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New Jersey Health Initiatives (NJHI) is a statewide grantmaking program of the Robert Wood Johnson Foundation (RWJF) charged with improving health care for New Jersey residents through creative, community-based health services. As of July 2009, NJHI has a portfolio of 41 active projects totaling $11,025,892.
Initially authorized in January 1987 by the RWJF Board of Trustees as the New Jersey Health Services Development Program, NJHI began with the principal objective of encouraging the development of innovative projects in ambulatory and community health care in New Jersey, RWJF's home state. The program was renamed New Jersey Health Initiatives in 1992. It has funded a variety of New Jersey community-based projects since its inception, yielding a diverse grant portfolio.
Overall Results to Date
In addition to supporting new service delivery projects or networks in a specific community, NJHI also works to see that successful concepts are replicated in other localities. Where warranted by the evidence of effectiveness, NJHI encourages implementation of health care delivery system improvements on a statewide basis With NJHI's distinct geographic focus, another core program strategy is strengthening networks of service providers.
This report highlights several current NJHI projects, and information on these active grants is available on the Web site. In addition, in-depth descriptions of a number of NJHI projects completed since 1997 are linked at the end of this report through the Project List. New projects are added periodically. They are listed in alphabetical order.
Under its first six authorizations (1987 to 2008), NJHI supported 190 projects:
Sustaining Results
To assess whether these projects funded by NJHI have been sustained after their RWJF funding, NJHI conducts a periodic online "look back" survey (2006, 2008 and 2009). Of the 116 grants that had closed out between 1990 and 2007 and had been funded for more than $100,000, staff from 69 projects responded to the survey, conducted about 12 to 18 months after the end of NJHI funding.
The 2009 "look back" survey update included responses from nine of the 11 projects that closed in 2007. It also compared these projects to those that closed in 2006, 2005 and 2004. Results included:
Most reported several of these types of sustainability; these are not mutually exclusive types and are likely to reinforce each other. Respondents saw the major barriers to sustainability as financial—especially obtaining additional resources. Few respondents reported that internal organizational or project factors were barriers to sustainability.
Program Design
The annual responsive grantmaking program (for projects that respond to critical issues in New Jersey) is the prominent feature of the NJHI program. Over time, responsive grantmaking has evolved from supporting a broader range of projects in New Jersey that reflected RWJF's work nationally to supporting projects that were especially relevant to New Jersey and addressed specific health issues in the state. Beginning in 2008, responsive grants have focused on themes:
The program also includes several additional elements:
Through these elements, RWJF continues to increase NJHI's influence by making meaningful grants across the breadth of the Foundation's strategic objectives and by building a cadre of skilled and informed health care leaders within the state.
Program Management
NJHI is managed by a national program office based at the Institute for Health, Health Care Policy and Aging Research of Rutgers University, located on the Rutgers campus in Camden, N.J. Calvin Bland, former chief of staff and special advisor to the president at RWJF, is the program's director, and Gretchen Hartling is the co-director. An advisory committee provides expert advice and consultation.
Funding
The RWJF Board of Trustees has authorized the program since 1987 up to a total of $72.3 million. In July 2008, the program was reauthorized at $16.8 million for 36 months—until August 2011.
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Along with the rest of the nation, New Jersey faces an array of health care problems and growing demands for services. The need for creative, community-based projects to address pressing health care needs throughout New Jersey continues to grow. Health services in New Jersey are provided in a multi-tiered system of community health centers, hospitals, health plans, school- and work-based clinics and private practitioners' offices, and these services are not usually coordinated.
Meeting challenges posed by the health care needs of the state's residents requires innovation in health services programs, delivery systems, provider arrangements and financing mechanisms. These challenges require new partnerships.
Since its establishment in 1987, NJHI has focused on health and health care needs of New Jerseyans—and opportunities to serve them. As New Jersey is the home state of the Robert Wood Johnson Foundation, NJHI grants provide important resources for New Jerseyans in three particular ways:
NJHI primarily funds projects to implement new health services and system changes. Supported projects must demonstrate strategies that aim to transform and improve health or health care of New Jersey residents and must relate to one of the Foundation's grantmaking portfolios. Since 2008, the program has focused most of its grantmaking on themes that are especially relevant to New Jersey and address a specific health issue, such as adolescent dating abuse prevention (2008) and health literacy among immigrants (2009).
