Strategies to facilitate equitable resource sharing in community-engaged research

Abstract

Community subcontracts are an essential component of community-engaged research, particularly community-based participatory research (CBPR). However, several barriers have limited community-based organizations’ ability to serve as subcontractors on research grants. This paper describes the barriers and strategies to implementing community subcontracts through a case study of the implementation of one federal grant. Specific lessons learned at the community-based organizational level, budget-creation level, and university-level are described to overcome barriers in executing community subcontracts in community-engaged research. We then conclude by making a call for institutional changes to facilitate equitable resource sharing in community-engaged research.

Introduction

Establishing subcontracts with community partners is an essential component of participatory research that can facilitate equal power-sharing between community and academic partners[1, 2]. Yet, several barriers hinder the implementation of community subcontracts in community-based participatory research (CBPR)[3]. Few papers have explicitly discussed the challenges and solutions in executing community subcontracts[3]. Previous papers have discussed the benefits of clearly delineating roles and responsibilities in community subcontracts through MOUs[1], and recommendations to funders to facilitate CBPR[2, 3]. However, to the authors’ knowledge, specific solutions to the challenges encountered by community-academic partners in implementing community subcontracts in the context of conducting CPBR have not been described. Thus, this paper describes the barriers to executing community subcontracts in community-engaged research and delineates specific strategies to address these barriers. The barriers and potential solutions are described in the context of a CBPR randomized-controlled trial of weight loss in African American adults[4].

Case Study: The WORD (Wholeness, Oneness, Righteousness, Deliverance)

The WORD is a 5-year randomized controlled weight loss trial implemented in 30 rural African American churches in the Arkansas Delta (n=425). Funded by the National Institute on Minority Health and Health Disparities (NIMHD) through the Arkansas Center of Health Disparities, The WORD trial includes a cultural adaptation of the Diabetes Prevention Program[5] and is testing the need for maintenance sessions on sustaining weight loss. The study builds on a 10+ year collaboration between community partners and the University of Arkansas for Medical Sciences (UAMS) researchers serving the Delta region of Arkansas, a predominately rural, underserved area with marked disparities in health. The project has a sizeable (about 40% of the entire project budget) community subcontract. Initially the fiscal agent for the community subcontract was Mid-Delta Community Consortium (MDCC), a non-profit 501(c)3 organization with a mission “to increase resources and understanding of partnerships to enhance and promote community-driven health improvement.” MDCC serves as a conduit of resources across the Delta and works with other Delta-serving organizations to improve health access.

MDCC had experience executing several local and federal research and service projects, but had not previously served as the community fiscal agent for a research award subcontract of The WORD’s size. Based on its previous experiences, MDCC expected that money would be provided upfront to conduct the research activities; however, the majority of federal grants (e.g., NIH, CDC) had recently moved from an upfront payment system to a reimbursement-based system, whereby grant-related expenses are “drawn down” the month after the expenses are posted to the grant, and then reimbursed. The subcontract did not indirect funds from the grant, but MDCC was fortunate to have unrestricted funds that their board allowed to use for the research project to begin in a timely manner. MDCC’s scope of research involved payment of community research staff and participant incentives, the timely payment of which was essential to maintain trust with Delta communities, where there are high rates of poverty and many residents live from paycheck to paycheck. For the first few years of the research project, MDCC used money from its unrestricted funds to cover research expenses, then MDCC submitted an invoice to UAMS, which then sent MDCC a reimbursement check. The reimbursement process took approximately 3–4 weeks from the submission of the invoice.

The reimbursement process placed a considerable burden on MDCC. As a small community organization, MDCC did not have a large amount of unrestricted funds and had other responsibilities to fulfill. In addition, several community investigators were purchasing approximately $2000 a month worth of gift cards (over ~36 months) for participant assessment incentives out of their own pockets and were waiting 3–4 weeks to be reimbursed. The financial situation caused a significant amount of stress to community and academic partners; the partnership was concerned about preserving the financial health of MDCC, executing The WORD project, maintaining positive community relationships, and removing the financial stress of individual partners supplying their own personal funds to support the project. If this had been the partnership’s first collaboration, the challenging financial situation may have threatened the project’s continuation. Fortunately, the partnership had a 10+ year collaboratively history, where mutual trust and respect had been built. Thus, in response to the stressful financial situation, the partners rallied together to preserve the community subcontract for the project.

