Don’t Psych Yourself Out! You Can Win That Award.

In 2018, Kristi Albertson, the grantwriter and coordinator for Lake Health District in Lake County, Oregon, was awarded a planning grant for $200,000 from the Health Resources and Services Administration (HRSA), a U.S. federal agency. The proposal focused on a growing opioid problem within the tri-county area, and the need for a collaborative and comprehensive approach to address this problem. Ms. Albertson submitted her winning proposal to GrantStation’s 2019 Winning Grant Proposal Competition, taking first place. This is an interview with Ms. Albertson; Francie Winters, the Prevention Coordinator in Lake County; and Jennifer Little, Director of Klamath County Public Health on their collaborative effort to address the opioid crisis in their region.

Cynthia: First, congratulations to Kristi on taking first place in the GrantStation Winning Grant Proposal Contest. It is no wonder the proposal was funded, it was so well written, the need was carefully documented, and the plan of action was clearly articulated. In addition, the collaborative effort and the sustainability of your proposed course of action were all commendable. I’d like to begin this interview by asking when and how this idea for the tri-county collaboration first come about?

Kristi: Thank you for making this opportunity available! We first began talking about a tri-county collaboration in June 2018.

Lake Health District operates primary care clinics in Lake County, Oregon, and Modoc County, California. Our providers have worked hard over the last few years to reduce the number of opioids they prescribe. At the same time, the Health District, in partnership with organizations in neighboring Klamath County, Oregon, began offering Chronic Pain Self-Management and other self-management education programs to give people additional tools to care for their chronic conditions. With representation in three counties in two states, we thought the HRSA planning grant was a great opportunity to expand the region’s capacity to address opioid abuse and substance use disorders.
 
Jennifer: Let me just add to what Kristi said by mentioning that Klamath and Lake counties really began collaborating when we were working on the Living Well with Chronic Conditions self-management program. That’s when relationships were first established, and considering our similarities, this was a natural partnership moving forward.

Cynthia: Could you share with us who all is involved in the consortium, and what their roles are?

Kristi: From Lake County, our active consortium members are Lake Health Clinic (primary care and specialty services), Warner Mountain Medical Clinic (primary care), Lake County Prevention, Lake District Wellness Center (mental health services), and Lake District Recovery Center (substance abuse services). The healthcare team members have created a countywide needs assessment, which will inform strategic and workforce plans in 2020.

The Lake County commissioners have been supportive and are invested in ensuring Lake County has as many substance abuse prevention, treatment, and recovery services as we need — no small feat in a frontier county with fewer than 8,000 people! We’ve had other partners along the way, including Lakeview Disaster Unit, the Lake County Sheriff’s Office, and Lake County Community Corrections. A volunteer with the Disaster Unit, who is also a family nurse practitioner, distributed the overdose-reversing drug naloxone to sheriff’s deputies and probation officers and trained them how to use it. The grant paid for the naloxone and the trainer’s time. The grant also covered her mileage from Lakeview to Klamath Falls, 90 miles away, to train the Klamath Falls Police Department in naloxone use.

Other active Klamath County partners include Klamath County Public Health, Klamath County Commissioners, Cascade Health Alliance (coordinates Medicaid services for Klamath County members), and Klamath Health Partnership (a provider team that includes dental services and primary care). A newly hired grant project coordinator is working with additional partners to create a county-level needs assessment that will inform strategic and workforce plans for Klamath County.

The consortium also includes a representative from Greater Oregon Behavioral Health, Inc., which provides behavioral health services in 12 eastern Oregon counties. Modoc County received its own HRSA grant focused on Northern California. When that happened, the consortium narrowed to include only Lake and Klamath counties.

Jennifer: Basically, we include justice (courts), law enforcement, medical, mental/behavioral health, treatment/recovery, and public health. Our roles are to bring diverse perspectives to the task force along the continuum of prevention through recovery.

Cynthia: Do you think the challenges you face are unique to your area, and does that require a unique approach to the problem?

Kristi: Yes and no. We are similar to other rural frontier areas in that we struggle with a lack of resources available locally, limited capacity, and small populations that make it difficult to sustain programs in the long run. In both Lake and Klamath counties, the economy was once largely natural resource-based. When logging regulations changed, mills closed and once-booming towns saw people leave in droves.

But we definitely have our own unique challenges, particularly in Lake County. Lakeview, the county seat, has fewer than 3,000 people. That makes it the largest town in the county, which has fewer than one person per square mile. The second largest community is an unincorporated area called Christmas Valley, located 100 miles north of Lakeview. Klamath Falls, the nearest town with stoplights and Starbucks, is more than 90 miles away. Cities with populations higher than 50,000 are three-hour drives in good weather. Our isolation makes it difficult to attract and retain qualified employees for a variety of jobs. It means we have to think creatively to solve universal problems such as food insecurity and lack of housing. It also means that for us, collaboration isn’t a buzzword. Working together is the only way to move forward.

Jennifer: I’d add that our challenges are unique to the rural environment when compared to urban areas. Although there is a crossover of challenges between Klamath and Lake counties, there are certain barriers each struggle with. For example, Lake doesn’t have any local residential treatment providers. Klamath does, but the system is very complicated and difficult to navigate.

