Maximizing Resources With Mini-Grants: Enhancing Preparedness Capabilities and Capacity in Public Health Organizations Victoria Wiebel, MPH; Christina Welter, DrPH, MPH; Geraldine Sanchez Aglipay, BS; Jason Rothstein, MPH rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Introduction: The Illinois Preparedness and Response Learning Center* engages in efforts to develop and maintain a competent, sustainable, and prepared public health workforce in Illinois. Training, education, and technical assistance activities are driven by assessments conducted to identify preparedness gaps, needs, and priorities of public health organizations and the communities they serve. Background: Many public health organizations face limited resources to engage in activities they identify as essential to building preparedness and response capabilities and capacity. In response to this challenge, the Illinois Preparedness and Response Learning Center adapted a mini-grant program to support short-term, targeted preparedness-related activities for which there was a need but no discretionary resources available. Methods: A mini-grant program was implemented on the basis of a request for proposals, with projects funded for a 6-month period. An evaluation was conducted at 6 and 12 months to assess the impact of the local project on the capabilities and capacity of the organizations that participated. Results: Thirteen projects were funded in local health departments and other organizations in a variety of communities across Illinois. Evaluation results indicate that these short-term projects contributed to the organization’s preparedness efforts and local partnerships 6 and 12 months after funding ended. Discussion: Even relatively small amounts of funding can assist public health agencies and their community partners in improving capabilities and building organizational and community capacity. Lessons Learned: (1) The mini-grant program model can help develop and cultivate preparedness partnership between academia and practice to achieve positive outcomes despite limited funding. (2) Funding self-assessed needs of organizations through a J Public Health Management Practice, 2014, 20(5), S83–S88 C 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright
mini-grant process may have value for larger programs without the staff resources or time to provide customized preparedness services to a large target market/service area. (3) There appear to be benefits to channeling small amounts of funding to address targeted needs and gaps identified by organizations. KEY WORDS: academia, capacity-building, mini-grants,
partnerships, preparedness, public health practice
In the fall of 2000, the Illinois Public Health Preparedness Center at the University of Illinois at Chicago School of Public Health was funded by the Centers for Disease Control and Prevention’s Public Health Practice Program Office to become one of the first in a national network of Centers for Public Health Preparedness in academic institutions.1 Over the ensuing decade, the Illinois Public Health Preparedness Center developed relationships with public health practice agencies in Illinois and surrounding states and engaged in collaborations across a range of innovative Author Affiliations: Illinois Preparedness and Emergency Response Learning Center (Mss Wiebel and Aglipay and Dr Welter), and MidAmerica Center for Public Health Practice, University of Illinois at Chicago School of Public Health (Mss Wiebel and Aglipay, Dr Welter, and Mr Rothstein). This work was supported by a Preparedness and Emergency Response Learning Center grant from the Centers for Disease Control and Prevention (CDC), under FOA CDC-RFA-TP10-1001, to the University of Illinois at Chicago (grant 5U90TP000412). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. The authors declare no conflicts of interest. Correspondence: Victoria Wiebel, MPH, University of Illinois at Chicago School of Public Health, 1603 W. Taylor St, MC923, Chicago, IL 60612 ([email protected]). DOI: 10.1097/PHH.0000000000000094 *The PERLC program is designed to address the preparedness and response training and education needs of the public health workforce. Supported by Federal funding (2010 to date), the program includes 14 centers in Council on Education for Public Health accredited Schools of Public Health. For additional information, see www.cdc.gov/phpr/perlc factsheet.htm.
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S84 ❘ Journal of Public Health Management and Practice activities and services to provide workforce preparedness education and training. In 2006, Pandemic and All Hazards Preparedness Act legislation was passed that included support for training and preparedness workforce development, and as a result, the Centers for Disease Control and Prevention issued a new funding initiative in 2010 to support the PERLC program.2 With this new funding, the Illinois Public Health Preparedness Center became the Illinois Preparedness and Response Learning Center (IPERLC) and the University of Illinois at Chicago School of Public Health was able to continue to support its training and practice partnership activities. IPERLC also began to work more closely with the MidAmerica Public Health Training Center (MAPHTC), a Health Resources and Services Administration–funded center at the University of Illinois at Chicago School of Public Health, to assess public health workforce needs in Illinois and to offer a continuum of consulting, technical assistance, and training that responds to those needs.3 Often efforts to enhance individual and organizational capabilities and capacity are addressed through creative and customized solutions. Through its partnership with MAPHTC, IPERLC adapted a mini-grant program model in an effort to address preparedness needs of communities throughout Illinois. This article describes the IPERLC mini-grant program and examines its impact on the capabilities and capacity of the organizations that participated.
activities are primarily driven by assessments conducted to identify preparedness gaps and needs among public health partners and by the priorities established by the community-related organizations being served. Once needs are identified, LHDs and community-based organizations often face limited resources available to engage in or implement many of the activities that they identify as essential to build preparedness and response capabilities and capacity. In response to these challenges, IPERLC developed a formal mini-grant process to support short-term, targeted preparedness-related activities for which there was a need but no discretionary resources available. The IPERLC mini-grant program was adapted from an approach used by our partner, MAPHTC, in which the mini-grant process is used as a tool to build organizational capacity in LHDs by addressing workforce gaps and needs that each participating agency identifies as critical priorities. By offering tailored solutions resulting from the use of such a tool, MAPHTC has increased capacity and strengthened existing partnerships offering a foundation for additional collaborative arrangements. IPERLC adopted these core principles and approach, with a goal to increase preparedness capacity across local communities and to help address unfunded, yet critical priorities.
