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									                           REQUEST FOR APPLICATIONS
                                    RFA # A173
                            Childhood Obesity Prevention

FUNDING AGENCY:             North Carolina Department of Health and
                              Human Services
                            Division of Public Health
                            Physical Activity and Nutrition Branch
                            1915 Mail Service Center
                            Raleigh, North Carolina 27699-1915

ISSUE DATE:                 July 23, 2008

IMPORTANT NOTE: The applicant’s name, date and RFA No. A173 must be included
on the front of each Brief Proposal and Grant Application envelope or package.

Brief Proposals will be accepted until 5:00 p.m., Wednesday, August 6, 2008. (See The
Procurement Process.)

Grant Applications, subject to the conditions made a part of hereof, for furnishing
services described herein, will be accepted until 5:00 p.m. Wednesday, September 3,
2008. (See The Procurement Process.)

SEND ALL APPLICATIONS DIRECTLY TO THE FUNDING AGENCY ADDRESS
SHOWN BELOW.

Direct all inquiries concerning this RFA to:

Mailing Address:                            Jamie Cousins, Project Coordinator
                                            Physical Activity and Nutrition Branch
                                            1915 Mail Service Center
                                            Raleigh, North Carolina 27699-1915

                                            Phone: 919-707-5222
                                            FAX: 919-870-4804
                                            Jamie.Cousins@ncmail.net

Location / Hand Delivery Address:           5505 Six Forks Road
                                            3rd Floor, D14
                                            Raleigh, North Carolina, 27609

NOTE: Two conference calls to answer questions about this Request for Applications
will be held. One call will be held on Monday, July 28, from 9:00 – 10:30 am (919-715-
0769). A second call will be scheduled and announced. Additional questions will be
received until close of business, Friday, August 1, 2008. A summary of all questions and
answers will be e-mailed to all local health departments.



DPH RFA #A173                                                                          1
INTRODUCTION

The North Carolina Division of Public Health is pleased to announce the Childhood
Obesity Prevention Project for State Fiscal Year 2008-2009. These grants are to
support implementation of recommended strategies to reduce the rates of childhood
overweight and obesity and will be awarded to North Carolina local health departments
through a competitive application process.

Funding for the grants is from state appropriations. Awards will be given to four local
health departments, with a maximum award of $475,000. The grant is for a period of 8
months, from October 1, 2008 – May 31, 2009.


BACKGROUND

Youth who are overweight or obese are at greater risk of being overweight as adults
and developing chronic disease at an early age. The Centers for Disease Control (CDC)
estimates that one in three children born in the year 2000 will develop diabetes in their
lifetime. For the first time in history, it is predicted that the current generation will have a
shorter lifespan than their parents, virtually negating all increases in life expectancy
from medical advances. In 2006, 31% of North Carolina children ages 10 -17 were
identified as overweight or obese, ranking North Carolina the fifth worst among the
states in childhood obesity. The CDC Morbidity and Mortality Weekly Report (MMWR,
July 18, 2008) states that “expansion of multidisciplinary, cross-sector collaborations
and partnerships that seek to improve nutrition and physical activity in settings such as
schools, workplaces, and communities will be an important strategy to reduce obesity
prevalence in the United States”. The goal of this project is to reduce the percentage of
children and adolescents who are overweight or obese in selected communities by
increasing physical activity and healthy eating. The reduction of North Carolina’s
childhood obesity rates will require a multimodal approach involving public health,
healthcare providers, schools, day care centers, and faith communities, as well as
media and policy changes that support families in adopting significant lifestyle changes.

The North Carolina Division of Public Health, Chronic Disease and Injury Prevention
Section’s mission is to reduce death and disabilities through education, policy change,
and working with community partners to ensure a long, productive, and healthy life for
all North Carolinians. Through this proposal, North Carolina has an opportunity to
implement science-based community interventions, demonstrate their effectiveness in
our communities, and learn how to replicate them in other communities with future
funding.

The purpose of this project is to demonstrate that strengthening partner linkages within
community sectors increases the utilization and effectiveness of childhood obesity
prevention and control efforts. Community partnerships, which include local health
departments, schools, health care providers, and community stakeholders will assess,
link and mobilize existing programs and services; implement multilevel approaches; and



DPH RFA #A173                                                                                  2
utilize recommended strategies to reduce the rates of childhood obesity by ten percent
by the year 2015.

SCOPE OF SERVICES

Funded partnerships will be required to:
1. Participate in partnership capacity building to include leadership development,
   creating organizational change, strategic planning, and legislative advocacy.
2. Conduct a county-wide health communication/social marketing campaign.
3. Implement a component or phase of the county Bicycle/Pedestrian Master Plan.
4. Implement and evaluate the following interventions: (1) Preschool/Child Care
   (2) Healthcare (3) WakeMed ENERGIZE! (4) Hospital Worksite Wellness (5) North
   Carolina Alliance for Athletics, Health, Physical Education, Recreation and Dance
   (NCAAHPERD) In-School Prevention of Obesity and Disease.

1. Preschool/Child Care:
   Interventions for the preschool/child care setting must be designed to implement the
   Nutrition and Physical Activity Self-Assessment (NAP-SACC) intervention. The NAP-
   SACC program targets child care policy, practice and environmental influences on
   nutrition and physical activity behaviors in young children.

