CNF Institutional Partnership in Care Coordination Application

The Child Neurology Foundation (CNF) is expanding our work in Care Coordination by looking to partner with one institution or practice. This partnership includes two discrete deliverables from the selected institution/practice:

1) an institutional convening, developed and presented by CNF in partnership with the grantee institution, offered to multiple departments, administration, and support staff to discuss the current care coordination process and how collaboration could support improved care coordination for patients and families living with neurologic conditions.

2) a $25,000 grant for the institution/practice to improve Care Coordination practices.

The institutional convening will be scheduled and based on the selected institution's needs. This workshop will take place between January and March of 2024.

Payment of Grant:

CNF will pay the Institution the total amount of $25,000 (the “Grant”), in two (2) equal installments as follows:

· $12,500 within thirty (30) days of the project kick-off meeting occurring to the satisfaction of CNF.

· $12,500 within thirty (30) days of the institutional convening occurring to the satisfaction of CNF.

Examples of initiatives can include research, outreach activities, software purchases, and labor costs. The grant monies will not be applied to the institutional convening offered by CNF, nor will the convening cost the selected institution any additional funds.

Preference will be shown to the institution or practice that has demonstrated an interest and commitment to care coordination. Additional consideration will be made for an institution already engaged in innovative work in this area, including (but not limited to) incorporating technology, building a care team, and reaching historically excluded populations.

Eligibility is restricted to an institutional department or practice within the United States of America that treats child neurology patients. Individuals serving in a volunteer capacity at the Child Neurology Foundation, such as the Transition Expert Panel (TEP), are ineligible to serve as PI, but coworkers are eligible to apply on behalf of the institution.

Please email khindery@childneurologyfoundation.org with any questions.

Applications are due by Friday, May 12, 2023.

Institutions will be notified of their status by June 16, 2023.

Grant activities and a final report are due by September 2024.

This opportunity is made possible thanks to our partnerships with Acadia Pharmaceuticals and Jazz Pharmaceuticals.

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* 1. Name and Address of Institution/Practice

Company *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Phone Number *

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* 2. Name and contact email of staff lead/PI

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* 3. How many neurologists work at this institution?

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* 4. What other members of the care team provide services to your pediatric patient population? (select all that apply)

Advanced Practice Providers

Physical Therapists

Occupational Therapists

Speech Therapists

Social Workers

Care Coordinators

Case Managers

Pharmacists

Other (please specify)

None of the above

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* 5. Approximately how many patients do you care for in child neurology annually?

100 or fewer

101-500

501-999

1000 or more

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* 6. The following questions ask about the kind of patient outreach currently happening at your institution/practice, and are required for completion of this application.

Please briefly describe the care coordination activities currently occurring at your practice for the child neurology community. What resources are available for patients and their families? (Suggested: 500 words)

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* 7. How does your institution work to support patients from historically underserved populations? This may include patient populations based on disease state or disability status, race or ethnicity, class or insurance status, and/or other markers of identity. (Suggested: 500 words)

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* 8. What is your institution doing around incorporating technology and/or other care delivery innovation in the practice of care coordination? (Suggested: 500 words)

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* 9. Are you aware of any funding your institution has received to perform research in care coordination or quality improvement? If so, please explain the status of that project and its outcomes. Please write N/A if this does not apply to your institution.

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* 10. If selected, your institution/practice will receive the $25,000 grant to improve care coordination for your patients and families. This funding can be for anything your institution believes will improve care coordination, including (but not limited to) salaries, software, outreach programming, research, and up to 10% indirect expenses.

If awarded the $25,000, how would your institution use these funds? Please provide a brief overview, including the stated goals and outcomes of the project, and how this program is an innovative improvement to care coordination services at your institution. (Suggested: 250 words)

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* 11. What is your program plan? What methods will you use to implement this project? (Suggested: 250 words)

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* 12. How will you evaluate the effectiveness of this program? Please explain your evaluation methods for demonstrating the outcomes of this program. (Suggested: 250 words)

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* 13. What is the timeline for this project? Please provide an outline of the project's major steps in from the planning to implementation stage, including end-point evaluation and benchmarks along the way.

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* 14. How will you guarantee the completion of this project? What are your anticipated struggles and difficulties, and how do you anticipate addressing these issues? (Suggested: 250 words)

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* 15. Please describe the program implementation team involved in this program--who are the key people involved, and what are their predicted roles?

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* 16. Please upload the CV of the individuals who will be working on the initiative should you receive funding.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 17. Please upload the budget you will be using for this project. The budget should include 1) total cost of the project (is this funding part of a larger initiative?), and 2) line-item expenses, which may include: salary and fringe benefits, contractual services, travel, supplies, administrative, and indirect costs.

Note: This grant is able to fund up to 10% of total indirect costs. It is not necessary for this grant to include indirect costs.

Please contact khindery@childneurologyfoundation.org with specific budget questions, or if you would like a budget template sent to you for this grant. SurveyMonkey does not support uploading Excel files, but it's easiest to perform this task in Excel and then copy to Word, or save as a PDF.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 18. By signing my name below, I agree that the questions have been filled out truthfully to the best of my knowledge. I understand that I am filling out this application on behalf of an organization that may receive 1) an institutional convening from CNF 2) and a $25,000 grant to be used for a project within the guidelines stated above, and I am guaranteed neither of these outcomes. Additionally, if awarded the grant, I agree to fill out a mid-project grant report and a final report upon completion of the project using guidelines provided by CNF.