Although RWJF's New Jersey Program Management Team manages the work of the program, the projects funded by the program are also closely linked to the work of RWJF's Vulnerable Populations Portfolio, as NJHI grants often focus on the most vulnerable New Jerseyans. NJHI encourages projects that are community focused, such as forming a collaboration of community-based partners to strengthen the effectiveness of a project. Grant Results reports on an array of NJHI projects are attached to this report through a Project List.
NJHI grantees in 2009 serve diverse needs and age groups. Some grantees are developing regional projects while others target a specific community need, confined to a small service area.
An important objective of NJHI is to transform the delivery of services on a broader scale. Therefore NJHI supports projects that present learning opportunities for other health care providers in a region or throughout the state.
To this end, grantees actively participate in efforts to communicate the results of their projects to stakeholders and other providers across New Jersey. Since NJHI is committed to building and enhancing a sustainable network of health care providers, grantees come together periodically over the course of their grant period to receive technical assistance on a wide variety of topics. In addition, NJHI helps projects focus on various implementation tactics that will enhance their efforts to sustain the project activities once grant funding ends.
The program is comprised of several components, which generally operate over two- or three-year cycles:
Assistance to Program Applicants
An important role of the program office has been to promote the program to potential applicants. The program's grantmaking process uses a Web-intense process to promote the program's annual call for proposals (CFP). Partnerships with both community-level and statewide agencies have allowed the program to make available its CFP to a vast audience through links on their Web sites.
NJHI's proposal submission process is fully online, using the Foundation's Grantmaking Online system. Since the program does not accept paper copies of proposals, NJHI staff works with all applicants to help them through the Grantmaking Online process. This guidance is necessary since some applicants are smaller, community-based organizations with limited technological expertise, and online proposals are a new experience for even some larger organizations. Annually, more than 300 organizations make CFP-related inquiries to NHJI staff.
The NJHI Web site is a comprehensive communications tool for NJHI grantees as well as potential grantees. The site provides information to the public on current funding initiatives and active grant projects. Current grantees are able to access pertinent information from the program office on a password protected section of the Web site.
NJHI has traditionally sought a broad range of projects, targeted to the goals and strategic objectives of RWJF. The Foundation first issues a call for proposals which typically results in submission of more than 200 brief proposals. Staff review narrows the pool of brief proposals to approximately 30 for which they invite organizations to submit full proposals. The advisory committee, RWJF staff and NJHI staff review the full proposals, and then further review 12 to 15 of the organizations and their work on a site visit. A maximum of 11 projects are selected for funding. The process takes 10 months from the release of the CFP to the start of the grant period.
The flexibility of NJHI responsive grantmaking has created a portfolio of grantees focused on a wide variety of issues related to the evolving strategic objectives of RWJF. Program intersections with RWJF portfolio strategies include:
Starting in 2008 the responsive grantmaking changed to emphasize a particular theme instead of a broad area. Calvin Bland noted that NJHI selects topics of particular relevance to New Jersey. "We contracted with the Rutgers Center for State Health Policy to do an environmental scan of health related issues.".
Projects funded in 2008 focus on preventing dating violence among adolescents using the "Safe Dates" curriculum, an evidence-based intervention. For example, Catholic Charities of the Archdiocese of Newark is conducting a three-year implementation of the Safe Dates curriculum for ninth grade students in five high schools in Hudson and Union counties, reaching 500 students and their parents each year (ID# 064606).
In another project, the Safe Dates curriculum was incorporated in the 8th and 9th grade health curriculum in six school districts in Millville, N.J. and related activities in out-of-school programs in two community centers (ID# 064610).
In 2009, the responsive grantmaking focused on projects that improve the health literacy of immigrants in New Jersey, Under one project active in 2009 (ID# 066442), Ironbound Community Corporation is helping Latino immigrants in the Ironbound section of Newark, N.J., increase their health literacy knowledge in four areas: oral, print, cultural and conceptual knowledge and numeracy. It is providing health fairs, one-on-one literacy coaching sessions, literacy workshops and 12-week health literacy seminars and is partnering with the University of Medicine and Dentistry of New Jersey's School of Nursing.
Another health literacy project, Zufall Health Center, is developing a health literacy curriculum for Latino people to be incorporated into established computer literacy and English-as-a-Second-Language (ESL) classes in Dover and Morristown, N.J. (ID# 066426).