● Background
In January 2012, IPERLC implemented a mini-grant process making $53 000 available to support short-term, targeted preparedness-related activities proposed by organizations in Illinois, for which discretionary resources were not available. The proposed projects were expected to increase preparedness and emergency response capabilities and organizational capacity of public health agencies to respond to man-made and natural disasters. Organizations eligible to apply included LHDs, primary care clinics (both stand-alone and federally qualified), and community-based organizations such as nonprofits, faith-based entities, and schools. Grants of up to $4500, for 6-month projects from March 1 to August 30, 2012, were offered through a request for proposals (RFP). In addition to providing the applicants with guidance, the RFP included examples of projects that would and would not be acceptable. Projects were expected to address the goal of increasing emergency response capability and capacity in Illinois. Funds would be made available to applicants proposing to address preparedness or workforce development needs within organizations or for serving target populations in their communities. Funded activities could include planning and delivering of specific trainings and exercises;
IPERLC addresses the needs of the public health workforce serving the state of Illinois, one of the nation’s largest and most diverse states. Illinois ranks as the nation’s fifth most populous state. Ninety-five local health departments (LHDs) cover 99 of the state’s 102 counties and a spectrum of urban, rural, and suburban communities. As a result of the legislative requirements set forth in the Pandemic and All Hazards Preparedness Act, IPERLC goals and activities were developed in response to “a plan to improve the nation’s public health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental, or natural” and “develop and deliver core competency-based training and education that respond to the public health preparedness and response needs of state, local and tribal public health authorities, and emphasize essential public health security capabilities.”2 As part of the national PERLC network, and in partnership with stakeholders within the state, IPERLC is engaged in efforts to develop and maintain a competent, sustainable, and prepared public health workforce in Illinois. IPERLC training, education, and technical assistance
● Methods
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Maximizing Preparedness Resources With Mini-Grants
developing needs assessments; creating or refining response plans; designing and developing awareness campaigns; as well as producing learning products and tools. Applicants were encouraged to propose activities that included collaborations with other public health partners in their communities to reach specifically identified target populations. For program evaluation purposes, applicants were asked to include short- and long-term goals to be achieved as a result of project activities, which were expected to support 1 or more of the following capability or capacity-building activities: r Increase organizational capabilities in emergency response. r Increase organizational capacity for emergency response. r Train the public health workforce. r Engage in emergency response collaborations with others in a community. r Engage in regional emergency response collaborations with neighboring communities. r Augment activities in the local Public Health Emergency Preparedness grant.4 Eligibility criteria and a scoring rubric were developed for reviewing the proposal responses. In addition to evidence as to how the proposed project would meet the objective of this mini-grant program, the review criteria assessed the readiness of the agency to implement the project, the target population that would be affected, the clarity and specificity of the project proposed, and the work plan and budget. Information about this mini-grant offering was distributed via the IPERLC Web site and through various online sources in Illinois. Letters of intent were requested, to anticipate the potential number of applications, and more than 100 letters of intent were received. An informational webinar was scheduled to provide the opportunity for potential applicants to get clarification on the RFP. Afterward, the webinar was archived on the IPERLC Web site and questions and answers provided during the webinar and via e-mail and telephone inquiries were posted on the Web site. (For those interested in more detail on developing and implementing the minigrant process, contact IPERLC directly.) The RFP drew more than 70 applications, which were distributed to 3 independent external reviewers and several IPERLC staff members. All agencies were notified of the decisions on their proposals. Contractual arrangements with the selected grantees were expedited, and IPERLC staff members were assigned as grantee coordinators. A progress report template for the midterm and end of the project was developed. To evaluate the overall impact of the mini-grant program, the report template included questions as to the impact of the project activities on the organizations and com-
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munities served, barriers and challenges encountered, factors that helped facilitate progress, and success stories. A multistage evaluation strategy assessed project activities at 6 and 12 months after conclusion of the grant period. This report focuses on 5 broad questions intended to assess the impact of the IPERLC program on the preparedness capacity of the agencies and organizations. The questions and analysis of responses to the 5 questions are discussed in the “Results” section.
● Results The 13 selected mini-grant recipients included 10 LHDs, 2 primary care clinics, and 1 faith-based organization, representing communities across Illinois, of which 7 organizations were from the northern portion and 6 from the southern portion of the state. A wide range of populations were targeted for project activities in urban, rural, and suburban areas. Two organizations served populations of more than 300 000 (one area urban and the other both urban and rural). One organization served a rural and suburban population of almost 140 000. Five organizations served populations of 50 000 to 100 000 (1 rural, 1 suburban, 1 rural and urban, and 2 rural and suburban). Five organizations served populations under 50 000, with 1 in an urban area and 4 in rural areas (Table 1). Grant awards ranged between $2163 and $4500, the maximum available per project. Projects targeted agency staff as well as a diverse range of specific audiences from their communities. These included residents, volunteers, first responders, faith-based organizations, non–English-speaking populations, longterm care professionals and clients, daycare center employees, university employees, the media, and food TABLE 1 ● Diverse Populations and Community Areas Served Across Illinois Through the Mini-Grant Model qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
Population Target
No. Organizations (N = 13)
Over 300 000
2
136 000-140 000 50 000-100 000
1 5
Up to 50 000
5
a Served b Served
Community Area(s) Urban Urban and rural Rural and suburban Rural Suburban Urban and rural Rural and suburbana Urban Ruralb
by 2 organizations. by 4 organizations.