2. Healthcare:
   Interventions in the healthcare setting must be designed to recruit and train clinicians
   to use the Pediatric Obesity Clinical Tools.

3. WakeMed ENERGIZE!:
   Replicate the WakeMed ENERGIZE! program for youth identified as being at risk for
   developing diabetes.

4. Hospital Worksite Wellness:
   Interventions must be designed to develop worksite wellness coordinators and
   committees in at least one hospital in the county (or one that serves the majority of
   the people in the county). Interventions should be designed to 1) recruit key people
   to establish and maintain the worksite wellness program 2) develop and implement
   key programs including those that focus on policy and environmental change, as
   well as employee education and group activities.

5. NCAAHPERD: In-School Prevention of Obesity and Disease (ISPOD) Program:
   Participate in the NCAAHPERD’s ISPOD initiative aimed at preventing childhood
   overweight and obesity through physical assessment and reporting and physical
   education for kindergarten - eighth grade students. The initiative includes the
   Sports, Play & Active Recreation for Kids! (SPARK) curriculum, which aligns with the
   North Carolina Standards and National Standards for schools. ISPOD requires the
   schools to use the FITNESSGRAM activity and physical fitness assessment.




DPH RFA #A173                                                                              3
Funded counties may also choose to implement intervention(s) in one or more of the
following settings. Interventions are to be designed to include the Centers for Disease
Control’s (CDC’s) recommended strategies as found in the Guide to Community
Preventive Services.

1. Schools:
   Interventions must be designed to create school environments that support healthy
   eating and physical activity, utilizing the eight components of Coordinated School
   Health and the School Improvement Process. Interventions should target all
   foods/beverages available in schools (vending, fundraising, snacks, celebrations,
   rewards, concessions, etc.,) and must include a plan to integrate the NC Nutrition
   Standards. Interventions must also target physical activity and physical education for
   students and worksite wellness for faculty and staff.

2. Faith:
   Interventions must be designed to establish and maintain opportunities for healthy
   eating and/or physical activity. Each faith community participating in the intervention
   must adopt two or more of the changes shown below:
          Environmental Change: establish and maintain supportive environments for
           healthy lifestyle options (i.e., healthy eating and physical activity) by
           improving accessibility, affordability and/or safety
          Policy Change: establish and implement policies and standards to support
           healthy eating and/or physical activity
          Interpersonal: establish programs to increase physical activity and/or improve
           healthy eating habits
          Individual Change: design programs to teach individuals skills needed to
           make behavioral changes related to healthy eating and/or physical activity

3. Community: Farmer’s Market/Farm Stands: Intervention must be designed to
   create or enhance farmers’ markets or farm stands in communities in the county.

Evaluation:

Projects will be evaluated on the implementation (process) and outcomes of the
interventions. Grantees will be required to report activities to the state Project
Coordinator monthly and report outcomes to the state Project Evaluator bi-monthly. The
Coordinator and the Evaluator may request reports more frequently, if needed.
Grantees will report using an Access Database application that will be provided to each
grantee. A final report will be required at the end of the grant period. Details on all of
the reporting requirements will follow after the awards are made.

Eligibility and Funding:
Local health departments that can demonstrate the ability to function effectively in all
sectors in their county (including preschool, school, healthcare, worksite, faith and
community) are eligible. Priority will be given to those that can demonstrate that
qualified, trained personnel are identified and ready to begin implementation of the


DPH RFA #A173                                                                              4
project interventions as soon as the award is made. The local county health department
must be an active member of the partnership.

Funding:
Four grant projects will be awarded up to $475,000.00 each for the period of October 1,
2008 – May 31, 2009.

The Procurement Process
The following is a general description of the process by which a health department will
be selected to complete the goal or objective:

1. The funding opportunity announcement is being sent to all local health departments.

2. There are two stages in the competitive application process:

    Stage 1: Brief Proposal
    Applicants must submit a Brief Proposal of three to five pages that describes the
    strength and comprehensiveness of the community collaboration and demonstrates
    the capacity of the collaboration to complete the interventions outlined in the
    announcement. Applicants must also demonstrate that qualified, trained personnel
    are in place to begin implementation of the project as soon as the funding is
    awarded. Due: Wednesday, August 6, 2008.

    Stage 2: Grant Application
    Selected applicants will be invited by phone, letter and e-mail to submit a Grant
    Application of no more than 20 pages, accompanied by a Budget and Budget
    Narrative, and additional supporting documents. Due: Wednesday, September 3,
    2008

3. Written questions concerning the RFA specifications will be received until the date
   specified on the cover sheet of this RFA. A summary of all questions and answers
   will be e-mailed to all local health departments Monday, August 4, 2008 as an
   addendum to the RFA.

4. The originals of the Brief Proposal and the Grant Application must be signed and
   dated by the county Health Director. Applicants must submit an original and three
   copies of both documents.

5. The Physical Activity and Nutrition (PAN) Branch must receive all applications not
   later than the date and time specified on the cover sheet of the RFA. Faxed
   applications will not be accepted.

6. Applications will be logged in on the date the PAN Branch receives them. Budgets
   will be included as part of the application.




