Community Grants Program

2015-2016 Request for Applications (RFA)

Susan G. Komen® remains committed to fulfilling our promise to save lives and end breast cancer forever by empowering people, ensuring quality care for all and energizing science to find the cures. The San Diego Affiliate of Susan G. Komen® along with those who generously support us with their talent, time and resources join more than 100,000 breast cancer survivors and activists around the globe as part of the world’s largest and most progressive grassroots network fighting breast cancer.

The Community Grants Program is made possible through individual donations, corporate support, and events such as the San Diego Race for the Cure. With the funds raised, we will continue to fund projects that focus on reducing breast cancer incidence and mortality within the next decade with an increased emphasis on finding solutions for disparities in breast cancer across populations. Our affiliate supports evidence-based strategies and promising practices that reduce disparities in breast cancer mortality in San Diego County.

The funding period for the 2015-2016 Community Grants Program is April 1, 2015 to March 31, 2016. Applications are currently being accepted for breast health/breast cancer projects that support and promote access to and utilization of services that address the entire continuum of care model to include the following components: education, screening, diagnosis, treatment, follow-up care, survivorship, and/or end-of life-care. Only applications that appropriately respond to the guidelines outlined in this document will be accepted.

Based on the recent submission of the 2015-2016 letter of intent, your organization has been selected to proceed in submitting a request for application (RFA) that supports and promotes breast health or breast cancer projects within San Diego County. Please submit all RFA inquiries prior to 4:00 p.m. January 2, 2015 to ensure a timely response to any inquiries.

Statement of Need

Our Affiliate’s goal is to increase access to breast health care, ensure quality and access throughout the continuum of care, and reduce breast cancer mortality, especially among those who are disproportionately affected by this disease. Drawing from outcome-based information from the current Community Profile and other local data, the San Diego Affiliate of Susan G. Komen has identified the following priority areas for this grant year. The most recent Community Profile can be found on our website at http://komensandiego.org/services/applyforagrant/ .

Komen National’s 2014 Breast Cancer Fact Sheet reveals that only 50.8% of women 40 years and older in the United States reported having a mammogram in the last year. With low screening rates and the need for a solid continuum of care system, priority is being given to projects that address the gaps in service as outlined by this Community Profile, and include a 2015-2016 priority area as submitted by the applicant in the letter of intent and approved for the submission of a request for application, including requested modifications:

Priority Area Category

Access to Diagnostic Services: ($375,000 grant limit):

A major grant to provide diagnostic services for women under 40 and for those who do not qualify for the Every Woman Counts program. Would serve in a fiscal agent capacity for diagnostic services within San Diego County.

Required Evaluation Methods:

Services provided (tracking logs)

What services were provided? How many services to how many unduplicated clients?

Timeline (tracking logs)

How many days from authorization request to approval/denial response? How many days from approval to diagnostic service provided?

Care Coordination (site-neutral): Serving all of San Diego County: ($50,000 grant limit):

Identified Project Needs/Examples:

A project that would develop and maintain a care coordination program and serve all of San Diego County. This would include the maintenance of a breast health information clearinghouse and an updated website.

b. A site-neutral project that would provide extensive case management and home visits to the newly diagnosed or anyone living with breast cancer and serve all of San Diego County.

c. A community-based project that provides care coordination support to breast cancer clients as they move through the continuum of care process, and serve all of San Diego County.

Required Evaluation Methods:

Linkages/Referrals provided (tracking logs)

What barriers to care were identified? What resources were referred to overcome identified barriers? Were resources obtained and utilized?

Client reported outcomes (survey)

Were the client’s needs met? Did the client receive follow up? Was the client satisfied with their care coordination?

Patient Navigation (clinic and/or hospital based): ($40,000 grant limit):

Project Category:

a. Projects that support clients within a clinical or hospital setting. Programs target a defined set of health services required to complete an episode of breast cancer care, focus on the identification of individual patient-level barriers to care, and aim to reduce delays in accessing the continuum of care services to ensure patients progress into treatment from an abnormal finding within the 90-120 day period.

Required Evaluation Methods:

Baseline disease specific data (survey/medical reports)

The type and stage of cancer at diagnosis and what treatment was prescribed. Cancer baseline data should be recorded according to NCI standards.

Abnormal screening and treatment follow up (tracking logs)

How many clients with an abnormal screening got a diagnostic resolution? How many clients completed their treatment program?

Time to progress through each step of the continuum of care (tracking logs)

How many days between screening and diagnostic resolution? How many days from diagnosis to treatment?

Overcoming barriers to care (tracking logs)

What barriers to care were identified? How were barriers overcome?