UAMS and MDCC tried to expedite the reimbursement process. Since this was MDCC’s first experience executing a multi-million dollar federal research grant, UAMS sought to assist in building MDCC’s capacity through providing technical assistance on setting up processes to facilitate MDCC’s submission of the necessary paperwork and working with MDCC in creating budgets for purchase orders. The community investigators and staff on the project were also very gracious in adjusting to the reimbursement time. Community and academic investigators also sought ways to provide upfront monies to MDCC for the project. Community investigators searched for Foundation funding, where the Foundation would receive its money back at the end of the grant when the final grant expenditures are reimbursed; or if the Foundation was willing, donate the money to the community-based organization (CBO) for use in subsequent studies. In parallel, academic investigators explored whether the University had funds, particularly from the University’s indirect costs from the project that could be given upfront to MDCC.

Despite UAMS’s and MDCC’s best efforts, upfront monies were not obtained. The MDCC board was willing to spend down the unrestricted funds of the organization because of its deep commitment to the project, but unfortunately, the CBO’s unrestricted funds were insufficient to cover all of the research project activities upfront. About three years into the project when research activities peaked, MDCC exhausted its unrestricted funds. The team considered absorbing the community subcontract into the UAMS budget, but decided against this for two reasons: 1) losing the community subcontract was inconsistent with the partnership’s deep commitment to equitable resource sharing in participatory research, and 2) a considerable portion of the already tight subcontract direct costs would have been needed to accommodate the University’s indirect cost rate, leaving only about 45% of the subcontract funds for project activities. Despite MDCC’s commitment to the project, the board decided that it could no longer serve as the project’s fiscal agent. Fortunately, community investigators secured another community organization to serve as the fiscal agent for the community subcontract. The new fiscal agent secured a low interest bearing loan to serve in this capacity.

Lessons Learned

Several valuable lessons were learned during this process that can be considered as potential solutions to overcome barriers to executing successful community subcontracts in participatory research.

Increase knowledge

Community and academic partners were fortunate to have business office managers and administrators who were familiar with processing community subcontracts and the importance of expediting reimbursements to community partnerships. Community-academic partnerships that are unfamiliar with community subcontracts in community-engaged projects may benefit from receiving more information about the fiscal processes of community subcontracts. The University of North Carolina at Chapel Hill released a Community-Academic Grants Administration Translation (CAGAT) information guide (available on the NC TraCS Institute’s website (www.tracs.unc.edu)), which can be utilized by community-engaged partnerships to facilitate efficient pre and post award processes.

Budget-creation level

Given that both community and academic partners were aware that MDCC did not have an indirect cost rate, The WORD project could have budgeted for MDCC’s administrative or indirect costs consisting of 10–15% of the total subcontract. Community and academic partners could have also more clearly communicated the fiscal responsibilities of the grant and only allocated funds to the community subcontract that MDCC could reasonably execute or pay upfront; the grant narrative could then explain why the community subcontract was meager. This may require that community staff be hired through the academic institution, which would reduce the community subcontract amount, provide community staff with benefits that may not be available to some CBOs, and provide community benefits through employing community staff. However, this strategy may not be ideal, as the reduced funds provided to the CBO limits the capacity built within the CBO, and could limit equitable power sharing.

Community organization-level

Although UAMS and MDCC had been working collaboratively on research projects for over a decade, MDCC did not have an indirect cost rate established. Establishing an indirect-cost rate for CBOs could eliminate or at least reduce the financial barriers to communities participating equitably in research. Given that the process to establish an indirect cost rate is long and requires a considerable amount of organizational infrastructure, community and academic partners need to begin the process of establishing an indirect-cost rate for CBOs as soon as possible and not wait until planning a grant submission. If both community and academic partners had worked together earlier to establish an indirect cost rate for MDCC, MDCC would have remained as the fiscal agent for the community subcontract for The WORD project’s entire duration.

