An Intro to Grant Writing at CCHC

Charlotte Community Health Clinic (CCHC) relies on a significant amount of grant funding from diverse organizations. These include local faith groups, national non-profits, and the state and federal government. During my year at the clinic, I was given the chance to work on a number of these grants. Here’s three things I’ve learned as a result of my foray into grant writing:

Know your audience: It’s important to think about exactly who the funder is, in terms of what you write and how you write it. When I wrote a request to a local church, there was more flexibility to talk about individuals and their stories, express our organization’s belief in the right to access care and the inherent worth of individuals we care for. While that’s all well and good, when writing a grant request to the NC Office of Rural Health, they tend to care more about things like, well, money. In that grant request, we were careful to emphasize ROI, calculating potential community savings brought about by prevention of unnecessary ER trips. Different outcomes constitute impactful results for different audiences.

It’s a team effort: For some of the more formal grants I worked on this year, as many as five or six people would be involved in their writing. Typically, I would get to take a first stab at the narrative and work to find any clinical, local, or national data we might need to support our request. Requests for general operating funds were pretty straightforward because I could use fairly similar wording across grants. However, when writing for a new program, like when we wanted one of our providers to work onsite at a public housing location, I needed information from clinical staff to understand what the program would actually look like. Often times, the individuals that would know this (namely, our Chief Operating Office), would be busy with other things, like you know, keeping the clinic running, so I would take a stab at outlining the program. Then, when I had a chance to sit down with the COO she’d provide input as to what resources would be needed for the program to succeed and what I missed in the narrative. She would also help come up with reasonable objectives, usually with support from our data analyst. This would then get passed on to my supervisor, the Director of Development, who would work on the detailed budget and make my narrative sound a lot nicer (despite my Writing 101 professor’s best efforts, I’m the queen of unnecessary commas). When she was done, it would go back to the COO and CEO for final approval.

Outcomes are really, really tricky: Outcomes are what support the worth of your work. They give the grantor an idea of the tangible results that we anticipate coming if they fork over the money. However, there are a lot of things that make coming up with these objectives tough. Sure, we know that having a nurse who coordinates the care of our patients with chronic disease improves outcomes for them, but how do we measure that? 150 unnecessary ER trips avoided? Lower A1c levels for our diabetics by 1? A 25% increase in access to a patient care team? Are these objectives too broad, do they have too little direct correlation to the nurse coordinator, or are they too hard to measure? Even if we already track this data, do we have the capability to export it from our Electronic Health Records system? Additionally, what we think are significant goals may not seem that impactful to funders. For example, when we say the hire of a nurse coordinator will improve outcomes for our diabetics by 5%, we’re taking into account the many social determinants that impact our patients and the comorbidities that they often present with. But for some funders who may not understand our patient population as well, a 5% improvement may hardly seem a worthy investment.

It has certainly been a challenge to attempt to convey the value of our work to those who will never have the chance to meet our patients, but one I have very much enjoyed. It’s also been pretty great to start seeing the results of our efforts. Over the last two weeks we have received notice of having been awarded more than $170,000 for various grants we wrote earlier this year. While this may seem like a drop in the bucket, for us it means kick starting our effort to provide onsite services in public housing, buying medical supplies for our pediatric patients, providing health education workshops for seniors, and covering the cost of part of our nurse care coordination team. As I’m currently finishing out my final weeks here at the clinic, I won’t be around to see these funds in action. However, I’m grateful to have been given a chance to play a small part in tracking down the resources needed to let our clinic staff do more of their incredibly important work.

In the Pursuit of a Seamless Network of Care

Since the implementation of the Affordable Care Act (ACA), the number of insured people in the United States has increased; however, 12.2% (Q4 2017) remain without insurance in many communities. Healthcare safety nets continue to provide essential, community-based services to the remaining underinsured and uninsured people. Some of these individuals lack employee-sponsored coverage and their income is too high for Medicaid, some might be recent immigrants or seasonal workers, some might hold multiple jobs and still cannot afford marketplace coverage, and some might just have too low of a health status, are unemployed, and still are not Medicaid-eligible. Just navigating the complex system of government and local agencies takes a toll in the health of individuals and their families. The greatest issues still remain: access to care, affordability of care, and delivery of care.

According to the Small Area Health Insurance Estimates (2015), there are approximately 23, 317 uninsured adults between ages 18 – 64 in Cabarrus County, of which 42.1 % are below or at 135% of the Federal Poverty Level. More than one in seven (15.7%) adults report being unable to see a doctor in the past year due to cost (County Health Rankings, RWJF, 2015). I have been a Fellow at the Community Free Clinic since June of last year. To give you some context, we serve chronic working-age adult patients at 125% or below the Federal Poverty Level, with an annual re-certification process. As a central hub for HealthNet Cabarrus and the Pink Card Program, we provide access to on-site primary care, laboratory, behavioral, and pharmaceutical services, as well as specialty, diagnostics, and medical referrals. We have been serving the unmeet health needs of the county and its uninsured residents since our foundation in 1994. Currently, the Clinic has full time and part time staff, hundreds of volunteers including physicians, nurses, pharmacists, lab technicians, and many more. Our funding has come from several sources over our years of service: United Way of Central Carolinas, The Cannon Foundation, The Kate B. Reynolds Trust, Office of Rural Health Community Health Grants, The Leon Levine Foundation, Atrium Health/Carolinas HealthCare System – NorthEast, and private donations.