NJHI also includes a periodic pro-active grantmaking component. The first round of strategic grants, NJHI Workforce Agenda, awarded in 2003, focused on the need for more registered nurses in hospitals and more paraprofesionals in long-term care institutions and home-health care settings—a concern RWJF was addressing nationally through a number of programs.
The second round of strategic grants in 2007 replicated a RWJF national program model—Expecting Success: Excellence in Cardiac Care—in New Jersey. Future rounds of strategic grantmaking will also focus on replicating effective national program models in New Jersey.
NJHI Workforce Agenda
NJHI supported nine projects under the NJHI Workforce Agenda (2003). Seven projects supported through NJHI Workforce Agenda addressed shortages of registered nurses in the hospital setting, and two focused on paraprofessionals in long-term-care institutions and home health care settings. NJHI worked closely with RWJF's nursing team (a part of the Building Human Capital Team) in shaping the call for proposals, selecting the grantees and integrating the work with the work of the team. RWJF commissioned an evaluation by Rutgers of the NJHI Workforce Agenda (ID#s 048887 and 051708, totaling $398,611). Its findings are available on the NJHI Web site.
NJHI Expecting Success: Excellence in Cardiac Care
NJHI Expecting Success: Excellence in Cardiac Care was launched in 2007. Ten hospitals participated in this 24-month learning network focused on improving the overall quality of care provided at hospitals that serve a significant number of African-American and Latino patients diagnosed with congestive heart failure. By modeling this program after Expecting Success, which ended in 2009, the Foundation brought proven successful practices to its home state to improve care for New Jerseyans.
The 10 hospitals participating in this learning network were:
The NJHI national program office expects to select the next strategic grantmaking focus for New Jersey in 2010.
NJHI periodically awards small grants to organizations in the state to help improve infrastructure and capacity, with the intention of affecting overall health service provision. The program awards these grants when staff members identify an organization that needs this type of assistance. Examples of the focus of projects funded with small grants in 2007, the most recent year in which small grants were awarded, are:
The NJHI program office provides its grantees with program development and technical support to enhance management of their projects as well as their overall organizations. Utilizing the expertise of the Support Center for Nonprofit Management and an evaluation consultant, NJHI offers its grantees workshops throughout each year as well as technical assistance by program office staff through site visits and other direct contact.
The technical assistance workshops focus on management issues often faced by non-profit organizations. Some smaller community-based agencies funded under NJHI have organizational issues that impinge on their ability to effectively work on their projects—such as cash flow problems or organizational development issues as the result of rapid growth—which provide a challenge for the program office. Rapidly growing organizations must adjust to this growth, which has sometimes been stimulated by RWJF grants. Other organizations experience difficulty working in a changing health care environment and need help with strategic planning.
The program office staff has worked with grantees to help them resolve inherent difficulties in implementing a new project in terms of project management. They have assisted each grantee organization with gaining access to other resources. They also have intervened programmatically, where appropriate, to assist a project to completion. Other issues that technical assistance addresses are evaluation planning, data collection and data presentation, communication strategies, and sustaining their projects.
The program office encourages projects to use systematically collected data to help manage projects via a multi-component evaluation framework to foster both internal improvement and reporting of results. An annual workshop introduces each group of new grantees to this evaluation framework, starting with guidance in developing their project's logic model.
Staff from each project frames expected accomplishments in a milestone scale, which forms the basis for annual reports. Each project must specify up to five key outcomes and identify data collection tools for each.
Program staff collects quarterly information about on-going project management from projects via an on-line survey measuring key factors of project implementation. Site visits and telephone contacts by program office staff complement and confirm the self-reported evaluative information from the projects. This helps project and program office staff and RWJF staff track progress in achieving objectives and to identify lessons learned and opportunities for replication.
The program office staff also provides technical assistance on communications issues. The program office has helped project staff members work with the media, prepare promotional materials, define a clearly articulated mission statement for their organization and develop objectives for the project being supported through NJHI.
In addition, the program office is committed to a high level of communications activities to build and sustain appropriate external relationships. As grantee projects report their results, the program office shares success stories with the overall health care community and appropriate policy-makers within New Jersey. In addition, NJHI staff supports project directors in their efforts to communicate their work and its implications for policy-making. In the past the NJHI program office had worked with RWJF's CONNECT project, an initiative to help staff of projects funded by the Foundation establish relationships with their representatives in Congress and state legislatures. For example:
RWJF has not commissioned a formal evaluation of NJHI overall. NJHI, however, conducts a periodic online "Look Back" survey to assess whether the funded projects have been sustained after their RWJF funding ended.
