OVERVIEW
The Indiana Department of Health (IDOH) has received funding from the Centers for Disease Control and Prevention (CDC) to help reduce the burden of the COVID-19 pandemic among racial and ethnic populations that have been disproportionately affected. As part of this effort, IDOH is implementing through its Office of Minority Health Together We Will, a grant program investing over $5,000,000 during 2021-2023 in community initiatives that address health inequities for disparate and marginalized populations of color and indigenous people. Applications for the Together We Will grant program will be accepted by the Office of Minority Health on a rolling basis, with awards ranging in amounts from $1,000 to $75,000.

IDOH’s Office of Minority Health is charged with working collaboratively to develop partnerships with organizations that have existing community or social service delivery programs for racial and ethnic minority communities. Focusing its efforts on improving disparities in preventable health conditions, the Office of Minority Health serves the Hispanic/Latino, Black, Asian, Pacific Islanders, and Native American Indian populations in Indiana, which constitute approximately 14% of the state’s population.

BACKGROUND
Long-standing systemic health and social inequities have put people from many racial and ethnic minority groups at increased risk of COVID-19. Before the pandemic, various studies already showed that minority groups suffer from a higher rate of chronic disease. The impact of COVID-19 has exacerbated existing health conditions and affected efforts to mitigate the pandemic.

Secondary effects of the virus include an uptick in domestic violence, increased behavioral/mental health problems, and exacerbated conditions in people with existing mental and/or substance use disorders (SUD). In Indiana, mental health providers are limited and there is only one professional per 500 people, and one in 3,000 for Black people. People with mental disorders and SUD are two-to-six times more likely to have co-occurring chronic physical conditions, such as diabetes and hypertension, than individuals without behavioral health conditions (McKenzie & Company, 2020). The most aggressive rise in opioid death rates over the last few years has been in the state’s Black population.

People living in vulnerable communities, especially ethnic and minority populations and rural populations, are significantly more likely to die from COVID-19 because they lack equitable access to healthcare, affordable housing, transportation, childcare or safe and secure employment (Melvin et al., 2020). Maternal mortality also plagues Indiana’s minority populations, with Black moms dying at significantly higher rates regardless of education and socioeconomic status (53.4 deaths per 100,000) (IDOH, 2019). Obesity and smoking lead to chronic conditions such as asthma, hypertension, diabetes, cancer, add heart disease and stroke, which elevate COVID-19 risk.

Gaps in essential services include infrastructure and workforce development around services to address social determinants of health that feed these chronic illnesses. Education and training to address systemic racism and the marginalization of citizens of color and minority groups within the healthcare culture also is missing. Of immediate concern is the hesitancy by minority groups to receive the COVID-19 vaccination due to decades of racism that have resulted in an overall distrust of the medical community. Underserved minorities also have communication needs that are not customized to their culture or primary language, creating gaps in health literacy, access, and patient safety.

ELIGIBILITY
Eligible applicants must be located within Indiana. These include local health departments, hospitals, local government agencies, local coordinating councils, recovery-oriented systems of care, recovery hubs, drug-free coalitions, and other community coalitions and non-profit organizations that have experience in leading community health improvement activities.

FUNDING
The amount available for the grant program is over $5,000,000. Applicants may apply for grants in an amount ranging from $1,000 at a minimum to $75,000 at a maximum. The final award amount for a grant is contingent on submission of a reasonable proposal that is approved by IDOH’s Office of Minority Health.

