CAMHS Transformation Innovation Fund 2016

CAMHS Transformation Innovation FundApplication Form

Please note that the deadline for returning all applications is:5pm on Friday 28 October 2016

Please refer to the Innovation Fund Guidance Document which will help you complete your application and ensure you provide all the required information.

It sets out:

  • Who can apply (Section A)
  • The areas all applications must address (B1)
  • How much you can apply for (B2) and what we will fund (B4 and B5)
  • The importance of identifying need for your project (B3)
  • How your application will be assessed (D1)

1. Applicant Details
1.1 Name of organisation/group
1.2 What is the legal structure of the organisation?
1.3Please describe the purpose of your organisation/group and an overview of your main activities
1.5 Contact name (of the person filling in this form)
1.6 Position in organisation
1.7 Address
1.8 Phone/Mobile Number
1.9 Email address
2. Proposal Summary
2.1 Proposed Project Title:
2.2Project Costs
Please state the overall amount of funding requested andprovide brief details of the costs of the project, separately identifying any communications, marketing and consultancy/management fees (please refer to B4 and B5 of the Guidance Document)
Details / Costs
TOTAL cost of project:
3. Details of your project(word limit = 1,000 words)
Please describe your proposed project – your response should include as a minimum:
  • Why you are proposing this service/activity (please refer to relevant data and research)
  • Details of whatyouwill offer, including what is innovative about the proposal
  • How you will deliver the service/activity
  • How you will work with other partners to deliver an integrated project
  • How children, young people and other stakeholders will be involved in its development

4. Aims and outcomes of your project(word limit = 500 words)
Please describe how your proposal will address the priorities and themes for the Innovation Fund. You should include as a minimum:
  • Which of the areas outlined in the Guidance Document your project will address
  • The key outcomes your project will achieve (see Section B of the Guidance Document)
  • What method(s) you will use to demonstrate these outcomes have been achieved?
  • How your group/organisation will apply the learning from this project

5. Promoting your project(word limit = 500 words)
Please describe how you will promote and publicise your project, including:
  • How you will ensure you reach the people you are targeting
  • How you will support children and young people who may struggle to access the service/activity
  • The key stakeholders and/or partners you will be working with

6. Project Plan(word limit = 500 words)
Please provide a project plan that includes as a minimum:
  • When you will spend the funding awarded
  • Key milestones and when the project will be delivered, including evaluation
  • Your plans for making the service/activity sustainable once funding ends
(e.g. how you will generate income through contracts, charging, etc once the project ends)
7.Which themes will your project support?
From the list below, please indicate the theme(s) of your project from which children / young people will benefit.
Pleaseinclude the approximate number of children and young peopleyou aim to reach:
Themes / Tick  / Approx No.
  • Developing resilience

  • Working with hard to reach / vulnerable groups

  • Perinatal mental health

  • Providing support for parents

  • Transition

  • Supporting loss / working with bereaved families

  • Working with autism / ADHD / ADD

  • Whole school emotional wellbeing

  • Early intervention and prevention

  • Self-esteem / body image

  • Other - please state:

Total number of individuals who will benefit from this project:
Please also indicate if your project will benefit other organisations:
8. Evaluating your project (word limit = 300 words)
Please describe how you will evaluate the success of your project, including as a minimum:
  • How you will monitor delivery of the service/activity
  • How you will measure outcomes to demonstrate they have been achieved
  • How you will use the learning from this project to benefit your organisation/service users

9. Where your project will be delivered
Please specify the areas of Hertfordshire you will deliver your project in – e.g. countywide, specific districts, GP locality areas, towns or wards

Before submitting this application, please ensure that:

  • Your organisation is eligible for a grant (see Guidance document – section A)
  • Your project meets the funding criteria (see Guidance document)
  • You can demonstrate there is a need/demand for your project
  • You have clearly identified who will benefit from your project
  • Your project is well-planned and properly resourced
  • You can measure the results of the project to demonstrate its success
  • You have attached the documents requested in the Guidance (Section C)

12. Declaration and data protection:
Data Protection Statement (Data Protection Act 1998): Hertfordshire County Council and the Clinical Commissioning Boards will use the information you give in this form, and in your application form to process your claim for project funds support. The Council and CCGs may share the information supplied to other Council departments and partners. Project funding applications paperwork is kept in accordance with the Council and CCGs’ retention policies. The Council is the data controller for the purposes of the Data Protection Act 1998.
By signing this declaration, I accept/confirm:
1. The terms and conditions of the project funds as set out in the Guidance Document
2. My organisation/group meets the conditions set out in section A of the Guidance Document
3. The information is true to the best of my knowledge
4. That I have authority on behalf of the organisation/group to make this application
5. That I have read and understood the Data Protection Statement
Signed:
Name:
Date:

Please return this application form and all documents to:

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CAMHS Transformation Innovation Fund application form Sept 2016