A Community Translational Research Pilot Grants Program to Facilitate Community–Academic Partnerships: Lessons From Colorado’s Clinical Translational Science Awards

Abstract

Background

National growth in translational research has increased the need for practical tools to improve how academic institutions engage communities in research.

Methods

One used by the Colorado Clinical and Translational Sciences Institute (CCTSI) to target investments in community-based translational research on health disparities is a Community Engagement (CE) Pilot Grants program. Innovative in design, the program accepts proposals from either community or academic applicants, requires that at least half of requested grant funds go to the community partner, and offers two funding tracks: One to develop new community–academic partnerships (up to $10,000), the other to strengthen existing partnerships through community translational research projects (up to $30,000).

Results and Conclusion

We have seen early success in both traditional and capacity building metrics: the initial investment of $272,742 in our first cycle led to over $2.8 million dollars in additional grant funding, with grantees reporting strengthening capacity of their community–academic partnerships and the rigor and relevance of their research.

The National Institutes of Health’s focus on translational research through its Clinical Translational Science Awards initiative has led to an influx of tools and resources to improve how academic institutions engage communities in research.^1,2 Although informed by literature on the benefits of engaging communities in participatory research, this more recent national emphasis provides an opportunity to learn how to integrate CE more deliberately within these larger translational research initiatives, where CE has historically not been part of the academic research culture.^3–5

In 2008, the University of Colorado Denver was awarded a Clinical Translational Science Awards from the National Institutes of Health (Grant Number UL1 RR025780, Sokol, PI), resulting in the establishment of the CCTSI. The primary goal of CCTSI is to accelerate the translation of research discoveries into improved patient care and public health (available from: http://cctsi.ucdenver.edu); its CE core is designed to build capacity of community–academic partnerships and transform the existing community research infrastructure using community-based participatory research (CBPR). The Partnership of Academicians and Communities for Translation (PACT) guides this work and facilitates bidirectional exchange between communities and academic programs. The PACT council serves as the governing body, composed of equal division of community members and health professionals from partner communities and academic researchers from participating research programs. The PACT’s ultimate goal is to reduce health disparities in the Rocky Mountain Region through targeted investments in community translational research and dissemination of successful practices.

CE PILOT GRANTS PROGRAM: A TOOL FOR TARGETED INVESTMENTS IN COMMUNITY TRANSLATIONAL RESEARCH

The CE Pilot Grants program, “Improving Translational Research Through Community–Academic Partnerships,” is an important tool used by the PACT Council to target investments of at least $200,000 per year to increase community-based translational research among community–academic partnerships targeting health disparities. The purpose of this paper is to describe the processes and impacts of this CE Pilot Grants program.

In the fall of 2008, academic researchers and community representatives of the PACT Council formed a CE Pilot Grants committee, with equal representation by community and academic members, and each serving as co-chairs. The committee rapidly designed the CE Pilot Grants program and a request for applications (RFA) to announce the first of five, 1-year, competitive grant cycles. The CE Pilot Grants program was intentionally designed to attract a diverse range of partnerships and fund applications submitted by either community representatives or academic researchers. We defined community and community partners broadly within the RFA as a set of persons with shared commonalities, such as a geographic location (e.g., the community of Pueblo), work specialization (e.g., the community of cardiovascular care providers), or a common cause (e.g., reducing disparities in blood pressure control for African Americans with hypertension). The RFA includes a clear stipulation that requested total grant funds would be split between community partners and academic researchers, with community partners receiving at least half of total grant funds.

The PACT requested applications in two categories to create new community–academic partnerships and strengthen existing ones:

• Joint Pilot Projects (up to $30,000): Applicants who already have a community–academic partnership in place and seek funds for a joint research project that results in pilot data and submission of a proposal to an external agency (with either the community or academic researcher serving as the primary applicant). Joint pilot project applicants may request pilot funds for many different expenses related to planning and implementing research projects (e.g., hosting meetings; personnel costs, data collection, and/or analysis of community-specific information or other quantitative and qualitative data; evaluating an existing community-based program; expenses for community facilitation or other consultants).

• Partnership Development (up to $10,000): Applicants who seek funds for developing a new community–academic partnership that results in the later submission of a joint pilot projects application or an application to another funder (with either the community or academic researcher serving as the primary applicant). Academic or community applicants are given the option of either applying together or alone (i.e., “matchmaking” option) to develop a new partnership. Partnership development applicants may request funds for a variety of expenses related to developing and sustaining a new community–academic partnership. These funds can be used to convene partners, develop capacity of the new community–academic partnership (e.g., facilitation or training materials), and plan collaborative research projects and grant proposals (e.g., literature searches, printing articles).