SCOPE OF WORK
In order to implement community initiatives, IDOH’s Office of Minority Health will fund each grantee to carry out their proposed activities. Activities will be carried out in Indiana and based on strategies developed by the grantee. Strategies must utilize practice-based evidence (PBE). These types of strategies are developed over time through practice and experience, and often support healing from a cultural framework. In addition, objectives must be used to support each strategy. It is important to bear in mind that strategies are approaches undertaken to carry out a successful project, and objectives are measurable steps taken to achieve a strategy. Allowable activities fall under eight priority health areas, and grantees may select one or more of the following:

Environmental Justice
Environmental justice refers to the fair treatment and meaningful involvement of all people, regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. CDC tracks environmental data on topics such as air quality, drinking water, heat-related illnesses, birth outcomes, and others. Data on those topics help inform environmental justice efforts across the U.S.
Strategies in this priority health area should focus on promoting the need for environmental justice or meeting the challenges of the effects of environmental inequities for affected communities. Examples of activities include grocery delivery to neighborhoods in food deserts, distributing transportation vouchers for healthcare appointments, and conducting a survey on environmental justice issues in the community.

Substance Use Disorder
Substance Use Disorder affects a person’s brain and behavior and leads to an inability to control the use of a legal or illegal drug or medication. The recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.
Strategies in this priority health area should advocate for, educate on or expand access to substance use prevention, treatment, and/or recovery. Examples of activities include developing and distributing substance use education information to the community, partnering to provide long-term recovery programming consistently, developing a social network for individuals in recovery, and surveying individuals in recovery for community needs.

COVID-19 Hesitancy
Within Indiana, there are zip codes across the state in which the COVID-19 vaccination rate is below 30% of the total population, and it is estimated that vaccination rates for populations of color are low (IDOH, 2021). Vaccine hesitancy remains a barrier to full population inoculation against highly infectious diseases such as COVID-19. Various factors account for this, such as a demand for more information before seeking vaccination. This includes wanting to know more about COVID-19 vaccines, including the process for developing and authorizing them, as well as their safety and effectiveness. Individuals may also have previous experiences that impact their confidence in the public health system.
Strategies in this priority health area should identify emerging issues of misinformation, disinformation, and how intervention efforts can positively increase vaccine confidence. Examples of activities include a question-and-answer town hall, a COVID-19 Vaccine Marketing/Ad Campaign, fact-checking myths and creating a social media campaign to help debunk vaccine myths.

Violence
As described by CDC, violence is a serious public health concern. Various forms of violence—including Adverse Childhood Experiences (ACEs), elder abuse, firearm violence, intimate partner violence, and sexual violence, among others—affects people in all stages of life. Survivors of violence can experience various physical, mental, or emotional health problems.
Strategies in this priority health area should address effects of violence on the health and well-being of survivors and provide or offer support, resources, and referrals to assistance. Examples of activities include youth violence education and prevention programs, referrals and resource assistance for victims of interpersonal violence, as well as naming types of violence and creating an awareness campaign.

Access
According to the Agency for Healthcare Research and Quality, access to health care means having the timely use of personal health services to achieve the best health outcomes. Access to health care consists of four components:

• Coverage: facilitates entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health status.
• Services: having a usual source of care is associated with adults receiving recommended screening and prevention services.
• Timeliness: ability to provide health care when the need is recognized.
• Workforce: capable, qualified, culturally competent providers.
Strategies in this priority health area should address issues of access in targeted communities within Indiana. Examples of activities include expanding telehealth services, hiring/deploying Community Health Workers (CHWs), and assistance with finding health insurance coverage.

Mental Health
CDC describes mental health as including emotional, psychological, and social well-being. It affects how individuals think, feel, and act. It also helps determine how individuals handle stress, relate to others, and make healthy choices.
Strategies in this priority health area should advocate for, educate on, or expand access to mental health care. Examples of activities include providing mental health first-aid training to employees, showcasing community stories focused on the fluidity of mental health, creating an anti-stigma campaign, and identifying ways to introduce art and music daily.

Structural & Systemic Barriers
COVID-19 has affected racial and ethnic minority groups, putting them more at risk of getting sick and dying from COVID-19 (CDC, 2020). Structural barriers can be policies, practices, and other norms that favor an advantaged group while systematically disadvantaging a marginalized group.
Strategies in this priority health area should combat systemic/structural barriers to basic needs, particularly in healthcare, such as language/communication, transportation, income, lack of care providers, lack of insurance, racism, sexism, etc. Examples of activities include educating providers on systemic barriers like racism, sexism, etc. via cultural competency training; providing telehealth services to patients/clients with no access to transportation to and from appointments; providing transportation vouchers and passes; as well as hiring Community Health Workers to address social determinants of health and provide referrals to community resources.

