At the opening of the 2011 American Public Health Association (APHA) Conference in Washington, D.C., last week, a collection of very provocative opening presentations challenged all 12,000-plus attendees to work harder for the health of those most in need. To view a few of the presentations, including one from former Senate Majority Leader Tom Daschle, visit APHA's YouTube Page .

During that same opening session, attendees were encouraged to visit the new Martin Luther King, Jr. Memorial. I did that and found the monument very thought-provoking. Below is a quote and picture from the memorial. If you've been there, what did you think?

The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. - Martin Luther King

The APHA Conference featured more than 1,000 scientific presentations, including one based on our work with the Foundation for a Healthy Kentucky on the Kentucky Health Issues Poll (KHIP). Take a quick look at our slides:

This presentation reviewed how the addition of surveys with the cell phone-only population can affect the results of traditional landline surveys, and considered the costs and benefits of adding this hard-to-reach, but growing, population of telephone users.

KHIP is a random-digit-dialing telephone health opinion survey of more than 1,500 adults that has been conducted annually since 2008. Landline-only samples fell short of U.S. Census estimates of young and non-white people living in Kentucky. Therefore, a sample of more than 200 cell phone-only households was included in the 2009 and 2010 KHIP. In both years, the unweighted cell phone-only sample was significantly more likely than the unweighted landline sample to be non-white and to be younger than 35 years old.

Combining landline-only and cell phone-only surveys resulted in improved sample coverage, but did this improved coverage affect results? The answer is yes. The cell-phone sample included considerably more uninsured Kentuckians than would have otherwise been possible with a landline-only sample.

Last week I was in Erie, Pennsylvania, presenting at a community forum. One of the speakers reminisced about his youth and how his family doctor practiced in a house in the neighborhood. That doctor was an integral part of the community and the speaker's childhood. In most places, that type of access to a family physician no longer exists. However, 2,000 communities across the nation have access to another provider that also plays an integral part in a community and in the lives of children and families: the school-based health center (SBHC). SBHCs are as local- and community-driven as healthcare can get these days. The school community--school staff, parents, students, supporters, and neighborhood representatives--helps define the SBHC and the services it will provide. One of the identified concerns about healthcare reform is the limited access to primary care services. At this point, it is estimated that once everyone has health insurance and begins seeking regular, on-going primary care services, these services will be hard to get because there won't be enough providers. This is where the SBHCs can play a role. SBHCs are mostly located in communities that have high numbers of uninsured adults, in addition to high numbers of children with Medicaid or no insurance. Structuring the SBHCs to be open to the community--and not just school children--will allow more access points in communities where they will be needed the most. One of the hidden gems in the healthcare reform bill is support for expanding SBHCs. The bill makes $200 million beginning this year available to provide capital improvements, equipment, and other supports for SBHCs. Those funds could be used to remodel existing facilities to make them available to the community while keeping the kids safe and sound in the school building. Doesn't that seem like a great way to bring the local doc back into the community and create an important relationship and childhood memory for today's children?

I wanted to call this blog from ice picks to applesauce, but I didn't think as many people would read it.

As many of you know, I recently had a second child. This means double the preparation every morning for daycare. My husband and I use a large backpack to carry all the things my kids need for the day. Last week, as I was packing this backpack, I realized that it had been completely repurposed. I purchased the very expensive backpack 5 or 6 years ago, before my husband and I had children. At that time, we were living in Italy and doing some serious alpine hiking. Last week, I put my son's applesauce in the compartment designed for my ice pick. Oh how life changes!! This backpack is a very expensive way to carry stuff to and from daycare every day, but it's what we already have so I will continue to use it.

This same thing happens often when nonprofits purchase technology: they use what they have. Sometimes this means trying to do things in Excel or Access that specialty software could do much better. Or, it means spending a lot of money on specialty software when a simple Access database could do the trick.

It is difficult to know what or how much your organization needs now and for the future. This is particularly true with donor management. I sometimes get asked about good donor management systems. There are so many options out there and each organization has different needs so this question is always difficult for me to answer. Luckily, a friend just sent me the Nonprofit Technology Network's (NTEN) excellent (and free!) report that thoroughly compares donor management systems for differently situated organizations. If you're in the market or wondering if what you have is a good fit, check out: A Consumer's Guide to Low Cost Donor Management Systems. I hope that this report will help you make a more informed choice.

Apparently, a public insurance option is very scary to our political representatives, but you know what? Public opinion polls in Ohio and across the nation continue to show strong public support for an affordable public health insurance plan.

The Health Foundation just finished a special Ohio Health Issues Poll focused exclusively on healthcare reform. I think the opinions of Ohioans would surprise anyone watching the news or reading newspapers lately: 69% of Ohio adults said that the option of an affordable public health insurance plan that any American can opt into would improve our current healthcare system. Not surprisingly, 88% of Ohio Democrats support the public option, but 40% of Ohio Republicans also think that the public option would improve the current healthcare system.

Similarly reputable national polls show that the majority of Americans also support the public option, support in September ranged from 73% support from the NBC/Wall Street Journal poll http://online.wsj.com/public/resources/documents/WSJ-NBC_Poll090922.pdf to 57% from the Kaiser Health Tracking Poll http://www.kff.org/kaiserpolls/upload/7988.pdf. With this level of support, it is unclear to me why the public option hit the cutting room floor so quickly in the Senate. The public option has been presented as something very polarizing, but the Health Foundation and other public opinion polls seem to suggest otherwise.