University-level

Some universities (e.g. University of California-Davis[6]) have used funds from their indirect costs or other university sources to establish a mechanism to expedite subcontract payments to community partners. Other universities have provided community organizations with a small amount of “start-up funds” that are deducted from the budget at the end of the project (e.g. University of Alabama at Birmingham), and some (e.g. University of Wyoming) have paid cash-limited CBOs subaward amounts quarterly in advance to enable participatory research partnerships that would not have been possible on a reimbursement basis. The community-academic partnership advocated for the use of indirect cost funds to provide funds or regularly-scheduled payments for community partners; however, university policies were not changed. Earlier advocacy for changes in institutional policies may have resulted in a different outcome. For example, faculty could have engaged in ongoing advocacy to address policies that hindered appropriate subcontract funding to CBOs rather than be reactive when issues arose in the project and partnership.

Budget cuts at some universities have also led to lean staff and shared services, whereby the financial administrative processes are centralized. Centralization of administrative processes has served as a barrier to faculty seeking to expedite the reimbursement process to community partners, as the centralized system makes it difficult for faculty to know exactly who is managing the budget. The community-academic partnership was fortunate to have consistent administrative personnel familiar with community-based grants manage The WORD project, thus minimizing potential communication barriers. Other partnerships who do not have consistent administrative personnel may advocate for a single person or team be responsible for community-engaged projects.

Supplemental funds

When executing the grant became increasingly untenable for MDCC, MDCC attempted to secure funding from other sources to provide the upfront monies and cash flow needed to complete research activities. Foundation monies were sought but were not obtained. The partnership may have attempted to partner with a larger non-profit or a ‘fiscal sponsor’ who could provide funds to smaller CBOs that need the monies upfront. However, this would have been a short-term solution, and not ideal for addressing the underlying barriers to CBO research engagement.

Conclusions

To the authors’ knowledge, this is the first paper that clearly describes challenges and potential solutions (other than targeting the funder alone) in successfully executing a community subcontract in the context of a CBPR project. Although some of the challenges identified in implementing community subcontracts can be mitigated through increasing knowledge of community budget execution and in creating a budget that community organizations can reasonably execute, changes at the institutional and funder level are needed to ultimately eliminate the challenges community organizations—particularly small grass-roots organizations—have in executing community-engaged grants.

The reimbursement-based policy of the majority of federal grants (e.g. NIH, CDC) and subsequently universities has forced the utilization of limited CBO funds to start up research projects. Using CBO funds to conduct initial as well as ongoing research activities is a significant financial burden for many small organizations. Community organizations with limited financial infrastructure may decide not to participate in participatory research because of their inability to provide upfront funds for research activities[7–9]. Some CBOs have ample resources to support large-scale research grants, and some may argue that participatory work should be limited to collaborations with such resource-rich organizations. However, not engaging smaller local CBOs that often mirror the limited resources of the communities they serve would preclude partnerships with the very organizations that need to be engaged in participatory research. Thus building the capacity of low-resourced community organizations—including the successful management of research funds—through research is part of the participatory process needed to address social determinants of health.

The current situation whereby research funding is awarded on a reimbursement only basis at both the university grantee and university’s subcontracts with CBOs places an unnecessary burden on communities that partner in community-engaged research. Funding policy changes at the institution and academic levels are necessary for community-engaged research to thrive. Institutions and universities that engage in community-engaged research will benefit from considering the provision of some modicum of upfront funding to CBOs to enable the community to meet the costs of active participation in the partnership. Addressing this ‘root’ cause of limited fiscal participation by communities is necessary for the advancement of participatory research and the health of underserved communities. Funders and funded institutions working together to find equitable solutions for research resource allocation would advance public health for everyone’s benefit.