Infant & Maternal Mortality
CDC describes the death of an infant as being before his or her first birthday. In 2019, the infant mortality rate in the United States was 5.6 deaths per 1,000 live births, with the highest rates occurring among populations of color. In addition, CDC describes maternal mortality as the death of a woman while pregnant, or within 1 year of the end of pregnancy from any cause related to or aggravated by the pregnancy. Approximately 700 women die each year in the United States as a result of pregnancy or delivery complications.
Strategies in this priority health area should offer support, education, and/or care to pregnant and/or newly parenting moms. Examples of activities include home visiting programs, doula support programs, a breast milk bank, diaper bank, organizing a community baby shower, and family planning education.

Regardless of strategy, all projects must be founded in community familiarity and wisdom. Grantees work on a variety of levels to create change—from health promotion and direct service to organizational or institutional change, to changing the policies, systems, and environments that impact the root causes of health inequities within COVID-19 context and beyond.

An applicant may partner with one or more organizations to implement a project, but participation of other organizations is not required. If a project includes a partner organization or organizations, then letters of support from each partner organization outlining their responsibilities must be submitted as part of the application. Letters of support will be assessed for bonus points in evaluating an application.

SUBMITTING A PROPOSAL
A webinar is available to provide potential applicants with information about this grant opportunity. To access the webinar please click on the button below entitled application instructions video. Proposals will be accepted on a rolling basis until funding is exhausted or by the close of applications on June 30, 2023. Awarded grantees must complete awarded grants by May 30, 2024. Proposals must be submitted via the online application at intogetherwewill.com. After review of an application has been completed, the respondent will be notified by e-mail regarding whether the application has been selected for a grant award or not selected for a grant award. Applications not initially chosen for a grant award will be eligible for technical assistance. A technical assistance team will contact the applicant to discuss the application, with the goal of providing technical assistance so that the application can be improved and re-submitted.

The information below will be requested on the application form, and each item must be completed by the applicant:

1. Organization Information

Organization Name
Address
Federal EIN/Tax ID Number
Website (optional)
Type of Organization (please select one):

• • Local Health Department
  • Local Government Agency
  • Local Coordinating Council
  • Recovery-Oriented System of Care
  • Recovery Hub
  • Drug-Free Coalition
  • Community Coalition
  • Non-Profit Organization
  • Faith-Based Institution
  • Hospital

Please upload the organization’s Certificate of Existence from the Indiana Secretary of State as a pdf document.

Please provide the following information for the organization’s main point of contact regarding the application:

Name
Title
Phone Number
E-mail Address

Please select the primary priority health area that will be the focus of the project:

• Environmental Justice
• Substance Use Disorder
• COVID-19 Vaccine Hesitancy
• Violence
• Access
• Mental Health
• Structural & Systemic Barriers
• Infant & Maternal Mortality

Please select any secondary priority health area(s) that will be the focus of the project:

• Environmental Justice
• Substance Use Disorder
• COVID-19 Vaccine Hesitancy
• Violence
• Access
• Mental Health
• Structural & Systemic Barriers
• Infant & Maternal Mortality

Current & Past Experience (Up to 3,500 characters)
Please describe your current and/or past initiatives related to the priority health area(s) that will be the focus of the project, including any current or past goals, objectives, and outcomes. In addition, please explain what differentiates your organization from others that provide similar services.

2. Project Description

Please provide a Project Title.

