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Gila River Indian Community Grant Application Municipality Information Date of Application: 4/11/2013 Name of City, Town or County: Maricopa County Mayor or Board of Supervisor’s Chairman: Andrew Kunasek Mailing Address: 301 W. Jefferson, 10th Flood City: Phoenix, State: AZ Zip Code: 85003 Department/Non-Profit Information Department or Organization Name: The Society of St. Vincent de Paul Mailing Address: P.O. Box 13600 City: Phoenix State: AZ Zip Code: 85002 Contact Person*: Dorian Townsend, Ph.D. Title: Grants Manager Phone Number: (602) 850-6762 E-mail Address: dtownsend@svdp-phx-az.org *The individual listed here will be our direct point of contact for grant-related questions or requests for information. Duplicates of all grant correspondence will be sent to the contact person. Grant Information Program or Project Name: Family Wellness Program Purpose of Grant: To support culturally sensitive health improvement services for children at risk of diabetes and their families. Beginning and ending dates of Program or Project:10/1/2013 to 9/30/2016 Amount Requested: $150,000.00 Total Project Cost: $200,000.00 Multi-year Request – If checked, # of years requested: 3 Amount/year: $50,000.00 Priority Funding Area: Economic Development Education Healthcare Public Safety Transportation Geographic Area Served:Phoenix Signature: Mayor OR Chairman BOS: Date: Typed Name and Title: Andrew Kunasek, Maricopa County Board of Supervisors Chairman Rev. 2/2012 Gila River Indian Community Grant Application Application Format (outline) Please structure your proposal to provide the following information in the order indicated. Use the headings and subheadings provided. Then, in your own words, address the questions and issues posed in the outline. The questions reflect the general interests and concerns of the Gila River Indian Community, but are not intended to be conclusive. Additional information pertinent to your project should be included. Please be thorough yet strive for brevity. Please submit one original and five copies of your completed grant application, including attachments A. NARRATIVE 1. Purpose of Grant a) Describe the proposed program or project b) Describe how the proposed program or project satisfies one or more of the “ priority areas” identified by the Gila River Indian Community. c) Identify the needs/problems to be addressed, target population and number of people to be served by the project. d) Describe the project goals and objectives, and your plan to meet them. e) Define the project as a new or continuing program. f) Identify other organizations, partners or funders participating in the project and their roles (see attachments section). g) Indicate any application to and/or awards made by a Tribe other than the Gila River Indian Community for state shared revenues for this and/or any other projects/programs. h) Provide a timetable for implementation. i) Identify long-term funding resources or project sustainability. 2. Reports • Describe your plan to document progress and results. Interim and final reports will be required for every grant awarded. B. ATTACHMENTS Required Attachments: 1. A resolution from the applicable governing body in support of the proposed project (eligible City, Town or County). 2. A proposed budget for the program or project. 3. List of other funders, potential funders and amounts committed or requested in support of the proposed project. Optional Attachments: 1. Letters of support (optional) that substantiate need for the project and collaboration with other organizations. Rev. 2/2012 Gila River Indian Community Grant Application Budget An accurate, detailed budget for proposed projects is a primary requirement of this grant application. This portion of your proposal should break down the total budget into specific items for your project. Please include a narrative description explaining any unusual budget items. “ In-Kind” expenses and donations, grants or matching funds should also be spelled out. Please include the following information in your budget. You may use this or a similar format. A. BUDGET PERIOD (e.g.1/ 1/ 20XX to12/31/20XX): 10/1/2013 to 9/30/2014 B. EXPENSES Please itemize expenses that are applicable to your program or project. Please note: Columns will not total automatically if a currency field is left blank. Proposed Budget Amount Amount In Kind Total Budget (list each budget item) Requested secured from Expense from GRIC other Funders Registered Dietician and 3 $50,000.00 $110,000.00 $0.00 $160,000.00 Health Educators Salary + Benefits Supplies $0.00 $10,000.00 $0.00 $10,000.00 Travel $0.00 $4,000.00 $0.00 $4,000.00 Educational Materials $0.00 $1,000.00 $0.00 $1,000.00 Medical On-Site Laboratory $0.00 $6,527.00 $0.00 $6,527.00 Testing: Cholesterol machine costs, Lipids (300 at $12/test), HBA1C (100 at $9/test) Diabetic Test Strips $0.00 $6,100.00 $0.00 $6,100.00 Participation Incentives $0.00 $400.00 $0.00 $400.00 (pedmoters, t-shirts, bands) YMCA Family Memberships $0.00 $6,000.00 $0.00 $6,000.00 Other Direct Program Costs $0.00 $5,973.00 $0.00 $5,973.