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S86 ❘ Journal of Public Health Management and Practice establishments. In most cases, the projects included close collaborations with other community partners or the target audiences. Many of the activities were designed to assist populations that were economically disadvantaged, isolated, or rural, as well as those with functional needs. The organizations proposed to engage in trainings and exercises, gather data on needs of special populations, create and distribute informational resources, and convene groups, coalitions, and committees that would continue the work started with mini-grant support. All grantees described the potential short- and long-term impact anticipated after the initial support provided by IPERLC. On the basis of the responses to information required in the RFP, the projects all fulfilled 1 or more of the capability or capacity-building efforts listed in the “Methods” section. Project activities were also reviewed in relation to 2 sets of federal preparedness guidelines and were found to support functional areas and capabilities addressed in Emergency Support Function 8 of the National Response Framework.5 All activities were aligned with the “Community Preparedness” Capability within the 2011 Centers for Disease Control and Prevention Public Health Preparedness Capabilities. Several projects also addressed Capability 3 “Emergency Operations Coordination,” Capability 4 “Information Sharing,” and Capability 15 “Volunteer Management.”6 At 6 months post–grant follow-up, IPERLC conducted an evaluation to which 69% of the grantees (n = 9) responded. For the 12-month post–grant followup in August 2013, IPERLC conducted a second evaluation, with 92% of grantees responding (n = 12). For both assessments, a 5-point scale (1 = low; 5 = high) was used to measure responses by the director of the health
department or agency in charge of training. Table 2 summarizes the means and standard deviations for self-reported responses by the mini-grant recipients to 3 key questions. Respondents rated their funded projects highly for meeting their needs and strengthening partnerships at 6 months and even higher at 12 months. Respondents felt less strongly about whether the funded activities could have been accomplished with grant funding at 12 months than the responses received at 6 months. Two additional questions invited the participants to reflect on ongoing outcomes and share insights about innovations that may have occurred. One question on the survey asked, “Since the completion of the project at the end of August 2012, please provide a brief comment on the continued success, at this time, as a result of support provided by the IPERLC mini-grant.” A final question asked, “Is there anything new, innovative, or interesting that you would like to share 6 months/1 year after the grant?” At both the 6- and 12-month post–project completion periods, responses to these questions were often similar. Review of all the responses 1 year following the conclusion of the IPERLC mini-grant program found that support provided by IPERLC appeared to have had a positive impact on 4 activity areas. Each of the 4 areas is identified, followed by quotes from select grantees that reflect the impact of the activity that was supported by the mini-grant, as follows: 1. Preparedness partnership development r “Partnerships with emergency preparedness stakeholders continue to strengthen as a result of networking opportunities during training events.”
TABLE 2 ● Self-Reported Responses to 6- and 12-Month Broad Impact Evaluation Questions 1, 2, and 3 (Organizations
Queried: N = 13)a qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
As a result of the IPERLC mini-grant that your organization received to support preparedness activities, answer the following: 1. At this time, to what extent does (do) the training outcome(s) of the IPERLC mini-grant continues to meet your organization’s preparedness needs and responsibilities?
Responses at 6 mo (n = 9) Responses at 12 mo (n = 12) aA
2. At this time, to what extent have partnerships been strengthened as a result of the IPERLC mini-grant?
3. Since the completion of the project at the end of August 2012, to what extent would your organization have been able to accomplish the same outcomes from the activities without the IPERLC mini-grant?
Mean
SD
Mean
SD
Mean
SD
4.11
0.78
4.11
0.78
3.22
1.39
4.250
0.866
4.75
0.45
2.75
1.05
5-point scale (1 = low; 5 = high) was used to measure responses.
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Maximizing Preparedness Resources With Mini-Grants
2. Preparedness awareness building r “Personal preparedness is now mentioned in new employee orientation . . . . ‘Preparedness’ is now a word that comes up frequently in meetings.” 3. Data gathering regarding functional needs populations r “With the information we’re now able to collect, the emergency medical services (EMS) will be aware of households with special needs residents. Living in a rural county with only (a small number of ambulances) in the entire county, the information we gathered will be invaluable in an emergency.” 4. Training and exercise support r “We were able to fully test out plan by conducting a FULL SCALE exercise (which we were unable to do) this year due to (lack of) funding.”
Box 1 ● IPERLC mini-grant support . . .
r was “ . . . essential in helping us take an idea and turn it into reality . . . and assures that we will be ready to handle spontaneous volunteers in an efficient manner.”
r . . . for our activities with community partners “inspired more organizations to write Emergency Response Plans.”
r . . . allowed a remote rural health department and its partners to begin a database of residents with special needs . . . in the event of an emergency. “This was monumental progress in our emergency preparedness planning.”
r . . . helped provide emergency preparedness and response
training “in the community to groups of people as well as agencies who had never had the opportunity to participate . . . .” r . . . helped leverage a $10 000 grant from a corporate foundation to continue community-based preparedness activities started.