DPH RFA #A173                                                                             5
7. At their option, the evaluators may request additional information from any or all
   applicants for the purpose of clarification or to amplify the materials presented in any
   part of the application. However, applicants are cautioned that the evaluators are not
   required to request clarification: therefore, all applications should be complete and
   reflect the most favorable terms available from your agency.

8. Applications will be evaluated according to completeness, content, experience with
   similar projects, ability of the health department’s staff, cost, etc. The award of a
   grant to one applicant does not mean that the other applications lacked merit but
   that, all facts considered, the selected application was deemed to provide the best
   service to the state.


General Information on Submitting Applications

1. Award or Rejection
All qualified applications will be evaluated and an award made to the local health
department whose combination of budget and service capabilities are deemed to be in
the best interest of the funding agency. The funding agency reserves the unqualified
right to reject any or all offers if determined to be in its best interest. Successful
applicants will be notified by Friday, September 12, 2008.

2. Decline to Offer
Any local health department that receives an invitation to submit a Grant Application,
but declines to make an offer, is requested to send a written "Decline to Offer" to the
Physical Activity and Nutrition Branch. Failure to respond as requested may subject the
agency to removal from consideration of future RFA’s.

3. Cost of Application Preparation
Any cost incurred by a local health department in preparing or submitting an application
is their sole responsibility. The funding agency will not reimburse any applicant for any
pre-award costs incurred.

4. Elaborate Applications
Do not submit elaborate applications (brochures or other presentations beyond that
necessary to present a complete and effective application).

5. Oral Explanations
The funding agency will not be bound by oral explanations or instructions given at any
time during the competitive process or after awarding the grant.

6. Reference to Other Data
Only information that is received in response to this RFA will be evaluated; reference to
information previously submitted will not suffice.

7. Titles



DPH RFA #A173                                                                               6
Titles and headings in this RFA and any subsequent RFA are for convenience only and
shall have no binding force or effect.



8. Application Form
Each application must be submitted on the form provided by the funding agency, and
will be incorporated into the funding agency's Performance Agreement (contract).

9. Exceptions
All applications are subject to the terms and conditions outlined herein. All responses
will be controlled by such terms and conditions. The attachment of other terms and
conditions by any applicant may be grounds for rejection of that agency’s application.
Funded agencies specifically agree to the conditions set forth in the Performance
Agreement (contract).

10. Advertising
In submitting its application, applicants agree not to use the results therefrom, or as part
of any news release or commercial advertising, without prior written approval of the
funding agency.

11. Right to Submitted Material
All responses, inquiries, or correspondence relating to, or in reference to, the RFA and
all other reports, charts, displays, schedules, exhibits, and other documentation
submitted by the applicant will become the property of the funding agency when
received.

12. Competitive Offer
Pursuant to the provision of G.S. 143-54, and under penalty of perjury, the signer of any
application submitted in response to this RFA thereby certifies that this application has
not been arrived at collusively, or otherwise, in violation of either federal or North
Carolina antitrust laws.

13. Local Health Department Representatives
Each applicant shall submit with its application the name, address, and telephone
number of the person who can answer questions or provide clarification concerning the
application.

14. Subcontracting
Local health departments may propose to subcontract portions of work provided that
their applications clearly indicate the scope of the work to be subcontracted, and to
whom. All information required about the prime grantee is also required for each
proposed subcontractor.

15. Proprietary Information




DPH RFA #A173                                                                              7
Trade secrets or similar proprietary data which the applicant does not wish disclosed to
anyone other than personnel involved in the evaluation will be kept confidential to the
extent permitted by NCAC TO1: 05B.1501 and G.S. 132-1.3 if identified as follows:
Each page shall be identified in boldface at the top and bottom as "CONFIDENTIAL."
Any section of the application that is to remain confidential shall also be so marked in
boldface on the title page of that section.
16. Participation Encouraged
Pursuant to Article 3 and 3C, Chapter 143 of the North Carolina General Statutes and
Executive Order No. 77, the funding agency invites and encourages participation in this
RFA by businesses owned by minorities, women and the disabled including utilization
as subcontractor(s) to perform functions under this Request for Applications.

17. Contract
The Division of Public Health will issue an Agreement Addendum and copy of the Grant
Application to the recipient of the grant. Expenditures can begin immediately upon
receipt of a completely signed Agreement Addendum.

Please be advised that successful applicants may be required to have an audit in
accordance with G.S. 143C-6-22 and G.S. 143C-6-23 as applicable to the health
department’s status. Also, the Agreement Addendum may include assurances the
successful applicant would be required to execute when signing the Agreement
Addendum.

Submission of Application:

Brief Proposal:
Assemble the proposal in the following order. Use a binder clip at top left corner on
each copy of the proposal. Number each page consecutively beginning with the
Application Face Sheet.

   Application Face Sheet
   Partnership
   Strength and Capacity
   Past Performance and Success
   Attachments
          o Project Coordinator Bio-sketch/Resume
          o Partnership Information Forms
          o Letters of Commitment

Grant Application:
Assemble the application in the following order. Use a binder clip at top left corner on
each copy of the application. Number each page consecutively beginning with the
Application Face Sheet.

