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Public Health Nursing (PHN) Grant Opportunity (IHS) - FAQs

1) What is the Public Health Nursing (PHN) grant opportunity?

The PHN grant opportunity is a competitive Indian Health Service (IHS) funding program intended to strengthen community-based public health nursing case management in American Indian and Alaska Native (AI/AN) communities. It supports demonstration-style projects that use a Public Health Nurse (PHN) as the central case manager for high-risk patients.

2) What is the main goal of this grant?

The main goal is to improve health outcomes for high-risk patients through structured, community-based nursing case management, while also building a replicable, sustainable service model that can continue after the grant period ends.

3) Which IHS office administers this grant?

The grant is offered through the IHS Division of Nursing, Office of Public Health Nursing.

4) What types of projects does the grant support?

The program supports demonstration-style projects that implement a standardized, PHN-led community-based case management model. The approach emphasizes coordinated care in the community and in the home, not only clinic-based visits.

5) Why is PHN case management central to the funded approach?

The opportunity is based on the idea that nursing case management has a strong track record as a cost-effective method to improve outcomes, especially when care is closely coordinated and follow-up is consistent over time.

6) What health disparities is this program trying to address?

The grant focuses on reducing significant health disparities experienced by AI/AN populations compared with the U.S. population overall, including higher infant mortality, higher suicide rates, higher rates of unintentional injury, and a rising chronic disease burden.

7) What is CFDA 93.933?

This funding opportunity is listed under CFDA 93.933, Demonstration Projects for Indian Health.

8) What laws authorize this grant program?

The opportunity is authorized under the Snyder Act (25 U.S.C. 13), the Public Health Service Act (as amended), and the Indian Health Care Improvement Act (IHCIA) (25 U.S.C. 1652).

9) Who is eligible to apply?

Eligible applicants include federally recognized Indian Tribes, non-profit Urban Indian Organizations as defined by the IHCIA, and non-profit Tribal organizations as defined by the IHCIA.

10) Is this a competitive grant?

Yes. The PHN grant opportunity is described as a competitive IHS funding program.

11) How much funding is available through this opportunity?

The estimated total program funding amount is $1,200,000.

12) What is the maximum award amount per grant?

The award ceiling is $150,000.

13) How many awards does IHS expect to make?

IHS expected to make eight awards.

14) Is cost-sharing or matching required?

No. The opportunity states there is no cost-sharing or matching requirement.

15) What is the Funding Opportunity Number?

The Funding Opportunity Number is HHS 2008 IHS PHN 0001.

16) When was this opportunity posted and when did it close?

It was posted on July 2, 2008, with an application closing date of August 4, 2008.

17) What does the archive date mean for this listing?

The listing shows an archive date of September 3, 2008.

18) What model does the program expect grantees to implement?

Grantees are expected to implement a standardized PHN community-based case management model built around core public health nursing functions, including assessment, planning, coordination of services, communication, monitoring, and evaluation.

19) Is the program focused only on individual patients?

No. While the PHN works directly with individuals and families, the program also requires a population-based perspective. The intent is to build a replicable service model that improves outcomes across a defined at-risk group in the community.

20) What are the phases of the project and what do they involve?

Projects are organized into a phased process that mirrors the nursing process:

• Phase 1 (Assessment): Conduct a comprehensive community assessment using a tool recommended by the Senior Nurse Consultant; incorporate local health status data and community input; identify priority health needs; begin sustainability planning.
• Phase 2 (Planning): Design the program based on assessment findings; arrange staff training as needed; define admission criteria, caseload size, care standards, policies and procedures, and an evaluation plan; develop education materials and obtain administrative approval.
• Phase 3 (Implementation): Start program operations; establish caseload; deliver services according to care standards; monitor progress and adjust as needed; track outcome data; continue sustainability planning.
• Phase 4 (Evaluation and patient experience): Collect patient satisfaction and stakeholder feedback; assess effectiveness and quality; revise materials and procedures; report progress; share materials and disseminate results.

21) What is required in Phase 1 (Assessment)?

