The Relationship between State Health Departments and State Sexual Assault Coalitions in administering Federal RPE/Sexual Violence Prevention Funds
Introduction
During FFY06 and FFY07, states prepared to conduct sexual violence prevention activities under the new cooperative agreement with the National Center for Injury Prevention & Control (NCIPC) of the CDC. The guidance developed by the CDC clearly stated that state health departments were expected to have substantial involvement with their state sexual assault coalitions for the assessment and planning phases of the grant. This document was drafted to provide some basic information for state sexual assault coalitions about the role of the state health department in administering RPE funds, as well as provide some direction for state health departments on strategies for better collaboration with their coalitions.
By federal statute, Sexual Violence Prevention (aka “RPE”) funds must go to state and territorial health departments (DOH).[1] This grant is distributed by a population formula, so the size of the award depends upon the population of the state or territory. The smallest award is around $8,000 for one of the territories and the largest is just under $5 million – so there is quite a bit of variation in funding levels. All states are given an equal travel allotment to help cover expenses for two people to go to the required annual meeting – the RPE program director from the health department and the state sexual assault coalition representative.
Expectations of the CDC for the State Department of Health
In the RPE Grant Program Orientation and Guidance Manual, published in 2004 by the CDC/NCIPC/Division of Violence Prevention, the following items are listed as the responsibility of the DOH staff:
· Submit the annual grant applications and reports (only DOH are authorized to submit the applications/reports to CDC, even if they collaborate with other organizations in the development of them);
· Allocate grant funds to appropriate partners, based on the state’s strategic plan and priorities;
· Engage in programmatic activities with other statewide and community partners;
· Monitor contracts to ensure that funds are used appropriately and effectively in accordance with legislative guidelines and federal policies;
· Maintain ongoing communication with assigned project officer, including requests for technical assistance;
· Attend required grantee meetings; and
· Manage correspondence with the Procurement and Grants Office (PGO) regarding fiscal matters, as necessary.
While not statutorily required, the CDC strongly expects the state DOH to collaborate with the sexual assault coalition in the development of the application, development of the plan, and implementation of programmatic activities. This collaboration could be in the form of participation on a joint advisory committee, discussion and mutual decision-making about the major activities of the grant, or planning and conducting program evaluation. To assist coalitions in understanding the structure and role of the DOH in managing the RPE/SVP[2] program, a brief description follows.
The DOH commitment to sexual violence prevention. Health departments vary regarding their understanding of, and commitment to, violence against women as a health issue. This has become better in the past five years since CDC/NCIPC has elevated the issue in injury prevention programs and research, and HRSA[3] has provided training and funding to maternal and child health programs. In some states, the Title X (Family Planning) program may have a staff person who understands the impact of sexual violence on women’s reproductive health. Depending upon the location of the grant within a particular organizational unit, the DOH’s commitment to sexual violence as a public health issue, and the assigned RPE/SVP Director’s experience and job duties – all of these will shape the degree to which a state DOH places the program as a priority.
Public health is well suited to address sexual violence prevention because of their expertise in data gathering and analysis, program planning approaches, cross-discipline coordination of groups, and commitment to evaluation as a tool for best practices. Many states have addressed this issue for a number of years through their women’s health programs (maternal and child health, family planning, WIC[4] programs) or through connections across several programs within a department.
Location of the SVP/RPE Program within the DOH. The location of the program within the DOH where the RPE/SVP funds are administered varies considerably from state to state. Generally, the program focus of the organizational unit in which the program is located will influence the particular “philosophy” of the program staff who administers the RPE/SVP funds in a particular state or territory. It is likely to be grouped with other programs that address a similar content area such as women’s health, prevention, or other injury-related programs. Many RPE/SVP programs are located in an injury prevention unit. Of course, government bureaucracies are notorious for reorganization, so a program may not stay in the same area over time.
Staff time commitment. Many states do not assign a full-time staff member to do sexual violence prevention work, especially in smaller states where fewer dollars are allocated. For the new cooperative agreement that began November 1, 2006 the CDC has required the state DOH to support a minimum of a .25 FTE.[5] Typically, that person will be responsible to manage a number of related grants or programs and they will contract out most of the work. This is the case for several states that “pass-through” their funds to another agency or non-governmental agency that actually does the RPE programming for them. Typically, the larger states have more DOH staff who works with the RPE/SVP program and they are likely to directly contract with communities for local service provision. In these cases, the RPE/SVP program staff will be very involved with local agencies that provide the services. In states where the state DOH passes through or contracts out the majority of funds, they may have much less involvement with the local agencies and a minimal role in oversight. In those circumstances, the state coalition or other contractor may then subcontract the funds to local entities.
Service contracting. State DOH’s typically do not provide “direct” services. They often contract funds to a local entity or service provider to do the RPE/SVP programming. The DOH may use one of several “models” for contracting. They are:
· Competitive bidding - The DOH develops an RFA/RFP[6] and other governmental or nongovernmental entities then apply for funding that is awarded to those who meet certain eligibility criteria or score high enough against a set of criteria.
· Pass-through – The funds are “passed-through” to another entity (usually established by statute) who then subcontracts or administers them locally.
· Sole-source contract – The DOH is able to establish a contract (without going through a competitive bidding process) that is issued directly to a state sexual assault coalition or other governmental/non-governmental entity. It is usually based on the premise that the services required are very specialized and there are no other sources available to provide them.
· Some combination of the above.