   Application Face Sheet
   Partnership Development Plan


DPH RFA #A173                                                                              8
   Health Communication/Social Marketing Plan
   Interventions
   Budget and Budget Narrative/Summary
   Attachments
   Indirect Cost Approval Letter if charge is included in Indirect Cost section (J) of
        Budget

Required Sections for the Brief Proposal:
Three to five pages maximum, single spaced, 1-inch margins, 12-point font.
Note: Bio sketches/resumes and partner information forms do not count as part of the
five- page maximum.

Introduction:
Describe the partnership’s interest in participating in this initiative and why your county
is best positioned to be successful if awarded funding.

Selection Criteria:
Partnership Description: (25 points)
Describe the current partnership within your county that fosters linkages and
collaboration between sectors including preschools, schools, faith organizations,
healthcare providers and organizations, and local communities. If representatives from
each of these sectors are not currently included in your collaboration, describe how you
will recruit and engage them.

Capacity of Partnership: (25 points)
Show that your team has the capacity to work in each of the settings to implement the
required interventions. List key staff (include bio sketches/resumes) and key team
members (include partner information forms) who will be responsible for ensuring the
completion of each intervention. Letters of commitment from key partners are required.

Project Coordination: (25 points)
Describe your plan to coordinate this grant project. Include information on the
individual(s) who will be responsible for the success of the demonstration project and
include details on their qualifications to manage this type of project.

Past Performance and Success: (25 points)
Include a brief summary of past experience and success in working in each of these
settings. Include the following as examples: 1) Describe the relationship between the
partnership and the school system and show the progress that has been made toward
the implementation of the NC Nutrition Standards. 2) Describe the progress that has
been made on the county Bicycle/Pedestrian Plan.


Required Sections for the Grant Application: (Note: The Grant Application
may be submitted only if your county has been invited to apply.)



DPH RFA #A173                                                                                 9
Funded partnerships will be required to:
1. Participate in partnership development to include assessment, strategic planning,
   capacity building and legislative advocacy
2. Conduct a county-wide social marketing campaign
3. Implement a component or phase of the county Bicycle/Pedestrian Master Plan
4. Implement and evaluate the following interventions: Preschool/Child Care,
   Healthcare, WakeMed ENERGIZE!, Hospital Worksite Wellness, and ISPOD.

Partnerships may also choose to include one or more interventions targeting Schools,
Faith, Community Farmer’s Market/Farm Stands. If interventions are currently being
implemented that meet the requirements, show how the current effort will be evaluated
and how this evaluation will be used to modify or enhance the intervention.

Required Interventions are to be conducted as outlined below. Additional interventions
are to be designed to include the Centers for Disease Control’s (CDC’s) recommended
strategies as found in the Guide to Community Preventive Services:
www.thecommunityguide.org .

Selection Criteria:

Partnership Development: (20 points)
Include in the partnership development narrative the plan to assess the partnership,
how the information gathered by the assessment will guide the strategic planning
process, and what membership training and skill development will occur as a result of
this process.

Health Communication/Social Marketing: (15 points)
Project counties will be required to utilize health communication and social marketing
strategies and tools to ensure that the entire community is aware of the community-wide
obesity prevention efforts and to ensure that specific audiences are targeted and
engaged in the creation of all obesity prevention programming.

Community-wide campaigns are interventions that use multiple strategies within one
community. Community-wide campaigns focus on both individual level behavior change
(in this case, focusing on the seven, key eat smart, move more behaviors), but also
target organizational and community factors that support behavior change (policies &
environments). Use of mass media, individual or group education/support, and
policy/environmental changes in concert are the hallmark of community-wide
campaigns.

The use of the Eat Smart, Move More North Carolina print, television and radio public
service announcements, as well as comprehensive public relations strategies (strategic
placement of stories in newspapers and on broadcast news, for example), are strongly
encouraged. Technical assistance in the use of public relations strategies and tactics,
as well as media placement for public service announcements, will be provided by the
PAN Branch.


DPH RFA #A173                                                                           10
Project counties should use social marketing strategies and tactics to target and engage
specific audiences in achieving the desired behavior changes. These specific strategies
are outlined in detail in the Obesity Prevention Coordinators’ Social Marketing
Guidebook, available online at http://hsc.usf.edu/NR/rdonlyres/1F6E6B64-967D-45D1-
8BC1-357EC9B3BC30/24125/ObesityPreventionCoordinatorsSocialMarketingG.pdf.
Technical assistance for social marketing is also available through the PAN Branch.

Project counties will be expected to contract with a research firm (to be designated by
the PAN Branch) to conduct an evaluation of the campaign through the use of pre-and
post-tests and to collect YRBSS (Youth Risk Behavior Surveillance System) data on
children using the recommended procedures outlined by the U.S. Centers for Disease
Control and Prevention (CDC).

Community; Bicycle/Pedestrian Plan Implementation: (15 points)
Interventions must be designed to implement a phase or portion of the Pedestrian and
Bicycle Master Plan for your county. Include a description of:
 How you will recruit and engage citizens of your county in this intervention
 How the partnership will assess the implementation of the Bicycle/Pedestrian Plan
    and prioritize the next steps to be targeted by this intervention
 What strategies will be used to implement the next steps
 What technical assistance will be provided and who will provide it
 How the implementation process will be evaluated. Include in your evaluation plan
    how you will measure performance and what level of performance must be reached
    for the intervention to be considered successful
 How additional phases of the master plan will be implemented after the funding
    period is over

(Use of the “Winning with ACEs! How You Can Work Toward Active Community
Environments” is recommended)

Interventions: (50 points)
Note: If interventions are currently being implemented that meet the requirements, show
how the current effort will be evaluated and how this evaluation will be used to modify or
enhance the intervention.

