Welcome to the Communities Learning Together Workshop

1
Welcome to the Communities Learning Together
Workshop

• Ryan White CARE Act
• Training and Technical Assistance Grantee Meeting
• August 29, 2006

2
Workshop Agenda

• Project Overview
• Major Federal Policy, Legislative Considerations
  and Requirements
• Seven Elements of Organizational Capacity
• Conclusion/QA

3
Project Overview Communities Learning Together
4
Overview CAEAR Foundation

• The CAEAR Foundation is a national organization
  committed to advancing effective care and support
  for people living with HIV/AIDS
• This mission is accomplished through the
  provision of training, technical assistance, and
  research to organizations and communities

5

• Introduction to the CLT Project

6
Project Overview

• Three-year cooperative agreement
• Focuses specifically on organizational
  development and fiscal management
• Is exclusively for CARE Act-funded grantees,
  specifically Title I and II sub-grantees, Title
  III EIS grantees and sub-grantees, and Title IV
  grantees and sub-grantees
• Training is not provided to Title I/II Planning
  Councils/Consortia
• Focuses on enhancing organizational development
  and fiscal management capacity to ultimately,
  improve the primary care and support services
  being provided to PLWHA

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Project Goal

• To address organizational development and fiscal
  management specific capacity-development needs as
  a way to improve the provision of primary care
  and support services to people living with
  HIV/AIDS.

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Project Objectives

• Increase the level of knowledge and skills among
  participating organizations in fiscal management
  and organizational development-specific content
  areas
• Work with organizations to assess
  capacity-development needs related to
  organizational development and fiscal
  management and
• Work with participating organizations to develop
  linkages and linkage strategies in order to
  maximize resources, enhance a continuum of care,
  and the quantity and quality of services provided
  to people living with HIV/AIDS

9
Primary Activities

• Activity 1 Three Learning Community trainings
  in a state in the northeast disproportionately
  affected by HIV/AIDS
• Two face-to-face trainings
• One training facilitated via Web-cast

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Primary Activities cont.

• Activity 2 Three Learning Community trainings
  in a state located in the south
  disproportionately affected by HIV/AIDS
• Two face-to-face trainings
• One training facilitated via Web-cast
• Activity 3 An On-line Resource Center
• Provides access to training resources, tools, and
  other information used during the CLT trainings

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Primary Activities cont.

• The CLT project also includes an evaluation plan
  to measure
• Process/implementation of the CLT project
• Outcome of CLT activities and
• Impact of the CLT trainings on grantees ability
  to address organizational development and fiscal
  management capacity-development needs

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Training Schedule

• Memphis, TN
• March 2 3, 2006
• May 4 5, 2006
• WebEx training July 2006

• Mid-Atlantic
• June 20 21, 2006
• October 17 18, 2006
• WebEx training Date TBD

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Training Methodology

• Provided through a Learning Community format
• Includes adult learning principles
• Based on non-profit capacity-building models

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Learning Community Format cont.

• Method of providing training and TA, based on
  Adult Learning Principles
• Includes more than one face-to-face training or
  TA opportunity
• Builds upon the strengths of a community as a way
  to identify and address challenges
• Provided to similarly-situated organizations
• Includes experiential learning activities

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Learning Community Format

• Provided around a specific training or TA topic
  common to the needs of the group
• Training participants decide on training topics
• Provides a feedback loop for learning through
  more than one face-to-face meeting/training
• Draws on the previous experience and knowledge of
  participants to learn and share as group

16
Non-Profit Capacity-Building Models

• Combines organizational development theory with
  opportunities for practical application
• First training in each series is a six module
  curriculum that presents
• Elements of organizational capacity framework
• Defines content areas that encompass
  organizational development and fiscal management
• Portion of curriculum based on Venture
  Philanthropy Partners (VPP) Guide, Effective
  Capacity-Building in Non-profit Organizations and
  other organizational development models and
  theories

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Non-profit Capacity-Building Model cont.

• Includes an Organizational Capacity Assessment
  Survey
• Assesses an organizations performance along core
  elements of organizational capacity
• Used to decide CLT training content
• Used to outline organization-specific training TA
  plan
• Formal permission granted from VPP to reference
  the materials and use the capacity assessment
  survey

18
Project Evaluation
19
Evaluation Framework

• Assess
• Process and implementation
• Short and intermediate outcomes
• Learning Community model effectiveness

20
Evaluation Activities

• Internal process measures
• Organizational Capacity Assessment Survey
• Onsite Post/Pre Evaluation
• Post CLT Outcome Follow-up Interviews

21
Questions?
22
Major Federal Policy and Legislative
Considerations and Requirements
23
Module Objectives

• By the end of the module, you will increase your
  understanding of
• nine core competencies that contribute to an
  organizations ability to deliver effective
  HIV/AIDS primary medical care
• HRSA/HABs guiding principles and priorities for
  providing quality care
• how HRSA/HAB grantees are evaluated
• sources and other documents available regarding
  federal requirements

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How Familiar Are You?