I have been involved in a series of meetings in order to develop a pathway for community members to more easily navigate our local system of care. The HealthNet task force has met for 18 working sessions, logging over 720-person hours to date to create a seamless system that serves the uninsured within Cabarrus County. Various health care and community organizations are involved in this endeavor: the Community Free Clinic, the Rowan Cabarrus Community Health Centers, Community Care of Southern Piedmont, Atrium Health/Carolinas HealthCare System – NorthEast, Carolinas HealthCare System – NorthEast Physicians Network, Cabarrus Health Alliance, Daymark Recovery Services, Cooperative Christian Ministry, and Cabarrus County Department of Human Services. All of us have the same goal in mind: to strengthen and revitalize the current health safety net for the uninsured population.

In a partnership with a team of consultants from Care Share Health Alliance, an organization that provides strategic support to other organizations forming coalition and safety nets in counties of North and South Carolina, we have strengthened our referral and enrollment system by implementing a web-based software, FHASES, to include multiple referral points and common data elements across partner agencies. Our principal goal is to increase the patient population accessing our services by 1000 within the next 12 months. With that in mind, we also want to increase individual trackability of referrals and appointments to make sure they do not get lost in the “black hole”. The collaborative has also focused in tracking population and individual data on social determinants of health. However, we will not only assess for SDOH, but also make the necessary referrals to local partners ranging from temporary housing to food pantries. This will be done using the Community Resource Hub, a platform established by Atrium Health using Aunt Bertha, that provides referral specialists the ability to close the loop.

Perhaps one of the most impactful experience has been working with these local, community leaders in the efforts to strategize and continue to meet the unmet needs of the Cabarrus community. The health care environment has shifted in the last 10 years with funding and policy becoming unstable and highly politicized. It has been fantastic to see the synergy among these organizations and leaders that continue to provide the necessary services to the community, and it has been a privilege being able to support them in this effort.

From Directionless to DIF and On…

 

As I approach the last quarter of my time as a Fellow and head on to pursue my Masters of Public Health next fall, the DIF’s fearless leader in Career Development asked if I might share how I got here from last year when I had no inkling of what I might do the next year, let alone for the rest of my life. So here goes…

During undergrad, it seemed like most of my friends figured out what they loved early on, from chem research to music theory, and stuck with it. Meanwhile, I had a blast bouncing around from gene editing and behavioral ecology to as many East Asian religions classes as I could sneak in (take a class with Dr. Pang and thank me later). But even after hours lounging outside the Union listening to tour guides assure parents that Davidson produced students before athletes (“Athletes and other students all go to the same classes AND eat in the same dining hall!”), I can’t deny swimming was my thing. I enjoyed going to class, but heading to Baker to try and chase down the guys at the end of a long set? That was what I loved.

Then senior year rolled around, and I was still sitting outside the Union drinking gallons of Honest Tea, now mulling over the fact that “run of the mill athlete in low interest sport” didn’t have a great post-collegiate outlook. I decided to buy more time by applying to a bunch of one year positions to put off figuring out what I actually wanted to do. I got an interview for the DIF’s Community Health Cohort despite having no significant public health background nor having taken a single public health centered class. The interview fell while I was off at NCAAs that spring, so I watched some quick webinars on the US health care system in between sessions, Skyped in from my hotel, and hoped for the best. Three months later, I walked in to my first day of work at Charlotte Community Health Clinic (CCHC).

Fortunately, my colleagues cared less about what I knew how to do and more about what I could learn to do quickly. I started by researching and writing grants, getting trained in EPIC (our electronic medical records system), and learning about the data gathering and analysis required for our federal grants. I taught myself our donor management system and became responsible for it. I worked with our referral coordinator on our follow-up process, rewrote our volunteer program, and worked with the community at outreach events. I interviewed our patients for advocacy and development purposes, analyzed our clinical and demographic data, and worked on program planning for expanding our women’s clinic and HIV services. I had the opportunity to sit in on a variety of health related community coalitions and work with my own cohort on writing a grant proposal for a resource we identified as missing from all of our clinics. And, I find value in the work I do. When I get tired of sitting at my desk for ten hours, I think of one of the countless stories that trickle back from clinical staff of lives changed and of individuals able to do the things they love most because of CCHC’s work. It’s more than enough to keep me going.

So, if you don’t know what you want to do next year, find an opportunity like this one that lets you try a little bit of everything. The exposure to a wide range of experiences allowed me to quickly identify what was not my thing (development) and what might be (health intervention implementation). By the time late fall rolled around, I had realized community focused public health was something I could imagine myself doing for the rest of my career. I look forward to getting to play with data while trying to communicate it in a way that creates the potential for systems level change. I’m excited to still work with the strict quantitative perspectives I revered in bio classes interwoven with the unpredictable challenges that surface when you try to apply them in real communities. I love how public health pulls from the multitude of disciplines and experiences I enjoyed at Davidson but never quite figured out how to tie together.

So, should I have tried to narrow my academic focus more while at Davidson? Probably. If I had to redo it, would I do anything different? Probably not. I had the time of my life making swimming my thing at Davidson. And, despite not finding my exact academic passion while at school, I’m still confident that I gained the writing, communication, and critical thinking skills that will allow me to tackle the challenges of a career in health interventions. I’ve now lived one of the benefits of a liberal arts education: my time at Davidson prepared me for a career I didn’t even know I was interested in while at school. So to any panicking seniors that don’t know where you’ll end up, go get yourself a Union Egg & Cheese Wrap (potentially what I miss most about Davidson), relax, and maybe apply for a DIF Fellowship or two. When you eventually figure out where you want to be, chances are Davidson has already given you many of the skills you’ll need to succeed there.

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