1. Preschool/Child Care
For this intervention include in the project description information detailing the target
group, capacity, and intervention as described below:

Target Group: Include in the project description the total number of preschools and
child care centers in your county and the number of these that you will target for this
intervention. Include the total number of children, staff and families who will be impacted
by this intervention.




DPH RFA #A173                                                                               11
Capacity: Show that your team has the capacity to work with child care providers in the
county to complete this intervention. List the team members who will be responsible for
ensuring the completion of this intervention. Include a brief summary of their past
experience and successes in working with preschools and child care centers.


Intervention: Interventions for the preschool/child care setting should be designed to
implement all five core elements of the Nutrition and Physical Activity Self-Assessment
(NAP-SACC) intervention.

The five core elements include:
 Self Assessment
 Goal Setting and Action Planning
 Workshop Delivery
 Targeted Technical Assistance
 Evaluation, Revision and Repetition

Describe how the team will work with the child care centers to implement the NAP-
SACC intervention. Include a description of:
 How child care centers will be recruited
 How you will ensure that participating centers will complete the assessment process
 How the assessment will be used by the centers to set physical activity and healthy
  eating goals and plan for action
 What strategies will be used to influence change
 What technical assistance and required workshops will be provided and who will
  provide them
 Evaluation Measures for this intervention are outlined in Attachment E and may be
  adjusted according to each county’s current level of implementation of the
  intervention. Grantees will work with the PAN Branch evaluator and partners to carry
  out evaluations for the intervention.
 How the intervention will be sustained after the funding period is over

2. Healthcare
For this intervention include in the project description information detailing the target
group, capacity, and intervention as described below:

Target Group: Include in the project description the total number of medical
clinic/practices and clinicians (physicians, nurses, nurse practitioners, physician
assistants) that will use the Pediatric Obesity Clinical Tools. Provide the potential
number of children who will be reached by these clinicians.

Capacity: Show that your team has the capacity to work with clinicians in the county to
complete this intervention. List the team members who will be responsible for ensuring
the completion of this intervention.




DPH RFA #A173                                                                               12
Intervention: Interventions must be designed to recruit clinicians to use the Pediatric
Obesity Clinical Tools. Include a description of:
 How clinicians will be recruited
 How the current process for managing pediatric obesity, including tracking BMI
    (Body Mass Index) annually, will be assessed
 What strategies will be used to influence organizational change and improve
    management of pediatric obesity
 What technical assistance will be provided and who will provide it
 How and when the process for managing pediatric obesity will be re-assessed
 How the use of Pediatric Obesity Clinical Tools will be sustained after the funding
    period is over

(Use of “Pediatric Obesity Assessment, Prevention and Clinicians Treatment Guide for
Clinicians” is recommended)

3. WakeMed ENERGIZE!
For this intervention include in the project description information detailing the target
group, capacity, and intervention as described below:

Target Group: Include in the project description the total number of local
pediatricians/family practice physicians serving overweight children ages 10-18 who
have risk factors for Type 2 Diabetes in your county and the number of physician-led
practices you will target to replicate the evidence-based WakeMed ENERGIZE!
Program.

Capacity: Show that your team has the capacity to replicate the WakeMed ENERGIZE!
Program. Identify key, non-profit community partners that will be responsible for the
completion of this intervention. Include a brief summary of their past experience and
successes in working with at-risk, overweight children ages 10 – 18. (Non-community
partners include, but are not limited to: provider practices such as pediatricians, family
practice, community health centers, clinics, a diagnostic laboratory screening facility, as
well as non-profit diabetes prevention education and youth fitness partners.)

Intervention: The intervention must be the replication of the WakeMed ENERGIZE!
program per their existing curriculum. The program begins with a physician referral and
screening lab work. Youth identified with elevated fasting glucose or metabolic
syndrome who qualify for the program, and their family, attend an individual assessment
visit with the educator to explain the program and evaluate their readiness to change.
ENERGIZE! is a 12-week, 3-night-per-week, community-based, intensive education and
lifestyle change program that includes lessons in nutrition, physical fitness, and
behavior change education. The group program takes place in a local community center
(YMCA, Parks and Recreation, YWCA) convenient to the child’s home. Families are
integrated into the program through nutrition classes and fitness offerings. The key
components of the WakeMed ENERGIZE! program include:
     Physician Advisor
     Local Physician Screening


DPH RFA #A173                                                                               13
       Lab Work
       Local Hospital
       Program Coordinator
       Diabetes Prevention/Health Educator
       Fitness Facility and Instructors

4. Hospital Worksite Wellness
For this intervention include in the project description information detailing the target
group, capacity, and intervention as described below:

Target Group: Include in the project description the total number of hospitals in your
county and identify which hospital(s) you will target for this intervention. Include the total
number of hospital staff who will be impacted by this intervention.

Capacity: Show that your team has the capacity to work with the hospital(s) in the
county to complete this intervention. List the team members who will be responsible for
ensuring the completion of this intervention. Include a brief summary of their past
experience and successes in working with the hospital(s).