Applications are a maximum of five pages long and organized by key sections based on specific review criteria: Project focus and outcomes related to translational research and health disparities, partners and partnership, the CE process, and budget. At least two reviewers from the CE Pilot Grants committee (one community and one academic researcher) review and score each application based on review criteria, make funding recommendations, then forward their recommendations to the PACT Council for approval. Nonfunded applicants are sent a brief summary of reviewer feedback and encouraged to reapply.

Funded community–academic partnerships participate in an orientation to review program requirements and timelines:

• Grantees conducting human subjects research must get approval of their projects from an accredited institutional review board (IRB) before funds are released to community and academic partners.

• Funded community partners and academic researchers must attend a mandatory 8-hour CE training session early in the funding cycle.

• All grantees are required to submit a 6-month progress report and brief final report to the PACT Council that describes their community–academic partnership, the CE process, project implementation, project results, lessons learned, overall accomplishments, and future plans.

• Grantees must regularly monitor and report on their project budgets. Community partners contract with the Colorado Foundation for Public Health and Environment to receive grant funds (an organizational structure set up by the PACT Council to facilitate fiscal management for communities); academic researchers typically use existing internal university budget processes to receive and monitor their grant funds.

EARLY LESSONS LEARNED AND PROGRAM ACCOMPLISHMENTS

At the end of September 2011, we accepted applications for our fourth cycle of CE Pilot Grant funding that begins in 2012. Through three cycles, we have awarded over $700,000 to 36 community–academic partnerships: 18 for joint pilot projects and 18 for partnership development. We have improved the grant program based on early lessons learned and demonstrated through program evaluation early program accomplishments as a result of this targeted funding tool.

Early Lessons Learned

Generating Interest in CE Pilot Grants Program

The CE Pilot Grants program hoped that both community and academic partners would apply for these research funds. The RFA was sent to several lists targeting potential community applicants with academic researchers receiving announcements and reminders from CCTSI. Although this approach was successful in generating interest in the CE pilot grants program—resulting in 47 applications in our first cycle and 39 applications in our second—academic researchers were far more likely to be the project lead in applications than community partners. Although not surprising, the lack of community-led applications signaled the need to improve community awareness of this funding opportunity. To address this gap, we expanded our lists for targeting potential community applicants, added an applicant webinar to clarify proposal requirements and address questions well ahead of the submission date, and enlisted PACT Council members to use their contacts to encourage more community-led applications and expand the reach more broadly across the region.

Diversity of Health Disparities Targeted By Community–Academic Partners

During our first two funding cycles, grants targeting a range of health disparities were awarded. Although this range indicates that the CE Pilot Grant program may be filling an important funding gap for health disparities research, the PACT Council realized that spreading funds to address many different health disparities would result in making less of an impact than it could in those areas most in need within the state and the nation. This discussion led to the PACT Council establishing health disparity priority areas beginning in its third funding cycle: Childhood chronic conditions, social/ emotional health, or cardiovascular disease prevention.

Slow Start in First Funding Cycle

Once grants were announced, all grantees were required to participate in a grant orientation (in the first year face-to-face; in subsequent years via webinar). During the orientation, we addressed human subjects and IRBs, contracting requirements for community grantees, and other project requirements. We soon learned that many of our community–academic partnerships were taking longer than anticipated to submit IRB applications and the process of signing contracts and receiving funds was often delayed. This resulted in some grantees not officially beginning their projects until several months after the grant start dates, leading to delays and no-cost extensions. These IRB and contracting delays in particular resulted in our making significant changes in the grant making process and the level of technical assistance offered to grantees. For example, our start date for the third funding cycle was intentionally set nearly 5 months after funding announcements so that partnerships had ample time to co-design project activities and obtain IRB approval before the official start date and release of funds. This extra time also allows community partners to sign contracts to ensure that project funds are released on time. We also found that grantees funded using the Partnership Development “matchmaking” option took longer than others to get started and identify a partner. During our first funding cycle, we funded three partnership development grants that requested matchmaking: Only one of three resulted in an effective, long-lasting partnership. Recently, the PACT Council voted to eliminate the matchmaking option from our grant making, deciding instead to integrate this matchmaking function into PACT’s overall charge of developing community–academic partnerships. Based on these and other changes, we updated our RFA and grant review templates (see online appendix at http://muse.jhu.edu/journals/progress_in_community_health_partnerships_research_educaton_and_action/v006/6.3.main_supp01.pdf).

