Granting Your Wish

Jan. 1, 1996
Although grant writing requires careful steering through red tape, funds from a variety of sources can allow you to pursue the dental hygiene project you feel your community needs. A hygienist shares his experience about writing a grant proposal.

Although grant writing requires careful steering through red tape, funds from a variety of sources can allow you to pursue the dental hygiene project you feel your community needs. A hygienist shares his experience about writing a grant proposal.

Dean Alcorn, RDH

Michigan, Wisconsin, and Washington State currently have provisions for unsupervised dental hygiene practice in certain public health and institutional settings. Unsupervised practice means that a dental hygienist can plan and initiate dental hygiene treatment without the specific permission of a dentist.

This can translate into new and exciting challenges for dental hygienists who are willing to create their own opportunities.

This is the account of one hygienist`s experience of writing a grant proposal. I wanted to establish a Dental Disease Prevention Program under Act No. 58 of the Michigan Public Acts of 1991 (PA 58). The act established a means of increasing access to dental care for underserved populations in the state. In doing so, it created a unique relationship between the dentist and the hygienist by waiving the need for a dentist`s initial examination (known as assignment in Michigan) of the patient before being seen by the hygienist.

The waiver now meant that, in certain public health settings, the hygienist could legally be the first provider to examine the patient, determine a dental hygiene treatment plan, and initiate the treatment plan without the physical presence of a dentist. By not having to keep a full-time dentist on staff, the delivery of dental hygiene services could be conducted with the most cost-effective utilization of personnel permitted by law. At the same time, it creates additional avenues of accessibility for people who might traditionally be shut-out from seeking dental care.

Why write a grant proposal

Many reasons may exist for writing such a proposal. But for me, the reason was threefold:

- A recognized need to increase access to dental care for the HIV-infected population in the area in which I was employed.

- To lend validity to PA 58 by demonstrating and documenting the efficacy of using a dental hygienist in the role of primary care provider. In addition, the proposal promoted the safe, efficient, and economical delivery of preventive dental hygiene services.

- For a little self-serving autonomy in a profession whose regulating counterpart affords hygienists with little or none, especially in the clinical setting.

Starting like a fish out of water

At first, the only consideration was to open up avenues to dental care for people with HIV. It would, in fact, be some time before I realized that writing a grant proposal might be the answer to the questions that my mind posed. I did, however, have some vague notion about PA 58 away tucked in the back of my mind. But even as I read and researched the law, its exact role in my quest would not present itself until some time later.

In deciding to write a grant proposal, I discovered a few things one should consider.

First, ask yourself what it is that you want to accomplish. What do you want to do? Knowing what you want to do and setting your mind to it is half of the battle. The "how" will naturally follow later.

Who gets grants?

Then, ask yourself why you want to do it. If your heart isn`t in the right place, then you might be setting yourself up for failure. The more you believe in what you are doing, the easier it will come. Or at least you will have the necessary motivation to sustain your drive through the pitfalls that will almost undoubtedly lie ahead.

Now that I knew what I wanted to do - increase access to dental care for those with HIV - how would I go about it? I knew that I would need money, and I also knew that I didn`t have any of my own.

I had heard about grants-in-aid. But how does one get a grant, and who is eligible to receive one? I didn`t know, so I set out for my local library for some answers. Here I found a litany of information. In short, what I found was that grants are dispersed by two major funding sources, public and private. And that grants, unlike loans, do not have to be paid back.

Relatively few grants, I also learned, are given to individuals, unless it`s for educational purposes. Most funding sources only make grants to nonprofit tax-exempt organizations to whom contributions are deductible, a designation made by the Internal Revenue Service [and often referred to as 501(c)(3) status]. This is not to say that individuals cannot receive grants. There are just fewer out there to be given, and the amounts awarded are usually smaller.

On the other hand, I did discover that an affiliation with an established organization eligible to receive such grants makes it possible to have your program sponsored through that organization. The organization accepts funds on your behalf. The organization makes a formal application for the grant and retains fiscal responsibility over the project. While this may result in some loss of control over your project, it is a good and viable option.

It was also at the library that I got my hands on the Michigan Compiled Laws, which contained Act No. 58 of the Public Acts of 1991. Having then read the act frontwards and backwards at least a dozen times, I now knew that I needed a sponsor for my project. Why? Because, among many other stipulations, the act stated that a dental disease prevention program carried out under PA 58 must be conducted by a local, state, or federal grantee health agency.

Seek and you shall find

At the same time I was considering the proposal, I was in need of another part-time job. Through researching the newspaper classifieds, I stumbled onto an ad for a part-time hygienist needed for an innovative school program in a city about 80 miles from where I lived. I interviewed and got the position.

As it turned out, this organization was a nonprofit corporation eligible to receive grant monies. But that`s not all. In addition to its own medical and dental programs which occupied the first two floors of its building, a local hospital shared the third floor with its medical/case management program for people with HIV.

Things were seemingly falling into place. However, because of the controversial target group I was proposing to assist, I would keep a low profile for some time to come. Besides, I had a lot of groundwork to cover, in order to sound credible before approaching my new employer as a potential sponsor.

Writing the actual proposal

Once again, I found a wealth of information at the library - some of it good and some of it overwhelming. And while the scope of this paper does not allow for a detailed discussion on proposal writing to obtain public or private funding, one author on the process stated, "Anyone with a good, well-planned idea, appropriate research on sources of support, and the ability to communicate effectively in writing can do a successful job of preparing a funding request."

This does not necessarily mean you`ll get funded. It simply means that you have the ability to present a good proposal. Competition for monies can be fierce, but many first-time grant seekers are funded each year.