Intervention: Interventions must be designed to develop worksite wellness coordinators
and committees for at least one hospital in your county, or one that serves the majority
of the people in your county. Interventions should be designed to (1) recruit key people
to establish and maintain the worksite wellness program (2) develop and implement key
programs, including those that focus on policy and environmental change, as well as
employee education and group activities. Include a description of:
 How hospitals will be recruited
 The assessment process that will be used to determine the current level of
    employee wellness activities and gather input from employees to guide future
    wellness activities
 How the assessment will be used by the hospital to set goals and plan for action
 What strategies will be used to influence organizational and individual behavior
    change
 What technical assistance will be provided and who will provide it
 Evaluation Measures for this intervention are outlined in Attachment E and may be
    adjusted according to each county’s current level of implementation of the
    intervention. Grantees will work with the PAN Branch evaluator and partners to carry
    out evaluations for the intervention.
 What strategies will be used to support the sustainability of the intervention

(Use of “Saving Dollars and Making Sense” is recommended)

5. NCAAHPERD: In-School Prevention of Obesity and Disease (ISPOD) Program:
For this intervention include in the project description information detailing the target
group, capacity, and intervention as described below:




DPH RFA #A173                                                                               14
Target Group: Include in the project description the total number of schools in your
county with kindergarten – eighth grade students and the number of Physical education
teachers within these schools.

Capacity: Show that your team has the capacity to work with the schools in the county
to complete this intervention. List the team members who will be responsible for
ensuring the completion of this intervention. Include a brief summary of their past
experience and successes in working with the schools.

Intervention: The NCAAHPERD’s ISPOD initiative aims at preventing childhood
overweight and obesity through training of physical education teachers of kindergarten –
eighth grade students. The training includes the Sports, Play & Active Recreation for
Kids! (SPARK) curriculum, which aligns with the North Carolina Standards. ISPOD
requires the schools to use the FITNESSGRAM activity and physical fitness
assessment (http://www.fitnessgram.net/overview/)

The ISPOD program involves:
 Training for all school physical education teachers (kindergarten – eighth grade) on
   the SPARK and FITNESSGRAM
 Bi-annual FITNESSGRAM testing, including BMI of all students in kindergarten -
   eighth grade.
 Reporting of FITNESSGRAM results through an existing web-based application
 Collaboration between physical education teachers and colleagues to incorporate
   aspects of SPARK appropriately within health and other curricula
 Completion of student surveys (online) targeting physical activity and nutrition
   behaviors
 Completion of teacher surveys (online) evaluating the SPARK


*Additional Interventions: (Up to 10 additional points may be awarded
for any added interventions.) *Applicants must meet all mandates to be eligible
for additional points.

Schools
Target Group: Include in the project description the total number of elementary, middle
and high schools in your county and the number of each of these that you will target for
this intervention. Include the total number of school-aged youth, staff and families that
will be impacted by this intervention.

Capacity: Show that your team has the capacity to work with the schools in the county
to complete this intervention. List the team members who will be responsible for
ensuring the completion of this intervention. Include a brief summary of their past
experience and successes in working with schools.

Intervention: Show how you will work with the schools in your county to assess the
impact that the school system’s current Local Wellness Policy is having in individual


DPH RFA #A173                                                                           15
schools. Describe how you will use this assessment to create school environments that
support healthy eating and physical activity, utilizing the eight components of
Coordinated School Health and the School Improvement Process. Interventions should
target all foods/beverages available in schools (vending, fundraising, snacks,
celebrations, rewards, concessions, etc.) and must include a plan to integrate the NC
Nutrition Standards. Interventions must also target physical activity and physical
education for students and worksite wellness for faculty and staff.

(Use of the “School Health Profile”, “School Employee Wellness, A Guide for Protecting
the Assets of Our Nation’s Schools” and “NC HealthSmart: School Worksite Wellness
Toolkit” is recommended)

Faith
Target Group: Include in the project description the total number of faith communities
in your county and the number of these that you will target for this intervention. Include
the total number of people who will be impacted by this intervention.

Capacity: Show that your team has the capacity to work with faith communities in the
county to complete this intervention. List the team members who will be responsible for
ensuring the completion of this intervention. Include a brief summary of their past
experience and successes in working with faith communities.

Interventions: Interventions must be designed to establish and maintain opportunities
for healthy eating and/or physical activity. Each faith community participating in the
intervention must adopt two or more of the changes shown below:
       Environmental Change: establish and maintain supportive environments for
         healthy lifestyle options (i.e., healthy eating and physical activity) by improving
         accessibility, affordability and/or safety
       Policy Change: establish and implement policies and standards to support
         healthy eating and/or physical activity
       Interpersonal: establish programs to increase physical activity and/or improve
         healthy eating habits
       Individual Change: design programs to teach individuals skills needed to make
         behavioral changes related to healthy eating and/or physical activity

Show how you will work with the selected faith communities to implement the
intervention. Include a description of:
       How faith communities will be recruited
       How these communities will be assessed to determine the communities’ current
        level of support for healthy eating and physical activity
       How the assessment will be used by the community to set goals and plan for
        action
       What strategies will be used to influence organizational and individual behavior
        change
       What technical assistance will be provided and who will provide it



DPH RFA #A173                                                                                  16
       Evaluation Measures for this intervention are outlined in Attachment E and may
        be adjusted according to each county’s current level of implementation of the
        intervention. Grantees will work with the PAN Branch evaluator and partners to
        carry out evaluations for the intervention.
       What strategies will be used to support the sustainability of the intervention

(Use of the “African American Churches Eating Smart and Moving More, A Planning
and Resource Guide” is recommended. The “Faith Communities Eating Smart and
Moving More, A Planning and Resource Guide” is currently in development and will be
available for use.)