• This module begins with a True/False/Multiple
  choice survey
• The survey asks questions related to the content
  that will be reviewed in the module
• Work independently, in pairs, or as a group to
  answer each of the questions
• Your responses will not be shared with the group

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HRSA Goal

• The goal for all HRSA programs is to assure
  access to high quality health care and reduce
  disparities in health outcomes for recipients of
  services in HRSA funded programs. The result is
  that all persons who need care have equal access
  to high quality health care, regardless of the
  payment source.

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HAB Guiding Principles

• The HIV/AIDS epidemic is growing among
  traditionally underserved and hard-to-reach
  populations
• The quality of emerging HIV/AIDS therapies can
  make a difference in the lives of people living
  with HIV disease
• Changes in the economics of health care are
  affecting the HIV/AIDS care network and
• Outcomes are a critical component of program
  performance.

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Ryan White CARE Act Guiding Principles for CARE
Act Programs

• Revise care systems to meet emerging needs.
• Ensure access to quality HIV/AIDS care.
• Coordinate CARE Act services with other health
  care delivery systems.
• Evaluate the impact of CARE Act funds and make
  needed improvements.

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Government Performance and Results Act (GPRA)

• HRSA evaluates its programs through use of the
  Government Performance and Results Act (GPRA),
  the Performance Assessment Rating Tool (PART) and
  the Grantee Performance Review Protocol (GPRP).
• HAB has identified specific measures under GPRA
  and PART to evaluate performance of grantees.
  PART measures look at performance of CARE Act
  grantees across all programs.

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GPRA (cont)

• Strategy I. Eliminate Barriers to Care
• Performance Goal Increase Utilization for
  Underserved Populations
• Increase the number of people receiving primary
  care services under Early Intervention Services
  Programs
• Increase the number of grant applicants that are
  Faith-Based and/or Community-Based Organizations

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GPRA (cont)

• Strategy II. Eliminate Health Disparities
• Performance Goal Increase Utilization for
  Underserved Populations
• Increase the number of racial and ethnic
  minorities who are receiving primary care
  services under Early Intervention Programs

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Objective Grantee Performance Reviews

• Site visit reviews are designed to analyze the
  key factors associated with successful
  performance of HRSA programs as follows
• Results and Outcomes
• Organizational Structure and Capacity
• Outreach and Consumer Satisfaction
• Business and Financial Management
• Leadership and Strategic Planning
• Partnerships

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HRSA Challenges

• HRSA/HAB faces a number of challenges ensuring
  that organizations are responsive to nine core
  competencies.
• These core competencies contribute to an
  organizations ability to deliver effective
  HIV/AIDS primary medical care and other
  health-related services.

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• The nine core competencies are
• Conducting effective HIV/AIDS clinical service
  delivery
• Management of program finances
• Developing and implementing quality assurance and
  continuous quality improvement programs
• Managing personnel

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• The nine core competencies are
• Developing governing boards
• Purchasing medical supplies and equipment
• Service provider ability to administer
  subcontracts for services
• Service Evaluations
• Developing culturally appropriate services

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HRSA Challenges

• These challenges include
• Increasing the capacity of providers in
  underserved communities
• Enabling providers to adapt to an environment of
  few resources, rising costs, and growing HIV/AIDS
  prevalence
• Ensuring access to medication at the lowest
  possible price

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HRSA Challenges

• These challenges include
• Prioritizing funding for primary care services
• Increasing the focus of providing care on
  measurable outcome, evaluation, and productivity
• Ensuring that the CARE Act is always the payer of
  last resort

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Organizational and Fiscal Capacity

• HRSA/HAB Expectations and
• Ryan White CARE Act program
• and legislative requirements

38
Expectations of Grantees

• Stewardship of grant funds
• Program and fiscal monitoring
• Adherence to reporting requirements
• Quality management program

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Stewardship of Grant Funds

• Grantees must
• Verify that they are the payor of last resort
• Ensure allowable, proper, authorized reasonable
  and necessary costs
• Ensure that grant funds are used for CARE Act
  purposes
• Monitor spending patterns
• Have adequate documentation
• Not supplant

40
Program and Fiscal Monitoring

• Grantees must
• Abide by costs and cost caps defined in
  legislation
• Take into consideration audit requirements as
  outlined in OMB circular A-133
• Take into consideration federal grant
  administration requirements as outlined in OMB
  circular A-122
• Take into consideration requirements for grants
  and cooperative agreements with state and local
  government as outlined in 45 CFR Part 92