Francie: I do believe our region faces unique challenges, though we share many of those with other rural communities in the greater regions of Eastern Oregon, Southern Oregon, and even parts of Central Oregon. We regularly face the challenge of educating the mindset and assumptions of colleagues and grant funders living and working in the populated valley and along the I-5 corridor. The basic needs here are not so different, but we have far fewer social service-type resources, yet we are rich in natural resources. So larger city issues of density and pollution, gang violence, etc. are not present here, but isolation of elders, and lack of parenting/family management skills, jobs, housing, access to healthcare, and affordable healthy food are.     

Cynthia: You appear to have taken a comprehensive approach to the problem, tackling all of the contributing factors. Was this a result of the triad planning? Or how did you develop this approach?

Kristi: I can’t imagine our team NOT taking a comprehensive approach, particularly for a planning grant like this. We started with the challenge — people dependent on or addicted to opioids and other drugs — and looked at everything we could think of that impacted that challenge. The original partners represented primary care, mental health, substance abuse, law enforcement, public health, chronic care management, and public transportation. That makeup alone forced us to look beyond the problem to the systemic and social factors that contributed to drug abuse.

Francie: Kristi gets credit for all of that, but I can say that as the Prevention Coordinator, covering all of Lake County for all populations, I get around and interact in the community a lot, and I share what I learn with Kristi. As a one-person department, it is great to have someone who is willing to listen and has a desire to understand and connect the dots on what we see and hear and then look for solutions and funding to support those needs.

Cynthia: Have you begun to implement any of the programs you’ve noted in your proposal?

Kristi: We knew going into the project that Lake County’s law enforcement officers needed naloxone. The Lake County Sheriff’s Office patrols an area nearly the size of New Jersey. They’re often first on the scene in emergencies. The county’s only emergency room is in Lakeview and the ambulance services are almost completely volunteer. If a deputy encounters someone who has overdosed in a remote corner of the county, an ambulance isn’t going to reach that person in time.

When we talked with partners in Klamath County, we learned the sheriff’s department had naloxone but its police departments didn’t. The grant allowed us to train Klamath Falls police officers and give them naloxone. We will do the same for two smaller police departments in 2020.

We completed a tri-county survey that has given us great insight into our community’s knowledge of and attitudes toward opioids and addiction. We’re using the knowledge gaps identified in those surveys’ analyses to create media messaging, develop educational materials, and plan interactive community presentations to reduce stigma and increase Lake and Klamath county residents’ knowledge.

Francie: Some of the programs were already in place. Living Well with Chronic Pain and Back to Health gentle yoga are the ones I am directly involved with. There is also a new chronic pain support group. Some things we can do without funding if we can get the partners on board. Others must wait for funding, so we can plan but not implement until we go for a program implementation grant or some other funding that is a good fit.

Cynthia: Kristi, can you give our readers any tips on how to write a complex proposal such as this one?

Kristi: I have several, but here are a few I think are most important. First, frontload. Know what your organization has capacity for right now and what you need to meet the need you want to address. Start working with partners before you look for funding so you’re prepared when an opportunity presents itself.

Organization is key. I read RFPs with highlighters in hand so I can note deadlines, formatting specifications, budget information, and project requirements. Then I work backward from the submission deadline to create a project timeline. I also create my proposal outline by pulling every question out of the RFP with all the details that need to be included. I add the scoring criteria to make sure I address everything the reviewers expect to see.

Write as you go. I add information to the proposal as I get it rather than waiting to have all, or even most, of the pieces in place before writing. It’s much less stressful to rewrite and rearrange a proposal along the way than it is to save the writing for last.

Give yourself breathing room. I try to submit a proposal at least two days before the deadline. This is partly because a single rodent can take out our Internet (this has actually happened), and partly to alleviate stress at the end. If partners miss deadlines and I’m late finishing a draft, I know I have a little bit of a cushion.

Cynthia: Any last words you’d like to share with our readers, many of whom are writing their very first federal proposal?

Kristi: Don’t psych yourself out. You might be going up against larger organizations with more experienced grant teams, but everyone is dealing with the same set of questions. If you tell a clear, compelling story with data and strategies to support your work, you have as good a chance as anyone. My attitude is always, why not Lake County? Even if our application isn’t funded, the experience of creating the proposal makes us better prepared for the next opportunity.

I want to thank Kristi, Francie, and Jennifer for participating in this interview.
You can read Lake Health District’s full grant request here.

Kristi Albertson is the grant writer and coordinator for Lake Health District in beautiful Lake County, Oregon, where cows outnumber people 10 to 1. She's a proud graduate of the University of Montana (go Griz!) who used her journalism degree to cover everything from avalanches to homelessness to Swedish reality TV for newspapers in northwest Montana and eastern Oregon before moving home to Lakeview. She loves mystery novels, hiking, crocheting, and writing.

Francie Winters’ decades of prevention work includes positions on both coasts, and ranges from informal prevention programs using outdoor skills, storytelling, graphic and performing arts, and youth advocacy to decades of facilitating research-based programs in schools and other organizations. She is a certified Prevention Specialist, published author/illustrator, and yoga teacher who found a home in prevention where she could apply her talents and experiences to encourage and nurture the gifts of new generations. The original author/director of the Methodologies Project in Southern Nevada, for which she was recognized by the state of Nevada as a “Woman of Distinction,” Ms. Winters is grateful for the generosity of all her colleagues along the way and excited to have returned to her home state of Oregon.

Jennifer Little is the director of the Klamath County Public Health Department in Klamath Falls, Oregon. She earned her bachelor’s degree in Human Development and Family Studies from Colorado State University and went on to earn her master’s degree in Public Health from Oregon State University. Jennifer is a health enthusiast and in her free time she loves to mountain bike and backcountry ski.