Farmer’s markets, farm stands:
Include in the project description the total number of communities in your county and the
number of these that you will target for this intervention. Include the total number of
people who will be impacted by this intervention.

Interventions must be designed to create or enhance farmers’ markets or farm stands in
communities in your county. Include in your description:
 How you will recruit and engage citizens of your county in this intervention
 What assessment will be conducted to determine the current level of support in your
    county for access to locally grown, fresh fruits and vegetables
 How you will use the information from this assessment to set goals and plan for
    action
 What strategies will be used to influence change
 What technical assistance will be provided and who will provide it
 Evaluation Measures for this intervention are outlined in Attachment E and may be
    adjusted according to each county’s current level of implementation of the
    intervention. Grantees will work with the PAN Branch evaluator and partners to carry
    out evaluations for the intervention.
 How the farmer’s market, farm stand will be sustained after the funding period is
    over




DPH RFA #A173                                                                            17
Partner Information Form
   Attachment A

Briefly describe the roles and commitments of every agency, group or individual you
have listed in your application as a partner. Include the following:

Partner #___

Organization:
Representative:
Title:
Role/Commitment(s):
Qualifications/Training:


Partner #___

Organization:
Representative:
Title:
Role/Commitment(s):
Qualifications/Training:



Partner #___

Organization:
Representative:
Title:
Role/Commitment(s):
Qualifications/Training:




(Use additional pages as needed.)



DPH RFA #A173                                                                         18
Budget & Budget Justification                           (For Grant Application Only)
    Attachment B
Provide a detailed, itemized budget and written justification consistent with planned
activities of the project. Budget items should be realistic and clearly linked to project
activities and expected outcomes. (You may describe the in-kind contribution and provide the
estimated value of the contribution in the County In-Kind column, but do NOT add the value of in-kind
contributions into your Actual Budget.)

Use the following categories for your itemized budget:

Name of Agency:

                                                                                           County
Budget Category                             Staff Names          Actual Budget             In-Kind
A. Salaries and Fringe Benefits
 County Coordinator
 (.5 to .75 position for 10 months)
 Administrative Support
 (.5 position for 10 months)
 ENERGIZE! Coordinator
 (.5 position for 10 months)
 NAP-SACC Coordinator
 (contracted position)
 Wellness Coordinator (Hospital)
 (.25 to .5 position for 10 months)
 Wellness Coordinator (School)
 (.25 to .5 position for 10 months)
 Faithful Families Coordinator
 (.5 position for 10 months)
 Specify if other salary / fringe:



SUBTOTAL salary and fringe

B. Sub-Contracts

 WakeMed ENERGIZE! Program
 (excludes local coordinator)
 Master Bicycle/Pedestrian Plan
 implementation
  Farm markets / farm stands
 Community physical activity
 specialists for WakeMed
 ENERGIZE! program
SUBTOTAL sub-contracts


DPH RFA #A173                                                                                           19
C. Marketing / Media
 Media Campaign
 Evaluation of Media Campaign
 YRBSS sampling

SUBTOTAL marketing/media

D. Equipment
 Specify equipment:



SUBTOTAL equipment

E. Staff Development

 Legislative Advocacy Conference
 Specify other staff development:



SUBTOTAL staff development

F. Training

 Partnership Development
 Workshops
 (Partnership assessment /
 enhancement, Communication
 Planning)
 Specify other training:


SUBTOTAL training

G. Educational Materials
 NAP-SACC resource materials
 Promotional materials for
 Nutrition Standards
School Health Index and
implementation of Action Plan
 Faithful Families curriculum
Specify other educational
materials:




DPH RFA #A173                       20
SUBTOTAL educational materials

H. Travel Expense
 Specify travel:

SUBTOTAL travel

I. Supplies
  Specify supplies:



SUBTOTAL supplies

J. Indirect Cost (allowed 5% of
total funding)
SUBTOTAL indirect cost

K. Other
 Specify Other:
 Incentives (specify per
 Intervention)
SUBTOTAL other


TOTAL Budgeted

                                             Total Amount Requested           $




Budget Justification
A. Salaries and Fringe Benefits                                     Amount: $

Provide a justification and description of any positions (include staff names & FTE) that will be
funded with grant funds. The following estimates are provided to assist you in developing your
budget:

Project Coordinator                         .50 - .75 FTE
Administrative Support                      .25 - .5 FTE
On-site WakeMed ENERGIZE! Coordinator       .50 FTE
NAP-SACC Coordinator                        300 hours per year for every 10 child care centers
                                            targeted
(Adjust to the number of centers in which you will support NAP-SACC intervention.)
Hospital Staff Wellness Coordinator         .25 - .5 FTE
School Staff Wellness Coordinator           .25 - .5 FTE



DPH RFA #A173                                                                                   21
Faith Coordinator                           .50 FTE for every 10 – 15 faith communities
                                            targeted
(Adjust to the number of targeted faith communities.)