41
Adherence to Reporting Requirements

• As stated in the Notice of Grant Award, e.g.
  quarterly or bi-annual programmatic reports
• Résumés of Key Staff
• Financial Status Report (90 days after grant
  period)
• PHS 272 Quarterly Financial Reports (every
  quarter)

42
Quality Management Program

• The reauthorized CARE Act of 2000 required that
  all CARE Act grantees develop, implement, and
  sustain quality management programs in order to
  assure appropriate treatment for clients they
  serve
• This represented the first time that Congress
  directed CARE Act grantees to develop and
  implement QM programs and procedures

43
Quality Management Program

• To carry out this mandate, HAB has directed all
  CARE Act programs to establish QM programs to
• Assess the extent to which HIV health services
  are consistent with the most recent PHS
  guidelines for the treatment of HIV disease and
  related opportunistic infections and
• Develop strategies for ensuring that such
  services are consistent with the PHS guidelines
  for improvement in the access to and quality of
  HIV services.

44
Quality Management Program

• According to HRSA/HABs Title I Training manual,
  a successful quality management program should
• Be a systematic process with identified
  leadership, accountability, and dedicated
  resources available to the program
• Use data and measurable outcomes to determine
  progress toward evidenced-based benchmarks
• Focus on linkages, efficiencies, and
  provider-client expectations in addressing
  outcome improvement

45
Quality Management Program

• Be a continuous process that is adaptive to
  change and that fits within the framework of
  other programmatic quality assurance and quality
  improvement activities (i.e., Joint Commission on
  the Accreditation of Healthcare Organizations
  JCAHO, Medicaid, and other HRSA programs), and
• Ensure that data collected are fed back into the
  quality improvement process to ensure that goals
  are accomplished and improved outcomes are
  realized.

46
Program and Fiscal Monitoring

• In summary, the following circulars outline
  program and fiscal requirements including fiscal
  accountability and the CARE Act
• OMB Circular A-110 Uniform Administrative
  Requirements for Grants and Agreements with
  Institutions of Higher Education, Hospitals, and
  Other Non-Profit Organizations
• OMB Circular A-122 Cost Principles for
  Non-Profit Organizations
• OMB Circular A-133 Audits of States, Local
  Governments, and Non-Profit Organizations
• 45 CFR Part 92 Uniform Administrative
  Requirements for Grants and Cooperative
  Agreements to State and Local Governments
• For additional information, visit the Office of
  Management and Budget www.whitehouse.gov/omb/circu
  lars

47
Additional Documents to Reference

• BBB Wise Giving
• Standards for Excellence An Ethics and
  Accountability Code for the Nonprofit Sector
  (Developed by the Maryland Association of
  Nonprofit Organizations)
• Your HAB Program Guidances

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End of Module
49
Seven Elements of Organizational Capacity
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Module Objectives

• By the end of the Module, you will increase your
• understanding of seven elements of organizational
  capacity
• knowledge about an organizational capacity
  assessment survey disseminated following the
  first CLT training in a location

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What is organizational capacity?

• Where is the organization in its continuum of
  development and growth?
• The ability of individuals and organizations or
  organizational units to perform functions
  effectively, efficiently, and sustainably.
• Capacity is the power of something (e.g., a
  system, an organization, a person, etc.) to
  perform or produce.

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• What affect does organizational capacity have on
  the ability to deliver quality HIV primary care
  services?

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(1 of 2)

• There are six organizational capacities that
  affect the delivery of HIV/AIDS-related services
• Overall organizational strength
• HIV/AIDS technical capacity
• Technical skills and expertise

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(2 of 2)

• Six organizational capacities that affect the
  delivery of HIV/AIDS-related services cont.
• Inclusive approaches that encourage and promote
  participation of people living with HIV/AIDS and
  other affected communities
• Institutional capacity to develop linkages and
  collaborative relationships with others
• Linkages, partnerships, and collaborative
  relationships with others and their contextual
  environment

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Seven Elements of Organizational Capacity A
Tool To Use
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What are the seven elements of organizational
capacity?

•  
• Venture Philanthropy, in their book Effective
  Capacity Building in Nonprofit Organizations,
  outlines seven elements of organizational
  capacity
• 1. Aspirations
• 2. Strategies
• 3. Organizational Skills
• 4. Human resources

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What are the seven elements of organizational
capacity cont.?

• 5. Systems and Infrastructure
• 6. Organizational Structure
• 7. Culture

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Organizational Capacity Exercise
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Organizational Capacity Exercise(1 of 2)

• Before we review definitions of each of the seven
  elements of organizational capacity, lets take a
  look at how much you already know about each of
  the seven elements
• Each table has a folder that includes a laminated
  table and cards with descriptions or topics that
  relate to each of the seven elements.