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ity categories that lend themselves more to mini-grant support than others. When the results from the first 2 questions are coupled with the narrative responses of the 2 additional questions about the continued impact of the activities 12 months post–project completion, it appears that individual and organizational capabilities or capacity improved as a result of IPERLC mini-grant support. The information gathered suggests that infrastructures were strengthened as a result of partnership expansion and greater collaborations during the IPERLCsupported activities. In some cases, these partnerships and collaborations resulted in critical data gathering efforts to improve their capacity to serve special populations identified within their communities. In addition, support for preparedness awareness efforts as well as for knowledge and skill building through trainings and exercises appeared to help improve individual and organizational capabilities and to build organizational and community capacity. One of the organizations was even able to leverage the work supported by the IPERLC mini-grant to obtain additional funding from a corporate foundation to continue its activity. Most of the organizations noted, in narrative responses to the additional 2 questions, that they would probably not have been able to achieve their objectives to the extent they had without IPERLC support. In the face of limited and shrinking resources for preparedness activities, the IPERLC mini-grant program indicates that providing even small amounts of funding to address targeted, self-assessed preparedness needs of public health organizations can have a positive impact on their ability to improve capabilities and build organizational and community capacity.
● Lesson Learned/Next Steps
● Discussion IPERLC evaluation of the mini-grant program indicates that the projects achieved positive outcomes. The responses to question 1 (noted in Table 2) suggest that the projects had a positive impact on addressing the preparedness training needs of the organizations. The responses to question 2 (noted in Table 2) suggest an even greater impact on the strength of partnerships that were created as a result of the IPERLC mini-grant program. While some organizations may have been able to accomplish the same outcomes without the minigrant funding, others may not have. Perhaps, looking at the type of projects that were funded merits further examination. It is possible that there are 1 or more activ-
There were several lessons apparent in implementing and evaluating the IPERLC mini-grant program. These focus on the model used, the opportunities for academic institutions to work with community-based partners, and the leverage afforded by even small grants. The mini-grant program is an example of a model that can help develop and cultivate preparedness partnerships between academia and practice to achieve positive outcomes despite the limited funding available to both. IPERLC learned that by offering minimal funding to support needs identified by organizations in the public health practice community, and assigning coordinators to help with specific projects, it built and strengthened partnerships and opportunities for potential future collaborations. The response rates for the 6- and 12-month evaluations were high, suggesting
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S88 ❘ Journal of Public Health Management and Practice that the grantees perceived success in meeting their targeted needs and experienced a strengthening of relationships as a result of support and services that the IPERLC provided. Another lesson learned relates to the evaluation of the mini-grant program based on the assessment of individual project evaluations. First, the evaluation of the individual mini-grant projects was limited in scope and rigor as a result of the short, 6-month project period. Only the immediate impact of project activities was measured by using “reaction” evaluation questions developed by the PERLC Evaluation Group (which were based on the Kirkpatrick model of evaluation).∗ The questions asked grantees how they felt about the training and/or activities they engaged in after the original 6-month interval and then the 12-month interval. While valuable information was captured, having a longer intervention period for the projects may have helped enhance the impact of the mini-grant program and allowed for a more rigorous evaluation. In addition, there were significant variances across the participating organizations and in the scope of activities conducted, making it difficult to perform comparisons between project sites. Given these limitations, it would be of interest to implement such a model again for a longer project period, to incorporate higher Kirkpatrick model evaluation levels, and to compare similarly structured projects or organizations. A third lesson suggests that funding the selfassessed preparedness needs of organizations through a mini-grant process may have value for larger centers or programs that may not have the staff resources or time to provide customized preparedness training or other services to a large target market or service area. For example, reduced funding to IPERLC had an impact on staff resources and ability to meaningfully address the preparedness needs of certain key partners in Illinois. By using the mini-grant program model, we were able to counterbalance the impact of reduced funding on our original proposed activities and still significantly impact academic-practice collaborations. The adaptation of the mini-grant model actually helped expand our center’s reach by contracting with agencies ∗
For additional information, refer to the Hites et al article in this supplement, titled “The Preparedness and Emergency Response Learning Centers: An Innovative Model to Advance Standardized Evaluation of Public Health Preparedness and Response Trainings.”
and their staff to do the planning, implementation, and evaluation of necessary preparedness activities themselves, rather than relying solely on the center staff. The center staff was still available to provide support, as needed, and to help build capacity in these agencies. This strategy also increased and strengthened partnerships and collaborations with the organizations, their partners, and their communities in our large service area. Based on the positive outcomes resulting from these collaborative activities, going forward, there may be opportunities for center staff to expand their support of these organizations by helping them develop customized trainings and services. The final lesson derives from the specific nature of the funding structure of the mini-grant model. Given limited and decreasing funds in public health agencies and community partner organizations, discretionary funds are seldom available for preparedness projects that may be required to increase and improve preparedness capabilities and capacity. There appear to be benefits to channeling small amounts of funding to address targeted preparedness needs and gaps identified by public health organizations, as reported in this article. These small but important dollars can catalyze activities and actions that may have significant impact on the organizations, their partners, and the communities they serve.
REFERENCES 1. Baker EL, Lichtveld MY, MacDonald PDM. The Centers for Public Health Preparedness program: from vision to reality. Public Health Rep. 2010;125(suppl 5):4-7. 2. Pandemic and All-Hazards Preparedness Act of 2006, Pub L No. 109-417 (2006). 3. Health Resources and Services Administration. Public Health Training Centers. http://bhpr.hrsa.gov/grants/ publichealth/trainingcenters/about/index.html. Accessed January 25, 2014. 4. Centers for Disease Control and Prevention. Public Health Emergency Response Grants. http://www.cdc.gov/phpr/ coopagreement.htm. Accessed January 25, 2014. 5. US Department of Homeland Security. National Response Framework. http://www.fema.gov/national-responseframework., Accessed January 25, 2014. 6. Office of Public Health Preparedness and Response. Centers for Disease Control and Prevention. Public Health Preparedness Capabilities: National Standards for State and Local Planning. http://www.cdc.gov/phpr/capabilities/ DSLR capabilities July.pdf. Accessed January 25, 2014.