B. Subcontracts                                                        Amount: $
Provide justification for all subcontracted services. The justification should include the name of
the contractor if known, the scope of work, the period of performance, and expected outcomes
or products.

WakeMed ENERGIZE! Subcontract is a required component of the demonstration project. The
county will contract with WakeMed Health and Hospitals for training and technical assistance.
Depending on the scope of the WakeMed ENERGIZE! intervention in the county, this
subcontract is estimated to cost from $10,200 per county, not including salary for the onsite
coordinator, and payment for fitness class instructors, lab work, and incentives, Counties
implementing WakeMed ENERGIZE! with funding from the Kate B. Reynolds Foundation, in
partnership with the North Carolina Division of Public Health, Diabetes Control and Prevention
Branch, will not be required to use demonstration project funds to support the WakeMed
ENERGIZE! program. The Kate B. Reynolds funding should be listed in the County In-Kind
column in the Budget.

Built Environment subcontracts may include Bicycle/Pedestrian Master Plans and/or farmers
markets and farm stands. The total of these subcontracts may not exceed $100,000.

C. Marketing/Media                                                   Amount: $

As part of the demonstration project, counties must coordinate a community-wide media
campaign. Counties are encouraged to work with partners in coordinating media efforts.
Demonstration project funds used toward the media campaign may not exceed $100,000. In
addition, outcome evaluation of the media campaign must be conducted and may be budgeted
for up to $40,000. Counties will be required to conduct an oversampling of the YRBSS.

D. Equipment                                                         Amount: $

List any equipment to be purchased, its estimated price, and a justification for each item.
Computers and office equipment may be purchased with these funds but will require prior
approval from the state Project Coordinator before purchase.

E. Staff Development                                                    Amount: $
Provide justification for training and/or conferences that staff will attend. Funds may be
budgeted to support staff development for partnering agency staff or coalition members. Travel
expenses for staff development can be entered here.

As part of staff development, counties are required to budget for one person to participate in a
Legislative Advocacy Training Workshop in Winston-Salem October 14-15, 2008. This
workshop is a train-the-trainer model, and participants are expected to train others in their
county following the workshop. Registration costs have not been determined. It is
recommended that $500 be budgeted for participation to include registration, lodging and meals
for one person.




DPH RFA #A173                                                                                    22
F. Training                                                            Amount: $
List all expenses anticipated for training that will be provided as part of the intervention. Include
rental space for training (if required), training materials, speaker fees, substitute teacher fees,
and any other applicable expenses related to the training.

Partnership development is a required component of the demonstration project. To meet this
requirement, counties should budget for training in Partnership Assessment/Enhancement and
Communication Planning.

G. Educational Materials                                           Amount: $
List the type and approximate quantity of educational materials purchased to support the
intervention and a brief description of how they will be used.

NAP-SACC resource materials
Pediatric Obesity Tools / materials
Promotional materials for Nutrition Standards
School Health Index and implementation of Action Plan
Faithful Families curriculum

H. Travel                                                                Amount: $
Identify titles of staff whose travel is supported, briefly explain the purpose of the travel and how
it relates to the action plan, and provide an estimate of mileage and per diem costs showing
how those expenses were calculated. (Note: Mileage reimbursement for use of personal
vehicles must be computed at, or below, the current IRS rate.)

I. Supplies                                                            Amount: $
You need provide only a reasonable dollar amount for general office supplies like pens, paper,
etc. Provide justification for supply items other than general office supplies.

J. Indirect Cost                                                      Amount: $
Administrative overhead cannot exceed 5%.

K. Other                                                           Amount: $
List any other budgeted items here and explain how they are essential to the implementation of
your proposed interventions. Note: funds requested for incentives may not exceed 2% of
the total amount requested. If proposing incentive, list separately for each intervention.


Total Funds Requested:                                                Amount $




DPH RFA #A173                                                                                       23
                       Application Face Sheet (Attachment C)




                     Childhood Obesity Prevention Project
                                 SFY 08/09
                    Physical Activity and Nutrition Branch
                          Chronic Disease and Injury Section
                         North Carolina Division of Public Health

                         RFA #A173 Application Form

                      Deadline for Brief Proposal

                               August 6, 2008

Local Health Department:

Name and Title of Primary Contact:

Address:


Telephone (     )                                Fax ( )

Email:

Total Funds Requested: $

Signatures:


_______________________Date______             ___________________Date______



DPH RFA #A173                                                                 24
Health Director                             Project Coordinator

                      Application Face Sheet (Attachment D)




                    Childhood Obesity Prevention Project
                                SFY 08/09
                  Physical Activity and Nutrition Branch
                        Chronic Disease and Injury Section
                       North Carolina Division of Public Health

                        RFA #A173 Application Form

                  Deadline for Grant Applications:

                          September 3, 2008

Local Health Department:

Name and Title of Primary Contact:

Address:


Telephone ( )                                  Fax ( )

Email:

Total Funds Requested: $

Signatures:


_______________________Date______           ___________________Date______
Health Director                             Project Coordinator


DPH RFA #A173                                                               25

								
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