Re: Partnership with the Delta Health Alliance, TEAM Sugar Free Networking Incentive

On behalf of the Delta Health Alliance (DHA), I am introducing you to a new partnership opportunity to
support focused community-based healthcare initiatives targeting diabetes awareness. The mission of the Delta
Health Alliance and the Training, Education, Access and Management for a life that is Sugar Free
(TEAM Sugar Free) program is to advocate, develop and implement collaborative programs to improve the
health of people who reside in the Mississippi Delta and North Mississippi.

TEAM Sugar Free is a program funded by the Office of Rural Health Policy Delta States Networking and
Development Grant Program. The purpose of TEAM Sugar Free is to improve access to diabetes education,
management, and prevention programs in an effort to improve outcomes for people with diabetes. This project
serves a 21 county area in the Delta and North Mississippi. To truly make a difference, our communities must
work together by mobilizing health care, faith-based, educational, community and government resources in a
targeted approach. The success of the DHA stems from largely from its ability to coordinate limited resources
to their best use, and we desire to work within communities willing to work together to address problems like
diabetes and chronic health problems.

To provide encouragement for building or expanding an existing Diabetes Coalition, the DHA is providing
Networking Incentives of $3,000 to $5,000 to select communities who have identified that reducing diabetes or
providing support for people with diabetes is a real need in their communities. To be eligible for a Networking
Incentive, a community must:

• Be located in the 21 county TEAM Sugar Free Service area identified on the application.
• Have a new or established diabetes coalition, or committee that exists within a larger health related
coalition, that meets at least quarterly to address the needs of the community’s diabetic population.
One (1) agency must be selected as the fiscal agent for this award and will be responsible for
invoicing and reporting requirements.
• Include at least one representative from each of the following: healthcare, government, faith-based,
and community organizations; and it must include at least one consumer (person with diabetes). We
highly encourage participation of local health departments, cooperative extensions, and similar
entities. Others might include business/ chamber of commerce, primary and secondary education,
and homemakers groups.

If you are interested in submitting a proposal for consideration, please utilize the attached template. Please
complete the form and return no later than 5pm CST March 31, 2011 to Kimberly Massey via email at
kmassey@deltahealthalliance.org. Approximately 10 communities will be selected and notified no later than
April 15. All funded projects must be of limited scope and will be required to end July 31 2011. Proposals
will be accepted for projects that will help a coalition experience success quickly in providing a service to their
community, such as an expanded health fair, series of healthy cooking classes, or “grassroots” campaign to
bring awareness to diabetes. Other creative ideas that will provide a direct service to individuals with diabetes
in your community are encouraged. Expenses must comply with federal regulations regarding eligible project
costs. In addition to the networking award, all applicants will be eligible for technical assistance and
partnership with TEAM Sugar Free and the Delta Health Alliance. We appreciate your interest in serving the
residents of the Mississippi Delta and look forward to a future partnership for the health of your community.

Sincerely,

Thomas Edwards
Vice President
Programs and Community Development
 Delta Health Alliance
PO Box 277
Stoneville, MS 38776
662.686.3520
662.686.3522 (fax)

If your group is interested in submitting a request for a TEAM Sugar Free Networking Incentive,
please complete the form below and return it no later than 5pm CST, March 31, 2011 to
Kimberly Massey at kmassey@deltahealthalliance.org (email preferred). Applications may also
be faxed or mailed but must be received in our office by the application deadline (e.g. simply
being postmarked by March 31st would not qualify). Please provide information and data for
each of the topics listed below and describe your collaboration and the project you are proposing
fully and succinctly. This application is limited to four pages, single spaced, 1" margins, 12 sized
font, plus the two required attachments. Awards will be between $3,000 and $5,000, but the
MAXIMUM award amount is $5,000. Please note: If DHA receives multiple requests from one
community, we may request the applicants to combine their proposals; DHA would provide
technical assistance in building the collaboration.

BACKGOUND:

The TEAM Sugar Free service area funded by the ORHP Delta States Grant covers the following
counties: Yalobusha, Tippah, Marshall, Washington, Grenada, Attala, Holmes, Sunflower,
Panola, Leflore, Tallahatchie, Tunica, Quitman, Coahoma, Bolivar, Carroll, Montgomery,
Tate, Benton, Union, and Lafayette. All activities proposed in this application must serve
residents of one or more of these counties only. You are not required to serve all counties and
are actually encouraged to focus on well defined communities. Activities being provided by
current TEAM Sugar Free partners include Diabetes Education, Diabetes Education for Health
Care Providers, Diabetic Retinopathy Screening, Prevention Education for At-Risk Women, and
personal health management for uncontrolled diabetes (available soon). These services can be
leveraged more effectively when coordinated through existing community resources within each
of the counties in the service area, thereby meeting specific community needs and preventing
service overlap.