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Organizational Capacity Exercise(2 of 2)

• Working with colleagues at your table
• Review each of the cards and decide which of the
  seven elements it describes.
• You will have 10 minutes to complete the exercise
• Lets see who can finish firstand have the
  elements placed correctly!

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Capacity Framework
Culture
Culture
Human Resources
Systems and Infrastructure
Organizational Structure
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Capacity Framework Mirror of the Nonprofit System
Culture
Culture
Line Staff Providing Services
Line Staff Providing Services
Line Staff Providing Services
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Seven Elements of Organizational Capacity

• 1. Aspirations
• An organizations mission, vision, and
  overarching goals, which collectively articulate
  its common sense of purpose and direction.
• 2. Strategy
• The coherent set of actions and programs aimed at
  fulfilling the organizations overarching goals.

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Seven Elements of Organizational Capacity

• 3. Organizational Skills
• The sum of the organizations capabilities,
  including such things (among others) as
  performance measurement, planning, resource
  management, and external relationship building
• 4. Human resources
• The collective capabilities, experiences,
  potential and commitment of the organizations
  board, management team, staff, and volunteers

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Seven Elements of Organizational Capacity

• 5. Systems and Infrastructure
• The organizations planning, decision making,
  knowledge management, and administrative systems,
  as well as the physical and technological assets
  that support the organization.
• 6. Organizational Structure
• The combination of governance organizational
  design, inter-functional coordination,and
  individual job descriptions that shapes the
  organizations legal and management structure

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Seven Elements of Organizational Capacity

• 7. Culture
• The connective tissue that binds together the
  organization, including shared values and
  practices, behavior norms, and most important,
  the organizations orientation towards
  performance

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End of Module
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Conclusion
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What are some of the other topics discussed
during the first CLT training?

• Definitions of organizational development and
  fiscal management
• Content areas that encompass organizational
  development and fiscal management
• Common theories/theorists of organizational
  development

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What are some of the other topics that may be
presented during subsequent trainings (in each
3-part series)?

• Organizational Development
• Board Development
• Board Responsibilities
• Organizational Sustainability
• Board Policies/Board Recruitment
• Bylaws
• Strategic Planning
• Legal Responsibilities

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Potential topics continued

• Fiscal Management
• Nonprofit Accounting (Internal Controls, Policies
  and Procedures, etc.)
• Accounting Systems for Nonprofits
• Grants Management
• Audit
• Legal Responsibilities
• Fiduciary Responsibilities

• Fiscal Management, cont.
• Program Income
• Sliding Scale Fees
• Medicare
• Billing and Collection
• Budget Development and Management Board
  Development

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Organizational Capacity Assessment Survey

• The organizational capacity assessment survey is
  a tool designed to help organizations assess
  their organizational capacity
• It is based on the seven organizational elements
  presented during the Communities Learning
  Together training
• The survey is adapted from the McKinsey Capacity
  Assessment Grid as presented in the Venture
  Philanthropy Partners guide, Effective Capacity
  Building in Nonprofit Organizations
• The results of the survey can serve as an
  organizations capacity-building plan

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What if I am interested in hosting a CLT training?

• Communities Learning Together Learning
  Communities will be identified through an
  application process submitted by interested
  states, counties, cities and/or Eligible
  Metropolitan Areas (EMAs).
• Communities that identify a need for group
  training in the areas of fiscal management and
  organizational development and demonstrate
  committed interest from at least 15-20
  organizations receiving Ryan White CARE Act
  funding may submit an application.
• For 2007, the Pacific Northwest, Midwest, and
  Mountain Plain regions have been identified as
  target areas. Communities outside these areas
  should still contact the CAEAR Foundation.

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How can I apply?

• Download an application and submit the completed
  application by email or fax.
• The completed application can be emailed to
  Robert Warren at robert_at_caear.org.
• Completed applications can also be faxed to (202)
  232-6750.

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Contact Information

• CAEAR Foundation
• 2001 S Street, NW Ste. 510
• Washington, D.C. 20009
• Tel. [phone] Fax [phone]
• www.caear.org
• Antigone Hodgins
• Executive Director
• antigone_at_caear.org

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CLT Project Contacts

• Melanie Ogleton
• Director of Training
• melanie_at_caear.org
• Jabari Bruton
• Training Coordinator
• jabari_at_caear.org

• Javier G. Salazar
• Director of Research
• and Evaluation
• javier_at_caear.org

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• Lauresa T. Washington, MHSAPublic Health Analyst
  and CLT Project Officer
• Division of Training and Technical Assistance
• HIV/AIDS Bureau 301-443-0251
• LWashington2_at_hrsa.gov
• http//hab.hrsa.gov

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Questions?