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Rev. 2/2012 Gila River Indian Community Grant Application $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total Budget $50,000.00 $150,000.00 $0.00 $200,000.00 Rev. 2/2012 Gila River Indian Community Grant Application C. BUDGET DETAIL, IF APPLICABLE (Narrative description of unusual budget items, in- kind expenses, donations, etc.) Rev. 2/2012 Gila River Indian Community Grant Application The Society of St. Vincent de Paul A. NARRATIVE 1. Purpose of Grant a) Describe the proposed program or project St. Vincent de Paul Virginia G. Piper Medical and Dental Clinic Overview The St. Vincent de Paul (SVdP) Virginia G. Piper Medical and Dental Clinic is a community-based clinic that offers no-cost primary and specialty health care services to uninsured working poor adults and children. On average, the clinic population lives at 200 percent or below the federal poverty level. Services are provided to the primarily Spanish-speaking clientele by volunteer clinicians who are supported by clinic staff members. Services include primary and specialty medical care, health education, and dental programs for adults and children. The Clinic provides approximately 15,000 medical, dental, and educational visits to men, women, and children per year. Family Wellness Program SVdP requests funding for one of the Clinic’s core services, the Family Wellness Program, which is an intervention program that provides education and lifestyle improvement skills as well as medical and counseling services to children and their families who have been diagnosed with diabetes and prediabetes and its associated comorbidities. Since 2000, the Family Wellness Program has utilized a culturally responsive model of healthcare that focuses on the diagnosis, treatment, and prevention of diabetes along with an integrated lifestyle education program. Bilingual and bicultural health educators and a Registered Dietitian deliver this program to patients and families in their own communities. The Family Wellness Program at the St. Vincent de Paul Virginia G. Piper Medical & Dental Clinic invites the entire family to participate and focuses on positive outcomes through patient involvement and ownership of their conditions. The program is divided into three components: 1. Every Little Step Counts Diabetes Prevention for Children and their Families 2. Diabetes Education for Families with Type 1 and Type 2 Diabetes 3. Health and Wellness Diabetes Intervention for Pre-Diabetic and Diabetic Adults. Often families who participate in Every Little Step Counts also participate in the additional education and intervention services offered through Family Wellness. Every Little Step Counts Every Little Step Counts is a community-based health education program created by St. Vincent de Paul’s Virginia G. Piper Medical & Dental Clinic to reduce childhood obesity among primarily Latino youth, a population that is disproportionately affected by and at higher risk for diabetes. The ELSC lifestyle education program delivers a specialized curriculum to children and their parents through bilingual and bicultural dietitians and promotoras (health educators). The practical topics include preparing cost conscious healthy meals, understanding the familial and environmental factors for diabetes, parent child roles and responsibilities, overcoming self- esteem issues, and fitness through physical activity. In conjunction with the Arizona State University College of Nursing and Health Innovation, a retrospective review was conducted on 67 Latino youths participating in the pilot study of ELSC. The 50 youth who returned after the program for follow-up measurement exhibited significant health improvements, including a 3.8 percent reduction in BMI; 5.4 percent and 8.6 percent decreases in total and LDL cholesterol, respectively; a 9.3 percent increase in HDL cholesterol; and a 24 percent decrease in fasting insulin. This pilot resulted in two manuscripts that were published in the July and October 2010 Journal of Primary Care and Community Health, entitled “Sustainability of a Culturally Informed Community-Based Diabetes Prevention Program for Obese Latino Youth” and “Development, Implementation, and Effects of a Community-Based Diabetes Prevention Program for Obese Latino Youth.” This scholarly evaluation credited the ELSC program as a strategy for improving health in this high-risk population and has resulted in further publications by Dr. Gabriel Shaibi and Arizona State University. Recent Program Success Last year a total of 105 children (62 boys/43 girls) and 34 adults (12 men/22 women) were enrolled in the program and were provided with 44 ELSC classes (intervention and wellness), 37 booster classes (reinforcement), 12 fitness classes, 25 Vinny’s Kids running program trainings, and two 5k runs. Of the 105 children enrolled, 75 children completed the program. Youth who finished the program saw the following improvements: * Average decrease in BMI of 2.2 percent * Average decrease in body fat percentage of 10 percent * Average increase of muscle mass of 6.7 percent As is expected in growing children, height, and weight both increased significantly, however the body composition results indicate that the increase in weight was primarily due to increases in fat-free mass (muscle and bone) as both BMI and body fat percentage decreased significantly. These findings are particularly relevant in obese youth as stabilizing BMI and adiposity trajectories is considered to have substantial health benefits. b) Describe how the proposed program or project satisfies one or more of the “priority areas” identified by the Gila River Indian Community. The SVdP Family Wellness Program satisfies the “Health Care” priority area. By targeting children and families at risk of diabetes and providing those families with culturally-sensitive, community-based programming that will help them live healthier lifestyles, the Family Wellness Program is significantly improving the health of the community we serve. c) Identify the needs/problems to be addressed, target population, and number of people to be served by the project. Community Need The Family Wellness Program began in 2000 as a comprehensive approach to teach self- management skills necessary for living with Types 1 and 2 diabetes. Type 2 diabetes (formerly “adult onset” diabetes) is the most prevalent chronic condition treated in the Clinic. Type 1 diabetes (formerly “insulin dependent” diabetes) is less common, but more challenging to manage. Obesity (and diabetes as a consequence) has become a community health epidemic. Almost 17 percent of today’s youth are obese. Youth from ethnic minority groups, including Latinos, are disproportionately affected. Clinical studies indicate that up to 30 percent of obese Latino youth have prediabetes suggesting that this group will likely suffer from premature obesity-related morbidity and mortality. This warrants special consideration by the health care community because Latinos represent the fastest growing segment of the pediatric population in the United States. Few medical interventions focus on preventative strategies and almost none approach it in a culturally specific manner. In fact, there are currently only five bilingual, culturally proficient Registered Dieticians in the entire state of Arizona. Our “signature” program, Every Little Step Counts, was developed in response to requests by school nurses for assistance with overweight children. Given the large numbers affected, the ELSC program chose to focus on children without healthcare who had the highest risk for developing diabetes. These “prediabetic” children already have laboratory markers that are known to result in cardiovascular disease, diabetes, and early disability and death. Approximately 250 children and 300 parents are expected to receive services in Fiscal Year 2013-2014. Of the 300 parents that are part of ELSC, approximately 95 percent of them are prediabetic. We focus on these adults as part of our adult prediabetic program as they are vested with their children in improving the families’ health. Success will be demonstrated with over 80 percent of patients by incorporating the cultural aspects of daily life, offering Spanish language instruction and recognizing the financial limitations that our families face. Program Need One of the most significant future program needs is the development of specialized services for children with Type 2 Diabetes. During the last few months, SVdP has had four new Type 2 children, who require extensive intervention including basic survival skills, insulin management, emotion triaging of their sense of grief/loss, post-traumatic stress, and fear of dying. Also, in order to meet the overall needs of the community, the Family Wellness Program’s primary need is to secure multi-year funding to build a strong and sustainable program infrastructure that will allow us to: a. Provide appropriate and effective clinical care and wellness services (building skills and lifelong tools) to patient/clients and their families b. Work with community partners, who augment services offered c. Continue to work with ASU research partners to validate effectiveness of the program through community-based participatory research with the goal to disseminate results more quickly and translate the program into other disenfranchised minority populations. d. Provide expanded service delivery through SVdP Clinic programs and respond to the increasing number of children with Type 2 diabetes. e. Systematically increase the number of bilingual, culturally