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Introduction: The Illinois Preparedness and Response Learning Center* engages in efforts to develop and maintain a competent, sustainable, and prepared public health workforce in Illinois. Training, education, and technical assistance activities are driven by assessments conducted to identify preparedness gaps, needs, and priorities of public health organizations and the communities they serve. Background: Many public health organizations face limited resources to engage in activities they identify as essential to building preparedness and response capabilities and capacity. In response to this challenge, the Illinois Preparedness and Response Learning Center adapted a mini-grant program to support short-term, targeted preparedness-related activities for which there was a need but no discretionary resources available. Methods: A mini-grant program was implemented on the basis of a request for proposals, with projects funded for a 6-month period. An evaluation was conducted at 6 and 12 months to assess the impact of the local project on the capabilities and capacity of the organizations that participated. Results: Thirteen projects were funded in local health departments and other organizations in a variety of communities across Illinois. Evaluation results indicate that these short-term projects contributed to the organization’s preparedness efforts and local partnerships 6 and 12 months after funding ended. Discussion: Even relatively small amounts of funding can assist public health agencies and their community partners in improving capabilities and building organizational and community capacity. Lessons Learned: (1) The mini-grant program model can help develop and cultivate preparedness partnership between academia and practice to achieve positive outcomes despite limited funding. (2) Funding self-assessed needs of organizations through a J Public Health Management Practice, 2014, 20(5), S83–S88 C 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright
mini-grant process may have value for larger programs without the staff resources or time to provide customized preparedness services to a large target market/service area. (3) There appear to be benefits to channeling small amounts of funding to address targeted needs and gaps identified by organizations. KEY WORDS: academia, capacity-building, mini-grants,
partnerships, preparedness, public health practice
In the fall of 2000, the Illinois Public Health Preparedness Center at the University of Illinois at Chicago School of Public Health was funded by the Centers for Disease Control and Prevention’s Public Health Practice Program Office to become one of the first in a national network of Centers for Public Health Preparedness in academic institutions.1 Over the ensuing decade, the Illinois Public Health Preparedness Center developed relationships with public health practice agencies in Illinois and surrounding states and engaged in collaborations across a range of innovative Author Affiliations: Illinois Preparedness and Emergency Response Learning Center (Mss Wiebel and Aglipay and Dr Welter), and MidAmerica Center for Public Health Practice, University of Illinois at Chicago School of Public Health (Mss Wiebel and Aglipay, Dr Welter, and Mr Rothstein). This work was supported by a Preparedness and Emergency Response Learning Center grant from the Centers for Disease Control and Prevention (CDC), under FOA CDC-RFA-TP10-1001, to the University of Illinois at Chicago (grant 5U90TP000412). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. The authors declare no conflicts of interest. Correspondence: Victoria Wiebel, MPH, University of Illinois at Chicago School of Public Health, 1603 W. Taylor St, MC923, Chicago, IL 60612 ([email protected]). DOI: 10.1097/PHH.0000000000000094 *The PERLC program is designed to address the preparedness and response training and education needs of the public health workforce. Supported by Federal funding (2010 to date), the program includes 14 centers in Council on Education for Public Health accredited Schools of Public Health. For additional information, see www.cdc.gov/phpr/perlc factsheet.htm.
S83 Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
S84 ❘ Journal of Public Health Management and Practice activities and services to provide workforce preparedness education and training. In 2006, Pandemic and All Hazards Preparedness Act legislation was passed that included support for training and preparedness workforce development, and as a result, the Centers for Disease Control and Prevention issued a new funding initiative in 2010 to support the PERLC program.2 With this new funding, the Illinois Public Health Preparedness Center became the Illinois Preparedness and Response Learning Center (IPERLC) and the University of Illinois at Chicago School of Public Health was able to continue to support its training and practice partnership activities. IPERLC also began to work more closely with the MidAmerica Public Health Training Center (MAPHTC), a Health Resources and Services Administration–funded center at the University of Illinois at Chicago School of Public Health, to assess public health workforce needs in Illinois and to offer a continuum of consulting, technical assistance, and training that responds to those needs.3 Often efforts to enhance individual and organizational capabilities and capacity are addressed through creative and customized solutions. Through its partnership with MAPHTC, IPERLC adapted a mini-grant program model in an effort to address preparedness needs of communities throughout Illinois. This article describes the IPERLC mini-grant program and examines its impact on the capabilities and capacity of the organizations that participated.
activities are primarily driven by assessments conducted to identify preparedness gaps and needs among public health partners and by the priorities established by the community-related organizations being served. Once needs are identified, LHDs and community-based organizations often face limited resources available to engage in or implement many of the activities that they identify as essential to build preparedness and response capabilities and capacity. In response to these challenges, IPERLC developed a formal mini-grant process to support short-term, targeted preparedness-related activities for which there was a need but no discretionary resources available. The IPERLC mini-grant program was adapted from an approach used by our partner, MAPHTC, in which the mini-grant process is used as a tool to build organizational capacity in LHDs by addressing workforce gaps and needs that each participating agency identifies as critical priorities. By offering tailored solutions resulting from the use of such a tool, MAPHTC has increased capacity and strengthened existing partnerships offering a foundation for additional collaborative arrangements. IPERLC adopted these core principles and approach, with a goal to increase preparedness capacity across local communities and to help address unfunded, yet critical priorities.