Phase 1 requires a comprehensive community assessment using a tool recommended by the Senior Nurse Consultant. The assessment must incorporate available local health status data and other community assessment findings and must include input from key stakeholders such as community members, health care administrators, and community health groups. Priority health needs are identified, and sustainability planning begins.

22) Is there a specific community assessment tool required?

The opportunity indicates grantees should use a tool recommended by the Senior Nurse Consultant. IHS planned to provide training on this tool in Fall 2008.

23) What kinds of stakeholder input are expected during assessment?

The assessment must include input from key stakeholders, specifically including community members, health care administrators, and community health groups.

24) What should be included in Phase 2 (Planning)?

Planning includes moving from assessment findings to program design and operational details. This includes arranging additional training (examples provided include evidence-based practice and motivational interviewing, plus training tied to the selected priority health topics), defining admission criteria and caseload size, setting care standards for the targeted at-risk population, establishing formal policies and procedures, creating an evaluation plan, developing program guidelines, securing approval from health care administration, and producing patient and community education materials.

25) Does the opportunity specify examples of staff training?

Yes. Examples mentioned include evidence-based practice and motivational interviewing, along with any topic-specific training connected to the chosen health priorities.

26) What operational details does the program expect grantees to define?

The program expects grantees to define admission criteria, intended caseload size, care standards for the at-risk population, formal policies and procedures, and an evaluation plan.

27) What happens in Phase 3 (Implementation)?

In Phase 3, the case management program begins active operation. The grantee establishes a patient caseload based on the defined admission criteria and targeted risk group, delivers services according to care standards, monitors progress, makes adjustments as needed, and tracks patient outcome data over time. Sustainability planning continues throughout implementation.

28) What does Phase 4 emphasize?

Phase 4 emphasizes evaluation and patient experience, including patient satisfaction surveys and broader stakeholder feedback. Grantees assess effectiveness and quality, revise policies and education materials as needed, and report progress back to stakeholders.

29) Are grantees required to track outcomes?

Yes. The opportunity repeatedly emphasizes outcome tracking, including mechanisms tied to the recommended case management tool and tracking patient outcome data over time during implementation and evaluation.

30) Is sustainability required, or just encouraged?

Sustainability is a key expectation. The opportunity specifically states the program created with grant funds should be sustainable after the award period ends, rather than ending when funding runs out.

31) How should sustainability be addressed during the project?

Sustainability planning begins in Phase 1 and continues through implementation. The opportunity highlights sustaining the service through operational integration, local support, staffing plans, and ongoing resource alignment.

32) Are grantees required to share tools or materials developed under the grant?

Yes. Each funded site is required to share program materials with IHS Headquarters PHN. The intent is IHS-wide replication of successful tools and processes, while crediting the organization that developed them.

33) Are grantees expected to present or disseminate results?

Yes. Grantees are expected to disseminate results through a poster or oral presentation at the National Combined Councils meeting or the IHS annual national nursing meeting.

34) Will there be site visits from IHS as part of this program?

Yes. The Senior Nurse Consultant for PHN is expected to conduct one or two site visits per funded site to provide support and oversight.

35) What prevention levels are emphasized in this case management approach?

The opportunity notes prevention strategies across primary, secondary, and tertiary levels, alongside earlier detection and diagnosis, timely treatment, consistent follow-up, and ongoing evaluation.

36) What is meant by "demonstration-style" projects in this opportunity?

Based on the description, demonstration-style projects are intended to implement a structured PHN case management model in real community settings, evaluate and improve it, and share the resulting materials and processes so they can be replicated across IHS.

37) What is the role of the PHN in these projects?

The PHN is positioned as the central case manager for high-risk patients, coordinating services and applying core public health nursing functions such as assessment, planning, communication, monitoring, and evaluation within a community-based model.

38) What kind of patients are targeted?

The opportunity targets high-risk patients and requires grantees to define admission criteria and a targeted at-risk group based on the Phase 1 assessment and identified priorities.

39) Does the program require administrative approval as part of planning?

Yes. Phase 2 includes securing approval from health care administration as part of developing and launching the program guidelines and operational plan.

40) What kinds of educational materials are expected?

The opportunity calls for developing patient and community education materials to support engagement and self-management, and it also notes that these materials may be revised based on evaluation findings.