NHJI has done three Look Back surveys:
Of the 116 projects that closed between 1990 and 2007 and had been funded for more than $100,000, staff from 69 projects responded to one of the Look Back surveys.; the 2008 and 2009 surveys were conducted 12 to 18 months after the end of NJHI funding. Mary Ann Scheirer, a program evaluation consultant with Scheirer Consulting in Princeton, N.J., conducted all three surveys.
The 2009 Look Back Survey
This 2009 update included responses from nine of 11 projects that closed in 2007. The evaluator also compared these projects to those that closed in 2004, 2005 and 2006. She reported the following findings:
As in previous surveys, securing funding was the most frequent barrier to sustainability. Nearly half of the 2007 close-outs also said staff turnover was a barrier, higher than in prior surveys.
See the Appendix for the findings from the 2008 and 2006 Look Back surveys.
NJHI will be considered for re-authorization in July 2011. As NJHI evolves through its current programming, new elements that emerge will be included in planning for future grantmaking.
New Jersey Health Initiatives Program
Rutgers, the State University, Institute for Health, Health Care Policy and Aging Research (New Brunswick - office located in Camden, NJ)
Contact
Program Director: Calvin Bland
(856) 225-6726
cbland@njhi.org
Program Co-Director: Gretchen Hartling
(856) 225-6727
ghartling@njhi.org
Health Research and Educational Trust (Princeton, NJ)
Cathedral Healthcare System (Newark, NJ)
Contact
Former Program Director: Jeffrey A. Warren (January 1987 to December 1993)
Former Program Director: Linda J. Rosen, Ph.D. (January 1994 to December 1994)
Former Program Director: Pauline M. Seitz, M.P.A. (January 1995 to December 2001)
Rutgers, the State University of New Jersey, the Institute for Health, Health Care Policy, and Aging Research (New Brunswick, NJ)
Contact
Evaluator: Margaret Koller
(732) 932-4655
mkoller@ifh.rutgers.edu
List of projects in this National Program
*RWJF has not commissioned an evaluation of the NJHI Program overall. RWJF did commission an evaluation by Rutgers of the NJHI Workforce Agenda.
Originally authorized by the Board of Trustees in January 1987. Total authorization: $72.3 million.
(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)
Findings from the Look Back Surveys of 2006, 2008 and 2009
The 2006 Look Back Survey
This survey included responses from 48 projects (of 90 projects) that closed between 1990 and 2005. About 80 percent of respondents reported they achieved at least one of four major types of sustainability:
Most respondents reported several of these types of sustainability; these are not mutually exclusive types and are likely to reinforce each other. Respondents saw the major barriers to sustainability as financial—especially obtaining additional resources. Few respondents reported that internal organizational or project factors were barriers to sustainability.
2008 Look Back Survey
2009 Look Back Survey
This update included responses from nine of 11 projects that closed in 2007. The evaluator also compared these projects to 23 projects that closed in 2004, 2005 and 2006. She reported the following results:
In summary, the projects closed-out in 2007 reported in early 2009 that they sustained most major types of activities from the grant period, but with some modifications, lower numbers of clients, fewer staff members and a lower budget. Even in an economy with severely strained financial resources, the projects were able to sustain some components, albeit often not at the same scope or service levels as had previous groups of NJHI closed projects.
Over the three waves of the survey, the patterns of results are similar. A majority of respondents indicated that at least something from their NJHI projects was sustained, but there is no one path to sustainability. The diverse projects cited a number of modifications and varied ways of obtaining the resources needed to sustain.
Report prepared by: Robert Mahon
Report prepared by: Molly McKaughan
Report prepared by: Lori De Milto
Reviewed by: Patricia Patrizi
Reviewed by: Molly McKaughan
Program Officer: Marco Navarro
Reports on a selection of projects managed under this National Program are listed below. Click on a project's title to see the complete report, which typically includes a summary, description of the project's objectives, its results, post grant activities and a list of key products.
New Reports on completed projects are added every few years. For descriptions of active projects in this program, go to www.njhi.org.
Access to Basic Health Care
Chronic Health Conditions
Preventing Harms Caused by Substance Abuse