Developing a Community-Engaged Grant Proposal Brian M. Rahmer, PhD, MS Heather Bittner Fagan, MD, MPH, FAAFP Carolyn Jenkins, DrPH, RD, APRN, FAAN

Funding for the DE-CTR ACCEL program is provided by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM with additional generous support from the State of Delaware, the University of Delaware, the Christiana Care Health System, Nemours, and the Medical University of South Carolina.DE-CTR ACCEL 1.Establish a new infrastructure that actively involves the community in setting clinical and translational research priorities. 2.Develop new community-institution partnerships in clinical and translational science. 3.Identify, educate and prepare community leaders, healthcare providers and institutional trainees, researchers and scholars in the principles and practices of community-engaged and community-based participatory research. Community Engagement and Outreach

Learning Objectives Framework and Tools for Partnership Delineate Necessary Steps in Proposal Development Highlight Components of a Quality Proposal and common pitfalls Overview of Funding landscape for Community Engaged Research (CEnR)

academic investigator and community investigator required 20k over 1 year LOI June 3 JUNE 20 PROPOSALS DUEJUNE 20 PROPOSALS DUE Accel Community Engagement ACE Awards

Iterative process

Partnership Common interest in the problem Belief that research can help solve

NIH Definition of Community Engagement “Scientific inquiry conducted in communities and in partnership with researchers. The process of scientific inquiry is such that community members, persons affected by the health condition, disability or issue under study, or other key stakeholders in the community's health have the opportunity to be full participants in each phase of the work (from conception - design - conduct - analysis - interpretation - conclusions - communication of results).” Reference:

Consider Partnerships Developed by MUSC academic and community co-investigators in response to investigation of partnership readiness to conduct CBPR and CBPA. Goal of toolkit is to foster a firm foundation for the partnership to conduct CBPR/CBPA and to achieve desirable health outcomes. Available for download from: ctr/programs/community_engagement/ Documents/SCTR%20CCHP%20Are% 20We%20Ready%20Toolkit.pdf

Academic research goals may be subordinate to goals of achieving true mutuality and inclusion… –mechanisms to verify that ethical principles are achieved are all the more critical… –implications of various study choices may need to be reviewed by research and community participants in a transparent process throughout the course of a project. Onerous? Maybe… Worth it? Certainly. Minkler (2003) has argued that the intrinsic complexity of many health issues often makes them poorly suited to traditional research methods and interventions. Partnership Challenges

Consider Competencies

Institutional fit Requisite skills Sponsor fit Time to address the research question A good idea

F Feasible I Interesting N Novel E Ethical R Relevant A Good Research Question

Development –Has project been recognized as a community- defined priority? If yes, then what is the supporting evidence? –Has clear link between community-defined priorities and proposed focus and approach been articulated? –Does project build community capacity? Will research create jobs, develop leaders, help sustain programs? –Does research build on the science? Consider Relevance

State the problem State the impact of the problem What do you plan to do about the problem –Include frameworks and theories State 1-2 specific aims Solicit, accept, and integrate feedback –before, during and after submission Concept Paper or Specific Aims page

Socio-ecological Model Consider Frameworks & Theories

One of my favorite Socio-ecological Model that fits with Team Science: Consider Frameworks & Theories

P population I intervention C comparison or control 0 outcome SPECIFIC AIMS

Are specific aims framed as patient- or community centric? –Will the information, once obtained, be sufficiently accurate and precise to be beneficial and reliable for patients, clinicians, and the community? Will this information be unbiased? How so? –Is the proposed study population relevant? Do identifiable limitations interfere with generalizations? –Are the outcome measurements framed as patient or community outcomes? Is there a logical flow from problem to outcome? Specific Aims

“There is no grantsmanship that will turn a bad idea into a good one, but there are many ways to disguise a good idea.” Norm Braverman, NIH

Consider CEnR Grant Logistics Engagement/Community-Engagement-Tools-and- Resources/~/media/0364AD817E4B416C DB7E8A0A.ashx Provides information about: Administrative logistics, ethics, and budget development Available from:

You must follow the guidelines exactly. Respond to all sections. Adhere to any format restrictions. Topics must be covered in order presented in guidelines. Use headings that correspond to the guidelines Consider Guidelines

ACE Awards Specific Aims (1 page) Significance (1/2 page) Innovation (1/2 page) Approach (4 pages) Impact (2 pages) Appendices allowed Biosketches – section A is key

Proposal Development Match the idea to a sponsor Read the guidelines Contact the sponsor and determine fit Plan in detail Develop the narrative & budget from detailed plan Read guidelines again with narrative in mind Edit & revise with team Outside review Edit and submit

