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Welcome to the PHW Mental Health Community Hub application!

We believe that sustainable long term access to mental health support and resources within the context of a supportive community is one of the most effective ways for individuals and communities to develop resiliency. Faith communities are well poised to leverage their strength of being community anchors.

The PHW BIPOC Mental Health Community Hub Grant is an opportunity up to $50,0000. This grant is designed to lay the foundation for a Mental Health Community Hub in Western, Eastern, and Central North Carolina. The initial role of the Mental Health Community Hub would be the development of an interfaith network with support and resources aimed at the acute nature of mental health needs across the state by region. Those support and resources would include access to sliding scale therapy services, support groups for children, families, teens and adults, the development of a referral network and resources that are based on identifying social determinants of health that are uniquely affecting individuals and communities as a direct result of COVID-19 pandemic.

The Mental Health Resource Hub will be the collective work of a partnership between the faith community and existing mental health services in their geographical region. This would extend the bandwidth of both the faith community and local mental health resources. The cross collaboration will help resources be more accessible, attainable, and affordable. With this grant, faith communities have the ability to train and equip individuals with needed skills that eliminate shame and stigma around mental health concerns, offering a generational impact.

This grant is an exciting opportunity for BIPOC faith communities that already have established efforts around mental health and eliminating stigma. This is not geared for a start-up or brand new ministry but one that has established trust, rapport, and collaboration with mental health efforts in their community.

This grant will be open until Friday, May 5, 2023 at midnight. Grants will be reviewed and awarded mid-May 2023. For any questions or assistance, please email Jessica@ncchurches.org

Please read all instructions and requirements before proceeding to the form.

You must have a current PHW Collaborative Pledge on file.

The applicant must be a faith community.

The faith community must be predominantly of color/ BIPOC (Black and Brown, Indigenous, and People of Color).

If awarded, faith community will sign a Memorandum of Understanding to use the grant award as intended.

If awarded, the faith community must complete a PHW Mental Health Inclusion Plan.

If you need assistance completing the form, please don't hesitate to contact the Associate Director, Partners in Health and Wholeness, Mental Health Advocacy, Rev. Jessica Stokes jessica@ncchurches.org

Attention

You are not able to save and come back to the Pledge form.

We recommend you print this document to prepare your responses BEFORE entering them on this form.

We also highly recommend you save your answers on a separate document as you fill out the form so that you do not lose your responses if the form closes for any reason.

A copy of your pledge submission will be sent to you and your faith leader.

ONCE YOU HAVE SUCCESSFULLY SUBMITTED THE FORM, PLEASE CHECK TO MAKE SURE YOU HAVE RECEIVED A CONFIRMATION EMAIL

All applications that include a request for grant funds that require in-person gatherings or other activities that could be affected by the COVID-19 virus, must include a Plan B in case of a worsening of the virus and/or a tightening of restrictions. For example: if your grant request includes in-person gatherings in an enclosed space, and the virus worsens or restrictions tighten, what will you do instead? If your grant request includes funds for children in school, but schools close, what will you do instead? Including this information in the grant request will allow us to review in a timely manner and not hold up your application while we follow up with you.

Form Submission Guidelines

When filling out the form, please type every name out fully with no abbreviations including congregation names, health lead names, and faith leader names.

Example: St. Maria's United Methodist Church
NOT: St Marias UMC

As we continue to expand our network, we hope you will continue to include as much detail as possible in the PHW forms. We ask Health Leads to always answer the 5 W's: Who, What, When, Where, and Why?

* Items with this symbol are required information

General Information

Faith Community Name

Website

Social Media Sites

Mailing Address

Street Address

City

Postal Code

Country

State/Province

District/County

Physical Address

Street Address 2

City 2

Postal Code 2

Country 2

State/Province 2

District/County 2

Health Leader's Title and Contact Information

Name Prefix

First Name

Middle Name

Last Name

Name Suffix

Phone Number

Faith Leader's Title and Contact Information

First Name

Last Name

Name Prefix

Middle Name

Name Suffix

Has your faith community completed the Collaborative Pledge? *

Yes

Denomination *

Denomination Other

Racial and Ethnic Make-Up *

COMMUNITY NEEDS: Please share specific needs found in your local context and community around mental health. Please include the demographics of people who face these issues. What are long standing impacts you are seeing due to mental health concerns in your community? *

PROJECT OR PROGRAM: Please describe the mental health program for which the funds are being requested. Include details about who will be involved in the project or program and when and where the project or program will take place. What will your project address around mental health? What acute needs will be met? What upstream needs will be met? This section should include SMART goals (specific, measurable, achievable, relevant, and time-bound) The more details you provide, the better we can understand your proposed project or program. *

Who do you specifically plan to work with: please include names and titles: *

List local agencies, organizations, and affiliated contacts that you plan to work with: *

Please include three references (name and title, email, phone number) that we can contact about your established partnership: *

Why is this project or program the most effective approach to address the congregational/community needs you identified above? *

WORK PLAN AND TIMELINE: Provide a brief statement outlining the scope of work including the following: 1) Timeline of project/program. 2.) Who will complete each activity * Offer an overview of each of the following phases of your project: *

PHASE I: Initiation Phase- This phase begins as soon as your grant is awarded. What is your immediate timeline and plan to begin your project? Some steps in the initiation phase include: Reconvening involved partnerships and individuals that are expected to be involved with the project, to communicate with the purpose and desired outcomes of the project Assess current resources: overall budget, individual and organizational support, local and regional resources Forecast potential delays: include time estimates: constraints and buffers, staff changes, budget constraints, inflation of prices/ costs Confirming team size and roles required: how often will those involved in supporting the project be involved? What accountability will be in place? Training? Confirmation of credentials? What support will be provided to those working on the program? *

2. IMPLEMENTATION How will you keep the project on track? Specifically share how you manage quality, eliminate risk or liability, practice transparency, measure progress, and make informative decisions. Include any details about plans on “kicking off your project” with the wider community and social media efforts to advertise/ share/ and include the wider community to the mental health resources in this project. *

3.CLOSE: How will you wrap up the PHW funded part of this project? Since this is a special grant opportunity, you will either have to sustain this effort or transform it into something different. Discernment will be a key part of this process. To plan, share: What milestones is your faith community looking for that will show success? How will you build momentum of your project to keep going? How will you evaluate the current needs of your community at the end of this funded cycle? *

FUNDING & BUDGET: Please list the itemized expenses associated with the project. Budgets should include specific amounts needed for each aspect of the project. If this request is part of a larger project, please indicate where other funds are being pursued. *

Example
"LivingWorks Faith" Suicide Prevention Training Class $166.62 per person (12)- $1999.44
Talkspace Therapy App vouchers 75.00 (50)- $3,750
Honorarium for Mental Health Speakers (3) at $600.00 each (lodging, gas, food)- $1800

*your costs may vary

Total Amount Requested: *

EVALUATION: How will you measure the results of the project to determine impact? For example: include church policy changes that consider mental health needs for staff and attendees, a community-wide inclusive mental health pledge, establishing trauma-informed practices, ongoing staff trainings that address mental health needs, welcoming signage, highlight mental health in worship, host support groups, etc * Please share how an impact report will be completed, that includes metrics of the difference this project made. How will you inform the volunteers, mental health professionals, and other involved participants of the metrics you found. How will you celebrate the good work of the project? *

RESULTS: What are the results you hope to achieve? Take into consideration where you are beginning and where you hope to go with your results. How will this project be sustained to continue meeting the intended needs? (Must be at least 10 sentences) * *

Please check below to indicate your understanding of the grant eligibility guidelines and dates of submission. *

I understand