Client reported outcomes (survey)

Was the client satisfied with their patient navigation? Did the client feel less distressed or have a better quality of life with the patient navigator?

Patient Financial Aid:

Project Category:

Project that provides needed patient financial support to the medically underserved, uninsured or underinsured. All financial support must be available to residents residing within all of San Diego County.

Required Evaluation Methods:

Financial aid provided (tracking logs)

How much financial aid was provided to how many unduplicated clients? What was the financial aid provided for? How was the financial aid provided (i.e. gift card, direct payment, etc.)?

Support Services: ($40,000 grant limit):

Project Examples:

A site-neutral project that would provide meal delivery for patients and their families going through the diagnosis and breast cancer treatment process. This project would serve all of San Diego County.

Projects that provide support services within all of San Diego County.

Required Evaluation Methods:

Support services provided (tracking logs)

How many support service items were provided to how many unduplicated clients?

Client reported outcomes (survey)

Were the client’s needs met? Did the client receive follow up? Was the client satisfied with their support service?

Education: ($40,000 grant limit):

Project Examples:

a. Project that focuses on educating the African American population with appropriate educational methods, and the implementation of a follow up plan that establishes links to provide women with free or low-cost breast cancer screenings and completion of screening. Emphasis is on serving the Southeast and/or Central San Diego population.

b.	Project that educates the public about breast health with appropriate educational methods, and the implementation of a follow up plan that establishes links to provide women with free or low-cost breast cancer screenings and completion of screenings. Emphasis on reaching targeted populations as identified in the most recent Community Profile.

Required Evaluation Methods:

Knowledge increase (Pre and post knowledge survey)

What percentage did the participants’ knowledge increase after the education?

Intent to get screened increase (Pre and post intent survey)

Did the participants’ intent to get screened change after the education?

Behavior patterns (behavior survey)

What are the participants’ current screening behavior patterns?

Number of requested screening and follow-up (tracking logs)

How many participants requested assistance in scheduling screening? How many of those participants made an appointment for screening? How many of those appointments were completed?

Mobile Mammography Screening: (50,000 grant limit):

Projects that increase early clinical breast exams and screening mammograms for rarely or never screened women. Must provide a customized approach of reaching women through the use of a mobile mammography service by reaching them where they work, worship or play. Emphasis is on reaching women in Central and South East San Diego and North County within the San Diego region (applying organization must be able to provide services in multiple areas).

Required Evaluation Methods:

Appropriate screening services provided (tracking logs)

How many clients received clinical breast exams? How many clients received mammograms? What were the clients’ ages?

Abnormal screening follow up (tracking logs)

How many clients had an abnormal screening? How many clients got a diagnostic resolution?

Educational Messages

Susan G. Komen® is a source of information about breast cancer for people all over the world. To reduce confusion and reinforce learning, we require that grantees provide educational messages and materials that are consistent with those promoted by Susan G. Komen® including promoting the messages of breast self-awareness, knowing your risk, getting screened, knowing what is normal for you and making healthy lifestyle choices. We do not recommend monthly breast self-exams and therefore will not fund education programs that teach monthly breast self-exams or use breast models. The consistent and repeated use of the same messages will improve retention and the adoption of the actions we deem important. Komen materials should be used and displayed whenever possible. Please visit the following webpage before completing your application and be sure that your organization can agree to promote these messages:

http://ww5.komen.org/BreastCancer/BreastSelfAwareness.html.

Educational Materials

Susan G. Komen® materials should be used and displayed whenever possible. To view our educational materials, visit www.shopkomen.com.

Patient Protection and Affordable Care Act

In 2014, we will still experience some changes in our health care environment. The Patient Protection and Affordable Care Act was passed by Congress in March of 2010. This law is intended to help more Americans gain access to health care through a variety of mandates that require most U.S. citizens to have health insurance by 2014 or face a tax penalty. Under this new policy, most Americans will have coverage that will pay for breast cancer screening and treatment. Please consider emerging policy changes when planning your grant project and drafting your proposal. Grant projects may be subject to revision based on the implementation of the law.

Insurance

Grantee agrees to maintain the following insurance during the term of this Grant Contract: (i) commercial general liability insurance with combined limits of not less than $1,000,000 per occurrence and $2,000,000 in the aggregate for bodily injury, including death, and property damage; (ii) workers’ compensation insurance in the amount required by the law in the state(s) in which its workers are located and professional liability insurance with limits of not less than $1,000,000; and (iii) excess/umbrella insurance, excess to the insurance set forth in (i) above, with a limit of not less than $5,000,000. In the event Grantee provides any transportation services in connection with the Breast Cancer Project, Grantee shall also maintain $1,000,000 combined single limit of automobile liability coverage. If Grantee provides or facilitates any medical services (other than referrals), Grantee shall maintain medical malpractice coverage with combined limits of not less than $1,000,000 per occurrence and $3,000,000 in the aggregate. Grantee shall name the San Diego Komen Affiliate and Komen National as an additional insured under its commercial general liability insurance policy solely with respect to the project and any additional policies and riders entered into by Grantee in connection with the project. Certificate of Insurance copies must be submitted to the San Diego Komen Affiliate prior to funding.

