1. PAEA Government Relations Committee Health Care Reform Update, Title VII Opportunities, HRSA Q&A, and Teaching Advocacy Skills to Students David Keahey, PA-C, MSPH PAEA Annual Education Forum October 20, 2010 Baltimore, MD

2. Title VII Opportunities Goal: –Attendees will utilize these grant writing suggestions to improve the odds of achieving Title VII Health Resources and Services Administration (HRSA) funding.

3. Title VII Opportunities Objectives: –Develop the skills necessary to identify needs in their programs that would benefit from Title VII funding. –Acquire the knowledge of the application format, review criteria, budget justification, and funding priorities and preferences to permit the successful authorship of a Title VII grant. My biases... as far as I know

4. HRSA (The Access Agency) Mission: Five Health Profession program areas (FM/GIM/Peds): –Residency Training –Predoctoral Training –Faculty Development Training –Academic Administrative Units –Physician Assistant Training HRSA provides national leadership, program resources and services needed to improve access to culturally competent, quality health care.

5. Physician Assistant HRSA Training Grant Purpose “To meet the costs to plan, develop, and operate or maintain programs for the training of physician assistants and for the training of individuals who will teach in programs to provide training of physician assistants”

6. Helpful Applicant Resources: http://www.hrsa.gov/grants/apply/TechnicalAssistance/index.html

7. What Just Happened to HRSA? Shortage of approximately 21,000 primary care physicians in 2015 $250 million in 2010 to increase the number of primary care providers Builds on the $500 million for health work- force investments made by the American Recovery and Reinvestment Act of 2009 Evolution to 5 year grant periods http://bhpr.hrsa.gov/grants/default.htm

8. One Time Opportunities?

9. What Does Your Program Want or Need to Do? Recent strategic planning/brainstorming? Recent needs assessment/ARC-PA visit? Innovation in didactic and/or clinical instruction (especially re: primary care)? Implementation of a new or improved program/service to learners or the community? Faculty development? 2 Bottom line: Focus on activities you need to accomplish for which you lack the resources (with a caveat) 2 Glicken, AD. Excellence in Physician Assistant Training Through Faculty Development. Academic Medicine. 2008;83(11): 1107-1110.

10. Step 1: Are you connected with a grants management division in your institution? Start the process before the grant announcement Obtain/Register/Identify/Confirm your acronyms –DUNS –CCR –POC –M-PIN –AOR http://www.palmbeachpost.com/

11. Step 2: Funding Factors: Priorities and Preferences

12. Disadvantaged Priority Funding Factors

13. Medically Underserved Community (MUC) Funding Preference Have a high rate (55%) for placing graduates/program completers* in practice settings having the principal focus of serving residents of medically underserved communities; or During the 2-year period preceding the fiscal year for which an award is sought, have achieved a significant increase (50%) in the rate of placing graduates/program completers in such settings; or Meet the criteria for a new program. *Must practice at least.5 FTE

14. MUC Table

15. Step 3: Special Considerations Special consideration shall be given to projects that prepare practitioners to care for: –Underserved populations –Other high risks groups, e.g., Elderly, individuals with HIV/AIDS, substance abusers, the homeless, and victims of domestic violence –Healthy People 2010 goals (2020?) –Culturally and linguistically appropriate care

16. Step 4: Writing the Grant

17. Organizing the Grant Organize a small team (2-4?) with diverse skills—Original brainstorming/strategic planning group may be larger Develop timeline for grant prep/writing/submission Task responsible persons with internal deadlines Negotiate needs of the project (space, curriculum time, faculty resources) Identify partnerships/collaborators where and think about potential letters of support (e.g., interdisciplinary/interprofessional)—may need to do this earlier Focus on access and improving healthcare outcomes

18. Program Guidance Outline—65 pages Project Abstract--1 pages Progress Report*--3 pages –Specific Objectives and Methodology –Outcomes and Evaluation Project Narrative –Introduction –Organizational Information –Needs Assessment (Rationale) –Methodology –Work Plan –Resolution of Challenges –Outcome Measures and Dissemination –Evaluation and Technical Support Capacity Attachments –Organizational charts –Letters of agreement –Budget** *Heed the Progress Report Requirements **Heed Funding Restrictions

19. Application Review Information 100 Points* Total--6 Criteria 1.Need (15 pts) –Needs Assessment 2.Response (30 pts) –Methodology, Work Plan, Resolution of Challenges 3.Evaluative Measures (15 pts) –Evaluation and Technical Support 4.Impact (10 pts) –Outcome Measures and Dissemination 5.Resources/Capabilities (20 pts) –Organizational Information, Work Plan, and Progress Report 6.Support Requested (10 pts) –Budget Justification *TA FY 2010 has 7 Review Criteria and points for Specific Program Criteria: Special Considerations