 Identify/address barriers to community participation  Childcare, transportation, interpretive services  Specify who from community will participate and why this choice was made  Specify how community will participate  Include detail on how community representatives will be recruited, retained Consider Approach

Methodologies of CEnR are not novel tools, rather it’s how and why to apply these tools. How? With the input of the community Why? According to the priorities of the community Approach = Research Plan

Noninterest in community-level concerns, capacity building, and issues of equity Situated only within a biomedical framework Lack of emphasis on action outcomes and dissemination Common Pitfalls

Lack of sufficiently detailed methods –Focus groups –Survey development and testing Scale of work is too large Impact and/or next steps in obtaining funding are unclear Common Pitfalls

Start early Seek advice from colleagues Start with a good idea Talk to your Program Official(s) Use the NIH webpage ( Remember review criteria Follow instructions carefully Consider Process

Document why the problem is importantDocument why the problem is important Read, understand, and cite the crucial studiesRead, understand, and cite the crucial studies Critically analyze key themes in literatureCritically analyze key themes in literature Distinguish empirical findings from speculationDistinguish empirical findings from speculation Consider alternative perspectives- be your own toughest criticConsider alternative perspectives- be your own toughest critic Common mistake: Failure to…

Make sure to tell your story

ACCEL ACE Awards Foundations Industry State and Local Government Centers for Disease Control and Prevention Patient Center Outcomes Research Institute Agency for HealthCare Research and Quality National Institutes of Health Funding for CEnR

Consider Funding for CEnR Sources of CBPR Funding Your Logo PCORI NIH Institutes NCATS Integrate Community Engagement in T1-R4 Research AHRQ CDC Prevention Research Centers REACH and others See: /home.html /home.html Sources of Funding for CBPR: Federal agencies 60% State and universities 20% Foundations 20% See: _results.htm?year=active&scope=pa andhttp://grants.nih.gov/Grants/guide/search _results.htm?year=active&scope=pa lts.htm?year=active&scope=rfa Health System Networks See: nd-opps/index.html nd-opps/index.html See: pportunities pportunities

NIH Reporter  A searchable database of federally supported biomedical research  Access reports, data, analyses, expenditures, results of NIH supported research activities  Identify, analyze research portfolios, funding patterns, funded investigators: Identify areas with many or few funded projectsIdentify areas with many or few funded projects Identify NIH-funded investigators and their researchIdentify NIH-funded investigators and their research Identify potential mentors/collaboratorsIdentify potential mentors/collaborators

NIH RePORTer Go to NIH RePORTer at: porter_searchresults.cfm NIH RePORTer allows you to search all NIH funded grants (current & past) You do not have to fill in all the blanks. Just try a few!

Review of applications based on NIH standard review criteria –Significance –Investigators –Innovation –Approach –Environment Also initiative specific review criteria, when applicable (such as CBPR) Different criteria for training related applications Consider Review Criteria-NIH

Review of applications based on PCORI review criteria –Criterion 1. Impact of the condition on the health of individuals and populations –Criterion 2. Potential for the study to improve health care and outcomes –Criterion 3. Technical merit –Criterion 4. Patient-centeredness –Criterion 5. Patient and stakeholder engagement Consider Review Criteria-PCORI

Community argument based on national data Community described only in terms of needs and not strengths No sound rationale for partnership No clear link between community priorities and focus/approach No room for participatory approach No methods for building & sustaining partnerships No details about community board No evidence of community capacity building No evidence of dividing funding with partners Not clear who involved in proposal development When most of funding retained by applicant Consider “What Drives Reviewers Crazy” From: Community Campus Partnership for Health

Lack of new or original ideas Diffuse, superficial or unfocused research plan Lack of knowledge of published relevant work Lack of experience in the essential methodology Uncertainty concerning the future directions Questionable reasoning in experimental approach Absence of acceptable scientific rationale Unrealistically large amount of work Lack of sufficient experimental detail Uncritical approach Reasons for Not Funding From: National Institutes of Health

Remember, most people are not funded on their first try. Look carefully at the reviewers’ comments Address them carefully AND TRY AGAIN!!!!!!! So You are Not Funded, What Next?

Relationships developed through ACE and other CEnR efforts can carry over How can your pilot research inform collaborative or participatory evaluation? Implementation and Programmatic grants/contracts can be fertile ground for tacit cultivation of research questions. Connect the dots via partner networks Local Impact in Context

Research objectives defined quite differently, depending on whether the aim is to address determinants of health or determinants of health inequities. Our job as CEnR practitioners… –Represent concepts in ways that clarify a distinction between social causes of health and factors determining the distribution of these causes between more & less advantaged groups. –Clearly defining terms, and agreeing on definitions is critical. –Community partners must play a role in defining… Consider Definitions

Data vs. Stories