The components of the proposal will vary not only for the type of funding source (public or private) but also for the specific funding source to which you are applying. Each source has its own guidelines to be followed. Some of the basic components of a proposal, however, might include: introduction, program statement, needs assessment, goals and objectives, methods, evaluation, future funding, and budgets.

The task proved a little daunting for this novice, and I enlisted the guidance of the associate dean for research and graduate education at the university from which I had graduated. He had extensive experience in writing grant proposals, and he agreed to do an independent studies course with me, for which I was even able to receive university credits. I got lucky! And while he did not write the proposal, his guidance, experience, and encouragement were what I needed.

Gathering statistical data

Research gathers statistical data. Research also helps understand why the problems exist, as well as what can be done to solve them. In essence, it helps refine your approach.

Consequently, a tremendous amount of my time was spent doing research. This turned out to be no easy task. I needed to support my assertion that those infected with HIV had inadequate access to preventive and remedial oral health care. I examined this on a national, state, and local level, but not much research had been done in this arena. It would take a long time to compile the necessary information to support what I already knew to be true.

I found periodicals offered the most up-to-date information. I also accessed governmental departments of public health, social services, and health and human services; hospitals and learning institutions with on-line systems; dental associations; organizations serving those living with HIV or AIDS; and virtually anyone else I could think of.

Eventually, I wrote and conducted a needs assessment survey at a local level, obtaining the input of the very people that I was proposing to assist. By assessing their needs, it is possible to document a compelling rationale for your proposal. Because of confidentiality issues, I required assistance of an organization in service to those with HIV. The organization acted as a go-between in order to ensure the complete anonymity of the respondents.

The survey also meant putting up my own money for printing and postage costs. But there are ways around this. For example, the survey could have been sent out with that organization`s monthly mailing, saving at least on the cost of postage.

In addition, it was also necessary to consult with a local hospital to determine whether there was a need, at this point, to have my proposed project reviewed by an institute review board (IRB). IRBs safeguard the rights and welfare of human subjects and evaluate proposed research for congruence with institutional commitments and applicable laws.

Networking to find allies

Networking proved an invaluable source for obtaining information that could be generalized for my project, for assisting me in areas where I had little or no knowledge, and for building support and involvement. Reading text helps with the gray areas, but nothing beats talking with someone who has been there and done it.

Early on, for example, I communicated with a dental hygienist participating in California`s Health Manpower Project #139. Why? Hygienists involved in this project work in nontraditional settings, provide oral health care to underserved populations, and are unsupervised by a dentist. Though the California project is far more complex than what I was proposing, it served as an excellent model for generalizing information to my own project.

Another such area was "evaluation design," which is one of the components usually required by funding sources when submitting a grant proposal. Although I had read all the information I could find on the subject, I needed guidance. Through contacts, I was referred to a hospital researcher who agreed to consult with me, free of charge.

This type of one-on-one interaction with "the experts" is indispensable.

I got into a habit of keeping the name, professional title, phone number, and brief biography of everyone I talked with, no matter how incidental the contact seemed. This would prove to be one of the smartest things that I did while working on the proposal. It obviously saved time in back-tracking a source. But when I would call back, these people often knew of additional sources that might be willing to assist me.

Approaching my as a sponsor

After a full year of part-time work for the nonprofit tax-exempt organization, I felt ready to approach them with the concept. The time was right, and I felt adequately prepared. I approached the administrative and dental directors, and they liked the idea. They asked me to put together a summary of the project, and it was presented to the oversight committee. Eventually, I had my sponsor. This also meant that I now had access to experienced fund developers and financial directors within the organization. And their experience proved invaluable in helping prepare a budget, and they also assisted in approaching a funding source.

The next step was to submit the application to the state for approval to operate under the public health dental disease prevention program, as defined in PA 58. This too proved to be a formidable task. The final application filled a one-inch ring-bound notebook. Almost to my surprise, confirmation was received a short time later that the program had been approved.

With these hurdles behind me, it was now time to focus on potential sources of funding. Unfortunately, having approval does not translate into having funding.

Approaching a funding source

In responding to a grant announcement made by a foundation, a letter of intent is sometimes asked for by the potential funding source. This is usually a brief description of your organization and a concise overview of the project you have proposed, including a budget.

Funding cycles vary from source to source, and letters of intent and proposals must be submitted within these guidelines. After reviewing letters, some organizations will invite full proposals. We submitted our letter of intent to what seemed like the most likely source, a state-level funding source of AIDS-related projects. In the end, however, we were not invited to submit the full proposal.

Although we were invited to resubmit the proposal for the next funding cycle (another year), it was a major disappointment. I had spent two years conceiving, researching, networking, and writing the proposal. I had given up evenings, weekends, days off, and sleep to work on it.

While my sponsoring organization was supportive of the project, they were growing by leaps and bounds and taking on new projects. The administrative director who had been so supportive of the project was now retiring, and the dental director was stepping down from his position.

Faced with trying to find an alternative funding source, waiting another year to resubmit to the one who had just rejected us, or, worse yet, finding a new sponsor, I put the project on an indefinite hiatus.

Rejection should not be taken personally. It means that you are doing the right thing ? you are out there asking. Ask enough times to enough people, you may eventually get what you want. Today I tell this story, hoping to influence others to finish where I left off.

As the cost of health care continues to skyrocket, greater emphasis has been placed not only on prevention but also access to less expensive treatment modalities. As changes continue to emerge in state dental practice acts, the unmet needs of people (such as those with HIV) may ultimately help pave the way to opening additional and cost-effective avenues to preventive dental hygiene services.

With that in mind, creative hygienists developing opportunities in alternative practice settings are in a unique position to demonstrate and document the safe, efficient, and economical delivery of preventive dental health care services.

Dean Alcorn, RDH, has been practicing for 10 years in the Grand Rapids, Mich., area