proficient Registered Dieticians with an obesity/diabetes certification in our state. SVdP has secured continued funding from the Virginia G. Piper Charitable trust and our corporate giving partners. Gila River Indian Community funds will support the additional multi- year funding necessary to sustain and grow this critical program. d) Describe the project goals and objectives, and your plan to meet them. Primary Goal and Program Objectives The primary goal of this program is to reduce and treat childhood obesity and related conditions, such as pre-diabetes and metabolic syndrome, among high-risk youth. In pursuing this goal, ELSC has four primary objectives: * Deliver a culturally sensitive health education program which is bilingual and engages families toward positive health practices, including increased physical activity, healthy eating practices, and family and child ownership of personal progress. * Improve the overall health of high-risk youth by providing appropriate medical care to treat, prevent, and improve associated comorbidities. * Create family awareness of self-improvement techniques for a healthier lifestyle and their roles and responsibilities in promoting, modeling, and reinforcing positive health practices for their children. * Strengthen community and research partnerships to increase program effectiveness and develop new approaches to reduce childhood obesity and improve the overall health of high-risk children. * Respond to the increasing need for intervention by developing competent professionals who can replicate the model throughout the community. Outputs: Every Little Step Counts (ELSC) Program (Classes include 4 groups per year participating 12 sessions of nutrition and wellness education; New patient enrollment, parent labs, classes, exercise sessions, MD and RD visits; Location include Christown YMCA and JB Sutton; Population include: Abrazo clinics, Phoenix Children’s Hospital, SVdP clinics) Approximate Annual Contacts: 960 NIH ELSC Program (Classes include 3 groups per year participating 12 sessions of nutrition and wellness education; Location: NIH YMCA Downtown) Approximate Annual Contacts: 900 Vinny’s Kids (Classes involve exercise sessions for ELSC program participants) Approximate Annual Contacts: 279 Total Participants Per Year: Parents 300; Children 250 Family Diabetes Program (Diabetes Management Classes for Adults with Type 2 Diabetes): Approximate annual contacts: 600 Specialty Clinic for Type 1 and Type 2 Diabetes Management (Insulin and BS Management for adults and children; Medical Nutrition Counseling for adults and children; Wound Patient Services for Adults): Approximate annual contacts: 1,000 Total Participants Per Year: Adults 150; Children 30 e) Define the project as a new or continuing program. The Family Wellness Program is a continuing program at the SVdP Clinic. The program hopes to build on past successes and expand programming to meet growing community needs. f) Identify other organizations, partners, or funders participating in the project and their roles (see attachments section). Recent partnerships with the YMCA and Arizona State University have greatly enhanced the capacity of the Family Wellness Program through leveraging of resources and expertise of two of the region’s most established and credible institutions. This collaborative endeavor sets a new standard for addressing obesity in vulnerable communities and serves as a framework upon which others can build. YMCA Partnership: Children are identified by our school-based health center partners (representing over 70 schools) as well as children seen in the Medical Clinic. Classes are held at the Chris-Town YMCA, Downtown YMCA, Sutton Elementary School and at the Clinic. ASU Partnership: The goal of this collaboration is to develop the necessary evidence and capacity to address obesity-related disease among high-risk, vulnerable youth. The collaboration is guided by a community-based participatory research model that facilitates the rapid translation of research discoveries into improved care and practice in real-world settings. We understand that obesity-related health and health disparities are far reaching and have made it a priority to disseminate our findings to various audiences including academic and non-academic arenas. SVdP and ASU believe that the ELSC model could be successfully adapted to other vulnerable communities such as Native Americans living on the reservation and African- Americans in urban areas. Formal evaluation by ASU adds an element of validity to the program that has resulted in four scholarly publications. Phoenix Children’s Hospital Partnership A partnership with the Phoenix Children’s Hospital has allowed ELSC to leverage resources and expertise in order to extend medical management and disease prevention from a medical clinic visit into the community. Phoenix Children’s Hospital believes patients