You might also be surprised what Ohioans think about other healthcare reform issues. You can learn more at http://www.healthfoundation.org/ohip.html or take a look at the Health Foundation's healthcare reform site at http://www.healthfoundation.org/reform. This is a nonpartisan source for information on the current debate in Washington and how it could affect our region.

So if you're going for scary this Halloween in Ohio, you'll have to cross the public option off your list. Ohioans support it, as do many people across the country.

I am often asked the question, "What do you want to see in this site visit?" My answer is, "It's not 'what,' it's 'who'." The reality is that a site visit is really a people visit, because people make the project.

A good site visit, whether it is related to getting a grant or reporting on an existing grant, has some specific components:

• More than one person represents the project, whether it is collaborative or internal to an organization.
  
• All (or most) collaborators are represented and prepared to speak about the project.
  
• All collaborators have a copy of the proposal or report and have had time to read it.
  
• A program participant is present and willing to talk about what this will mean or what it has meant to them, if possible.
  
• It is located in one of the sites used in the project.

• a description of the proposed project or work done in the reporting period by the people involved,
  
• questions from those making the site visit (Health Foundation staff or board members),
  
• suggestions for improving the proposal or the existing project, and
  
• timelines for any follow-up from the Health Foundation or the grantee.

Site visits are not meant to be scary...they give grantees the chance to show us who you are and vice versa. It is important that we all feel free to share our thoughts, our dreams, our challenges in doing this work with each other. So look forward to your next site visit!!!

In my next blog – what is the difference between a proposal site visit and an annual or final site visit?

Last week the snow and ice in our area resulted in many cancellations and delays. Large organizations, schools, universities and every hospital system I worked in have plans and protocols for notifying staff, students and clients of closures and delays. It definitely makes it easier and reduces the questions if a protocol is in place and it is known in advance.

For the first time, we had to cancel and reschedule one of our Capacity Building workshops, Purposeful Boards, Powerful Fundraising. In the process we realized that it would be useful to have more detailed plans and instructions in place. Now on the Go Sign Me Up confirmations there will be a number to check if you have questions about any workshop we are offering and you have registered for here. We will also put notification on local TV stations, email and call numbers participants have supplied us. My hope is now that we have our own workshop disaster plan in place; we will not need it very often! If your plan is not in place or there were kinks in it- for example, people without power have trouble checking email-it may be time to review and revise the plan. Despite our efforts, we had a couple people show up who had not checked their phone messages. We learned we need to work on our communication. There were probably some things to be learned for each of us as individuals or organizations. You often know or were told in driver's education that having extra windshield deicer, a snow shovel, and salt or cat litter in your car are useful. I was never without these in my car trunk fall through spring while living in Ann Arbor. When you are in a climate where such vital supplies are needed infrequently, it is easy to get complacent. I found myself with no salt, thinking you should know better! I would bet I was not the only area resident caught wondering what was I thinking? It is a wake-up call and learning experience.

Since our beginnings, our goal has been to be a hybrid of a grantmaking foundation and an operating foundation. Consequently, the Health Foundation has always done some of its work directly rather than through grants to other organizations. In both cases, our work benefits the communities we serve. In doing work directly, the funding flows through us to create community benefit; in doing work through grants to other nonprofits, the funding flows through a grantee to create a community benefit. An example is illustrative:

Early on, we learned that many of our grantees needed to develop their skills in fundraising. We made a small grant to an organization so that it could send its home-grown development director to the Indiana University Center on Philanthropy Fundraising School. Their courses are excellent. The costs covered by the grant and the agency included: course tuition, travel to the course site, five days of hotel, and of course the salary and other incidental expenses of sending a staff member away on business. In some projects, agencies have to cover the cost of a replacement, too.

There was, and is, tremendous need for this content among our grantees. It was clear, however, that providing dozens of Fundraising School grants to dozens of organizations was not the way to go. For about the same money that could send one person to the IU courses, we could bring the IU speakers here and allow up to 55 people to attend a program that is more tailored to our grantees' needs.

This is how our capacity building program began. We now spend around $180,000 a year to provide various highly-subsidized workshops to 1400 attendees; these programs would have cost the community an estimated $450,000 more than our registration fees if priced at market rates (All figures are for 2007). To see our Capacity Building courses for 2009, go to: http://www.healthfoundation.org/events/Capacity%20Building%20Programs%202009.pdf (Please copy & paste this into your browser – a hyperlink on the blog site is beyond my ability just now!).

Other reasons that push us to do a project ourselves:

• Projects that need to serve all three states and twenty counties in our service area have a hard time finding a good home
• Occasionally, we need or want something done that is far more important to us than it can be to any potential grantee
• Grantees rightly resist being pushed off-mission just because we would fund it
• Grants that are stepchildren in an agency seldom thrive; we can see to it that some programs get the attention and priority they need
• Some projects are critically important to us meeting our objectives, and we do not want to leave execution or timing to another organization
• Sometimes, for some projects, it just is easier, or more value-added, to do it yourself; for example, our staff can learn more by directly providing group technical assistance to many agencies than they would learn dealing with just a few grantees
• Sometimes we want to maintain ownership of intellectual property or some other issue
• Every now and then there is no one we can choose as a granteee without ticking off someone else.

That said, we will always make a project as a grant if it involves providing or financing direct client care. We do not aspire to be a provider or a source of funding individuals' care.