S Am, B Pm H C.

(28, J). Health centers: Americas primary care saety net, reections on success, 2002-2007. R J 2, 29, m: f://f.

.//HRSA_HCPmR..


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HIgH ImPaCT PHIlaNTHroPy IN THe dowNTurNRef-v

N A Cmm H C, R Gm C C L. (27, A).Access granted:

Te primary care payo. R J 2, 29, m ://..m//A_G_FULL_REPOR..

S, P., F, B., Rm, S. (28, F 25). How does investment in community health centers aect the

economy? G G Pm/ RCHN Cmm H F, R B #. R M 2, 29, m:

://.m.//m//_P/_/P_A5C8D794-556-9D2-

3DD5D5A9CD2DAFD.2 N A Cmm H C. (28, A). Health centers and the uninsured: Improving health and access to

care actsheet. R A 2, 29, m ://..m//m/U_F_S_FINAL92..

3 I m mm z (

) S 33 U.S. P H S A. T

(FQHC). FQHC - m m FQHC

.

4 S R 9.

5 D, A., P, Y., S, P. Rm, S. (28, A 3). Uninsured and Medicaid patients access to preventive care:

Comparison o health centers and other primary care providers. G G Pm/ RCHN Cmm H F,

R B #4. R A 2, 29, m ://.m.//m//CHPR//

RCHN_4_8-3-28..

6 S, P., J, K., Rm, S. (23, Sm). Reducing racial and ethnic health disparities: Estimating the impact o highhealth center penetration in low-income communities. P N A Cmm H C. R

J 5, 29, m ://.m.//m////GWU_D_R..

7 E, S., M, P., G, P. (28). C Am m m? Journal o

Urban Health: Bulletin o the New York Academy o Medicine, 85(5), 766-778.

8 I M. (23). Unequal treatment: Conronting racial and ethnic disparities in health care. W, DC: N

Am P.

9 S R 8.

2 P, M. (25, Dm). D : H - - .Journal o

Ambulatory Care Management, 28(4), 32-33.

2 S A: S Fm H C. (29). C. R M , 29, m ://../S--

.m#. N: S Fm H C A P m z m m

m . S B: A. (29). E m !

R Sm , 29, m ://..m//8.m. S C: H B B. (29).

O , , 3. R Sm , 29, m ://..m/_R.

x?=225=MD.

22 J, N., O, P., Wm, E. (29, Sm 3).An update on state budget cuts: At least 41 states have imposed cuts that

hurt vulnerable residents; ederal economic recovery unds and state tax increases are reducing the harm . C B P

P. R Sm 2, 29, m ://../3-3-8.

23 Am H R W J F. (29, M). Shortchanging Americas health: A state-by-state

look at how ederal public health dollars are spent and key state health acts. R J 24, 29, m ://.m-

.///9..

24 K, L. A., K, M. R., C, J. S. (25). Early childhood interventions: Proven results, uture promise. S M,

CA: RAND C. R M 2, 29, m ://..//m/25/RAND_MG34..

25 K, J.W., , .K., S, L., W, M. (25, A). T S-K m j: A mz mm x m .American Journal o

Public Health, 95(4), 652-659.

26 Sx, C. S., O, S. (28, M/A). x-Mx m 2 .

Diabetes Educator, 34(2), 299-39.

27 Lm, . K., MP, S. J., M, J., W, C., D, H. ., N, ., L, K. Q., H-I, ., L, . N. (23).

E Vm Am m m .

Journal o General Internal Medicine, 8, 56-524.


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28 S, L. K., S, L. L., B, D., P, V., E, J. (25, J). P A: T mm-

m. Preventing Chronic Disease: Public Health Research, Practice and Policy, 2(), -.

29 N-Fm P. (29, M).A sound investment that can yield substantial public and private gains. R J 7,

29, m ://.m.///PDF/F_S/NFP_P_F..

3 S R 24.

3 S R 24.

32 S N 3.

33 T J Cmm. (..) What is accreditation?R J 24, 29, m ://.jmm./NR//

D4B6788-98B-4642-A4F-ADB685C335//m_.; T J Cmm. (29, A 24). Facts about ambulatory care

accreditation. R J 24, 29, m ://.jmm./APm/AmC/_.

m.

34 P Cmm J M, m , S Fm H C. M 29.

35 P Cmm S S, x (CEO), C S V. J 29.

36 P Cmm Ez H, m , Cmm

H N. M - J 29.

opportunity 3: referenCes And endnotes

T C S N Am Pm (C-SNAP) M-L P C (MLPC) B

M C. (28, O). Bringing children in rom the cold: Solutions or Bostons hidden homeless . R J 3, 29,

m ://..///BCFmC..

2 N, M., A, M., C, S. (28, Nm). Household ood security in the United States, 2007. U S Dm

A Em R R Nm 66. R, J 2, 29, m ://.../P/ERR66/

ERR66..

3 B, J. (28).All you can eat: How hungry is America?N Y: S S P. (. 28).

4 Em m : USDA C N P Pm. (29, J). Ofcial

USDA ood plans: Cost o ood at home at our levels, U.S. average, June 2009. R Nm , 29, m ://..

./P/FP/29/CFJ9.; USDA F N S. (29).Supplemental Nutrition

Assistance Program: Fact sheet on resources, income, and benets. R Nm , 29, m ://...//

_/_R_B_E.m; C, S., C, L., M, J., S, J. (27, Nm). Dynamics o ood stamp

program participation, 2001-2003 . USDA F N S, O R, N A. R Nm

, 29, m ://...//MENU///FILES/P/Dm2-23.; C, S., G,

P., S, B., S, M., S, J. (25, F 4). Food stamp program entry and exit: An analysis o participation trends in

the 1990s. USDA Em R S. W, DC: Mm P R, I. R Nm , 29,

m ://.mm-m.m//_PDB.?S=PDF/FSPx.; L, C., R, W.,

S, J. (26, J). Food stamp program costs and error rates, 1989-2001. USDA C C R N. 5.

R J , 29, m ://.../P/CCR5/5..

5 T U S C M. (28, Dm). Hunger and homelessness survey: A status report on hunger and

homelessness in Americas cities: A 25-city survey. R J 2, 29, m ://m.//m/

m_228..

6 F Am. (28). Local impact survey results summary. R J 2, 29, m ://m./~/m/

F//-m-/28-m-.x.

7 S R 5.

8 SModels in Practice m .

9 USDA C N P Pm. (29, J). Ofcial USDA ood plans: Cost o ood at home at our levels, U.S. aver-

age, June 2009. R Nm , 29, m ://.../P/FP/29/CFJ9..

M S U O P. (998-999). Om U S. Best Practice Brie, N. 8,

998-999. R O 3, 29, m ://.m.///8.; P mm J

A, Ex D, W M F B. J 2, 29.


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P mm J A, Ex D, W M F B. J 2, 29.

2 B U.S. Dm A Em R S m ,

m m 4 5 .

3 C USDA Em R S m m

m.

4 P Cmm Wm C, P Ex D, P, J 4, 29.

5 S R 4.

6 C m mm Wm C, P Ex D, P,

J 4, 29.

7 S R 9.

8 Wz, K. (28, J). rends in ood stamp program participation rates: 2000 to 2006. P Mm P R,

I. U.S.

Documents

High Impact Philanthropy in the Downturn: Focus on Housing, Health, and Hunger (A Guide for Donors)