RURAL HEALTH NETWORK DEVELOPMENT GRANT PROGRAM



Please follow this template. Reports should be submitted through the EHB under ‘Progress Reports.’

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Grant Number: P10

Grantee/Organization Name:

Contact Person for This Document (contact person who will be able to answer questions about your report and discuss your grant-funded efforts):

E-Mail:

Telephone:

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Network Overview

a) List the name of the Network, if different, from the Grantee entity.

b) Year Network was formed and incorporation status.

c) If your network created and maintains a website, please list the address.

d) Provide a brief description of the network’s governing body, including the Network’s board composition.

e) Explain each member’s respective contributions and responsibilities during the network planning project.

f) List the name of the Network Director.

g) List the number of health and human service providers represented or encompassed by the network.

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Network Funding

a) Break out how the grant funds were spent per line item, i.e., personnel, consultants, travel, meetings, equipment, etc. (Should be taken from your budget). If not applicable, put N/A

|Personnel |$ |

|Fringe Benefits |$ |

|Travel |$ |

|Equipment |$ |

|Supplies |$ |

|Contractual |$ |

|Other |$ |

|TOTAL |$ |

b) If you received a no-cost extension, list the new official end date for your grant. (XX-XX-XXXX Format)

c) List your network’s current annual budget and include a breakdown of sources of income. List other funding sources and amounts received during the period FORHP grant funds also were received (list all other government grants, dues, program revenue, foundation support, in-kin contributions etc.).

|Current Annual Budget |

|[Name of Funding Source # 1] |$ |

|[Name of Funding Source # 2] |$ |

|[Name of Funding Source # 3] |$ |

|[Name of Funding Source # 4] |$ |

|Network Planning Award Amount |$ |

|[Other] |$ |

|[Other] |$ |

|Total Network Annual Budget |$ |

d) Describe/list resources that were successfully leveraged as a result of the FORHP grant and the amounts for each.

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Network Activities/Implementation

a) Describe the original goal of the network project. (Should come from original grant application)

b) Describe any significant changes that occurred during the course of the project.

c) Describe your network’s major accomplishments (these might include administrative, organizational, clinical, financial, or technological accomplishments).

d) Describe any significant barriers faced in achieving your network’s goals and describe the strategies you used to overcome them. Also, include a description of any unachieved objectives in your discussion and the barriers that prevented their attainment.(Problems might include State and Federal policies that impede network development, local community barriers, network member problems, financial issues, provider issues, technological barriers, etc.)

e) Include the latest work plan matrix listing the goals, objectives, activities and outcomes. Also include the organization or individual responsible for carrying out the activities and the timeline. (Can be submitted as an attachment)

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Results of the Grant

a) Have the objectives of the Network Planning project been met?

b) If applicable, describe the services, functions, and benefits created, or those you anticipate will be created as a result of your network a (e.g., creation of a management information system, referral network, electronic medical records, shared clinical protocols, case management, joint purchasing, coordinated services, shared quality improvement systems, joint recruitment and retention, etc).

c) Describe the impact of your network on the community(ies) you serve, (e.g., whether the network has increased access to care, improved quality of care, improved integration of services/referral systems, decreased out-migration of services).

d) How has the planning grant served as a catalyst for other network activities or programs within the community?

e) If applicable, if a needs assessment was conducted during the grant period, describe the results of the needs assessment and the impact of the needs assessment.

f) Please calculate the economic impact of your program by using the Economic Impact Tool on the Rural Assistance Center webpage (). This tool will help you determine the economic impact of grant dollars in your communities. At the end of this tool, you will be provided your total economic impact, ratio of economic impact to total spending and ratio of economic impact to HRSA funding. Please provide here.

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After the Grant

a) Will your network continue operations after the FORHP grant funds are expended?

1. If so, describe your future plans for the network, including your expectations for sustaining activities/programs/products.

2. If not, explain the reasons for the network not continuing.

b) Describe how the network will document and/or disseminate the value of its programs and services.

c) Briefly describe a mechanism for assessing continued need for the programs and services provided to the network and to the community.

d) Provide your networks “lessons learned.”

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Feedback to the Federal Office of Rural Health Policy (FORHP)

a) Provide your opinion on whether similar projects could work well in other rural settings.

b) Based on your experience, discuss the main issues and problems that other communities might face in using your project as a model for establishing a rural network.

c) Now that the grant funds are depleted, what would be most helpful to your network in the future?

d) Technical Assistance

1. Was the technical assistance offered helpful?

2. How often did you utilize services of the TA provider outside of the monthly calls?

3. What type of technical assistance would have been beneficial to your network? (i.e. face to face workshop/webinars/web modules/peer to peer calls).

e) Reporting Requirements

f) Moving forward, do you think your network will utilize the Performance Improvement Measurement System (PIMS) data?

1. If so, how?

2. If not, what measures would be useful capture as your network moves forward with developing?

g) Moving forward, do you think your network will utilize the information gleaned from performing the network organizational assessment? Please provide suggestions on how to improve the utilization of this tool.

h) Do you have any suggestions for FORHP that you believe would improve the grant program? What did you find most/least helpful during the past year? What can be improved? Please share your candid thoughts and observations. Your comments are not for attribution and will not be used in any publications about the program.

i) Other Opportunities

1. Share the success of your program. If you feel that your program is a model for best practices, has been an innovator for improving the delivery of care within your community, or have notable lessons learned, please let FORHP work with you to share your program’s success with others through tool kits and online resources including .

2. Would you be interested in serving as a resource for new grantees to the FORHP Network Planning Grant program, for instance, if a network intends to create a program similar to one your network developed?

Thank you for sharing your experiences. We hope this grant was able to make a difference in your community.

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