Program Accomplishments

Our CCTSI evaluation and tracking component has worked closely with the PACT Council and its CE Pilot Grants committee to evaluate the pilot grant program. Their evaluation involved an external assessment of those community–academic partnerships awarded grants in our first funding cycle.⁶ During the first year, their evaluation relied primarily on review of 6-month and final reports (see page 4 for contents). Reports were completed by each project lead (community or academic partner), with instructions that they involve their partners so that perspectives from both academic and community partners informed the progress reporting process. The evaluation component reviewed each progress report to determine both financial and social return on investment (ROI). Financial ROI is measured in terms of follow-on (external) funding support that can be directly attributed to a partnership leveraging the pilot award process and products. Social ROI is measured in terms of sustained partnerships, publications, and other efforts (such as presentations locally and nationally/internationally) to disseminate novel insights and innovative approaches and products.

Although too early to determine the full impact of the CE Pilot Grants program as a tool for promoting community translational research to address health disparities, early indications are promising. In terms of financial ROI, Table 1 illustrates that the initial investment of $272,742 awarded during the first round of funding yielded over $2.8 million dollars in new funding to several grantees. The social RO1 indicators are also encouraging, as demonstrated by several peer-reviewed publications, many local and national presentations and programmatic innovation (Table 2). These measures of success, however, do not adequately capture how the CE Pilot Grants program helped to develop and strengthen community–academic partnerships for research translation.

Table 1.

Financial Return on $292,742 CCTSI Investment: Cohort 1

SLV Physical Education Collaborative ($1.8 million, 3-year Colorado Health Foundation grant)

Mental Health of Latino Families ($1 million, 4-year Safe Start grant from the Office of Juvenile Justice and Delinquency Prevention)

Health on the Eastern Plains (2009 Joint Pilot Award, $30,000)

Improving Care at the End of Life (2009 Joint Pilot Award, $30,000)

Health Care Needs of a Geriatric Hispanic Population (Joint Grant Award from the American Association of Family Physicians; no information was provided regarding the amount or duration of the grant)

Table 2.

Examples of Programmatic Innovation From the 2009 Cohort of Pilot Awardees

Supplementing face-to-face visits with phone calls to provide enhanced support to families and patients at the end of life

Leveraging technology to increase access to providers for audio-verbal therapy following cochlear implantation in children

Enhancing the referral network and staff capacity to identify and serve patients with early dementia

Establishing community supports necessary for the GLBT communities to “age in

Strengthening Community–Academic Partnerships

Evaluation findings highlighted the value community partners brought to the research process. Specifically, investigators described how partners strengthened the rigor and validity of instrument development, data collection, and analysis efforts, and promoted creative problem solving. In progress reports, clinical investigators in particular described how community partners had transformed not only interventions to enhance their effectiveness and the research process to enhance the insights gained, but also their belief in the value of CBPR. One clinical investigator wrote, “I always believed in community participatory research on a theoretical level but [this project] turned me into a true believer and a zealous advocate for CBPR … CBPR may be the only way to truly change clinical practices.” Findings also showed how community partners valued their partnerships with academic researchers. For example, when a partnership development grantee was awarded a joint pilot project grant in their second year, they formalized the role of the academic researcher within their organization by creating an “academic advisor” position. In addition, the organization contracted to support the time of two other academic researchers who had been involved in the partnership.

Strengthening Community Research Translation

As shown in Table 3, the first cohort of funded joint pilot project partnerships advanced a range of translational research opportunities, including development of novel research methods, dissemination strategies, and tailored interventions. Many partnerships took advantage of the different strengths of community and academic partners, so that the products of their projects were more likely to be useful and used. For example, one joint pilot project evaluated the use of neighborhood “house meetings” as a dissemination method; their success led to their being routinely used in subsequent community research and grant proposals.

Table 3.

Translational Opportunities Represented by Cohort 1 Joint Pilot Projects

Pilot Project	Description
Health to Heart	A novel methodological approach that enhanced the breadth and depth of perspectives that were available to inform neighborhood-based public health interventions.
Growing Healthy Communities	Data analysis surfaced associations between gardening (access to community gardens, in particular) and positive health behaviors, positive social and emotional health, and enhanced civic involvement (e.g., giving produce grown to those in need). Research findings have been disseminated (through a variety of methods, including a film documentary) to public health officials, city planners and council members, public school officials and medical providers.
School-based Health Center and Childhood Obesity	CBPR and community-engaged research as transformative educational and professional development experiences for graduate and medical students, to prepare the “next generation” of translational researchers and elevate the “science” of CE for translation.
Refugees and Medical Care	A joint research effort that, like so many of the projects funded in Year One, corrected misperceptions (e.g., about the desire of community members to be involved), enhanced understanding and awareness, and fostered mutual respect regarding the resident knowledge and skills of those representing different sectors/systems/social worlds.
Maltreated Youth with a History of Foster Care	The development of a thorough, well-informed and piloted assessment to identify the support needs of youth who are transitioning to independence. The assessment was developed through a rigorous process that involved academic researchers, youth and young adults from the out-of-home care population, and professionals who work with these youth.
Youth at Risk for Violence in School	The pilot demonstrated that screening for violence is feasible in a school setting with adequate administrative support. Preliminary evidence suggested that involvement with Project PAVE can decrease an adolescent’s violence involvement and disciplinary action within the school context.

