2023 CNF Institutional Partnership in Transition of Care Application

Application for Patient/Caregiver Workshop and Grant to Improve Transition of Care Practices

The Child Neurology Foundation (CNF) is expanding our work in Transition of Care by looking to partner with two (2) separate institutions or practices. This partnership includes two discrete deliverables to each selected institution/practice:

1) a virtual workshop, developed and presented by CNF in partnership with the grantee institution, offered to the institution's patient and caregiver community about best practices in transition of care, and

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

Payment of Grant

(i) $12,500 will be paid within thirty (30) days of the first project kick-off meeting occurring to the satisfaction of CNF.

(ii) $12,500 will be paid within thirty (30) days of the institution a patient and family educational workshop hosted virtually in partnership with CNF. This workshop will take place between January and March 2024.

The grant is expected to contribute toward a discrete, specific, measurable initiative to improve Transition of Care at the home institution over the following year. Examples of initiatives can include research, outreach activities, software purchases, and labor costs. The grant monies will not be applied to the virtual workshop offered by CNF, nor will the workshop cost the selected institution any additional funds.

Preference will be shown to institutions and practices that have a demonstrated interest and commitment to transition of care. Additional consideration will be made for institutions 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 institutional departments and/or practices within the United States of America that treat child neurology patients. Individuals serving on committees 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 jnickrand@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 partnership with Genentech, Horizon Therapeutics, Jazz Pharmaceuticals, and UCB.

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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 transition of care 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 telehealth and/or other care delivery innovation in the practice of transition of care? (Suggested: 500 words)

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* 9. Are you aware of any funding your institution has received to perform research in transition of care 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 transition of care for your patients and families. This funding can be for anything your institution believes will improve transition of care, including (but not limited to) salaries, software, outreach programming, and research.

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 transition of care 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 you 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.

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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.

Administrative costs are expenses not directly related to delivering program objectives, but are necessary to support this grant initiative. These are the general expenses that can be tracked. These include employee salaries, contractual services, travel, supplies, and other costs that can be directly accounted for.

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 jnickrand@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.

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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) a virtual workshop 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 grant report one year after receiving funding.