Presentations

Grantees must be willing to attend community, educational, and/or board meetings as requested. Participation from each funded grantee is required at the annual Grants Reception and Grantee Orientation.

Important Dates

Grants Workshop/GEMS

Training (mandatory):	December 1, 2014, 8:00am

Project Director/Authorized Signor

registration. No late registrations accepted:	December 12, 2015

Inquiries Deadline:	January 2, 2015, 4:00pm

Application Deadline:	January 7, 2015, 4:00pm

Award Notification:	March 18, 2015

Award Period:	April 1, 2015 to March 31, 2016

Eligibility

Applicants must meet the following eligibility criteria to be considered. Failure to adhere to the following guidelines may result in delayed processing or denial of the application:

Qualifications:

A representative must attend the mandatory grant application workshop.

Applicant has tax-exempt status under the Internal Revenue Service code. Applications will be accepted from U.S. nonprofit (federally tax-exempt) organizations, e.g., educational institutions, government agencies, and Indian tribes.

Applicant organizations must provide services that benefit residents of San Diego County.

The project must be specific to breast health and/or breast cancer (if a project is a combined breast/cervical cancer project, funding may only be requested for the breast cancer portion).

All past and current Komen-funded grantees must be in good standing to re-apply, this includes current Komen grantees to be in compliance with current contracts/programs. For applicants who have previously received funding from the Komen San Diego Affiliate, the past performance of that applicant will be considered.

The grant project can be managed by any project personnel, with the exception of family members, whose compensation is directly or indirectly influenced by the Project/Project Director.

If the applicant or any of its key employees, directors, officers or agents is convicted of fraud or a crime involving any other financial or administrative impropriety, then applicant is not eligible to apply for a grant during this current cycle and will not be eligible to apply for a new grant until the later of 12 months after the conviction or until applicant can demonstrate that appropriate remedial measures have been taken to ensure that any criminal misconduct does not recur.

If funded, submission of a W-9 form is required.

Restrictions:

No indirect costs are allowed for this grant: all costs associated with the implementation of this grant must be stated.

Salaries, if requested, are for personnel related to this project only and not for general work of the applicant organization.

Fringe benefits are capped at 25%.

Equipment costs are limited to $5,000.

Funds must not be used for entertainment or refreshments

Funds may not be used for meeting or conference costs unless these costs directly affect the delivery of services or education.

Funds may not be used for:

Medical research

Scholarships or Fellowships

Construction or renovation of facilities

Political campaigns or lobbying

Endowments

Debt reduction

Annual Fund-raising campaigns

Event Sponsorships

Projects completed before the date of grant approval

Employee matching gifts

Land acquisition

Program related investments/loans

Expenses for Thermography

Expenses to purchase breast models

Organizations may not submit more than one RFA for the same project.

Research Projects are not eligible for this project; however, Komen provides national funding opportunities for research driven projects which can be accessed at www.komen.org/grants

Allowable Expenses:

Funds may be used for the following types of program expenses:

Salaries and fringe benefits for program staff

Consultant fees

Clinical services or patient care costs

Meeting Costs

Supplies

Travel

Other direct program expenses

Application Instructions

All applications must be completed and submitted online through the Grants e-Management System (GEMS) at https://affiliategrants.komen.org. on or before January 7, 2015 by 4:00pm. No late submissions will be accepted.

When submitting make sure you apply for a community grant (CG Application) not a small grant (SG Application) application within GEMS. Only complete applications that are in full compliance with the application guidelines will be submitted for grant review by an independent professional peer review panel established through the San Diego Affiliate grants committee, in accordance with the grant making guidelines set forth by Susan G. Komen, National. Please do not contact the San Diego Affiliate of Susan G. Komen® regarding the status of the application during the review period.

Project Narrative

In the project narrative page of the application on GEMS, please address each section below:

Organization Capacity (limit-3500 characters)

Explain why the applicant organization has the capacity to lead the project, and both manage the delivery of and accomplishment of the goals and objectives set forth in this application.

Describe evidence of success in delivering breast health/cancer services to the proposed population.

Describe the organization’s ability to effectively work with and meet the diverse needs of the populations to be served by this project.