Interestingly, although there was considerable variability in how community and academic partners used grant funds, the requirement that at least half of the funds go to the community partner resulted in their carrying out tasks that are often the purview of academic researchers. Consequently, opportunities were created for knowledge/skill transfer and community capacity building. For example, one community partner used the majority of project funds to train and pay community members as data collectors and meeting facilitators (with the academic partner receiving a smaller percentage of funds for data management and analysis).

Together, early evaluation findings of the CE Pilot Grants program provide evidence of the “mutually reinforcing nature of CBPR as an approach that supports both the translational research process, as well as the partnership development process that serves as the necessary foundation for this work.”⁶ Table 4 includes a case example of a funded partnership that has benefited from these important processes.

Table 4.

One Grantee’s Story: A Case Example from the CE Pilot Grants Program

Phase	Description
A Community Advisory Council Refocuses the Project	The home blood pressure monitoring program had been designed to make it very easy for participants to monitor and report their home blood pressures. Participants were asked to check their home blood pressure once daily. The home blood pressure cuff automatically averaged the patient’s last 30 blood pressure readings and patients were asked to report this average to their primary care physician monthly. When the High Plains Research Network (HPRN) Community Advisory Council (CAC) reviewed the program, they concluded that we had made the program too easy for patients! They felt the program failed to engage participants in the self-management and lifestyle changes that are essential for controlling blood pressure. The HPRN CAC recommended that we develop a Hypertension (HTN) Self-Management Toolkit for participants and change the focus from home blood pressure “monitoring” to “management” to denote a stronger sense of action and responsibility.
The “Just Check It” Toolkit is Developed	The toolkit was modeled on a very successful asthma management toolkit previously developed by the HPRN CAC. The Hypertension Toolkit incorporated facts about hypertension, messages about taking responsibility for one’s health, and action steps. A key part of the toolkit was the Blood Pressure Tracking Log where patients record their daily blood pressure readings. This log provided short hypertension facts, motivational messages, and lifestyle change reminders to further engage patients in the process of improving their blood pressure control. A Lifestyle Management Booklet helped patients develop lifestyle change goals that were then recorded in the blood pressure log. Each participant also received a validated home blood pressure monitor, a pedometer, and measuring spoons (imprinted with “Half the salt!”) to encourage exercise and dietary sodium reduction.
Community-based Practitioners Enhance the Feasibility and Impact of Implementation:	Patients seen in a primary care clinic were recruited to participate in the program. Initially, recruitment letters were mailed to potential participants and group HBPM instruction visits were scheduled. Some patients were recruited in this manner. However, the clinic found that it was more efficient to recruit and train patients at their regular office visits. The office developed a simplified system for patients to report HPBM results. The patient would call the clinic to speak to the CNA. The patient would report to the CNA their bi-monthly average home blood pressure and the number of readings done. The CNA would enter the results and ask the patient about their medication adherence. This report would then be forwarded to the practice nurse who would follow up with patient. The practice developed an Individualized Treatment Plan (ITP) form that was used for follow up if the patient’s blood pressure was above target. At enrollment, the physician or physician’s assistant used this form to lay out the next steps and medication changes that should be done if the patient’s blood pressure was above target. The nurse could then use this “protocol” to provide patients with immediate feedback and an action plan. This type of “protocol-based” follow up has been shown to improve blood pressure control.

Note. Grantee Awarded Partnership Development grant in year 1, Joint Pilot Project grant in year 2.

It is worth noting that although these reported accomplishments focus primarily on partnerships funded in our first grant cycle, evaluators are replicating and extending their methods with grantees from all funding cycles to provide a more comprehensive analysis of the range of impacts over time. For example, beginning with the third funding cycle, all grantees are now asked to complete the Collective Capacity Building Tool at the beginning and end of the grant cycle to evaluate specifically the partnership development process and the infusion of CBPR principles as each project develops.

CONCLUSIONS

As national research initiatives place a greater focus on translational research to improve medical care, health and health disparities,⁷ tools for strengthening investments in CE and CBPR are needed more than ever before. Colorado’s CCTSI, through its CE core, has developed a CE Pilot Grant program to invest its resources in building and strengthening community–academic partnerships to improve community translational research. Based on findings to date, we have established the value of this grant making strategy and developed replicable processes and methods for implementing this CE Pilot Grants program widely.