20. Narrative (the meat of the proposal) Intro/Org Info/Rationale –Description of Your current program, setting, and resources Your program’s/institution’s strengths relevant to the project Need for the project (from the Needs Assessment) –National trends/drivers (e.g., service learning, learner-centered instruction, patient- centered home care models, HP 2010+) –Impact on learners, educational community, and patients –Relevance of your project to national priorities

21. Rationale Can you provide a rationale and assumptions upon which the project objectives will be based? Recent Retreat/ARC-PA Review? Is there an emerging medical education topic that merits incorporation into the curriculum? What does the literature say?* –Are there existing PA data? If not, what about medical school or graduate medical education? *Remember: PA educators are scoring your grant

22. Needs Assessment Student, faculty, community survey data—e.g., a competency or core clinical skill is lacking upon graduation –Interest of students and faculty (or community) –Demonstrated need in a specific area—e.g., special populations, cultural competence, health literacy Focus groups, census data, historical and geographical data, local/state health department statistical data

23. Alignment with Special Consideration Areas Special populations –Elderly, Homeless, Victims of Domestic Violence, Substance Abuse, Patients with HIV/AIDS Areas of innovation –Quality Improvement/Patient Safety, Health Literacy/Cultural Competency, PCMH Healthy People 2010+ Overarching Goals –Increase quality and years of life, eliminate health disparities

24. Methodology/Work Plan Link activities to specific objectives Report trainee diversity and recruitment status Describe staffing/expertise you have in place to conduct the activities Indicate Timeline (text and tables help reviewers) Describe how activities will be evaluated (T&T) Be realistic—the reviewers are experienced educators

25. Challenges and Resolution of Challenges For each objective, or where pertinent, what are the specific barriers, or perceived barriers, to success, e.g., –Hiring key personnel –Personnel training –Establishing partnerships/linkages –Competition for clinical sites Address how you will manage/resolve these challenges

26. Outcome Measures and Dissemination/ Technical Support and Evaluation Be specific in the evaluation –Have clear and measurable objectives –Allow for feedback into the process –Develop process and outcome measures Are the student evaluations summative, formative, qualitative? Are evaluations objective with realistic outcome measures? Staff expertise

27. Other Points Attachments—multiple Make it easy for reviewers to find required elements –Follow the Narrative Outline and Review Criteria! Sustainability after the grant (+/-) The proposed project should be doable by your program: highlight your track record The proposed project should be relevant to the mission of HRSA

28. Budget What will it cost to undertake each component of the project Account for time, equipment, office costs, etc. –Faculty support and consultant costs –Student stipends? (check the guidance) –Travel? (check the guidance) –Rental and leases –Office supplies –Equipment cost/maintenance –Other…

29. Budget Justification Justify all personnel –List all personnel, including those without requested salary support : “in kind contributions” Identify unique roles each person will play Justify all costs/travel/expenses –Who will travel and for what purpose, estimate expenses Indirect costs (F&A): “It depends”

30. Performance Reviews and Progress Reports Set up monitoring system (enrollees and graduates, see preferences/priorities tables) Involve key support personnel—”buy-in” Continuously gather data PD (PI) should monitor due dates and assure that reports are submitted in a timely manner

31. Take Home Points Know the purpose of HRSA grant support Identify program needs within the HRSA framework Strongly consider investing faculty time as HRSA grant reviewers Register at Grants.gov or become familiar with grants management at your institution (DUNS, POC, M-PIN, AOR) Utilize Program Guidance and Technical Assistance –Use the Program Guidance as an outline –Employ the Review Criteria as a sub-outline

32. Take Home Points Write the content in the comprehensive framework and to be consistent with the 6 (7?) Review Criteria From the outset, use tables from the Program Guidance to track faculty and students for future performance reviews and progress reports Contact successful Program Directors (PIs) to see if they will offer support and mentoring Early in the process: beg, borrow, or steel a majorly awesome impertial editer

33. References Catalog of Federal Domestic Assistance (CFDA) No. 93.884. Training in Primary Care Medicine and Dentistry. Authority: Title VII, Section 747, Public Health Service Act, as amended, (42 U.S.C-293k). Cawley, JF. Physician Assistants and Title VII Support. Academic Medicine. 2008;83(11):1049-1056. Glicken, AD. Excellence in Physician Assistant Training Through Faculty Development. Academic Medicine. 2008;83(11): 1107-1110.