Statement of Need

• Please define the geographic area for the project within Indiana, including the name of each county and municipality where the project will take place. and the region(s) in which the project will take place. (Up to 3,500 characters)
• Please describe the population of focus (demographic information from the U.S. Census Bureau on the population of focus such as race, ethnicity, age, and socioeconomic status). Why is this particular population the focus of the project? (Up to 3,500 characters)
• Please describe what gaps this grant funding can fill in the geographic area’s response to the COVID-19 pandemic among racial and ethnic populations that have been disproportionately affected, and how will the project be innovative in meeting the needs of the population. (Up to 3,500 characters)

3. Strategies & Objectives

Strategies

• Please describe the promising strategies that will be used in the project that are based on practice-based evidence (PBE) and/or the lived experiences of communities of color. (Up to 3,500 characters)

Objectives

• Please identify clear objectives to support each strategy. (Up to 3,500 characters)

4. Activities

• Please describe the activity or activities of the priority health area(s) that will be implemented. (Up to 3,500 characters each)
  Please note: the priority health area(s) selected in the first part of the application will appear, and applicants will input the activities.

5. Required Templates & Other Documentation

Budget & Budget Narrative Template

• Please use the Budget and Budget Narrative Template to provide a detailed budget with supporting narrative for all anticipated costs. Please refer to the “Instructions – Budget & Narrative” button below for directions on how to fill in the template. Please use the “Budget & Budget Narrative Template” button below to provide the budget and budget narrative in the application.
• Requested project funds can include the following direct costs: salaries, fringe benefits, supplies, equipment, and travel (such as meal and incidental expenses). Direct costs are expenses directly related to the project and are necessary for its implementation and operation.
• If needed, a proposal may also include other direct costs, as well as indirect costs. Other direct costs are types of expenses that may relate to a particular project and include items such as consultant or professional services. Examples of indirect costs include Internet access and postage.
• A third tab on the template, titled “FTE Calculation,” contains a worksheet to calculate the number of full-time equivalent (FTE) employees that will be working on the project. Please follow the instructions on the worksheet to complete the FTE calculation and include it in the application.

Staffing Plan
Please list and describe the staff positions for the project, including the Project Director and other key personnel, showing the role of each. If your organization plans on hiring staff, please describe how this will be accomplished. (Up to 3,500 characters)

Timeline

• Please use the Timeline Template to provide a chronological listing of key dates and activities for the proposed project. Please identify the types of activities in the timeline, using the definitions below as a guide:

Trainings: Activities with assigned personnel to complete.
Events: Coordinated activities with a specified audience for participation and a defined, common purpose.
Milestones: Major activities showing a significant point of progress in achieving outcomes.

• In compiling the timeline, include the types of activities that are appropriate for the project.

Letters of Support
If a project includes a partner organization or organizations, then letters of support from each partner organization outlining their responsibilities must be submitted as part of the application. A maximum of five letters of support may be submitted. Each letter of support must use the attached template as a format, with each letter placed on an organization’s letterhead and signed by the organization’s chief executive officer.

BIBLIOGRAPHY

Centers for Disease Control and Prevention (CDC). (2020.) Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. Morbidity & Mortality Weekly Report, 69:759–765. DOI: http://dx.doi.org/10.15585/mmwr.mm6924e2

Center for Societal Benefit Through Healthcare. (2020, Sept. 1). Behavioral health crisis in the United States: The fallout from the COVID-19 pandemic. McKinsey & Company. https://www.mckinsey.com/about-us/covid-response-center/leadership-mindsets/webinars/americas-behavioral-health-crisis-the-fallout-from-the-covid-19-pandemic#

Indiana Department of Health. (2021.) Indiana COVID-19 Vaccination Dashboard [Data file]. Retrieved from https://www.coronavirus.in.gov/vaccine/2680.htm

Indiana Department of Health, Office of Minority Health (IDOH). (2019). Interagency Council on Black and Minority Health. https://www.in.gov/isdh/23413.htm
Melvin SC, Wiggins C, Burse N, Thompson E, Monger M. (2020). The Role of Public Health in COVID-19 Emergency Response Efforts From a Rural Health Perspective. Preventing Chronic Disease, 17. DOI: http://dx.doi.org/10.5888/pcd17.200256