● Background
In January 2012, IPERLC implemented a mini-grant process making $53 000 available to support short-term, targeted preparedness-related activities proposed by organizations in Illinois, for which discretionary resources were not available. The proposed projects were expected to increase preparedness and emergency response capabilities and organizational capacity of public health agencies to respond to man-made and natural disasters. Organizations eligible to apply included LHDs, primary care clinics (both stand-alone and federally qualified), and community-based organizations such as nonprofits, faith-based entities, and schools. Grants of up to $4500, for 6-month projects from March 1 to August 30, 2012, were offered through a request for proposals (RFP). In addition to providing the applicants with guidance, the RFP included examples of projects that would and would not be acceptable. Projects were expected to address the goal of increasing emergency response capability and capacity in Illinois. Funds would be made available to applicants proposing to address preparedness or workforce development needs within organizations or for serving target populations in their communities. Funded activities could include planning and delivering of specific trainings and exercises;
IPERLC addresses the needs of the public health workforce serving the state of Illinois, one of the nation’s largest and most diverse states. Illinois ranks as the nation’s fifth most populous state. Ninety-five local health departments (LHDs) cover 99 of the state’s 102 counties and a spectrum of urban, rural, and suburban communities. As a result of the legislative requirements set forth in the Pandemic and All Hazards Preparedness Act, IPERLC goals and activities were developed in response to “a plan to improve the nation’s public health and medical preparedness and response capabilities for emergencies, whether deliberate, accidental, or natural” and “develop and deliver core competency-based training and education that respond to the public health preparedness and response needs of state, local and tribal public health authorities, and emphasize essential public health security capabilities.”2 As part of the national PERLC network, and in partnership with stakeholders within the state, IPERLC is engaged in efforts to develop and maintain a competent, sustainable, and prepared public health workforce in Illinois. IPERLC training, education, and technical assistance
● Methods
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Maximizing Preparedness Resources With Mini-Grants
developing needs assessments; creating or refining response plans; designing and developing awareness campaigns; as well as producing learning products and tools. Applicants were encouraged to propose activities that included collaborations with other public health partners in their communities to reach specifically identified target populations. For program evaluation purposes, applicants were asked to include short- and long-term goals to be achieved as a result of project activities, which were expected to support 1 or more of the following capability or capacity-building activities: r Increase organizational capabilities in emergency response. r Increase organizational capacity for emergency response. r Train the public health workforce. r Engage in emergency response collaborations with others in a community. r Engage in regional emergency response collaborations with neighboring communities. r Augment activities in the local Public Health Emergency Preparedness grant.4 Eligibility criteria and a scoring rubric were developed for reviewing the proposal responses. In addition to evidence as to how the proposed project would meet the objective of this mini-grant program, the review criteria assessed the readiness of the agency to implement the project, the target population that would be affected, the clarity and specificity of the project proposed, and the work plan and budget. Information about this mini-grant offering was distributed via the IPERLC Web site and through various online sources in Illinois. Letters of intent were requested, to anticipate the potential number of applications, and more than 100 letters of intent were received. An informational webinar was scheduled to provide the opportunity for potential applicants to get clarification on the RFP. Afterward, the webinar was archived on the IPERLC Web site and questions and answers provided during the webinar and via e-mail and telephone inquiries were posted on the Web site. (For those interested in more detail on developing and implementing the minigrant process, contact IPERLC directly.) The RFP drew more than 70 applications, which were distributed to 3 independent external reviewers and several IPERLC staff members. All agencies were notified of the decisions on their proposals. Contractual arrangements with the selected grantees were expedited, and IPERLC staff members were assigned as grantee coordinators. A progress report template for the midterm and end of the project was developed. To evaluate the overall impact of the mini-grant program, the report template included questions as to the impact of the project activities on the organizations and com-
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munities served, barriers and challenges encountered, factors that helped facilitate progress, and success stories. A multistage evaluation strategy assessed project activities at 6 and 12 months after conclusion of the grant period. This report focuses on 5 broad questions intended to assess the impact of the IPERLC program on the preparedness capacity of the agencies and organizations. The questions and analysis of responses to the 5 questions are discussed in the “Results” section.
● Results The 13 selected mini-grant recipients included 10 LHDs, 2 primary care clinics, and 1 faith-based organization, representing communities across Illinois, of which 7 organizations were from the northern portion and 6 from the southern portion of the state. A wide range of populations were targeted for project activities in urban, rural, and suburban areas. Two organizations served populations of more than 300 000 (one area urban and the other both urban and rural). One organization served a rural and suburban population of almost 140 000. Five organizations served populations of 50 000 to 100 000 (1 rural, 1 suburban, 1 rural and urban, and 2 rural and suburban). Five organizations served populations under 50 000, with 1 in an urban area and 4 in rural areas (Table 1). Grant awards ranged between $2163 and $4500, the maximum available per project. Projects targeted agency staff as well as a diverse range of specific audiences from their communities. These included residents, volunteers, first responders, faith-based organizations, non–English-speaking populations, longterm care professionals and clients, daycare center employees, university employees, the media, and food TABLE 1 ● Diverse Populations and Community Areas Served Across Illinois Through the Mini-Grant Model qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
Population Target
No. Organizations (N = 13)
Over 300 000
2
136 000-140 000 50 000-100 000
1 5
Up to 50 000
5
a Served b Served
Community Area(s) Urban Urban and rural Rural and suburban Rural Suburban Urban and rural Rural and suburbana Urban Ruralb
by 2 organizations. by 4 organizations.