and families will be more successful in preventing and managing disease if resources are available on a regular basis in their local community. Media : ELSC has been featured twice in the Society of St. Vincent de Paul newsletter, the “Vincentian Connection,” including a December 2012 article called “Running to Good Health,” which highlighted the ELSC’s running program, Vinny’s Kids. This newsletter is distributed to 50,000 people on the St. Vincent de Paul mailing list, 5,000 people through the e-newsletter, and is distributed at St. Vincent de Paul thrift stores. ELSC was honored to be featured on Spanish channel Univision 33 during “Salud es Vida.” The segment can be found at: http://univisionarizona.univision.com/videos-univision- arizona/video/2012-12-28/programa-para-combatir-la-obesidad/embed. In addition, the ELSC kids were proud to be featured on Fox 10 News at the Jingle Bell Toys for Tots 5k Run in December. http://www.myfoxphoenix.com/story/20354065/2012/12/15/jingle- bells-rang-during-run-for?autoStart=true&topVideoCatNo=default&clipId=8072605. Further media and social media coverage of St. Vinny’s Kids and ELSC can be found at http://www.facebook.com/runvinny. g) Indicate any application to and/or awards made by a Tribe other than the Gila River Indian Community for state shared revenues for this and/or any other projects/programs. There have been no other applications submitted to Tribes outside of the Gila River Indian Community. Gila River Indian Community members have been volunteering with St. Vincent de Paul since 2011, particularly in the Phoenix Dining Room, where volunteers serve meals four to five times a year. h) Provide a timetable for implementation. Family Wellness Timelines: Every Little Step Counts: Intervention is delivered on a 12 week cycle given every other week covering a total of six classes. Two cycles are often run in tandem based on the number of children. SVdP generally completes four to six 12 week sessions per year. Once completed participants receive a monthly intervention reinforcement (booster) class for six months, which is delivered twice a year. Family and Children Fitness Sessions: Fitness sessions focus on learning active play for children ages 8 to 11. Classes are given monthly for a total of six sessions per cycle. The program is delivered twice per year. Vinny’s Kids: Running program for children ages 12 to 16 and their families. Sessions are conducted three times a week during fall, winter, and spring. Family Diabetes: Intervention classes for survival and enhancement skills run continuously five times per month. Special Interventions and Counseling: Ongoing throughout the week based on client and patient needs. NIH ELSC: Intervention programming includes 12 classes given weekly followed by a monthly booster class for three months. Three to four intervention sessions are held each year. Ongoing: Recruitment, labs, and client tracking occur throughout the year New (Future) Programming: Specialized classes for children diagnosed with Type 2 Diabetes. Classes will be delivered in 4-5 week sessions and offered 4-6 times per year. i) Identify long-term funding resources or project sustainability. The Family Wellness Program has received funding from the Virginia G. Piper Charitable trust, J.W. Kieckhefer Foundaton, and Medtronic. ELSC has also entered into a collaboration with the National Institutes of Health to replicate the program for additional communities. 2. Reports a) Describe your plan to document progress and results. Interim and final reports will be required for every grant awarded. Program evaluation occurs three times per year. The results are also published three times a year by ASU. Records and personal health plans for all clients are kept and monitored on an ongoing basis. Early evaluation of the program yielded the following results as measured by ASU: The ELSC intervention resulted in increased in mean LDL particle size (269.3±3.4 to 271.6±2.9 Å, P=0.0003) and cholesterol in large high-density lipoprotein (HDL) subfractions (22.4±11.2 to 26.8±10.6% area, P=0.007) along with decreases of cholesterol in small LDL (1.6±2.0 to 0.6±1.2% area, P<0.01) and HDL subfractions (23.2±9.4 to 19.0±6.7% area, P=0.05). These improvements were observed independent of changes in weight (90.7±26.2 to 89.9±27.8 kg, P>0.05) and suggest that lifestyle modification in obese youth may reduce cardiovascular risk by shifting lipoprotein particle size and cholesterol distribution to a less atherogenic phenotype, i.e. the program has shown improvement in children’s health and propensity for diabetes. The Society of St. Vincent de Paul Family Wellness Program Funding Sources Virginia G. Piper Charitable Trust Clinic Endowment: $75,000 (continuous) J.W. Kieckhefer Foundation: $50,000 Gila River Indian Community: $50,000 (pending) Medtronic Foundation: $15,000 Individual Donations: $10,000 TOTAL: $200,000