Most states require a competitive bidding process before the DOH can enter into contracts. Administrative rules or state law will usually govern the contracting process used by a particular state. It will not be at the discretion of the program staff. Sole-source contracts, for example, are hard to obtain in government because of the appearance of favoritism. States who use this method to directly contract with their state sexual assault coalition must provide strong justification why their coalition is the ONLY entity able to offer RPE/SVP services.
A competitive bidding process may take 6-12 weeks to complete, depending on the levels of approval required in the DOH bureaucracy. In addition, approval is also required from the CDC and PGO. Once the RFP/RFA is drafted, approved and announced, the application process begins. At the close of that period another 4-6 weeks may pass before awards are announced and contracting can begin. With the new CDC Cooperative Agreement that began November 1, 2006 many states had to develop entirely new RFA/RFP’s for the new project period. Some were prohibited from even starting their competitive bidding application process until they received their notice of award (NOA). The CDC Procurement and Grants Office (PGO) awards RPE funds to states in two parts; half of the award is usually sent in late October and the other half in late April. If a state was not permitted to begin RFP/RFA development until a notice of award was received, it is possible that contracts for local services would not have been finalized until December or January for the new project period.
The Role of the State Sexual Assault Coalition
For the benefit of DOH staff who are not familiar with state domestic violence or sexual assault coalitions, it is important to note that many of them came into existence beginning in the early 1980’s, following the growth of the battered women/rape victim rights movements. The state coalitions were organized to bring a collective voice and structure to the political advocacy that was an early part of this social change movement. Their “members” are the community shelters and rape crisis programs that provide the direct services to victims of these crimes. Many state coalitions have varied funding sources, including other federal grants, state funds and/or private money. They may vary in staff size, depending upon the services they offer to members, the degree of “direct” services offered, and the stability of their funding streams.
Some states have a separate sexual assault coalition and domestic violence coalition; others are combined into one organization. Regardless of their structure, most all of them provide training and technical assistance to their member agencies, do state and national level policy advocacy, and set standards for community programs and/or individual victim advocates. The early work of these state coalitions and their members helped establish the RPE grant program and get the Violence Against Women Act passed. Their strengths are in their role as advocate for victims and the 30-40 years of experience that has informed their work. They are “experts” in understanding the nature of violence against women in all its forms and the social/cultural norms that engender it. To this end, they may need to take positions that seem counter to the work that a government agency does – they may challenge policy, procedure, and practice. However, it is a role that complements the role of the state health department in carrying out its mission to protect or improve the public’s health.
Moving Toward Collaboration
The new cooperative agreement clearly emphasizes that CDC wants both the coalition and the state health department to collaborate together in carrying out the RPE/SVP program activities. Collaboration is different than cooperation or coordination, and demands a more intensive degree of commitment. Cooperation may simply involve sharing information. Coordination usually involves mutual planning, shared labor, open communication, and some shared risk. Collaboration requires more commitment to a common vision and results, a comprehensive planning process, clearly-defined communication, shared resources, and shared risk. It is mutually beneficial to the organizations involved and the expectation is that their results are more likely to be achieved together than alone.
Within the scope of activities for the new RPE/SVP project period, some examples of ways the DOH and state coalition can collaborate include:
· Co-chairing the state sexual violence prevention advisory committee
· Holding regular planning meetings during the assessment and planning period to clarify the roles of each entity and the resources each can offer
· Planning and conducting training and technical assistance together for community partners (on subjects such as primary prevention, data sources, planning tools, evidence-based curricula, evaluation, etc.)
· Identifying resources within the state health department that may assist the coalition/community partners with their training/TA needs
· Inviting state coalition staff to participate on inter-agency collaboration groups working on other prevention programming
Some states do not have a working relationship between the two partners, which negatively impacts the success of the state’s RPE/SVP program. Collaboration between the health department and the coalition is essential. The effect of this collaboration is highly influenced by the relationships between the key players at each of the organizations. It is important for sexual assault coalition staff to have an understanding of government bureaucracy and the benefits of public health models and approaches. Likewise, DOH staff needs to understand the history of the anti-sexual violence movement and appreciate the dedicated advocacy that has created these federal programs. It is incumbent that where there has not been a good working relationship, the DOH takes the initiative to develop it. Since they are the primary recipient of RPE funds and are accountable to the CDC, they must take responsibility to invite their coalition counterparts to “come to the table”.
Working Together to End Sexual Violence
As with any process involving human beings personal values, organizational biases, and styles of relating will affect the quality of the collaboration in which people engage. With that in mind, a strong collaboration between a DOH and state sexual assault coalition creates a “best of both worlds” circumstance. State departments of health offer a unique approach to program planning and implementation that is data driven, population based, and oriented to effective practice. State coalitions bring a rich history of advocacy and deep understanding of the impact that sexual violence has on individuals, families, organizations and communities. The combination of the specialized knowledge and passion that coalition members bring to the field of sexual violence prevention enriches the more “scientific” approach that public health uses to address population health problems. Essentially, we need each other to share the common vision of preventing sexual violence to be truly effective reaching our goal. The work it takes to collaborate is well worth the time and effort we put into it.
1
May 2007
[1] Some exceptions are allowed where state statute requires certain funds to be administered by another governmental agency. Permission must be obtained from CDC.
[2] Rape Prevention Education/Sexual Violence Prevention. These terms are used interchangeable in this document because some states refer to their program as RPE and others as SVP.
[3] Health Resources Services Administration.
[4] Women, Infants, & Children’s
[5] Full time equivalent.
[6] Request for Proposal or Request for Application.