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S86 ❘ Journal of Public Health Management and Practice establishments. In most cases, the projects included close collaborations with other community partners or the target audiences. Many of the activities were designed to assist populations that were economically disadvantaged, isolated, or rural, as well as those with functional needs. The organizations proposed to engage in trainings and exercises, gather data on needs of special populations, create and distribute informational resources, and convene groups, coalitions, and committees that would continue the work started with mini-grant support. All grantees described the potential short- and long-term impact anticipated after the initial support provided by IPERLC. On the basis of the responses to information required in the RFP, the projects all fulfilled 1 or more of the capability or capacity-building efforts listed in the “Methods” section. Project activities were also reviewed in relation to 2 sets of federal preparedness guidelines and were found to support functional areas and capabilities addressed in Emergency Support Function 8 of the National Response Framework.5 All activities were aligned with the “Community Preparedness” Capability within the 2011 Centers for Disease Control and Prevention Public Health Preparedness Capabilities. Several projects also addressed Capability 3 “Emergency Operations Coordination,” Capability 4 “Information Sharing,” and Capability 15 “Volunteer Management.”6 At 6 months post–grant follow-up, IPERLC conducted an evaluation to which 69% of the grantees (n = 9) responded. For the 12-month post–grant followup in August 2013, IPERLC conducted a second evaluation, with 92% of grantees responding (n = 12). For both assessments, a 5-point scale (1 = low; 5 = high) was used to measure responses by the director of the health
department or agency in charge of training. Table 2 summarizes the means and standard deviations for self-reported responses by the mini-grant recipients to 3 key questions. Respondents rated their funded projects highly for meeting their needs and strengthening partnerships at 6 months and even higher at 12 months. Respondents felt less strongly about whether the funded activities could have been accomplished with grant funding at 12 months than the responses received at 6 months. Two additional questions invited the participants to reflect on ongoing outcomes and share insights about innovations that may have occurred. One question on the survey asked, “Since the completion of the project at the end of August 2012, please provide a brief comment on the continued success, at this time, as a result of support provided by the IPERLC mini-grant.” A final question asked, “Is there anything new, innovative, or interesting that you would like to share 6 months/1 year after the grant?” At both the 6- and 12-month post–project completion periods, responses to these questions were often similar. Review of all the responses 1 year following the conclusion of the IPERLC mini-grant program found that support provided by IPERLC appeared to have had a positive impact on 4 activity areas. Each of the 4 areas is identified, followed by quotes from select grantees that reflect the impact of the activity that was supported by the mini-grant, as follows: 1. Preparedness partnership development r “Partnerships with emergency preparedness stakeholders continue to strengthen as a result of networking opportunities during training events.”
TABLE 2 ● Self-Reported Responses to 6- and 12-Month Broad Impact Evaluation Questions 1, 2, and 3 (Organizations
Queried: N = 13)a qqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqqq
As a result of the IPERLC mini-grant that your organization received to support preparedness activities, answer the following: 1. At this time, to what extent does (do) the training outcome(s) of the IPERLC mini-grant continues to meet your organization’s preparedness needs and responsibilities?
Responses at 6 mo (n = 9) Responses at 12 mo (n = 12) aA
2. At this time, to what extent have partnerships been strengthened as a result of the IPERLC mini-grant?
3. Since the completion of the project at the end of August 2012, to what extent would your organization have been able to accomplish the same outcomes from the activities without the IPERLC mini-grant?
Mean
SD
Mean
SD
Mean
SD
4.11
0.78
4.11
0.78
3.22
1.39
4.250
0.866
4.75
0.45
2.75
1.05
5-point scale (1 = low; 5 = high) was used to measure responses.
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Maximizing Preparedness Resources With Mini-Grants
2. Preparedness awareness building r “Personal preparedness is now mentioned in new employee orientation . . . . ‘Preparedness’ is now a word that comes up frequently in meetings.” 3. Data gathering regarding functional needs populations r “With the information we’re now able to collect, the emergency medical services (EMS) will be aware of households with special needs residents. Living in a rural county with only (a small number of ambulances) in the entire county, the information we gathered will be invaluable in an emergency.” 4. Training and exercise support r “We were able to fully test out plan by conducting a FULL SCALE exercise (which we were unable to do) this year due to (lack of) funding.”
Box 1 ● IPERLC mini-grant support . . .
r was “ . . . essential in helping us take an idea and turn it into reality . . . and assures that we will be ready to handle spontaneous volunteers in an efficient manner.”
r . . . for our activities with community partners “inspired more organizations to write Emergency Response Plans.”
r . . . allowed a remote rural health department and its partners to begin a database of residents with special needs . . . in the event of an emergency. “This was monumental progress in our emergency preparedness planning.”
r . . . helped provide emergency preparedness and response
training “in the community to groups of people as well as agencies who had never had the opportunity to participate . . . .” r . . . helped leverage a $10 000 grant from a corporate foundation to continue community-based preparedness activities started.
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ity categories that lend themselves more to mini-grant support than others. When the results from the first 2 questions are coupled with the narrative responses of the 2 additional questions about the continued impact of the activities 12 months post–project completion, it appears that individual and organizational capabilities or capacity improved as a result of IPERLC mini-grant support. The information gathered suggests that infrastructures were strengthened as a result of partnership expansion and greater collaborations during the IPERLCsupported activities. In some cases, these partnerships and collaborations resulted in critical data gathering efforts to improve their capacity to serve special populations identified within their communities. In addition, support for preparedness awareness efforts as well as for knowledge and skill building through trainings and exercises appeared to help improve individual and organizational capabilities and to build organizational and community capacity. One of the organizations was even able to leverage the work supported by the IPERLC mini-grant to obtain additional funding from a corporate foundation to continue its activity. Most of the organizations noted, in narrative responses to the additional 2 questions, that they would probably not have been able to achieve their objectives to the extent they had without IPERLC support. In the face of limited and shrinking resources for preparedness activities, the IPERLC mini-grant program indicates that providing even small amounts of funding to address targeted, self-assessed preparedness needs of public health organizations can have a positive impact on their ability to improve capabilities and build organizational and community capacity.
