Thursday, July 14, 2011

Community Transformation Grants: How Transformational Will They Be?

For community advocates and local non-profits, community-based health interventions have long been considered a critical component to reducing chronic disease and eliminating health disparity at the ground level. With the passage of the Affordable Care Act, the policy world has also recognized the importance of community in preventative health activities. The Affordable Care Act created Community Transformation Grants, which aim to help communities implement projects proven to reduce chronic diseases and promote healthy lifestyles. Over the five year project period, the Community Transformation Grants (CTGs) will support two categories of activity: building community capacity to implement change and implementing evidence-based and practice-based programs to achieve change. The implementation grants, which are open to States, local governments, and non-profits, range between $500,000 and $10 million for the first budget year.

As envisioned in the Affordable Care Act, these grants would emphasize community in all aspects of the process. County applicants (including New York City, which got a special dispensation to apply under this category) must allocate at least 50 percent of their award to local community entities or local governments. The applicant must also provide evidence of a community coalition committed to the planning, implementation, and evaluation of the CTG. This community-focused approach is crucial, but many community groups are concerned about how much “transforming” these grants will actually spur. In the past, collaborations with agencies such as the NYC Department of Health have employed a more top-down approach. The agency planned the project and the community groups implemented it. This method has worked sporadically at best, with community groups unable to provide the necessary feedback to make the projects applicable and workable in their neighborhoods.

Under the proposed CTG, the Department of Health (considered by many a strong candidate to receive a large grant) has to make changes in its approach to community-based interventions. The Bronx Health REACH coalition, and other coalitions in New York City, have spent years building relationships in their communities to address widespread health issues. These relationships will give the DOH a considerable advantage if they build on these partnerships and employ the capabilities of community groups in the planning process. Some in the Health Department seemingly recognize the value of community efforts and have indicated an interest in partnering with community coalitions in each borough to plan and implement the grant if it was awarded. However, many community groups view with understandable skepticism any suggestion from the Health Department that does not indicate its leadership’s commitment to a strong community presence in the shaping of an initiative intended to transform communities and improve health for its residents.

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