APPLICANT

Please put the following information at the beginning of your four-page narrative.

Name of LEAD Agency/Organization and Tax Status (i.e.: for-profit, 501(c) 3, etc):
Complete Address:
Contact Name, Phone Number, and Email:
Project Lead/Principal Investigator:
Name of Proposed Project (put on each page):
PROPOSAL

1) Agency and Collaboration Background (20 points)

a) Background information about applicant. Briefly state why your agency/organization is

qualified to propose the solution and/or act as lead agency.

b) Please list the other agencies/organizations/individuals that will be partnering with you on this
Diabetes Collaboration and the name of at least one representative at each agency.

c) Please describe your collaboration on diabetes efforts to date. New collaborations are
acceptable. Please note: each participating entity must sign the collaboration statement provided
as Attachment 1.

2) Background & Need (20 points)

a) What is the service area and target population of your project? If you will serve more than
one county, please explain how your collaboration will effectively cover a broad area. How has
diabetes effected your community and what gaps in providing care or prevention currently exist?

b) Who is currently addressing the problem in your targeted area/population? Please be specific
and briefly describe all efforts currently addressing diabetes and diabetes education in your
community.

3) Proposal (30 points)

a) What is your collaboration’s project for diabetes awareness/prevention/education and how will
you reach people with diabetes by July 31, 2011?

b) Why do you think this is needed in your community?

c) What are your general goals and objectives (make them SMART – Specific, Measureable,
Achievable, Relative, and Time Oriented) ie., what will you do, who will you impact, how many
people will you impact, by when, and what good will that do?

d) What resources are currently being used to address the problem? How will your project
support, enhance, or provide different services from those in existence?

e) Please complete and attach a Condensed Work Plan Matrix for your proposal. (This can be an
attachment and will not count as part of the 4 pages. Please use the attached template.)
4) Proposed Budget: What are your *estimated* costs? (10 points)

a) Personnel and Fringe (Salary for a project coordinator or project director may be included up
to 10% of the requested budget, if the person is already serving in this capacity. Grant
administrator and grant evaluator are not allowable costs.)
b) Equipment- (equipment is generally defined as items over $5,000; therefore, requests for
equipment must be highly justified.
c) Travel
d) Supplies (Include "equipment" items under $5,000 per item)
e) Other
f) Contractual
g) Indirect costs - limited to 10% of eligible direct costs

5) Impact/Conclusion (20 points)

a) DHA/TEAM Sugar Free will need to know how many people you impacted and any other
measurable objectives or effects your project had on the participants. How will you learn this?
What impact do you anticipate?

Examples of TEAM Sugar Free Measurable Objectives:

Number of people attending educational
programs
Number of Health Care providers at health fair
Number of screenings and types of screenings
conducted
Percent of diabetics with reduction in HgA1c
after three months
Number of people exercising 3 times a week
after program
Number of participants in Diabetes awareness
day
Percent improvement in knowledge as
demonstrated on pre/post tests
Number of people newly registered for
Medicare/Medicaid
Number of people with uncontrolled diabetes
(HgA1c >9) referred for personal health
management programs
Number of people referred to a medical home

Number of pounds lost/ reduction in BMI Number of new partners participating in

Diabetes Coalition
* These examples are not intended to be provided as an all-inclusive listing.
 ATTACHMENT 1

Statement of Intent to Collaborate:

My signature below indicates that I have reviewed the attached proposal to the Delta Health
Alliance submitted by __________________________________________ and that I agree to
participate in a Diabetes Collaboration or similar Diabetes Committee within my community. I
understand that my signature indicates that I agree to be an active participant in this
committee in reviewing the healthcare needs of people with diabetes in my community and in
developing solutions and communicating solutions as discussed and appropriate. I understand
that, if our community is selected for a Networking Incentive, our project must be implemented
between April 1, 2011 and July 31, 2011 to receive reimbursement for our expenses.

Representative Signature Email Agency

 ATTACHMENT 2

TEAM Sugar Free Condensed Work Plan Matrix

A. Lead Agency:

B. Project Name:

C. Brief Project Description:

TEAM Sugar Free Networking Activity Work Plan Matrix (tab at end of row to add another row)
Steps to Complete Activity Organization/Person Responsible Timeline