● Lesson Learned/Next Steps
● Discussion IPERLC evaluation of the mini-grant program indicates that the projects achieved positive outcomes. The responses to question 1 (noted in Table 2) suggest that the projects had a positive impact on addressing the preparedness training needs of the organizations. The responses to question 2 (noted in Table 2) suggest an even greater impact on the strength of partnerships that were created as a result of the IPERLC mini-grant program. While some organizations may have been able to accomplish the same outcomes without the minigrant funding, others may not have. Perhaps, looking at the type of projects that were funded merits further examination. It is possible that there are 1 or more activ-
There were several lessons apparent in implementing and evaluating the IPERLC mini-grant program. These focus on the model used, the opportunities for academic institutions to work with community-based partners, and the leverage afforded by even small grants. The mini-grant program is an example of a model that can help develop and cultivate preparedness partnerships between academia and practice to achieve positive outcomes despite the limited funding available to both. IPERLC learned that by offering minimal funding to support needs identified by organizations in the public health practice community, and assigning coordinators to help with specific projects, it built and strengthened partnerships and opportunities for potential future collaborations. The response rates for the 6- and 12-month evaluations were high, suggesting
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
S88 ❘ Journal of Public Health Management and Practice that the grantees perceived success in meeting their targeted needs and experienced a strengthening of relationships as a result of support and services that the IPERLC provided. Another lesson learned relates to the evaluation of the mini-grant program based on the assessment of individual project evaluations. First, the evaluation of the individual mini-grant projects was limited in scope and rigor as a result of the short, 6-month project period. Only the immediate impact of project activities was measured by using “reaction” evaluation questions developed by the PERLC Evaluation Group (which were based on the Kirkpatrick model of evaluation).∗ The questions asked grantees how they felt about the training and/or activities they engaged in after the original 6-month interval and then the 12-month interval. While valuable information was captured, having a longer intervention period for the projects may have helped enhance the impact of the mini-grant program and allowed for a more rigorous evaluation. In addition, there were significant variances across the participating organizations and in the scope of activities conducted, making it difficult to perform comparisons between project sites. Given these limitations, it would be of interest to implement such a model again for a longer project period, to incorporate higher Kirkpatrick model evaluation levels, and to compare similarly structured projects or organizations. A third lesson suggests that funding the selfassessed preparedness needs of organizations through a mini-grant process may have value for larger centers or programs that may not have the staff resources or time to provide customized preparedness training or other services to a large target market or service area. For example, reduced funding to IPERLC had an impact on staff resources and ability to meaningfully address the preparedness needs of certain key partners in Illinois. By using the mini-grant program model, we were able to counterbalance the impact of reduced funding on our original proposed activities and still significantly impact academic-practice collaborations. The adaptation of the mini-grant model actually helped expand our center’s reach by contracting with agencies ∗
For additional information, refer to the Hites et al article in this supplement, titled “The Preparedness and Emergency Response Learning Centers: An Innovative Model to Advance Standardized Evaluation of Public Health Preparedness and Response Trainings.”
and their staff to do the planning, implementation, and evaluation of necessary preparedness activities themselves, rather than relying solely on the center staff. The center staff was still available to provide support, as needed, and to help build capacity in these agencies. This strategy also increased and strengthened partnerships and collaborations with the organizations, their partners, and their communities in our large service area. Based on the positive outcomes resulting from these collaborative activities, going forward, there may be opportunities for center staff to expand their support of these organizations by helping them develop customized trainings and services. The final lesson derives from the specific nature of the funding structure of the mini-grant model. Given limited and decreasing funds in public health agencies and community partner organizations, discretionary funds are seldom available for preparedness projects that may be required to increase and improve preparedness capabilities and capacity. There appear to be benefits to channeling small amounts of funding to address targeted preparedness needs and gaps identified by public health organizations, as reported in this article. These small but important dollars can catalyze activities and actions that may have significant impact on the organizations, their partners, and the communities they serve.
REFERENCES 1. Baker EL, Lichtveld MY, MacDonald PDM. The Centers for Public Health Preparedness program: from vision to reality. Public Health Rep. 2010;125(suppl 5):4-7. 2. Pandemic and All-Hazards Preparedness Act of 2006, Pub L No. 109-417 (2006). 3. Health Resources and Services Administration. Public Health Training Centers. http://bhpr.hrsa.gov/grants/ publichealth/trainingcenters/about/index.html. Accessed January 25, 2014. 4. Centers for Disease Control and Prevention. Public Health Emergency Response Grants. http://www.cdc.gov/phpr/ coopagreement.htm. Accessed January 25, 2014. 5. US Department of Homeland Security. National Response Framework. http://www.fema.gov/national-responseframework., Accessed January 25, 2014. 6. Office of Public Health Preparedness and Response. Centers for Disease Control and Prevention. Public Health Preparedness Capabilities: National Standards for State and Local Planning. http://www.cdc.gov/phpr/capabilities/ DSLR capabilities July.pdf. Accessed January 25, 2014.
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