Is the organization culturally competent?

What specific languages will services and materials address?

Describe the organizations capability in ensuring adequate measures for internal control of grant dollars and ability to submit accurate program and budget reports.

Statement of Need (limit-3500 characters)

Describe the population to be served and the specific risks/needs within that population.

Provide statistics specific for the target population in relation to the project being proposed.

What specific impact will this project have for the population to be served and if this is a previously funded project, what new benefits will be achieved from the implementation of this project?

Project Description (limit-3500 characters)

Describe the program, its benefits and also the challenges that could be encountered throughout the implementation process.

Describe the impact the program will make for the priority area selected.

Explain how the project’s goals and objectives address the selected priority area and address the statement of need.

Projects that benefit from Komen funding must have a customer service and/or cultural competency component. Include your organization’s training plan for staff and volunteers.

Explain the past history in working with the target population and how the applying organization is respected and valued by the target population.

To ensure our constituency benefits from ongoing health care, what provisions will be made to ensure each client has a primary medical home?

How will health care reform be incorporated into this project?

Collaboration (limit-3500 characters)

To support our goal of maximizing resources and impact, we expect projects to collaborate, integrate and coordinate with other service providers. Describe the roles and responsibilities of all partnering organizations or entities participating in this project.

Explain how these collaborations strengthen the project and why they are best suited to partner in carrying out the project and accomplish the goals and objectives set forth in this application.

Projects must reflect a seamless “continuum of care” through a clearly identified referral and follow-up process. This can include those who enter, stay in or progress through the continuum of care. Include the specific plan that would be in place to address referrals and follow-up of services to include the partnerships/collaborations that would be in place for ensuring a continuum of care.

How will these partnerships/collaborations benefit the recipient of services being offered?

Sustainability (limit-3500 characters)

What resources (financial, personnel, partnerships, etc.) will be needed to sustain the effort over time? How will those resources be secured throughout the funded project period?

What are your organization’s plans to support the Project Director in implementing, managing and overseeing all aspects of the proposed project?

Describe the organization’s current financial state. Has your organizational budget increased or decreased from last year? Please explain why.

What efforts will be taken to communicate this project to leadership to ensure support throughout the grant period?

What emerging trends from the Affordable Care Act did your organization experience in 2014 and/or foresee for the coming year that will impact the implementation of this project?

Evaluation (limit-3500 characters)

A strong evaluation plan measures both the quantity and quality of strategy implementation and outcomes. Describe in detail how the program will measure achieving project goals and objectives and how the impact of the project on the priority area selected will be assessed.

Impact Evaluation: Assesses the changes that can be attributed to a particular intervention, such as a project, program or policy. Impact Evaluation helps us to answer key questions such as, what works, what doesn’t, where, why and for how much?

Process Evaluation: Assesses the delivery of programs. Process evaluation verifies what the program is and whether it is being implemented as designed. It answers the questions of what is delivered in reality and where are the gaps between program design and delivery?

Describe the evaluation expertise that will be available for this purpose.

What methods or tools will be used to measure and track evaluation? (Surveys, tracking logs, sign-in sheets, etc.)

Include the required evaluation methods outlined in your funding category description.

Attachments

Information regarding key personnel: For personnel that are currently employed by the applicant, provide a resume or curriculum vitae. For new or vacant positions, provide job descriptions (2-page limit per individual).

Proof of non-profit status: To document the organization’s federal tax-exempt status, attach the determination letter from the Internal Revenue Service. Evidence of state or local exemption will not be accepted. Please do not attach your federal tax return.

Letters of support, collaboration and/or memorandums of understanding (4-letter max): Demonstrate your partnerships to support the proposed program and the continuum of care model. For education/outreach applications, activities must link clients with providers to offer clinical breast exams and mammograms. This link must be clearly stated and outlines in a letter of support/collaboration.

Evaluation forms, surveys and/or logic model: Include documents related to demonstrating the effectiveness of your program as defined in your work plan. If a form, survey and/or logic model is mentioned in the application narrative, it must be uploaded to the application. Any application missing a form, survey and/or logic model will not proceed to the review process.

The grant application process is competitive regardless of whether or not an organization has received a grant in the past. Funding in subsequent years is never guaranteed. The actual number of awards will depend on the amount of funds available.

All inquiries related to this process should be directed to the Director of Grants and Public Policy at lizzie@sdkomen.org. All inquiries will be responded to within 2 business days therefore plan accordingly. The final date for submitting an inquiry is January 2, 2015.

As a non-profit, Komen San Diego seeks to always receive refreshments and entertainment from in-kind donors. We expect grantees to do the same.